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Pathophysiology for Nursing > Unit 3 Module 3: Urinary/Renal > Flashcards

Unit 3 Module 3: Urinary/Renal Flashcards

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1
Q

Up or down in CKD? calcium

A

down (inverse to phosphorus, so when the phosphorus can’t be excreted, it goes up)

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2
Q

If only one ureter is blocked, will that cause acute renal failure?

A

No, can still excrete through the other ureter. But bilateral ureter blockages or blockages further down will cause ARF.

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3
Q

Four symptoms related to fluid and electrolyte imbalance in ARF

A 
hypertension
hypervolemia
heart failure
edema
hyperkalemia (stage 5)
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4
Q

ARF Phase 3:

name, symptoms, duration

A 
Diuretic phase
Symptoms:
- increased urine output
- electrolyte imbalance
- dehydration
days to weeks
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5
Q

Can AKI patients have permanent kidney dysfunction?

A

Yes

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6
Q

Why does poor activation of vitamin D cause osteodystrophies?

A

it causes hypocalcemia (which then also triggers hyperparathyroidism)

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7
Q

Most patients are in which stage of CKD?

A

3 (GFR 30-59)

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8
Q

up or down in kidney failure: phosphorus

A

up (excreted by kidney)

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9
Q

What are causes of low blood flow to the kidneys which would cause pre-renal failure?

A

Hypovolemia, shock, sepsis, drugs like NSAIDs, low cardiac output

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10
Q

Why does acid-base imbalance lead to osteodystrophies?

A

skeletal buffering – the kidneys leave the blood too acidic, so the bones try to compensate

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11
Q

Which stage CKD patients need dialysis?

A

5 (GFR <15)

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12
Q

What are the three types of ARF?

A

pre-renal
intrarenal
postrenal

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13
Q

Why do patients urinate a lot in phase 3 ARF?

A

In the diuretic phase, the kidney is healing but doesn’t concentrate urine very well.

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14
Q

Stage 5 GFR

A

<15

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15
Q

ARF Phase 1:

name, symptoms, duration

A

onset phase
asymptomatic
hours to days (typically <48 hours)

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16
Q

What is the most common type of intrarenal failure?

A

ATN: acute tubular necrosis

they’re easily damaged because they’re sensitive to ischemia and toxins

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17
Q

Why does low blood flow cause pre-renal failure? (Hypovolemia, shock, sepsis, drugs like NSAIDs, low cardiac output)

A

There isn’t a pressure gradient to filter waste.

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18
Q

What are the four functions of the kidneys?

A

eliminate waste
fluid/electrolyte
regulate blood pH
regulate blood pressure

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19
Q

If we give a patient fluids and their status improves, which type of AKI is it?

A

prerenal – it improves because there’s more bloodflow in the kidneys

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20
Q

Up or down in CKD? GFR

A

down

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21
Q

Normal BUN

A

10-20 mg/dL

ARF: elevated

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22
Q

CKD GI problems

A

anorexia, nausea (early morning), metallic taste

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23
Q

ARF GFR is elevated or decreased?

A

Decreased

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24
Q

Which organ systems are affected by poor elimination of nitrogenous wastes?

A
  • cardiovascular (pericarditis, bleeding)
  • immune
  • integumentary (itching from high levels of phosphate)
  • GI (nausea)
  • neurologic (peripheral neuropathy)
  • sexual
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25
Q

ARF BUN/creatinine is elevated or decreased?

A

Elevated (15-20:1 ratio)

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26
Q

Do patients recover from CKD?

A

No. They need kidney transplants ultimately.

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27
Q

CKD patients have progressively higher albumin in their urine. That makes sense with which systemic symptom?

A

Edema. Remember, albumin draws fluid out of the 3rd space into the vasculature. If it’s getting peed out: edema.

28
Q

As the nephron number goes down, [hyper/hypo]filtration occurs

A

hyperfiltration at the glomerulus occurs

29
Q

Normal creatinine

A

0.6-1.2 mg/dL

ARF: elevated

30
Q

Normal GFR

A

120-130 mL/min

ARF: Decreased

31
Q

Up or down in CKD? BUN

A

up

32
Q

What are causes of ischemia leading to intrarenal failure?

