Kidney

Question 1

Normal urine

Answer 1

No blood cells
No plasma
No protein

Question 2

Glomerular filtration rate

Answer 2

Rate that blood is passed through nephron

125ml/min

Question 3

Factors that increase GFR

Answer 3

Elevated BS

Increased protein intake

Question 4

Mild disease

Answer 4

60-89

Question 5

Moderate disease

Answer 5

Below 60

Question 6

End stage kidney disease

Answer 6

15 or less

Question 7

BUN

Answer 7

End product of protein metabolism

Question 8

BUN normal

Answer 8

10-20

Question 9

Digesting blood

Answer 9

GI bleed

Makes BUN rise

Question 10

If BUN elevated

Answer 10

Either have a decrease in kidney function or less fluid

Question 11

Creatinine normal

Answer 11

0.6-1.2

Question 12

Creatinine

Answer 12

Byproduct of anaerobic metabolism in skeletal muscle

Question 13

If creatinine elevated

Answer 13

GFR decreased

Question 14

Oliguria

Answer 14

400 or less in 24 hours

Question 15

Anuria

Answer 15

100 mL or less in 24 hours

Question 16

Azotemia

Answer 16

Build up of nitrogenous wastes in blood

Question 17

Uremic frost

Answer 17

White crystals that appear on skin composed of urea

Question 18

Prerenal

Answer 18

Deceased blood supply

Shock, dehydration, vasoconstriction

Question 19

Intrinsic

Answer 19

Kidney tubule function is decreased

Ischemia, toxins, intratubular obstruction

Question 20

Postrenal

Answer 20

Urine flow is blocked 
Stones
Tumors
Enlarged prostate
Catheter

Question 21

When to report urine output

Answer 21

Less than 0.5/kg/hr for two hours

Question 22

Onset (initiation) phase of AKI

Answer 22

Normal perfusion is abruptly diminished-hours to days

No symptoms yet

Question 23

Oliguric phase of AKI

Answer 23

Urine output less than 400ml/24 hours
1-7 days
Lasts 1-3 weeks
Collection of debris/wastes/h2o in tubules

Question 24

Oliguric phase labs

Answer 24

Increased 
Creatinine 
BUN
K+
Phosphorus 
Mag
Sodium 
All masked by fluid retention

Question 25

Diuretic phase of AKI

Answer 25

``` Movement towards recovery Starts 2-6 weeks Lasts 1-3 weeks Renal perfusion and GFR increase LARGE DILUTE URINE Risk for dehydration and electrolytes 10L/hr ```

Question 26

Recovery phase of AKI | Convalescent phase

Answer 26

Takes up to a year | Damage does not grow back

Question 27

Signs and symptoms of AKI

Answer 27

``` Weight gain Decreased urine output Fluid volume overload Nausea HA, confusion Cramps, twitching Dysthymia ```

Question 28

Drug History that may lead to AKI

Answer 28

NSAIDS Antibiotic Some antifungals

Question 29

Treatment for AKI

Answer 29

``` IV fluid challenge Calcium channel blockers Bicarbonate infusion Renal diet Dialysis ```

Question 30

More drugs that hurt the kidney

Answer 30

Acetylcytetine Dopamine Diuretics

Question 31

Renal diet

Answer 31

Stay away from Potassium Sodium Phosphorus

Question 32

Prevention and health maintenance

Answer 32

Avoid hypotension Monitor labs Monitor weight Use touch nephrotoxic drugs

Question 33

Nursing care in AKI

Answer 33

Monitor fluid balance Labs Maintain MAP of 65 Educate

Question 34

Causes of CKD

Answer 34

Diabetes HTN AKI Genetic

Question 35

CKD

Answer 35

Progressive, irreversible kidney injury GFR 15 or less Azotemia Uremia

Question 36

Renal filtering function decreases fluid and electrolytes

Answer 36

Acidosis Hyperkalemia Hypertension

Question 37

Wastes build up in blood Toxic to CNS, RBCs, platelets

Answer 37

Increased creatinine and BUN

Question 38

Kidney metabolic functions decrease

Answer 38

Erythropoietin | Vitamin D activation

Question 39

No symptoms of CRF until

Answer 39

75-80% loss of nephrons

Question 40

Chronic renal failure GFR

Answer 40

Less than 60ml/min for 3 months or more

Question 41

CRF difficult to diagnose

Answer 41

Healthy nephrons enlarge to compensate

Question 42

Stage 1

Answer 42

At risk | Greater than 90

Question 43

Stage 2

Answer 43

Mild 60-89

Question 44

Stage 3

Answer 44

Moderate 30-59

Question 45

Stage 4

Answer 45

Severe 15-29

Question 46

Stage 5

Answer 46

End stage | Less than 15

Question 47

Stage 2..... | What to do?

Answer 47

Control risk factors No NSAIDS No ACE/ARBS

Question 48

What happens to patient at stage 2

Answer 48

``` 75-90% loss Polyuria Nocturia Hyponatremia Increase in BUN May be diet controlled ```

Question 49

Stage 3, what to do?

Answer 49

Same as #2

Question 50

Stage 4 what to do?

Answer 50

Initiate AV fistula

Question 51

RRT is considered for

Answer 51

Fluid overload Really bad hyperkalemia Symptoms from azotemia

Question 52

Stage 5, what to do ?

Answer 52

More than 90% loss Hyperkalemia kills them Death without transplant or RRT

Question 53

CKD manifestations

Answer 53

Kidney changes Metabolic changes Electrolyte changes

Question 54

Calcium can not be

Answer 54

Absorbed from food due to decrease production of vitamin D, also stimulated by kidneys

Question 55

Calcium is reabsorbed from the bones to

Answer 55

Balance the loss in the blood and pH of blood Also need for muscle contraction

Question 56

Phosphate binders

Answer 56

Eat with food to decrease phosphorus | Keeps calcium up and bones in better shape

Question 57

Calcium and blood

Answer 57

Calcium is needed for clotting cascade

Question 58

Uremia manifestations

Answer 58

``` Metallic taste in mouth Anorexia Nausea Vomiting Muscle cramps Uremic frost Itching Fatigue Hiccups Edema Dyspnea Paresthesias ```

Question 59

Creatinine

Answer 59

Comes from proteins in skeletal muscle

Question 60

BUN levels

Answer 60

Vary with protein intake

Question 61

Renal osteodystrophy

Answer 61

Less vitamin D from kidney= less calcium Increased phosphorus Increased parathyroid hormone Bone mineral loss

Question 62

Pericarditis

Answer 62

Occurs with CKD | Pericardial sac becomes inflamed from toxins

Question 63

Decreased erythropoietin levels

Answer 63

Decreased RBC lifespan | Decreased platelets

Question 64

Calcium channel blockers best for

Answer 64

Improve GFR

Question 65

ACE inhibitors best for

Answer 65

Slow progression of pts with CKD and hypertension