Kidney Function Overview
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Questions and Answers

What is a common symptom of the condition affecting children aged 6 months to 5 years as described?

  • Hepatic failure
  • Cyanosis
  • Pulmonary edema (correct)
  • Chronic cough
  • What type of therapy involves the movement of fluid and molecules across a semi-permeable membrane?

  • Osmosis therapy
  • Renal replacement therapy
  • Dialysis (correct)
  • Diffusion therapy
  • What is a potential complication during acute renal failure?

  • Hyperkalemia (correct)
  • Hypoglycemia
  • Osteoporosis
  • Hyperlipidemia
  • Which dietary restrictions are typically recommended for patients undergoing hemodialysis?

    <p>Restricted protein, phosphate, potassium, and fluids</p> Signup and view all the answers

    What is a characteristic of hemodialysis?

    <p>It circulates blood through a filter</p> Signup and view all the answers

    Which of the following renal function tests evaluates the ability of the kidneys to concentrate solutes in urine?

    <p>Urine specific gravity</p> Signup and view all the answers

    What is the primary extracellular ion regulated by aldosterone?

    <p>Sodium</p> Signup and view all the answers

    Which condition stimulates the production of erythropoietin?

    <p>Decreased oxygen in renal blood flow</p> Signup and view all the answers

    What regulates the reabsorption of bicarbonate ions in the kidneys?

    <p>Acid-base balance mechanisms</p> Signup and view all the answers

    What is the normal range for blood urea nitrogen (BUN) in adults?

    <p>2.5 – 7 mmol/L</p> Signup and view all the answers

    How does low renal artery pressure affect blood pressure?

    <p>Stimulates release of renin and aldosterone</p> Signup and view all the answers

    Which metabolic waste product is an indicator of kidney function and relates to muscle metabolism?

    <p>Creatinine</p> Signup and view all the answers

    What is the consequence of decreased kidney function related to Vitamin D?

    <p>Decreased calcium absorption</p> Signup and view all the answers

    What is the normal range for specific gravity in urine?

    <p>1.010 to 1.025</p> Signup and view all the answers

    Which phase of Acute Kidney Injury (AKI) is characterized by a severe decrease in urine output?

    <p>Oliguric phase</p> Signup and view all the answers

    What lab value is commonly elevated in chronic renal failure?

    <p>Creatinine</p> Signup and view all the answers

    Which of the following is NOT a cause of prerenal acute kidney injury?

    <p>Nephrotoxic agents</p> Signup and view all the answers

    During which phase of AKI is the urine output expected to gradually increase?

    <p>Diuretic phase</p> Signup and view all the answers

    What is a potential complication related to chronic renal failure?

    <p>Hypertension</p> Signup and view all the answers

    What is the minimum urine output per hour that indicates normal kidney function?

    <p>0.5 mL/kg/hour</p> Signup and view all the answers

    What type of diagnostic study involves evaluating the kidneys using energy-based imaging?

    <p>Nuclear scans</p> Signup and view all the answers

    Which of the following is a primary nursing intervention during the oliguric phase of AKI?

    <p>Monitoring daily weight</p> Signup and view all the answers

    Which electrolyte is expected to be elevated in kidney failure due to decreased excretion?

    <p>Potassium</p> Signup and view all the answers

    What is the impact of acute renal failure on blood pH levels?

    <p>Decrease due to acid buildup</p> Signup and view all the answers

    Which assessment finding would indicate fluid retention in a patient with renal failure?

    <p>Weight gain</p> Signup and view all the answers

    What is the primary focus in patient education for individuals with renal failure?

    <p>Understand dietary restrictions</p> Signup and view all the answers

    In which phase of acute kidney injury is metabolic acidosis most likely to occur?

    <p>Oliguric phase</p> Signup and view all the answers

    What complication is associated with acute renal failure that can lead to fluid accumulation around the heart?

    <p>Pericarditis</p> Signup and view all the answers

    Which treatment option for acute renal failure involves the continuous removal of waste products through a machine?

