Chapter 26

---- failure, the most common form of acute renal failure, is characterized by a marked decrease in renal blood flow

Prerenal

Uremia

Presence of excessive amounts of urea in the blood

Sexual dysfunction in people with CKD is thought to be multifactorial. What are thought to be causes of sexual dysfunction in people with CKD?

- antihypertensive drugs - psychological factors - uremic toxins

Which of the following have the potential to cause chronic kidney disease?

- hypertension - diabetes - glomerulonephritis

Uremia pericarditis is a disorder that accompanies chronic kidney disease (CKD). What are its presenting signs and symptoms?

- pericardial friction rub - chest pain with respiratory accentuation - fever without infection

Acute tubular necrosis (ATN) is the most common cause of intrinsic renal failure. One of the causes of ATN is ischemia. What are the most common causes of ischemic ATN?

- severe hypovolemia - burns - overwhelming sepsis

The parents of a hospitalized 4-year-old boy have just been that their son has a chronic renal disease. The nurse is planning discharge teaching for this family. 1. What would the nurse know to include in the discharge teaching for this child and his family? 2. The parents inquire about treatment for their son and if kidney transplantation could occur. What would be the nurse's best response?

1. Description of the disease; prognosis; manifestations of said disease; medication regimen; dietary restrictions if any 2. CKD is a progressive disorder that can be slowed by adherence to dietary restrictions and medication regimen. The disorder usually progresses to the point where the child needs either hemodialysis or peritoneal dialysis or a kidney transplant. All forms of renal replacement therapy are considered safe in the pediatric population, and renal transplantation is considered the best treatment for children.

The normal GFR, which varies with age, gender, and body size, is approximately ---- mL/min (1.73 mL/minute/mm2) for normal young healthy adults

120 to 130

Azotemia

Accumulation of nitrogenous wastes in the blood

---- represents a rapid decline in kidney function sufficient to increase blood levels of nitrogenous wastes and impair fluid and electrolyte balance

Acute renal failure

Name of the most common intrarenal cause of renal failure, and describe its different forms.

Acute tubular necrosis (ATN) is characterized by the destruction of tubular epithelial cells with acute suppression of renal function. ATN can be caused by a variety of conditions, which includes acute tubular damage due to ischemia, sepsis, nephrotoxic effects of drugs, tubular obstruction, and toxins from a massive infection. Tubular epithelial cells are particularly sensitive to ischemia and are vulnerable to toxins. The tubular injury that occurs in ATN frequently is reversible.

Chronic kidney disease impacts many systems in the body. What is the number one hematologic disorder caused by CKD?

Anemia

Why is chronic kidney disease considered to have an insidious progression?

As kidney structures are destroyed, the remaining nephrons undergo structural and functional hypertrophy, each increasing its function as a means of compensating for those that have been lost. In the process, each of the remaining nephrons must filter more solute particles from the blood. It is only when the few remaining nephrons are destroyed that the manifestations of kidney failure become evident.

Acute renal failure occurs at a high rate in seriously ill people who are in intensive care units. What is the most common indicator of acute renal failure?

Azotemia and a decrease in the GFR

Creatinine

By-product of muscle metabolism

Uremic encephalopathy

Decreased CNS activity

Oliguria

Decreased urine production

People with CKD have impaired immune responses to infection because of high levels of urea and metabolic wastes in the blood. What is one thing that is missing in an immune response in people with CKD?

Failure to mount a fever with infection

Normal aging is associated with a decline in the _____ and subsequently with reduced homeostatic regulation under stressful conditions.

GFR

How is chronic kidney disease classified?

GFR is used to classify chronic kidney disease into 5 stages, beginning with kidney damage with normal or elevated GFR, progressing to chronic kidney disease, and potentially, to kidney failure.

---- commonly is an early manifestation of chronic renal failure

Hypertension

Salt wasting

Impaired tubular reabsorption of sodium

Osteitis fibrosa

Increased bone resorption and formation

In hemodialysis, access to the vascular system is most commonly through what?

Internal arteriovenous fistula

---- failure results from obstruction of urine outflow from the kidneys

Postrenal

Prostatic hyperplasia

Most common cause of postrenal failure

How does renal disease cause cardiovascular disease?

