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The kidneys are responsible for removing wastes from the body,
regulating electrolyte balance and blood pressure,
and stimulating red blood cell production.
RENAL DISEASES
Terms:
*aldosterone *hematuria
*antidiuretic hormone *nocturia
*anuria *oliguria
*bacteriuria *proteinuria
*clearance *pyuria
*dysuria *Valsalva Leak Maneuver Point
*frequency *vesicoureteral reflux
*GFR
-retroperitoneal organs
-120 – 170g
-12cm long, 6cm wide and 2.5cm thick
-with 8 – 18 pyramids
-with 4 -13 minor calyces
-with 2 – 3 major calyces
-with protective structures:
a. Pararenal fat
b. Gerota’s fascia
c. Perirenal fat
d. Renal capsule
Nephron
-basic structural and functional unit of the kidney
DIAGNOSIS:
UTZ Nuclear scan
CT scan Urine Culture and Sensitivity
IVP Test
MEDICAL MANAGEMENT:
a. uncomplicated
-no dehydration, no nausea and vomiting, no sepsis
>2 weeks of oral antibiotics
Trimethoprim-Sulfamethoxazole
Ciprofloxacin
Gentamicin with or without Ampicillin
Third Generation Cephalosporins
>6 weeks of oral antibiotics if with relapse
*urine culture 2 weeks after antibiotic therapy
b. complicated
-pregnant patients
>hospitalization (antibiotics from IV to oral)
B. Chronic Pyelonephritis
-repeated acute pyelonephritis >> chronic
pyelonephritis
-no s/sx unless there’s an acute exacerbation
-kidneys scarred, contracted and non functional
SIGNS AND SYMPTOMS:
fatigue polyuria
headache excessive thirst
anorexia weight loss
DIAGNOSIS:
creatinine and BUN clearance
creatinine levels
intravenous pyelography
COMLICATIONS:
a. ESRD
b. hypertension
c. formation of renal stones
-may be due to the presence of urea
splitting microorganisms
MEDICAL MANAGEMENT:
a. urine culture and sensitivity guided antibiotic therapy
Nitrofurantoin
TMP-SMZ
NURSING MANAGEMENT:
a. monitoring
-I&O
b. oral fluids (3-4L/day)
c. symptomatic
-antipyretics
d. education
-advise bed rest
-prevention of UTI
C. Acute Glomerulonephritis
-primarily a disease of children older than 2 years old
-may affect any age
-causes:
>autoimmune
SLE
>streptococcal
Acute Post Streptococcal
Glomerulonephritis
Acute Post Streptococcal Glomerulonephritis
-2 to 3 weeks after
>impetigo
>sorethroat
SINGS AND SYMPTOMS:
hematuria hypertension
tea colored urine headache, malaise, flank pain
proteinuria (+) kidney punch
inc serum BUN and crea congestion
anemia confusion, somnolence
edema and seizures
Group A Beta-Hemolytic Streptococcal Infection
Antigen-Antibody Reaction
Glomerulus
WBC Infiltration
Thickening
Scarring
Decreased GFR
DIAGNOSIS:
a. kidney biopsy
b. electron microscopy
c. immunoflourescence analysis
d. Anti-Streptolysin O Titer
Anti-DNAse B Titer
e. Serum Complement Determination
-decreased
-will normalize in 2 – 8 weeks
IgA Nephropathy
-most common type of primary
glomerulonephritis
-Inc IgA; with normal serum complement
-complications:
a. Hypertensive Encephalopathy
b. Heart Failure
c. Pulmonary Edema
Rapidly Progressive Glomerulonephritis
-patient deteriorates in weeks to months
-course is more severe and more rapid
Management To Glomerulonephritis
Goals:
1. Treat symptoms
2. Preserve renal function
3. Treat complications
a. antibiotics d. protein restriction
b. steroids e. sodium restriction
c. cytotoxic agents f. diuretics
g. dialysis
D. Chronic Glomerulonephritis
-components:
repeated acute glomerulonephritis
hypertensive nephrosclerosis
hyperlipidemia
chronic tubulo-interstitial injury
hemodynamically mediated glomerular sclerosis
-contraction of the kidneys to 1/5 of its original size
-deformed kidneys
-may result to ESRD
DIAGNOSIS:
1. Urinalysis- fixed sp. Gravity at 1.010
