1primary functions of the kidneys
1. filtration of metabolic waste
2. regulation of fluid/electrolyes/acid-base
3. blood pressue control via RASS
4. Production of erythroprotein
5. activation of Vitamin D
2functional unit of the kidney
Nephron
3nephrons 3 essential processes
processes are
1. glomerular filtration
2. tubular reabsorption
3. tubular secretion
4the kidneys get approx how much of resting cardiac output
20-25%
53 Categories of AKI
1. prerenal
2. intrarenal
3. postrenal
6Why does prerenal AKI occur
becuase of decreased renal perfusion
kidney is normal the problem is inadequete blood flow
7causes of prerenal AKI
dehydration
hemorrhage
sepsis
cardiogenic shock
8why does intrarenal AKI occur
because of damage within the kidney itsself
9examples of intrarenal AKI
Acute tubular necrosis
glomerulonephritis
nephrotoxic medications
prolonged ischemia
10why does postrenal AKI occur
beacsuse of obstruction of urine flow
11examples of post renal AKI
benign porstatic hyperplasis
ureteruc calculi
urethreal obstruction
tumors
12what is azotemia
its a lab finding
elevated nitrogen-contaning waste products primarily BUN and creatinine in blood stream
13what is uremia
is a clinical syndrome from severe kidney failure and may include
LOA
N/V
prurtus
pericarditis
14what is AKI characterized by
a rapid decline in kidney function occuring ober hours to days
15Chronic kindey disease (CKD) is characterized as
a progressive and irreversible loss of kidney function over months to years
16common causes of CKD
diabetes mellitus
hypertension
chronic glomerular disease
polycystic kidney disease
17what does CKD eventually need
dialysis and kindey transplantation
18how do pts present in renal failure
fatigue
weakness
N/V
peripheral edema
hypertension
dyspnea from fluid overload
19hyperkalemia in renal failure
is the most lifethreatining complications
20clinical findings in hyperkalemia
muscle weakness
cardiac dysrhythmias
bradycardia
cardiac arrest
21hyperkalemia ECG findings may include
peaked T waves
widened QRS complexes
progressive conduction abnormalties
22what does hemodialysis remove
excess fluid
electrolytes
meabolic waste products
23how many times a day is hemodialysis
3x a week
24what should a functioning AV fustula have
a palatable thrill
an audible bruit
25what to avoid with an AV fistula
BP measurement on the acess arm
IV insertion into the acess arm
Venipuncture involving the acess arm whenever possible
26complications of dialysis
hypotension
muscle cramps
bleeding
infection
hyperkalemia
fluid overload
27S/S of dialysis diseuilibrium
headahce
N/V
restlessness
confusion
seizures
Decreased LOC
28what do most uncomplicated UTIS involve
the lower urinary tract (cytitis)
29common symptoms of UTI
dysuria
urinary frequency
urinary urgency
suprapubic discomdort
hematuria
afebrile
30what is pyelonephritis
an innfection of the kidney and represents the upper urinary tract infection
31symoptoms of a pyelonephritis
fever
chills
flank pain
costoverebral angle tendereness
N/V
dysuria
32what does nephrolithiasis (renal calculi) commonly produce
sudden severe flank pain
pain radiating towards the groin
restlessness
hematuria
nausea and vomiting
these pats cannot remain still
33Benign Prostatic Hyperplasisa (BPH)
is a common cause of urinary obstruction in older males
34symptoms of BPH
difficulty initating urination
weak urinary steam
urinary frequency
nocturia
incomplete bladder emptying
acute urianry retention may occur
35Epididmymitis
inflammation of the epididmyis
36Epididmymitis commonly presents with
gradual onset unilateral scrotal pain
swelling
tenderness
occasinally fever
37what is epididymitis is commonly associated with
Chlamydia trachomatid and neisseria gonorrhoeae
38clinical findings of testicular torsion
sudden severe unilateral scrotal pain
high riding testicle
neausa vomiting
swelling
39common casues of urinary retention
benign prostatic hyperplasia
urethral obstruction
neruological disroders
certain medications
40What do patients often complain of with urinary retention
lower abdominal discomfort
inability to void
bladder distention
41fluid overload commonly presents with
dyspnea
orthopnea
pulmonary edema
peripheral edema
hypertension
JVD
42When to suspect hyperkalemia
missed dialysis
present with weakness
develop bradycardia
demonstarte ECG abnormalities
43UTI or pyelonephritis may progress to sepsis and red flags include
fever
tahchycardia
hypotnesion
altered mental status
tachypnea
44MAP formula
MAP= (SBP + 2 X DBP) / 3
45MAP of what is considered necessary to maintain adequate perfusion
65mmHg