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75 Cards in this Set

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Acute Renal Failure is defined as:
a rapid decrease in kidney function, leading to the collection of metabolic wastes in the body.
Acute Renal Failure - Causes


glomerular nephritis
Intrarenal
Acute Renal Failure - Causes


when the basement membrane is not intact
-what cause?
-what are the CM?
Intrarenal

you have protein and erythrocytes leaking out of the kidney (hematuria, proteinuria).
Acute Renal Failure - Causes


drugs that are toxic to the kidneys (aminoglycoside antibiotics and NSAIDS)
Intrarenal
Acute Renal Failure
(1st phase) is what?
Oliguric Phase
Acute Renal Failure
Oliguric Phase (1st phase)

Tell me about urine output in this stage
-Oliguria: less than 30 mL per hour or less than 400 ml/day
Acute Renal Failure
Oliguric Phase (1st phase)

-Caused by reduction in what?
GFR (glomerular filtration rate) – the amount of blood going through the kidney, decreases your filtration rate
Acute Renal Failure
Oliguric Phase (1st phase)

-Usually occurs when?

- how long does this last?
in 1 – 7 days after causitive event

-Lasts days to months; average 10-14 days
Acute Renal Failure
Oliguric Phase (1st phase)
- The longer the person is in this phase, the longer it will take them to
recover and the greater chance they have of chronic renal failure
Acute Renal Failure
Oliguric Phase (1st phase)

-Tell me about a characteristic of their urine
-Proteinuria (because the basement membrane is not intact and protein is leaking out)
Acute Renal Failure
Oliguric Phase (1st phase)

Tell me about their fluid volume
-Fluid volume excess (fluid is retained, while protein is leaking out)
Acute Renal Failure
Oliguric Phase (1st phase)

what acid base imbalance are they in?
-Metabolic acidosis: ammonia not synthesized --> H+ and acid metabolites not excreted
–NHCo3 (bicarb) decreased due to being used up in buffering H+
Acute Renal Failure
Oliguric Phase (1st phase)

What happens to their Na+ balance?
damaged tubules can’t conserve
-(hypernatremia because it isn’t being excreted but it is masked by the fluid volume excess)
Acute Renal Failure
Oliguric Phase (1st phase)

what happens to K+?
there is an excess: not excreted (hyperkalemia because it is not being excreted and it is being retained)
Acute Renal Failure
Oliguric Phase (1st phase)

What happens to Calcium and phosphorus levels?
Ca+ deficit/phosphate excess

decreased GI absorption of Ca+ from decreased vitamin D
-phosphorus is going up, so calcium will go down.
Acute Renal Failure
Oliguric Phase (1st phase)

BUN and creatinine?
elevated Bun and creatinine - can’t secrete urea (protein metabolism) and creatinine (muscle metabolism)
ARF – Diuretic Phase
-this is also phone as the _________ phase
high output
ARF – Diuretic Phase

Tell me about the amount of UO per day?
-Increase in UO of 1-5 L/day (high urea concentration causes osmotic diuresis and tubules can’t concentrate urine)
ARF – Diuretic Phase

-What electrolyte imbalances are occuring?
- All electrolytes are low because they are being flushed out of the body
ARF- what phase?

Kidneys can excrete waste but not concentrate urine and can’t reabsorb elements like it is supposed to
diuretic phase (II)
ARF- Diuretic phase

BUN and creatinine?
-Azotemia (means elevated BUN and creatinine)
ARF- Diuretic phase

How long does this phase last?
-Lasts 1-3 weeks
ARF – Recovery Phase

What are the kidneys starting to do to the urine?
-Kidneys are starting to concentrate urine. Important piece
ARF – Recovery Phase

BUN and creatinine?
- BUN and creatinine will be high but on the normal side of high.
ARF – Recovery Phase

-What happens to the pts activity level?
-The patient begins to return to normal levels of activity
ARF – Recovery Phase

