Regulatory disorders of kidneys

Question 1

Main causes for chronic kidney disease

Answer 1

Diabetes, 
hypertension, 
glomerulonephritis, 
pyelonephritis, 
polycystic or congenital disorders, 
renal cancer

More than 20% of the US population age 20 years and older have hypertension with chronic kidney disease.

Question 2

Glomerular filtration rate GFR

Answer 2

Amount of plasma filtered through the glomeruli per unit of time.

Question 3

Azotemia

Answer 3

Abnormal concentration of nitrogenus wastes in the blood

Question 4

Glomerulonephritis is inflammation of glomerular capillaries.
When does it occur?
And what happens to the kidneys?

Answer 4

Occurs usually after an infection:
Strep, impetigo, shingles, hep B, HIV.

Kidneys become large, damages, and congested. All renal tissues are affected

Question 5

Care for glomerulonephritis

Answer 5

Reduce protein

Daily weight

Question 6

End stage renal disease (EKSD)

Answer 6

Retention of uremic wastes and the need for renal replacement therapies, dialysis or kidney transplant.

Question 7

Symptoms of chronic glomerulonephritis

Answer 7

Maybe no symptoms for many years.
Hypertension,
elevated BUN and serum creatinine levels. Decreased weight and strength,
irritability
nocturia, headaches, dizziness and digestive disturbances

Question 8

Symptoms of chronic kidney disease

Answer 8

Poorly nourished appearance, peripheral Edema, hypertension, abnormal retinal findings,
anemia,
enlarged heart and other symptoms of heart failure and fluid overload
Mental status changes

Question 9

Diagnostic findings of chronic kidney disease as renal failure progresses and GFR falls below 50

Answer 9

Proteinurea, 
urinary casts (which is proteins secreted by damaged kidney tubules)

Hyperkalemia and acidosis due to decreased potassium and acid secretion and inability to regenerate bicarbonate

Anemia- decreased RBC production.
Hypoalbuminemia,
increased phosphorus and decreased calcium

Impaired nerve conduction/ abnormal ekg due to electrolyte abnormalities

Question 10

What is nephrotic syndrome?

Answer 10

Type of renal failure Characterized by increased glomerular permeability and is manifested by massive proteinuria.

Liver is still increasing production of albumin but it cannot keep up with the daily loss of albumin through the kidneys.

Question 11

What are clinical manifestations and symptoms of nephrotic syndrome?

Answer 11

Protein in urine particularly albumin,
decrease of albumin in the blood,
hyperlipidemia.

Pitting edema in dependent areas such as sacrum, ankles, hands and periorbital Edema,

ascites,
irritability, headache and malaise

(Main answer would probably be edema and albumin in urine)

Question 12

What are some complications of nephrotic syndrome?

Answer 12

Infections due to deficient immune response,
thromboembolism especially of the renal vein,
pulmonary embolism,
AKI do to hypovolemia,
atherosclerosis due to hyperlipidemia

Question 13

Treatment of nephrotic syndrome

Answer 13

Slowing progression of CKD,

diuretic for Edema,

ace inhibitors to reduce proteinuria,

lipid lowering agent for hyperlipidemia

Question 14

What is polycystic kidney disease PKD?

Answer 14

Genetic disorder characterized by growth of numerous cysts in the kidneys.
Cysts are filled with fluid and destroy the nephrons.
Can profoundly enlarge kidneys and result in reduced kidney function and lead to kidney failure.

Question 15

What are the signs and symptoms of PKD polycystic kidney disease?

Answer 15

Loss of renal function, 
hematuria, 
polyuria, 
hypertension, 
renal calculi, 
UTIs 
proteinuria. 

Also abdominal of fullness and flank pain

Question 16

Treatment of polycystic kidney disease

Answer 16

No cure
includes blood pressure control, pain control and antibiotics to resolve infections.
Renal replacement therapy is indicated once the kidneys fail.

Question 17

What are three types of acute kidney injury?

Answer 17

Prerenal- hypoperfusion of kidney

Intrarenal- damage to kidney tissue

Postrenal- obstruction to urine flow

Question 18

Causes of prerenal AKI

Answer 18

Pre-renal is approximately 60 to 70% of cases.
Result of impaired blood flow caused by:
Volume depletion such as burns, hemorrhage, G.I. losses,
hypotension
sepsis,
shock,
renal artery stenosis

Question 19

Causes of intrarenal AKI

Answer 19

Damage to glomeruli or kidney tubules,

acute tubular necrosis,

Question 20

Causes of postrenal AKI

Answer 20

Obstruction distal to the kidney by renal calculi, 
structures, 
blood clots, 
BPH, 
malignancies and 
pregnancy

Question 21

What are the four phases of acute kidney injury? With brief descriptions.

Answer 21

Initiation: begins with initial insult and ends when oliguria develops

Oliguria.: Increase in serum concentration urine. Life-threatening conditions such as hyperkalemia develop.

Diuresis: gradual increase In urine output, urine output may reach normal or elevated levels but renal function may still be abnormal.

