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Renal Failure
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.
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ARF is often associated with Oliguria which means decrease in urinary output, to less than 400ml/day
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Most commonly ARF follows severe, prolonged hypotension and hypovolemia
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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.
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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.
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Postrenal (outside kidney, obstructions, calculi, tumors)
as the flow of urine is obstructed, urine refluxes into the renal pelvis impaire kidney function
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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.
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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)
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To treat Hyperkalimia
Kayexalate is given to lower potassium level in stage 4, pt should be monitored for sodium and water retention.
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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.
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Mylanta or Maalox (magnesium containing antacids)
should not be used because magnesium id dependent on the kidneys for excretion. Aluminun toxicity (dementia)
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Aranesp (Darbepoetin alfa)
to treat anemia, newer and longer acting erthropoietin product for subQ and IV use.
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Demerol
should never be administered to pts with CKD other pain meds can be given such as acetaminophen or morphine sulfate
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Vancomicin & Garamycin (micins) are toxic to the kidney
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CKD nutrition
- 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)
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Meperidine and ACE inhibitors may be harmful because of renal insufficiency
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Dietary for CKD
Protein, sodium, phosphate, potassium are restricted
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Rationales
- 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
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