Renal Failure & Kidney Disorders Flashcards
What is Acute Kidney Injury (AKI)?
Previously known as Acute Renal Failure; Abrupt, often reversible, damage that causes a buildup of waste, fluid, & electrolyte imbalances.
SUDDEN RENAL DAMAGE
What is Prerenal Failure?
Damage BEFORE the kidneys & DECREASED VOLUME/PERFUSION TO THE KIDNEYS.
Causes of Prerenal Failure?
Cardiac damage, decreased or impaired cardiac output (MI), vasodilation, hemorrhage (hypovolemia), burns, GI losses (vomiting/diarrhea).
What is Intrarenal Failure?
Damage IN the kidneys due to PROLONGED ISCHEMIA.
Causes of Intrarenal Failure?
Myoglobinuria, hemoglobinuria, rhabdomyolysis, nephrotoxic drugs (e.g., NSAIDs, antibiotics, chemo drugs, contrast dyes), infections (e.g., glomerulonephritis), or reduced blood supply
What is Postrenal Failure?
Damage AFTER the kidneys due to OBSTRUCTION/BLOCKAGE IN THE URINARY TRACT.
Causes of Postrenal Failure?
Renal calculi (stones), blood clots, retroperitoneal issues, benign prostatic hyperplasia (BPH), tumors, neurological damage (stroke).
What are the phases of AKI?
-Onset phase
-Oliguric (anuric) phase
-Diuretic phase
-Recovery phase
Memory aid: ‘OH OH DARN RENAL’.
What is the Oliguric phase (2nd phase)?
Time frame: 1-7 days
Description: Glomerulus decreases the ability to filter blood = decrease urine output
Treatment: Strict I&Os, daily weight, dialysis may be needed until kidney function returns, Monitor EKG & labs (watch for hyperkalemia), low-protein diet, limited fluid intake
What is the Diuretic phase (3rd phase)?
Time frame: 1-3 weeks.
Description: Cause of AKI is corrected, gradual increase in urinary output (large amount of diluted urine with electrolytes)
Treatment: Monitor for dehydration & hypokalemia
What is the Recovery phase (final)?
Time frame: 3-12 months.
Description: increase in kidney function
Treatment: some develop chronic kidney disease (CKD)
Needs dialysis or kidney transplant
What is the treatment for AKI?
Treat the underlying cause to prevent long-term damage.
What diet modifications are needed for AKI?
Low-protein diet and limited fluid intake.
What should be monitored in patients with AKI?
Monitor for dehydration & hypokalemia (K+ < 3.5).
What treatments may be needed for AKI?
Dialysis and kidney transplant may be required.
What is Acute Glomerulonephritis (AGM) also referred to as?
Post-streptococcal glomerulonephritis
What triggers inflammation in Acute Glomerulonephritis?
Formation of antigen-antibody complexes resulting from strep trigger inflammation
How long after a streptococcal infection do antibodies get lodged in the glomeruli?
14 days after infection
What are the signs and symptoms of Acute Glomerulonephritis?
Hypertension, Positive ASO test results, Swelling in the face/eyes,
Tea-colored urine (due to a toe is: build up of waste products),
Recent strep infection, Decreased GFR,
Elevated labs: increased BUN & creatinine levels, mild Proteinuria
What is the treatment for Acute Glomerulonephritis?
Medications:
Antibiotics, Antihypertensives, Diuretics, Corticosteroids
Monitor fluid status:
Strict I&Os, assess urine color, daily weights (best indicator), assess for edema, auscultate hear & lung sounds (abnormal can indication fluid)
Diet:
Fluid & sodium restriction
-decreased protein
-increase carbs (as they provide energy & stop the breakdown of protein)
What can abnormal lung sounds indicate in patients with Acute Glomerulonephritis?
Presence of fluid in the lungs
What is Chronic Kidney Disease (CKD)?
CKD is a gradual and irreversible loss of kidney function that occurs over a long period of time.
What are the stages of CKD based on?
The stages of CKD are based on the glomerular filtration rate (GFR).
What are the GFR ranges for CKD stages?
> 90: Stage 1
60-89: Stage 2
45-59: Stage 3A
30-44: Stage 3B
15-29: Stage 4
< 15: End-stage renal disease (ESRD)
What are the 3 causes of CKD?
Diabetes, hypertension, glomerulonephritis
What happens to GFR as CKD worsens?
As CKD worsens, GFR decreases because the glomeruli are able to function and filter out.
What are the treatments for CKD?
Dialysis and kidney transplant.
What are some signs and symptoms of CKD?
Signs and symptoms can affect almost every body system, including lethargy, weakness, altered LOC, confusion, and seizures.
