Term
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Definition
| Acute Renal Failure; rapidly worsening GFR, generally reversible, ICU pt mortality 40-75% |
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Term
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Definition
| Chronic Kidney Disease; progressive, irreversible, DM is #1 cause, preceded or exacerbated by ARF |
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Term
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Definition
| Volume depletion=reduced effective circulating volume (CHF, hepat cirrhosis, shock), or obstructed renal perfusion (trauma, renal artery stenosis (clot, aneurysm, tumor) |
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Term
| Describe Intra-renal ARF. |
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Definition
| Glomerular disease, Vascular disease, Tubular disease and interstitial disease |
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Term
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Definition
| Acute Tubular Necrosis; prolonged pre-renal insult, nephrotoxins. heme pigments; rhabdomyolysis=muscle injury w/ vol depletion (Hydrate!). Intravasc hemolysis, will se hemoglobinuria |
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Term
| What causes postrenal disease? |
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Definition
| Obstruction of flow of urine. Prostate disease, pelviv or retroperitoneal tumors, calculi, congenital abnormalities |
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Term
| What is the concept of ARF? |
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Definition
| 1) non/oliguric RF lasting 5-8D. 2) Diuretic phase w/ tubular function returning. Can deplete electrolytes. 3) Recovery Phase; 3-12mo for creatine to return to normal. CKD may result |
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Term
| How do we support ARF and what do we monitor? |
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Definition
| fluid balance, dietary restriction of Na, K & phos, infectious precautions. Eliminate nephrotoxic agents. Conserve circulating volume. MONITOR BUN, Creatinine, weight QD, vital signs |
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Term
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Definition
| Blood Urea Nitrogen, normal 10-20mg/dl. Elevated in RF. Filtered at flomerulus and partially reabsorbed in tubule |
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Term
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Definition
| normal 1.0mg/dl. By-product of muscle metabolism. Filtered completely, NOT reabsorbed. Good measure of kidney function. |
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Term
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Definition
| End Stage Renal Disease, same as CKD. Progressive/irreversible. DM #1 cause |
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Term
| What are CKD manifestations? |
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Definition
| Weakness, fatigue, malaise, anorexia, nausea, cold, pruritis, edema, SOB, muscle cramp/jerk, tremulousness, pericardial friction rub (unusual), hiccups, HyperK=heavy arms & legs |
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Term
| What are the renal replacement therapies available? |
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Definition
| ACUTE= continuous venovenous hemofiltration/dialysis * CHRONIC= intermittent hemodialysis, peritoneal, short daily and nocturnal dialysis |
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Term
| What are the necessary elements of dialysis? |
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Definition
| Blood flow, semipermeable membrane, waste disposal |
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Term
| What indications require hemodialysis? |
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Definition
| correction of metabolic abnormalities, fluid col overload, removal of toxins/poisons |
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Term
| What are advantages of peritoneal dialysis? |
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Definition
| Use own peritoneum. Portable system, done at home, enhanced self care, continuous=more gentle (lavaging) |
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Term
| What are disadvantages of peritoneal dialysis? |
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Definition
| Q D 4-5x, storage space for medical waste, peritonitis, hard to treat DM d/t dextrose based diaysate, weight gain |
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Term
| What types of vascular access are used? |
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Definition
| AVF=arteriovenous fistula, on wrist or upper arm (radio/brachiocephalic), AVG=arteriovenous graft, goretex, forearm loop, TUNNELED central cath= enter jugular the tunnel to exit on anterior chest wall |
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Term
| Which pts are not eligible for a kidney transplant? |
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Definition
| Metastatic disease, severe vascular disease, other major disability |
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Term
| What has to mach for kidney donors? |
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Definition
| 1) Blood type, 2) HLA (human leukocyte antigen)=antigenic marker on WBC, 3) antibodies to donor tissue |
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Term
| What is the best case scenario for transplantation? |
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Definition
| Live donors, scheduled simultaneous surgeries |
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Term
| What are problems r/t transplantation? |
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Definition
| 1) Lifetime immnosupressives=cyclosporine, Prograf, prednisone 2) rejection 3) infection 4) HTN, hyperlipidemia, DM 4) recuuence of underlying cause of renal failure. |
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