proteinuria; urinary casts
2. serum chemistry
-hyperkalemia
- hypoalbuminemia
-hyperphosphatemia
-hypocalcemia
-hypermagnesemia
3. CBC
-anemia
4. Chest X-Ray
-cardiomegaly
-pulmonary edema
5. ECG
-left ventricular hypertrophy
MANAGEMENT:
1. treatment of hypertension
2. weight monitoring
3. give proteins of high biologic value
4. adequate calories
5. dialysis
NURSING MANAGEMENT:
1. monitoring
E. Nephrotic Syndrome
-components:
proteinuria hyperlipidemia
hypoalbuminemia
CAUSES:
a. chronic glomerulonephritis
b. diabetes mellitus
c. amyloidosis
d. SLE
e. multiple myeloma
f. renal vein thrombosis
SIGNS AND SYMPTOMS:
edema (soft and pitting)
-eyes, dependent area and abdomen
malaise irritability
headache fatigue
DIAGNOSIS:
1. Urinalysis
-proteinuria (3-3.5g/day)
-inc WBC
2. Protein Electrophoresis
Immunoelectrophoresis
3. Biopsy
4. AntiC1q antibodies (SLE)
COMPLICATIONS:
a. infection d. acute RF
b. thromboembolism e. accelerated
atherosclerosis
c. pulmonary emboli
MANAGEMENT:
1. diuretics
2. ACE inhibitors
3. immunosuppressants
4. steroids
5. hypolipidemic agents
6. sodium restriction
7. CHON intake of 0.8g/kg/day
low saturated fats
Urolithiasis
-stones or calculi in the urinary tract
-supersaturation of substances such as calcium
oxalate, calcium phosphate and uric acid
SIGNS AND SYMPTOMPS:
>depends on
*the site of obstruction *edema
*infection
ASSESSMENT AND DIAGNOSIS:
>IVP, Intravenous Urography
>Retrograde Pyelography
>UTZ
>serum chemistries and 24 urine tests
deficiency of citrate, mg
nephrocalcin & uropontin
dehydration
infection
Urolithiasis
urinary stasis
periods of immobility
a. hyperparathyroidism
b. renal tubular acidosis
c. cancers
d. granulomatous disease
e. excessive intake of Vitamin D
f. excessive intake of milk and alkali
g. myeloproliferative disease
-substances other than calcium that may precipitate
and form stones
a. uric acid
-5%-10% of renal stones
-gout, myeloproliferative disorders
b. struvite
-15% of renal stones
-in persistently alkaline and ammonia rich urine
(caused by urease-splitting bacteria)
-in neurogenic bladder, foreign bodies and
recurrent UTI
c. cystine
-1%-2% of renal stones
-hereditary defect in the renal absorption
-medicines that increases the risk of urolithiasis
a. acetazolamide d. laxatives
b. Vitamin D e. high doses of aspirin
c. antacids
MANAGEMENT:
a. eradicate the stone
b. determine the stone type
c. prevent nephron destruction
d. control infection
e. relieve any obstruction
>Opioid Analgesics
NSAIDs
>Hot Baths and Moist Heat to the flank area
>Advise to increase oral fluid intake
(urine output of >2L/day is advisable)
SPECIFIC MANAGEMENT:
1. Calcium stones
-restrict proteins and sodium in the diet
-acidify the urine using Ammonium chloride
or Acetohydroxamic Acid
-Cellulose sodium phosphate
(binds calcium from food)
-thiazide diuretics (if caused by inc PTH)
2. Uric Acid Stones
-low purine diet (shellfish, mushrooms,
asparagus, organ meats)
-Allopurinol
-alkalinize the urine
3. Cystine
-low protein diet
-penicillamine (to decrease excretion
through the urine)
4. Oxalate
-dilute the urine
-limit oxalate containing foods
(spinach, strawberries, rhubarb, tea,
bran)
SURGICAL MANAGEMENT:
a. Ureteroscopy
b. Extracorporeal Shock Wave Lithotripsy
c. Percutaneous Nephrostomy or Nephrolithotomy
ACUTE RENAL FAILURE
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Acute kidney failure occurs when the kidneys suddenly stop working.
This may occur after surgery or due to an injury. It can also occur due to the
use of certain drugs. People with acute renal failure may regain their kidney function
depending on the cause of the damage.