    <p>Continuous renal replacement therapy</p> Signup and view all the answers

    What is a significant risk factor for developing end-stage renal disease (ESRD) following acute renal failure in children?

    <p>Infection</p> Signup and view all the answers

    Which of the following is a common clinical manifestation in children with acute renal failure?

    <p>Oliguric or anuric state</p> Signup and view all the answers

    What is the primary mechanism through which hemodialysis removes excess waste and fluid from the blood?

    <p>Diffusion</p> Signup and view all the answers

    Which of the following dietary restrictions is typically enforced for patients undergoing hemodialysis?

    <p>Limited phosphate</p> Signup and view all the answers

    What is the most common cause of prerenal acute kidney injury?

    <p>Dehydration and hypovolemia</p> Signup and view all the answers

    Which phase of acute kidney injury typically results in an abrupt decrease in urine output?

    <p>Oliguric phase</p> Signup and view all the answers

    What is the primary function of the kidneys regarding blood pressure?

    <p>Release of renin</p> Signup and view all the answers

    What significant change occurs during the diuretic phase of acute kidney injury?

    <p>Gradual increase in urine output</p> Signup and view all the answers

    Which metabolic waste product is considered an end product of muscle metabolism and an indicator of kidney function?

    <p>Creatinine</p> Signup and view all the answers

    Which lab values are expected to increase in chronic renal failure?

    <p>Creatinine, potassium, and serum BUN</p> Signup and view all the answers

    How do the kidneys maintain acid-base balance in the body?

    <p>Through selective reabsorption of bicarbonate ions</p> Signup and view all the answers

    What is the primary nursing intervention during the oliguric phase of acute kidney injury?

    <p>Limit fluid intake to 600 mL/day plus output</p> Signup and view all the answers

    What hormone produced by the kidneys stimulates the production of red blood cells in the bone marrow?

    <p>Erythropoietin</p> Signup and view all the answers

    What indicates fluid retention in a patient with renal failure?

    <p>Increased abdominal girth</p> Signup and view all the answers

    Which electrolyte is primarily maintained by aldosterone and plays a crucial role in extracellular fluid balance?

    <p>Sodium</p> Signup and view all the answers

    During the recovery phase of acute kidney injury, what is a key factor influencing recovery?

    <p>The severity of renal failure</p> Signup and view all the answers

    What is a common nursing diagnosis for a patient experiencing excess fluid volume due to acute renal failure?

    <p>Imbalanced nutrition: less than body requirements</p> Signup and view all the answers

    What is the normal urinary pH range that indicates proper kidney function?

    <p>7.35 - 7.45</p> Signup and view all the answers

    What happens to urine concentration when the body is dehydrated?

    <p>Urine becomes more concentrated</p> Signup and view all the answers

    Which assessment finding suggests metabolic acidosis in a patient with acute kidney injury?

    <p>Elevated serum potassium levels</p> Signup and view all the answers

    In children, which factor is most commonly associated with the development of acute renal failure?

    <p>Dehydration or poor perfusion</p> Signup and view all the answers

    Which mechanism increases sodium retention in response to low blood pressure?

    <p>Renin-angiotensin mechanism</p> Signup and view all the answers

    What effect does an increase in bicarbonate reabsorption by the kidneys have on blood pH?

    <p>Makes it more alkaline</p> Signup and view all the answers

    Study Notes

    Kidney Function

    • Primary functions:

      • Removal of metabolic wastes
      • Fluid balance
      • Electrolyte balance
      • Acid-base regulation
      • Blood pressure control
      • Hormone production
    • Metabolic wastes:

      • Urea:
        • End product of protein metabolism
        • Measured as BUN (Blood Urea Nitrogen)
        • Normal adult range: 2.5 – 7 mmol/L
        • Normal pediatric range: 3.2 – 6.4 mmol/L (age and gender dependent)
      • Creatinine:
        • End product of muscle metabolism
        • Indicator of kidney function
        • Normal ranges vary by age and gender
        • Increases with age
    • Fluid balance:

