NRSG 250: Exam 2 - Renal Disorders

What are the key structures of the renal system"?

1. Nephron: functional unit of kidney

2. Glomerulus: filters blood plasma via hydrostatic pressure

3. Bowman’s Capsule: encases the glomerulus and collects filtrate

4. Tubules; reabsorb needed substances and secrete wastes

What is considered normal urine output, oliguria, and anuria?

1. Normal output: 800-2,000 mL/day or 30 mL/hr minimum

2. Oliguria: <400-500 mL/day or 20 mL/hr

3. Anuria: little to none

What does oliguria and anuria indicate?

Oliguria → concern for hypoperfusion, AKI, dehydration

Anura → concern for severe kidney injury or obstruction

What labs are pertinent to kidney function?

• creatinine

• BUN

• eGFR

• electrolytes

* urine output alone does not determine kidney function

What are the functions of the kidney?

A: Acid-base balance → maintains pH

B: BP → renin activates RAAS

C: Ca2+ absorption → bone & neuron function

D: Vit D activation → Ca2+ absorption

E: Erythropoietin → RBC production

F: Fluid & electrolyte balance → control volume

G: Garbage removal → removes waste

What is a UTI?

an infection that occurs in any part of the urinary system, including the kidneys, ureters, bladder, or urethra

Types:

• uncomplicated cystitis

• complicated cystitis

• pyelonephritis

• asymptomatic bacteriuria

• CAUTI

What is cystitis and what is it caused by?

inflammation/infection of the bladder; most commonly caused by Escherichia coli and Candida from GI flora (also most common type of HAUTI

Types:

• uncomplicated = lower UTI in otherwise healthy urinary tract

• complicated = worse manifestations & high risk d/t obstruction, catheter, pregnancy, DM, renal disease, males, immunosuppression

What are the manifestations of acute uncomplicated cystitis?

• Dysuria

• Frequency and urgency

• Suprapubic discomfort

• Cloudy or foul-smelling urine

• Older adults may present with nonspecific changes (i.e., AMS)-

What are the manifestations of acute complicated cystitis?

• Fever

• chills

• rigors

• malaise

• flank pain

• CVA tenderness

• N/V

What is pyelonephritis?

infection of the renal pelvis and kidney tissue, usually acsending from a lower UTI

What causes pyelonephritis?

• escherichia coli

• enterococcus faecalis

• other gram-negative organisms

What are the risk factors for pyelonephritis?

• untreated/recurrent UTI

• urinary obstruction or stones

• vesicoureteral reflux

• indwelling urinary catheter

• DM

• Pregnancy

• immunosuppresion

• BPH or urinary retention

What are the manifestations of pyelonephritis?

• fever & chills

• flank pain or CVA tenderness

• N/V

• Dysuria, urgency, and frequency

• malaise or fatigue

Subjective findings:

• flank/back pain

• burning w/ urinary

• urgency/frequency

• N/V

• feeling very ill

Objective findings:

• fever (>102F/38.9C)

• tachycardia

• CVA tenderness

• cloudy/foul-smelling urine

• hypotention

• decreased urine output

What are the diagnositics for pyelonephritis?

1. urinalysis (WBCs, bacteria, leukocytesterase, nitrites, hematuria)

2. urine culture → identifies organism; guides antibiotic therapy

3. Bloodwork

   • CBC w/ differential → infection

   • BUN, creatinine, eGFR → kidney function

   • CRP/ESR → inflammation

4. Blood cultures if fever, sepsis, hospitalization

5. imaging

   • CT or ultrasound for obstruction/stone, recurrent infection, or poor response to antibiotics

What is the tx used for pyelonephritis?

Medications:

• antibiotics (IV might b needed)

• antipyretics

• analgesics

• antiemetics

Other:

• hydration

What nursing interventions are used for pyelonephritis?

• support hydration

• monitor VS

• I&Os

• monitor BUN, creatinine, eGFR

• monitor for signs of sepsis

• promote rest and safety (cluster care, assist w/ ambulation, fall precautions)

When is it appropriate to use an indwelling urinary catheter?

