Week 4: renal diseases & renal failure

● Risk factors associated with renal disorders

○ Chemical or environmental toxin exposure, contact sports, diabetes mellitus,
family history of renal disease, frequent UTIs, heart failure, high-sodium diet,
hypertension, medications, polycystic kidney disease, trauma, urolithiasis or
nephrolithiasis
● Normal renal function values
○ BUN - 10-20 mg/dL
○ Serum creatinine level 0.5-1.1 mg/dL (female); 0.6-1.2 mg/dL (male)
○ BUN/creatinine ratio 6-25
● Acute Kidney Injury
○ Rapid loss of kidney function from renal cell damage
○ Occurs abruptly and can be reversible
○ Causes
■ Prerenal: outside the kidney, caused by intravascular volume depletion
such as blood loss, decreased cardiac output, dehydration, decreased
peripheral vascular resistance, decreased renovascular blood flow
■ Intrarenal: within the parenchyma of the kidney; caused by tubular
necrosis, prolonged prerenal ischemia, intrarenal infection or obstruction,
and nephrotoxicity
■ Postrenal: between the kidney and urethral meatus, such as bladder neck
obstruction, bladder cancer, calculi and postrenal infection
○ Phases of AKI
■ Oliguric
● Sudden decrease in urine output; less than 400mL/day
● Signs of excess fluid volume, uremia, metabolic acidosis,
neurological changes, pericarditis
● Interventions
○ Restrict fluid intake to 400-1000mL, administer meds such
as diuretics to increase blood flow and diuresis of retained
fluid and electrolytes
■ Diuretic
● Urine output rises slowly, followed by diuresis (4-5L/day)
● Dehydration, hypovolemia, hypotension, and tachycardia can
occur
● Interventions
○ Administer IV fluids as prescribed to replace losses
■ Recovery
● Complete recovery may take up to 1-2 years
 ● Urine volume returns to normal, memory improves, strength
increases
■ Interventions
● Monitor vital signs, urine, intake and output, daily weight, monitor
kidney labs, urinalysis, LOC, infection
● Administer prescribed diet (low - moderate protein and high
carbohydrate)
● Restrict potassium and sodium intake
● Chronic Kidney Disease (CKD)
○ Slow, progressive, irreversible loss of kidney function GFR less than or equal to
60mL/min for 3 months or longer, occurs in stages
○ Special problems in kidney failure
■ Activity intolerance & insomnia, anemia, GI bleeding, hyperkalemia,
hypermagnesemia, hyperphosphatemia, hypertension, hypervolemia,
hypocalcemia, hypovolemia, infection, metabolic acidosis, muscle cramps,
neurological changes, ocular irritation, potential for injury, pruritus,
psychosocial problems
○ Primary causes
■ May follow AKI, DM & other metabolic disorders, hypertension, chronic
urinary obstruction, recurrent infections, renal artery occlusion,
autoimmune disorders
○ Interventions
■ Same as AKI
■ Provide oral care, provide skin care, teach client about fluid & dietary
restrictions and daily weights
● Hemodialysis
○ Intermittent renal replacement therapy involving the process of cleansing the
client’s blood
○ Cleanses the blood of accumulated waste products
○ Removes byproducts of protein metabolism such as urea, creatinine, & uric acid
○ Maintains or restores buffer system of the body
○ Corrects electrolyte levels
○ Uses an arteriovenous fistula
■ Permanent access of choice for dialysis
■ Surgically created by anastomosis of a large artery and vein in the arm
● Peritoneal dialysis
○ Type of dialysis where the peritoneum in a person's abdomen is used as the
membrane through which fluid and dissolved substances are exchanged with the
blood
○ Solution for this is STERILE!!
○ Increase in proteins for patients on peritoneal dialysis