Acute kidney injury etc... Flashcards

Question

AKI/ARFTwo Phases pretty much the same they can be used interchangeably.

Answer 1

AKI stands for Acute Kidney Injury, while ARF stands for Acute Renal Failure. These two terms are often used interchangeably to describe a sudden and rapid decline in kidney function. There are two phases of AKI/ARF: A) Oliguric phase: (1-3 weeks) During this phase, urine output decreases to less than 400 milliliters per day. The fluid volume in the body increases due to fluid retention, which can lead to edema (swelling) in various parts of the body. Potassium levels in the blood may increase, which can lead to life-threatening cardiac arrhythmias. B) Diuretic phase: During this phase, urine output increases to more than 400 milliliters per day. The excess fluid that was retained during the oliguric phase is excreted in the urine, and as a result, the fluid volume in the body decreases. Potassium levels may also decrease due to increased urine output. It is important to note that not all patients with AKI/ARF will progress through both phases, and some may skip the oliguric phase entirely. The duration of each phase can also vary depending on the underlying cause of AKI/ARF and the individual patient's response to treatment.

Answer 2

The RIFLE classification system is a widely used system to classify and stage Acute Kidney Injury (AKI) based on changes in serum creatinine (Cr) levels and urine output. The acronym RIFLE stands for Risk, Injury, Failure, Loss, and End-stage kidney disease (ESKD). The classification criteria for each stage are as follows: GFR Criteria: Risk: Increase in serum creatinine by 1.5 times or GFR decrease by 25% Injury: Increase in serum creatinine by 2 times or GFR decrease by 50% Failure: Increase in serum creatinine by 3 times or GFR decrease by 75% or serum creatinine at or above 4 mg/dL Urinary Criteria: Risk: Urine output < 0.5 mL/kg for six hours Injury: Urine output < 0.5 mL/kg for 12 hours Failure: Urine output < 0.3 mL/kg or anuria for 12 hours Loss: Complete loss of renal function for at least 4 weeks End-stage kidney disease (ESKD): Need for renal replacement therapy (RRT) for more than 3 months. It is important to note that AKI is a serious condition and requires prompt diagnosis and treatment to prevent further kidney damage and associated complications. The RIFLE classification system helps to identify and stage the severity of AKI and guide appropriate treatment and management strategies.

Answer 3

The clinical approach to a patient with Acute Kidney Injury (AKI) involves several evaluation processes and responses. These are as follows: Evaluate volume status: This involves performing a physical examination, measuring weight, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and administering a fluid challenge to assess for fluid responsiveness. Rule out obstruction: A physical examination should be performed to assess the patency of catheters, and a renal ultrasound may be ordered to rule out obstruction. Foley catheterization may also be performed to obtain urine output measurements. Renal function tests: These tests include measuring blood urea nitrogen (BUN), creatinine, electrolytes, hemoglobin, calcium, and phosphorus to evaluate kidney function and electrolyte balance. Probable cause for renal dysfunction: Nephrotoxic (drug) exposure such as NSAIDs, aminoglycosides, and hypotension, among other causes, should be evaluated and addressed. Urine routine and microscopy: A urine sample should be obtained for routine and microscopy evaluation, which includes assessing specific gravity, protein, glucose, blood, casts (granular and/or cellular), cells, and crystals. A spot urine sodium and creatinine may also be obtained. Urinary indices: The fractional excretion of sodium (FeNa) may be calculated to evaluate for tubular function and distinguish between prerenal and intrinsic AKI. The approach to AKI should be individualized based on the patient's clinical status and underlying cause of kidney injury. Treatment and management strategies may involve addressing the underlying cause, fluid and electrolyte management, and renal replacement therapy, among others.

Answer 4

Risk factors for the development of AKI include: Advanced age Chronic kidney disease (CKD) Diabetes Hypertension Cardiovascular disease Liver disease Sepsis Surgery Trauma Nephrotoxic medications Contrast dye Dehydration Hypovolemia Obstruction Physical assessment: Neurologic: Assess for altered mental status, confusion, seizures, or coma. These symptoms can be indicative of uremic encephalopathy, which is a potential complication of AKI. CV: Monitor blood pressure, mean arterial pressure (MAP), pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), preload, afterload, cardiac output (CO), ejection fraction (EF), coronary artery disease (CAD), and myocardial infarction (MI). These factors can impact renal perfusion and contribute to the development of AKI. Pulmonary: Assess for signs of respiratory distress, hypoxemia, and pulmonary edema. These symptoms can be indicative of fluid overload and can contribute to the development of AKI. GI: Monitor for nausea, vomiting, diarrhea, constipation, appetite, calorie intake, protein intake, and sodium intake. These factors can impact fluid balance and electrolyte balance and contribute to the development of AKI. Hematologic and immune system: Monitor for anemia, leukocytosis, and thrombocytopenia. These factors can impact renal function and contribute to the development of AKI. Integumentary: Assess for skin turgor and mucous membranes. These factors can be indicative of hydration status and can impact renal function. Skeletal: Assess for bone pain and fractures. These factors can be indicative of underlying metabolic bone disease and can impact renal function. Laboratory: Monitor blood urea nitrogen (BUN), creatinine (Cr), glomerular filtration rate (GFR), osmolality, and electrolyte imbalances. These factors can be indicative of renal function and can contribute to the development of AKI. Remember all the reasons for an altered urine output, including decreased oral fluid intake and excess fluid loss, as these can contribute to the development of AKI.

Answer 5

Check slide 32

Answer 6

- Loop diuretics such as Furosemide (Lasix) are commonly used in the management of AKI to increase water excretion and improve fluid balance. Furosemide works by interfering with the chloride binding cotransport system in the Loop of Henle, which in turn inhibits the reabsorption of sodium and chloride ions. This results in increased urinary output and decreased fluid volume. The peak action of Furosemide is typically reached about 60 minutes after administration, and its duration of action is approximately 6-8 hours. However, the actual onset and duration of action can vary depending on factors such as the patient's renal function, hydration status, and co-administration of other medications.

Answer 7

Dopamine is a medication that can be used in the management of AKI as an inotrope, which is a medication that increases myocardial contractility and cardiac output. In addition to its inotropic effects, dopamine can also cause selective dilation of the renal vasculature at low doses (1-5 mcg/kg/min) due to its activity on specific dopamine receptors in the renal vasculature. By increasing renal blood flow and enhancing renal perfusion, dopamine can improve urine flow and help to prevent or treat AKI.

