Acute Renal Failure

marissatalley9's version from 2015-06-21 14:47


Question Answer
acute renal failuresudden deterioration in renal fnx
ARFcharacterized by change in urine output, fluid overload, electrolyte imbalance, acid base imbalance
types of ARFpre-renal, intra-renal, post-renal
pre-renalhypo-perfusion, diminished renal perfusion
pre-renalcaused by: hypovolemia- burns, fluid loss, dehydration, GI issues
pre-renalcaused by: impaired cardiac output- MI, heart failure, cardiogenic shock
pre-renalcased by: vasodilation: sepsis, anaphylaxis, meds
pre-renal labsBUN, creatinine, nml sediment, few casts, urine specifity gravity up
intra-renal damage to kidney parenchyma (inside)
intra-renalcaused by: myoglobinurea- increased protein- burns, tissue damage, trauma, crush injury, rhabdo
intra-renalcaused by: hemoglobinurea- transfusion reaction, hemolytic anemia
intra-renalcaused by: nephrotoxic agents- meds, solvents, chemicals
intra-renalcaused by: infectious process, acute pylonephritis, glomerulonephritis
intra-renal labsBUN, creatinine, abnormal casts, debris, urine specifity low, metabolic acidosis, H&H low, potassium/phosphate/calcium high
diagnostic evaluationKUB, bladder cath, renal u/s, CT, IVP, renal biopsy, renal arteriogram, bladder u/s, urodynamic studies
acute tubular necrosis most common type of intra-renal failure
ATNpost ischemia or nephrotoxic, lack of O2 to kidneys/tissues
post-renalcaused by: obstruction/dysfunction in post-renal structures
post-renalmechanical, urine can not drain: calculi, tumors, BPH, strictures, clots
post-renal labsBUN, creatinine, abnormal cast debris- varies, urine specifity gravity varies
phases/stages ARFinitiation, maintenance, recovery/diuretic
initiation phasehard to recognize, BUN & creatinine begin to increase, lasts hours to days
maintenance phaseeither oliguric or nonoliguric, lasts 1-2 weeks, increased urea, creatinine, uric acid & K; urine output less than 400mL/day
recovery/diuretic phasegradual increase in urine output, fluid loss as GFR recovers, electrolyte imbalances, rapid recovery 1st 5-25 days and continues up to 1 year, may not return to baseline, but w/i normal limits, electrolytes return to normal
ARF c/m nervous systemaccumulation of nitrogenous wastes products from impaired renal function & metabolic acidosis
ARF c/m nervous systemuremic encephalopathy
ARF c/m nervous systemcan lead to cerebral edema
ARF c/m nervous systemlethargy, confusion, disorientation, asterixis, myoclonic muscle twitching, possible seizures
ARF c/m cardio systemtachycardia, HTN, CHF, periorbital & peripheral edema, cardiac dysrhythmias, death
ARF c/m pulmonary systemfluid overload and no where to go
ARF c/m pulmonary systemcrackles- adventitious breath sounds, decreased cough reflex, kussmaul breathing
ARF c/m pulmonary systeminfiltrates on CXR- pneumonia, pulmonary edema
ARF c/m GI systemurea decomposition in gut = ammonia release = capilarry fragility & GI irritation
ARF c/m GI systemn/v, gi bleed, impaired glucose use, impaired protein synthesis
ARF c/m hematopoietic systemimpaired renal function= decreased RBC production & impaired platelet function, anemia
ARF hematopoietic system t/mepogen SQ 3x a week
ARF c/m integumentary systemdry, pruritic skin, petechiae, ecchymosis, uremic frost (rare)
t/m fluid overload: excess fluid volumefluid restrictions: in = out, diuretic therapy= lasix, mannitol, bumex; dialysis
t/m electrolyte imbalances: hyperkalemia (most life-threatening)decreased GFR, pt unable to excrete K
t/m electrolyte imbalances: hyperkalemia (most life-threatening)monitor K levels, admin kaexalate (exchange sodium for potassium ions), glucose & insulin, calcium gluconate (stabilize heart)
meds for ARFvolume expanders, diuretics, kaexalate, IV glucose, insulin, ca gluconate/NaBicarb, anti-HTN= ACE, ARBS, dopamine, antacids, H2 blockers
nitrogenous wastesdue to catabolic process/protein breakdown- goal limit accumulation of nitrogenous wastes
nitrogenous wastes interventiondecrease K intake, decrease protein, decrease sodium, decrease phosphorus
nitrogenous wastes interventiondiet high in carbs, fats, essential amino acids
dialysisdue to volume ovrload, untrolled hyperkalemia, uncontrolled acidosis, symptomatic uremia, pericarditis
types of dialysis hemodialysis- takes blood out, cleans, puts back
types of dialysisperitoneal- slower- diffusion- in stomach
types of dialysisCRRT- one to one, 24 hours
age considerations- pediatricsARF uncommon, prone to dehydration, glomerulernephritis (infection)
age considerations- eldersprone to dehydration, (pre-renal), co-morbidities (intra-renal), BPH obstruction (post-renal)

Recent badges