      • Kidney regulates urine concentration (dilute or concentrate) in response to blood osmolarity changes
      • Plays a role in maintaining arterial blood pressure
      • Dehydration increases blood osmolarity, leading to ADH release, which increases water reabsorption
    • Electrolyte balance:

      • Sodium:
        • Primary extracellular ion
        • Regulated by aldosterone, angiotensin II, and renin
        • Renin release stimulated by decreased renal perfusion or low renal artery pressure
        • Increased sodium retention leads to increased water retention
      • Potassium:
        • Primary intracellular ion
      • Calcium and magnesium:
        • Also regulated by the kidneys
    • Acid-base regulation:

      • Through selective secretion of hydrogen ions and reabsorption of bicarbonate ions
      • Bicarbonate ions are filtered in the glomerulus and reabsorbed in the renal tubules
      • Normal pH range: 7.35 - 7.45
      • Healthy kidneys excrete 70 mEq of acid per day until urine pH reaches 4.5
      • Excess acid is bound to chemical buffers (phosphate and ammonia)
      • Phosphate is filtered in the glomerulus
      • Ammonia is produced by renal tubule cells
      • This allows more acid to be excreted without lowering urine pH
    • Blood pressure control:

      • Decreased renal perfusion or low renal artery pressure stimulates renin, aldosterone, and ADH (anti-diuretic hormone) release.
      • Leads to vasoconstriction, increasing blood pressure.
    • Hormone production:

      • Erythropoietin:
        • Stimulates bone marrow to produce red blood cells
        • Released in response to low blood oxygen levels in renal blood flow
        • Deficiency leads to anemia
      • Vitamin D:
        • Activated by the kidney
        • Impaired kidney function leads to decreased calcium absorption.

    Renal Function Tests

    • Urine osmolality: Evaluates the kidney's ability to concentrate solutes in urine.
    • Specific gravity: Evaluates the kidney's ability to concentrate solutes in urine. Normal range is 1.010 to 1.025.
    • Creatinine clearance: Measures the rate at which creatinine is cleared from the blood.

    Diagnostic Studies

    • Urinalysis and urine culture
    • Renal function tests
    • Ultrasonography
    • CT and MRI
    • Nuclear scans
    • Intravenous urography, retrograde pyelography, cystography, renal angiography
    • Endoscopic procedures
    • Biopsies

    Renal Failure (Acute Kidney Injury)

    • Definition: Occurs when the kidneys cannot remove waste or perform regulatory functions.
    • A systemic disorder with various causes.
    • Acute renal failure: Reversible syndrome characterized by decreased glomerular filtration rate (GFR) and oliguria.
    • Chronic renal failure (ESRD): Progressive, irreversible deterioration of renal function leading to azotemia.
    • AKI: Abrupt decrease (within 48 hours) in kidney function.
      • Characterized by increased creatinine, decreased urine output.
      • Reflects a spectrum of kidney injury.

    Consequences of Kidney Damage

    • Increased creatinine and urea levels in the blood.
    • Acid buildup in blood, decreasing serum bicarbonate levels and pH.
    • Sodium retention and increased serum potassium levels.
    • Renin release leads to increased blood pressure.
    • Decreased red blood cell production (anemia) leading to fatigue, shortness of breath, and dizziness.
    • Decreased calcium absorption.

    Signs and Symptoms

    • Fluid retention: Weight gain, peripheral and pulmonary edema, increased blood pressure.
    • Electrolyte imbalances:
      • Hyperkalemia: Can lead to cardiac arrhythmias.
      • Hyponatremia: Can lead to weakness, lethargy, confusion.
      • Hypokalemia: Can lead to fatigue, weakness, leg cramps.
    • Anemia:
      • Fatigue, weakness, shortness of breath.
    • Metabolic acidosis: Dyspnea, lethargy, confusion.
    • Uremic symptoms: Nausea, vomiting, fatigue, confusion.

