Renal Disorders Flashcards by Erin Nolan

T or F: Kidney disease have super obvious symptoms.

FALSE

can have compromised functioning but no symptoms

down to a GFR of 30 before we start to see real changes, up to 90% affected

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Type of things that don’t normally get through the glomerulus

proteins

large RBCs

glucose

–> bad if in urine

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Functional unit of the kidney

nephron

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Glomerulus

selective filtration water & solutes from blood

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Bowman’s capsule

also filtration

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Proximal tubule

reabsorbs about 80% of water, solutes back to blood

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Loop of Henle

where loop diuretics work

e.g. furosemide

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Distal Tubule

changed to be permeable or impermeable so we can have final concentration

bicarb, acid

e.g. dehydration - anterior pituitary secretes ADH to work on tubules, more permeable so water can be reabsorbed back into circulatory system

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Collecting duct

all comes together and is excreted out

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Afferent arterioles

a SINGLE afferent arteriole supplies blood to each glomerulus

dilation of afferent arteriole allows a great volume to go IN

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Efferent arterioles

blood exits the glomerulus by the efferent arteriole

constriction of efferent=increased pressure

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Urine formation processes (3)

1) glomerular filtration

2) tubular reabsorption

3) tubular secretion

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Functions of the kidneys (6)

1) elimination of metabolic wastes

2) BP regulation
-angiotensin I
-angiotensin II - constriction, to raise BP
-cortex - aldosterone - fluid retention

3) erythrocyte production
-can see anemia in patients with kidney disease

4) Vitamin D activation

5) prostaglandin synthesis
-for the RAAS

6) acid–base balance

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A person with respiratory distress will have a(n) _______ blood pH

acidic

respiratory acidosis

CO2

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Supplements that patients with kidney disease should be on

Vitamin D - calcitriol (active form)

calcium

iron

folic acid (RBC maturation)

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Labs for kidney disease

often identified through labs due to the lack of symptoms

urea

creatinine

GFR

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What would LOW urine output indicate

dehydration

kidneys not getting well perfused

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Why would someone with kidney disease have a HIGH urine output

wrong composition

very, very dilute

or with the wrong things, like creatinine

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Chronic Kidney Disease

low GFR over 3+ months

develops slowly

1 or both:
decreased function: GFR of less than 60 mL/min
damage: urinary albumin excretion of ≥30 mg/day or equivalent

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adaptive hyperfiltration

increased perfusion/filtration to the nephrons, but overtime its maladaptive and causes damage

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Acute Kidney Injury

SUDDEN decline in renal function

develops over hours or days

increased BUN & Cr

oliguria <400ml/24 hrs

hyperkalemia & Na retention

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Major consideration when assessing patient

how stable they are

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Predisposing factors

infections requiring antibiotics

OTC meds

nephrotoxic meds

antihypertensive meds

dyes

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Concerning: weight gain of more than ___ pounds/day

2 pounds

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Signs that suggest extracellular fluid DEPLETION include [dehydration]

thirst, decreased skin turgor, and lethargy

Signs that imply intravascular fluid volume OVERLOAD include

pulmonary congestion, increasing heart failure, and rising blood pressure

Ongoing Assessments (4)

1) weight monitoring 2) intake/Output 3) neuro 4) hemodynamics

What is a better indicator of fluid retention? a) urinary output b) weight

b) weight urine tells you about what you're losing

Minimum urine output per hour

30 mL

BUN normal range

3.6 - 7.1 mmol/L elevated with decreased GFR - staying in system

Creatinine normal level - male

53 - 106 mmol/L elevated with decreased GFR

Creatinine normal level - female

44 - 97 mmol/L elevated with decreased GFR

Normal GFR

90 - 120 only good indicator with a steady state and slow decline over time

normal BUN:Creatinine ratio

10:1

Creatinine clearance

85 - 135ml/min

Urinalysis

appearance pH specific gravity osmolality protein glucose ketones electrolytes sediment (intrarenal) blood (hematuria)

Goal of interventions for acute kidney injury

perfuse the kidneys not diagnose

Diagnostic procedures (many)

ultrasounds CT x-ray bladder scan contrast dye biopsy

Considerations when giving contrast dye

lots of fluids before and after!! nephrotoxic may need to hold meds like metformin

Top causes of chronic kidney disease (3)

1) hypertension 2) DM 3) CVD

Symptoms of Chronic Kidney Disease

EVERY SYSTEM

Goals of Care of CKD

prevent and slow! slow progression manage co-morbidities like DM and HF prepare patients for RRT

Meds to avoid in CKD

nephrotoxic NSAIDs contrast dye

CKD Urinary System Progression

1) Polyuria -early -2.5-3 L/24 hours 2) Oliguria -late < 400ml/24 hours 3) Anuria -late <40 mL per 24

Type of respiration in patient with CKD

Kussmaul respiration deep and labored acidotic - trying to blow off excess CO2

Med for fluid overload

furosemide GFR >30 mL: 80 mg bad: 200 - 500 mg

What to give for metabolic acidosis

bicarb decreased protein intake increased fruit intake (EXCEPT if high in vitamin K)

With CKD, are you more likely to see: a) hypokalemia b) hyperkalemia

b) hyperkalemia

When to give pharmacological interventions for hyperkalemia

> 5.5

Pharmacological interventions

glucose calcium gluconate cation exchangers – ex Kayexalate diuretics

Side effect of Erythropoietin (Epogen, Darbepoetin)

hypertension

uremic state symptoms

anorexia N/V pericarditis peripheral neuropathy CNS abnormalities (seizures, coma, death)

Treatment for uremic state

RTT dialysis or transplant

CKD nursing care

systems assessment maintaining skin integrity monitoring excess fluid overload daily weights risk for infection monitoring nutrition risk for constipation risk for injury balancing activity and rest patient teaching anticipatory grieving

What values should you look at for acute kidney injury? (2)

1) creatinine 2) urine output

Types of acute kidney injuries (3)

1) prerenal 2) intrarenal 3) postrenal

Clinical course of acute kidney injury (3)

1) initiation 2) maintenance 3) recovery

Population where you're more likely to see acute kidney injury

elderly population renal changes co-morbidities

Goals of care for AKI

treatment of underlying cause manage symptoms prevent complications

What you need to figure out for AKI care

fluid overload or depletion

Fluid depletion intervention

crystalloids - 0.9 NaCl, 0.45 NaCl colloids – albumin, pentaspan, hetastarch

Fluid overload intervention

diuretics! fluid restriction RRT

What does dialysis mimic

nephrons semi-permeable

Peritoneal dialysis

using the peritoneal cavity and lining as the semi-permeable membrane

Biggest complication from peritoneal dialysis

infection

Hemodialysis

machine is acting like the kidney

What medication is added to hemodialysis?

heparin

normal findings fistula

thrills and bruits

Palliative care goals for end stage renal disease

Symptom Management pain constipation hypervolemia N/V delirium

Renal Disorders Flashcards

(69 cards)