renal failure Flashcards by Ang A

AKI is a rapid ___ in kidney function, leading to the ____ of ____ ____

decrease
collection
metabolic
waste

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pre- renal acute kidney injury

decreased blood flow to the kidney

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effects of AKI

reduced GFR
damage to nephron cells
obstruction of urine flow

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intra- renal acute kidney injury

damage to the glomeruli, interstitial tissue, tubles

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post- renal acute kidney injury

obstruction of urine flow d/t stones, or BPH

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causes of aki

poor perfusion- hypovolemic shock
toxins
infection
obstruction

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in hypoperfusion/ shock, the kidney compensates by ___ renal blood vessels, activating the ____, and releasing ____

constricting
RAAS
ADH

*This will improve kidney perfusion but reduce urine volume and lead to the retention of N in blood

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when the pressure in the ____ ____ (__ ___) exceeds ____ ____, the GFR stops. this allows __ to collect in the blood and will increase ___ and serum ____ levels

kidney tubules
intra renal pressure 
glomerular pressure
N
BUN 
creatinine

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phases of AKI

onset
oliguric
diuretic
recovery

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early acute syndrome may be reversible by treatment to

correct blood volume
increase blood pressure
improve CO

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Prolonged kidney injury

severe damage and intra- renal damage may occur

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oliguria

reduced urine volume

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azotemia

retention and build up of nitrogenous waste in the blood

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toxins in the kidney cause

blood vessel constriction, leading to reduced kidney blood flow and ischemia

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chronic renal failure (CRD)

progressive, irreversible disorder. kidney function does not recover

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primary causes of crd

untreated ACF
DM
HTN- end organ damage to the kidney
intra-renal: glomerulonephrities, Systemic lupus erythematous, polycystic kidney disease

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____ is staged using ____. the lower the _, the worse the kidney failure.

CRF
GFR
GFR

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STAGE 1

kidney damage with normal or increased GFR

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Stage 2

kidney damage with mild decrease in GFR

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stage 3

moderate decrease in GFR

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Stage 4:

severe decrease in GFR

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Stage 5

kidney failure

an early complication of CRD is ____, because there are fewer healthy nephrons to reabsorb ___, which can also cause p____

hyponaterima
Na
polyuria

later in CRD excretion of sodium is ___ as urine production ____, so ____ occurs even with only modest increases in the diet

reduced
decreases
HYPERnatremia

late in CRD there is ______, so these changes in potassium cause EKG changes and ____

hyperkalemia | dysrhythmias

affect of CRD on pH: early stages

little changes because the remaining nephrons increase acid excretion

as more ___ are lost in the later stages of CRD, ___ cannot be excreted as much, so __ occurs

nephrons acid acidosis

in CRD ___ production decreases, and bicarb ___ doesn't really occur so it is even more ____

ammonium reabsorption acidic

kidney changes with CRD

- healthy nephrons become larger and work harder - poor water excretion - abnormal urine production - electrolyte imbalances - metabolic abnormalities

normally the kidney excretes excessive ____. it is controlled by ____

phosphate | parathyroid hormone

early in CKD there is ___ secretion of phosphorus, which leads to a ___ of _ levels. this in turn results in __ levels decreasing

reduced increase phosphourus ca

____ controls phosphate in the blood by causing tubular ____ in excess

PTH | excretion

chronic low levels of ca, cause the parathyroid gland to release more ___. calcium then comes from ___ ____ and can lead to ____ ____ ___ "renal __"

PTH bone reabsorption bone density loss "renal osteodystrophies"

the decrease in kidney function leads to metabolic abnormalities like ___ (from protein metabolism) and ___ (from protein in skeletal muscle) build up

urea | creatinine

BP is ____ by causing ___ and __ overload, and dysfunction of the ____

elevated fluid sodium RAAS

the heart is ___ due to long term stress

enlarged

hyperlipidemia occurs due to changes in __ metabolism that increase ____, total ____, and __ levels

lipid triglycerides cholesterol LDL *Pt is more at risk for CAD and acute cardia events

___ occurs in the late stages of CKD and worsens manifestations. d/t decreased ___, RBC dies because of uremia, __ deficiency, and __ because of poor platelet function

anemia erythropoietin iron bleeding

uremia is ___ in blood. this affects the entire ___. the normal flora of the mouth changes, there is ___, N/V, and ____

urea GI anorexia hiccups

uremia causes changes to the GI and can cause

peptic ulcer disease uremic cholitis erosion of blood vessels in the stomach, small intestine, large intestine-> blood loss -> hemorrhagic shock

uremic cholitis

watery diarrhea and colitis

CM of CKD

``` neurological respiratory cardiovascular GI skeletal urinary skin *d/t changes in fluid volume, electrolyte and acid base imbalance, N waste build up* ```

neuro sx of CKD

lethargy seizures or coma encephalopathy weakness in extremities

cardio sx of CKD

``` fluid overload HTN CHF pericarditis K+ induced dysthrythmias ```

respiratory sx of CKD

``` halitosis- breathe smells like urine deep sighing yawning SOB severe metabolic acidosis= kussmal's breathing ```

hematologic sx of CKD

``` Anemia and abnormal breathing causing: fatigue pallor lethargy weakness SOB dizziness ```

GI sx of CKD

Foul breath mouth ulcerations mouth inflammation

Skeletal sx of CKD

thin fragile bones= increased risk for fractures break easily with slight trauma compact vertebrae, bend forward, loss of height

urinary sx of CKD

Dilute, clear urine because of tubular reabsorption of water reduced end stage= oliguria

skin sx of CKD

yellowish discoloration due to uremia

potiential complications of Chronic renal failure

``` HTN and edema uremia anemia metabolic acidosis hypocalcemia hyperphosphatemia encephalitis (end stage) ```

treatment of end stage renal disease

``` hemodialysis peritoneal dialysis kidney transplant diet modification medication modification ```

dialysis

removes excess fluids and waste products; restores chemical and electrolyte balance

diet modification for pt in end stage renal disease

control protein intake limit fluid intake restrict na, k, p supplements of vitamin d, calcium and iron