Renal failure

Question 1

Acute renal failure?

Answer 1

inability for the kidney to carry out its function

Question 2

what are some of the main functions of the kidney?

Answer 2

ultrafiltrations and reabsorption

Question 3

Acute?

Answer 3

arises abruptly and/or for a short duration

Question 4

Briefly summarize renal failure.

Answer 4

loss of renal function = decrease urine output = azotemia and fluid electrolyte imbalance

Question 5

Azotemia and electrolyte imbalance can have an impact on other organs of the body. Explain a few organs affected

Answer 5

• waste sent to the brain = encephalopathy

- potassium imbalance = impacts the heart

Question 6

is acute renal failure and chronic renal failure reversible?

Answer 6

Acute renal failure is reversible, chronic is not.

Question 7

What does GFR require in order to be measured?

Answer 7

urine volume + creatinine in blood and creatinine in urine

Question 8

Oliguria?

Answer 8

100-400 mL of urine output per day

Question 9

Anuria?

Answer 9

Less than 100 mL of urine output per day

Question 10

Etiology of ARF?

Answer 10

• prerenal
• infrarenal
• poystrenal

Question 11

Prerenal?

Answer 11

ischemic/circulatory problem preventing proper perfusion to the kidney (HypoTN or hypovolemia)

Question 12

Intrarenal?

Answer 12

problem with the kidney eg. glomerular nephritis

Question 13

Postrenal?

Answer 13

preventing obstruction of urine flow out of the kidney (eg. BPH)

Question 14

Explain the patho regarding prerenal

Answer 14

Eg. hemorrhage -> lose blood volume = inadequate perfusion to glomerulus -> ischemia and ischemic damage -> decreased filtration

Question 15

examples of intrarenal

Answer 15

eg. acute tubular necrosis (ATN) -> nephrotoxic drugs, intratubular obstruction (takes days or weeks to happen).

Question 16

What are the 3 phases that occur in intrarenal?

Answer 16

1. initiating phase
2. maintenance phase
3. recovery phase

Question 17

Initiating phase?

Answer 17

(hours-days) Lasts from trauma event to the time that manifestations become apparent

Question 18

Maintenance phase?

Answer 18

refers to maintaining the problem, not maintaining the kidney function. Decrease GFR, oliguria, azotemia, fluid retention (HTN, EDEMA, PULMONARY CONGESTION)

Question 19

Recovery phase?

Answer 19

offending event that has been addressed (gradual increase in GFR as tissue is repaired)

Question 20

How can BPH cause ARF?

Answer 20

BPH -> hydronephrosis -> ARF

Question 21

Manifestations?

Answer 21

• oliguria or anuria
• fluid-electrolyte imbalance
• azotemia
• proteinuria, hematuria

Question 22

Complications?

Answer 22

HTN, EDEMA, PULMONARY CONGESTION

Question 23

Diagnostics?

Answer 23

• renal function tests : BUN, Creatinine, GFR
• RIFLE
• new early biomarkers (eg. interleukin-18)

Question 24

RIFLE?

Answer 24

Risk, injury, failure, loss, end stage renal failure

• risk = risk of running into renal failure
• injury = actual damage in the kidney
• failure = some kind of renal failure has begun
• loss = loss of renal function (mnfts apparent)
• E = ESRD -> kidney shuts off and the pt will die

Question 25

What is interleukin 18?

Answer 25

a mediator produced together with inflammation in the proximal tubule when there is ischemic damage

Question 26

Which area of the kidney is usually the first to be affected during renal failure?

Answer 26

Proximal tubule

Question 27

Treatment?

Answer 27

- reversible but not self-limiting - STAT intervention - Cautious fluid and electrolyte replacement - Diet -> careful protein ingestion - dialysis (hemo/peritoneal/intermittent dialysis/CRRT)

Question 28

Why is a protein restricted diet suggestion?

Answer 28

protein is broken into ammonia, which is a nitrogenous waste so limiting protein ingestion will help to avoid or decrease azotemia.

Question 29

Hemodialysis?

Answer 29

blood is filtered externally from he body through a dialyser which acts as an artificial artery

Question 30

Peritoneal dialysis?

Answer 30

dialysate introduced into the peritoneum which acts as a semi-permeable membrane which wastes are filtered through

Question 31

CRRT?

Answer 31

continuous renal replacement therapy

Question 32

Chronic RF?

Answer 32

progressive, permanent damage

Question 33

List the stages of chronic renal disease.

Answer 33

1. Diminished renal reserve stage 2. Renal insufficiency 3. renal failure

Question 34

Diminished renal reserve stage?

Answer 34

GFR is less than 50% of normal. GFR is about 60 mL/min which is still adequate for filtration. No signs of decreased renal function.

Question 35

Does the kidney have a large functional reserve?

Answer 35

YES

Question 36

Renal insufficiency?

Answer 36

GFR is 20-50% of normal (inadequate filtration)

Question 37

Renal failure?

Answer 37

GFR is less than 20%. The kidney will shut down once the GFR is <5%