    Causes of Acute Renal Failure

    • Hypovolemia: Dehydration.
    • Hypotension: Low blood pressure.
    • Reduced cardiac output and heart failure: The heart cannot pump enough blood to the kidneys.
    • Obstruction of the kidney or lower urinary tract: Blockage in the urinary tract.
    • Obstruction of renal arteries or veins: Blockage in the blood supply to the kidneys.
    • Nephrotoxic agents: Toxins that damage the kidneys.
    • Injury: Trauma, burns, and other injuries.

    Causes Based on Location of Damage

    • Prerenal (most common - 70%): Factors outside the kidneys that reduce renal blood flow, leading to decreased GFR.
      • Causes: Hypovolemia, decreased cardiac output, decreased peripheral vascular resistance, blocked renal artery, medications (NSAIDs, ACE inhibitors).
    • Intrarenal (25% of cases): Damage to renal tissue.
      • Causes: Glomerulonephritis, burns, crush injuries, severe transfusion reactions, acute tubular necrosis related to nephrotoxins (NSAIDs, acetaminophen), ischemia, toxemia in pregnancy.
    • Postrenal: Mechanical obstruction of urine outflow, causing backflow into the renal pelvis.
      • Causes: Prostatic hyperplasia, prostate cancer, strictures, calculi formations, blood clots.
      • High incidence among the elderly.

    Chronic Renal Failure (ESRD)

    • Characterized by changes in lab values:
      • Increased creatinine, potassium, serum BUN
      • Decreased pH

    Phases of AKI

    • Initiation period: Initial insult to the kidneys.
    • Oliguric phase: Decreased GFR, typically occurs within 1-7 days after injury and lasts 10-20 days.
      • Markedly decreased urine output.
      • Increased serum concentration of substances normally excreted by kidneys.
      • Longer duration is associated with a poorer prognosis.
    • Diuretic phase: Gradual increase in urine output (1-5 L/day), lasts 1-3 weeks.
    • Recovery phase: Lasts 1-2 weeks but can take up to 1 year.
      • Lab values return to normal limits.
      • Recovery depends on the individual’s overall health, severity of renal failure, cause of failure, and any complications.
      • Can lead to chronic kidney disease.

    Nursing Process

    • Assessment:

      • Fluid status:
        • Intake and output monitoring is crucial.
        • In oliguric phase, fluid restriction may be necessary.
      • Nutritional status:
        • Consult a dietitian to ensure adequate intake and adjust dietary restrictions (protein, potassium, sodium, phosphate, fluids).
      • Patient knowledge:
        • Assess understanding of renal failure and its implications.
      • Activity tolerance:
        • Monitor patient's ability to perform daily activities.
      • Self-esteem:
        • Address potential body image concerns and psychosocial issues.
      • Potential complications:
        • Monitor for signs and symptoms of hyperkalemia, pericarditis, pericardial effusion, pericardial tamponade, hypertension, anemia, bone disease, and metastatic calcifications.
    • Diagnosis:

      • Excess fluid volume
      • Imbalanced nutrition
      • Deficient knowledge
      • Risk for situational low self-esteem
    • Planning:

      • Goals:
        • Maintain ideal body weight with no excess fluid.
        • Ensure adequate nutritional intake.
        • Increase patient knowledge regarding renal failure.
        • Promote patient participation in activities within their tolerance.
        • Improve self-esteem.
        • Prevent complications.
      • Nursing actions:
        • Accurate intake and output monitoring throughout all phases of AKI.
        • Fluid restriction in oliguric phase (typically 600 mL/day plus previous 24-hour output).
        • Education regarding fluid restrictions.
        • Assistance with coping with fluid restrictions.
        • Frequent oral hygiene to promote self-esteem.
        • Daily weight monitoring at the same time each day.
        • Vital sign monitoring, particularly blood pressure and edema assessment.
        • Nutritional monitoring and consultation with a dietitian (high carb, low potassium, sodium, protein, phosphate, and fluid restriction).
        • Monitor laboratory values for electrolyte imbalances and other abnormalities.
        • Assess for infections.

