oliguria (<400ml/day)

rbc and wbc casts in urine

increase in SG with prerenal. with intrarenal, fixed

intrarenal=high levels of na in urine

fluid retention-distended neck veins, bounding pulses

edema, HTN

metabolic acidosis

kussmaul's respirations

lethargy, stupor

increase BUN

hyperkalemia.

anemia

calcium deficit, phosphate excess

fatigue

Chronic renal failure (signs and symptoms)

lethargy, fatigue, even coma

uremic lung, insterstitial edema, thick mucous

dyspnea

mucousal ulcerations

increased BUN, CR, Fixed SG @ 1.010

metallic taste. uremic fetor

yellow-gray skin

paresthesias, neuropathy, kussmaul's

HTN. atherschlerosis

anemia

metabolic acidosis

increased K

N/V.

hypertensive disease

diabetic nephropathy

cystic kidney disease

glomerulonephritis

BUN elevated

CR elevated

hyperkalemia

Na in urine, hyponatremia

hypermagnesemia if taking laxatives c magnesium or antacids

SG at 1.010

decreased GFR

fluid volume excess

impaired urinary elmination

potentially-impaired gas exchange

ineffective breathing pattern

imbalanced nutrition

risk for infection

impaired urinary elimination

fatigue

risk for infection

increased carbohydrates, decreased protein, limit intake of K, Mg, Na, Phosphate

Water restriction

drink adequate fluid-avoid dehydration

high fluid intake recommended

limit consumption of colas, coffee, and tea because tend to increase rather than diminish risk

high dietary calcium intake

low sodium diet

limiting oxalate rich foods and reducing oxalate excretion

purine: sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads

calcium: milk, cheese, ice cream, yogurt, all beans, fish with fine bones, cocoa/chocolate

oxalate: dark roughage, spinach, asparagus, tomatoes, beets, nuts, parsley, chocolate, ovaltine, tea

decreased sodium intake

adjust protein to compensate for loss

high biolgic value protein

small, frequent feedings

peritoneal dialysis

benefits: immediate initation

less complicated

portable system

fewer dietary restrictions

short training time

less cardiovascular stress

home dialysis possible

preferable for diabetic

hemodialysis

advantages: rapid fluid removal

effective potassium removal

less protein loss

home dialysis possible

temporary access at bedside

CRRT:

uremic toxins and fluids are removed while acid base status and electroolytes are adjusted slowly and continuously from a hemodynamically unstable pt.

hypotension: hypovolemia

muscle cramps: rapid removal of na & h20

loss of blood

hepatitis: blood transfusions or lack of adherence to precautions used to prevent spread of infection (B&C)

sepsis: infections of vascular access sites

disequilibrium syndrome: rapid changes in composition of extracellular volume

exit site infection: staph aureus.

peritonitis: contamination of tubing

abdominal pain: pain is common complication

outflow problems: may require surgical manipulation or merely bowel evacuation

hernias: increased intraabdominal pressure

lower back problems: increased intraabdominal pressure

bleeding: check BP & hematocrit

pulmonary complications: atelectasis, pneumonia, bronchitis

protein loss

carbohydrate/lipid abnormalities

encapsulating sclerosing peritonitis

don't lift heavy objects

keep meticulously clean

no clothes over site

maintain aseptic technique to avoid peritonitis

keep bag below abdomen

do not heat bag in microwave

elevated alt

alkaline phosphatase >120

bilirubin >1

pt time >15

inr >3

albumin 2

anemia hgb <12, hct <37

thrombocytemia platelets <100,000

leukocytopenia

> nh4+3

increase in aldosterone, ADH

urine: dark appearance, coca-cola colored

RBC, positive leukocyte esterase.  positive nitrate.

always have epi pen

always have bracelet

ineffective protection. risk for infection.

apply pressure, cover with pressure dressing, lie on side 50-60 minutes on side aspirated from.

occurs days to months after transplantation

hyperacute: w/in 48 hours of surgery. fever, htn, pain at transplant site. immediate removal

acute: 1 week to 2 yrs following surgery. oliguria, anuria, low grade fever, htn, tenderness over kidney, lethargy, azotemia, fluid retention. increase doses of immunosuppressents.

chronic: gradual return of azotemia, fluid retention, electrolyte imbalance, fatigue.

calcineurin inhibitors

• cyclosporine, tacrolimus
• potentially nephrotoxic. prevent toxicity by following drug levels. 

corticosteroids (prednisone)

mycophenolate mofetil (cell cept

fatigue/malaise

fever

butterfly rash on face

alopecia

anorexia/weight loss

anemia

lymphadenopathy

depression

joint pain, swelling, tenderness

raynaud's phenomenon

systemic manifestations include system involved