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What is the function of the kidney?
The kidney has several functions, including the excretion of waste, formation of urine, regulation of fluid and electrolyte balance, acid-base balance, erythropoietin secretion, renin production, activation of vitamin D, and production of bradykinins and prostaglandins.
How do the kidneys regulate fluid and electrolyte balance?
The kidneys regulate fluid and electrolyte balance by maintaining osmolality and volume of body fluids through the regulation of water and electrolyte intake.
What is the role of the kidneys in acid-base balance?
The kidneys help maintain normal blood pH levels by regulating the acid-base balance.
What is erythropoietin, and how do the kidneys produce it?
Erythropoietin is a hormone produced by the kidneys that regulates red blood cell (RBC) production in response to oxygen levels in the blood.
What is the renin-angiotensin-aldosterone system, and how do the kidneys regulate it?
The kidneys produce renin, which regulates blood pressure, sodium levels, and blood volume by activating the renin-angiotensin-aldosterone system.
How do the kidneys activate vitamin D?
The kidneys convert stored vitamin D in the liver into its active form, calcitriol, in response to low calcium levels.
What are the roles of bradykinins and prostaglandins in the kidneys?
Bradykinins and prostaglandins produced by the kidneys help maintain proper blood pressure and regulate sodium excretion.
How does unfiltered blood enter the kidneys?
Unfiltered blood enters the kidneys through the renal arteries, which branch off from the aorta.
How does filtered blood exit the kidneys?
Filtered blood exits the kidneys through the renal veins and returns to the body.
How do the kidneys filter blood?
The kidneys filter blood through tiny structures called nephrons, which contain a glomerulus for filtration and a tubule to carry waste into the urine.
What is the normal urine output range per hour?
The kidneys typically produce approximately 35 to 70 mL of urine per hour.
What can abnormal urine output indicate?
Abnormal urine output (either higher or lower than 35 to 70 mL per hour) could indicate a kidney problem or renal impairment.
What are common renal impairments?
Common renal impairments include Acute Kidney Injury (AKI), Polycystic Kidney Disease (PKD), Glomerulonephritis, Benign Prostatic Hypertrophy (BPH), Transurethral Resection of the Prostate (TURP), and bladder irrigation.
What is Benign Prostatic Hyperplasia (BPH)?
BPH is the enlargement of the prostate gland, which compresses the urethra, obstructing the outflow of urine from the bladder, leading to urinary retention, feelings of fullness, and inconsistent urine flow.
Who is most at risk for developing Benign Prostatic Hyperplasia (BPH)?
BPH occurs more frequently in men over 70 years of age.
What are common signs and symptoms (S/S) of BPH?
Difficulty starting the urine stream, weak stream of urine and dribbling, urgency of urination, nocturia, bladder outlet obstruction, and acute urinary retention.
What are potential complications of untreated BPH?
Untreated BPH may cause bladder outlet obstruction, acute urinary retention, bladder infection, renal calculi (kidney stones), and Acute Kidney Injury (AKI).
What is the recommended treatment for asymptomatic BPH?
Asymptomatic BPH is typically monitored with yearly exams, including a digital rectal exam (DRE).
What medications are used to treat BPH?
Alpha blockers (e.g., tamsulosin) relax the prostate and bladder neck muscles to ease urine flow, while 5-alpha reductase inhibitors (e.g., finasteride) shrink the prostate by blocking the hormone responsible for prostate growth.
What is a Transurethral Resection of the Prostate (TURP)?
TURP is a surgical procedure to remove excess prostate tissue blocking the urethra to improve urine flow.
What is a Transurethral Incision of the Prostate (TIP)?
TIP is a surgical procedure where small cuts are made to relieve pressure on the urethra, easing the symptoms of BPH.
What is the purpose of a Comprehensive Metabolic Panel (CMP)?
A CMP evaluates kidney function, electrolyte balance, and overall metabolic status.
What does a Complete Blood Count (CBC) assess?
A CBC assesses for infection, anemia, or other blood abnormalities.
What is the purpose of a urinalysis (UA)?
A UA screens for infection, hematuria, and kidney dysfunction.