Decreased urinary output
Hypervolemia (excessive amount of fluid), hypertension, heart failure
Proteinuria & hematuria
Anemia (decreased erythropoietin, Epogen treats)
Uremia & Uremic frost (crystallized urea deposits)
Increased BUN, Creatinine, Potassium (elevated T-waves), Magnesium, & Phosphate
Decreased calcium
Azotemia (nitrogenous wastes accumulate)
What are cardiac system symptoms of CKD?
Symptoms include fluid volume excess (hypervolemia), hypertension, and heart failure.
What are hematological symptoms of CKD?
Symptoms include anemia, increased risk for bleeding, and amenorrhea.
What is Epogen used for in CKD?
Epogen is used to treat anemia.
What are integumentary system symptoms of CKD?
Symptoms include uremic frost and pruritus due to crystallized urea deposits.
What is Hemodialysis?
Uses a dialyzer (an artificial kidney) to remove excess fluids and toxins.
Most common method of dialysis.
What is the process of Hemodialysis?
Blood is filtered, removing toxins/waste. Blood with toxins/waste is brought to the dialyzer (artificial kidney). Clean blood is brought back to the body.
What are some complications of Hemodialysis?
- Fistula infection or thrombosis
- Hypotension
- Hemorrhage
- Air embolus
- Electrolyte imbalances
- Dialysis disequilibrium syndrome
What is Dialysis disequilibrium syndrome?
A rare complication caused by rapid removal of urea during the filtration process, leading to neurological symptoms like nausea/vomiting, altered level of consciousness (LOC), restlessness, and seizures.
What should patients avoid on the extremity with vascular access?
- Compression
- Blood draws
- Blood pressure readings
- Tight clothing
- Pressure from carrying bags
- Sleeping on that arm
What do healthy kidneys do?
Filter waste products from the blood.
What happens when kidneys are injured?
Not functioning properly need help removing excess waste from the blood; otherwise, waste accumulates and becomes toxic and harmful to the body.
What is an Arteriovenous Fistula (AVF)?
Joining an artery and a vein.
What is an Arteriovenous Graft (AVG)?
Joining an artery and a vein using a synthetic graft material.
Increased risk for infection due to the synthetic graft insertion.
What medications should be held before dialysis?
- Water-soluble vitamins
- Antibiotics
- Antihypertensives
- Digoxin
What should be checked before started dialysis
Feel the thrill (palpating the fistula) and hear the bruit (heard during auscultation); report if these are not noted over the site
What is Peritoneal Dialysis?
Peritoneal Dialysis drains into the peritoneum to remove excess fluids and toxins.
(Inside the body, fluid gets through the abdominal wall)
Can be done at home; performed daily 7x a week
What is the process of Peritoneal Dialysis
Dialysate is a solution infused into the peritoneal cavity by gravity.
The clamp is closed on the infusion line, and dialysate dwells for a set amount of time (dwell time).
The drainage tube is unclamped, and fluid drains from the peritoneal cavity by gravity. A new container of dialysate is infused as soon as drainage is complete.
How is access achieved for Peritoneal Dialysis?
Access is achieved through a peritoneal catheter, and the procedure is performed at the bedside or in the operating room.
What are the complications of Peritoneal Dialysis?
Hyperglycemia and peritonitis, which has an increased risk for infection in the peritoneum.
What are the signs and symptoms of peritonitis?
Signs and symptoms include cloudy or bloody drainage, fever > 100.4°F (38°C), abdominal pain, and malaise.
What are some patient education tips to avoid infections?
Practice good hand hygiene before and after dialysis, clean the catheter site daily, and keep supplies in a clean, dry place.
How should the dialysate solution be warmed prior to administration?
Warm the solution prior to administration using an incubator or heating cabinet; do not use a microwave.
What is the most common method of dialysis?
Hemodialysis
Outside the body (blood is filtered through a machine)
Where is Hemodialysis typically performed?
Done in the hospital or a dialysis clinic
How often is Hemodialysis performed?
Performed 3-5 times per week
What are the access methods for Hemodialysis?
Arteriovenous fistula (AVF) or arteriovenous graft (AVG)
What is the access method for Peritoneal Dialysis?
Peritoneal catheter
What are some complications of dialysis?
Fistula infection or thrombosis, hypotension, disequilibrium syndrome, hemorrhage, air embolism, electrolyte imbalances, peritonitis, hyperglycemia
What is the onset/initiation phase (1st phase)?
Time frame: When the injury occurred
Description: Triggering event (prerenal, intracranial, or postrenal failure)
Treatment: Treat the underlying cause to prevent long-term damage.
