NURS 5315 Test 5 (Module 10)
Acute Kidney Injury - ANS-Sudden decline in kidney function with a decrease in GFR and
accumulation of nitrogenous waste products in the blood
Increase in serum creatinine and blood urea nitrogen
50-80% mortality rate
Treat- treat underlying cause
I: creatinine 1.5-1.9x higher or >0.3mg/dl increase
II: creatinine that is 2-2.9x higher or need for renal replacement therapy
S/S- oliguria, edema, dyspnea, mental status changes, electrolyte imbalances, metalbolic
acidosis, BUN:creatinine >20 in pre-renal and normal in intranrenal, FeNa, muddy brown
cast cells in ATN
\Acute Tubular Necrosis - ANS-Most common type of intrinsic acute kidney injury. Commonly
from pre-renal issues with hypovolemia and poor perfusion.
Urine volume <400, urine osmolality <400, urine sodium >30meq/L, urine specific gravity
1.010-1.012.
Failure to restore blood volume or blood pressure and oxygen delivery can cause ischemic
cell injury and acute tubular necrosis (ATN).
Causes- IV radiocontrast, nephrotoxic meds, trauma
S/s- nonoliguria, urine fractional excretion of sodium >2%, urine sodium >40, urine sediment
muddy-brown with granular casts
Response to fluid resuscitation is slower than pre-renal AKI and takes up to 72 hours.
Pre-renal AKI takes 48 hours
\aging effect on kidneys - ANS-Reach adult size by adolescence
Hypertrophy with older age, reduced ability to excrete urine, kyperkalemia from reduced
excretion, more glucose excreted because of decreased reabsorption (not necessarily
indicator of diabetes), drugs not clearing as easily, harder to activate vitamin d, which affects
calcium absorption.
GFR- increased directly after birth, reaches adult levels by age 2, more dilute urine up to
6mo of age, renal blood flow and GFR decrease with older age (d/t atherosclerosis)
Nephron- decrease in number and size with age (atherosclerosis), number of nephrons at
age 75 decreased by 30%.
, Tubular system- immature in infants (harder to excrete potassium, reabsorb bicarb, buffer
hydrogen), matures by age 2. Tubular atrophy is common with age.
Bladder- descends into pelvis after birth, may not void for 12-24 hours following birth.
Frequency and nocturia are common with age.
\AKI intrarenal - ANS-Impaired renal function at the cellular level in the kidney.
Acute tubular necrosis (ATN) is the most common cause of intrarenal renal failure. Dead
cells slough off and cause tubular obstruction, which causes increase in tubular pressure
and decreased GFR- will cause rising BUN and creatinine. Common causes of ATN-
ischemia, sepsis, post-surgical complications, OB complications, medications
Other causes- glomerular nephritis, vasculitis, drug induced toxicity (aminoglycosides,
ARBS, NSAID, ACEi, radiocontrast media, abx), heavy metals like merucry and arsenic,
bacterial toxins.
\AKI postrenal - ANS-Cause by injury past kidney like urinary obstruction.
Bladder outlet obstruction could be from prosthetic hyperplasia, or urinary stones.
S/S- several hours of anuria, flank pain, polyuria
\AKI Prerenal - ANS-Most common cause of ARF
Caused by impaired renal blood flow
GFR declines
Causes- vasoconstriction from medications, shock states, hypotension, hypovolemia,
hemorrhage, failing cardiac output, HF, NSAIDs, renal artery stenosis
FeNa <1%
\BPH - ANS-(non-malignant) typically begins at 40-45 and compresses urethra and causes
outlet obstruction. Post-renal AKI common from this obstruction in elderly men.
\Breast Cancer - ANS-Risks- family hx, early menarche, oral contraceptive use,
post-menopausal estrogen use, obesity, BRCA1 and BRCA2, high breast density, radiation
to the chest during childhood.
Most common- upper outer quadrant of the breast.
S/S-
Painless lump, nipple retraction, dimpling of the breast tissue, swollen axillary nodes, nipple
eczema, nipple discharge.
\Cervical cancer - ANS-Highest prevalence in developing countries. Risks
Risks- Hispanic, African americans, Caucasians (in that order), early onset of sexual activity,
multiple partners, HPV, oral contraceptive use, smoking, immune deficiency. Usually caused
by HPV types 16 and 18. Types 6 &11 can too but are lower risk.
