AHN TEST 1
Creatinine
0.6-1.2 mg/dL
Blood Urea Nitrogen (BUN)
10-20 mg/dL
Stages of CKD (GFR)
1: >90 2: 60-89 mild 3: 30-59 moderate 4: 15-29 severe 5: <15 or dialysis
Chronic Kidney Disease (CKD) aka Chronic Renal Failure (CRF) aka End Stage Renal Disease (ESRD
75% lost before symptoms manifest Progressive/irrevocable loss of nephrons
CKD prevention
ACEI/ARB BG/BP control Evaluate CV R/F
Infra-Renal Acute Renal Failure
Acute glomerulonephritis Acute Tubular Necrosis (ATN) Drug-induced: Contrast media, ACE inhibitors, bactrim, renal stenosis/thrombosis
Primary glomerular disease
Acute/chronic glomerulonephritis Nephrotic syndrome
AKI risk increase with
Advanced age Atherosclerosis HTN Liver/heart failure Diabetes
Congenital obstruction
Anatomical malformation
Acute glomerulonephritis Tx
Antibiotics Temp dialysis Education of diet Plasmapheresis
Cystitis (bladder infection)
Bacterial invasion (E.coli most common) Catheterization Sexual activity Poor hygiene Contraception
Glomerular filtration rate (GFR)
Best indicator of kidney function
Acute Pyelonephritis Manifestation
Burning, urgency, frequency of urination Fever/chills Flank, back, loin pain CVA tenderness
Acquired obstruction
Calculi Tumors
Mixed Incontinence
Combo of stress, urge, overflow, and incontinence Common in older women Disrupt ADLs
incontinence
Common in women NOT normal part of aging
Pre-renal acute renal failure
Decrease in blood volume/perfusion =decreased GFR
AKI clinical manifestations Hallmark signs
Decreased UOP Elevated Creatinine
CKD risk factors
Diabetes HTN
Incontinence neurogenic bladder
Disruption in nervous control of micturation Stroke Parkinsonism Spinal cord injuries/defect
Peritoneal Dialysis (PD)
Done daily Poor vascular access Older adults Can't tolerate anticoagulation
Acute Pyelonephritis Tx
Dx via UA, UC Clean catch WBC, bacteria, RBCs, nitrates
Chronic Glomerulonephritis circulatory overload
Edema Weight gain JVD Crackles
RCC Patho R/F
Exposure to heavy metals HTN Obesity Smoking
Nephron (functional unit of the kidney)
Filtration Reabsorption Secretion
Long term HD
Fistula (2-4 Months) Gortex graft (mature 1-2 weeks)
Chronic Pyelonephritis Manifestation
Flank pain less than acute Symptoms minimal
ESRD/CRF clinical manifestation
HTN Edema Heart failure Anemia Hematuria/oliguria Bone pain
Cystitis manifestations
Hematuria Odor/cloudy urine
RCC Manifestations
Hematuria- late sign Palpable abd mass CVA tenderness asymptomatic until late
Obstruction Patho
Hydrostatic pressure increases proximal to obstruction Dilation follows reduction in GFR
Obstruction manifestation
Hydroureter Hydronephrosis Thickening of bladder wall
Nephrotic syndrome manifestation
Hypoalbuminemia Hyperlipidemia
RCC staging
I: Tumor in capsule II: Invades perirenal fat III: Renal vein/lymphatics IV: Lungs, heart, bone, liver
AKI Prevention
Identify r/f Nutrition Treat hypoperfusion promptly
Renal Transplanation
Immunosuppressive therapy (lifetime)
Secondary glomerulopathies
Injury from drug exposure, infection, systemic or vascular pathology
Renal tuberculosis (Most common TB site outside the lungs)
Invades kidneys through bloodstream
Treatment Goals
Maintain normal volume state (daily wgt) Support nutritional needs Prevent/treat acid-base/electrolyte abnormalities, anemia, uremia
nephrotic syndrome etiology
Massive loss of protein into urine Severe proteinuria 3.5g/24 hour
BUN (renal function)
Measures hydration Reflect: Diet, GI bleeding, tissue breakdown, protein
CKD complications
Metabolic acidosis Malnutrition Uremic syndrome
Nephrotic syndrome Tx
Mild diuretics Cholesterol lowering drugs ACE inhibitors Immunosuppressive therapy Treat underlying condition
Glomerulus (site of fluid filtration from blood to nephron)
More permeable Prevent transports of blood/protein 125 mL/min