Answer 8

is a medication that belongs to a class of drugs known as vasodilators. It is a selective dopamine receptor agonist that has minimal adrenergic effects and is 6 times more potent than dopamine. Fenoldopam is primarily used to treat severe hypertension, including patients with renal compromise, by causing vasodilation of the peripheral blood vessels and increasing renal blood flow. It is administered intravenously and is typically used in a hospital setting. While fenoldopam is effective at lowering blood pressure, it can also cause some side effects, including headaches, flushing, nausea, and hypotension. It is important to monitor patients closely for these side effects and adjust the dosage as needed to minimize the risk of adverse events. In summary, fenoldopam is a vasodilator that is used to treat severe hypertension in patients with renal compromise. While it is an effective medication, it can cause side effects and requires close monitoring when used in a hospital setting.

Answer 9

Calcium channel blockers are a class of medications that work by blocking the entry of calcium ions into smooth muscle cells, leading to vasodilation and relaxation of blood vessels. One of the calcium channel blockers that is used in the treatment of acute kidney injury (AKI) is nifedipine. Nifedipine is used to enhance the function of transplanted kidneys by improving blood flow and oxygenation to the organ. The vasodilation effect of nifedipine is thought to be mediated through the relaxation of smooth muscle in blood vessels. In summary, nifedipine is a calcium channel blocker that is used to enhance the function of transplanted kidneys in patients with AKI. It works by producing vasodilation and improving blood flow and oxygenation to the kidneys.

Answer 10

Reduction of blood flow to the kidneys often caused by renal artery disease (HTN, diabetes) Defined as decline in renal function to approximately 25% of normal Risks include: Older age, gender, family history, race or ethnicity, genetic factors, hyperlipidemia, HTN, smoking, diabetes Stages Usually symptomatic when <50% “kidney function” is left.

Answer 11

Limit the 3 P’s and Sodium A renal diet is a special diet that is designed to help individuals with kidney disease maintain good health and manage their symptoms. The diet typically involves limiting certain nutrients that can be harmful to the kidneys, such as protein, potassium, phosphorus, and sodium. The "3 P's" refer to the nutrients that individuals with kidney disease should limit in their diet: potassium, phosphorus, and protein. High levels of these nutrients can be harmful to the kidneys and can exacerbate symptoms of kidney disease. Potassium is a mineral that is found in many foods, including fruits, vegetables, nuts, and legumes. In individuals with kidney disease, high levels of potassium can cause muscle weakness, irregular heartbeats, and other complications. Therefore, individuals with kidney disease may need to limit their intake of high-potassium foods. Phosphorus is a mineral that is found in many foods, including dairy products, meat, fish, and nuts. In individuals with kidney disease, high levels of phosphorus can cause bone disease and other complications. Therefore, individuals with kidney disease may need to limit their intake of high-phosphorus foods. Protein is an essential nutrient that is needed for growth and repair of the body. However, in individuals with kidney disease, high levels of protein can cause damage to the kidneys and exacerbate symptoms. Therefore, individuals with kidney disease may need to limit their intake of high-protein foods, such as meat, poultry, fish, and dairy products. Sodium is a mineral that is found in many foods and is often added to processed foods. In individuals with kidney disease, high levels of sodium can cause high blood pressure and fluid retention. Therefore, individuals with kidney disease may need to limit their intake of high-sodium foods, such as processed foods, fast food, and salty snacks. In summary, a renal diet is a special diet that is designed to help individuals with kidney disease manage their symptoms and maintain good health. The diet typically involves limiting certain nutrients, such as protein, potassium, phosphorus, and sodium, to reduce the risk of complications associated with kidney disease.

Answer 12

Potassium: Limit or avoid foods such as organ meats (liver, kidney), fish (salmon, tuna, halibut), dried fruits (raisins, prunes), beef, chicken, pork, milk, yogurt, dark green leafy vegetables (spinach, kale), and salt substitutes (potassium chloride). Phosphorus: Limit or avoid foods such as milk, cheese, yogurt, nuts, seeds, beans, lentils, whole grains, bran cereals, chocolate, and dark sodas. Protein: Calculation of protein needs and restriction is based on body weight and dialysis. For non-dialysis patients, protein intake is usually limited to 0.6-0.8 grams per kilogram of body weight per day. For dialysis patients, protein intake is usually higher, at 1.2 grams per kilogram of body weight per day. Sodium: Limit or avoid processed foods, fast food, packaged meats (sausage, hot dogs), canned soups and vegetables, potato chips, pretzels, ham, bacon, and cheese. It's important to note that every individual's nutritional needs may vary, depending on their specific condition and stage of kidney disease. A registered dietitian who specializes in renal nutrition can provide personalized recommendations for a renal diet.

Answer 13

Systemic affects are wide ranging: Chronic renal failure (CRF) and end-stage renal disease (ESRD) are serious medical conditions that affect the function of the kidneys. CRF refers to a gradual and irreversible loss of kidney function over time, while ESRD is the complete and permanent failure of the kidneys. Both conditions have systemic effects that are wide-ranging, affecting multiple body systems. These effects include cardiovascular, hematologic, gastrointestinal, and neurologic symptoms. Patients with CRF or ESRD often require palliative interventions to manage their symptoms and maintain their quality of life. Fluid and electrolyte imbalances are also common in CRF and ESRD patients. The kidneys play a crucial role in regulating the balance of sodium, potassium, calcium, and phosphorus in the body. In these conditions, there may be sodium and fluid retention, leading to edema and hypertension. The kidney is the primary organ responsible for potassium balance, so patients may experience hyperkalemia if the kidneys are not functioning properly. Additionally, imbalances in calcium and phosphorus levels can lead to hypocalcemia and bone disease. Treatment for CRF and ESRD typically involves managing symptoms, addressing fluid and electrolyte imbalances, and supporting kidney function through dialysis or kidney transplantation. Dietary modifications, medications, and lifestyle changes may also be recommended to slow the progression of the disease and improve quality of life.

Answer 14

ESRD can lead to various complications such as acid-base imbalances, anemia, hypertension, and heart failure. Treatment is aimed at managing these complications and improving quality of life. Also hypotension if rennin is not produced or released. In terms of acid-base imbalances, ESRD can result in metabolic acidosis due to the loss of nephrons, which are responsible for regulating the body's acid-base balance. Treatment may involve the use of sodium bicarbonate to correct the acidosis. Other complications of ESRD include fluid and electrolyte imbalances such as hyperphosphatemia, hypocalcemia, and hyperkalemia. Management involves restricting fluid intake and limiting dietary intake of phosphorus, potassium, and sodium. Increasing calorie intake through fats and carbohydrates may also be recommended to help maintain muscle mass. Overall, management of ESRD requires a multidisciplinary approach involving nephrologists, dietitians, and other healthcare professionals to optimize patient outcomes and improve quality of life.

