Critical Care: Study Guide Test #3 | Chapter 48: Acute Kidney Failure and
Chronic Kidney Disease | Complete Solutions (2025/2026)
Chapter 48: Acute Kidney Failure and Chronic Kidney Disease
Acute Kidney Injury
- Rapid reduction in kidney function occurring over a few hours or days.
- Creatinine increases by 0.3 mg/dL withing 48hrs or urine volume <0.5ml/kg/hr for 6 hrs
- Can be temporary or progress to CKD
- Results in a failure of kidneys to eliminate waste, balance fluid and electrolytes, and excrete hydrogen ions
- Causes:
• Low perfusion to kidneys
• Damage to kidney
• Obstruction of urine outflow Pre-Renal AKI
- Kidney compensates by constricting kidney blood vessels, activating the renin angiotensinaldosterone pathway,
and releasing ADH - Causes:
• Shock
• Dehydration
• Burns
- Oliguria: urine output <400ml/day (<16ml/hr)
- Azotemia: retention and buildup of nitrogenous wastes in blood, accumulation of nitrogenous waste products
(BUN/creatinine) in the blood due to decreased kidney function
- Anuria: <100mL/day
Nursing Priorities
- Prevent volume depletion
- Assess continually for signs and symptoms of volume depletion
Intrinsic Renal Failure
- Causes:
• Embolism of renal vessels
• Nephrotoxic agents
Antibiotics: Rifampin, Vancomycin
Chemotherapy agents
NSAIDs
Acetaminophen- OD can affect both liver and kidneys
Radiographic Contrast
Metformin- patient with DM on this drug CANNOT have contrast
• Allergic disorders
• Glomerunephritis
Post-Renal Failure (Urine Flow Obstruction) - Causes:
• Cancers
• Clots
, • Kidney Stones
- Induces similar response as prerenal renal failure
Cues
- UOP < 0.5 ml/kg/hr for 2 or more hours
- Pulmonary crackles (posterior bases, back)
- Edema
- Drop O2
- Increase BUN & Creatinine
- Increase Potassium
Diagnosis Studies
- Renal US: shows kidneys size and patency of ureters Keep the patient’s bladder full for
test.
- CT scan w/o contrast: determines adequacy of kidney perfusion and identify any
obstruction
Usually avoided, if necessary pre-hydrate 500-1000mL an hour before the scan
Nursing Interventions
- Goal: avoid hypo/hypertension & maintain normal fluid balance
- Keep MAP closer to 70mmhg
- Strict I&O, daily weights
- Monitor electrolytes, edema and pulmonary crackles
- Monitor therapeutic vs toxic drug levels
- Give IV fluid or diuretics depending on UOP
Nutrition Therapy
- If patient NOT in HD, 40grams protein/day
- AKI patients have high catabolism or protein breakdown leading to the breakdown of muscle tissue
Kidney Replacement Therapy - When to
start:
• Decline in LOC
• Persistently high potassium
• Severe metabolic acidosis
• Fluid overload that inhibits tissue perfusion
- Types:
• Intermittent or continuous hemodialysis
• Peritoneal dialysis
- Life expectancy: 3-5yrs
Hemodialysis
- Blood dialysate flow in opposite directions across semipermeable membrane.
• Dialysate: resembles human plasma
- Removes unwanted molecules from blood by diffusion
- HD occurs 3-4x wk, delivered 3-6hrs - Anticoagulant used - Symptoms during:
• Fatigued
• Hypotensive (do not give BP meds prior to dialysis)
, AV Fistula & Graft
- Fistula surgically connects artery and vein. Must mature prior to use
- Graft is used when fistula does not develop or complication
- Care:
• Cap refill and pulse in distal extremity
• Fill for thrill Listen for bruit - Don’t do:
Don’t check BP affected extremity
• Don’t start IV or do venipuncture unrelated to HD on affected arm
• Don’t compress extremity while sleeping or carrying a heavy bag
Complications During HD
- Hypotension
- Dialysis disequilibrium syndrome
• Mild: N/V, HA, fatigue, restlessness
• Severe: Mental status changes, seizures, coma
- Cardiac events
- Reaction to dialyzers:
• Allergic reaction
• Stop HD and do not return blood
- 200mL is lost when the blood is NOT returned to the patient
Continuous Renal Replacement Therapy
- Start flow rate at 50
- Removes 2-3L fluid in 2-3 hours
- Restores acid-base balance and fluid and electrolyte balance in patients that cannot tolerate HD
- Continuous process so there is not as much drop in BP due to more subtle fluid shifts
Chronic Kidney Disease
- Chronic, irreversible disorder lasting LONGER than 3 months
- Stage 1
• eGFR: 90 or >
• Level of kidney damage: mild kidney damage
- Stage 2
• eGFR: 60-89
• Level of kidney damage: mild kidney damage
- Stage 3A
• eGFR: 45-59
• Level of kidney damage: Mild to moderate kidney damage
- Stage 3B
• eGFR: 30-44
• Level of kidney damage: Mild to moderate kidney damage
- Stage 4
• eGFR: 15-29
• Level of kidney damage: Moderate to severe kidney damage
- Stage 5
• eGFR: < 15
• Level of kidney damage: End-sate kidney disease. Kidneys are close to failure or have completely failure
or have failed. Will need start dialysis or kidney transplant.