RCC treatment
Nephrectomy Chemotherapy Ablation Cryoablation
Obstruction Tx
Nephrostomy tube Stent Remove stone
Normal Micturation (emptying of bladder)
Normal bladder capacity 400-500mL Urge to void 150-300mL Post-void residual 50mL
Interventions/Treatment CRF
Nutrition therapy (Protein, Na+, K+, P+ restriction) Fluid volume (restriction) BP control
Post-Renal Acute Renal Failure
Obstruction of urine outflow Causes: BPH, kinked/obstructed catheters, tumors, strictures, calculi Easiest to treat
Renal cell carcinoma (RCC)
Occurs more in men Higher occurrence in AA Expose to metals
Stages of AKI
Oliguric, diuretic, recovery (normal creatinine is marker for full recovery)
Primary glomerulopathies
Only involves kidney
AKI treatment
Optimize bp Manage fluid status Support other body systems
Functional incontinence
Physical/environmental limitations prevent access in time
Acute Renal Failure (Acute Tubular Necrosis or AKI)
Potentially reversible Abrupt deterioration of renal function
Acute Renal Failure categories
Pre-renal Infra-renal Post-renal
Incontinence R/F
Pregnancy Altered LOC Immobility Diabetes Spinal cord injuries UTI
Cystitis Tx
Prevention Antibiotic therapy
Chronic glomerulonephritis
Progress into chronic end stage renal disease
Acute glomerulonephritis
Proteinuria/Hematuria Dark urine Increased BUN/creatinine Edema
Creatinine (renal function)
Reflects GFR Only renal disease increases levels Most use for recognizing AKI
Hormonal Regulation of Kidney
Renin Angiotensin II Aldosterone Prostaglandins Bradykinin Erythropoietin Vitamin D
Function of Renal system
Rid body of water-soluble waste Activation of Vitamin D to increase calcium absorption Production of erythropoietin Acid-base balance Fluid & electrolyte balance
Secondary glomerular disease
SLE Goodpastures's syndrome Amyloidosis Diabetic glomerulopathy Hep A/C Cirrhosis SCD Multiple myeloma
Catheter Associated Urinary Tract Infections (CAUTIs)
Sentinel events; not reimbursed
Chronic Glomerulonephritis treatment
Slow disease progression Change diet Drug therapy Maintain sufficient fluid intake
Chronic Glomerulonephritis Uremic assessment
Slurred speech Tremors Asterixis Skin changes
Stress incontinence
Sneezing/coughing Laughing Heavy lifting
Overflow Incontinence
So full it overflow Obstruction prevent complete emptying Bladder too weak to contract (diabetes, spinal injuries)
Catheter Associated Urinary Tract Infections (CAUTIs) Evidence based bundles of care
Sterile technique on insertion Discontinue ASAP Catheter care Must justify insertion and continued use on a daily basis
Acute glomerulonephritis patho
Symptoms after 10 days Seen in men after acute streptococcal infection Present w/dark urine
Hemodialysis: Short term (Vas/tunnel cath) Acute
Temp access Maintain access Monitor hemodynamics Monitor lab values
Renal Replacement Therapy (RRT)
Temp for ARF Permanent for CRF Types: Hemodialysis/peritoneal dialysis, renal transplant
Oliguria
UOP< 400mL/24 hours
Anuria
UOP<100mL/24 hours
Urge (overactive bladder) incontinence
Urgency/leakage of urine Males-BPH Bladder infections Tumors/radiation Calculi
Hemodialysis: Long term chronic
Usu 3 day/wk for 4-6hrs Monitor access, fluid status, labs Patient education
Acute pyelonephritis (inflammation kidney/renal pelvis)
Usually unilateral Ecoli Ascending infection Pregnancy chronic r/f Common in young women, infants, elderly NSAID use
hemodialysis (HD)
Vascath (temp) dialysis only Use immediately after insertion Placed in chest/groin Instilled w/heparin afterward Not used for blood sampling
Incontinence Tx
review of contributing factors behavioral therapy, pharmacological therapy ( anticholinergics, urecholine) surgical therapy
Chronic Pyelonephritis etiology
small atrophied kidneys with diffuse scarring
