Renal Failure
Terms
undefined, object
copy deck
- What acid base imbalance often occurs with renal failure?
- Metabolic Acidosis
- Use phosphoru binding mecications to treat what?
- hyperphosphatemia
- Complications of transplantation (2)
-
1. Finding compatible donor
2. Rejection - Peritoneal Dialysis
- Watch for abnormal soln color, should be straw colored.
- How long does the soln usually dwell in peritoneal dialysis?
- 4 to 6 hours
- How often for hemodialysis?
- Every three to five days for 3-5 or more hours at a time.
- Initian Phase in ARF
-
1-2 days
reduced urine output and increased BUN - Oliguric phase (Maintance) in ARF
-
1-2 weeks
hyperkalemia and fluid volume overload - Polyguric Phase (Diuretic) in ARF
-
progressive increase in urination in pts that were olyguric
May indicate beginning of renal repair
Substantial renal loss of sodium and water
May dehydrate - Phase of Functional recovery
-
No beginning or end
Repair of renal injury
BUN, creatinine, and urine volume gradually return to normal. - 5 stages of chronic renal failure
-
1. slight damage GFR more than 90
2.Mild decrease in function GFR 60-89
3. Mod decrease in function GFR 30-59
4. Sever dEcrease in function GFR 15-29
5. kidney failure GFR less than 15 - What is the main protein found in the urine?
- albumin
- What are the filters of the kidney?
- glomeruli
- Proteinuria is caused by what?
- glomerulonephritis
- Glomererular Filtration is best checked by what lab?
- Blood creatinine
- What lab checks the ability of the kidneys to concentrate urine?
- Urine Specific Gravity
- What is the diet ordered for patient with renal failure?
-
Low protein
Low sodium
High calorie - Antidiuretic Hormone effects kidneys by
- controlling permeability
- Aldosterone effects kidneys by
- causing the distal tubule and collecting ducts to reabsorb increased levels of sodium.
- Causes of intrarenal ARF
-
*Glomerulonephritis*
Nephrotoxic damage
NSAID's
heavy metals - Causes of postrenal ARF
-
*calculi (kidney stones)*
obstruction of indwelling cath
tumors - Causes of prerenal ARF
-
Sepsis
dehydration
hemmorhage
heart/liver failure
burns - How long does recovery phase last?
- About 6 months
- Renin-Angiotensin Mechanism
-
one of the most potent vasoconstrictors known.
RAS is a defense mechanism to prevent fall in BP due to loss of blood or fluid.
It can be improperly activated in renal disease causing HTN. - Alterations in fluid may produce what?
- Generalized Edema
- Accumulation of wastes (amonia) may cause what?
- Mucosal Errosion
- Alterations in platelet function may lead to what?
- Eccymosis
- What is a "silent killer"?
- Hypertension
- Causes of Acute Renal Failure ARF
-
1. prerenal- low blood flow to kidneys
2.intrarenal-direct damage to kidney parenchyme
3.postrenal-obstruction to flow of urine(may cause hydronephrosis) - What is ARF
- Rapid deterioration or cessation in kidney function.
- ARF and childhood!
- It is uncommon in childhood!!
- Biggest cause of prerenal failure!
- Hemmorrhage
- Biggest cause of post renal failure.
-
Renal Calculi
(more men than women have renal calculi) - Biggest cause of intrarenal failure.
- glomerulonephritis.
- Children with untreated strep may end up with what?
- pyelonephritis
- Chronic Renal Failure
- Progressive and Irreversible Destruction of kidneys.
- CRF caused by what?
-
Conditions that cause permanent nephron loss:
diabetes, HTN, glomerulonephritis, polycystic kidney disease - Each kidney contains how many nephrons?
- one million
- Diminished Renal Reserve
-
GFR 50% of normal
usually 40-70 mL/min - Renal Innsuffiency
-
GFR 20-50%
usually 20-40 mL/min - Renal Failure
-
GFR less than 20%
usually 10-20 mL/min - End Stage Renal Disease (ESRD)
-
GFR less than 5%
usually less than 10 mL/min
Requires dialysis for survival - What med is used for hyperkalemia?
- Kayexalate
- Clinical Manifestations of Chronic Renal Failure
-
Hyperlkalemia
High or low Na
Hyperphosphatemia - Procurement Interview
- Checks for possible donor.
- Avoid using ________with antacids or mg because of toxicity.
- Aluminum Hydroxid
- Epogen given for renal failure.
- To see if it is working, check to see if Hematocrit level is rising.
- Dry scaley skin with ecchymoses, petechiae, and purpura.
- Because of eurythropeotin
- Facts about acute renal failure
-
-occurs suddenly
-usually reversible
-3 phases
oliguric, diuretic, and
recovery - Emergency tx of hyperkalemia.
- dialysis and 50% hypertonic glucose IV, calcium gluconate IV, regular insulin, sodium bicarb IV, Kayexelate
- Lab results with ARF
-
-urine output below 400 mL in 24 hours
-increased blood urea nitrogen level
-increased serum creatine
-