Answer 15

ESRD stands for End-Stage Renal Disease, which is a condition in which the kidneys fail to function adequately, and the patient requires either dialysis or a kidney transplant to survive. The Social Security Administration (SSA) considers ESRD as a disability, and a person may qualify for Social Security disability benefits if they are unable to perform gainful activity for 12 consecutive months due to ESRD. Medical management of ESRD includes controlling hypertension, managing volume overload, ensuring adequate nutrition, and monitoring electrolytes and toxins. Pharmacological interventions may also be necessary to manage the symptoms and complications of ESRD. These interventions may include folic acid and ferrous sulfate supplementation, phosphate binders (taken with meals), calcium sources and supplements, and stool softeners and laxatives. Regular monitoring and management of these factors can improve the patient's quality of life and help them to live longer with ESRD. Additionally, kidney transplantation is considered the most effective treatment for ESRD and offers the best chance for a patient to return to a normal life.

Answer 16

This process relies on the principles of osmosis and diffusion, which involve the movement of molecules from an area of higher concentration to an area of lower concentration. Hemodialysis requires a large vascular access, typically in the form of an arteriovenous fistula or graft, to allow for adequate blood flow through the dialysis machine. This access is created by surgically connecting an artery and a vein in the arm or leg, or by placing a synthetic graft between an artery and a vein. Hemodialysis is considered the most efficient and effective form of clearance for end-stage renal disease. It can remove large amounts of waste products and excess fluids from the body, helping to maintain a patient's electrolyte balance and fluid levels. However, hemodialysis is associated with several potential complications. These can include disequilibrium syndrome, muscle cramps, hemorrhage, air embolus, and hemodynamic flux, which can manifest as hypotension, dysrhythmias, and anemia.

Answer 17

Components include Access: Hemodialysis requires access to the patient's bloodstream, which is usually obtained through a surgically created arteriovenous fistula, arteriovenous graft, or central venous catheter. Dialyzer: The dialyzer, also known as the artificial kidney, is the central component of the hemodialysis machine. It contains a semipermeable membrane that allows waste products and excess fluids to pass from the patient's blood into the dialysate. Filter: The filter, also called the membrane or screen, is located in the dialyzer and removes waste products and excess fluids from the patient's blood. Dialysate: Dialysate is a solution that is circulated through the dialyzer and helps to remove waste products and excess fluids from the patient's blood. The composition of the dialysate can be adjusted to meet the specific needs of each patient. During hemodialysis, the patient's blood is drawn from the access site and pumped through the dialyzer, where it is filtered and cleaned by the dialysate. The cleaned blood is then returned to the patient's bloodstream through the access site. This process usually takes several hours and is performed several times a week, depending on the patient's individual needs.

Answer 18

These are the different components of a typical hemodialysis machine, which work together to filter the blood of patients with end-stage renal disease: Blood pump: The blood pump is responsible for drawing blood from the patient's access site and circulating it through the hemodialysis machine. Dialyzer (Filter): The dialyzer is the central component of the hemodialysis machine. It contains a semipermeable membrane that allows waste products and excess fluids to pass from the patient's blood into the dialysate. Dialysate: Dialysate is a solution that is circulated through the dialyzer and helps to remove waste products and excess fluids from the patient's blood. The composition of the dialysate can be adjusted to meet the specific needs of each patient. Dialyzer inflow pressure monitor: This component monitors the pressure of the blood as it enters the dialyzer. Venous pressure monitor: This component monitors the pressure of the blood as it leaves the dialyzer and returns to the patient's bloodstream. Arterial pressure monitor: This component monitors the pressure of the blood as it is pumped into the dialyzer. Heparin pump: The heparin pump is used to prevent blood clots from forming in the dialyzer or the patient's access site. Air trap and air detector: These components are used to prevent air bubbles from entering the patient's bloodstream during hemodialysis. Air detector clamp: This component automatically clamps the tubing if air bubbles are detected. After the blood has been filtered and cleaned by the dialyzer, it is returned to the patient's bloodstream through the access site. The cleaned blood is then circulated through the patient's body, carrying oxygen and nutrients to the organs and tissues. The hemodialysis process usually takes several hours and is performed several times a week, depending on the patient's individual needs.

Answer 19

Hemodialysis (HD) works by using the principles of diffusion to remove waste products and excess fluids from the patient's blood. Diffusion is the process by which molecules move from an area of high concentration to an area of low concentration until equilibrium is reached. During HD, the patient's blood is pumped through the semipermeable membrane of the dialyzer, where it is in close proximity to the dialysate solution. The dialysate contains a balanced solution of electrolytes, such as sodium and magnesium, and other substances that help to remove waste products and excess fluids from the patient's blood. As the blood flows through the dialyzer, metabolic toxins, urea, small proteins, and other waste products diffuse from the bloodstream across the membrane into the dialysate solution. At the same time, electrolytes and other substances that are needed by the body are allowed to pass from the dialysate into the bloodstream to maintain the body's electrolyte balance. Water molecules also move across the membrane in a process called ultrafiltration, which removes excess fluid from the patient's bloodstream. The rate of ultrafiltration can be adjusted by altering the pressure and composition of the dialysate solution. why is removing water called ultrafiltration ? The process of removing water from the blood is called ultrafiltration because it involves the use of a filtering system that selectively removes water and certain dissolved solutes from the blood based on size and charge.

