Week 3 - Renal Flashcards
What are the functions of the kidney?
- Remove waste products from the body by turning them into urine
- Remove drugs from the body
- Balance the body’s fluids
- Release hormones that regulate blood pressure (renin, erythropoietin)
- Produce an active form of vitamin D that promotes strong, healthy bones
- Control the production of red blood cells
- Electrolyte Regulation
What is Glomerular Filtration Rate?
Glomerular filtration rate (GFR) is the amount of blood that passes through the glomeruli each minute
The normal blood flow through the kidneys is 105-125 mls/min →99% is reabsorbed resulting in 1- 1.5L of urine per 24 hours
What are the 3 factors needed for urine production?
Pre-renal:
Adequate perfusion pressure (renal blood flow) and oxygenation of kidneys. If there isn’t enough pressure in the system then urine output will decrease. The kidneys may be functioning fine but if the system isn’t functioning well
Renal:
The kidney units must be functioning properly i.e. no damage to the structures in the kidney such as tubules, glomerular
Post-renal:
There must be no obstruction to urine flow
What is Oliguria?
Low Urine output. 100-400ml/day (an early warning sign related to poor urine output)
What is Anuria?
Lack of urine production. A late warning sign related to poor urine output. <100ml/day
How many hours of Oliguria can cause acute kidney injury?
Two hours
What is an acute kidney injury?
Acute kidney injury (AKI)occurs when the kidneys are unable to remove the body’s metabolic waste or perform their seven regulatory functions, in particular, Maintenance of BP and electrolyte regulation. These metabolic wastes build up in the body and GFR falls as the disease progresses
What are the three causes of Acute Kidney Injury?
Pre-Renal Causes: (Low cardiac output, low BP, severe vomiting)
Intrarenal (Intrinsic) causes (Damage to renal tissue, nephrotoxins, NSAIDS (Non-steroidalanti-inflammatorydrugs)
Post-renal causes (Obstruction (kidney stones), renal calculi)
What are the 4 phases of Acute Kidney Injury and how long do they occur for?
Initiating phase hours = days
Oliguric phase = 10 - 14 days
Diuretic phase
Recovery phase = 3 - 12 months
What nursing assessments would you undertake for Acute Kidney Injury?
- Fluid balance chart (FBC)
- Daily weigh (1kg of weight = 1L retained fluid)
- Skin integrity
- Vital signs → EWS
- Capillary refill time (CRT)
- Palpate and/or scan the bladder
- Bloods – GFR, electrolytes, CBC
- Ability to manage ADLs
What are the 2 types of dialysis?
Haemodialysis
Peritoneal dialysis
What is Haemodialysis?
A machine removes blood from your body, filters it through a dialyser (artificial kidney) and returns the cleaned blood to your body. This 3- to 5-hour process may take place in a hospital or a dialysis centre three times a week.
What is Peritoneal dialysis?
During peritoneal dialysis, a cleansing fluid flows through a catheter into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded.
What needs to happen for BP to remain stable?
Need a fully functioning myocardium and kidneys
What are some risk factors for chronic kidney injury?
Diabetes
Hypertension
Smoking
Obesity
Ethnicity
Gender men>women
Age - kidney function decreases with age
Specific conditions – glomerulonephritis
What is Chronic Uramia?
Built up waste in the kidneys which the body wants to get rid of
Why do people with chronic kidney disease have anaemia?
When your kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells. With less EPO, your body makes fewer red blood cells, and less oxygen is delivered to your organs and tissues
What is the treatment aimed at for chronic kidney disease?
Treatment is aimed at slowing the progression of the disease
- Reducing BMI
- Moderate physical activity
- Reducing salt intake
- At least 2 alcohol-free days per week
- Smoking habits
What are some nursing interventions for Chronic Kidney Disease?
- Maintain adequate nutrition
- Fluid restriction
- Promote activity and rest as tolerated (waste build-up can make someone fatigued)
- Provide skin care (waste product build-up, oedema)
- Provide education on condition and complications (Tailor it to how the patient understands, online? Community group?)
- Provide culturally appropriate care
- Psychological/emotional support
- Support for smoking cessation
How does Chronic Kidney Injury (CKI) differ from Acute Kidney Injury (AKI)?
AKI tends to cause sudden, severe symptoms that are easily recognised, while CKD symptoms develop slowly and are easily mistaken for other conditions. While AKI can usually be reversed by resolving the underlying cause, CKD is not reversible and need to be managed to preserve the function of the kidneys. AKI is often associated with medications such as morphine and ibuprofen
How does Heart failure and the Renal System relate to each other?
- Prior heart attack, high blood pressure and coronary artery disease can lead to heart failure and impacts the ability to efficiently pump blood to the rest of the body
- As a result, the heart may beat faster and the left ventricle may increase in size becoming an even less effective pump
- When the kidneys sense the reduced blood flow, they attempt to compensate by retaining more water and salt
- This excess fluid retention often causes congestion in tissues and results in swelling and an increased strain on the weakened heart
- The progressive effect of the heart failing to properly circulate blood and congestion due to fluid retention is known as congestive heart failure
What is the development of peripheral oedema in patients with heart failure from?
Related to fluid excess. As the heart starts to fail, renal perfusion falls. The kidneys respond byincreasing the production of renin, leading to more aldosterone production, which is consequently followed by sodium and water retention with less urine production with these products and try and maintain/increase BP
What are the 2 structures that filter blood for each nephron in the kidney?
- Blob-like structure called Glomerulus
- Long Stringy structure called Tubule
What structure sifts through blood in the kidney?
Nephrons
What do the Glomerulus and Tubule do in the kidneys?
- The glomerulus works like a sift to only allow specific ingredients such as vitamins and minerals to pass into the tubule
- The tubule detects whether any of those ingredients are needed in the body, if they are needed, they are reabsorbed in amounts the body needs so they can circulate in the blood again. The tubules also sense compounds that the body doesn’t need (urea, left over from the breakdown of proteins) and redirect them as urine, transporting it out of the kidneys via 2 ureters
