Question

Review Chapters 44-46

Review your NCLEX Review Questions on your Evolve Account corresponding to these chapters

Elaborate a paragraph or table where you identified the differences between :1-acute kidney injury and chronic kidney injury. 2-peritoneal dialysis and hemodialysis

Answer 1

Acute Kidney Injury and Chronic Kidney Disease
	Acute Kidney Injury	Chronic Kidney Disease
Onset	Sudden	Gradual (months to years)
Common causes	Acute tubular necrosis (ischemia or nephrotoxin exposure) Pre-renal disease (hypovolemic states, hypotension) Urinary tract obstruction (prostate disease, metastatic cancer)	Diabetic nephropathy Hypertension Glomerulonephritis Polycystic kidney disease Nephrotoxin exposure
Diagnosis*	One of the following: • Serum creatinine (SCr) increases by 0.3 mg / dl within 48 hours • Rise of SCr to 1.5 times the baseline known or assumed to have occurred during the 7 days • Amount of urine < 0.5 ml / kg / hr during 6 hours	One of the following, for at least 3 months: · Damage to the kidneys (albuminuria, urinary casts, irregular renal biopsy or imaging) · Decreased glomerular filtration rate ( GFR) below 60 mL / min/1,73 m2 for a period of 3 months
Symptoms	· Low volume or no urine, hematuria, oedema, fatigue , shortness of breath · Signs are sometimes correlated with the cause (thirst in dehydrated patients, flank pain in obstructed patients); · • Many patients do not show any symptoms	· Weakness, tiredness, anorexia, edema, nausea / vomiting, reduced urine output; · Many patients are asymptomatic before improving with CKD
Reversibility	Usually reversible	Irreversible, progressive
Management	· Assess aetiology · Treat reversible causes including hypotension, loss of volume or blockage of the urinary tract · Exclude any nephrotoxic drugs to mitigate new injury · Recognise and treat risks such as hyperkalemia, fluid overload and acidemia	· Manage the underlying disease mechanism optimally · Take off some nephrotoxic drugs · Track and correct the imbalances in water and electrolytes · Blood pressure control to low-normal values · Treat osteopathy and renal anaemia

Peritoneal Dialysis and Hemodialysis

Hemodialysis or peritoneal dialysis can treat insufficiency in the kidneys. Both processes include removing body waste and excess fluid. Hemodialysis is performed with the help of a dialyzer system. In contrast, the latter uses a combination of the peritoneal membrane lining (abdominal cavity) and a solution.

Hemodialysis

· Before the procedures begin, the doctor would need to establish a site for blood flow inside and out of the body. A machine to which tubes attached to the blood vessels are connected, will be used to clean the blood.

· Since waste disposal is done by machine, the person on a fixed schedule has to go to a hospital or dialysis centre.

· There is an opportunity to do dialysis at home but the individual and at least one other individual assigned to help would need to be educated. There will also be some improvements needed for the home in order for the equipment to function.

· Since the machine is in the home, set your own dialysis schedule but it must be more regular, even though the sessions would be shorter. Should, for example, have a regular session lasting two to three hours.

· Hemodialysis has one advantage that the person has four free days in the week. Moreover, it's done only once and takes a few hours of the day.

· Yet there are disadvantages, too. The medication can make the person feel exhausted, causing complications like low blood pressure, anaemia, and depression-just to name a few.

· Even when undergoing this kind of therapy, the diet should be strictly followed. The person should only consume a certain amount of fluid and there are a variety of items that the person must avoid.

Peritoneal dialysis

· The person needs to undergo a certain procedure, like hemodialysis, before dialysis begins. A catheter will be put in the ventre for this operation. Using it to filter the blood.

· The method of dialysis of this type is called an exchange which needs to be done four to six times a day. But unlike hemodialysis, to get this done, the person does not need heavy equipment or hospital visits; you may also undergo the treatment at home or while commuting.

· Although this form of dialysis is more relaxing, because of the existence of the catheter it can be quite a discomfort. But the person with the clothes can easily hide that.

· Unlike hemodialysis, when it comes to food and drink consumption there are less limitations. Then again it has some drawbacks, too.

· Peritoneal dialysis has to be done several times over a single day. It can take a big chunk of the day to complete hemodialysis, but there are days when the person doesn't have to go through it.

· Although this form of treatment uses no needles, it can still be daunting for others to do. Plus, the lining of the abdomen (peritonitis) also runs the risk of infection.