Answer 20

Refractory hyperkalemia: High levels of potassium in the blood that do not respond to medical treatment or dietary changes can lead to dangerous arrhythmias and other complications. Refractory acidosis: A buildup of acids in the blood can cause severe symptoms such as confusion, lethargy, and seizures. Hemodialysis can help remove excess acids from the bloodstream. Volume overload: Hemodialysis can help remove excess fluid from the body that can accumulate in patients with kidney failure and cause swelling in the legs, ankles, and other areas. Elevated BUN with symptoms of complications: A high level of blood urea nitrogen (BUN) can indicate kidney failure and may cause symptoms such as fatigue, nausea, and vomiting. Pericarditis: Inflammation of the sac surrounding the heart (pericardium) can occur in patients with kidney failure and may require hemodialysis to remove excess fluid and toxins. Encephalopathy (hepatorenal syndrome/AMS, ALOC): Buildup of toxins in the bloodstream can cause neurological symptoms such as confusion, altered mental status, and even coma. Pulmonary edema: Fluid buildup in the lungs can lead to shortness of breath, coughing, and other respiratory symptoms that may require hemodialysis to remove excess fluid and improve breathing. Mnemonic = HAVEPEE

Answer 21

Hemodialysis can be performed in different settings, including inpatient units, dialysis centers, and at home. In the inpatient and dialysis center settings, patients are typically given a set schedule or time slot for their hemodialysis treatments, and there may also be a night-time option available. However, home hemodialysis offers several advantages over inpatient or center-based hemodialysis. Patients on home hemodialysis have a more flexible schedule, and they may experience less nausea, more energy, and better sleep. Home hemodialysis also decreases the risk of complications and problems associated with inpatient or center-based hemodialysis, such as painful muscle cramps, high blood pressure, headaches, stroke, hypotension, high phosphate, and pruritus (itching). Home hemodialysis treatments can last between 2-10 hours, depending on the type of treatment prescribed. There are several types of home hemodialysis, including standard home hemodialysis (3 times per week), short daily hemodialysis (5-7 days per week), and nightly home hemodialysis (3-6 times per week). Patients on home hemodialysis are trained to perform their own treatments at home or with the help of a caregiver.

Answer 22

Continuous renal replacement therapy (CRRT) is a form of renal replacement therapy that is primarily used for critically ill patients who are hemodynamically unstable. Unlike hemodialysis, which is done over a period of several hours, CRRT is more gradual and continuous. There are five main methods of CRRT: SCUF, CAVH, CAVH-D, CVVH, and CVVH-D. SCUF (Slow Continuous Ultrafiltration) works by convection to pull off fluid, while CAVH (Continuous Arteriovenous Hemofiltration) works by convection to pull off fluid and waste using the patient's blood pressure. CAVH-D (Continuous Arteriovenous Hemodialysis) and CVVH-D (Continuous Veno-Venous Hemodialysis) both use dialysate to remove waste in addition to convection. Finally, CVVH (Continuous Veno-Venous Hemofiltration) works by diffusion like a "slow" hemodialysis, but is still considered a form of CRRT due to its continuous nature. CRRT is indicated for patients with multiple organ dysfunction syndrome (MODS), sepsis, acute renal failure (ARF), or those who are unable to tolerate hemodialysis or peritoneal dialysis. Complications of CRRT can include fluid imbalance, hemorrhage, hemofilter occlusion, infection, thrombus, and vascular occlusion.

Answer 23

A: Metabolic acidosis (pH <7.1) - CRRT can help to correct acid-base imbalances in patients with severe metabolic acidosis. E: Electrolytes –Hyperkalemia (K > 6.5 or rapidly rising), hypermagnesemia - CRRT can help to remove excess potassium and magnesium from the body in patients with severe electrolyte imbalances. I: Ingestion –Certain alcohol and drug intoxications - CRRT can be used as part of the management of certain types of poisoning, including salicylates, lithium, methanol, ethylene glycol, theophylline, and phenobarbital. O: Refractory fluid overload (postoperative) - CRRT can help to remove excess fluid in patients with refractory fluid overload, which can occur after surgery or in other clinical contexts. U: Uremia –high catabolism of ARF (pericarditis, neuropathy, decline in mental status) - CRRT can help to remove uremic toxins and other waste products from the body in patients with AKI or other conditions that cause uremia. In general, CRRT is recommended for patients who require renal support, even before the development of complications of AKI. It is important to individualize the indications and timing of CRRT based on the patient's clinical condition and response to treatment.

Answer 24

Temporary dialysis vascular access refers to the use of catheters for hemodialysis (HD) in patients with acute kidney injury (AKI) or other conditions that require renal support. The following are some important considerations for temporary dialysis vascular access: -Do not use for routine access or blood draw: Temporary dialysis catheters are designed for short-term use and should not be used for routine access or blood draws, as this can increase the risk of infection and damage to the catheter. -HD team use only: Insertion, maintenance, and removal of temporary dialysis catheters should be performed by a qualified HD team, such as a nephrologist or dialysis nurse. -Use only the 3rd port if present during an emergency: Some temporary dialysis catheters may have multiple ports. In an emergency situation, only the third port should be used for HD access, as the first two ports may be used for other purposes such as medication administration. -Flush lock with sodium citrate (4%) versus heparin: To prevent catheter-related bloodstream infections, temporary dialysis catheters should be flushed with an anticoagulant lock solution after each use. Sodium citrate (4%) is preferred over heparin, as it has been shown to be more effective in reducing the risk of infection. -Aspirate and discard: Before use, the catheter should be aspirated and the aspirated fluid discarded to ensure that there is no clot or other debris that could cause catheter-related complications such as thrombosis or infection. Overall, proper use and maintenance of temporary dialysis vascular access is essential for the safe and effective delivery of hemodialysis in critically ill patients.

Answer 25

The following are some general standards of care for patients receiving HD: Pretreatment: Medications, nutrition, fluids: Patients should take their medications as prescribed and follow any dietary or fluid restrictions given by their healthcare provider. Vital signs, weight, labs, symptoms: Patients should have their vital signs checked, their weight measured, and blood tests done before each HD session to monitor their health status. Post-treatment: Handoff -VS, Labs, fluids in/out, weight changes, blood glucose: Healthcare providers should communicate important information such as vital signs, labs, fluid intake and output, weight changes, and blood glucose levels between shifts to ensure continuity of care. Labs: Blood tests should be performed after HD sessions to monitor fluid and electrolyte levels and to adjust the patient's treatment plan if necessary. Fluid and electrolyte shifts: Healthcare providers should monitor for changes in fluid and electrolyte levels during and after HD sessions to prevent complications such as hypotension, cramping, or arrhythmias. Site observations: The access site for HD should be monitored for signs of infection or other complications. Medications, nutrition, rest: Patients should be given any necessary medications or nutritional support after HD sessions, and encouraged to rest. Discharge, support services (transportation, groups): Patients should be discharged after HD sessions with appropriate support services in place, such as transportation or access to support groups. Complications and stressors: Healthcare providers should monitor for and manage common complications and stressors associated with HD, such as fluid and food limitations, muscle cramps, fatigue, sleep problems, peripheral neuropathy (in patients with diabetes), vacation limitations, social isolation, pruritus (itching), and long dialysis treatment times. Overall, HD treatment should be individualized and tailored to the patient's specific needs and goals, with careful attention paid to managing potential complications and ensuring patient comfort and well-being.

