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Renal Disease

Chapter 47-Acute & Chronic Renal Disease

What is Azotemia? Accumulation of nitrogenous waste products (measured by BUN & Creatinine)
What is Uremia? Renal function declines and causes systemic symptoms
What is Oliguria? <400mL urine in 24 h
Three types of acute kidney injury Pre-renal: before blood gets to kidney; hypovolemia, hypotension, no profusion to kidney (i.e., code pt.) Intrarenal: direct damage to renal tissue by medications (nephrotoxins), renal artery stenosis, CT dye Post renal: obstr to urine (kidney stone)
What is Acute Tubular Necrosis? Tubules in kidney become necrotic, sloth off and block tubes
What is the initiating phase of acute kidney injury? time of insult until S&S appear
When does the oliguric phase of acute kidney injury occur? 1-7 days onset, can last 2 wks or longer
What urinary chgs take place in oliguric phase? Fixed specific gravity (1.010); casts in urine (tubular necrosis, sloughing off)
What FVE symptoms occur in oliguric phase? edema, jugular venous distention (JVD), crackles, HTN
Why does Metabolic Acidosis occur in oliguric phase? kidneys producing decrease amount of bi carb
How to treat Na balance and K excess in oliguric phase? Na may be normal or decreased (may be diluted b/c of fluid retention) Treat K is >6 or if pt symptomatic
What hematologic disorders occur in the oliguric phase? Anemia, altered WBC function--puts at risk for infection
What neurological disorders in oliguric phase? fatigued, decreased concentration, can lead to seizures and coma
What is the diurectic phase? "getting better" phase; gradual increase in urine output, kidneys can excrete waste, but cannot concentrate urine--putting out 1-3L/day Watch for hypovolemia, decrease bp, can last 1-3 wks
What is the recovery phase? increase GFR, renal function may take up to 12 mos to stablize; kidneys are very finicky...do not recover quickly
What are diagnostics for Acute Renal Failure? Depend of precursors--if pre-renal, pt may be dehydrated, push fluids & see if kidneys respond Intrarenal: UA-look for casts, proteins, WBC, RBC, Na; can do renal biopsy, CT, ultrasound
What is collaborative care for acute renal failure? 1)need to manage bp; if kidneys are failing they will be hypertensive, but if cause is pre-renal, they may be hypotensive. If fluids don't work at first, pull back and put on fluid restriction 2)treat hyper K, 3) dialysis
What are indications for dialysis? Volume overload: not producing enough urine, need cardiac or pulmonary compromise Hyper K: meds not working; getting EKG chgs Bi carb of <15-metab acidosis BUN >120 Chg in mental status Cardiac issues, hx cardiac issues to get volume off & cleanse b
Created by: divelmama