UNIT NINE
710
Understanding the Urinary System
Table 37.5 Common Nephrotoxins
done for more than a month, if needed, via temporary vascu- lar access. During CRRT, a permeable hemofilter is attached to the vascular access. Blood flows through the hemofilter as excess fluids and solutes move into a collection bag. The remaining blood returns to the patient via the venous access. Replacement fluid and electrolytes can be given through the vascular access. Monitoring hourly vital signs, vascular access, I&O, electrolytes, and daily weights is important. Chronic Kidney Disease Kidney disease is the eighth leading cause of death in the United States (CDC, 2020; see “Evidence-Based Practice”). CKD affects about 37 million people, and the incidence is on the rise (CDC, 2021). Many people are unaware they have kidney disease (Healthy People, 2030). CKD is a gradual, progressive, irreversible deterioration in renal function in which the body is unable to maintain metabolic, fluid, and electrolyte balance. The result is accumulation of nitroge- nous waste products in the blood and uremia . CKD affects each body system (Table 37.6).
Antibiotics
Aminoglycosides Amphotericin B Cephalosporins Sulfonamides Tetracyclines Acetaminophen NSAIDs Salicylates
Analgesics
Other Medications
Angiotensin-converting enzyme (ACE) inhibitors Amphetamines Cisplatin Dextran Heroin Interleukin-2 Mannitol
Heavy Metals
Arsenic Copper
Evidence-Based Practice Clinical Question
Gold Lead
What is the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes? Evidence This study analyzed data from the 2005 through 2014 National Health and Nutrition Examination Surveys for 1,376 adults who had diabetes and CKD to look at the effect that social determinants of health had on mortality. Social determinates of health relate to socioeconomic; psychosocial; neighborhood environment; and political, cultural, and economic factors that people experience during their lifetime. This analysis looked at family income to poverty ratio, food insecurity, and depression. It was found that these social determinants had a cumulative effect on mortality that increased by 41% for each addi- tional social determinant. Depression was independently associated with mortality (Ozieh et al, 2021). Implications for Nursing Practice An awareness of social determinants of health, and screen- ing for them as well as for depression in CKD patients, to plan interventions or make referrals (e.g., for Meals on Wheels or mental health services) may help reduce mortal- ity for CKD patients. Reference: Ozieh, M. N., Garacci, E., Walker, R. J., Palatnik, A., & Egede, L. E. (2021). The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease. BMC Nephrology, 22 (1), 76. https://doi.org/10.1186/s12882-021-02277-2
Lithium Mercury
Contrast Media Organic Solvents
Contrast agents used for diagnostic testing
Gasoline Glycols Kerosene Tetrachloroethylene Turpentine
Therapeutic Measures AKI is treated by correcting the cause if possible. Prevention of permanent damage is the goal of treatment. Signs and symptoms are managed as they develop, and supportive care is given. Treatment may include restoring fluid and electro- lyte balance, discontinuing nephrotoxic drugs, bypassing urinary tract obstructions with catheters to relieve urine retention, or using short-term continuous renal replacement therapy to filter blood and restore potassium and other elec- trolytes to normal. The care of the patient with AKI is similar to care of the patient with CKD. CONTINUOUS RENAL REPLACEMENT THERAPY. Continuous renal replacement therapy (CRRT) is used to remove fluid and solutes in a controlled, continuous manner in unstable patients with AKI. Unstable patients may not be able to tolerate the rapid fluid shifts that occur in hemodialysis , so CRRT pro- vides an alternative therapy that results in less dramatic fluid shifting. CRRT is not as complex as hemodialysis. It can be
• WORD • BUILDING • hemodialysis: hemo—blood + dialysis—passage of a solute through a membrane uremia: ur—urea + emia—in the blood
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