Renal Failure and Dialysis Flashcards
Is acute renal failure reversible?
Usually- involves tubular cell death and regeneration
What are symptoms of acute renal failure?
Decreased urine output (70%) Edema (usually LE) Mental changes Heart failure Nausea/vomiting Pruritus (severe itching) Anemia Tachypenia Cool, pale, moist skin
What are causes of acute renal failure at the pre-renal level?
Vomiting Diarrhea Poor fluid intake Fever Use of diuretics Heart failure Liver dysfunction Septic shock
What are intrinsic causes of acute renal failure?
Interstitial nephritis Acute glomerulonephritis Tubular necrosis Ischemia Toxins
What are some post-renal causes of acute renal failure?
Prostatic hypertrophy
Retroperitoneal disorders
neurogenic bladder
Bilateral renal calculi
At what level is acute renal failure most commonly caused?
Pre-renal = 55%
Intrinsic = 40%
Post renal = 5-15%
What are the stages of acute renal failure?
Onset to time of oliguria
Oliguric/anuric phase
Diuretic phase
Describe the oliguric phase.
Less than 400 ml of urine output in 24 hours
How long does the diuretic phase last?
From time of urine output at <400 ml/24 hours to the time the BUN levels stop rising
What are the sub phases of the diuretic phase?
Late/recovery phase (BUN levels stabilize)
and the
Convalescent phase (urine output and BUN are WNL
What is the life threatening condition and symptoms associated with acute renal failure?
Hyperkalemia: weakness, lethargy, muscle cramps, paresthesias, hypoactive DTRs, dysrhythmias
THIS CAN CAUSE CARDIAC ARREST
What would an EKG look like for a pt with hyperkalemia?
K>5.5-6 • Tall,peakedT’s • WideQRS • Prolong PR • DiminishedP • ProlongedQT • QRS-Tmerge–sine wave
What are the steps in managing acute renal failure?
- Treat life threatening conditions
- Identify cause (hypovolemia? drugs? obstruction?)
- Treat reversible elements (Hydrate, remove drug, relieve obstruction)
Which part of the kidney is lost in chronic renal failure?
The nephron –> 75% of function can be lost before it is noticed
What is the mortality of chronic renal failure?
20%
What are the causes of chronic renal failure?
Diabetic nephropathy Hypertension glomerulonephritis HIV nephropathy Polycystic kidney disease Kidney infections and obstructions
What are symptoms of chronic renal failure? (hint: theres a ton)
Malaise Weakness Fatigue Neuropathy CHF Anorexia Nausea/vomiting Seizures Consitpation Peptic ulceration Diverticulosis Anemia Pruritus Jaundice Abnormal hemostasis
What are some other problems related to ESRD?
Metabolic (K/Ca/Na) Volume overload Anemia, platelet disorders, GI bleeding HTN, pericarditis Peripheral neuropathy Dialysis dementia Abnormal immune function
What is the purpose of dialysis?
Diffuse harmful waste out of the body
Control blood pressure
Keep safe level of chemicals in the body
How does hemodialysis work?
Pts go 3-4 times a week for 2-4 hours, machine filters blood and returns it to the body
What are the different kinds of access for hemodialysis?
Temporary site AV fistula (surgeon combines artery and vein, 3-6 months to mature) AV graft (surgeon inserts tube to connect artery and vein, 2-6 weeks to mature)
What are the PT implications for hemodialysis?
No BP on the same arm as port
Protect arm from injury
Control obvious hemorrhage (Will be arterial, maintain direct pressure)
How does peritoneal dialysis work?
The abdominal lining filters the blood
What is continuous renal replacement therapy? what are the two types?
It slowly removes fluid, electrolytes, and solutes, and is mainly used in ICU.
- Continuous arteriovenous hemofiltration
- Continuous venovenous hemofiltration