A

infection, inflammation, nephrotoxic drugs

33
Q

CKD sexual dysfunction

A

decreased sex hormones -> decreased libido

34
Q

up or down in kidney failure: pH

A

down (metabolic acidosis)

35
Q

Why does CKD cause anemia?

A

Kidneys produce erythropoetin which drives red blood cell production

36
Q

Up or down in CKD? creatinine

A

up

37
Q

Stage 3 GFR

A

30-59

38
Q

Under what conditions is AKI reversible?

A 
We identify it early
We identify (and treat) the cause
39
Q

Why does poor phosphate elimination cause osteodystrophies?

A

Phosphate and calcium have an inverse relationship, so it causes hypocalcemia (which then also triggers hyperparathyroidism)

40
Q

What portion of the cardiac output goes to the kidneys?

A

20-25%

They’re greedy!

41
Q

ARF BUN/creatinine ratio

A

15-20:1

42
Q

What’s the relationship between aging and CKD?

A
  • Natural decrease in kidney function with age (usually doesn’t need dialysis)
  • more comorbidities
43
Q

Normal relationship between BUN and creatinine

A

10:1 BUN:creatinine (direct)

44
Q

CKD cardiovascular symptoms

A

Coagulopathies, pericarditis

45
Q

Up or down in CKD? Hemoglobin/hematocrit/RBC

A

down: lack of erythropoeitin (+ chronic blood loss, iron deficiencies, hemolysis)

46
Q

ARF Phase 4:

name, symptoms, duration

A

Recovery phase

3-12 months

47
Q

CKD integumentary symptoms

A

skin disorders: discoloring - sallow, dry, pruritis (itching), uremic crystals on skin (stage 5 pre-dialysis)

48
Q

Stage 1 GFR

A

=>90

49
Q

Underlying disease process of CKD

A

Non-functioning nephrons replaced by scar tissue

50
Q

What are the top two causes of CKD?

A
  1. Diabetes (due to vascular damage)

2. HTN (sustained pressure causes damage to the glomerulus)

51
Q

CKD neuro symptoms

A

peripheral neuropathy

52
Q

What is the etiology of intrarenal failure?

A

ischemia

53
Q

What does oliguric mean?

A

Decreased urine output, from oli (scanty) + uric (urine).

Oliguric is phase 2 of ARF, sometimes called anuric

54
Q

What are the two key characteristics of AKI (compared to chronic)

A 
reversible
abrupt onset (<48 hours)
55
Q

ARF Phase 2:

name, symptoms, duration

A 
*this is the big one where patients usually present*
Oliguric/anuric phase
Extremely symptomatic:
- Low urine output
- fluid volume overload
- fluid/electrolyte imbalance
- acid/base imbalance (metabolic acidosis)
- azotemia -> uremia
1-2 weeks
56
Q

Stage 4 GFR

A

15-30

57
Q

Stage 2 GFR

A

60-90

58
Q

Is azotemia or uremia worse?

A

Uremia (in A-Z order, AZotemia is first and Uremia is last). Uremia, from Greek for urine + in the blood – not in the toilet where it belongs.

59
Q

What is the etiology of postrenal failure?

A

obstruction that blocks urine excretion (so urine backs up and the toxins that should be excreted cause internal damage)

60
Q

Up or down in CKD? Potassium

A

up (excreted by kidney)

61
Q

up or down in kidney failure: albumin

A

down (glomeruli allow protein to pass through and get excreted)

62
Q

CKD immune symptoms

A

impaired immune function, increased risk of infection d/t dialysis

63
Q

Azotemia vs. uremia: which has symptoms or signs of renal failure?

A

Uremia – azotemia just has elevated BUN and creatinine

64
Q

What are the four phases of ARF

A

onset
oliguric/anuric ( from scanty or no + urine)
diuretic (from through + urine)
recovery

65
Q

As glomerular permeability and RAAS go up, what process occurs?

A

Nephrotoxic inflammation and remodeling -> fibrosis in the kidneys

Pathophysiology for Nursing (16 decks)

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