Recovery: improvement of renal function may take 3 to 12 months

Question 22

Azotemia

Answer 22

Nitrogen in blood

Characterized by abnormally high levels of nitrogen containing compounds such as urea, creatinine, various body waste compounds in the blood

Question 23

Most immediate life-threatening imbalance seen in acute kidney injury

Answer 23

Hyperkalemia

Ensure the patient is not taking an extra potassium through food, parenteral fluids, or medications.

Question 24

neurological Symptoms of End stage kidney disease or chronic renal failure

Answer 24

Weakness and fatigue, 
confusion, disorientation, 
tremors, 
seizures, 
restless legs, 
peripheral neuropathy with severe pain and burning on soles of feet

Question 25

What is the predominant cause of death in ESKD?

Answer 25

Cardiovascular disease

Question 26

Integumentary symptoms of end-stage kidney disease

Answer 26

Gray bronze skin color, 
dry flaky skin, 
pruritus, 
Ecchymosis, 
purpura, 
Thin brittle nails, 
course thin hair

Question 27

Cardiovascular symptoms of end-stage kidney disease

Answer 27

Hypertension, 
pitting edema, periorbital Edema, pericardial friction rub, 
engorged neck veins 
hyperkalemia 
hyperlipidemia

Question 28

Pulmonary symptoms of end-stage kidney disease

Answer 28

Crackles, 
thick tenacious sputum, depressed cough reflex, 
pleuritic pain, 
shortness of breath, 
tachypnea, 
Kussmaul respirations

Question 29

Gastrointestinal symptoms of end-stage kidney disease

Answer 29

Ammonia odor to breath “uremic fetor”
Metallic taste, 
mouth ulcerations and bleeding, 
anorexia nausea vomiting, 
constipation or diarrhea, 
bleeding from G.I. tract

Question 30

Hematologic symptoms of end-stage kidney disease

Answer 30

Anemia,

thrombocytopenia

Question 31

Muscular skeletal and reproductive symptoms of end-stage kidney disease

Answer 31

Muscle cramps,
loss of muscular strength,
bone pain, bone fractures,
foot drop,

infertility, testicular atrophy,
amenorrhea

Question 32

Three types of dialysis

Answer 32

Hemodialysis: procedure that circulates the patient’s blood through an artificial kidney to remove waste products and excess fluid.

Peritoneal dialysis: procedure that uses patients peritoneal membrane as the semi permeable membrane to exchange fluid and solutes

Continuous renal replacement therapies: Circulating patient’s blood through a Hemofilter

Question 33

Common complications of dialysis

Answer 33

Episodes of shortness of breath between dialysis treatments as fluid accumulates.
Hypotension: nausea and vomiting, diaphoresis, tachycardia
Muscle cramping
Bleeding -if blood lines separate or in needles become dislodged.
Dysrhythmias, air embolism

Question 34

What dietary restrictions apply to hemodialysis patients?

Answer 34

Restriction of:
dietary protein, 
sodium, 
potassium, 
phosphorus and 
fluid intake.

Question 35

Continuous renal replacement therapies may be indicated for which type of patients?

Answer 35

Patients with acute or chronic renal failure who are too clinically unstable for traditional hemodialysis,

patients with fluid overload secondary to oliguric renal failure

patients whose kidneys cannot handle their acutely high metabolic or nutritional needs

Question 36

What are kidney stones called?

Why do they form?

Answer 36

Urolithiasis - condition that involves presence renal calculi

Causes: Parathyroid dysfunction, abnormal Uris acid metabolism,
excessive calcium intake,
Lack of fluid
Immobility

Question 36

Symptoms of renal calculi

Answer 36

Paroxysmal renal calculi— sudden, sharp, severe pain that radiates through thigh and genital area

Nausea, vomiting
Diaphoresis
Dysuria
Hematuria
Pyruria- pus in urine

Question 37

Name and describe four types of nephrolithiasis

Answer 37

• Calcium stones are the most common type of kidney stones. They are usually made of calcium and oxalate (a natural chemical found in most foods), but are sometimes made of calcium and phosphate.
• Uric acid stones form when your urine is often too acidic. Uric acid can form stones by itself or with calcium.
• Struvite stones can happen when you have certain types of urinary tract infections in which bacteria make ammonia that builds up in your urine. Struvite stones are made of magnesium, ammonium and phosphate
• Cystine stones are made of a chemical that your body makes naturally, called cystine. Cystine stones are very rare, and happen in people who have a genetic disorder that causes cystine to leak from the kidneys into the urine.

Question 38

What is the difference between urolithiasis and nephrolithiasis?

Answer 38

Urolithiasis refers to stones originating anywhere in the urinary system, including the kidneys and bladder.

Nephrolithiasis refers to the presence of such stones in the kidneys. …

The condition is called ureterolithiasis when a calculus is located in the ureter.

Question 39

What kind of fistula is used most often for hemodialysis?

Answer 39

The arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis (HD)

Question 40

How do you check patency of AV fistula?

Answer 40

Assess for patency at least every 8 hours.
Palpate the vascular access to feel for a THRILL or vibration that indicates arterial and venous blood flow and patency.

Auscultate the vascular access with a stethoscope to detect a BRUIT or “swishing” sound that indicates patency.