Alteration in Urinary and Renal Function and Fluid Balance
Kidney Failure
Results when the kidneys cannot remove wastes or perform regulatory
... [Show More] 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 [Show Less]