Why is Peripheral Intravenous (PIV) insertion important?
PIV insertion ensures IV access for potential fluids, medications, or contrast studies.
What is the purpose of a bladder scan?
A bladder scan assesses urinary retention and guides further management.
What is the importance of strict intake and output (I/O) monitoring?
I/O monitoring evaluates fluid balance and renal function.
Why is an indwelling catheter insertion necessary?
An indwelling catheter helps manage urinary retention and allows for accurate urine output measurement.
What is the rationale for continuous cardiac monitoring?
Continuous cardiac monitoring detects arrhythmias related to electrolyte imbalances, such as hyperkalemia.
Why is a 12-lead EKG ordered?
A 12-lead EKG assesses for cardiac abnormalities due to irregular heart rate and electrolyte imbalances.
Why is Peripheral IV (PIV) insertion prioritized in treatment?
Establishing PIV access is crucial for fluid resuscitation, medications, or contrast if needed.
What is the purpose of a renal ultrasound?
A renal ultrasound assesses for hydronephrosis, kidney stones, or other structural abnormalities.
hat is the order of prioritization for the following provider orders: Bladder Scan, Urinalysis, 12-lead EKG, Peripheral IV, CMP/CBC?
1⃣ Bladder Scan – Determines severity of urinary retention and guides catheterization decisions.
2⃣ Indwelling Catheter Insertion – Relieves retention and prevents complications.
3⃣ Urinalysis – Identifies infection, hematuria, or kidney dysfunction.
4⃣ Continuous Cardiac Monitoring – Detects arrhythmias related to electrolyte imbalances.
5⃣ 12-Lead EKG – Assesses for cardiac abnormalities.
6⃣ Peripheral IV (PIV) Insertion – Establishes IV access for fluids, medications, or contrast studies.
7⃣ Lab Draw (CMP, CBC) – Monitors kidney function, electrolyte imbalances, infection, or anemia.
8⃣ Renal Ultrasound – Assesses for structural abnormalities like hydronephrosis or kidney stones.
What should be done after receiving bladder scan results?
Call the provider with bladder scan results and receive further orders. If retention is confirmed, proceed with indwelling catheter insertion. Continue strict intake and output (I/O) monitoring to assess urine output and kidney function.
What is an important consideration for catheter insertion?
Sterile technique is crucial to prevent infection during catheter insertion.
Why is the use of a Coude catheter indicated for catheterization?
A Coude catheter is used when there is a potential BPH-related obstruction to facilitate insertion.
What should be done if catheter insertion is difficult?
If catheter insertion is difficult, a nephrologist or urologist may need to be consulted for assistance.
What lab findings suggest a high risk for developing Acute Kidney Injury (AKI)
Increased BUN & creatinine levels indicate poor kidney function and decreased perfusion, while elevated potassium (K⁺) levels suggest impaired renal clearance and increased risk of cardiac arrhythmias.
What does an increase in BUN and creatinine levels indicate?
Increased BUN and creatinine levels indicate waste accumulation due to poor kidney excretion and decreased kidney perfusion, which could lead to Acute Kidney Injury (AKI).
Why is elevated potassium (K⁺) level a concern in renal patients?
Elevated potassium levels suggest impaired renal clearance, which increases the risk of cardiac arrhythmias, a serious complication.
What does an EKG result showing sinus tachycardia with PVCs (Premature Ventricular Contractions) indicate?
Sinus tachycardia (HR 106, irregular) may be due to stress, anxiety, pain from BPH, and compensatory response to fluid retention and electrolyte imbalances. PVCs are likely caused by electrolyte imbalances, particularly hyperkalemia, or NSAID use (e.g., ibuprofen), which can contribute to kidney stress.
Why might tachycardia occur in a patient with AKI?
Tachycardia could be due to stress, anxiety from urinary retention and discomfort, pain from BPH and a distended bladder, or a compensatory response to fluid retention and potential electrolyte imbalances.
What is the cause of PVCs in this patient?
PVCs are likely caused by electrolyte imbalances, particularly hyperkalemia (elevated potassium) due to impaired kidney function and NSAID use, which can contribute to kidney stress and decreased potassium clearance.
