Class 4 chapter 26

Question 1

When kidneys fail

Answer 1

1. Poor filtration of blood
Waste buildup
Electrolyte imbalances
Acid/base imbalances
2. Blood volume/BP changes
3. Decreased activation of vitamin D
4. Decreased erythropoietin (hormone secreted by the kidneys that increases rate of production of RBCs in response to falling levels of O2 in the tissues)

Question 2

Prerenal Failure

Answer 2

Due to decreased blood flow to kidney
Hypovolemia
HF, cardiogenic shock
Sepsis
Medications, toxins
Reversible if caught early

Question 3

Prerenal Failure manifestations

Answer 3

Marked decrease in urinary output
Elevation of BUN in proportion to creatinine to 20:1 (normal is 10:1) - BUN not excreted enough
Azotemia (Abnormally high levels of nitrogen containing compounds - most common indicator of ARF)

Question 4

Intrinsic Renal Failure

Answer 4

1. Disorder within kidney structure
Prolonged ischemia
Injury to tubular structures
Intratubular obstruction
Infection
Nephrotoxic agents

Question 5

Radiocontrast Agents

Answer 5

Giving N-acetylcysteine reduces ARF risk by 50%

Question 6

Acute Tubular Necrosis – 3 phases

Answer 6

Destruction of tubular epithelial cells
D/t sepsis, nephrotoxins, medication, obstruction, infection
Coagulation process and rbc lysis = crystals, toxins
Results in hypoxia and ischemia
Often reversible!

1. Onset phase
Hours to days
2. Maintenance phase
Marked decreased GFR and urinary output
Edema, pulmonary congestion, htn
Retention of urea/K/sulfate/creatinine
CNS symptoms d/t toxin build up 
3. Recovery phase
Gradual increased output

Question 7

Postrenal Failure

Answer 7

Obstruction of urine output
Ureter (calculi, strictures)
Bladder (tumours, neurogenic bladder)
Urethra (BPH - common)

Question 8

Treatment of all types of Renal Failure

Answer 8

Prevention!
Early diagnosis!

Fluids – be careful!
Electrolytes
Calories
Dialysis
Continuous renal replacement therapy

Question 9

Chronic kidney disease

Answer 9

Stage 1 - kidney damage, decreased GFR
to
Stage 5 - kidney failure, minimal GFR

Question 10

Chemical changes in renal failure

Answer 10

Increased - K, Cl, H, Mg, NH, PO, PTH

Decreased - EPO, vitamin D, calcium

Question 11

Clinical Manifestations of Chronic Kidney Disease

Answer 11

1. Altered fluid and electrolytes
Dehydration or fluid overload
Sodium/salt wasting (late stage)
Hyperkalemia (release d/t trauma, acidosis
2. Altered acid-base balance
H ion buildup 
3. Vitamin D deficiency
4. Bone disease
Decreased calcium absorption (d/t vitamin D deficiency), increases PTH, breaking down bone
5. Anemia (common and early sign)
D/t chronic blood loss, hemolysis, impaired erythropoietin, iron deficiency
6. CV complications
Htn (increased PVR, increased RAAS)
7. Accumulation of nitrogenous wastes
Azotemia – elevated BUN (early sign)
Uremia (urine in blood)
8. Impaired drug elimination 
9. Integument (d/t platelet dysfunction)
Platelet dysfunction = bruising, pruritus

Question 12

Cardiovascular Consequences of RF

Answer 12

Decreased blood viscosity
Increased blood pressure
Decreased oxygen supply

Question 13

Management of Chronic Kidney Disease

Answer 13

1. Dialysis
Hemodialysis
Peritoneal dialysis
2. Dietary management
3. Transplantation

Question 14

Hemodialysis

Answer 14

Allows all molecules (except for blood cells and plasma proteins) to move from blood to dyalysate and back
2-4 x/week for 3-4 hours

Question 15

Hemodialysis side effects

Answer 15

Hypotension, chest pain (weight gain common between treatments)
NV
Restless leg syndrome, cramps
Dialysis disequilibrium syndrome (DDS)

Question 16

Peritoneal Dialysis

Answer 16

Temporary way to regulate electrolytes and fluids

Slow exchange process