Chapter 28 Kidney Disorders
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| Age-related changes in kidney function | Increased resistance to ADH
Kidneys less able to concentrate urine
Potassium excretion decreased
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| Symptoms of pt with renal tumor | - Often asymptomatic
- Gross hematuria
- Flank pain
- Palpable abdominal mass
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| Systemic manifestation of renal tumor | - Fever without infection
- Fatigue
- Weight loss
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| Kidney Cancer (Renal Cell Carcinoma) | - Most common type of kidney cancer
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| Systemic effects of Renal Cell Carcinoma | - Anemia
- Erythrocytosis
- Hypercalcemia
- Liver dysfunction w/elevated liver enzymes
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| Kidney cancer often occurs in which age of patients? | 55-60 years of age
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| Major concern for surgical treatment of kidney cancer | Blood loss during and after surgery
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| Monitor post surgical kidney cancer patients for | Hemorrhage and adrenal insufficiency
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| What is used for targeted therapy in renal cell carcinoma? | Nexavar and Torisel
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| Kidney Failure | Kidneys unable to effectively remove accumulated metabolites from the blood
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| Kidney Failure | Leads to altered fluid, electrolyte and acid-base balance
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| Renal replacement therapy | Hemodialysis
Peritoneal dialysis
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| Intermittent hemodialysis | Blood taken from patient and pumped to dialyzer (ultrafiltration)
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| Complications of intermittent hemodialysis | Hypotension, bleeding and infection
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| Nonsurgical management of kidney cancer | Radiofrequency ablation can slot tumor growth
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| Kidney cancer | Chemo has limited effectiveness against this cancer type
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| Nonsurgical management of kidney cancer | Interleukin-2 and tumor necrosis factor (TNF) lengthens survival times
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| Interleukin-2 | Protein that regulates the activities of white blood cells that are responsible for immunity
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| Tumor necrosis factor (TNF) | Superfamily of cytokines that can cause cell death
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| Cytokines | Any of a number of substances, such as interferon, interleukin, and growth factors, that are secreted by certain cells of the immune system and have an effect on other cells
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| Nexavar (Sorafenib) | Used to treat kidney, liver, and thyroid cancer. (Chemotherapy medication)
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| Torisel (Temsirolimus) | Used to treat advanced kidney cancer. (Chemotherapy medication)
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| Complications of surgical procedure for kidney cancer | Decreased blood pressure
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| Diagnostic tests for kidney cancer | - Renal ultrasonography
- CT scan
- Chest x-ray, bone scan, MRI, liver function studies
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| Continuous renal replacement therapy (hemodialysis) | - Porous hemofilter for 8-12 hrs
- CVVH - Continuous venovenous hemofiltration
- CVVHD - Continuous venovenous hemodialysis
- CVVHDF - Continuous venovenous hemodiafiltration
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| Long-term vascular access devices for hemodialysis | - Ateriovenous fistula (AVF)
- Ateriovenous graft
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| Temporary vascular access devices for hemodialysis | - Hemodialysis catheter (dual/triple lumen)
- Ateriovenous shunt
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| Complications of access devices | - Thromboses
- Clotting of AV access
- Graft fail
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| Most common type of peritoneal dialysis | - CAPD (Continuous ambulatory peritoneal dialysis)
- CCPD (Continuous cycling peritoneal dialysis)
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| CAPD | Not attached to pt. Pt able to ambulate.
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| CCPD | Pt attached to cycler at night while sleeping. Exchange takes 8-10 hours.
