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Renal Failure


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What acid base imbalance often occurs with renal failure?
Metabolic Acidosis
Use phosphoru binding mecications to treat what?
Complications of transplantation (2)
1. Finding compatible donor
2. Rejection
Peritoneal Dialysis
Watch for abnormal soln color, should be straw colored.
How long does the soln usually dwell in peritoneal dialysis?
4 to 6 hours
How often for hemodialysis?
Every three to five days for 3-5 or more hours at a time.
Initian Phase in ARF
1-2 days
reduced urine output and increased BUN
Oliguric phase (Maintance) in ARF
1-2 weeks
hyperkalemia and fluid volume overload
Polyguric Phase (Diuretic) in ARF
progressive increase in urination in pts that were olyguric
May indicate beginning of renal repair
Substantial renal loss of sodium and water
May dehydrate
Phase of Functional recovery
No beginning or end
Repair of renal injury
BUN, creatinine, and urine volume gradually return to normal.
5 stages of chronic renal failure
1. slight damage GFR more than 90
2.Mild decrease in function GFR 60-89
3. Mod decrease in function GFR 30-59
4. Sever dEcrease in function GFR 15-29
5. kidney failure GFR less than 15
What is the main protein found in the urine?
What are the filters of the kidney?
Proteinuria is caused by what?
Glomererular Filtration is best checked by what lab?
Blood creatinine
What lab checks the ability of the kidneys to concentrate urine?
Urine Specific Gravity
What is the diet ordered for patient with renal failure?
Low protein
Low sodium
High calorie
Antidiuretic Hormone effects kidneys by
controlling permeability
Aldosterone effects kidneys by
causing the distal tubule and collecting ducts to reabsorb increased levels of sodium.
Causes of intrarenal ARF
Nephrotoxic damage
heavy metals
Causes of postrenal ARF
*calculi (kidney stones)*
obstruction of indwelling cath
Causes of prerenal ARF
heart/liver failure
How long does recovery phase last?
About 6 months
Renin-Angiotensin Mechanism
one of the most potent vasoconstrictors known.

RAS is a defense mechanism to prevent fall in BP due to loss of blood or fluid.

It can be improperly activated in renal disease causing HTN.
Alterations in fluid may produce what?
Generalized Edema
Accumulation of wastes (amonia) may cause what?
Mucosal Errosion
Alterations in platelet function may lead to what?
What is a "silent killer"?
Causes of Acute Renal Failure ARF
1. prerenal- low blood flow to kidneys
2.intrarenal-direct damage to kidney parenchyme
3.postrenal-obstruction to flow of urine(may cause hydronephrosis)
What is ARF
Rapid deterioration or cessation in kidney function.
ARF and childhood!
It is uncommon in childhood!!
Biggest cause of prerenal failure!
Biggest cause of post renal failure.
Renal Calculi
(more men than women have renal calculi)
Biggest cause of intrarenal failure.
Children with untreated strep may end up with what?
Chronic Renal Failure
Progressive and Irreversible Destruction of kidneys.
CRF caused by what?
Conditions that cause permanent nephron loss:
diabetes, HTN, glomerulonephritis, polycystic kidney disease
Each kidney contains how many nephrons?
one million
Diminished Renal Reserve
GFR 50% of normal
usually 40-70 mL/min
Renal Innsuffiency
GFR 20-50%
usually 20-40 mL/min
Renal Failure
GFR less than 20%
usually 10-20 mL/min
End Stage Renal Disease (ESRD)
GFR less than 5%
usually less than 10 mL/min
Requires dialysis for survival
What med is used for hyperkalemia?
Clinical Manifestations of Chronic Renal Failure
High or low Na
Procurement Interview
Checks for possible donor.
Avoid using ________with antacids or mg because of toxicity.
Aluminum Hydroxid
Epogen given for renal failure.
To see if it is working, check to see if Hematocrit level is rising.
Dry scaley skin with ecchymoses, petechiae, and purpura.
Because of eurythropeotin
Facts about acute renal failure
-occurs suddenly
-usually reversible
-3 phases
oliguric, diuretic, and
Emergency tx of hyperkalemia.
dialysis and 50% hypertonic glucose IV, calcium gluconate IV, regular insulin, sodium bicarb IV, Kayexelate
Lab results with ARF
-urine output below 400 mL in 24 hours
-increased blood urea nitrogen level
-increased serum creatine

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