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