Answer 26

- The patient is a 67-year-old male, who is 3 days postoperative after a CABG x 3 operation. The patient has a history of HTN, type 1 diabetes, CAD, and ESRD, which is treated with hemodialysis 3x/week. The patient has a left AV shunt. He is taking the following medications: evSevelamer (Renegel) 2 capsules with each meal Vitamin D, B12 and iron supplements with each meal Calcium carbonate (OS-Cal): 3 tablets with each meal Procrit (epoetin alfa): 100U/kg dose subcutaneously every M, W, & F on dialysis days 70/30 NPH and regular insulin 30U twice daily and finger stick blood glucose taken before meals and at bedtime and regular insulin given as per CHO intake as per sliding scale Coreg (carvedilol 12.5 mg twice daily Lanoxin 0.125 mg every other day (on even days) Acetaminophen with Codeine No.3 1-2 tabs every 6 hours PRN for pain Diphenhydramine hydrochloride 25 mg ery 8 hours PRN for itching DSS (Colace)100 mg twice daily - The patient is ordered to have daily dialysis. What is the rationale for this? - The patient is going to hemodialysis at 0900 on an odd day. Which medication(s) should the nurse hold before sending the patient? Why? - What nursing management considerations should be made for this patient? Case Study Dialysis Answers The increased metabolic rate increases (due to the surgury) metabolic wastes, therefore wastes accumulate faster in those with ESKD –uremia develops, and they need daily dialysis to get rid of wastes. Hold the beta blocker/antihypertensive Sign for restrictive extremity,; assess AV fistula, assess VS for hypotension, Check IVF for rate, K+ & Mg++, assess for FVE (weight, etc), lung sounds, heart sounds, monitor for complications: pericarditis, pleural effusions, PNA, electrolytes, monitor diet, appetite, check pre/albumin. Check skin/skin care, wound healing, blood glucose, saturation, pain control. In the case study provided, the nurse was instructed to hold the patient's beta blocker medication (carvedilol, or Coreg) before sending the patient to dialysis. The reason for this is because beta blockers can lower blood pressure, and dialysis can also lower blood pressure. Therefore, holding the medication can help prevent further drops in blood pressure during the dialysis treatment.

Answer 27

Peritoneal dialysis (PD) is a type of renal replacement therapy that involves using the peritoneal cavity as a semipermeable membrane for fluid and solute exchange. This process relies on both osmosis and diffusion to remove excess fluid and waste products from the body. PD requires a prescribed volume of dialysate solution, which is warmed and infused into the peritoneal cavity by gravity. The dialysate solution is left in the peritoneal cavity for a prescribed dwell time, during which time it absorbs excess fluid and waste products from the bloodstream. After the dwell time, the solution is drained out of the peritoneal cavity and replaced with fresh solution. Patients undergoing PD have specific dietary needs, as the process of dialysis can result in the loss of important nutrients. Dietary recommendations are typically made by a registered dietitian. Complications of PD can include peritonitis (which is indicated by abdominal pain and cloudy effluent), anorexia, hernia, low back pain, altered body image and sexuality, and a constant sweet taste. PD can be administered continuously or intermittently. Continuous ambulatory peritoneal dialysis (CAPD) involves the patient performing manual exchanges of dialysate four times a day, seven days a week. Continuous cycling peritoneal dialysis (CCPD) is an automated form of PD that uses a machine to perform exchanges at night. Nighttime intermittent peritoneal dialysis (NIPD) involves cycles of dialysate exchanges throughout the night.

Answer 28

Peritoneal dialysis (PD) is a type of dialysis that uses the peritoneal cavity as a semipermeable membrane to remove waste products and excess fluid from the body. The process involves the insertion of a soft, flexible tube (catheter) into the abdominal cavity, through which a solution (dialysate) is instilled, allowed to dwell for a prescribed amount of time, and then drained. PD is considered less effective than hemodialysis (HD), but it has several advantages, including easier access via an intraabdominal catheter, less dietary restrictions, and the ability to perform the procedure at home. PD also allows for more continuous clearance of waste products, which can result in better blood pressure and electrolyte control. The various solution gradients used in PD range from low to high, and the weight difference of the solution before and after instillation helps determine how much water has been gained or lost during the procedure. PD can be performed using different cycles, including continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and night-time intermittent peritoneal dialysis (NIPD). Labs are used to monitor the clearance of wastes and other parameters during PD, including blood urea nitrogen (BUN), creatinine, electrolytes, and fluid balance. Regular monitoring is essential to ensure that the procedure is working effectively and to detect any potential complications.

Answer 29

Verification of orders: The nurse should verify the orders for the type of solution, dwell time, and cycles prescribed for the patient. Assessment of vital signs, weight, breath sounds, signs of peritonitis, and labs: The nurse should monitor the patient's vital signs, weight, and breath sounds, and assess for any signs of peritonitis, such as a rigid abdomen, pain, distension, and increased white blood cell count. The nurse should also monitor the patient's labs, including BUN, creatinine, and electrolyte levels. Assessment of the abdominal insertion site: The nurse should assess the abdominal insertion site for redness, swelling, drainage, pain, catheter stabilization, and dressing. The nurse should also perform site care to prevent infection and ensure proper catheter function. Check lines, tubing, and caps: The nurse should check the lines, tubing, and caps for any signs of damage or disconnection, and ensure that they are securely in place. Assessment for mechanical complications: The nurse should assess for any mechanical complications, such as catheter blockage, leakage, or displacement. Confirmation of phase of therapy: The nurse should confirm the phase of therapy (infusion, dwell, or capped) and adjust the procedure as necessary. Assessment of solution: The nurse should assess the solution before and after instillation to evaluate the efficacy of therapy. Evaluation of patient self-care knowledge and technique: The nurse should evaluate the patient's knowledge and technique regarding self-care, including the proper administration of the solution and site care. The nurse should provide education and support as needed to promote patient safety and comfort.

