PATHOLOGY
What renal hormone is in charge of blood pressure regulation?
What hormone stimulates RBC production in the bone marrow?
What is needed for Calcium absorption?
renin is a renal hormone in charge of BP regulation.
Erythropoietin stimulates RBC production in bone marrow
Vitamin D
Define polyuria
> 2L in 24 hours
A 58-year-old male is admitted to the medical-surgical floor after a 3-day history of severe gastroenteritis, persistent vomiting, and watery diarrhea. His vital signs are: BP 85/50 mmHg, HR 118 bpm, and RR 20/min. His urine output over the last 4 hours has been 60 mL total. Lab results show: serum creatinine of 2.1 mg/dL (baseline was 0.9 mg/dL) and BUN of 42 mg/dL
Which type of acute kidney injury is this patient experiencing?
What is the primary underlying physiological cause?
pre renal
hypotension
A patient has developed AKI. they have baseline CKD followed by their nephrologist. Their potassium levels have reached a dangerous high and they are symptomatic.
What should the nurse anticipate?
Mediation management. Dialysis if it does not respond.
A patient presents to the emergency room with flank pain, headaches, abdominal pain and hematuria. He states his blood pressure has been elevated for months despite loosing weight and lowering his salt intake. While obtaining the H & P, he states he thinks his parents had kidney issues but he's unsure what they had. What disorder might the nurse be concerned about?
polycystic kidney disease.
Genetic disorder presents with clusters of fluid filled cysts that develop in renal tubule.
Autosomal dominant
Autosomal recessive
Name risk factors of glomerulonephritis.
Infection (strep)
Immune diseases (lupus, good Pasteur's)
vasculitis (ANCA- associated antibodies attack tine blood vessels in kidney)
htn
dm
What is Anuria?
What is DYSuria?
less than 100ml in 24 hours
Dysuria is difficulty or pain when urinating
A 45-year-old female with a severe bacterial infection is treated with high-dose intravenous gentamicin (an aminoglycoside antibiotic) and receives a CT scan with iodinated contrast dye. On day 5 of admission, her urine output drops to less than 20 mL/hour. Urinalysis reveals muddy brown casts and protein. Her serum creatinine rises from 0.8 mg/dL to 3.4 mg/dL
Which type of acute kidney injury is this patient experiencing?
Intra-renal (intrinsic) AKI (specifically Acute Tubular Necrosis, or ATN)
Name some negative side effects of hemodialysis
hypotension
muscle cramps, headache, dizziness, nausea, malaise
bleeding related to platelet dysfunction
infection
dialysis associated dementia
dialysis disequilibrium syndrome (neurological manifestations)
Direct damage to the renal tubule is known as what?
infrarenal
what finding on a UA concerns the nurse for chronic kidney disease?
proteinuria
Define Oliguria, how would you confirm a patient is oliguric?
Less than 400 cc/24 hours
Measure strict I and O
Bladder scan
Straight Cath if needed
A 72-year-old male with a history of benign prostatic hyperplasia (BPH) presents to the emergency department with severe lower abdominal pain, restlessness, and inability to void for the past 12 hours. A bladder scan shows over 800 mL of retained urine. Blood work reveals a serum creatinine of 2.9 mg/dL
Which type of acute kidney injury is this patient experiencing?
What is the mechanical mechanism causing the renal failure?
post renal
An obstruction in the urinary outflow tract (enlarged prostate blocking the urethra), causing urine to back up into the renal pelvis and raising pressure inside the nephrons
What type of dialysis requires dwell time and can be performed at home?
Peritoneal.
Define urolithiasis.
urinary stone or kidney stone
A female patient comes to the ER with a history of kidney stones. She has flak pain, fever and tachycardia. What orders does the nurse anticipate? What is the nurses concern?
Fluids, antibiotics, concern for pyelonephritis
67 year old male was diagnosed with the flu 5 days before admission. He completed his tamiflu before being admitted but is still febrile and developed pneumonia. On admission he was given vancomycin and zosyn, later de-escalated to rocephin and azithromycin. This is day 4 of his hospital stay and the nurse notices that the creatine has increased significantly. What could be a cause of this AKI? what do you anticipate the provider to order?
Medication induced injury likely secondary to vancomycin. Given the time frame of roughly 4 days likely intrinsic injury.
IV fluids, avoid hypotension, close monitoring, renal dose meds, avoid NSAIDS.
A patient comes in with shortness of breath and tachycardia. He has known CKD. The provider orders a bilateral lower extremity ultrasound, a D-Dimer, and a CT angiogram. Which one of these tests might the nurse question and why?
CTA, contrast induced kidney injury is a concern. A test without contrast to help diagnose PE includes V/Q scan.
A patient returns to the floor after HD. She is confused, altered with headache nausea and tremoring.
What could be happening? What should the RN anticipate?
Disequilibrium Syndrome, Head CT
A 70 year old man presents with complaints of urinary frequency. He states when he goes it only a little bit at a time. He is diagnosed with post renal AKI. What does the nurse suspect the etiology of his AKI could be?
post renal AKI. anticipate alpha-1 blockade such as tamsulosin
A patient is admitted with pyelonephritis. What orders does the nurse anticipate?
The patient is pregnant, and there is a high concern for renal stones what test could be safely done to further investigate?
UA, Cultue, KUB or CT, CBC
ultrasound
A patient with heart failure, DM, HLD, HTN comes to your unit. Their kidney function starts to decline and the nurse reports the creatinine has significantly increased this admission. What should the nurse anticipate the provider to order?
Vitals, Edema assessment, oxygen, breath sounds, daily weights, diuretics if hemodynamically stable.
Cardiorenal syndrome
what kind of kidney injury does glomerulonephritis cause?
What signs and symptoms may present?
intrarenal damage within the kidney secondary to inflammation and damage to the glomeruli
proteinuria (bubbly foamy urine), hematuria, edema, hypertension, decreased urine output
A patient tis in the ICU requiring the use of Vaso active drips to increase his blood pressure. He was not able to tolerate traditional dialysis. What other modality could be tried?
CRRT
in patients with renal diseases what electrolyte should the nurse monitor closely?
potassium