1. acute urinary retention or obstruction

2. accurate output in critically ill pt

3. perioperative use

4. heal open sacral/perineal wounds in incontinent pts

5. comfort care

How do you handle a urinary catheter?

• keep closed drainage system

• keep bag below bladder & off floor

• prevent kinks & dependent loops

• secure catheter to prevent traction

• routine hygiene, no excessive cleaning

• assess need for catheter every shift = want to remove asap

Before inserting a urinary catheter, what is necessary?

• consider alternatives:

  • toileting schedule

  • bladder scanner

  • external catheter

  • intermittent catheterization

• ensure doctor’s order

• hand hygeine

• aseptic technique

• sterile equipment

• trained personnel

What is urolithiasis?

kidney stones; presence of calculi or stones anywhere in the urinary tract

What are the manifestations of urlithaisis?

• severe colicky flank pain that radiates to lower abd/groin

• hematuria

• urinary obstruction

• infection

• hydronephrosis

• AKI

• N/V

• restlessness

• dysuria, urgency, or frequency if stone is in lower UT

What are concerning cues of urolithiasis?

• fever/chills

• decreased urine output

• anuira

• hypotension or tachycardia

• rising creatinine

What are risk factors for urolithiasis?

• previous stones/family hx

• low fluid intake/dehydration

• high sodium intake

• high animal protein intake

• obesity & DM

• Gout

• recurrent UTI

• hyperparathyroiism

• certain meds or supp

What tx/interventions are used for urolithiasis?

• pain & nausea management

• promote urine flow

• monitor for complications

• prepare for procedures:

  • lithotripsy → shock waves break stone into fragments

  • ureteroscopy → scope removes/breaks stone

  • stent → keeps ureter open

  • percutaneous nephrolithotomy → removes large/complex stones

What is hydronephrosis, hydroureter, and urethral stricture?

Hydronephrosis: dilation/swelling of kidney → blocks urine flow

Hydroureter: dilation/swlling of ureter → blocks urine blow

Urethral stricture: narrowing of urethra → blocks urine flow

What causes hydronephrosis?

inside urinary tract:

• stone, stricture, or stenosis

• blood clot or tumor

outside compression:

• abdominal/pelvic tumor

• pregnancy

• enlarged prostate

functional causes:

• neurogenic bladder

• urinary retention

• incomplete bladder emptying

congenital causes:

• structural abnormality

• vesicoureteral reflux

What are the complications of hydronephrosis?

• urine can’t drain normally → backs up

• kidney/ureter dilate

• urinary stasis → increases infection risk

• pressure increases above blockage

• prolonged obstruction → impaired kidney function

What are the manifestations of hydronephorsis/hydroureter?

Subjective:

• flank, abd, pelvic, or suprapubic pain

• difficulty starting urine stream

• weak stream/dribbling

• incomplete emptying

• dysuria, urgency, frequency

• nausea/malaise

Objective:

• decreased urine output/anuria

• bladder distension

• fever/chills

• hematuria

• elevated BUN/creatinine

What diagnostics are used for hydronephrosis and hydroureter?

Labs:

• urinalysis

• urine culture if infection

• BUN, creatinine, eGFR

• CBC if infection

Other:

• I&Os

• bladder scan

• post-void residual

• urine appearance

Imaging:

• renal/bladder ultrasound

• CT → stone/tumor/obstruction

• cystoscopy or ureteroscopy

What is the tx for hydronephrosis?

• catheterization for obstruction/retention

• ureteral stent

• nephrostomy tube

• stone removal/lithotripsy

• dilation → stricture

• surgery → tumor, severe stricture, prostate obstruction

What nursing interventions are used for hydronephrosis?

