renal dysfunction and dialysis

renal impacts

pH and cardiac function

upper urinary tract, lower urinary tract

kidneys, ureters; bladder and urethra

functions of kidney

control mineral and water balance, filter waste products and remove excess fluid from the blood

renal endocrine functions

produce erythropoietin, calcitrol, and renin

(end stage can result in anema, activate vitamin D3, renin angiotension-aldosterone system to regulate minerals and blood pressure)

renal exocrine function

secrete urine

BUN (bun urea nitrogen) normal and critical levels

6-25 normal

rises with decrease renal function

critical is over 100

serum creatinine normal and critical

creatinine normal waste of skeletal muscle

male 0.6-1.2

female 0.5-1.1

critical over 4

rise indicates dysfunction

why women get UTI more than men

urethra shorter, relationship of vagina and rectum, sexual intercourse bacterial movement towards bladder, increase risk with pregnancy and after menopause

general UTI risk factors

age, female, immbolie, catheterization, atonic bladder, spermicide, uncircumised penis, obstruction, constipation, kidney transplant, DM, STD

why do people with DM have increased risk of UTI

immunologic impairments, glycosuria, neuropathy and detrusor paresis

pathogenesis and route of entry for uti

fecal or hospital bacteria

urethra route

(can also be bloodborne or lymphatic)

s/s of UTI

frequency, urgency, dysuria, nocturia, enuresis, fever, chills, malaise, pain, change in urine color and odor

referred kidney pain

ipsilateral shoulder, lumbar back pain, malaise, anorexia, mental status change

how to prevent UTI

8 8 oz glasses of water daily, urinate after sex, genital hygiene, avoid spermicidal agent

pyeloneprhritis acute vs chronic

acute: kidneys, ascending UTI, women more

chronic: scar kidney parenchyma and renal pelvis, can contribute to renal insufficiency

s/s of acute pyelnephritis

abrupt onset, fever, chills, malaise, headache, flank pain, murphy sign (tender over costovertebral angle), bladder irritation

renal calculi

most form in kidneys

calcium most common

struvite linked to UTI

uric acid linked to gout

renal calculi s/s

pain in mid abdominal, lower quadrant, flank, or groin/perineal

frequency/urgenecy, hematuria, N/V

common causes of chronic kidney disease

diabetes, HTN, glomerulonephritis

cystic kidney diseases, excessive aspirin or acetaminophen use

hemodialysis

3 weekly, 3-4 hrs, AV fistula placement

dialysis complications

fluid shift, depression, infection rate, metabolism disorder (catabolism, anorexia, malnutrition), anemia, PN, chest and back pain (first use syndrome), hypersensitivity reactions, access site thrombosis

for dialysis and exercise

can do before, after, during, but longer episode of care needed, functional capacity is 2 SD below the normal

can improve physical function, exercise tolerance, QoL, fatigue, monitor vitals, DO NOT take BP on dialysis arm

with ERSD: associated with autonomic dysfunction and cardiac mortality, esp if diabetic (monitor glucose)

use RPE

exercise testing is not recommended

do not exercis if BP is over 200 or DBP is over 110

renal transplantation for children vs adults

adults: extraperitoneal in iliac fossa

children: retroperitoneal

lab values if ESRD

low Hgb and HCT, high creatinine and BUN, abnormal electrolytes

hemoglobin critical high and low

5 and 20

hematocrit critical high and low

15%-60%

Na, K, Ca can alter excitability of neurons, cardiac and skeletal muscles

arrhythmias, weakness, spasms, tremors

critical values of potatssium

2.5 and 6.5

s/s of mega dosing electrolytes

weakness, discoordination, dizziness, dehydration, irritability/agitation, confusion/mental status, cardiac arrhythmia