Medsurge test 2 renal

oliguria

when there is <400ml in 24 hr of urine

anuria

when there is <100mL of urine in 24 hrs.

BP changes, edema, CVA tenderness, auscultation for bruits

what objective data is obtained in the physical exam of the renal assessment

50-1200

what is the normal range for osmolality

1.005-1.030

what is the normal range for specific gravity

specific gravity

a high ___________ indicates concentrated urine, often due to dehydration or other conditions affecting kidney function.

nephrotoxic medications

NSAIDS, aminoglycosides, vancomycin, amphotericin B, rifampin, contrast dye, Ace inhibitors, ARBS, lithium, penicillins, antirejection drugs (tacrolimus) are all

decreased

Glucose is _________ in severe kidney disease.

increased

phosphorus is ________ in Chronic kidney disease,

calcium

___________ is decreased due to phosphate retention and vitamin D deficiency

increased

potassium is _________ in CKD/AKI

decreased

sodium is ________ in CKD with fluid overload

decreased

albumin is ________ in nephrotic syndrome and liver disease

3.5-5

what is a normal range for albumin

increased

anion gap(8-16) is _________ in metabolic acidosis

8-16

what is a normal anion gap range

90 ml/min

GFR should be greater than

decreased

total protein is ___________ in nephrotic syndrome and liver disease

ultrasound, CT, MRI, renal biopsy

what are some diagnostic imaging tools for renal conditions

acute tubular necrosis

what is the most common cause of AKI

diabetic nephropathy

what is the most common cause of CKD

Acute reduction in urine output (<30 mL/hr) and/or elevation in serum creatinine

how is AKI diagnosed

GFR < 60 mL/min/1.73m² for > 3 months and /or kidney damage > 3 months

how is CKD diagnosed

infection - becomes septic

what is the cause of death in acute kidney injury

cardiovascular disease

what is the cause of death in chronic kidney disease

azotemia

accumulation of nitrogenous waste products in blood due to acute kidney injury. leads to sodium excretion, water retention, and decreased urine output

heart failure, dehydration, liver failure

what are examples of prerenal causes of acute kidney injury

ureteral obstruction, neurogenic bladder, UTI, medications, Benign prostatic hypertrophy

what are examples of postrenal causes of acute kidney injury

prolonged ischemia, nephrotoxins, hemoglobin released, myoglobin released, acute glomerulonephritis from group A strep, Lupus,

what are some causes of intrarenal problems

acute tubular necrosis

results from ischemia, nephrotoxins, or sepsis and causes the lack of oxygen and blood flow to the kidneys, damaging them and leading to acute kidney failure.

48

Bilateral ureteral obstruction—hydronephrosis, you want to relieve obstruction in _____ hours increased chance of recovery

oliguric, diuretic, recovery

what are the three phases of acute kidney injury

10-14 days

how long does oliguria last in AKI

heart failure, pulmonary edema, pericardial and pleural effusions

Decreased urine output leads to fluid retention which leads to:

kussmaul respirations

severe acidosis from impaired kidney function can cause

cerebral edema

hyponatremia can lead to

oliguric phase

In what AKI phase are there sodium and potassium imbalances

leukocytosis, increased BUN/creatinine, fatigue, trouble concentrating, seizures from hyponatremia, coma

what are some clinical manifestations in the oliguric phase of AKI

1-3L up to 5L.

how high is daily urine output in the diuretic phase

high urea and inability of tubules to concentrate urine

osmotic diuresis happens from:

Gadolinium

MRI or MRA with _________ would be a contraindication in AKI

48

diabetics taking metformin should hold the med_____ hours before and after use of contrast medium bc of risk for lactic acidosis

insulin and glucose, calcium gluconate, kayexalate, patiromer, dialysis

how can hyperkalemia be treated

Renal replacement therapy (RRT)

medical treatments used to replace the function of the kidneys in patients with acute or chronic kidney failure

maintain adequate caloric intake. maintain protein, restrict sodium.

what is dietary care for those with AKI