Answer 30

Psychological assessment and support to address anxiety and stress related to the surgery Nutritional evaluation and counseling to optimize the patient's health before and after surgery Screening and treatment of infections or other medical conditions that may affect the transplant Evaluation of the patient's social support network and readiness for the demands of post-transplant care Education about the transplant process, including risks and benefits, medication regimen, follow-up care, and lifestyle changes Consent for the surgery and organ donation Verification of blood type and cross-matching with the donor kidney Preoperative testing, such as blood work, imaging studies, and cardiac evaluation, to assess the patient's overall health status Informed consent for the procedure. Administer immunosuppressive drugs to prevent immediate graft rejection

Answer 31

- VS and hemodynamic monitoring - Measure UO every 30-60 minutes to determine transplant function **Diuretics **Indwelling urinary catheter care - Replace fluid mL for mL - Monitor electrolytes and renal function tests - Postoperative education include medications, S&S of rejection, VS, fluids, diet, prevent infection, support because there is no guarantee

Answer 32

- ATN - Electrolyte imbalances - Hemorrhage **Surgical emergency - Urethral anastomosis failure (Urethral anastomosis is a surgical procedure that involves joining two segments of the urethra together to reconstruct the urethra) - Renal artery thrombus **Abrupt onset of HTN and reduced GFR -Infection **Immediate and ongoing risk due to patient’s immunosuppression **Monitor urine, surgical sites, LOC - Rejection

Answer 33

- Hyperacute (humoral, B-lymphs) **Minutes to hours after transplant **Microcoagulation leads to ischemia causes necrosis - Acute (cell-mediated by T-lymphs) **Days to months after transplant **Antibody-mediated vasculitis (not clot) - Chronic **Chronic inflammatory response **Functional tissues, fibrotic scarring **Vessels damaged, progressive ischemia

Answer 34

- Symptoms Elevated BUN/creatinine & K+ Decreased creatinine clearance Decreased urine output Graft (graft here literally means the kidney like a bone graft for an implant taken from a dead person or your own body then planting it) tenderness Graft enlargement Low-grade temperature Elevated blood pressure - Pharmacological management **Rejection: cell-mediated immunity response **Drugs target cell mediated immune response ***Induction (started perioperative) ***Maintenance (low dose) ***Rescue (high dose more drugs)-immunosuppressants ***Side effects ****Secondary infection, hepatotoxicity, nephrotoxicity, delayed wound healing, hyperglycemia, fevers , itching, fluid overload Kidney transplant rejection occurs when the immune system recognizes the transplanted kidney as foreign and mounts an immune response against it. The immune system attacks and damages the kidney, which can lead to decreased kidney function or even complete kidney failure. The symptoms of kidney transplant rejection may include elevated levels of blood urea nitrogen (BUN) and creatinine, decreased urine output, graft tenderness and enlargement, low-grade fever, elevated blood pressure, and decreased creatinine clearance. Pharmacological management of kidney transplant rejection involves the use of immunosuppressive drugs to target the cell-mediated immune response. These drugs are typically administered in three phases: induction (started perioperatively), maintenance (low dose), and rescue (high dose or additional drugs). Common immunosuppressive drugs used in the management of kidney transplant rejection include corticosteroids, calcineurin inhibitors (such as tacrolimus or cyclosporine), and antimetabolites (such as mycophenolate mofetil or azathioprine). However, these drugs can have side effects such as secondary infections, hepatotoxicity, nephrotoxicity, delayed wound healing, hyperglycemia, fevers, itching, and fluid overload. Regular monitoring of kidney function and medication levels is crucial in preventing and managing kidney transplant rejection. If rejection occurs, prompt treatment is necessary to prevent irreversible damage to the transplanted kidney.

Answer 35

Renal cancer, also known as kidney cancer, refers to the uncontrolled growth of abnormal cells in the kidneys. Here are some details regarding its pathophysiology, risk factors, symptoms, and treatment options: Pathophysiology: Renal cancer can arise from different types of cells within the kidney, such as renal tubular cells or renal pelvis cells. The cancer cells can obstruct the flow of urine and invade the surrounding functioning tissues and lymph nodes, leading to further complications. Risk factors: Several factors can increase the risk of developing renal cancer, including smoking, overuse of pain killers (such as NSAIDs), exposure to certain chemicals (such as asbestos, cadmium, or organic solvents), and a family history of renal cancer or other related conditions. S & Sx: The signs and symptoms of renal cancer may include: Hematuria (blood in the urine) Dysuria (painful urination) Frequency and urgency in urination Fever Hypertension (high blood pressure) Abdominal mass or lump Flank pain (pain in the side or back) Persistent fatigue Rapid or unexplained weight loss Edema (swelling) in the lower extremities Treatment: The treatment options for renal cancer depend on various factors, such as the stage and location of the cancer, as well as the patient's overall health and preferences. Here are some common treatment modalities: Radical or partial nephrectomy: Surgical removal of the affected kidney (or part of it) is often the primary treatment for renal cancer. The surgeon may also remove nearby lymph nodes or other affected tissues as needed. Radiation therapy: This treatment uses high-energy radiation to kill cancer cells or shrink tumors. It may be used before or after surgery, or as the main treatment for patients who cannot undergo surgery. Chemotherapy: This treatment uses drugs to kill cancer cells throughout the body. It may be used in combination with surgery or radiation, or as a standalone treatment for advanced cases. Cystectomy: This is a surgical procedure that involves the removal of the bladder. It may be necessary for some cases of renal cancer that have spread to the bladder. Nephron-sparing treatment: This refers to surgical techniques that aim to preserve the healthy parts of the kidney while removing the cancerous parts. This approach may be suitable for some patients with small or early-stage tumors. Gene therapy: This experimental treatment involves the modification of cancer cells or the patient's own immune cells to better target and destroy cancer cells. Biological or immunotherapy: These treatments use drugs that target specific molecules or pathways involved in cancer growth or stimulate the patient's immune system to fight the cancer. They may be used alone or in combination with other treatments.

Answer 36

Your patient, a 42-year-old factory worker made an appointment with his PCP because he had lost 15 pounds in the last 2 months and recently noticed blood in his urine. During the admission assessment he stated that he is a 2-pack-per-day smoker and just thought he was losing weight due to increased stress form money problems (his twins just started college). He also stated that he worked, for 30 years, in a building that was recently closed due to asbestos contamination. Upon physical assessment the patient c/o pain when you percuss his flank area but denies pain on urination. A CT and ultrasound are ordered, and both reveal a mass in the renal pelvis. Case Study-RCC continues ....... What risk factors for renal cancer does this patient demonstrate? List. The diagnosis of renal cancer is made. What are the classic symptoms of this disease process? Upon further evaluation, metastatic renal carcinoma is diagnosed, and the patient is schedule for renal artery embolization. What is the rationale for this procedure? The patient develops postinfarction syndrome. What clinical manifestations does the nurse correlate to this syndrome? How are the symptoms managed? Case Study-RCC Answers - Gender, tobacco, asbestos - Classic triad = hematuria, pain, and a mass in the flank. Painless hematuria is the first symptom - Renal artery embolism is performed to impede blood flow to the tumor. **Stimulates immune response **May also reduce the number of tumor cells entering the venous system during surgery - Clinical manifestations include pain localized to the flank and abdomen, elevated temp, GI symptoms **Treat pain with parenteral analgesics; acetaminophen for fever; antiemetics, restricted oral intake and IV fluids for GI symptoms