    ARF in Children

    • Most common causes: Dehydration or poor perfusion (trauma, crush injuries, low blood pressure, fever).
    • Prerenal: Related to diarrhea, vomiting, surgery, and trauma.
    • Oliguria: Less than 1 mL/kg/hr.
    • Treatment and nursing actions similar to adults.
    • Fluid restrictions: 400 mL/day plus 24-hour output (weight-dependent).

    Hemolytic Uremic Syndrome (HUS) in Children

    • Also known as thrombotic thrombocytopenic purpura (TTP) in adults or Hamburger disease.
    • Acute renal disease characterized by:
      • Acute renal failure often triggered by E.coli infection.
      • Hemolytic anemia: Red blood cells are destroyed faster than they can be created.
      • Thrombocytopenia: Low platelet count.
    • Typically affects children 6 months to 5 years.
    • Often follows acute GI or upper respiratory tract infections.
    • Signs and symptoms: Oliguria or anuria, seizures, stupor, pulmonary edema.
    • May last 1-2 weeks.
    • 5% mortality rate; 10% develop ESRD.

    Collaborative Problems and Potential Complications

    • Hyperkalemia: High potassium levels can lead to cardiac arrhythmias.
    • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart.
    • Pericardial effusion: Accumulation of fluid in the pericardium.
    • Pericardial tamponade: Compression of the heart due to excessive fluid in the pericardium.
    • Hypertension: High blood pressure.
    • Anemia: Low red blood cell count.
    • Bone disease and metastatic calcifications: Due to altered calcium and phosphate metabolism.

    Treatment Options for Acute Renal Failure

    • Hemodialysis: Rapid removal of fluid, urea, creatinine, and potassium.
      • Blood is circulated through a filter.
      • Requires vascular access (central line, arteriovenous fistula, or graft).
      • Typically performed 3 times per week for 4 hours each session.
      • Requires dietary restrictions (protein, phosphate, potassium, fluids).
      • Medications may be required (antihypertensives, phosphate binders, vitamins).
    • Continuous renal replacement therapies (CCRT): A type of dialysis that can be used for patients who are critically ill or unstable.

    Dialysis

    • Definition: Uses a semi-permeable membrane to separate two solutions, enabling the movement of fluid and molecules.
      • Osmosis: Movement of water from an area of low solute concentration to an area of high solute concentration.
      • Diffusion: Movement of molecules or ions from a region of higher concentration to a region of lower concentration.

    Hemodialysis

    • Rapid removal of fluid, urea, creatinine, and potassium.
    • Blood is circulated through a filter.
    • Requires vascular access (central line, arteriovenous fistula, or graft).
    • Patients are typically hooked up to a machine for 4 hours, 3 times per week.
    • Dietary restrictions: Protein, phosphate, potassium, and fluid intake.
    • Medications: Antihypertensives, phosphate binders, vitamins.

    Note:

    • The text you provided is a valuable resource for studying acute and chronic renal failure. It covers essential information about the normal kidney function; the causes, pathophysiology, and signs and symptoms of renal failure; various diagnostic studies; potential complications; and treatment options.

    • For a complete understanding, supplement the text with additional resources, like trusted medical websites and textbooks.

    Kidney Functions

    • Metabolic waste removal: The kidneys filter waste products from the blood, including urea (from protein breakdown), creatinine (from muscle metabolism)
    • Fluid balance: Regulates fluid levels by concentrating or diluting urine based on blood osmolality. Increased osmolality triggers ADH (antidiuretic hormone) for water reabsorption, leading to concentrated urine.
    • Electrolyte balance: Controls electrolyte levels like sodium (regulated by aldosterone, angiotensin II, and renin), potassium, calcium, and magnesium.
    • Acid-base regulation: Maintains blood pH by selectively excreting hydrogen ions and reabsorbing bicarbonate ions. Kidneys can excrete up to 70 mEq of acid per day, assisted by phosphate and ammonia buffers.
    • Blood pressure control: Decreased renal perfusion triggers renin, aldosterone, and ADH release, resulting in vasoconstriction and increased blood pressure.
    • Hormone production: Produces erythropoietin, stimulating red blood cell production, and activates vitamin D for calcium absorption.