What are possible findings in a urinalysis (UA) for a patient at risk for AKI?
Possible findings in UA include hematuria (blood in urine), proteinuria (suggesting kidney dysfunction), elevated specific gravity (due to urinary retention), and leukocytes or nitrites (indicating a possible infection, such as UTI).
What does high specific gravity in a urinalysis indicate?
High specific gravity indicates more waste products in the kidneys, suggesting that the kidneys may be working harder to filter blood. This can occur in conditions like dehydration or kidney dysfunction, where the kidneys concentrate urine to retain water.
What does proteinuria in a urinalysis suggest?
Proteinuria suggests kidney damage or dysfunction, as protein should typically not be present in significant amounts in the urine.
What is considered a normal amount of protein in urine?
A small amount of protein in the urine is generally normal.
What does moderate proteinuria suggest?
Moderate levels of protein in the urine could suggest potential kidney damage, particularly if the patient has risk factors such as diabetes or high blood pressure.
Why is proteinuria an important early sign?
Proteinuria is a common early sign of kidney damage, as it indicates that the kidneys may not be functioning properly.
What is considered high proteinuria, and what does it indicate?
More than 150 mg/day of protein in the urine is considered high and may indicate kidney issues such as glomerulonephritis, nephrotic syndrome, or other kidney diseases.
What is considered severe proteinuria, and why is it concerning?
Levels of 3 g/day or higher are considered severe proteinuria and require immediate medical attention, as they indicate significant kidney dysfunction.
What is the patient's risk regarding Acute Kidney Injury (AKI)?
The patient is at risk for postrenal AKI due to urinary retention and BPH obstruction, which leads to the buildup of waste products such as nitrogenous waste (urea, nitrogen, creatinine) and hyperkalemia due to decreased excretion.
How does urinary retention and BPH contribute to kidney injury?
Urinary retention and BPH obstruction cause the accumulation of waste products (e.g., urea, creatinine), leading to hyperkalemia and kidney damage due to decreased waste excretion.
What is the primary cause of postrenal AKI?
The primary cause is Benign Prostatic Hyperplasia (BPH) and urinary retention. An enlarged prostate compresses the urethra, blocking urine flow, leading to bladder distension, backflow of urine, and kidney damage.
How does BPH lead to kidney damage?
BPH causes the prostate to enlarge, compressing the urethra and obstructing urine flow. This results in bladder distension, backflow of urine, and ultimately kidney damage.
How does ibuprofen (NSAID) contribute to postrenal AKI?
Ibuprofen can increase the risk of acute urinary retention (AUR) by reducing renal perfusion, which worsens kidney function, especially with prolonged use (e.g., 5 days).
What effect does lisinopril (ACE inhibitor) have on kidney function?
Lisinopril can cause fluid retention and potentially worsen AKI in predisposed individuals by interfering with fluid balance and renal function.
What is Acute Kidney Injury (AKI)?
AKI is characterized by rapid and progressive azotemia, which is the accumulation of nitrogenous waste products such as urea, nitrogen, and creatinine. It also includes a progressive increase in potassium levels, which can be life-threatening.
What is oliguria, and why is it significant in AKI?
Oliguria is defined as urine output less than 400 mL per day and is common in AKI, particularly in the oliguric phase. It signifies reduced kidney function.
What symptoms are associated with uremia in AKI?
Uremia occurs as renal function declines and can affect multiple body systems. Symptoms include fatigue, nausea, confusion, and pericarditis.
What is the difference between nonoliguric AKI and oliguric AKI?
Nonoliguric AKI: Urine output is greater than 400 mL/day, and these patients generally recover more quickly with fewer complications.
Oliguric AKI: Associated with less urine output, a higher risk of chronic kidney disease (CKD), and may progress to anuria if untreated.
What are the major causes of AKI?
The three major categories of AKI are:
Prerenal AKI: Caused by decreased blood flow to the kidneys (e.g., dehydration, shock, heart failure).
Intrarenal AKI: Caused by direct damage to the kidneys (e.g., nephrotoxins, glomerulonephritis, acute tubular necrosis).
