Upgrade to remove ads
Only $2.99/month

Chapter 42: Acute Renal Injury and Chronic Kidney Disease

Terms in this set (38)

Renal failure
Failure of kidneys to remove metabolic waste and regulate fluid, electrolyte and pH
Causes of renal failure:
Renal disease
Systemic disease
Urologic defects
Prevention and diagnosis of acute renal failure:
Assessment measures for those at risk:
Preexisting renal insufficiency
Diabetes
Elderly persons
Increase waste levels/BUN
Decreased GFR
Acute renal failure:
Onset is reversible if recognized early and treated
Pre-renal cases of acute renal failure:
Hypovolemia
Decreased vascular filling
Heart failure
Cardiogenic shock
Decreased renal perfusion
Post-renal causes of acute renal failure:
Bilateral ureteral obstruction
Bladder outlet obstruction
Chronic renal failure:
Results in irreparable damage
Develops slow over a course of years
Congestive heart failure would be a(n) __________ cause of renal failure.
A. Prerenal
B. Intrarenal
C. Postrenal
A. Prerenal
Acute tubular necrosis (ATN)
Prolong renal ischemia and intra-tubular obstruction by exposure to drugs, metals and organic solvents
Phases of acute tubular necrosis:
Onset or initiating phase
Maintenance phase
Recovery phase
Onset of initiating phase
Last hours or days
Time from onset until tubular injury occurs
Maintenance phase
Marked decrease in GFR
Recovery phase
Repair of renal tissue
Causes of Chronic renal disease:
Hypertension
Diabetes Mellitus
Polycystic kidney disease
Obstructions of urinary tract
Glomerulonephritis
Cancers
Autoimmune disorders
Diseases of heart or lungs
prerenal failure signs
decreased renal flow
elevation of BUN
sharp decrease in urine
Stages of progressing chronic renal failure:
Diminished renal reserve
Renal insufficiency
Renal failure
End stage renal disease (ESRD)
Diminished renal reserve
Mild reduction of GFR
60 to 89 ml/min/1.73m2
Renal insufficiency
Moderate reduction of GFR
30 to 59 ml/min/1.73m2
Renal failure
Severe reduction in GFR
15 to 29 ml/min/1.73m2
Hyponatremia caused by impaired renal re absorption
End stage renal disease (ESRD)
Kidney failure with GFR
< 15 ml/min/1.73m2
Need renal replacement therapy
A GFR of _____________ best describes renal failure.
A. 60 to 89 mL/min/1.73 m2
B. 30 to 59 mL/min/1.73 m2
C. 15 to 29 mL/min/1.73 m2
D. <15 mL/min/1.73 m2
D. <15 mL/min/1.73 m2

Less than 15 mL/min/1.73 m2 is the result of significantly decreased renal filtration and is the cut-off point of renal failure
Manifestations of chronic renal failure:
Nitrogenous waste accumulation
Water, electrolyte and pH alterations
Mineral and skeletal disorders
Anemia and coagulation disorders
Hypertension
Gastrointestinal disorders
Neurologic complications
Skin integrity disorder
Immunologic disorders
Factors determining manifestations of renal failure:
Extent
Condition
Type of renal replacement therapy
Treatment for renal insufficiency:
Treating urinary tract infections
Avoid medication cause renal damage
Controlling blood pressure
Controlling blood sugar
Stop smoking
Altered drug metabolism in kidney disease:
Altered drug absorption
Altered metabolism
Alterations in dosage
Which of the following alterations may affect drug efficacy in a patient with Chronic kidney disease?
A. Loss of K+
B. Alteration in pH
C. Loss of albumin
D. Increased Ca2+
C. Loss of albumin

Loss of albumin will result in altered drug metabolism via increased intermediates and faster action
Medical management of renal failure:
Dialysis (hemodialysis and peritoneal)
Transplantation
Dietary management of renal failure:
Protein
Carbohydrates, fat and calories
Potassium
Sodium and fluid intake
Chronic kidney disease in children causes:
Congenital malformations
Inherited disorders
Acquired diseases
Metabolic syndromes
Chronic kidney disease in children manifestations:
Severe growth impairment
Developmental delays
Delayed sexual maturation
Bone abnormalities
Psychosocial problems
Chronic kidney disease in elderly:
Normal decrease in GFR with age
Increase detrimental effects of drugs
Greater incidence of cerebrovascular, cardiovascular and skeletal system effects
AKI (acute kidney injury)
rapid loss of kidney function that occurs over a few hours or days
AKI (acute kidney injury: manifestations)
- HIGH BUN, K
- LOW Ca, UOP, Hct
-
chronic kidney disease
GFR less than 60, for 3 months
or kidney damage
CKD etiology
removal of a kidney
extracellular cell volume decrease
systemic illness
HYPERTENSION
DIABETIC KIDNEY DISEASE
CKD signs and symptoms
deceased GFR (normal is 120-130/min)
increased excretion albumin
vitamin D synthensis decreased
CKD clinical manifestations
accumulation of nitrogenous wastes (azotemia + uremia)
alterations in water/electrolyte/acid-base balance (sodium + potassium excretion impaired, can lead to metabolic acidosis)
mineral and skeletal disorders
neurologic complications
disorders of skin
immunologic disorders
elevated PTH
anemia
cardiovascular disorders
CKD treatment
control BP
control suger in diabetics
ACE inhibitors + ARBs
quit smoking

dialysis and renal replacement therapy (transplantation)

dietary management
THIS SET IS OFTEN IN FOLDERS WITH...