Acute Kidney Injury - ANS-Sudden decline in kidney function with a decrease in GFR and
accumulation of nitrogenous waste products in the blood
Increase in serum creatinine and blood urea nitrogen
50-80% mortality rate
Treat- treat underlying cause
I: creatinine 1.5-1.9x higher or >0.3mg/dl increase
II: creatinine that is 2-2.9x higher or need for renal replacement therapy
S/S- oliguria, edema, dyspnea, mental status changes, electrolyte imbalances, metalbolic
acidosis, BUN:creatinine >20 in pre-renal and normal in intranrenal, FeNa, muddy brown
cast cells in ATN
\Acute Tubular Necrosis - ANS-Most common type of intrinsic acute kidney injury. Commonly
from pre-renal issues with hypovolemia and poor perfusion.
Urine volume <400, urine osmolality <400, urine sodium >30meq/L, urine specific gravity
1.010-1.012.
Failure to restore blood volume or blood pressure and oxygen delivery can cause ischemic
cell injury and acute tubular necrosis (ATN).
Causes- IV radiocontrast, nephrotoxic meds, trauma
S/s- nonoliguria, urine fractional excretion of sodium >2%, urine sodium >40, urine sediment
muddy-brown with granular casts
Response to fluid resuscitation is slower than pre-renal AKI and takes up to 72 hours.
Pre-renal AKI takes 48 hours
\aging effect on kidneys - ANS-Reach adult size by adolescence
Hypertrophy with older age, reduced ability to excrete urine, kyperkalemia from reduced
excretion, more glucose excreted because of decreased reabsorption (not necessarily
indicator of diabetes), drugs not clearing as easily, harder to activate vitamin d, which affects
calcium absorption.
GFR- increased directly after birth, reaches adult levels by age 2, more dilute urine up to
6mo of age, renal blood flow and GFR decrease with older age (d/t atherosclerosis)
Nephron- decrease in number and size with age (atherosclerosis), number of nephrons at
age 75 decreased by 30%.
, Tubular system- immature in infants (harder to excrete potassium, reabsorb bicarb, buffer
hydrogen), matures by age 2. Tubular atrophy is common with age.
Bladder- descends into pelvis after birth, may not void for 12-24 hours following birth.
Frequency and nocturia are common with age.
\AKI intrarenal - ANS-Impaired renal function at the cellular level in the kidney.
Acute tubular necrosis (ATN) is the most common cause of intrarenal renal failure. Dead
cells slough off and cause tubular obstruction, which causes increase in tubular pressure
and decreased GFR- will cause rising BUN and creatinine. Common causes of ATN-
ischemia, sepsis, post-surgical complications, OB complications, medications
Other causes- glomerular nephritis, vasculitis, drug induced toxicity (aminoglycosides,
ARBS, NSAID, ACEi, radiocontrast media, abx), heavy metals like merucry and arsenic,
bacterial toxins.
\AKI postrenal - ANS-Cause by injury past kidney like urinary obstruction.
Bladder outlet obstruction could be from prosthetic hyperplasia, or urinary stones.
S/S- several hours of anuria, flank pain, polyuria
\AKI Prerenal - ANS-Most common cause of ARF
Caused by impaired renal blood flow
GFR declines
Causes- vasoconstriction from medications, shock states, hypotension, hypovolemia,
hemorrhage, failing cardiac output, HF, NSAIDs, renal artery stenosis
FeNa <1%
\BPH - ANS-(non-malignant) typically begins at 40-45 and compresses urethra and causes
outlet obstruction. Post-renal AKI common from this obstruction in elderly men.
\Breast Cancer - ANS-Risks- family hx, early menarche, oral contraceptive use,
post-menopausal estrogen use, obesity, BRCA1 and BRCA2, high breast density, radiation
to the chest during childhood.
Most common- upper outer quadrant of the breast.
S/S-
Painless lump, nipple retraction, dimpling of the breast tissue, swollen axillary nodes, nipple
eczema, nipple discharge.
\Cervical cancer - ANS-Highest prevalence in developing countries. Risks
Risks- Hispanic, African americans, Caucasians (in that order), early onset of sexual activity,
multiple partners, HPV, oral contraceptive use, smoking, immune deficiency. Usually caused
by HPV types 16 and 18. Types 6 &11 can too but are lower risk.