Chronic Kidney Disease | Complete Solutions (2025/2026)
Chapter 48: Acute Kidney Failure and Chronic Kidney Disease
Acute Kidney Injury
- Rapid reduction in kidney function occurring over a few hours or days.
- Creatinine increases by 0.3 mg/dL withing 48hrs or urine volume <0.5ml/kg/hr for 6 hrs
- Can be temporary or progress to CKD
- Results in a failure of kidneys to eliminate waste, balance fluid and electrolytes, and excrete hydrogen ions
- Causes:
• Low perfusion to kidneys
• Damage to kidney
• Obstruction of urine outflow Pre-Renal AKI
- Kidney compensates by constricting kidney blood vessels, activating the renin angiotensinaldosterone pathway,
and releasing ADH - Causes:
• Shock
• Dehydration
• Burns
- Oliguria: urine output <400ml/day (<16ml/hr)
- Azotemia: retention and buildup of nitrogenous wastes in blood, accumulation of nitrogenous waste products
(BUN/creatinine) in the blood due to decreased kidney function
- Anuria: <100mL/day
Nursing Priorities
- Prevent volume depletion
- Assess continually for signs and symptoms of volume depletion
Intrinsic Renal Failure
- Causes:
• Embolism of renal vessels
• Nephrotoxic agents
Antibiotics: Rifampin, Vancomycin
Chemotherapy agents
NSAIDs
Acetaminophen- OD can affect both liver and kidneys
Radiographic Contrast
Metformin- patient with DM on this drug CANNOT have contrast
• Allergic disorders
• Glomerunephritis
Post-Renal Failure (Urine Flow Obstruction) - Causes:
• Cancers
• Clots
, • Kidney Stones
- Induces similar response as prerenal renal failure
Cues
- UOP < 0.5 ml/kg/hr for 2 or more hours
- Pulmonary crackles (posterior bases, back)
- Edema
- Drop O2
- Increase BUN & Creatinine
- Increase Potassium
Diagnosis Studies
- Renal US: shows kidneys size and patency of ureters Keep the patient’s bladder full for
test.
- CT scan w/o contrast: determines adequacy of kidney perfusion and identify any
obstruction
Usually avoided, if necessary pre-hydrate 500-1000mL an hour before the scan
Nursing Interventions
- Goal: avoid hypo/hypertension & maintain normal fluid balance
- Keep MAP closer to 70mmhg
- Strict I&O, daily weights
- Monitor electrolytes, edema and pulmonary crackles
- Monitor therapeutic vs toxic drug levels
- Give IV fluid or diuretics depending on UOP
Nutrition Therapy
- If patient NOT in HD, 40grams protein/day
- AKI patients have high catabolism or protein breakdown leading to the breakdown of muscle tissue
Kidney Replacement Therapy - When to
start:
• Decline in LOC
• Persistently high potassium
• Severe metabolic acidosis
• Fluid overload that inhibits tissue perfusion
- Types:
• Intermittent or continuous hemodialysis
• Peritoneal dialysis
- Life expectancy: 3-5yrs
Hemodialysis
- Blood dialysate flow in opposite directions across semipermeable membrane.
• Dialysate: resembles human plasma
- Removes unwanted molecules from blood by diffusion
- HD occurs 3-4x wk, delivered 3-6hrs - Anticoagulant used - Symptoms during:
• Fatigued
• Hypotensive (do not give BP meds prior to dialysis)
, AV Fistula & Graft
- Fistula surgically connects artery and vein. Must mature prior to use
- Graft is used when fistula does not develop or complication
- Care:
• Cap refill and pulse in distal extremity
• Fill for thrill Listen for bruit - Don’t do:
Don’t check BP affected extremity
• Don’t start IV or do venipuncture unrelated to HD on affected arm
• Don’t compress extremity while sleeping or carrying a heavy bag
Complications During HD
- Hypotension
- Dialysis disequilibrium syndrome
• Mild: N/V, HA, fatigue, restlessness
• Severe: Mental status changes, seizures, coma
- Cardiac events
- Reaction to dialyzers:
• Allergic reaction
• Stop HD and do not return blood
- 200mL is lost when the blood is NOT returned to the patient
Continuous Renal Replacement Therapy
- Start flow rate at 50
- Removes 2-3L fluid in 2-3 hours
- Restores acid-base balance and fluid and electrolyte balance in patients that cannot tolerate HD
- Continuous process so there is not as much drop in BP due to more subtle fluid shifts
Chronic Kidney Disease
- Chronic, irreversible disorder lasting LONGER than 3 months
- Stage 1
• eGFR: 90 or >
• Level of kidney damage: mild kidney damage
- Stage 2
• eGFR: 60-89
• Level of kidney damage: mild kidney damage
- Stage 3A
• eGFR: 45-59
• Level of kidney damage: Mild to moderate kidney damage
- Stage 3B
• eGFR: 30-44
• Level of kidney damage: Mild to moderate kidney damage
- Stage 4
• eGFR: 15-29
• Level of kidney damage: Moderate to severe kidney damage
- Stage 5
• eGFR: < 15
• Level of kidney damage: End-sate kidney disease. Kidneys are close to failure or have completely failure
or have failed. Will need start dialysis or kidney transplant.