Acute Renal Failure
BUN
1. Prerenal
-shock
2. Intrarenal
-the result of actual parenchymal damage
-use of nephrotoxic drugs (NSAIDs and ACE inh)
3. Postrenal
-the result of an obstruction in the distal urinary tract
Acute Renal Failure
PREVENTION:
*prevention of exposure to nephrotoxic drugs
-aminoglycosides, cyclosporine, amphotericin B
*serum BUN and creatinine monitoring
MANAGEMENT:
a. restore chemical balance and prevent complications
b. identification and treatment of the underlying cause
c. maintain fluid balance
-BP, CVP, serum and urine elect., fluid loses
d. monitoring for over hydration
-dyspnea, crackles, distended neck veins
-Furosemide, Ethacrynic Acid
e. dialysis
-to prevent serious complications
*hyperkalemia
*severe metabolic acidosis
*pericarditis
*pulmonary edema
f. pharmacologic
-cation exchange resin
(sodium polystyrene sulfonate-kayexalate)
-retention enema
-diuretic therapy
-low dopamine dose (1-3g/kg)
-phosphate binding agents (AlOH)
g. nutritional therapy
-give additional proteins (1g/kg/day during the
oliguric phase)
-high potassium and phosphate foods are
restricted (banana, citrus and coffee)
-potassium restricted to 20-40mEq/day
-sodium restricted to 2g/day
-may require parenteral nutrition
NURSING MANAGEMENT:
CAUSES:
*diabetes mellitus- most common
*hypertension
*chronic glomerulonephritis
*obstruction of the urinary tract
*polycystic kidney disease
*infections
*nephrotoxic medications
STAGES:
Stage 1
-Reduced Renal Reserve
-40%-75% loss of nephron function
-usually asymptomatic
Stage 2
-Renal Insufficiency
-75%-90% loss of nephron function
-increase in serum BUN and creatinine
-inability to concentrate urine
-anemia may develop
-with polyuria and nocturia
Stage 3
-End Stage Renal Disease
-<10% of nephron function remaining
-regulatory, excretory and hormonal functions
are lost
-requires dialysis
SIGNS AND SYMPTOMS
cardiovascular
*hypertension *pulmonary edema
*heart failure *pericarditis
dermatologic
*pruritus
*uremic frost (deposit of urea crystals)
GI and Neurologic s&sx
ASSESSMENT AND DIAGNOSIS:
a. glomerular filtration rate
creatinine clearance
b. serum electrolytes
c. ABG
d. CBC
COMPLICATIONS:
a. Hyperkalemia
b. Pericarditis, Pleural Effusion and Cardiac
Tamponade
c. Hypertension
d. Anemia
e. Bone Disease
MEDICAL MANAGEMENT:
a. maintain kidney function and homeostasis
b. treat the underlying cause and contributory
factors
>medications >dialysis
>diet therapy
1. Pharmacologic Therapy
a. antihypertensives
> includes intravascular volume control
*fluid restriction
*sodium restriction
b. sodium bicarbonate
c. erythropoietin
>will achieve a Hct of 33%-38%
>IV or SC 3x a week
>takes 2-6 weeks to increase Hct
>A/R:
*hypertension
*increased clotting of vascular access
sites
*seizures
*depletion of body iron stores
d. iron supplementation
e. antiseizure agents
>Diazepam
>Phenytoin
f. antacids
>aluminum based antacids
neurologic symptoms
osteomalacia
>calcium carbonate
2. Nutritional Therapy
-regulation of protein intake
-regulation of fluid intake
(500-600ml more than the previous day’s 24 hour
UO)
-regulation of sodium intake
-regulation of potassium
-adequate calories and vitamins
3. Dialysis
-to prevent hyperkalemia
NURSING MANAGEMENT:
a. avoid the complications of reduced renal
function
b. assess fluid status
c. identify potential sources of the imbalance
d. implement a dietary program
e. encourage self care and independence
ADPIE
Assessment
Subjective: Dysuria and Frequent
urination
Objective: Hyperthermia Urinary
incontinence or retention
Nursing Diagnosis
-Impaired urinary elimination r/t renal
problems as evidenced by urinary
incontinence.
-Hyperthermia r/t kidney infections.
-Acute pain r/t damaged kidney.
ADPIE
Planning
STG: After an hour of nursing intervention the patient’s body temperature
will decreased and the pain will be verbalized as tolerable.
LTG: Within hospital stay the patient will maintain normal body
temperature, verbalizes pain not occurring and will maintain normal
urinary elimination.
Intervention
-TSB
-Provide teachings of safety measures
-Explain patient’s condition
-Monitor VS to know any alteration
-Assess patient’s pain tolerance
-Administer medications as prescribed
-Monitor I and O
Evaluation
STG: After an hour of nursing intervention the patient’s body temperature
has reduced and the patient verbalizes pain as tolerable.
LTG: Within hospital stay the patient has maintain normal body
temperature, verbalizes pain not occurring and has maintained normal
urinary elimination.
REFERENCES
Brunner and Suddarth’s Textbook of
Medical and Surgical Nursing
10th Edition, Suzanne C.
Smeltzer; Brenda Bare
www.google.com
END!!!
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