Renal II Flashcards
what are the types of congenital renal malformation?
-agenesis/hypoplasia
-alterations in kidney position
-horseshoe kidney
polycystic kidneys
what is agenesis/hypoplasia?
small, or complete absence of both kidneys
what is potters syndrome?
The kidneys fail to develop properly as the baby is growing in the womb.
-fatal if bilaterally
what are some precautions of renal agenesis/hypoplasia?
-No aminoglycosides
-no sports
-no IV contrast-things (could harm the one kidney if you have unilateral)
what do alterations in kidney position effect in the body?
Can affect ureters and urine flow, resulting in UTIs, stones.
what is a horseshoe kidney?
One horseshoe shaped kidney with 2 ureters
what are some precautions to take with an horseshoe kidney?
-Educate patient to avoid dehydration, use good hygiene to avoid UTIs
-Avoid sports-damage to kidney
what is polycystic kidney?
Fluid-filled cyst formation develop in nephrons of kidney r/t abnormal cell division. Renal blood vessels and nephrons are compressed and obstructed.
when do s/s of polycystic kidney dominant form develop?
-slow progression
-Symptoms usually develop by 30-50 years of age
what are the s/s of polycystic kidney?
hematuria
proteinuria
HTN (r/t kidney ischemia)
UTIs
renal injury->chronic renal failure
what is the most common cause of pre-renal azotemia?
perfusion reduction, or decreased cardiac output
-hemorrhage, shock, MI
what is azotemia?
the retention and buildup of nitrogenous wastes in the blood.
is pre-renal azotemia reversible?
yes, rapidly reversible when blood flow is restored
what is the cause of intrinsic (intra-renal) injury?
Damage is within the kidney (damage to the glomeruli, nephrons or tubules).
what ways can the kidney be damaged and lead to intrinsic failure?
-Nephrotoxins (certain chemotherapies, antibiotics, contrast media)
-Glomerulonephritis, pyelonephritis, lupus, scleroderma
-Rhabdomyolysis (rapid breakdown of skeletal muscle tissue due to “crush” injury->myoglobin released into bloodstream->clogs tubules=Acute Tubular Necrosis)
-Infection(sepsis) & chronic pyelonephritis
-Major trauma or surgery,
what causes post-renal azotemia? What is the most common cause?
Problem occurs after the kidney:
-obstruction of ureter, bladder, etc., reducing urine flow.
-BPH most common cause!
* Kidney stones, neurogenic bladder, certain cancers, blood clots
Is AKI reversable?
often if treated early
what are the common s/s of AKI?
*Decreased urine output (oliguria)
*Fluid volume overload
*Labs: Increased K and Phos, decreased Na and Ca, anemia, increased BUN and Creatinine
*N/V, azotemia
*Metabolic acidosis
what occurs in the initiation or onset phase of oliguric AKI?
*A decrease in UO with high specific gravity can be observed.
*If AKI is identified now and pre-renal condition corrected, prognosis is best to prevent renal dysfunction.
*Compensatory mechanisms like aldosterone, ADH, etc. will respond.
what happens during the oliguric phase of oliguric AKI?
*U/O = 100-400ml/day
*Elevated BUN/Creatinine
*Electrolyte imbalances; fluid volume overload can occur
*Metabolic acidosis d/t impaired renal hydrogen ion elimination
what happens during the diuretic phase of oliguric AKI?
*Often sudden onset. Occurs when cause of AKI has been corrected.
*Osmotic diuresis occurs from high urea levels. UO = 1-5 L/day
*Risk for dehydration from severe fluid loss
what happens during the recovery phase of oliguric AKI?
*Kidney begins to return to regular function with increased GFR.
*Fluid and electrolyte balance stabilize.
what is the most important renal lab value and the range?
creatinine (0.6-1.2)
what lab value is related to nutrition, protein, and hydration? what is the range of this lab value?
BUN (6-20)
what are some phosphate binders?
-calcium carbonate (tums)
-calcium acetate (phoslo)
-sevelamer HCL (renvela)
co2 in a chem panel relates actually to what value and what is the range?
bicarb (22-26)
what is the range for Ca?
-who do you call (9-1-1)
9-11
what happens during AKI or CRF to serum creatine? what diet implication should be used?
-increased
-low protein diet
what happens during AKI or CRF to GFR?
it would decrease
what is the normal range for GFR?
120-125
what happens during AKI or CRF to sodium? what diet implication should be implemented?
-increased, decreased, or normal
-low sodium diet, fluid restriction
what happens during AKI or CRF to potassium? what diet implication should be used?
-increased
-low potassium diet
what happens during AKI or CRF to phosphorus? what diet implication should be used?
