Final: Ch 26 Acute Renal Failure & Chronic Kidney Disease Flashcards Preview

Pathophysiology > Final: Ch 26 Acute Renal Failure & Chronic Kidney Disease > Flashcards

Flashcards in Final: Ch 26 Acute Renal Failure & Chronic Kidney Disease Deck (57):
1

acute renal failure is the rapid decline in _____ function and high ____ _______ waste levels

renal, high blood nitrogenous waste levels

common cause of ICU death

2

clinical presentation of acute renal failure

high serum BUN and creatinine

low GFR

3

filtration definition

blood to urine (glomerulus)

anything smaller than a protein

4

reabsorption definition

urine to blood

proximal/distal convoluted tubules

loop of henle

5

secretion definition

blood to urine

K+, H+

6

creatinine clearance is ~ what

the GFR

7

urine formation begins with _______

filtration

8

filtrate is modified by ______ & _______

reabsorption & secretion

9

definition of GFR

volume of fluid filtered from blood plasma to urine/min

10

creatinine is filtered at the ______; not ______ or ________

glomerulus, secreted, reabsorbed

11

the amount of creatinine filtered = the amount _______

excreted

12

calculation for amount of creatinine filtered

filtered = [creat]plasma x GFR

13

calculation for amount of creatinine excreted

excreted = [creat]urine x volume of urine

14

prerenal failure

decreased renal blood flow

15

causes of prerenal failure

hypovolemia

HF

shock

some meds (contrast dye)

16

prostaglandins dilate the ______ arteriole artery

afferent

17

NSAIDS can cause renal failure in people with...

decreased function

18

prerenal failure results from renal ______ when RBF

ischemia, 25%

19

prerenal failure levels

U/O & fractional excretion of Na are low, but SG is high

BUN more elevated than serum creat

20

at low GFR, urine flow in tubules is _______

sluggish

urea is small and high reabsorption when flow is slow

creat is larger and not reabsorbed

21

postrenal failure

obstruction in ureter or bladder

stones, rumors, neurogenic bladder (spinal injury)

re-establish flow, surgically if necessary

22

intrinsic renal failure

damage to the kidney - glomeruli, tubules, or interstitium

causes: ischemia, toxins, tubular obstruction

23

acute tubular necrosis is the most common cause of....

intrinsic renal failure

24

acute tubular necrosis (ATN)

destruction of tubular epithelium

caused by ischemia, sepsis, toxins, tubular obstruction

may or may not be reversible

25

acute tubular necrosis is seen in...

major surgery with blood loss

massive infection

trauma

burns

26

ATN complicates the use of what

potentially nephrotoxic medications

aminoglycosides (gentamycin), chemo, contrast dyes

27

ATN hemoglobin/myoglobin, uric acid

Hb, uric acid, myoglobin in urine causes obstruction

Hb from blood rxn

myoglobin from muscle trauma, rhabdomyolosis

28

stages of ATN

onset

maintenance

recovery

29

onset stage of ATN

hours to days

happens when the initiating event is occuring

30

maintenance stage of ATN

low GFR, oliguria, edema, electrolyte imbalance

low dose dopamine may improve renal blood flow

31

recovery stage of ATN

nephrons are repairing

gradual increase in U/O

fall in serum creatinine

32

Dx, Rx of ATN

Dx: determine cause

Rx: treat symptoms/cause, hemodialysis

33

in prerenal failure the BUN:Creatinine ratio is what

fraction of excreted Na

SG

greater than 20:1

less than 1%

greater than 1.02

34

in intrarenal failure the BUN:Creatinine ratio is what

fraction of excreted Na

SG

10:1 to 20:1

greater than 1%

1.01 - 1.02

35

the ultrasound for postrenal failure shows

hydronephrosis

36

a nephrology consult involves a ________, and a urology consult involves a _______

specialist, surgeon

37

chronic kidney disease classification

GFR used to define 5 stages

stage 2: modest decline in GFR (hypovolemia)

kidney failure stage 5: very low GFR requires dialysis (permanent loss of nephrons)

38

CKD can result from conditions (3)

diabetes

HTN

glomerulonephritis

39

what is the best measure of kidney function

GFR - measure of functional nephrons

falls as # of working nephrons falls

40

constant = GFR x [creat]p so if GFR is high, then [creat]p is...

low

41

GFR can be measured by ________ clearance or calculated from....

creatinine clearance

serum creatinine

42

albuminuia is a marker for _____ injury

nephron

43

in CKD there is an accumulation of what

nitrogenous waste

BUN is high

uremia

44

CKD causes what imblances

electrolyte, cardiovascular, acid/base

reduced ability to regulate Na

sodium retention --> volume expansion --> HTN CHD HF uremia --> pericarditis

hyperkalemia

acidosis

45

calcium and phosphate imbalances in CKD

phosphate is high, calcium is low

high PTH --> osteoclast stimulation

sometimes osteoblasts/osteoclasts inhibited

decreased mineralization occurs (osteodystrophies)

46

should you restrict high phosphate foods (milk) and give vitamin D in CKD?

yes

47

can CKD cause anemia?

yes

low EPO

48

GI symptoms of CKD

N/V - urea in intestinal flora

49

neuromuscular symptoms of CKD

peripheral neuropathy

encephalopathy

50

other symptoms of CKD

poor immune response

poor skin integrity

poor drug elimination

51

slowing progression of CKD

BP target 125/65 - ACEI & ARBS

glucose control for those w/ diabetes

stop smoking

52

hemodialysis for CKD

blood exchange with dialysis fluid

excess H2O, urea, K+ leaves blood

may need to replace bicarb

53

peritoneal dialysis

uses peritoneal memb. as dialysis memb.

infuse 1-3L of soln and equilibriate for 30min

allow to run out

repeat 4x/day

advantage: can be done at home

54

transplantation for CKD

from cadaver or living donor

improved anti-rejection meds have increased success

55

dietary management of CKD

restrict protein

feed fat/carbs to insure adequate calories

restrict Na/H2O

56

Type of Acute renal failure associated w/ highly concentrated urine is...

Pre-renal failure

57

Chronic renal failure produced what acid/base abnormality the most

Metabolic acidosis