Renal Failure

Total Flash Cards » 93
 
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