Week 8 - Renal Flashcards
the renal system consists of ? (4)
- kidneys
- ureter
- bladder
- urethra
the kidney functions?
primary function is to maintain a stable environment for optimal cell and tissue metabolism
- excrete metabolic wastes
- regulate blood Ph
- secretes hormones to regulate BP
Acute Kidney injury (Define)
sudden, severe impairment of renal function causing an acute build up of toxins in the blood
- results in fluid and electrolyte imbalances
- can develop over hours or days
AKI - Causes
- (3 main types)
Prerenal: (outside the kidneys)
*due to factors external to the kidneys that reduce renal blood flow
- hypovolaemia (dehydration, Hemorrhage, Diarrhoea and vomiting)
- decreased cardiac output
(shock, AMI, hypotension)
Intrarenal; (injury directly to the kidneys)
- Acute Tubular Necrosis
(can be caused by side effects of medications or triggered by acute events such as hypotension. results in death of the tissue within the tubule > causing blocking of the tubules and decrease in function over time)
Post Renal: (damage further down in the renal tract)
*involves mechanical obstruction of urinary outflow >
as flow of urine is obstructed urine refluxes into the renal pelvis which impairs renal function
- enlarged prostate
- renal cancer
- bladder cancer
AKI - Risk Factors
- pre existing renal impairment (diabities0
- hypotension
- dehydration
- age > 70
- admission to icu, AKI occurs in 20 - 50% of pts admitted to icu
specific conditions:
- burns
- cardiac disease
- sepsis/ MODS
- abdominal surgery
AKI - signs and symptoms (11)
- decreased urine output
- proteinuria
- volume overload
- hypotension (early)
- hypertension (late)
- arrhythmias
- PO
- pleural effusions
- nausea and vomiting
- anorexia
- seizures
AKI - pt assessment
- what to ask about when taking history?
- dysuria
- incontinence
- nocturia
- haematuria
- diabities
- hypertension
AKI - aim of treatment
maintain effective circulating volume
- treat cause!
AKI - pt assessment
- DRSABCD
Airway:
- patent?
- 80% of pts with AKI will require mechanical ventilation
Breathing:
- RR, WOB
- High flow 02
- observe for kussmauls respirations (Breathing rapidly and deeply) bodys attempt to get rid of C02
- auscultate lungs (crackles or diminished breath sounds)
Circulation
- HR
- BP (GFR cannot be maintined with systolic BP <9 intubate (indicate uremia very bad and requires urgent dialysis)
AKI - interventions & investigations
- IV access
- FBC
- IDC
- CVC
- (+/-) inotropes to maintain perfusion to the kidneys
- ECG (look for signs of hyperkalaemia)
- CXR
- abdominal xray
- CT
- pathology
hyperkalaemia on ECG
- prolonged PR interval
- wide QRS
- tall peaked T waves
- untreated can lead to VF and VT
how to treat hyperkalaemia?
insulin and glucose (10 - 20 units actrapid) > takes potassium with glucose into the cells > = decreased potassium
Dialysis - define
is the diffusion of solute molecules across a semi permable membrane from an area of higher concentration to lower concenctration
- used to remove excess fluid and metabolic waste products in the pt with renal failure
dialysis - 2 types
- haemodyalysis
- peritional dialysis
Haemodialysis
a procedure by which blood passes by an artificial semi permable membrane outside the body
- needs a permanent vascular access site > internal arteriovenous fistula
Peritoneal Dialysis
- uses the peritoneum surrounding the abdominal cavity as the dialyzing membrane
- 2 - 3L of dialysate fluid infused
- fluid must be changed 4-5 times per day
Peritoneal Dialysis
- advantages
- pt can be ambulant
- can be managed at home
Peritoneal Dialysis
- disadvantages
- risk of bowel perforation
- risk of infection at catheter site
Chronic Renal Failure
- defined by either the prescence of kidney damage or a GFR of <600ml/min for over 3 months
- progressive and irreversible destruction of renal function over time
- renal system experiences ischaemia, inflammation, fibrosis and scaring
- nephrons are permanently destroyed distrupting fluid & electroylete balance as well as waste removal
- CRF is progressive and often goes unnoticed. pt can lose up to 90% of renal function asymptomatically
CRF - 3 stages
1) diminished renal reserve
2) renal insufficiency
3) renal failure and uremia
brief patho of CRF
as renal failure is occurring subtances that are usually excreted accumulate in the body including nitrogenous waste, electrolytes and uremic toxins ^ eventually all organs affected ^ in the end = systemic disease
CRF - causes
- chronic infection
- vascular disease
- obstructive processes (prostate, ascities)
- endocrine disease
- congenital abnormalities
- diabities
CRF - signs and symptoms
Airway/ Breathing:
- SOB
- kassmauls RR’s
- PO
- pleural effusion
Circulation:
- polyuria
- oliguria > anuria as CRF worsens
- hypertension
- electrolyte and acid base imbalance
- cardiac arrhythmias
Disability:
- decreased mental activity
- weight loss
- coma (late sign)
CRF - what conditions can it result in/ lead to?
- HF
- anaemia
- bleeding tendicies (especially GIT bleeding)
CRF - Management
early management focuses on:
- eliminating factors that may further decrease renal function
- measures to slow progressive of disease to ESRD
Airway/ breathing;
- 02
Circulation:
- control BP
- balance fluid intake and output
- dialysis
- monitor electrolytes
Disability:
- identify and treat complications
- maintain nutrition
- energy conservation with ADL’s
CRF - medications
- alkalinizing agents for acidosis
- insulin and glucose to decrease potassium
- antihypertensives
- antibiotics for infection
End Stage Renal disease (ESRD)
- what is it?
is reached when damage to the kidney function is irreparable and irreversible
End Stage Renal disease (ESRD)
- how is it diagnosed?
by a GFR of < 15 l/min
End Stage Renal disease (ESRD)
- treatment options
- haemodyalis
- peritioneal dialysis
- renal transplantation
- palliative care
kidney transplant
- only definite treatment for pts with ESRD
- immunosuppression required to avoid rejection
eg; prednisolone - don’t take out old kidney put new one in flank can feel it sitting there
