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An X-ray shows that a patient's left kidney is slightly higher than his right kidney. What should you do?
Nothing. It is normal for the left kidney to be slightly higher than the right kidney.
What is erythropoietin and where is it produced?
Erythropoietin is a hormone produced in the kidneys in response to low oxygen levels in arterial blood. It travels to bone marrow and stimulates increased RBC production.
- Additional Info:
- Those with kidney disease can have anemia due to decreased erythropoietin and shortened lifespan of RBCs.
What percent of filtrate does the proximal convoluted tubule reabsorb?
What could happen if the proximal convoluted tubule is damaged?
Filtrate passes through the tubular parts of the nephron. Most of the water and electrolytes are reabsorbed. The proximal convoluted tubule reabsorbs 65% of filtrate; and all together, the tubules return almost 99% of all filtered water back into the body.
If the proximal convoluted tubule is damaged dehydration can result.
List the stages of chronic renal failure. Describe the amount of nephron function that existes in each stage.
Stage 1: Reduced Renal Reserve - 40-75% loss of nephron function:
Stage 2: Renal Insufficiency - 75-90% loss of nephron function
Stage 3: End Stage Renal Disease - Final stage of CKD. All the normal regulatory, excretory and hormonal functions of the kidney are severely impaired.
Serum Creatinine Norm?
0.5 - 1.2
With CKD serum creatinine may increase by 0.5-1 mg/dl every 1-2 years. The patient may not show symptoms until serum creatinine is 15-30.
No common pathologic condition other than renal disease increases the serum creatinine level. It is the best indicator of renal disease. Serum creatinine does not increase until at least 50% of the renal function is lost. Therefore any elevation is important.
Blood Urea Nitrogen (BUN)
What is the normal range?
May reach 180-200 before symptoms develop. Other factors do influence the BUN level so an elevation does not always indicate renal disease. but an elevated BUN is highly suggestive of renal disease.
What is the norm for creatinine clearance?
- Male 107-139
- Female: 87-107
Value will be decreased with chronic kidney disease - will be compared to serum creatinine level; is assessed by doing a 24-hour urine collection for creatinine clearance.
What is the norm for serum Sodium?
Will serum sodium levels be high or low in early CKD?
Will serum sodium levels be high or low in late CKD?
Early CKD: patient at risk for hyponatremia because there are fewer healthy nephrons to reabsorb sodium; sodium is lost in the urine.
Late CKD: patient is at risk for hypernatremia because kidney excretion of sodium is reduced as urine production decreases.
What is the normal value for Hemoglobin?
What is the normal value for Hematocrit?
If a patient has renal failure, what will happen to these values?
HGB: Females = 12-16 Males = 14-18
HCT: Females = 37%-47% Males = 42%-52%
H&H Decrease with renal failure. (The hematocrit can decrease to 20%.)
Treatment of Chronic Renal Disease:
When should calcium supplements like calcium carbonate or tums be taken?
Any calcium supplement should be given with meals.
How much protein should a person with chronic renal disease eat on a daily basis?
What kind of protein should be eaten?
Restrict protein to about 1g/kg of the person's ideal body weight.
Eat high value protein (eggs, meat, milk, poultry, fish, cheese)
Describe and Arteriovenous Graft.
Describe and Arteriovenous Fistula.
AV Graft: a biologic, semibiologic, or synthetic graft material which can be interposed subcutaneously between an artery and a vein. Usually placed in the forearm, upper arm or upper thigh.
AV Fistula: is more permanent and placed in the arm (usually forearm). the fistula is created by surgical anastomosis of the artery and vein, most often the radial artery and cephalic vein. It takes approximately 1-4 months for the AV fistula to mature... to be ready for dialysis.
Describe the care of the AV Fistula.
- -NO blood pressures or venipunctures in
- the affected arm of the fistula before or after it is inserted. These procedures may damage vessels and lead to failure of AV fistula.
- -Palpate and auscultate fistula q4hrs. A functional AV fistula has a palpable pulsation (“thrill”) and bruit on
-Thrombosis, infection and aneurysms can be a problem (can cause the fistula to fail) – if these problems occur, the a new fistula may need to be developed at a different site
-AV fistula sites should not be used to administer IV therapy or any type of blood draws.
-Patient needs to sleep in a position that will keep body weight off the arm with the fistula.
-Instruct patient to avoid carrying heavy items and not to wear tight fitting clothes over arm with the fistula.
Assess distal pulses and circulation frequently.
For peritoneal dialysis, what should the drainage look like.
Drainage should be colorless or straw-colored. Should not be bloody or cloudy.--> bloody drainage may be seen in the first few exchanges because of the surgery of insertion of the new catheter, but should not occur after that time.
The best way to assess effectiveness of PD is examining the drainage before and after treatments.
What is the most common and most serious complication of peritoneal dialysis?
Peritonitis: It is usually caused by contamination. It is important to use sterile technique when caring for the PD catheter and when hooking up or climping dialysate bags.
What are the manifestations of peritonitis?
cloudy outflow (first sign), fever, abdominal tenderness & pain, N/V
How is peritonitis treated?
- To treat: rapid exchanges with dextrose solution
- without added meds to wash out the inflammation and reduce abdominal pain.
Heparin may be added to dialysate solution to prevent fibrin clot formation.
- Antibiotics (either IV or intraperitoneally) administered for 10-14 days
- If unresolved after 4 days, the patient may need to have a new catheter inserted.
- The pt will be maintained on hemodialysis for 1 month before the new catheter insertion.
Peritonitis causes the pt to lose large amounts of protein through the peritoneum resulting in acute malnutrition and delayed wound healing.
What are the signs and symptoms of benign prostatic hypertrophy (BPH)?
Name two particular signs of UTI that are not signs of BPH.
Signs/Symptoms of BPH:
- Decreased urine stream
- Decreased force of urination
- Dribbling at the end of voiding
- Difficulty in starting the stream (dysuria)
- Increased frequency
- Interruption of the urinary stream
- Sensation that the bladder is not emptied completely
- Recurrent UTIs
- FatigueN&VAnorexiaEpigastric discomfort
- Azotemia (accumulation of nitrogenous waste products) – can occur with chronic urinary retention and large volumes
- Pain and burning are signs of UTI. They are not signs of BPH.
What is an intravenous pyelogram (IVP)?
- IVP: test requiring infusion of dye into the bloodstream to outline the urinary tract. Xrays are then performed to assess
- the anatomy of the upper urinary tract, check for stones and evaluate bladder emptying. Not routinely
- ordered unless hematuria is present.
What is the most commonly performed surgical procedure for benign prostatic hypertrophy?
Transurethral resection of the prostate (TURP).
This is discussed on pg. 16-18.
Name one risk factor for UTI.
Inability or failure to empty the bladder completely.
What are the signs and symptoms of lower UTI?
Burning/Pain with urination
Pain or spasm in the bladder region or suprapubic area
Pyuria (caused by WBCs in the urine) – looks like cloudy urine
Foul smelling urine
Low back pain
Some pts may be asymptomatic
- Older adults: increasing mental confusion most
Bactrim is a drug used to treat lower UTI. What is a possible side effect of this drug, and how can it be avoided?
When taking bactrim you must drink plenty of water so you don't get crystals.
Pyridium is a urinary analgesic used to treat lower UTI. Name a side effect of this drug.
Urine may have an orange color. Teach the patient not to be alarmed if this happens.
Name some drugs that are toxic to the kidneys.
NSAIDS (naproxen ibprofen motrin)
Diabetes meds like glucophage, metformin