Renal

  • Phases of Acute Kidney Injury

    • Stage 1: >90 GFR; GFR is within normal ranges but other tests suggest signs of kidney damage. 

    • Stage 2: 60-89 GFR; slightly reduced kidney function with other tests suggesting kidney damage. 

    • Stage 3: 30-59 GFR; moderately reduced kidney function

    • Stage 4: 15-29 GFR; severely reduced kidney function

    • Stage 5: very severe or end stage kidney failure

  • Acute Kidney Injury nursing diagnosis

    • ypovolemia, hypotension, reduced cardiac output and heart failure, obstruction of kidney, lower urinary tract, renal arteries and renal veins.  

  • Nephrotoxic drugs: Aminoglycosides(gentamycin, tobramycin and vancomycin), chronic use of NSAIDs, and contrast induced AKI. 

    • Signs & symptoms: changes in urinary habits: decreased or increased urine output, bloody or foamy urine. 

    •  Treatment: Adequate hydration 

  • Role of Erythropoietin in kidneys: Cells in the kidney detect oxygen levels causing the kidney to release erythropoetin stimulating the red bone marrow to produce more red blood cells. 

    • Epoetin alfa and Darbepoetin alfa: synthetic erythropoietin. 

  • S&S of peritonitis: cloudy dialysate effluent, diffuse abdominal pain/rebound tenderness(later). 

  • Fistulas/AV grafts: 

    • Priority assessments: check daily for a thrill and bruit and observe for signs of infection. 

  • Chronic Kidney disease

    • Pathophysiology: Kidney disease or decrease in GFR >3 months. 

  •   Integumentary Manifestations: Gray-bronze skin, dry itchy skin. 

  • Glomerulonephritis: Inflammation or damage occurs to portions of the glomerulus. 

    • S&S: proteinuria, azotemia and hematuria. 

    • Interventions: Treating symptoms and preserving kidney function, corticosteroids, managing hypertension, and controlling proteinuria. Pharmacologic includes PCN for strep, restricted protein, sodium/potassium, and fluid restriction. 

    • Etiology: Autoimmune disorders such as lupus or streptococcus. 

  • Acute Glomerulonephritis

    • Findings: Hematuria, proteinuria, uremia, azotemia, edema, hypertension, Increased BUN and creatinine, headache, malaise, flank pain, and circulatory overload in older adults. 

  • Peritonitis: redness or swelling of the lining of the peritoneal cavity. 

    • S&S: Cloudy dialysate effluent, diffuse abdominal pain/rebound tenderness(later sign). 

    • Treatment: Broad-spectrum antibiotics added to exchanges. 

  • Dialysis 

    • Need to know words: 

      • Dialyzer: artificial kidney used to filter the blood.

      • Dialysate: fluid made up of electrolytes.  

    • Different types: 

      • Hemodialysis: Using a fistula or catheter blood is removed from the body and cleaned by the dialyzer then returned back into the body to remove excess fluid and nitrogenous wastes. 

        • Advantage: Rapid fluid removal, home hemodialysis possible, less protein loss, effective removal of potassium, rapid removal of urea and creatnine. 

        • Disadvantage: vascular access problems, schedueled patient appointments, hypotension, blood loss from anemia, surgery for access placement, and self image problems. 

      • Peritoneal Dialysis: Using a sterile dialysate is introduced into the abdominal cavity through an abdominal catheter. Steps are instilled, dwell, and drain.

        • Advantages: less complicated, portable, fewer restrictions, easy to learn, less cardiac stress, immediate initiation after access placement and done at home. 

        • Disadvantages: protein loss, hyperglycemia, infection, training time, a catheter can migrate, contraindicated with abdominal surgeries, catheter is surgically placed and self image problems. 

  • Kidney transplant 

    • Rejection: usually occurs 24 hours to 2 weeks to many years after. 

      • signs: olguria, edema, fever, hypertension, weight gain, swelling or tenderness overy transplanted kidney graft. 

    • Ideal candidates: ABO and HLA must match

    •  use of immunosuppressive medications: Must take for the entire time they have the transplanted kidney. 

  • Polycystic Kidney Disease: a rare genetic disorder that causes fluid-filled cysts to develop on the kidneys. 

    • S&S: Flank pain, polyuria, kidney masses, hematuria, hypertension and proteinurea. ESRD occurs as disease prgresses.  

    • Need for genetic counseling

  • Risk factors for developing kidney disease

  • Azotemia: an abnormal amount of nitrogenous wastes in blood.