Answer 37

Nephrouterectomy: This surgical procedure involves the removal of the kidney, along with the adrenal gland and surrounding lymph nodes. It may be necessary for certain types of kidney cancer or other conditions that have spread to nearby tissues. Nephrectomy: This is a surgical procedure that involves the removal of all or part of the kidney. It may be necessary for kidney cancer, severe kidney damage or infection, or other conditions that affect the kidney's function. Open surgery: This is a traditional surgical approach that involves making a large incision in the abdomen or side to access the kidney. It provides the surgeon with a clear view of the kidney and surrounding tissues, but may result in a longer recovery time and more visible scarring. Laparoscopic surgery: This is a minimally invasive surgical approach that involves making several small incisions in the abdomen and using a laparoscope (a thin, flexible tube with a camera) to visualize the kidney and surrounding tissues. It may result in less pain, a faster recovery time, and less visible scarring compared to open surgery. Robotic-assisted surgery: This is a type of laparoscopic surgery that uses a robotic system, such as the da Vinci Surgical System, to assist the surgeon with precise movements and improved visualization. The system consists of a console that the surgeon uses to control the robotic arms, which hold the surgical instruments and laparoscope. This approach may result in even greater precision and better outcomes compared to traditional laparoscopic surgery. The da Vinci Surgical System is a robotic-assisted surgical system that has been approved by the FDA for urological surgeries, including renal surgery. It allows the surgeon to perform complex procedures with greater precision and control, while also minimizing trauma to surrounding tissues. It may also result in less pain, a faster recovery time, and less visible scarring compared to open surgery. However, it's important to note that not all patients may be candidates for this approach, and treatment decisions should be made in consultation with a healthcare professional.

Answer 38

Glomerulonephritis is an inflammatory reaction that occurs in the glomeruli, the small blood vessels in the kidneys that filter waste from the blood. The main cause of glomerulonephritis is a streptococcus infection. There are different types of glomerulonephritis, and one of the most common is IgA nephropathy, also known as Berger's disease. (In IgAN, the immune system produces an excess amount of a protein called immunoglobulin A (IgA), which deposits in the glomeruli and triggers an inflammatory response. ) The signs and symptoms of glomerulonephritis may include a sore throat, malaise, headache, increased levels of blood urea nitrogen (BUN) and creatinine, fluid volume excess, flank pain, increased blood pressure, facial edema, decreased urine output, increased urine specific gravity, and anemia. Proteinuria, red blood cell casts, and hematuria may also be present. Treatment of glomerulonephritis may involve getting rid of the streptococcus infection, if present, through antibiotics or other medications. Dialysis may be necessary in severe cases to remove excess fluid and waste from the blood. A diet that is low in sodium and high in carbohydrates may be recommended, along with bed rest, monitoring of fluid intake and output, and daily weights. Patients should also be taught to recognize the signs and symptoms of renal failure, such as fatigue, confusion, nausea, and shortness of breath.

Answer 39

Nephrotic syndrome is a condition characterized by an increased permeability of the glomerular filtration barrier, leading to the loss of large amounts of protein in the urine. The exact cause of nephrotic syndrome is not fully understood, but it is thought to be related to an inflammatory response in the glomerulus. The signs and symptoms of nephrotic syndrome may include anasarca (generalized edema), hypoalbuminemia (low levels of albumin in the blood), and proteinuria (high levels of protein in the urine). Treatment of nephrotic syndrome may involve bed rest to reduce fluid accumulation, diuretics to reduce edema, and prednisone to reduce inflammation. A diet that is low in sodium and high in protein may also be recommended. Dialysis may be necessary in severe cases to remove excess fluid and waste from the blood. It's important to note that while a low-protein diet is often recommended for kidney problems, in the case of nephrotic syndrome, a high-protein diet may actually be beneficial to help replace lost proteins. However, dietary changes should be made in consultation with a healthcare professional.

Answer 40

Chronic kidney disease (CKD) can cause a variety of changes in the urine that can be detected on a urinalysis. Some of the common findings on a urinalysis in CKD include: Proteinuria: As I mentioned earlier, damage to the glomeruli in the kidneys can cause proteins to leak into the urine. Proteinuria is a common finding in CKD and is typically detected on a urinalysis. Hematuria: Hematuria, or the presence of blood in the urine, can also be a sign of kidney damage in CKD. The presence of red blood cells in the urine can indicate damage to the kidneys or other parts of the urinary tract. White blood cells: The presence of white blood cells in the urine can indicate inflammation or infection in the urinary tract, which can be a complication of CKD. Glucose: In some cases, CKD can lead to impaired glucose metabolism, which can cause glucose to be excreted in the urine. This can be detected on a urinalysis. Casts: Casts are tiny structures that can be seen under a microscope in the urine. They are made up of various substances, including proteins and white blood cells, and can be a sign of kidney damage in CKD. In summary, a urinalysis that shows proteinuria, hematuria, white blood cells, glucose, and casts can be suggestive of kidney damage or dysfunction, which may be caused by CKD. However, it is important to note that these findings can also be caused by other conditions, so further testing and evaluation may be needed to confirm a diagnosis of CKD.

Answer 41

pH: 7.35 to 7.45 - This is the normal range for arterial blood pH, which reflects the acid-base balance in the body. P-------CO2 (carbon dioxide): 35 to 45 mmHg - This is the normal range for the partial pressure of carbon dioxide in arterial blood, which reflects the respiratory function of the body. (((((((((((((((((((((((((((((((P---------O2 (oxygen): 75 to 100 mmHg - This is the normal range for the partial pressure of oxygen in arterial blood, which reflects the oxygenation status of the body.))))))))))))))))))))))))))))))))))))) When we do ABG we don't look at this one that much if not at all HCO3: 22 to 26 mEq/L - This is the normal range for the bicarbonate level in arterial blood, which reflects the metabolic function of the body. It's important to note that the normal ranges for ABG values may vary slightly depending on the laboratory and the reference values used.

Answer 42

Shock, on the other hand, is a medical emergency that occurs when there is an inadequate delivery of oxygen and nutrients to the body's tissues and organs. Shock can be caused by a variety of factors, including severe bleeding, trauma, heart failure, sepsis, and anaphylaxis.

