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Initiating phase
- -Begins at time of insult and continues until s+s become apparent. Progressive increase in BUN, Cr, K, with our without oliguria.
- -Can last hours to days
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Oliguric Phase
- Multiple organ systems-urinary, cardiac, resp, GI, heme, neuro, metabolic.
- 10-14 days, up to months
- Reduction in GFR
- WATCH for pulm edema and ecg changes
-
Diuretic phase
- Begins with gradual increase in daily urine output.
- Persistant s+s, symptoms gradually returning closer to regular function
- 1-3 weeks
- Monitor for hyponatremia, hypokalemia, and dehydration
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Recovery phase
- Increase in GFR, causing BUN+Cr to eventually decrease
- 1-2 weeks for major improvement and up to 12 months for renal function to stabalize
- Some do NOT recover and go into chronic kidney disease :(
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Creatinine: value and relevance to impaired kidney function
- N=0.5-1.5
- HIGH bc kidneys filter creatinine through urine and when they are impaired, levels rise
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BUN: value and relevance to impaired kidney function
- N=5-25
- HIGH bc kidneys can't remove urea
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Potassium: value and relevance to impaired kidney function
- N=3.5-5
- HIGH bc kidneys can't remove excess K
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Calcium: value and relevance to impaired kidney function
- N=8-10
- LOW bc phosphate increases, which makes ca drop. Takes ca out of bones, and is lost even more
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Hgb & Hct: value and relevance to impaired kidney function
- Hbg (N=12-18) Hct (N=35-45)
- LOW bc decrease in kidney function=decrease in EPO=decrease RBC=decrease oxygen
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Metabolic acidosis ( LOW: ph, paco2, pa02, HCO3, o2) WHY?
Functioning nephrons start to decrease, ammonium excretion also drops bc of drop in GFR-now there is not enough functioning nephrons. More common as you age (lose nephrons)
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Peritoneal Dialysis: principles involved
- Catheter through abd wall, "exchanges"- inflow, dwell, drain.
- Usually 4 exchanges a day at home, portable!
-
Peritoneal Dialysis: advantages vs disadvantages
- ADVANTAGES:
- Heparin not needed
- Less cardiovascular stress
- Can be used at home
- Fewer dietary restrictions
- DISADVANTAGES:
- prolonged immobility
- Peritonitis
- Dialysate leak
- Respiratory compromise
- Contraindicated after abd surgery
- SLOW/ hyperglycemia
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Hemodialyis: principles involved
- Obtain vascular access, very rapid blood flow required, & AV fistula/graft/shunt.
- Dual-lumen catheter
- Heparin required
- Weekly exchange outpatient 3-4x week
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Hemodialysis: advantages vs disadvantages
- ADVANTAGES:
- quick & efficient
- effective potassium removal
- Can prolong life!
- useful for OD's poisonings
- DISADVANTAGES:
- exchange rate 3-4hrs
- cardio stress
- does NOT remove phosphorus
- access may clot
- Heparin required
- diet/fluid restrictions
- Hypotension
- Medications lost thru dialysis!
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