Nursing 465 - Alteration in Urinary and Renal Function and Fluid Balance. Complete Study Guide.

Alteration in Urinary and Renal Function and Fluid Balance Kidney Failure  Results when the kidneys cannot remove wastes or perform regulatory functions  A systemic disorder that results from many different causes  Acute renal failure is a reversible syndrome that results in decreased glomerular filtration rate and oliguria  Chronic renal failure (ESRD) is a progressive, irreversible deterioration of renal function that results in azotemia Note: *Reason for KF: HTN, DM *Acute is reversible. Whatever is causing the injury we can take it away & recover *Chronic: Progressive, we end up with nitrogen in our blood Acute Kidney Injury (AKI) - Acute Renal Failure (ARF) - Acute Kidney Failure (AKF) Types  Prerenal  Intrarenal  Postrenal Causes of Prerenal Acute Kidney Failure- Perfusion or Obstruction 60-70%  Hypovolemia  Hypotension  Reduced cardiac output and heart failure  Obstruction of the kidney or lower urinary tract o Could be a malignancy  Obstruction of renal arteries or veins  Clots, plaques (Atherosclerosis) Note: Majority AKF is Pre renal. Intrarenal - What happens IN the kidney  Intrarenal –directly affecting kidney  Nephrotoxins o Aminoglycoside (Abx)  Usually end in “–Mycin”  “Think Mice in-side a little kidney”  When giving ABX, monitor kidney function  Can be permanent or reversible o Contrast media injuries  Sometimes we don’t know this is happening until they have decrease urine output & edema o Myoglobin released from necrotic tissue (Damages kidneys  PT’s involved in traumatic accidents  Hemolytic Dx too  Rabdomyolysis (SP?)  Beta Hemolytic strep o Hemoglobin from RBC breakdown o Someone has taken something that has caused damage Post-renal Failure – Outside the kidney  Post-renal – mechanical outflow obstruction backup into renal pelvis. o Prostatic hypertrophy/hyperplasia o Prostate Cancer  BPH o Calculi (stones) o Extra-renal tumors  Turmors outside of the kidney  Bilateral = hydronephrosis (RF on both sides)  Unilateral post-renal doesn’t usually cause azotemia (elevated nitrogen) because the other kidney can take care of it.  GFR recovery if corrected in 48 hr Phases of AKI  Oliguric – A phase with decreased or no urine output  Diruretic– Then suddenly you go up in urine output  Recovery Oliguric Phase of AKI  Oliguric- last for 8 to 14 days o Output 400 ml day (16cc/hr) may be anuric.  30cc/hr to indicate normal kidney function o Ischemic insult = rapid onset of oliguria  R/T a clot, something that happens quick! o Nephrotoxic more gradual onset of oliguria  May not be seen right away, longer period of time