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medsurg-GU
kidney
24
Nursing
Undergraduate 3
04/10/2013

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Cards

Term
Renal system functions
Definition
- Fluid and electrolyte balance
- Blood filtration
- Acid-base balance
- Blood pressure regulation
- Erythropoietin production
- Vitamin D production
Term
Nephron
Definition
Functional unit of kidney
- Arteriole brings in unfiltered blood
- Glomerulus (ball of capillaries): filters blood, retains proteins and RBCs
- Distal tubule carres away filtered waste into the urine
- Venule returns filter blood to the body
Term
Renal labs
Definition
BUN (10-20)
Creatinine (<1.5)
GFR (125)
URinalysis: specific gravity, protein, blood
Term
Renal failure
Definition
Decrease in the glomerular filtration rate so that the kidneys can no longer effectively filter water and waste from the blood
Term
Types of renal failure
Definition
- Acute renal failure (ARF): sudden onset, reversible with supportive care
- Chronic (CRF): gradual onset over months to years
- End stage renal disease
Term
Acute kidney failure
Definition
- Usually doesn't go on over 3 months
- Half of the nephrons are destroyed
Term
RIFLE criteria for renal failure
Definition
Risk: >25% GFR
Injury: GFR >50%
Failure: >75%
Loss: irreversible AKI or persistant AKI >4 wks
ESRD: ESRD >3 months
Term
Acute kidney injury causes
Definition
Can be community acquired or secondary
- Due to hypovolemia
- Frequently part of multi organ failure
Term
AKI risk factors
Definition
- Age
- Diabetes
- Severe illness
- Atherosclerotic disease
- Dehydration
Term
AKI classifications
Definition
Prerenal
Intrarenal
Postrenal
Term
Pre-renal AKI
Definition
- Most common type of AKI
- Hypoperfusion, results conditions that interrupt the renal blood supply, thereby reducing renal perfusion
- Nephrons remain structurally intact
- Causes: hypovolemia, shock, hemorrhage, diuretic therapy, sepsis
Term
Post-renal AKI
Definition
- Results from obstruction of urine flow
- Least common cause of AKI
- Reversible with removal of obstruction unless its been present long enough to damage the kidney
- Causes: BPH, tumors, kidney stones, neurogenic bladder
Term
Intra-renal AKI
Definition
Direct injury to kidneys with structural and functional damage to nephrons
- Causes: ischemia, inflammation, infection, toxins, meds, IV contrast, rhabdomylosis
Term
AKI s/s
Definition
- Oliguria
- Proteinuria
- Fluid retention
- Increased serum potassium
- Increased creatinine
- Decreased serum bicarb
Term
AKI treatment
Definition
- Varies according to cause: treat precipitating condition
- Rehydration with IVF
- Monitor fluid status closely (strict I and Os)
- Monitor labs: BUN, creatinine, K+
- Treat hyperkalemia
- Oxygen
- Meds: diuretics
- Dialysis
(Metformin increases risk of kidney function)
Term
Chronic kidney disease
Definition
If you don't treat acute renal failure then go into chronic renal failure
- Progressive decline in kidney function that correlates with loss of nephrons
- Symptoms occur when less than 20-25% of nephrons remain (until then remaining nephrons hypertrophy to compensate)
Term
Causes of CKD
Definition
Diabetes
Hypertension
Unsuccessfully treated ARF
Glomerulonephritis
Autoimmune disorders
Congenital defects
Term
Early s/s CKD
Definition
Malaise
Fatigue
Pruritis
Headaches
Weight loss
Anorexia and nausea
Edema
Hypertension
Polyuria
Term
Late s/s CKD
Definition
Oliguria/anuria
CNS symptoms: drowsiness, confusion
Numbness in hands and feet
Easy bruising or bleeding
Excessive thirst
Breath orod of urine
Uremic frost
N/V, constipation/diarrhea
Stomatitis, gastritis
Term
Complications of CKD
Definition
Decompensated HF, pulmonary edema
Metabolic acidosis
Pericarditis (fluid around heart)
Pleural effusion
Arrhythmias
Anemia
Malnutrition
Term
Medical treatment of CKD
Definition
- Goals: delay progression to ESRD, prevent complications, plan for long-term renal replacement therapy in a timely manner
- Hemodialysis
- Peritoneal dialysis
- Kidney transplant
Term
Dietary therapy for CKD
Definition
- Fluid restriction
- Diet restriction: low protein, low potassium, low sodium
Term
Medications for CKD
Definition
Antihypertensives
Diuretics
Meds to manage electrolytes
Erythropoietin
Term
Patient teaching for CKD
Definition
- Dietary restrictions: low protein, low K, Na, phosphorous
- Fluid restrictions: replace urinary output plus 500ml
- Avoid OTC meds: NSAIDs, antacids and laxatives that contain magnesium
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