Postrenal AKI: Caused by obstruction in the urinary tract (e.g., BPH, kidney stones, or bladder obstruction).
What causes prerenal AKI?
Prerenal AKI is caused by decreased blood flow to the kidneys, often due to dehydration, shock, or heart failure.
What causes intrarenal AKI?
Intrarenal AKI is caused by direct damage to the kidneys, such as from nephrotoxins (e.g., medications, contrast dye), glomerulonephritis, or acute tubular necrosis (ATN).
What causes postrenal AKI?
Postrenal AKI is caused by obstruction in the urinary tract, which can result from conditions like BPH, kidney stones, or bladder obstruction.
What is the potential outcome of untreated impaired renal function in AKI?
If left untreated, impaired renal function in AKI can lead to chronic kidney disease (CKD) or end-stage renal disease (ESRD).
How can impaired renal function in AKI be managed?
Fluid management, monitoring electrolytes, and treating the underlying cause are crucial for improving kidney function and potentially reversing AKI.
What is the definition of Acute Kidney Injury (AKI)?
AKI is the sudden decline in kidney function that occurs within hours to weeks. It can be reversible if treated early.
What functions are impaired in AKI?
AKI impairs the kidney's ability to remove waste, filter blood, and maintain electrolyte balance.
What is the relationship between Acute Kidney Injury (AKI) and Acute Renal Failure (ARF)?
AKI and ARF are used interchangeably, as both refer to the sudden decline in kidney function, which can be reversible with timely intervention.
What causes Prerenal AKI?
Prerenal AKI is caused by decreased blood flow to the kidneys due to factors like dehydration, excessive blood loss (hypovolemia), and heart failure. Early treatment improves the chance of recovery.
What are common causes of Intrinsic / Intrarenal AKI?
: Intrarenal AKI is caused by direct damage to the kidneys, such as from nephrotoxic medications (e.g., contrast media, NSAIDs, vancomycin, aminoglycosides), glomerulonephritis, and lupus nephritis.
What causes Postrenal AKI?
Postrenal AKI is caused by obstruction in the urinary tract below the kidneys, such as from BPH, kidney stones, cancer, or blood clots. This blockage leads to waste buildup in the kidneys.
How does fluid volume deficit affect blood pressure in renal failure?
In renal failure with fluid volume deficit (dehydration), there is a decrease in circulating blood volume, which leads to hypotension (low blood pressure).
What compensatory mechanisms are activated in response to low blood pressure in renal failure?
A: To compensate for low blood pressure, the body activates:
Renin-Angiotensin-Aldosterone System (RAAS): Renin is released, causing vasoconstriction and sodium/water retention, increasing blood pressure.
Sympathetic Nervous System Activation: Increases heart rate and vasoconstriction to elevate blood pressure.
ADH Secretion: Promotes water retention in the kidneys to help restore fluid balance and raise blood pressure.
What is the Initiation Phase of Acute Kidney Injury (AKI)?
The Initiation Phase begins with the initial kidney insult (e.g., ischemia, nephrotoxins, or obstruction). It lasts for hours to days, with the key concern being early detection to prevent progression.
What occurs during the Oliguric Phase of AKI?
During the Oliguric Phase, urine output drops to less than 400 mL/day. There is an increase in BUN and creatinine levels, along with electrolyte imbalances (e.g., hyperkalemia, metabolic acidosis). Potential complications include fluid overload, pulmonary edema, and cardiac arrhythmias.
What happens during the Diuretic Phase of AKI?
In the Diuretic Phase, there is a gradual return of kidney function with increased urine output (3-5L/day). However, there is a risk of dehydration and electrolyte depletion (e.g., hypokalemia, hyponatremia), and monitoring for hypotension and worsening kidney function is crucial.
What is the Recovery Phase of AKI?
In the Recovery Phase, kidney function normalizes, and waste product clearance improves. This phase lasts for weeks to months, but in severe cases, permanent kidney damage may occur.
What are the key signs of Acute Kidney Injury (AKI)?
The key signs of AKI are an abrupt elevation in creatinine levels and a reduction in urinary output, which result in decreased kidney function and filtration capabilities.
What is Renal Replacement Therapy (RRT)?
