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is the partial or complete impairment of kidney function resultin in an inability to excrete metabolic waste products & water. Has a rapid onset, it's potentially reversible.
ARF is often associated with Oliguria which means decrease in urinary output, to less than 400ml/day
Most commonly ARF follows severe, prolonged hypotension and hypovolemia
Prerenal (External to kidney) before glomerulus, decreased blood volume(nausea, vomitting, diarrhea)
Hypovolemia, decreased cardiac output, the kidneys compensate by conservation of sodium & water. BUN and serum ccreatinine and inability of kidneys to conserve sodium.
Intrarenal (direct damage to the renal tissue causing impaired nephron function) Within the kidney
prolonged ischemia, nephrotoxins drugs, hemoglobin release or myoglobin release from necrotic muscle cells.
Postrenal (outside kidney, obstructions, calculi, tumors)
as the flow of urine is obstructed, urine refluxes into the renal pelvis impaire kidney function
Kayexalate (sodium polystyrene sulfonate)
potassium is excreted in stool, drug of choice is Kayexalate. Do not give to pts with paralitic ilius because bowel necrosis can occur.
Stages of Chronic Kidney Disease
- Stage 1- kidney damage with normal increase GFR >90
- Stage 2- Kidney damage with mild decrease GFR 60-89
- Stage 3- Moderate decrease GFR 30-59
- Stage 4- Severe decrease GFR 15-29
- Stage 5- Kidney Failure <15 (or dialysis)
To treat Hyperkalimia
Kayexalate is given to lower potassium level in stage 4, pt should be monitored for sodium and water retention.
Fosrenol (lanthanum carbonate)
does not contain either calcium or aluminun, and its chewable. helps to decrease BP. Phospate binders may cause constipation and may need stool softener.
Mylanta or Maalox (magnesium containing antacids)
should not be used because magnesium id dependent on the kidneys for excretion. Aluminun toxicity (dementia)
Aranesp (Darbepoetin alfa)
to treat anemia, newer and longer acting erthropoietin product for subQ and IV use.
should never be administered to pts with CKD other pain meds can be given such as acetaminophen or morphine sulfate
Vancomicin & Garamycin (micins) are toxic to the kidney
- Protein is restricted
- supplement vit are Rx
- Carbs & Fats are prescribed
- water intake depends on urine output
- Sodium & Potassium depend on kidney ability(avoid cured meats, pickled food, canned soups, cold cuts, soy sauce, salad dressings.(High SODIUM)
- (High Potassium)oranges, bananas, melons, tomatoes, prunes, raisins, deep green & yellow veggies, beans & legumes
- (High Phosphate) milk, ice cream, cheese, yogurt, pudding.(high in Ca)
Meperidine and ACE inhibitors may be harmful because of renal insufficiency
Dietary for CKD
Protein, sodium, phosphate, potassium are restricted
- Phosphate binders(including calcium supplements used as phosphate barriers) should be taken with meals.
- Calcium supplements prescribed to treat hypocalcemia directly should be taken on an empty stomach(but not at the same time as iron supplements)
- Iron supplements should be taken between meals