Renal Failure

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1. 
Acute Renal Failure
 
Sudden loss of renal function that may be reversible
 
2. 
Causes of acute renal failure
 
Illness, injury, or toxin that stresses the kidneys.
 
3. 
Classifications of acute renal failure
 
Prerenal, intrarenal and postrenal depending on the location of the illness in relation to the kidneys
 
4. 
Prerenal failure
 
Result of insufficient blood flow into the kidneys caused by shock, trauma, severe dehydration or cardiac disease
 
5. 
Intrarenal failure
 
Result of direct toxic or traumatic injury to the kidney
 
6. 
Postrenal failure
 
Results when an obstrucction from the lower urinary system causes backup of urine, which injures the kidneys
 
7. 
Chronic Renal Failure
 
Long, usually slow process that involves a progressive loss of nephrons (loss of more than 75% of nephrons in each kidney to cause obvious illness)
 
8. 
Chronic renal failure to ESRD
 
May take many years to progress from chronic renal failure to ESRD
 
9. 
Characterizatons of Chronic Renal Failure
 
Proteinuria, Nocturia, Hypertension, Sodium retention, Anemia, Dyspnea, Uremic symptoms, Nausea and vomiting
 
10. 
Proteinuria
 
Leaking of protein through the glomeruli in to the renal tubules, and then into the urine
 
11. 
Nocturia
 
Night time urination due to loss of the ability to concentrate the urine
 
12. 
Hypertension
 
High blood pressure
 
13. 
Sodium retention
 
Leading to edema, or water retention/swelling
 
14. 
Anemia
 
A shortage of red blood cells
 
15. 
Dyspnea
 
Difficulty breathing
 
16. 
Uremic
 
Symptoms such as fatigue, loss of appetite, sleep disorders, mental changes, itching and skin disorders
 
17. 
Nausea and vomiting
 
Occurs late in the course of renal failure
 
18. 
Diagnosing chronic renal failure
 
Symptoms may not arise until it is advanced. Regular blood tests for urea and/or creatinine can identify renal failure iin the early stages when treatment to slow its progress will be most effective
 
19. 
Stage 1 kidney failure
 

Mild renal insufficiency

Pt has few or no symptoms

 
20. 
Stage 2 kidney failure
 

Moderate renal insufficiency

Creatinine clearance is 50% normal

Few, if any symptoms
Anemia is present

 
21. 
Stage 3 kidney failure
 

Marked renal insufficiency

Creatinine clearance drops to 10-15% of normal

Few or no symptoms

Anemia is present

 
22. 
Treatment for stage 3 kidney failure
 

Phosphate binders, restricted protein diet, and prep. for dialysis or transplant

Oral bicarbonate supplements to help maintain normal acid/base balance and erthyropoeitin for control of anemia

 
23. 
Stage 4 kidney failure
 

ESRD

The creatinine clearance is 10mL/min or less

Uremic symptoms are present

Dialysis and transplant is needed to sustain life

 
24. 

Creatinine Clearance

 
a measure of the body's ability to remove waste from the blood
 
25. 
Stalling progression of kidney failure
 
BP control, medications and diet have been developed to slow the course of some forms of chronic renal failure
 
26. 
Causes of chronic renal failure
 
Diabetes, hyptertension, glomerulonephritis, cystic disorders or polyssistic kidneys, drug toxicity, interstitial nephritis, obstruction
 
27. 
Leading cause of ESRD
 
Diabetes (diabetic nephropathy)
 
28. 
Type 1 diabetes
 
body's immune system destroys the insulin-producing cells in the pancreas
 
29. 
Type 2 diabetes
 
body does not make enough insulin or cannot use insuling properly
 
30. 
Microalbuminuria
 

Presence of tiny amounts of albumin, or protein, in the urine

Sign of kidney damage (blood tests)

 
31. 
Complications of dialysis with diabetic pts
 
Diabetes can cause high bp, heart disease, small blood vessel disease that can cause leg ulcers andl imb loss, blindness, and digestive disorders which make treatment of kidney disease more complicated
 
32. 
2nd most common cause of ESRD
 
Hypertension (high bp)
 
33. 
Hyptertension symptoms
 
may cause no symptoms until it is very advanced, therefore many people are not treated until damage is done to the kidneys, heart, blood vessels and eyes
 
34. 
High BP and nephrons
 
High BP puts continuous stress on the nephrons, leading to loss of kidney function
 
35. 
Renal artery stenosis
 

Narrowed renal arteries

Can lead to hypertension by reducing blood flow to the kidneys causing kidneys to produce more of the substances that raise bp

 
36. 
Glomerulonephritis
 

inflammation of the glomeruli

damages the glomeruli, sometimes enough to cause chronic renal failure

 
37. 
Polycystic kidney disease (PKD)
 

inherited disease that causes large, fluid filled cysts to develop in the kidneys

cysts can become so large and numerous that normal kidney tissue is crowded out, therefore kidney function ceases (only 50% reach this point)

 
38. 
Drug toxicity
 

an increasing # of pt's need dialysis because of drug or medication use has destroyed their kidneys

NSAIDS, ibuproen, and naproxen if not taken correctly can cause kidney damage

 
39. 
Heroin nephropathy
 
the damage heroin can do to the renal system
 
40. 
Interstitial nephrititis
 

damage to the supporting structure of the kidneys

ex. allergic reaction to antibiotics

 
41. 
Obstruction
 
Malformation of the lower urinary tract caused by congenital anomalies (birth defects), kidney stones or scarring from infections can cause urine to back up into the structures of the kidney and injure them
 
42. 
Other causes of chronic kidney failure
 
collagen-vascular diseases (lupus), cancer, congenital defects, AIDS, and sickle cell disease.
 
