what is this?
excess of urea and nitrogenous compounds in the blood
due to breakdown of proteins
metabolism of carbohydrates and fats yields water and CO2
if symptoms are present use the term uremia
3 test you should consider ordering for renal failure
you can see obstructions and size very well!! so this is good!
no risky dye contrast dye
2. plain Xray
probally better but risk of dye and raising creatinine
what are 6 complications of acute renal faillure?
1. volume overload
decreased sodium and water excretion
resultant weight gain, heart failure, and edema
paresthesias, cramps, seizures, confusion
4. hyperkalemia (increases), phosphatemia (increases), magnesemia
5. metabolic acidosis
what are the 5 tx of acute renal failure?
(avoid nephrotoxins, diabetes control etc)
2. reverse poisons
(ETOH, bicarbonate in acidosis)
3. restore fluid volume and electrolyte balance
(saline/crystalloids, colloids, blood)
4. dialysis when needed
(acute if responsive or dialyzable toxin or CRF)
5. relieve obstruction
(easiest way to fix ARF)
how long does it take acute renal failure to come on?
are there symptoms?
hours to days
typically little symptoms found randomly on lab tests
what are the 3 classifications of acute renal failure?
what one is most common?
1. prerenal renal failure (renal hypoprofusion) 55%
2. renal/parenchyma/intrinsic 45%
3. post renal (obstructive) 5%
pre renal azotemia (failure) most common
acute renal failure
what are the two things that cause this the most often?
damage to kidney?
3 things that cause the first?
4 things that cause the second
due to renal hypoprofusion and Hypovolemia
usually reversible if restoring renal blood flow (RBF)
parenchyma usually not damaged
in severe cases, ischemia/injury
a. fluid loss
b. decreased cardiac output
c. decreased systemic vasculature
-epi relase and vasoconstriction
-arginine vasopressin rlease
2. renal hypoprofusion
a. vasoconstriction from epi
b. cycloxygenase inhibitors
c. hyperviscosity syndrome
d. hepatorenal syndome
acute kidney failure
hepatorenal syndrome causing hypoprofusion of kidneys
what is this?
what does it do?
cirrhosis leads to intrarenal vasoconstriction
acute renal failure
2 tests and 1 result
low urine output
hyaline/bland casts due to concentrated urine
acute renal failure:
intrinsic renal failure
what are the two main categories of this?
2 in fist
6 im second
WHAT ONE IS THE MOST COMMON CAUSE OF intrinsic renal disease?
1. renovascular cause
a. obstructed renal artery (atherosclerosis/thrombus)
b. renal vein obstruction
2. glomerular/microvascular disease
c. acute tubular necrosis *MOST COMMON CAUSE OF INTRINSIC RENAL FAILURE*
e. intersitial nephritis
what are 6 nephrotoxins that can cause acute intrinsic renal failure?
1. radioconstrast dye
5. solvents (ETOH)
6. endogenous nephrotoxin (things in the body taht can be toxic if too much is present, rhabdomylosis, hemolysis, UA etc.
Acute intrinsic renal failure
what does this cause?
how long after exposure?
what are the 4 features?
how can you prevent this?
intrarenal vasoconstriction resulting in acute tubular necrosis (ATN)
24-48 hours after contrast exposure
1. decrease eGFR
4. elevation of BUN
HOW TO AVOID:
use NON IONIC contrast, more expensive
resolves 1-2 weeks
what are 7 RF for having a negative rxn to contrast dye and having it cause acute intrinsic renal failure?
age over 80
acutre intrinsic renal failure
1. are there symptoms?
3. what might you see on labs (5)
often no sxs
azotemia on lab tests
1. muddy brown casts (ischemia/nephroxic)
2. red cell cats (nephritis/acute glomerular)
3. eosinophilic cats (allergic nephritis)
4. white cell casts (interstitial nephritis)
what are the 4 signs of nephritic syndrome?
