Podcast
Questions and Answers
Which of the following diagnostic studies is most useful in ruling out an obstruction in the urinary collecting system?
Which of the following diagnostic studies is most useful in ruling out an obstruction in the urinary collecting system?
In the management of renal failure, which of the following is the most important principle for correcting fluid imbalance?
In the management of renal failure, which of the following is the most important principle for correcting fluid imbalance?
Which of the following electrolyte imbalances is the most common in renal failure?
Which of the following electrolyte imbalances is the most common in renal failure?
Which of the following diuretics is typically avoided in the management of renal failure because of diminished potassium elimination?
Which of the following diuretics is typically avoided in the management of renal failure because of diminished potassium elimination?
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Which of the following is the most important principle for treating acidosis in renal failure?
Which of the following is the most important principle for treating acidosis in renal failure?
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Which of the following diagnostic studies is used to evaluate for renal artery stenosis in acute renal failure?
Which of the following diagnostic studies is used to evaluate for renal artery stenosis in acute renal failure?
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What is the purpose of obtaining daily weights in the management of renal failure?
What is the purpose of obtaining daily weights in the management of renal failure?
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Which of the following diagnostic studies is used to distinguish between acute kidney injury (AKI) and advanced chronic kidney disease (CKD)?
Which of the following diagnostic studies is used to distinguish between acute kidney injury (AKI) and advanced chronic kidney disease (CKD)?
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Which of the following is the most important principle for preventing life-threatening electrolyte imbalances in renal failure?
Which of the following is the most important principle for preventing life-threatening electrolyte imbalances in renal failure?
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Which of the following is the most common cause of acute renal failure?
Which of the following is the most common cause of acute renal failure?
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Study Notes
Functions of the Kidney
- Urine formation essential for waste elimination
- Excretion of waste products including urea and creatinine
- Regulation of electrolytes, maintaining balance of sodium, potassium, and calcium
- Acid-base balance control, crucial for overall body homeostasis
- Water balance regulation influencing hydration status and blood volume
- Control of blood pressure through renin-angiotensin system
- Renal clearance indicating kidney's filtering efficiency
- Regulation of red blood cell production via erythropoietin synthesis
- Synthesis of vitamin D to its active form for calcium metabolism
- Secretion of prostaglandins contributing to renal blood flow and blood pressure regulation
Acute Kidney Injury (AKI)
- AKI characterized by sudden onset of reduced renal function affecting fluid and electrolyte balance, blood pressure, and erythropoiesis
- Hallmark of AKI is decreased glomerular filtration rate (GFR), marked by elevated blood urea nitrogen (BUN) and serum creatinine, known as azotemia
- Serum creatinine preferred as a clearer indicator of renal function, less influenced by metabolic factors
- Estimated mortality rate in critically ill patients with AKI ranges from 30% to 80%
Prerenal Failure Causes
- Decreased intravascular volume due to dehydration, hemorrhage, or third-spacing
- Cardiovascular failures such as heart failure or myocardial infarction
- Drugs like ACE inhibitors and NSAIDs can impede renal blood flow
- Effective renal perfusion can be impaired by conditions such as sepsis, cirrhosis, and neurogenic shock
Intrarenal Failure Conditions
- Acute glomerulonephritis linked to immune complex-mediated diseases (e.g., lupus nephritis)
- Vascular disease leading to malignant hypertension or microangiopathic hemolytic-uremic syndrome (HUS)
- Acute interstitial disease such as allergic interstitial nephritis
- Acute tubular necrosis (ATN) resulting from ischemia or nephrotoxins
- Various nephrotoxins include contrast dye and specific drugs affecting kidney function
Postrenal Failure Causes
- Ureteral obstruction can be intrinsic (e.g., stones, tumors) or extrinsic (e.g., cancer, retroperitoneal fibrosis)
- Bladder issues may arise from tumors, neurogenic bladder, or stones
- Urethral obstruction commonly associated with benign prostatic hypertrophy, cancer, or strictures
Clinical Course of Acute Kidney Injury
- The clinical progression of Acute Tubular Necrosis (ATN) follows four phases:
- Onset phase: Initiation of injury
- Oliguric or nonoliguric phase: Characterized by reduced urine output, risk of fluid overload
- Diuretic phase: Increased urine output, indicating recovery
- Recovery phase: Restoration of renal function and improvement in urine output and indices of renal health
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Description
Test your knowledge on the functions of the kidney and the characteristics of Acute Kidney Injury (AKI) in critical care nursing. Topics include urine formation, electrolyte regulation, blood pressure control, renal clearance, and more.
