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MED SURG: KIDNEY FAILURE

Terms in this set (34)

functions of the kidney
1. filtration of blood to regulate fluid, electrolyte and acid-base balance and remove waste products
2. secretion of renin and regulation of BP
3. production of erythropoietin (RBCs)
4. activation of Vitamin D
renal failure
the partial or complete impairment of kidney function
classified as acute (rapid onset) or chronic (develops slowly over months to years)
anuria
absence of urine production or less than 100mL/day
oliguria
urinary production 100-400mL/day
polyuria
excessive production and excretion of urine
glomerular filtration rate (GFR)
-calculation mL/min/1.73m2 plus additions made for age, gender and race
normal GFR
125mL/min
<15 to >90
pre-renal
FLOW PROBLEM
-hypovolemia
-decreased CO
-decreased peripheral resistance
-decreased blood flow to renal arteries and veins
azotemia
(excessive) urea and nitrogenous substances in the blood
creatinine
not absorbed so it is a better indicator
we do not want creatinine in blood because it means the kidneys are not working properly
Acute Kidney Injury (AKI)
rapid loss of renal function with a progressive accumulation of nitrogenous waste products (azotemia)
uremia
onset of systemic symptoms related to the accumulation of waste product
intra-renal
ACTUAL PROBLEMS WITH KIDNEYS ITSELF
-prolonged ischemia****
-nephrotoxins (leads to acute tubular necrosis-ATN)
-malignant hypertension
-eclampsia
-thrombosis
-conditions: acute GN, lupus and interstitial nephritis
categories of AKI
1. pre-renal
2. intra-renal
3. post-renal
4 phases of AKI
1. initiating phase (AKA: onset phase)
2. oliguric phase
3. diuretic phase
4. recovery phase
most common cause of intra-renal
interstitial nephritis
post-renal
BLOCKAGE
-BPH
-bladder cancer
-calculi (stones)
-prostate cancer
-strictures
-trauma
initiating phase
-begins at time of renal insult
-continues until S and S are apparent
-duration: hours to days
MI, stroke and sepsis are causes
oliguric phase
-urine production of less than 400mL/day
-often the initial manifestations of AKI caused by decrease in GFR
-occurs within 1-7 days of precipitating event
-duration: 10-14 days but can last months
-the longer this phase, the poorer the prognosis of regaining renal function
-closely watch fluid intake!!!!!!!!!!
Don't overload fluids!! They are not getting rid of it
FR calc
all fluid losses from previous 24 hrs + 600mL
oliguric phase
How much urine should you produce per day?
AT LEAST 800mL
s/s of oliguric phase
-FVE
-metabolic acidosis
-hyponatremia
-hyperkalemia
-anemia
-infection (major cause of death with AKI)- sepsis
-hypocalcemia
-hyperphosphatemia
-waste product accumulation (increased BUN and creatinine)
normal creatinine
0.6 - 1.2 mg/dL
diuretic phase
-urine production occurs
-osmotic diesis from high urea levels and kidneys inability to concentrate urine
-initial urine output of 1-3L/day and may increase to 3-5L/day
-may need to give IV fluids to prevent dehydration
-duration: 1-3 weeks
-acid-base, electrolyte, BUN and creatinine values begin to normalize as phase ends
s/s of diuretic phase
-excessive urine production, dilute urine
-hypovolemia
-hypotension
-hypokalemia
-uremic sx to start to improve as lab values return to normal
recovery phase
-begins when the GFR increases
-BUN and creatinine levels plateau and then decrease
-duration: lasts 12 months or longer
-some patients never reach this phase and progress to chronic renal failure
s/s of recovery phase
-continued improvement of uremic sx
-decreasing BUN and creatinine
-acid-base, fluid and electrolyte balance
-return to normal activity level
-kidney's decreased ability to concentrate urine may be mild and continue for years
urinalysis
-urine sediment containing casts, cells or protein indicates infrarenal cause
-hematuria, pyuria and crystals seen with postrenal causes
**urine osmolality, sodium content and specific gravity help to differentiate type of ARF
renal ultrasound
shows structures and function
can show tumor
renal scan
shows perfusion and collecting system integrity
CT and MRI
show masses, collections and vascular anomalies
contrast dye in patients with renal disease
the use of contrast dye in patients with renal disease is not advised because:
1. contrast-induced nephropathy (CIN)
2. diabetics taking metformin: hold 48 hours before and after use of contrast medium to low risk of lactic acidosis
3. if must be used, low dose and optimal pre and post hydration
Nutrition for AKI
-adequate caloric intake to prevent catabolism of body protein
-intake of carbs and fats to prevent ketosis
-restrict or encourage Na, Ca, P, fluid and K
-consider GI symptoms
#1 goal for AKI
eliminate the cause, treat the signs and symptoms and prevent complications such as infection
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