Pathophys Exam 3

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Author:
Rx2013
ID:
53627
Filename:
Pathophys Exam 3
Updated:
2010-12-05 23:19:02
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Renal failure
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Description:
Renal Failure
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  1. Acute renal failure
    • azotemia
    • accumulation of urea, nitrogen, uric acid and creatinine
    • decreased GFR
  2. postrenal failure
    • ureteral obstruction
    • bladder obstruction
    • prostatic hyperplasia
  3. Stage 1 acute renal failure
    • oliguria lasting 1-2 weeks
    • may be followed by a diuretic stage for 2-10 days
  4. Stage 2 acute renal failure
    • diuretic phse
    • urine volume increases
    • tubular function remains impared
    • azotemia continues
  5. stage 3 acute renal failure
    • recovery phase
    • lasting up to 12 months
    • gradual normalized scr and BUN
    • a degree of renal insuficiency persists
  6. Causes of pre-renal acute renal failure
    • decreases in renal blood flow
    • drugs/toxins
  7. Symptoms of pre-renal acute renal failure
    • less urine output
    • elevated BUN and Scr
    • low FeNa <1
    • high urine specific gravity
    • low urinary sodium <20
  8. Treatment for pre-renal acute renal failure
    • improve renal blood flow
    • remove offender
    • dialysis
  9. FeNa >2%
    intrinsic acute renal failure
  10. Intrinsic acute renal failure causes
    • ischemia
    • sepsis
    • drugs
    • obstruction
  11. Chronic kidney disease
    • kidney damage for > 3 months + markers of damage or abnormalities
    • or GFR <60 mL/min for >3 months with our without kidney damage
  12. common causes of chronic kidney disease
    • diabetes mellitus
    • nephritis
    • polycystic kidney disease
  13. complications of chronic kidney disease
    • HTN
    • cardiovascular risks
    • e- imbalance
    • osteodystrophy
    • malnutrition/anemia
  14. Stages of chronic kidney disease
    • 1: GFR >90 ml/min
    • 2: GFR 60-89
    • 3: GFR 30-59
    • 4: GFR 15-29
    • 5: GFR <15
  15. Nephron loss of stage 1 and 2 CKD
    75%
  16. Stage 3 and 4 nephron loss
    • 75-90%
    • mild azotemial
    • polyuria
    • nocturia
  17. stage 5 - end stage renal disease
    • 90% nephrons lost
    • BUN and Cr are increased
    • e- abnormalities
    • uremia, bone problems
  18. signs and symptoms of CKD
    • decreased urine output
    • hyperkalemia
    • aneima
    • weak....
    • urine changes
    • edema/heart failure symptoms
  19. Clinical Manifestations
    • accumulation of nitrogenous wastes
    • fluid, e-, acid base imbalance
    • calcium and phosphorus
    • hematologic
    • pharmacokinetics
  20. Uremia
    urin in the blood
  21. azotemia
    accumulation of nitrogenous wastes in blood
  22. Clinical manifestation of CKD fluids and e-
    • impaired sodium excretion
    • salt wasting
    • increased potassium excretion
    • metabolic acidosis
  23. clinical manifestations -calcium and phosphorus
    • impaired phosphate excretion = increased phos & decresed calcium
    • increased PTH affects bones
    • impaired vitamin D synthesis
  24. Hyperphophatemia
    • not seen until stage 5
    • restrict phosphorus in diet
    • use phosphate binders
  25. Pharmacokinetic changes with renal failure
    • alterations in gastric emptying
    • antacids and phosphate binders may decrease absorption of other meds
    • uremic pt may suffer from n/v
    • low albumin protein in blood
  26. Indication acronym for dialysis
    • A-acidosis
    • E-electrolyte (hyperkalemia)
    • I-intoxication
    • O-refractory fluid overload
    • U-uremia

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