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| CAPD or CCPD | Less effective but more continuous metabolic clearance (avoids fluctuations)
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| Complications of peritoneal dialysis | - Peritonitis
- Body image disturbance
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| Chronic Kidney Disease | Prevalent among people 65 and older
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| Pathophysiology of Chronic Kidney Disease | - Glomerulosclerosis; hardening of the glomerulus in the kidney
- Interstitial inflammation: swelling between the kidney tubules
- Fibrosis: thickening and scarring of connective tissue
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| Chronic Renal/Kidney Disease | - Gradual irreversible kidney damage and loss of function
- Eventually unable to function adequately, leading to ESRD
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| Leading cause of End-Stage Renal Disease (ESRD) | Diabetes
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| Stages of Chronic Kidney Disease (CKD) | - Decreased renal reserve
- Renal insufficiency
- Renal failure
- ESRD
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| Early-stage CKD manifestations | - Proteinuria, hematuria, polyuria, nocturia
- Dehydration
- Fixed specific gravity: SG of 1.010 regardless of fluid intake
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| Manifestations of CKD | - Uremia, nausea, apathy, weakness, fatigue
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| Fluid and electrolyte effects of CKD | - Proteinuria, hematuria, hyperkalemia
- Metabolic acidosis
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| Cardiovascular effects of CKD | - CVD leading cause of death
- Accelerated atherosclerosis
- Systemic hypertension
- Pericarditis
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| Hematologic effects of CKD | - Anemia
- Epistaxis: nose bleeds
- GI bleeding
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| Immune system effects of CKD | - Increased risk of infection
- Fever suppressed
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| GI effects of CKD | - Anorexia, nausea, and vomiting
- Hiccups, gastroenteritis frequent
- Uremic fetor
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| Neuro effects of CKD | - CNS changes
- Peripheral neuropathy
- Restless leg syndrome
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| Musculoskeletal effects of CKD | - Renal osteodystrophy (rickets)
- Bone tenderness, pain, fractures
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| Endocrine and metabolic effects of CKD | - Reproductive function impaired
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| Derm effects of CKD | - Pallor, yellowish hue to skin
- Uremic frost: crystallized urea deposits on skin of pt w/CKD
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| Diagnostic tests for CKD | – Urinalysis, urine culture
– BUN, serum creatinine
– eGFR
– Serum electrolytes
– CBC
– Renal ultrasonography
– Kidney biopsy
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| Treatment Medications for CKD | – CKD affects the pharmacokinetic/pharmacodynamic effects
of drug therapy.
– ACE inhibitors and ARBs (angiotensin II receptor blockers)
– Diuretics or other loop diuretics
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| Treatment Medications for CKD | – Drugs to manage CV disease, electrolyte imbalances/acidosis
– Folic acid and iron supplements
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| Nutrition and fluid management for CKD | – Prevent protein-calorie malnutrition
– Regulate, restrict sodium intake
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| Hemodialysis | - Occurs in dialysis center
- Usually 3 times/wk (9-12 hrs/week)
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| Hemodialysis | - Most common therapy for ESKD.
- Removes excess fluids and waste and restores chemical and
electrolyte balance by passing patient’s blood through an
artificial semipermeable membrane.
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| Post-dialysis care | – Monitor vital signs and weight for pre-procedure comparison.
– Avoid invasive procedures 4 to 6 hours after dialysis.
– Continually monitor for hemorrhage
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| Post-dialysis complications | – Dialysis disequilibrium syndrome
– May develop after initial, rapid HD has been completed
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| S&S of Dialysis disequilibrium syndrome | - HA, N&V, restlessness, Dec LOC, inc intracranial pressure,
seizures
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| Post-dialysis complications | - Infectious diseases – most serious:
- Hepatitis B and C infections
- HIV exposure—poses some risk for clients undergoing dialysis
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| Peritoneal Dialysis (PD) | - Uses body’s own peritoneal membrane which lines the
abdominal cavity as the semi-permeable membrane to filter out
excess fluids and electrolytes and end-products of metabolism
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| Complications of PD | - Peritonitis – major complication
- Pain
- Exit site and tunnel infections
- Poor dialysate flow – re constipation
- Dialysate leakage
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| Nursing Care During PD | - Before treating, evaluate baseline VS, wt, and lab tests.
- Continually monitor for respiratory distress, pain/discomfort.
- Monitor prescribed dwell time and initiate outflow.
- Observe the outflow amount and pattern of fluid.
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| Kidney transplant | - Treatment of choice for patients with ESRD
- Improves quality of life
- Most obtained from deceased donors
- Meet criteria for brain death
- Less than 60 years old
- Free from disease, malignancy, infection
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| Kidney transplant | - Renal artery, vein, ureter anastomosed
- Immunosuppressive drugs minimize response to reject organ.
- Hypertension possible complication
- Infection is a continuing threat
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| Health promotion for kidney transplant | - Kidney disease prevention
- Diabetes and hypertension management
- Treatment of infections
- UTI prevention
- Maintenance of proper blood pressure and blood glucose levels
- Hydration of patients with compromised renal function
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