Week 4 - Renal Flashcards
Oliguria
Less than 30 ml of urine produced an hour
Anuria
less than 50 ml of urine produced per day
Three stages of acute renal failure
- Pre renal
- Intrarenal
- Post renal
Causes of Prerenal failure (AKI)
- Hemorrhage
- Burns
- D&V
- Septic shock
- PE
Causes of Intrarenal failure
- CONTRAST DYE
- GLOMERULONEPHRITIS
- Acute tubular necrosis
- Vascular damage
- Renal artery occlusion
- Bilateral acute pyelonephritis
Causes of post renal failure
- Stones in the ureters, tumors, BPH
- Anything that block urine flow
- Bladder neck obstruction
- Neurogenic bladder
Acute Renal Failure
Sudden decline in kidney function with a decrease in glomerular filtration and urine output with an accumulation of nitrogenous waste products demonstrated by an elevation in plasma creatinine and BUN.
Pre renal failure
Prerenal renal failure occurs due to poor perfusion of nephrons, which in turn leads to a decrease in the GFR. There is an imbalance in the delivery of nutrition and oxygen to the nephrons during periods of increased energy demand. Therefore, any process that affects the systemic circulation or decreases renal perfusion can compromise the GFR.
Intra renal failure
Intrinsic or intrarenal acute kidney injury (AKI) occurs when direct damage to the kidneys causes a sudden loss in kidney function.
Post renal failure
Postrenal acute kidney injury, occurs when an obstruction in the urinary tract below the kidneys causes waste to build up in the kidneys
How do you determine a good prognosis for acute kidney injury/failure?
Kidneys respond to diuretics with good output, indicates that kidneys are functioning well, returning to normal function
Acute pyelonephritis
Infection of one or both upper urinary tracts (ureter, renal pelvis, kidney interstitium)
Symptoms of pyelonephritis
- BURNING AND PAIN (flank/groin)
- Fever
- Chills
- Urinary Frequency
- Dysuria (painful urination)
How to diagnose pyelonephritis?
- Signs and symptoms
- Urine culture
- Urinalysis - WBC casts indicate this but not always present
- Complicated pyelonephritis requires blood cultures
(check for sepsis)and urinary tract imaging (check for issues with the urinary tract)
How to diagnose pyelonephritis?
- Signs and symptoms
- Urine culture
- Urinalysis - WBC casts indicate this but not always present
- Complicated pyelonephritis
- requires blood cultures (check for sepsis)
- urinary tract imaging (check for issues with the urinary tract)
Renal calculi
Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.
Treatment for renal calculi
- Manage acute pain
- Promote passage of stone
- Surgical removal (ureteroscopy or percutaneous nephrolithotomy)
- Reduce size of stone already formed (lithotripsy)
- Prevent new stone formation
Types of renal stones
- Calcium stones (urolithiasis) most common
- Struvite stones – contain Mg ammonium phos (Staghorn configuration)
- Uric acid stones (Gout)
Renal colic
Renal colic is a sudden, acute pain in the kidney area (flank) caused by the obstruction of urine flow from the kidney to the bladder. Kidney stones are the most frequent cause of obstruction.
How are renal stones diagnosed?
- symptoms
- history
- focused assessment
- imaging
Treatment for renal stones
- Manage acute pain
- Promote passage of stone
- Surgical removal
- Reduce size of stone already formed
- Prevent new stone formation
Percutaneous Nephrolithotomy
procedure used to remove kidney stones from the body when they can’t pass on their own. “Percutaneous” means through the skin. The procedure creates a passageway from the skin on the back to the kidney.
Ureteroscopy
It is a procedure in which a small scope (like a flexible telescope) is inserted into the bladder and ureter and it is used to diagnose and treat a variety of problems in the urinary tract. For ureteral stones (a stone in the ureter), it allows the urologist to actually look into the ureter, find the stone and remove it. The surgeon passes a tiny wire basket into the lower ureter via the bladder, grabs the stone and pulls the stone free. This is an outpatient procedure with or without a stent inserted (a tube that is placed in the ureter to hold it open).
Lithotripsy
Laser lithotripsy is used to break apart the kidney stone so that it can pass through the ureter. The pieces will either be removed by the surgeon using a special basket or left in place where they will move from the ureter to the bladder, then out of the body with the urine.
Laser lithotripsy may be chosen if other non-surgical treatments have failed or if kidney stones are:
Too large to pass
Irregular in shape
Causing bleeding or damage to surrounding tissue
Chronic Kidney Disease
Progressive loss of renal function associated with systemic diseases such as DM, HTN, lupus, intrinsic kidney disease, AKI, chronic glomerulonephritis, obstructive uropathies, vascular disorders
When to start dialysis?
Patient must be in stage 5 (ESRD) and choice of time is guided by symptoms
Diseases associated with CKD
- HTN
- DM (most significant risk factor)
- systemic lupus erythematosus
- intrinsic kidney disease
CKD Stage 1
Kidney damage with normal or reduced GFR
GFR 90-120 ml/min
CKD Stage 2
Kidney damage with mild decrease in GFR
GFR 60-89 ml/min
CKD Stage 3
Moderate decrease in GFR
GFR 30-59 ml/min
CKD Stage 4
Severe decrease in GFR. Progression to stage 5 is inevitable. Will need dialysis or transplant at some point.
GFR 15-29 ml/min
CKD Stage 5
End stage renal disease. Pt needs dialysis.
GFR less than 15 ml/min
What is the most significant risk factor for chronic kidney disease?
Diabetes