RRT is a medical treatment that replaces normal kidney function in patients with acute or chronic kidney failure. It includes treatments such as dialysis (hemodialysis or peritoneal dialysis) and kidney transplants.
What is Thrombotic Thrombocytopenic Purpura (TTP)?
TTP is a rare blood disorder characterized by thrombocytopenia (low platelet count), microangiopathic hemolytic anemia (destruction of red blood cells), and ischemic manifestations due to clot formation in small blood vessels.
What is Hemolytic Uremic Syndrome (HUS)?
HUS is a condition often associated with acute kidney failure, typically seen after gastrointestinal infection caused by E. coli. It involves thrombocytopenia, hemolytic anemia, and ischemic damage, similar to TTP.
What is Glomerulonephritis?
Glomerulonephritis refers to the inflammation of the glomeruli (tiny filtering units in the kidneys), impairing their ability to filter waste products, excess fluid, and toxins, leading to waste buildup in the body.
What are the symptoms of Glomerulonephritis?
Symptoms include swelling (edema), hematuria (blood in the urine), high blood pressure (hypertension), decreased urine output, fatigue, and proteinuria (protein in the urine).
What is Acute Glomerulonephritis?
Acute Glomerulonephritis develops suddenly, often as a response to an infection (e.g., streptococcal throat infection). Symptoms include swelling, hematuria, high blood pressure, decreased urine output, fatigue, and proteinuria.
What is Chronic Glomerulonephritis?
Chronic Glomerulonephritis develops gradually and can lead to long-term kidney damage, potentially resulting in kidney failure. Severe cases may require dialysis or a kidney transplant.
What are common causes of Glomerulonephritis?
Causes include post-infectious conditions (e.g., streptococcal throat infection), autoimmune diseases (e.g., lupus, vasculitis), genetic conditions, and other kidney diseases.
What medications are used to treat Glomerulonephritis?
Medications may be prescribed to reduce inflammation, control blood pressure, and manage symptoms. Antibiotics or antiviral medications are used if an infection is the underlying cause.
What is the treatment for severe cases of Glomerulonephritis?
In severe cases, dialysis or a kidney transplant may be required if kidney function does not recover.
What is the role of fluid management in AKI treatment?
Isotonic IV fluids (e.g., Normal Saline) are used to restore intravascular volume and improve kidney perfusion in AKI patients.
How do loop diuretics like Furosemide (Lasix) help in AKI?
Loop diuretics promote diuresis and remove excess fluid in volume-overloaded patients, helping manage fluid retention and prevent pulmonary edema
What is the role of vasodilators in AKI treatment?
Norepinephrine is used as a first-line vasopressor for mild renal impairment. Dopamine is beneficial in severe renal dysfunction by improving renal perfusion.
How do inotropes like Dobutamine and Dopamine aid in AKI treatment?
Inotropes strengthen cardiac contractions, improving cardiac output, especially in CHF patients, which helps with renal perfusion.
What electrolytes are commonly corrected in AKI treatment?
Potassium (K), Magnesium (Mg), Calcium (Ca), Sodium (Na), and Chloride (Cl) may require replacement or correction. Renal Replacement Therapy (RRT) may be needed for severe imbalances.
How is acid-base balance corrected in AKI?
Bicarbonate is used to treat metabolic acidosis in kidney disease patients, restoring pH balance and slowing the progression of chronic kidney disease (CKD).
How is blood sugar control managed in AKI?
Insulin is used to reduce hyperglycemia and protect the kidneys from glucose-induced damage. D25/D50 is used to treat hypoglycemia, which is common in advanced kidney disease.
How is hyperkalemia managed in AKI?
Sodium Polystyrene Sulfonate (Kayexalate) is used to remove excess potassium from the body in CKD/AKI patients, preventing life-threatening arrhythmias.
What medication is used to protect the kidneys in AKI?
N-acetylcysteine (Acetadote) is used to prevent kidney injury from contrast media, ischemia, and nephrotoxins.
What is the goal for BUN and Creatinine levels in AKI management?
The goal is for BUN (Blood Urea Nitrogen) and Creatinine to level off and improve with appropriate treatment.