-increased phosphorus (no Ca)
-low phosphorus diet, admin a phosphate binder
what happens during AKI or CRF to calcium?
it would be decreased (low activated vitamin D)
what happens during AKI or CRF to magnesium?
it would be high or low
what happens during AKI or CRF to hemoglobin and hematocrit?
they would be decreased (low EPO)
what happens during AKI or CRF to your ABG? pH?
-metabolic acidosis
-pH would be low
-HCO3 would be low
what would happen to a EKG when someone has hyperkalemia?
-peak (extra) T wave
What ways do you treat hyperkalemia?
-Ca gluconate, or furosemide (calms the heart)
-insulin and D50
why do you give dextrose when admin insulin?
dextrose makes the cells more permeable to insulin
what is a K binder example med? what does this medication do?
sodium polystyrene sulfonate (kayexalate)
-excretes K in the stool, slower than admin through an IV
how does albuterol effect K?
makes K move into the cell
how does spirolactone effect K?
-K sparing
-do NOT give to someone with hyperkalemia
what is the primary complication of peritoneal dialysis? how is it prevented?
peritonitis (cloudy fluid)
-sterility is important
-infection prevention
what is the secondary complication of peritoneal dialysis? how is this monitored/prevented?
occlusion
-monitor dialysate outflow, last bowel movement (avoid constipation
-monitor for respiratory distress (retained fluid creates more pressure in the diaphram)
what is the best way to prevent a dialysis complication? what is the #1 complication?
hypotension
-check BP!!!!!!!
how do you prevent occlusion of AV fistula/catheter?
-avoid tight clothing
-avoid labs/bp on affected side
-assessment signs:
*absent of bruit (no whoosh)
*absent of thrill (feel the thrill)
*decreased cap refill
*coolness of extremity
how would you tell if there was an infection at the dialysis site?
redness/swelling at the shunt site
what is the major concern when doing a kidney biopsy if the cause of AKI is unclear?
bleeding!
-needs monitored
what is the major concern when treated AKI with diuretics?
-balance of bp
Aggressive hypertension treatment with avoidance of hypotension
what is an very early finding sign for AKI?
specific gravity
what is the most dangerous electrolyte imbalance associated with renal failure?
hyperkalemia
what are other common electrolyte imbalances in renal failure?
hypocalcemia
hyperphosphatemia
hypermagnesemia.
what are some general characteristics for CKD?
*Generally slow and gradual onset
*Nephron damage is irreversible
*Normal function of the kidney is disrupted: decreasing filtration, decreasing resorption, decreasing erythropoietin production
what are some common causes of CKD?
*Diabetes (44%)
*HTN (16%)
*Glomerulonephritis (17%),
*Recurrent kidney infections
*Others- polycystic disease, SLE, HF
what are the stages of CKD?
- at risk/ decreasing renal reserve
- mild CD
- moderate CKD
- severe CKD
- ESRD/ESKD
what are the characteristics of stage 1 CKD?
*GFR WNL (>90 ml/min per your book, 120ml/min per other sources)
*Decreased renal function without waste build-up
*Undamaged nephrons overwork to compensate
what are the characteristics of stage 2 CKD?
*GFR 60-89
*Not enough healthy nephrons remain to completely compensate
*Slight elevations of metabolic wastes; sometimes large amounts of dilute urine produced
*careful medical management can prevent further damage and slow progression
what are the characteristics of stage 3 CKD?
*GFR 30-59
*Remaining nephrons can’t keep up
*Fluid overload (crackles in lungs, SOB), electrolyte imbalances, metabolic waste build-up (IMPORTANT)
*Dietary restrictions of fluid, proteins, electrolytes and other strategies are needed to slow disease progression
what are the characteristics of stage 4 CKD?
*GFR (15-29)
*Severe fluid, electrolyte, acid/base imbalance; manage complications
what are the characteristics of stage 5 CKD?
*GFR (<15)
*Replacement therapy or kidney transplant is needed for life to continue
what are some medical management concerns of a pt with CKD?
1- fluid volume status
#2- Na levels risk for hypo (hyper in late)
–wt and bp (indicate fluid and Na)
what are potassium containing foods?
citrus, tomatoes, potatoes, and salt substitutes are big offenders.
dialysis will not increase what lab level of a patient?
hemoglobin concentrations
what is hemodialysis?
Involves shunting patient’s blood from the body, through a dialyzer (artificial kidney) which filters the blood, and returns the blood to the patient with use of dialysate tailored to the client’s needs and a semipermeable membrane filter (artificial kidney).
1 aftercare for dialysis?
check bp as soon as they return to the floor
what is one CV complication about kidney transplant? how can this be prevented?
HTN and increased risk of stroke and MI (monitor blood pressure frequently post-op)
what is the most serious complication or kidney transplant
-rejection
