How is urine formulated?
Includes 3 complex processes:
- Glomerus filtration
- Tubular reabsorption
- Tubular Secretion
What happens in the glomerus filtration process?
- Blood flows @ 1200mls/min
- 20% enters the nephrons
- Dependant on the flow & pressure
What happens in tubular reabsorption process?
- Majority happens within the proximal tubules.
2. Reabsorption of filtrate back to the capillaries
What happens in tubular secretion process?
- Movement from capillaries to the tubular filtrate.
2. Results in 1000ml-1500mls of urine
What are the roles of the kidneys?
- Regulation of water excretion
- Regulation of electrolytes
- Regulation of acids/bases
- Auto-regulation of Blood pressure
- Vit. D synthesis
- RBC production
What does ADH do?
Anti- diuretic hormone regulates water excretion and urine concentration, varying amount of water reabsorption.
What are the 3 types of ARF?
- Pre-renal: 60-70% of cases (decreased perfusion of kidneys -damage)
- Intra-renal: Drainage to nephrons
- Post- renal: Blockage of urethra
What is ARF?
- Rapid loss of renal function
- Causes imbalance fluid and electrolytes
- Can be life threatening
- Elevated creatinine 50% above baseline
What are the phases of ARF?
- Initiation
- Oliguria
- Diuresis
- Recovery
What is the initiation phase of ARF?
Initiation:
- Injury causing event
What is Oliguria in ARF?
Oliguria is the production of small amounts of urine
1 ) F&E imbalance
2) Decreased urine output
3) Increase Ur & Cr, K,
4) Lack of Oliguria in pt taking nephrontoxic antibiotics
What is Diuresis phase in ARF?
Return of urine
How long does it take in the recovery phase of ARF?
3-12 months
What are the signs/symptoms of ARF?
- Critically ill
- Lethargic
- Nausea, vomiting, diarrhoea
- Uraemic fetor
- Dehydration of the skin
How dose ARF affect CNS?
- Drowsiness
- Headaches
- Seizures
- Muscle twitching
Your Nursing considerations of ARF?
- Prevent/Minimise causative factor
- Care with nephrontoxic drugs
- Care with NSAIDs -> nephritis
- Age
- Co- morbidities
- Contrast
Medication Management of ARF?
- Kidneys are robust if limited damage to the organ
- Monitor for complications of overload: APO
- Dialysis
- Pharmacological treatments:
- Resonium: PO/PR
- Diuretics
- Glucose/insulin
- Ca
Nursing Management of ARF
- Early identification of ARF & implement preventative measures
- Treat the underlying cause
- Monitor F&E
- Conduct a holistic assessment of the patient
- Decrease metabolic rate
- Promotion respiratory function
- Prevent infections
- Provide skin care
- Psychological support
What is Chronic Renal Failure?
- 3 or more of kidney damage or decreased glomerus filtration rate (GFR)
- Results in decrease QOL & frequent health care
- Results in pre-mature death
- Lead to end-stage renal disease (ESRD)
- Associated with CVD, HT, diabetes, obesity
Name the 5 stages of CRF
Stage 1: Kidney damage with chronic inflammation Stage 2: Mild decrease GFR Stage 3: Moderate decrease GFR Stage 4: Severe decrease GFR Stage 5: End-stage renal failure
Acute on Chronic:
- When patients with CRF develop ARF
- Tends to increase severity
- Escalation of CKD -> require treatment of ARF
What is ESRD?
- 5th stage of CKD
- Build up of by-products; increase waste products: increase symptoms
- Symptoms:
- Fluid retention
- Anaemia/Acidosis
- Hyperkalaemia/ pericarditis/ pericardial tamponade
- HT, Bone disease
- CVD is predominately cause of death
- Require RRT on permanent basis (renal replacement therapy)
What is the predominant cause of death in ESRD
- Cardiovascular disease
- Retention of fluid (oedema, HF, HT)
- Acidosis, anaemia
- Hyperkalaemia
- Pericarditis
- Pericardial
- Tamponade
- Bone disease
What pharmacological interventions for ESRF?
- Anti-hypertensive: volume control
- Cardiac glycosides
- Beta-blockers
- Erythropoietin
- Fe
- Ca
- Phosphate
