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43 Cards in this Set
- Front
- Back
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Nephron
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Functional unit of the kidney. Composed of glomerulus, Bowman's capsule, and a tubular system
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Renal bllod supply
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1200 ml/min
approx 20-25% of cardiac output flows to the kidneys |
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Glomerular function
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Semipermeable membrane that allows filtration of blood. Place where urine formation begins.
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Glomerular filtration rate
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Tjhe amount of blood filtered by the glomeruli in a given time
Normal value=125ml/min (only 1ml/min is excreted as urine-most is reabsorbed into the circulatory system. |
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Tubular function
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Reabsorbs essential materials and excretes nonessential ones
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Erythropoietin
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Hormone produced by the kidneys that stimulates the production of RBCs in the bone marrow.
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Vitamin D
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Essential for absorption of calcium, but inactive until broken down by the kidneys
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Renin
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Produced by the kidney in response to decreased renal perfusion, bp, etc..
Stimulates Angiotenison converting enzyme ->Aldosterone -> Water retention, rise in BP |
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Acute renal failure
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Rapid onset, potentially reversible, mortality rate approx 50%
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Azotemia
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Accumulation of nitrogenous waste products
Protein metabolism -> blood urea-> nitogen |
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How do you diagnosis azotemia (uremia)
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BUN
Creatinine |
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Uremia
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Systemic azotemia
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Normal urine output
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1500-1800 ml/day
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Oliguria
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Little to no urine
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What are symptoms of kidney failures
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Uremic sx's
Poor nutrition / muscle wasting Fluid overload HTN Hyperkalemia Metabolic acidosis Bone disease |
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PRERENAL cause of failure?
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Causes outside the kidney that decrease renal blood flow
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INTRARENAL casue of failure?
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Causes that directly damage the renal tissue leading to nephron malfunction
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Acute Tubular necrosis
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INTRARENAL failure
caused by ischemia, nephrotoxins -antibiotics -IV contrast dye -hemolyzed RBCs |
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POSTRENAL casue of failure
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Involves mechanical obstruction of urinary outflow
Stone, prostate enlargement, tumor, trauma Only 5% of acute renal failure |
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What are the 4 phases of acute renal failure?
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1. Initiating
2. Oliguric 3. Diuretic 4. Recovery |
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Initiating phase of ARF
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From time of insult until signs and symptoms become apparent.
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Oliguric phase of ARF
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Less than 400 ml of urine/ 24hrs
Caused by reduction in GFR Longer the phase=poorer prognosis (1-7 days, up to months) |
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What percent of patients with ARF will demonstrate oliguria?
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50%
Need to distinguish prerenal from intrarenal ARF |
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Characteristics of prerenal oliguria
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No damage to renal tissue
Caused by decrease in circulating blood volume Ususally reversible UA: High specific gravity, low NA concentration |
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Characteristics of intrarenal oliguria?
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Normal specific gravity, high NA
If caused by ischemia or toxins, may have tubular, RBC and WBC casts in urine |
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What is the major difference between prerenal and intrarenal oliguria?
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Dehydration
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What are the 2 leading causes of death with renal failure?
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Infection & Cardio-pulmonary issues
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What is Procrit?
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Synthetic erythropoeitin
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Other manifestattions of intrarenal oliguric phase?
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RBC, WBC, and protein in urine
Fluid volume excess Metabolic acidosis Increase in NA and K Anemia Calcium deficit / PO4 excess Waste product accumulation Neurologic disorders |
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How can you force K into the cell?
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Insulin and bicarb (temp)
Dialysis and Kaexolate (longer) |
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Diuretic phase of ARF
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Gradual increase in daily urine output, nephrons not fully functional
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Recovery phase of ARF
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Begins with GFR increases.
Major improvements in first weeks of phase, May take up to yeat for renal function to stabilize |
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How is ARF diagnosed?
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History
UA Renal US, scan, ST, MRI |
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What are indications for dialysis?
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Volume overload
Increased K+ Increased wastte products in the blood |
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What electrolyte do you especially monitor for in ARF?
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K+
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What is cardiac tamponade?
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Pressure on the heart with accompanying poor function
Caused by excess fluid |
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What is the primary test for dialysis?
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Creatinine
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What is the general appearance of someone with ARF?
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Greyish, ashen, almost jaundiced color
Generalized edema, bruises, dry oral mucosa |
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Nutrition for ARF
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Primarily from carbs and fat sources (30-40%)
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Metabolic acidosis
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Result of kidney unable to get rid of H+
Significant change in mental status, pericarditis, pericardial effusion, or cardiac tamponade |
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What is the problem with strep infections?
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Can cause glomeular nephritis
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What are some risk factors for ARF?
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Massive trauma
Major surgery Extensive burns HTN, Diabetes |
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How do you handle nephrotoxic drugs?
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Force fluids to get out
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