People with CKD tend to have an increased prevalence of left ventricular dysfunction, with both depressed left ventricular ejection fraction, as in systolic dysfunction, and impaired ventricular filling, as in diastolic failure. Multiple factors lead to the development of left ventricular dysfunction, including extracellular fluid overload, shunting of blood through an arteriovenous fistula for dialysis, and anemia. coupled with hypertension that often is present, they caused increased myocardial work and oxygen demand, with the eventual development of heart failure.

Isosthenurina

Polyuria with urine that is almost isotonic with plasma

Neuromuscular disorders can be triggered by CKD. For those clients on dialysis, approximately two thirds suffer from what peripheral neuropathy?

Restless legs syndrome

The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?

Serum creatinine

Which is the principle measure of GFR?

Serum creatinine concentration

How is anemia related to chronic kidney disease?

The anemia of chronic kidney disease (CKD) is due to several factors including chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decreased red cell production due to impaired production of erythropoietin and iron deficiency. The kidneys are the primary site for the production of the hormone erythropoietin, which controls red blood cell production. In renal failure, erythropoietin production usually is insufficient to stimulate adequate red blood cell production by the bone marrow.

Describe the progression of acute tubular necrosis (ATN).

The initiating phase, which lasts hours or days, is the time from the onset of the precipitating event until tubular injury occurs. The maintenance phase of ATN is characterized by a marked decrease in the glomerular filtration rate (GFR), causing sudden retention of endogenous metabolites. Fluid retention gives rise to edema, water intoxication, and pulmonary congestion. If the period of oliguria is prolonged, hypertension frequently develops and with, signs of uremia. The recovery phase is the period during which repair of renal tissue takes place. It onset usually is heralded by a gradual increase in urine output and a fall in serum creatinine.

What are the clinical manifestations of chronic kidney disease?

The manifestations of CKD include an accumulation of nitrogenous wastes; alterations in eater, electrolyte, and acid-base balance; mineral and skeletal disorders; anemia and coagulation disorders; hypertension and alterations in cardiovascular function; gastrointestinal disorders; neurologic complications; disorders of skin integrity; and disorders of immunologic function. The point at which these disorders make their appearance and the severity of the manifestations are determined largely by the extent of renal function that is present and the coexisting disease conditions.

Hemodialysis

Use of artificial kidney to filter blood

Neuropathy is caused by ______ and _____ of nerve fibers, possibly caused by uremic toxins.

atrophy, demyelination

The term renal ---- is used to describe the skeletal complications of CKD

osteodystrophy

Prenatal failure is manifested by a sharp decrease in urine output and a disproportionate elevation of ---- in relation to serum creatinine levels

blood urea nitrogen

The acidosis that occurs in persons with kidney failure seems to stabilize as the disease progresses, probably as a result of the tremendous buffering capacity of _____.

bone

A major concern in the treatment of acute renal failure is identifying and correcting the _____.

cause

Regardless of cause, ---- represents a permanent loss of functioning kidney nephrons with progressive deterioration of glomerular filtration, tubular reabsorptive capacity, and endocrine functions of the kidneys

chronic kidney disease

In clinical practice, GFR is usually estimated using the serum ---- concentration

creatinine

Chronic renal failure can produce ---- or fluid ----, depending on the pathology of the kidney disease

dehydration, overload

The causes of acute renal failure commonly are categorized as ----, ----, or ----

prerenal, intrinsic, postrenal

In chronic renal failure, the kidneys lose the ability to regulate ---- excretion

sodium

Because of their high metabolic rate, the _____ cells are most vulnerable to ischemic injury.

tubular epithelial

Increased excretion of low molecular weight globulins is a marker of ---- disease and excretion of ---- a marker of CKD

tubulointerstitial, albumin

Anorexia, nausea, and vomiting are common in patients with _____, along with a metallic taste in the mouth that further depresses the appetite.

uremia

The ---- state includes signs and symptoms of altered fluid, electrolyte, and acid-base balance, and alterations in regulatory functions

uremic