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renal basics
pathophysiology
| Question | Answer |
|---|---|
| structures in renal parenchyma responsible for initial formation of urine | nephrons |
| If function of neurons is less than ____ of normal, renal replacement therapy may be needed. | 20% |
| Normally is 1200 ml/minute | GFR |
| Reabsorbs about 98-99% with waste excreted at 1-2 ml/min (urine) | GFR |
| Controlled by BP & blood flow | GFR |
| By age 65, GFR has ↓ by 50%. If DM or hypertension, the percent will be higher. | GFR |
| Regulates F & E balance | kidneys |
| _______ of_________concentrate or dilute urine as needed (water, Na+, K+, Cl-, Ca+, phosphorus, creatinine, uric acid, Mg+, HCO3, glucose, urea, & other wastes). | Tubules of nephrons |
| If dehydrated → ____ released in posterior pituitary → distal tubules reabsorb, not excrete substances | ADH |
| If overhydrated →____ not released→ substances excreted | ADH |
| kidney is primary organ of | acid-base balance |
| kidneys secrete hydrogen ions into urine & hold bicarbonate | metabolic acidosis |
| kidneys hold hydrogen ions & secrete bicarbonate | metabolic alkalosis |
| water follows ___ to maintain osmotic balance | Na+ |
| Regulation depends on aldosterone (released from adrenal cortex) which is under the control of angiotension II | Na+ |
| kidneys excrete more than 90% of total | K+ |
| Aldosterone causes the kidneys to excrete | K+ |
| Acid-base balance, dietary K+ intake & filtration of K+ influence the amount of | K+ secreted in the urine |
| reabsorbed by kidneys; parathyroid hormone responds to a drop in serum | Ca+ |
| by increasing reabsorption of bone & absorption of Ca+ from small bowel. | Ca+ |
| is also reabsorbed by kidneys; if serum levels high will excrete phosphate. | phosphorous |
| is necessary for the GI system to absorb Ca+ & deposit in the bones. | vitamin D |
| The kidneys activate | vitamin D |
| Ca+ & phosphate bind together to cause Ca+ to be released from the bones → bone demineralization. | without vitamin D |
| Produces erythropoietin -stimulates bone marrow to produce RBC’s. | kidneys |
| develops without erythropoietin. | anemia |
| control of arterial BP & for proper function of glomerulus | Renin |
| Expected laboratory findings of renal dysfunction: | Urine – blood & protein Smoky brown color If low levels of protein & albumin, causes edema BUN/creatinine ratio- both ↑ at the same rate |
| normal= 0.5-1.2 mg/dL | BUN |
| normal= 10-20 mg/dL | Creatinine |
| Expected intervention for renal dysfunction: | 24 hour urine for creatinine clearance |
| (3.5- 5 mEq/l) | Potassium |
| S/S: cardiac dysarrhythmias, dizziness, weakness, muscle cramps, N, V, D | potassium |
| sodium polystyrene (Kayexalate)- PO or PR regular insulin with dextrose IV calcium gluconate IV low K+ diet | treatment for potassium |
| normal (136-145 mEq/l) | Na+ |
| S/S: muscular weakness & twitching, mental confusion, anxiety | sodium |
| Rx: diuretics, fluid & Na+ restriction | treatment of sodium |
| normal(3- 4.5 mg/dl) | phosphate |
| S/S: demineralization of bones, metastatic Ca+ deposits | phosphate |
| Phosphate-binding agents- calcium carbonate (Tums), sevelamer (Renagel) Vitamin D low phosphorus diet | treatment of phosphate |
| normal(9-10.5 mg/dl) | Ca+ |
| S/S: Abdominal cramps, tingling in fingers, spasms in feet & wrists | Ca+ |
| Vitamin D, calcium supplements, low phosphorus & high calcium diet | treatment for Ca+ |
| normal(7.35-7.45) | Arterial blood pH |
| normal(22- 26 mEq/l) | Arterial blood bicarbonate |
| S/S: Kussmaul respirations | metabolic acidosis |
| bicarbonate supplements | treatment of metabolic acidosis |
| (n= 1.3- 2.1 mEq/l) | magnesium |
| S/S: neuromuscular irritability | magnesium |
| avoid antacids & laxatives containing magnesium (dementia, osteomalacia) | treatment of magnesium |
| see more in CKD unless hemorrhagic blood loss or lysis of RBCs) | Hemoglobin/hemotocrit |
| S/S: pallor, weakness, SOB, dizziness, lethargy | decreased hemoglobin/ Hct |
| opoetin alfa (Epogen, Procrit)- erythropoietin therapy | treatment of hemoglobin/ Hct |
| S/S of ARF: | HTN,Edema,wt gain,Anorexia, N&V&D or constip.CVA tenderness,tingling extremities, hand tremors,irritability, restlessness, HA,lethargy, drowsiness, stupor, coma,Pallor,ecchymosis, epitaxis Stomatis Thick, tenacious sputum Oliguria, anuria |
| S/S of CRF (CKD): | sezures,coma,tremors,ataxia,paresthesias,cardiomyopathy,CHF,pericarditis,peri.effusion,anemia,abnormal blding,hallotosis,NVD,metallic tste,GI,stomatitis,yellow-gray pallor,uremic frost,dry skin,itch,ecchymosis,muscle wknss&crmpin,bone pain,fractures,impot |
| Urinary S/S of CRF (CKD): | Urinary- proteinuria, hematuria Early- polyuria & nocturia Late- oliguria, anuria |
| accumulation of nitrogenous waste products in the blood | Azotemia |
| azotemia + clinical symptoms | Uremia |
| Dietary therapy for CKF | very restrictive; to help maintain renal function as long as possible & delay dialysis Diet is “better” after on dialysis Dietitian to consult & calculate caloric & fluid requirements |
| (40 g/day or 0.6 g/kg/day; if on dialysis 1-1.5 g/kg) | protein |
| uremia caused by buildup of waste products from the breakdown of _________ | protein |
| usually 60-90 mg/day | sodium |
| usually 1500 mg/day | potassium |
| usually 500-1000 mg/day | phosphorus |
| usually limited to urine output plus 500 ml/day | Fluids |
| to increase urine output | Diuretics |
| act on glomerulus & tubular system | Osmotic diuretics |
| IV drug that causes rapid diuresis Use filter needle SE- severe dehydration | Mannitol (Osmitrol) |
| act on cortical diluting site of ascending limb of Loop of Henle | thazide diuretics |
| hydrochlorothiazide (HCTZ, Hydrodiuril) chlorthalidone (Hygroton) metolazone (Zaroxolyn | thazide diuretics |
| act on ascending limb of loop of Henle | Loop diuretics |
| furosemide (Lasix) bumetanide (Bumex) | Loop diuretics |
| act on distal convoluted tubule | Potassium-sparing diuretics |
| spironolactone (Aldactone) amiloride (Midamor) | Potassium- sparing diuretics |
| catecholamine that causes release of norepinephrine | Dopamine (Intropin) |
| 0.5-2 mcg/kg/min.-dopamine | produces renal vasodilation |
| 2-10 mcg/kg/min.- dopamine | produces cardiac stimulation & renal vasodilation |
| doses >10 mcg/kg/min- dopamine | causes renal vasoconstriction |
| BP, P & R every 5-15 minutes | if cardiac dose of dopamine |
| phentolamine (Regitine) injected around & in site | if infiltration of dopamine |
| Interventions of dopamine | Weigh daily Monitor vital signs Daily labs “Renal” diet Strict I&O Meds- diuretics, antihypertensives Renal replacement therapy |
Created by:
minimouse74
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