Answer 43

Urinary casts are cylindrical structures that are formed in the renal tubules and are composed of various materials, including proteins, cellular debris, and sometimes cells such as red or white blood cells, or renal epithelial cells. Some types of casts, such as granular casts, may be composed of debris from damaged renal tubules, while others, such as white blood cell casts, may be formed by the aggregation of white blood cells that have migrated into the renal tubules due to inflammation or infection. Therefore, the composition of casts may vary depending on the underlying cause and the stage of the kidney disease.

Answer 44

Yes, calcium channel blockers are commonly used to reduce blood pressure. They work by blocking the entry of calcium into the smooth muscle cells of the heart and blood vessels, which causes relaxation of the muscles and dilation of the blood vessels. This reduces the resistance to blood flow and lowers blood pressure. Calcium channel blockers can be used alone or in combination with other medications to treat high blood pressure.

Answer 45

BUN stands for blood urea nitrogen, which is a waste product generated by the liver during protein metabolism. It is eliminated from the body through the kidneys in the form of urine. Dehydration can cause an increase in BUN levels because when the body is dehydrated, the kidneys try to conserve water by reducing urine output. As a result, there is a decrease in the amount of water available to get rid of. This leads to an increase in the concentration of BUN in the blood.

Answer 46

Steroid use can cause an increase in BUN levels due to its effects on protein metabolism and kidney function. Steroids are known to increase protein breakdown and decrease protein synthesis, which can lead to an increase in the amount of nitrogen waste products, including BUN, produced in the body

Answer 47

BUN (blood urea nitrogen) levels can be elevated with a GI (gastrointestinal) bleed due to several reasons. When there is a GI bleed, blood is lost from the body, and the body responds by conserving water to maintain blood pressure and volume. This results in reduced blood flow to the kidneys, and as a result, the kidneys have a reduced ability to filter and excrete nitrogen waste products, including urea. As a result, the concentration of urea in the blood increases, leading to an increase in BUN levels.

Answer 48

Certain medications can increase creatinine levels by affecting kidney function or altering the way creatinine is produced or excreted in the body. Here are some examples: Cimetidine: Cimetidine is a medication used to treat acid reflux and ulcers. It can interfere with creatinine excretion by inhibiting an enzyme in the kidneys responsible for its elimination. Trimethoprim-sulfamethoxazole (Bactrim): Bactrim is an antibiotic commonly used to treat bacterial infections. It can cause an increase in creatinine levels by inhibiting the secretion of creatinine in the kidneys. Corticosteroids: Corticosteroids are anti-inflammatory medications used to treat a variety of conditions, such as asthma, rheumatoid arthritis, and inflammatory bowel disease. They can increase creatinine levels by reducing renal blood flow and decreasing glomerular filtration rate (GFR), which is the rate at which the kidneys filter waste products, including creatinine. Vitamin D metabolites: Vitamin D is important for bone health and immune function. However, excessive use of vitamin D supplements can increase creatinine levels by increasing muscle breakdown. Salicylates: Salicylates are medications used to relieve pain and reduce inflammation. They can increase creatinine levels by interfering with kidney function. Phenacemide: Phenacemide is an anticonvulsant medication that can increase creatinine levels by inhibiting the elimination of creatinine in the kidneys. Pyrimethamine: Pyrimethamine is an antiparasitic medication used to treat certain types of infections, such as malaria. It can increase creatinine levels by affecting kidney function and reducing the rate at which the kidneys filter waste products.

Answer 49

Yes, you are correct. An increased BUN (blood urea nitrogen) to creatinine ratio, such as a ratio above 20:1, can be an indication of a fluid volume deficit or hypoperfusion of the kidneys, meaning that the kidneys are not receiving enough blood flow to function properly. In cases of dehydration or decreased blood flow to the kidneys, the kidneys will attempt to conserve water and increase the reabsorption of sodium, leading to an increased concentration of urea in the blood and a higher BUN/Cr ratio. On the other hand, a decreased BUN/Cr ratio, such as a ratio below 10:1, may indicate fluid volume excess or malnutrition. This is because the intake of excessive fluids or a high-protein diet can lead to an increase in creatinine production and a decrease in the concentration of urea in the blood, resulting in a lower BUN/Cr ratio. Malnutrition, liver disease, and other conditions that reduce the production of urea in the body can also result in a decreased BUN/Cr ratio.

Answer 50

Kidney disease is divided into 5 stages, based on filtration

Answer 51

Acute tubular necrosis (ATN)

Answer 52

is edema a type of third spacing ? Yes, edema can be considered a type of third spacing. Edema is the abnormal accumulation of fluid in the interstitial space,

Answer 53

how does esrd cause constipation ? ESRD, or end-stage renal disease, can cause constipation in a few different ways: Decreased fluid intake: Patients with ESRD may have restrictions on their fluid intake, which can lead to dehydration and constipation. Medications: Patients with ESRD may be taking medications, such as phosphate binders or iron supplements, that can cause constipation as a side effect. Electrolyte imbalances: Patients with ESRD may have imbalances in their electrolyte levels, particularly high levels of potassium or magnesium, which can contribute to constipation. Neuropathy: Patients with ESRD may develop neuropathy, or nerve damage, which can affect the nerves that control bowel function and lead to constipation. Changes in gut microbiota: Patients with ESRD may experience changes in their gut microbiota, which can alter the balance of beneficial bacteria in the gut and contribute to constipation.

Answer 54

pH ranges from 4.5 to 8.0.

Answer 55

Classic triad = hematuria, pain, and a mass in the flank. Painless hematuria is the first symptom

Answer 56

Cimetidine is a medication used to treat acid reflux and ulcers. It can interfere with creatinine excretion by inhibiting an enzyme in the kidneys responsible for its elimination.

Answer 57

Bactrim is an antibiotic commonly used to treat bacterial infections. It can cause an increase in creatinine levels by inhibiting the secretion of creatinine in the kidneys.

Answer 58

Corticosteroids are anti-inflammatory medications used to treat a variety of conditions, such as asthma, rheumatoid arthritis, and inflammatory bowel disease. They can increase creatinine levels by reducing renal blood flow and decreasing glomerular filtration rate (GFR), which is the rate at which the kidneys filter waste products, including creatinine.

Answer 59

Vitamin D is important for bone health and immune function. However, excessive use of vitamin D supplements can increase creatinine levels by increasing muscle breakdown.

Answer 60

smooth muscle surrounding blood vessels causing vasodilatation.

Acute kidney injury etc... Flashcards

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