Unit 3 Module 3: Urinary/Renal Flashcards
Up or down in CKD? calcium
down (inverse to phosphorus, so when the phosphorus can’t be excreted, it goes up)
If only one ureter is blocked, will that cause acute renal failure?
No, can still excrete through the other ureter. But bilateral ureter blockages or blockages further down will cause ARF.
Four symptoms related to fluid and electrolyte imbalance in ARF
hypertension hypervolemia heart failure edema hyperkalemia (stage 5)
ARF Phase 3:
name, symptoms, duration
Diuretic phase Symptoms: - increased urine output - electrolyte imbalance - dehydration days to weeks
Can AKI patients have permanent kidney dysfunction?
Yes
Why does poor activation of vitamin D cause osteodystrophies?
it causes hypocalcemia (which then also triggers hyperparathyroidism)
Most patients are in which stage of CKD?
3 (GFR 30-59)
up or down in kidney failure: phosphorus
up (excreted by kidney)
What are causes of low blood flow to the kidneys which would cause pre-renal failure?
Hypovolemia, shock, sepsis, drugs like NSAIDs, low cardiac output
Why does acid-base imbalance lead to osteodystrophies?
skeletal buffering – the kidneys leave the blood too acidic, so the bones try to compensate
Which stage CKD patients need dialysis?
5 (GFR <15)
What are the three types of ARF?
pre-renal
intrarenal
postrenal
Why do patients urinate a lot in phase 3 ARF?
In the diuretic phase, the kidney is healing but doesn’t concentrate urine very well.
Stage 5 GFR
<15
ARF Phase 1:
name, symptoms, duration
onset phase
asymptomatic
hours to days (typically <48 hours)
What is the most common type of intrarenal failure?
ATN: acute tubular necrosis
they’re easily damaged because they’re sensitive to ischemia and toxins
Why does low blood flow cause pre-renal failure? (Hypovolemia, shock, sepsis, drugs like NSAIDs, low cardiac output)
There isn’t a pressure gradient to filter waste.
What are the four functions of the kidneys?
eliminate waste
fluid/electrolyte
regulate blood pH
regulate blood pressure
If we give a patient fluids and their status improves, which type of AKI is it?
prerenal – it improves because there’s more bloodflow in the kidneys
Up or down in CKD? GFR
down
Normal BUN
10-20 mg/dL
ARF: elevated
CKD GI problems
anorexia, nausea (early morning), metallic taste
ARF GFR is elevated or decreased?
Decreased
Which organ systems are affected by poor elimination of nitrogenous wastes?
- cardiovascular (pericarditis, bleeding)
- immune
- integumentary (itching from high levels of phosphate)
- GI (nausea)
- neurologic (peripheral neuropathy)
- sexual
ARF BUN/creatinine is elevated or decreased?
Elevated (15-20:1 ratio)
Do patients recover from CKD?
No. They need kidney transplants ultimately.
CKD patients have progressively higher albumin in their urine. That makes sense with which systemic symptom?
Edema. Remember, albumin draws fluid out of the 3rd space into the vasculature. If it’s getting peed out: edema.
As the nephron number goes down, [hyper/hypo]filtration occurs
hyperfiltration at the glomerulus occurs
Normal creatinine
0.6-1.2 mg/dL
ARF: elevated
Normal GFR
120-130 mL/min
ARF: Decreased
Up or down in CKD? BUN
up
What are causes of ischemia leading to intrarenal failure?
infection, inflammation, nephrotoxic drugs
CKD sexual dysfunction
decreased sex hormones -> decreased libido
up or down in kidney failure: pH
down (metabolic acidosis)
Why does CKD cause anemia?
Kidneys produce erythropoetin which drives red blood cell production
Up or down in CKD? creatinine
up
Stage 3 GFR
30-59
Under what conditions is AKI reversible?
We identify it early We identify (and treat) the cause
Why does poor phosphate elimination cause osteodystrophies?
Phosphate and calcium have an inverse relationship, so it causes hypocalcemia (which then also triggers hyperparathyroidism)
What portion of the cardiac output goes to the kidneys?
20-25%
They’re greedy!
ARF BUN/creatinine ratio
15-20:1
What’s the relationship between aging and CKD?
- Natural decrease in kidney function with age (usually doesn’t need dialysis)
- more comorbidities
Normal relationship between BUN and creatinine
10:1 BUN:creatinine (direct)
CKD cardiovascular symptoms
Coagulopathies, pericarditis
Up or down in CKD? Hemoglobin/hematocrit/RBC
down: lack of erythropoeitin (+ chronic blood loss, iron deficiencies, hemolysis)
ARF Phase 4:
name, symptoms, duration
Recovery phase
3-12 months
CKD integumentary symptoms
skin disorders: discoloring - sallow, dry, pruritis (itching), uremic crystals on skin (stage 5 pre-dialysis)
Stage 1 GFR
=>90
Underlying disease process of CKD
Non-functioning nephrons replaced by scar tissue
What are the top two causes of CKD?
- Diabetes (due to vascular damage)
2. HTN (sustained pressure causes damage to the glomerulus)
CKD neuro symptoms
peripheral neuropathy
What is the etiology of intrarenal failure?
ischemia
What does oliguric mean?
Decreased urine output, from oli (scanty) + uric (urine).
Oliguric is phase 2 of ARF, sometimes called anuric
What are the two key characteristics of AKI (compared to chronic)
reversible abrupt onset (<48 hours)
ARF Phase 2:
name, symptoms, duration
*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
Stage 4 GFR
15-30
Stage 2 GFR
60-90
Is azotemia or uremia worse?
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.
What is the etiology of postrenal failure?
obstruction that blocks urine excretion (so urine backs up and the toxins that should be excreted cause internal damage)
Up or down in CKD? Potassium
up (excreted by kidney)
up or down in kidney failure: albumin
down (glomeruli allow protein to pass through and get excreted)
CKD immune symptoms
impaired immune function, increased risk of infection d/t dialysis
Azotemia vs. uremia: which has symptoms or signs of renal failure?
Uremia – azotemia just has elevated BUN and creatinine
What are the four phases of ARF
onset
oliguric/anuric ( from scanty or no + urine)
diuretic (from through + urine)
recovery
As glomerular permeability and RAAS go up, what process occurs?
Nephrotoxic inflammation and remodeling -> fibrosis in the kidneys
