Disorders of the Kidneys
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| What do changes in the glomeruli interfere with in the PT with nephrotic syndrome? | Changes in the glomeruli interfere with permeability, allowing protein loss through the kidney
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| What incites Nephrotic Syndrome? | upper respiratory infection or allergic reaction.
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| What maintains serum osmotic pressure? | Protein (More specifically Albumin)
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| What does a loss of serum protein result in? | decreased serum osmotic pressure, allowing fluid to seep into interstitial spaces resulting in edema and decreased intravascular volume
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| What is a major cause of morbidity and mortality in PTs with Nephrotic Syndrome? | Infection
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| Why is infection an increased threat in a PT with nephrotic syndrome? | Immune responses are decreased in nephrotic syndrome
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| What characterizes nephrotic syndrome? | *Marked proteinuria *Hypoalbuminemia *Edema
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| How does the urine appear in a PT with nephrotic syndrome (nephrosis)? | Foamy from the presence of protein
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| What diet will a PT with nephrotic syndrome (nephrosis) be pplaced on? | Low-sodium, High-protein (meat, fish, poultry, cheese, eggs)
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| What is Acute Glomerulonephritis? | An inflammatory process of the kidneys usually preceded by an infection or other pre-existing disease (i.e., systemic lupus erythematosus)
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| Who does Acute Glomerulonephritis occur most in? | Children and young adults
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| List 3 clinical manifestations of Acute Glomerulonephritis. | *Periorbital edema and visual disturbances *Generalized edema, exertional dyspnea *Hematuria or other urinary disfunction *pain/tenderness in flanks *Cerebral involvement and altered mental status *HTN, CHF, distended neck veins
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| What is the diet for a PT with Acute Glomerulonephritis? | Low protein, low sodium
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| What drug types are given for Acute Glomerulonephritis? | Diuretics, Anti-HTN, Corticosteroids, Immunosuppressants, Iron and vitamins
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| Why is the PT with Acute Glomerulonephritis given a low sodium/low protein diet? | to decrease blood urea levels.
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| What becomes the main energy source for a Acute Glomerulonephritis PT on a low sodium/low protein diet? | Carbohydrates
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| What are signs and symptoms of worsening glomerulonephritis that need to be evaluated by a physician? | *Hematuria *Headache *Edema *Hypertension
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| What is Chronic Glomerulonephritis associated with? | with clients with multiple episodes of acute glomerulonephritis and autoimmune connective tissue disorders
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| When do the symptoms of Chronic Glomerulonephritis become apparent? | When kidney damage is severe
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| What systemic issues can Chronic Glomerulonephritis lead to? | *Hyperkalemia *Anemia *Hypoalbuminemia. *Metabolic acidosis *Hypomagnesemia
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| What may be done to determine the severity of renal involvement in the PT with glomerulonephrosis? | Kidney biopsy
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| If the PT with Acute/Chronic Glomerulonephritis suffers from edema or HTN, what must they be placed on? | Bedrest until edema/HTN is controlled
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| True or False: Acute renal failure is reversable with early intervention | True. Often reversible in a majority of clients with early intervention.
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| List 4 causes of acute renal failure | *Thrombosis of the renal arteries *Severe, prolonged hypotensive episodes *Loss of intravascular volume *Blood transfusion reactions *MI/CHF *Nephrotoxins *Crushing injuries
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| List 4 nephrotoxic drugs | *Cephalosporins *Aminoglycoside *Amphotericin B *Lithium *Cimetidine *Ibuprofen *Chemo-therapy
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| Diabetes Mellitus contributes to what percentage of cases of acute renal failure? | 40% of cases
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| What are the three phases of acute renal failure? | *Oliguric *Diuretic *Recovery
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| What percentage of cases of acute renal failure occure in the pre-renal area? | 40-70%
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| What percentage of cases of acute renal failure occure in the renal area? | 20-50%
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| What percentage of cases of acute renal failure occure in the post renal area? | 10-20%
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| How long can the oliguric phase of acute renal failure last? | 4-6 weeks
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| What characterizes the oliguric phase of acute renal failure? | Increased BUN and serum creatinine, decreased urine output, Metabolic acidosis, and Hyperkalemia.
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| What can the hyperkalemia from acute renal failure cause? | life-threatening dysrhythmias
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| If acute renal failure is caused by hemorrhage, will it lead to a fluid volume deficit or overload? | Volume deficit
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| If acute renal failure is caused by heart failure, will it lead to a fluid volume deficit or overload? | Volume overload
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| True or False: Oliguria is always a defining factor in acute renal failure | False. Nonoliguric renal failure also exists with urine output exceeding 2 liters/day
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| What characterizes the diuretic phase of acute renal failure? | *Polyuria (May exceed 2L/day) *Hypokalemia *Hypocalcemia *Hyperphosphatemia
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| What characterizes the recovery phase of acute renal failure? | Kidneys return to normal or near normal function.
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| How long can the recovery phase of acute renal failure take? | May take up to one year
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| List 4 clinical manifestations of acute renal failure | *Anorexia *N/V/D *Oliguria *Hematuria *Proteinuria *Lethargy *Muscle twitching and convulsion *Anasarca, edema
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| What activates the renin-angiotensin-aldosterone system (retaining Na+ and h2o leading to increased vascular resistance)? | Decreased renal blood flow
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| What test results will confirm a Dx of acute renal failure? | Elevated serum BUN and creatinine (azotemia) will confirm a diagnosis
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| Acute renal failure can cause decreased erythropoietin, which can lead to what? | Decreased hemoglobin and hematocrit
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| What kind of diet should a PT with acute renal failure be put on? | Low protein/potassium/sodium, high carbohydrate diet
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| What is used to manage fluid overload and treat electrolyte imbalances when drug therapy is unsuccessful? | Renal dialysis
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| What are signs of worsening acute renal failure? | *Decreased alertness *Confusion *Headache
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| Up to what percentage of renal function may be lost in a PT with chronic renal failure before symptoms are noticed? | up to 80%
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| What is the terminal stage of chronic renal failure called? | Uremia
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| Define uremia: | a toxic state characterized by a marked accumulation of urea and other nitrogenous waste products in the blood
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| What is Uremic halitosis? | Urine smelling breath
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| What is Uremic frost? | Urine smelling skin
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| What causes uremic halitosis/frost | Bodies inability to clear waste products from the kidneys, so they are excreted through the skin and lungs
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| What are notable clinical manifestations of end stage renal failure? | *Anuria *Pulmonary edema, pneumonia, apnea or Cheyne-Stokes respirations *Uremic pericardial effusion - fluid surrounding the heart *Dusty yellow-tan or gray skin *Uremic halitosis, uremic frost *May progress to seizures and coma
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| What procedures are done to determine the level of function and degree of damage in renal failure? | *Intravenous pyelogram (IVP) *Intravenous urography (IVU) *Renal biopsy
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| Patients with iron-deficiency anemia must be treated with what before receiving Epogen (synthetic erythropoieten)? | Ferrous Sulfate (Iron)
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| List four medications that patients with chronic renal failure are prescribed: | *Electrolyte replacements (Mg, Ca) *Diuretics (Lasix) *Antihypertensive agents *Anticonvulsants
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| Define hemodialysis: | process by which blood is circulated with dialysate through a semi-permeable membrane to remove nitrogenous waste products, control fluid and electrolyte balance and maintain acid-base balance
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| Does hemodialysis work by diffusion or osmosis? | Trick question. Works by diffusion (movement of electrolytes) and osmosis (movement of water) from an area of higher to lower concentration
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