    Renal Failure

    • Acute Kidney Injury (AKI): Sudden decrease in kidney function within 48 hours.
      • Characterized by increased creatinine and decreased urine output (oliguria).
      • Is usually reversible.
      • Causes: Hypovolemia, hypotension, reduced cardiac output, obstruction in the kidney or urinary tract, nephrotoxic agents, injuries.
    • Chronic Renal Failure (ESRD): Progressive, irreversible deterioration of kidney function leading to azotemia (severe waste buildup in the blood).
      • Signs: Increased creatinine and urea, decreased pH, electrolyte imbalances (hyperkalemia, hyponatremia), hypertension, anemia, and decreased calcium absorption.

    Acute Renal Failure (AKI)

    • Phases:
      • Initiation Phase: The initial insult to the kidneys.
      • Oliguric Phase: Decreased glomerular filtration rate (GFR) leading to reduced urine output (usually 1-7 days after injury).
        • Increased serum concentrations of substances normally excreted by kidneys.
        • Can last 10-20 days.
      • Diuretic Phase: Gradual increase in urine output (1-5 L/day).
        • Monitor for electrolyte imbalances (hyponatremia, hypokalemia).
      • Recovery Phase: Lab values return to normal (can take 1-2 weeks, up to a year).
        • Recovery influenced by overall health, severity of AKI, and complications.
        • Can progress to Chronic Kidney Disease.

    Diagnostic Studies

    • Urinalysis and urine culture: Evaluate urine components for abnormalities.
    • Renal function tests: Assess kidney function (creatinine, BUN, creatinine clearance).
    • Ultrasonography: Visualize the kidneys and urinary tract.
    • CT and MRI: Provide detailed images of the kidneys and surrounding structures.
    • Nuclear scans: Use radioactive material to assess kidney function.
    • Intravenous urography, retrograde pyelography, cystography, renal angiography: Imaging techniques to visualize the kidneys, ureters, and bladder.
    • Endoscopic procedures: Visualize the inside of the urinary tract.
    • Biopsies: Obtain tissue samples for diagnosis.

    Treatment Options for Acute Renal Failure

    • Hemodialysis: Rapid removal of fluids, urea, creatinine, and potassium.
      • Blood circulated through a filter.
      • Requires a vascular access (central line, arteriovenous fistula, or graft).
      • Performed 3 times a week, typically for 4 hours each session.
      • Requires dietary restrictions (protein, phosphate, potassium, fluids).
    • Continuous Renal Replacement Therapies (CCRT): Continuous method of blood filtering for patients with unstable hemodynamics.

    Hemolytic Uremic Syndrome (HUS)

    • An acute renal disease in children (6 months to 5 years).
      • Usually follows a gastrointestinal or respiratory infection.
      • Characterized by:
        • Acute renal failure
        • Hemolytic anemia
        • Thrombocytopenia
      • Signs: Oliguria, anuria, seizures, stupor, pulmonary edema.
      • Can lead to end-stage renal disease in 10% of cases.

    Nursing Considerations

    • Fluid Status: Monitor intake and output, restrict fluids (especially during oliguric phase), and assess for edema.
    • Nutritional Status: Consult with a dietitian for appropriate dietary restrictions (low potassium, sodium, phosphate, high carbohydrates, protein restrictions may be necessary).
    • Patient Knowledge: Educate patients and families about renal failure, treatment options, and self-care.
    • Activity Tolerance: Assess activity level and provide appropriate interventions for fatigue.
    • Self-Esteem: Address potential issues related to body image, sexual function, and fluid restrictions.
    • Potential Complications: Monitor for hyperkalemia, pericarditis, hypertension, anemia, and bone disease.

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    Description

    This quiz covers the essential functions of the kidneys, including waste removal, fluid and electrolyte balance, and hormone production. Explore how the kidneys regulate blood pressure and maintain acid-base balance through various metabolic processes. Test your knowledge on key concepts such as urea, creatinine, and urine concentration.

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