Final Prep - Kidney/Renal Flashcards

Renal Failure

partial or complete impairment of kidney fx results in
inability to excrete metabolic waste products contributes
to disturbances of all body systems can occur suddenly -
ARF / AKI or slowly - CKD pts can tolerate dec. in kidney
fx by 30-40% w/o noticeable effects

Acute Renal
Fail - ARF

abrupt loss of kidney fx develops over hrs to
days rise in creatinine & BUN dec. in UOP &
GFR is reversible condition, but high mortality rate
often results from other life-threatening conditions


oliguria: UOP 100-400ml/24hr
anuria: UOP < 100ml/24hr
polyuria: UOP up to 2L/24hr

Stages of

onset: precipitating event to renal
oliguric-anuric: 1-8wks (poor prognosis if
>8wks, may require dialysis)
diuretic: leveling out BUN & rise in UOP, may
lead to dehydration
recovery: 3-12mo., BUN & creatinine begin to

Causes of
ARF/AKI - Prerenal

renal blood perfusion is affected by external factors, dec. renal
blood flow = dec. GFR, no injury to renal tissue
circulatory hypovolemia:
dehydration dec. C.O. shock
burns volume shifts dec. vascular
resistance renal artery obstruction

Causes of
ARF/AKI - Intrarenal

results from conditions that cause direct damage to kidney tissue,
impaired nephron fx, usually results from prolonged ischemia,
nephrotoxins or myglobulin released from muscle cells

ATN - acute tubular necrosis
glomerulonephritis thrombosis vasculitis
scleroderma trauma atherosclerosis
tumors rhabdomylosis metabolic d/o

Causes of
ARF/AKI - Postrenal

mechanical obstruction in outflow of urine, urine refluxes into renal
pelvis, impairing kidney fx
BPH prostate cancer renal calculi
trauma extrarenal tumors spinal chord

ARF Manifestations

alteration of expected UOP (oliguria vs polyuria)
edema weight gain or loss fluid electrolyte
imbalances acidosis inc. susceptibility to secondary
infections anemia, weakness proteinuria or
albuminuria platelet dysfunction GI
complications inc. incidence of pericarditis uremic
encephalopathy impaired wound healing


prevention is primary intervention prompt recognition
& appropriate action careful replacement fluid &
electrolytes diuretic Tx (furosemide, mannitol) low
dose dopamine Tx of anemia (transfusions /
erythropoietin) dialysis


Excess Fluid Volume Deficient Fluid Volume
Imbalanced Nutrition Fatigue Risk for

Chronic Kidney Failure

irreversible & progressive reduction of fx of renal
tissue ultimately will need dialysis, transplant, or end of
life care divided into 5 stages based on GFR most
common cause = diabetes 2nd most common cause = HTN
other risk factors: age & obesity more common than
ARF/AKI prevalence is 1in9 US adults high mortality

CKF Manifestations

renal fx deteriorates - all systems affected poss.
polyuria if diabetes primary cause anuria may occur as pt
is needing dialysis abnormal UA - proteinuria marks damage
to glomerulus, low spec. gravity BUN, creatinine, &
triglycerides inc. altered carb metabolism
electrolyte & acid-base imbalances anemia
bleeding tendencies (platelet dysfunction)
infection cardiovasc. probs - most common cause of
death Kussmaul breathing (metabolic acidosis)
anorexia, N/V, wt. loss, malnutrition DM
gastroparesis CNS depressions peripheral
neuropathy hypocalcemia hyperphosphatemia
pruritus (dry skin, neuropathy, uremic frost)
infertility & decreased libido personality &
behavior changes small, atrophied kidney on imaging

- Tx

goal - preservation of renal fx, delay dialysis need
BP control diabetic pts - BS control dietary
adjustments monitor electrolytes treat anemia
adjust meds d/t dec. kidney excretion
meds: mannitol, iron, vit B12, folic acid,
erythropoietin, vit D, calcium carbonate/acetate, phosphate binders,
antihypertensives, statins, furosemide

Polycystic Kidney Disease

fluid-filled pouches form in both kidneys, lead to kidney
enlargement & failure most common life-threatening
genetic disease in US
2 forms: ARPKD & ADPKD
autosomal recessive: present at birth, develops
rapidly, no Tx, least common
autosomal dominant: more common, manifestations
develop during adulthood, 5% of ESRD results from this


genetic testing UA serum chem panel
imagery studies


HTN painless hematuria abdominal, flank, or
back pain inability to concentrate urine frequent
bladder or kidney infection microalbuminuria in some


largely aimed at supportive care attempt to slow
progression manage HTN prevent UTIs fix
electrolyte imbalances (hyperkalemia & hyperphosphatemia,
metabolic acidosis) weight loss nephrectomy

Renal Failure - Tx Options

dialysis - renal replacement therapy, hemodialysis, peritoneal
dialysis (correct electrolyte imbalances & remove waste
products) cessation of Tx, death

Dialysis Type - CRRT

slow, temporary type indicated when conservative Tx
not effective common indications: volume overload,
hyperkalemia, metabolic acidosis, BUN >120, significant changes
in mental status, pericarditis, pericardial effusion, cardiac

CRRT Nursing Care

ongoing assessment of fluid, electrolyte, & acid-base
mgmt ongoing assessment of all organ systems attend
to alarms from hemofilter & tubing monitor pt wt &
VS, body temp monitor capillary refill times watch
for S/S of clotting measure accurate I&O
monitor bleeding times monitor for S/S of