4. urine sediment
acute postrenal kidney failure
what is this?
what are 6 things that can cause it?
urinary outflow obstruction
single kidney or urethral obstruction leading to anuria
1. prostate disease
2. neurogenic bladder (spinal cord injuries)
3. blood clots
5. tumor or other extrarenal obstruction
acute postrenal failure
what are 4 signs of this?
what are the 2 tx options?
1. bladder distension
2. abdominal pain-colic
3. renal distension (check with US)
4. hx of RF (prostate disease, stones etc)
fix the plumbing!
2. nephrostomy tube or suprapubic catherer
what might dopamine promote?
water and sodium excretion
what are 5 conditions that might warrent dialysis?
5. toxins (multiple, digoxin)
end stage chronic renal failure
characterized by what 3 things?
3. 3 month of disease and eGFR less than 60/ml
what are the stages and values for eGFR of CKD?
currently what are the two most common causes of end stage CKD/uremia?
what is this?
syndrome of anemia, malnuitrition, and metabolic problem
what are 5 sxs of end stage CKD?
anorexia (weight loss/loss of appetite)
what are 3 metabolic effects you see with chronic kidney disease?
1. hypothermia: decreased Na transport; source of energy/head
2. impaired carbohydrate metabolism: “pseudodiabetes”, slower handling of glucose load to insulin resistance
3. increased triglycerides
when does decreased K excretion occur? what does this leave the chronic kidney disease patient at risk for?
typically occurs if GFR less than 10 cc/min
at risk for hyperkalemia
why does CKD cause calcium disorders?
what is the nickname for this? what two things contribute to fracture risk? explain the process?
osteomalacia and osteitis fibrosa cystica due to hyperthyroidism increase fracture risk
1. decreased conversion of vitamin D to 1,25 dihydroxy (activated) vitamin D
2. decreased calcium in serum since less active vitamin D to absorb it
3. increase in PTH in response to low Ca
4. results in weakness of bones because it sucks the the Ca out
seen in CKD
why is this increased?
what is the domino effect of increase phosphorus?
what are 3 tx options?
decreased phosphorus excretion in CKD so it accumulates in the blood
Domino effect of bad things:
1. causes low calcium
2. increase in PTH
3. bone reabsorption
4. weak bones/fractures
1. decrease serum phosphate
-diet restriction of proteins, dairy, colas
what is the most common complication of end stage renal disease?
what are 7 random other things you can see with CKDs?
1. pericarditis (toxin induced)
3. metabolic acidosis
6. platelet dysfunction
anemia in CKD
what are 5 causes of this?
what helped to sove this problem?
decreased need for?
1. bone marrow toxins
2. decreased eryhtropoetin
5. decreased RBC
**this used to be aa HUGE problem in CKD patients, but now with ERYTHROPOETIN we can fight it!! REVOLUTION!** and helps to limit the need for transfusion
explain what sxs you would see in CKD for:
*don't memorize just read it*
periphreal neuropathy/restless leg syndrome
uremic fetor/ bad breath
when is transplant or dialysis appropriate?
where can you get it from?
creatinine greater than 8
creatinine clearance less than 10
what are the three ways you can accomplish this?
what alows you to accomplish this?
what are the 2 requirements?
what are 2 things you must monitor?
1. requires a shunt that connects artery and vein, "must ripen", allow for diffusion across semipermeable membrane
2. artificial options
3. IV cathertic into IJ
300-450 ml/min blood flow
9-12 hour commitment a week
urea pre and post dialysis
what is this process?
what are 3 advantges?
catheter- can use immediately, goes in the stomach, put catheter in the belly dump fluid in there with certain osmolarity and you keep doing it over and over again and it comes out, makes you less likely to be able to receive a kidney
push fluid for 4-6 hours
can do at night, cyclic
1. no heparin
3. no vascular acess
what are 3 disadvantes of periotoneal dialysis?
1. DONT USE IN LUNG DISEASE
2. PERITONITIS major risk( may be so risky that they can be disqualified from recieving a kidney transplant)
3. need to be trained