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Primer for APN Nephrology Practice or CNN-NP Certification Preparation

Primer for APN Nephrology Practice or CNN-NP Certification Preparation. Renal Anatomy/Physiology Linda Shenton, MN, RN, ACNP, CNN-NP. References. ANNA Certification Review ANNA Certification Study Guide ANNA Core Curriculum KDOQI KDIGO National Kidney Foundation

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Primer for APN Nephrology Practice or CNN-NP Certification Preparation

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  1. Primer for APN Nephrology Practice or CNN-NP Certification Preparation Renal Anatomy/Physiology Linda Shenton, MN, RN, ACNP, CNN-NP

  2. References • ANNA Certification Review • ANNA Certification Study Guide • ANNA Core Curriculum • KDOQI • KDIGO • National Kidney Foundation • Renal Physicians Association

  3. Objectives 1.Interpret key lab and clinical data to develop the diagnosis of renal disease 2.Explain factors that contribute to chronic kidney disease and progression of renal disease and or AKI 3.Develop treatment strategies for management of a person with CKD

  4. Kidney - Anatomy • 2 kidneys 150 grams each • Size 5-7cm wide, 11-13cm long • Blood Supply: 1,200 ml/minute or approximately 25% of CO • Nephron 1 Million per kidney • Efferent arteriole/afferent arteriole • Tubules

  5. Basic Renal Anatomy • Kidneys-Retroperitoneal • Weight-120-160 gm • Size-4.5 cm x 9 cm x 2.5 cm • Functional Unit- Nephron

  6. Nephron • Filters the blood of it’s small molecules and ions • Reclaims the amount of useful materials Did you Know? In 24 hrs the kidneys reclaim • 1,300g of NaCl • 400 g NaHCO3 • 180 g Glucose

  7. Anatomy • Blood supply: renal artery arises from the aorta and divides into 3 branches; renal vein is formed by a series of small veins • The kidney receives approximately 25% of the cardiac output.

  8. Blood Supply • Afferent artery supplies blood to the kidney • Efferent artery returns blood to the systemic circulation • Total blood volume circulates through the kidneys every 5 minutes

  9. Functions of Healthy Kidney • Regulation of water and inorganic ion balance • Removal of metabolic waste products • Removal of chemical toxins and drugs • Regulates acid base balance of body fluids • Production of hormones/enzymes • Erythropoietin • Renin • 1,25-dihydroxyvitamin D

  10. Statistics

  11. AnemiainCKD

  12. Definition of AnemiaWorld Health Organization • Males: hemoglobin less than 13g/dl • Females: hemoglobin less than 12g/dl

  13. RBC Formation

  14. Hematopoiesis/Erythropoiesis • Undifferentiated cells gradually differentiate to become stem cells, that form blood cells • Occurs in myeloid tissue (bone marrow of long bones) and lymphoid tissue • 2 types of Hematopoiesis: Erythropoiesis: Formation of RBCs Leukopoiesis: Formation of WBCs

  15. Erythropoiesis

  16. Causes of Anemia in CKD • Relative or absolute iron deficiency • Decreased erythropoetin production • Increased risk for bleeding due to uremic effects on platelets • Blood losses – GI, dialysis, lab draws • B12 and or folate deficiencies • Hyperparathyroidism • Low grade hemolysis or hypersplenism • Other conditions: cancer, infections, medication related

  17. Iron Metabolism

  18. Causes of Anemia in CKD • Relative or absolute iron deficiency • Decreased erythropoetin production • Increased risk for bleeding due to uremic effects on platelets • Blood losses – GI, dialysis, lab draws • B12 and or folate deficiencies • Hyperparathyroidism • Low grade hemolysis or hypersplenism • Other conditions: cancer, infections, medication related

  19. Bone and Mineral Disorder

  20. Normal Phosphate Metabolism 85% of PO4 is stored in bones; 14% in soft tissue; 1% extracellular  PTH stimulates release of PO4 and Ca from bone 1,25-dihydroxy vitamin D3 enhances gut absorption of PO4 and Ca PTH stimulates kidneys to resorb or excrete PO4, as needed. 60% to 70% of dietary intake is absorbed in small intestine 90% is filtered through the glomerulus; only 10%25% is excreted in urine

  21. Phosphorus Homeostasis

  22. Hyperphosphatemia Pathophysiology

  23. Secondary Hyperparathyroidism, Bone Disease, and Calcification Renal Osteodystrophy1,2 Soft-Tissue Calcification3,4 Chronic Kidney Disease  Phosphorus  Ca x P product  Calcitriol  Parathyroid Hormone • Vascular • Nonvascular • High Bone Turnover • Low Bone Turnover • Mixed 1. Malluche H & Faugere MC. Kidney Int. 1990;38:193-211. 2. Malluche HH & Monier-Faugere MC. Kidney Int. 1992;42 (suppl 38):S62-S67. 3. Moe SM. Perit Dial Int. 2001;21(suppl 3):S241-246. 4. Reslerova M & Moe SM. Am J Kidney Dis. 2003;41( suppl 1):S96-S99.

  24. Normal Laboratory Values

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