43. 
Uremia
 

Urine in the blood

Pts whose kidneys are failing may have severe uremia and even pts with dialysis have some uremia since dialysis is only about 15% as effective as healthy kidneys

 
44. 
Symptoms of uremia
 

Pallor of the skin, edema, high bp, loss of appetite, nausea and vomiting, itching, restlessness, shortness of breath, fatigue and weakness, and mentan changes.

 
45. 
Pallor of the skin
 

yellow-gray appearance

caused by a pigment called urochrome, which is retained in the body instead of being excreted in the urine

 
46. 
People with long term renal failure almost universally suffer from 2 complicating conditions:
 

Anemia and renal osteodystrophy

Other complications:

pericarditis, electrolyte imbalance, nerve damage, amyloidosis, carpal tunnel syndrome, itching, sleeping problems, bleeding abnormalities and reproductive system changes

 
47. 
Anemia
 
shortage of RBCs and therefore a shortage of hemoglobin
 
48. 
Hemoglobin
 
protein component of RBCs that carries oxygen to all the cells in the body
 
49. 
Symptoms of anemia in renal patients
 
fatigue, dizziness, heart problems, disordered thoughts, erectile difficulties, and lack of energy
 
50. 
Causes of anemia in renal patients
 
inadequate amounts of erythropoietin, iron deficiency and vitamin deficiency
 
51. 
Erythropoietin (EPO)
 

a hormone produced by the kidneys that signals the bone marrow to make red blood cells

therefore, inadequate EPO results in a shortage of RBCs

 
52. 
Blood tests to assess anemia
 

Hemoglobin (measures oxygen carrying red pigment in RBCs)

Hematocrit (measure of RBCs in blood stated as a percent of RBC per total blood volume)

 
53. 
Maintaining Hemoglobin and Hematocrit in dialysis pts
 

regular administration of Epogen (epoetin alfa)

Pts must have an adequate amount of iron and vitamins to permit the Epogen to work (must monitor levels and prescribe vitamins as neccessary)

 
54. 
Iron deficiency
 

Iron is needted to make RBCs

Pts with renal failure lose iron containing blood with each lab test and dialysis treatment

"Blood loss=iron loss

Occult (hidden) blood loss (hemorrhoids, ulcers, improper anticoagulation (anticlotting) during dialysis)

Many dialysis pts need iron infusions

 
55. 
Vitamin deficiency
 

Vitamin B12, folic acid and pyridoxine promote good blood cell growth and maturity

Dialysis removes these vitamins along with the wastes

Many dialysis pts need vitamin supplements AFTER dialysis so they are not dialyzed out

 
56. 
Renal Osteodystrophy
 

Type of bone disease that occurs in renal pts because when kidneys fail, they stop making calcitrol, and they stop excreting excess phosphorus in the urine

Without calcitrol, calcium absorption from food is impaired

Because phosphorus is so abundant, it builds up in the body, even though it is not absorbed as well as before

 
57. 
If there is too little calcium and too much phosphorus in the blood:
 
a feedback mechanism kicks in to correct the problem: the parathyroid glands secrete PTH (PTH raises blood calcium levels) PTH triggers the kidneys to produce calcitrol so more calcium will be absorbed, and the calcium balance will be restored.
 
58. 
When failing kidneys cannot make calcitriol:
 

the parathyroid glands continue to pump out PTH to solve the problem

PTH acts on the bones to release needed calcium into the bloodstream so the body can function

Over long term, too much calcium is pulled out of the bones, and the bones become weak

 
59. 
Secondary hyperparathyroidism
 

overproduction of PTH due to renal failure

This is a cause of hyperparathyroid bone disease (bone remodeling rates are greatly increased. The bones are poorly mineralized and fractures may occur)

 
60. 
Pericarditis
 
inflammation of the membrane or sac that surrounds the heart
 
61. 
Effects of pericarditis
 
persistent pain in the center of the chest that may be relieved by sitting up and taking deep breaths
 
62. 
Treatment of pericarditis
 
After a period of thorough dialysis, symptoms should diminish, however some pts need surgery
 
63. 
Electrolytes
 

substances that break apart into ions, electrically charged particles, when dissolved in a fluid.

found in bodily fluids and inside cells and are involved in many basic cell functions, including the sending of important signals between different types of cells

 
64. 
Electrolyte Imbalance
 

Electrolyte levels in the body are normally controlled in part by the kidneys.

