Nurs 3366 - Disorder of Kidneys

What is Acute Kidney Injury(AKI)?

barupt (occurs over <48hrs)

• decrease in urine output (ie, GFR)

• increased serum creatinine

classified as prerenal, intrarenal, or postrenal AKI

What are the S&S of AKI?

• acute oliguria - low urine output

• acute jump in serum creatinine

What is Prerenal AKI?

(“pre” = before the kidney)—most common subtype of AKI

• caused by acute vasoconstriction

• hypotension/decreased cardiac output

What are the S&S of Prerenal AKI?

oliguria and increased serum creatinine (sCr.)

What is Postrenal AKI?

occurs when there is an acute obstruction that occurs somewhere between kidneys & urethral meatus

What are the causative factors of Postrenal AKI?

• urethral obstruction - BPH in a man or uterine prolapse in a woman

• ureteral obstruction such as calculi

What are the S&S of Postrenal AKI?

• elevated sCr, acute oliguria

• retrograde flow resulting in hydronephrosis - kidneys swollen due to urine

• can cause Acute Tubular Necrosis(ATN)

What is Intrarenal AKI?

the kidneys have acutely diminished function from direct kidney tissue injury

• nephron, the glomerulus and/or the kidney tubules

What can cause Glomerular damage?

autoimmunes situations - post- streptococcal glomerulonephritis (GN)

• causes proteinuria and hematuria

What causes Kidney tubular damage?

acute tubular necrosis (ATN) - tubular cell injury/death

What is the Patho of ATN?

reduced blood flow (ischemia) or direct injury of tubular cells → cause necrosis (death) of tubular cells →cast formation→ abnormal clumps of casts cause tubular blockage

What are the causes/initiators of Chronic Kidney Disease(CKD)?

• inherited renal problems- polycystic kidney disease (PKD)— an autosomal dominant disease cysts interfere with normal renal function

• acquired diseases - AKI, Hypertension, Atherosclerosis, Diabetes Mellitus

What is the Patho of CKD?

impairment to water & solute balance & impairment to metabolic functions

What occurs when there is a “Sick” Nephron?

faulty decision-making - wastes & other solutes accumulate in blood

• high serum electrolyte levels:

  • hyperphosphatemia, hyperkalemia(potassium) & hypernatremia

• high serum waste levels = high serum creatinine & urea nitrogen

What is Azotemia?

high levels of waste in your blood

What is Uremia?

having azotemia PLUS other S&S

• pruritis (itching from deposition of urea on skin)

• uremic encephalopathy-- neurological changes (from toxic levels of blood

  urea)

What is a Urinalysis(UA)?

most common test; is a general, broad measurement of the state of the urine

• if blood/protein in urine - glomerulonephritis

• if bacteria - UTI

• if concentration of urine is not right - Low specific gravity

What is creatinine clearance urine test?

measures 24 hours worth of creatinine excreted in urine & compares it to serum creatinine; normal range means kidneys are doing a good job filtering waste into the urine

• if the urine creatinine clearance is LOWER than normal, the serum creatinine will be HIGH

What is Hypocalcemia?

• less vitamin D activation = inability to effectively absorb ingested calcium in GI tract

impaired metabolic function

What are the S&S of Hypocalcemia?

• positive Chvostek’s sign - hyperexcitability of cells→ muscle spasms,

  peripheral paresthesias

• osteoporosis

What is Anemia?

• sick kidneys = less RBC-stimulating hormone called erythropoietin

impaired metabolic function