Glomerular filtration rate?
-GFR increases
ARF – Recovery Phase

-Major improvements 1-2 weeks but can take up to how long?
12 months
ARF – Recovery Phase
-if BUN and creatinine are not normal within 1 year, what is our concern?
Concern that they are developing chronic renal failure if the BUN and creatinine are not normal within 1 year
Acute Renal Failure – Care

what can help determine that cause of ARF?
-x rays help determine the cause of ARF
Acute Renal Failure – Care


-The CM are related to what 2 things?
- the buildup of nitrogenous wastes (Azotemia) as well as to the underlying cause
Acute Renal Failure – Care

Treat the cause:
-if it's hypovolemia, do what?
-if it's a kidney stone, do what?
-Treat cause (if it’s hypovolemia, give them fluid or dopamine drip.
-If it is a kidney stone, remove it.
Acute Renal Failure – Care

Treat the cause:
-if it is an intrarenal problem, do what?
give steroids or antibiotics
Acute Renal Failure – Care

-Fluid restriction in the oliguric phase may be necessary
What is the formula for fluid restriction?
500-600 ml + previous 24 hour fluid loss
Acute Renal Failure – Care

If pt is on fluid restriction, what can we do to help their craving for liquid?
use swab, ice chips (monitor), mouth moisturizer
Acute Renal Failure – Care

Tell me about their diet?
Potassium, phosphorus, and sodium restriction

provide adequate protein
Acute Renal Failure – Care

-Hyperkalmia occurs. What are some treatments used to lower potassium (4)
•dialysis
•Kayexalate (oral or an enema)
• regular insulin drip (D 50%) - (Insulin forces K+ moves into cell)
•Can give sodium bicarb (NaHCO3) to correct acidosis and K+ moves into cell)
•try giving insulin before giving bicarb because hypoglycemia is easier to treat than the effects of giving bicarb
Chronic Renal Failure also known as
chronic kidney disease.
Chronic Renal Failure - what is the most common cause?
•Diabetic nephropathy – 45% -highest cause of CKD. No matter how well a pt has diabetes controlled, they will eventually develop renal problems. DM type II is more prevalent and it can be easily managed
Chronic Renal Failure - 2 other causes
Hypertension – 27%

Glomerulonephritis – 8.8%
Chronic kidney disease defined:
-you have to have kidney damage that is evaluated through GFR for greater than 3 months

GFR = <60 ml/min/1.73/m2
Chronic Kidney disease stages 1-5

what is the best stage? 1 or 5
stage 1- GFR is normal or a bit higher than 90. You will have protein or albumin in urine. cells or casts in urine
Chronic Kidney disease stages 1-5

what is the worst stage? 1 or 5
Stage 5: GFR less than 15 (failure) and dialysis
Chronic kidney disease Diagnosis:

-Tell me about anemia, will it be present?
-pt will be anemic (no erythropoiesis taking place)
Chronic kidney disease Diagnosis:

-BUN, serum creatinine, and creatinine clearance levels are all used

What does the creatinine clearance test evaluate?
evaluates how well the kidneys remove creatinine from the blood. it is the best indication of overall kidney function.
Chronic kidney disease Diagnosis:

creatinine clearance test- what is it?
-It is a 24 hour urine collection and they look at the amount of creatinine.
Chronic kidney disease Diagnosis:

creatinine clearance test provides the best estimate of:
the glomerular filtration rate and
-the normal GFR is 125 mL/min
Chronic kidney disease Diagnosis:

creatinine clearance test
-tell me about the supplies that you need?
-use a brown or orange jug that must be kept on ice. WHY ON ICE?
because you don’t want the urine to break down)
Chronic kidney disease Diagnosis:

creatinine clearance test
contaimination can occur, such as:
-what do you do?
if urine gets dumped in the toliet instead of in the jug or toliet paper gets in the jug
or if the ice runs out, how long has it been on room temperature
-start collection all over
Chronic kidney disease Diagnosis:

creatinine clearance test
- to prevent from having to start this test over, what can you do?
-put up signs not to dump the urine, tell everybody not dump it, can put something over the toilet so the pt can’t urinate in the toilet
Chronic kidney disease Diagnosis:

creatinine clearance test
-what do you if a patient has a foley in?
cover it so it is not exposed to light and put it on ice
Chronic kidney disease Diagnosis:

creatinine clearance test
-what do you do at the start time?
- ask the pt to void (or emptying the tubing and drainage bag if the pt has a foley) and discard the first sample
Chronic kidney disease Diagnosis:

creatinine clearance test
-what do you encourage with the pt during the test?
-what do you tell them to avoid?
-encourage fluids before and during the test
-avoid caffeinated beverages
Chronic kidney disease Diagnosis:

Protein-to-creatinine ratio test
-what is this?
-this estimates the amount of protein you excrete in your urine in a day and avoids the need to collect a 24 hour sample of your urine
Chronic kidney disease Diagnosis:

Protein-to-creatinine ratio test
-when is this done?

-what is a positive result?
the first morning voided specimen

-greater than 300 mg albumin/ 1 gm creatinine
Chronic kidney disease Diagnosis:

Urine Analysis
-what is considered a positive result?
1+ protein, 2 or more times over 3 months
CRF – Diminished Renal Reserve phase

-What are the CM:
•Asymptomatic
• you are seeing changes at the cellular level
CRF – Diminished Renal Reserve phase

-BUN and creatinine level?
•Normal BUN and creatinine
CRF – Renal Insufficiency phase

-tell me about the CM:
- start seeing CM or you may just see Azotemia (elevated BUN and creatinine)
CRF – Renal Insufficiency phase

What is the GFR?
-GFR is 25% of normal (60 or below)
CRF – Renal Insufficiency phase

-Fatigue and weakness are common. As this stage progress, what other 3 CM do you see?
headache, nausea, pruritus
-because of the increase in the retention of waste products (urea and creatinine)
CRF – Renal Insufficiency phase

-As kidneys lose ability to concentrate urine may see what 2 other CM?
nocturia and polyuria
CRF – Renal Insufficiency phase

--Why is nocturia seen?
because the body slows down at night and blood is shunted towards the kidney
CRF – Renal Insufficiency phase

-Why is polyuria seem?
because the body is saying hey we have an increase in Na, K, Urea, and nitrogen and we are going to increase UO to flush out these elements that are elevated
CRF – ESRD (end stage renal disease)

GFR level?
Creatinine clearance level?
GFR less than 5 % - 10% of normal (15 or less)

creatinine clearance is rising, < 5 – 10 ml/min
CRF – ESRD (end stage renal disease)

-tell me about nephron loss?
Lost 90-95% of nephrons (you see CM when you lose 70%)
CRF – Uremia is a result of what?
elevated urea levels (the waste product that can’ t be eliminated) and it starts accumulating in the brain and tissues
CRF – Uremia is a syndrome that affects all body systems, brain and nerve tissue (true or false)
true
CRF – Uremia

CM affecting energy level and mental capacity
•Weakness and lethargy
•Seizures as a result of urea levels crossing the BBB
•Disorientation and confusion
•Irritability
CRF – Uremia

GI CM:
anorexia,
N/V,
uremic fetor (foul smell),
stomatitis,
GI bleeding,
gastritis
CRF – Uremia

Hematologic CM: 3
anemia, bleeding, infection
CRF – Uremia

Eye CM: 2
hypertension of the eye causing edema,

retinopathy
CRF – Uremia

Skin:
-pallor, yellowish skin,
-dry/scaly,
-decreased perspiration,
-pruritus (urea accumulating in the skin),
-uremic frost (rarely seen, urea accumulates in skin and gets to such a high level and it looks like snow) ,
-ecchymosis and petechiae
CRF – Uremia

-What happens to ones hair?
dry and brittle and may fall out
CRF – Uremia

-What happens to ones nails?
thin & brittle (because metabolism is impaired) and ridged
CRF – Uremia

-what happens to the taste in their mouth?
-metabolic taste in the mouth