Renal failure can disturb the normal balance between elimination and reabsorption of electrolytes in the kidneys, and lead to imbalances. This can have serious effects on many body functions

 
65. 
Most important electrolytes to consider in uremic pts
 
Sodium, potassium, calcium, phosphate, magnesium, and bicarbonate
 
66. 
Sodium
 
Important for maintaining the body's water content and fluid balance and plays a role in regulating the acid-base status of the body
 
67. 
Hypernatremia
 

higher than normal level of sodium in the blood

can cause edema (accumulation of water in various tissues), crenation (shriveling) of RBCs

 
68. 
Symptoms of hypernatremia
 
excessive thirst, high bp, headaches, confusion, seizures and coma
 
69. 
hyponatremia
 

low blood sodium levels

Water moves into cells, RBCs may swell to the point of hemolysis (bursting)

 
70. 
Symptoms of hyponatremia
 
low bp, muscle cramping, headaches, nausea, vomiting, tremors, seizures and coma
 
71. 
Potassium
 

major role in function of nerves and muscles, including contraction of heart muscle

Most of bodys potassium is found in muscle cells

 
72. 
Hyperkalemia
 

is a high level of potassium in the blood

can cause serious or even fatal changes in the heart rhythm

 
73. 
Symptoms of hyperkalemia
 

extreme muscle weakness, abnormal heart rhythms

sometimes no warning signs before cardiac arrest

 
74. 
Hypokalemia
 

lower than normal blood potassium level

unusual in kidney pts, but could happen if pt has vomiting and diarrhea or too much removed by dialysis

 
75. 
Symptoms of hypokalmia
 
fatigue, muscle weakness, paralysis, respiratory failure, abnormal heart rhythms and cardiac arrest
 
76. 
Calcium
 

found in the body within the bones and teeth

Small amounts of calcium is vital for regulating many cell activities including blood clotting, enzyme regulation, hormone action and function of nerves and muscles

 
77. 
Hypercalcemia
 

Presence of high levels of calcium in the blood

Pts may have loss of appetite, nausea, vomiting, and abdominal pain, central nervous system may also be affected, and the pt may experience confusion, irritability, delierium, and even coma

 
78. 
Hypocalcemia
 

low blood calcium levels

primarily affecgts the nervous system

pt. may have dementia, depression, numbness, seizures, tetany (muscle spasms and pain), high levels of pth contributing to bone disease in renal failure

 
79. 
Phosphate
 
important structural component of cell membranes and bones, and many essential cellular reactions (especially those involved with energy metabolism) depend on phosphate
 
80. 
Hyperphosphatemia
 

High blood phosphorus levels

Leads to itching, bone damage and 2ndary hyperparathyroidism

Asymptomatic until late in the disease

 
81. 
Hypophosphatemia
 

below normal phosphate in the blood

Muscle weakness and osteomalacia (softening of the bones) as well as more serious neuromuscular problems and come

Asymptomatic until late in the disease

 
82. 
Magnesium
 
required for many cellular reactions such as synthesis of proteins, fats, and carbs and plays an important role in contraction of muscles
 
83. 
Hypermagnesemia
 

High blood magnesium levels may be seen in pts who take meds containing mg.

Interferes with the transmission of nerve impulses, leading to loss of reflexes, low bp, respiratory depression and sleepiness.

 
84. 
Bicarbonate
 

base reabsorbed by the kidneys that helps maintain normal body pH by neutralizing the acids that are formed when proteins are broken down and used by cells.

In kidney pts, the acid-base buffering system is disturbed, and there is a relative lack of bicarbonate

 
85. 
Bicarbonate deficit
 

causes the condition known as metabolic acidosis, or high blood acid levels

the main symptom of metabolic acidosis is deep, rapid breathing, which is the bodys way to compensate for the build-up of acids in the bloodstream.

 
86. 
Neuropathy
 

Nerve damage

Build up of waste produts in the blood from inadequate dialysis or problems with their vascular accesses

 
87. 
Symptoms of neuropathy
 

tingling, burning, numbness, weakness, and pain in the hands and feet

In most cases can be treated with dialysis and adherence to diet

 
88. 
Amyloidosis
 
condition in which amyloid (starch like protein substance) deposits in the bones or joints cause pain, carpal tunnel syndrome and arthritis like symptoms
 
89. 
Carpal Tunnel Syndrome
 

painful condition of the hand caused by compression of nerves in the wrist

Symptoms: pain, numbness, tingling and limited movement of the hand

Due to vascular access complications or amyloidosis

 
90. 
Itching
 
Severe and persistent itching or pruritus may develop due to dry skin, build up of calcium or phosphorus in the skin
 
91. 
Sleeping problems
 
Restlessness and the inability to sleep (insomnia) caused by calcium and phos imblances, stress of illness, anemia, depression, and/or build up of wastes in the body
 
92. 
Bleeding abnormalities
 

due to complex bloo factor changes

Signs include easy bruising, GI bleeding ,blood in stools, nose bleeds, etc.

Can be minimized with consistent and effective dialysis (watch heparin)

 
93. 
Reproductive system changes
 
Fertility may be reduced, men impotent, women may stop menstruating