CH 22, Renal Exemplars

Acute Glomerulonephritis

An immunological response seen in someone with autoimmune disorder or someone with a streptococcal infection that can cause end stage renal disease if untreated

manifestations of acute glomerulonephritis

• Oliguria  

• Anuria

• Periorbital edema

• Hypertension 

• Dark urine 

oliguria

scant urine being produced

anuria

no urine being produced

diagnostics for acute glomerulonephritis

• Low albumin

• Elevated CR and BUN

treatments for acute glomerulonephritis

• Diuretics

• Antibiotics

• Dietary modifications

  • Limit salt

  • Limit potassium

  • Limit protein

nephrotic syndrome

a massive increase in albumin in the blood, leading to hyperlipidemia, proteinuria, and edema, and is most commonly seen in diabetics or those with lupus 

• can be treated with adequate fluids and dietary modifications

nephrolithiasis

AKA kidney stones; they travel from the kidney down the very thin ureter

what are the two types of kidney stones?

• Calcium stones (most common)

• Uric acid stones 

risk factors for nephrolithiasis

• Genetics

• Diet 

• Excessive calcium intake

• Dehydration

• Hyperparathyroidism 

• Gout 

• UTI

• Immobility 

manifestations of nephrolithiasis

• Severe abdominal or flank pain 

• Hematuria

treatments for nephrolithiasis

• Pain relief (opioids)

• Prevent recurrent UTIs

• Strain urine 

• High fluid intake 

• Lithotripsy

• Surgery (manually remove stone)

• Dietary

  • Depending on type of stone, keep urine acidic or alkalytic 

how much fluid should be taken in with kidney stones?

3L/day

what is lithotripsy?

When they send pt to surgical suite, put under anasthesia and direct a high beam of laser light over the kidney to break up the stone

pyelonephritis

renal pelvis infection

causes of pyelonephritis

• most common is E coli

• Urine going back up to kidneys with UTI

• Stasis of urine, good breeding ground for bacteria 

• Obstructive uropathy

• Neurogenic bladder

• Pregnancy

what is neurogenic bladder?

a conduction problem of nerves going to bladder, which causes stasis 

manifestations of pyelonephritis

• CVA tenderness

• Fever

• Flank pain 

• N&V

• Dysuria (painful)

• Urinary frequency 

• microscopic hematuria 

• Pyuria (pus, green or yellow urine)

diagnostics for pyelonephritis

• urine culture

• dipstick test (may show pyuria)

• CECT/CT scan

treatments for pyelonephritis

• Antibiotics 

• Analgesic 

• Increase fluid to 3L per day 

• Rid obstruction 

acute kidney injury

an abrupt insult to kidney, AKA acute renal failure 

manifestations of AKI

• Creatinine might be up 

• Azotemia

• Fluid retention

pre-renal causes of AKI

• Something causing renal ischemia 

• Hemorrhage 

• Shock

intra-renal causes of AKI

• Nephrotoxic drugs 

• Radio opaque dyes

• Infections

post-renal causes of AKI

• Nephrolithiasis 

• Enlarged prostate

How many phases of AKI are there? What are they?

4; initial insult, oliguria, diuresis, recovery

initial insult phase AKI

kidneys are not producing enough urine to rid body of toxins

oliguria phase AKI

• Low GFR

• Less than 400 ml per day

• Fluid overload

diuresis phase AKI

Large unconcentrated urine output as function returns

recovery phase AKI

Healthy nephrons take over function of damaged nephrons and kidney function resumes

treatment of AKI

address the underlying cause

Chronic renal failure

90-95% of nephrons are affected, resulting in irreversible and progressive loss of kidney function, eventually causing ESRD

treatment for chronic renal failure

• dialysis (person is eligible if GFR is less than 10-20mL/min)

• kidney transplant

• Fluid and electrolyte management 

• daily weights

causes of chronic renal failure

• Diabetes 

• Hypertension 

• Glomerulonephritis 

complications of chronic renal failure

• Uremic encephalopathy(brain and mental status effected 

• Fluid overload 

• Oliguria (30 mL per hour)

• Thrombocytopenia 

• Anemia

Diagnostics of chronic renal failure

• CBC (low)

• BUN (high)

• Cr (high)

• Urinalysis to test albumin (low)

• Renal imaging (CT or MRI of kidneys)

patient teaching for daily weights

• use the same scale

• wear the same type of clothes

• weigh at the same time each day

• go to hospital if weight gain is more than 2lbs/day or 5lbs/week