• Monitor urine output closely

• assess pain and bladder distention

• Trend BUN, creatinine, eGFR

• Monitor for fever, chills, and sepsis

• Maintain catheter, stent, or nephrostomy tube patency per policy

• Teach patient when to report decreased output, fever, flank pain, or hematuria

What is polycystic kidney disease (PKD)?

genetic kidney disorder characterized by the presence of numerous cysts in the kidneys

What is the patho of PKD?

1. genetic kidney disorder

2. Cysts arise from renal tubules

3. Cysts enlarge and compress nephrons

4. Cysts replace functioning renal tissue

5. Kidney filtration ↓ & kidneys enlarge

6. Waste products build up → uremia

7. Can progress to HTN, CKD, & ESRD

What are the manifestations of PKD?

• Flank or abdominal pain

• Hypertension

• Hematuria or cloudy urine

• Recurrent UTIs

• Kidney stones

• Increased abdominal girth

• Constipation from enlarged kidneys

What diagnostics are used for PKD?

• Ultrasound → kidney size/cysts

• CT or MRI → cyst burden and complications

• urinalysis → hematuria, proteinuria, WBCs

• genetic/family hx assessment

What nursing interventions are used for PKD?

• control BP

• manage pain safely

• encourage prescribed hydration plan

• monitor for infection

• prevent constipation

• avoid nephrotoxic medications unless prescribed

• teach follow-up and renal-protective lifestyle habits

What is glomerulonephritis (GN)?

inflammation of the glomeruli and is often immune-mediated

• may be acute or chronic

• common cause of nephritis syndrome

What are the manifestations of GN?

• impaired filtration

• hallmark sign: hematuria

  • cola-colored or pink urine!!!

• mild to mod proteinuria (foamy)

• oliguria

• HTN

• edema, especially preorbital

What are the key points of acute GN?

1. often follows infection, esp. strep

2. antigen-antibody complexes deposit in glomeruli

3. inflammation decreases GFR

4. sudden onset

5. can improve if treated early

What are the key points of chronic GN?

1. long-term glomerular inflammationm

2. results from systemic disease

   • Lupus, DM, Goodpasure syndrome

3. gradual decline in kidney function

4. may progress to CKD or kidney failure

What are the diagnostics of GN?

Labs:

• urinalysis

• BUN, creatinine, eGFR

• albumin

Others:

• BP & signs of fluid overload

• I&Os and daily weight

• urine color & output

• Edema: hands, face, feet

Imaging:

• possible kidney biopsy

What are the nursing interventions for acute GN?

• Restore fluid balance

• Control blood pressure

• Improve urine output

• Reduce edema

• Prevent complications from fluid overload

• Monitor for recovery of renal function

What are the nursing interventions for chronic GN?

• Slow progression of kidney damage

• Maintain stable electrolytes

• Preserve remaining kidney function

• Control hypertension

• Maintain nutrition and renal diet adherence

• Prepare for CKD management if disease progresses

What is nephrOtic syndrome?

increased glomerular permeability to proteins → proteinuria, hypoalbuminemia, edema, and hyperlipidemia.

What causes nephrotic syndrome?

• DM

• glomerulonephritis

• lupus

• drugs

What are the manifestations of nephrotic syndome?

• proteinuria (>3.5g/24hr)

• edema

• hypoalbuminemia

• HLD

• lipiduria

• protein casts

What is the tx for nephrotic syndrome?

Medication:

• corticosteroids or immunosuppressants

• ACE inhibitors/ARBS → reduce proteinuria & BP

• diuretics → edema

• statins → HLD

• anticoagulants → if high clot risk

Other:

• low-sodium diet

• protein plan as prescribed

What is nephritic syndrome?

a kidney disorder characterized by inflammation of the glomeruli, leading to symptoms such as hematuria, hypertension, and moderate proteinuria

What causes nephritic syndrome?

• glomerulonephritis (most common)

• bacterial infection

• Goodpasture’s

• Lupus

What are the manifestations of nephritic syndrome?

• oliguria

• hematuria

• non-selective proteinuria

• HTN

• decreased GFR

• increased BUN & Cr

• RBC & protein casts

• cola-colored urine (hematuria)