Kidney conditions exam 4

Pyelonephritis

• Microbial invasion of renal pelvis

  • Inflammatory response

    • Resulting fibrosis (scar tissue)

      • Decreased tubular resorption & secretion

        • Impaired kidney function

Pyelonephritis

• Bacterial infection → starts in bladder and moves upward to infect kidneys

• Abscesses (pockets of infection) may occur

• Common cause

  • E.coli

  • Enterococcus faecalis

Acute pyelonephritis

• An active bacterial infection

• Acute tissue inflammation, local edema, tubular cell necrosis, and possible abscess

Key factors for pyelonephritis

• Fever, Chills, Nausea, & Vomiting

• Tachycardia & Tachypnea

• Flank pain

• Tenderness at the CVA (lower mid back)

• Recent cystitis or treatment for UTI

S&S of acute pyelonephritis

• General malaise or fatigue

• Burning, urgency, frequency

• Abdominal discomfort

• Nocturia

Chronic pyelonephritis

• Results from repeated or continued upper UTIs that occur almost exclusively in patients who have anatomic abnormalities of the UT

S&S of chronic pyelonephritis

• Hypertension

• Inability to conserve sodium

• Decreased urine-concentrating ability, resulting in nocturia

• Tendency to develop hyperkalemia and acidosis

Laboratory assessment for pyelonephritis

• Urinalysis (to determine the specific organisms causing the infection)

• Blood cultures (determine the source and spread infectious organisms)

• WBC/ESR/CRP (immunity response)

• BUN/Cr/GFR (kidney function)

Imaging assessment for pyelonephritis

• KUB

• CT

• Both are preformed to visualize anatomy, inflammation, fluid accumulation, abscess formation, and defects in kidney and the urinary tract

• Also identifies stones, kidney tumors, cysts, or prostate enlargement

Diagnostic assessments

• Antibody-coated bacteria in urine

• Radionuclide renal scan

• Both help determine if long term antibiotic therapy is needed

Acetaminophen

• Preferred drug therapy for pyelonephritis for reduced pain

Catheter replacement

• Supportive for a patient requiring a urinary catheter for 2 or more weeks

• Involves removal and replacement of the catheter and closed drainage system before starting antibiotic therapy

Two

• Fluid intake is recommending __ L of water per day

Pyelolithotomy

• Stone removal from the kidney

Ureteroplasty

• Ureter repair, revision, or ureteral reimplantation (through another site in the bladder walls)

• Preserves kidney function and eliminates infection

Nephrectomy

• Removal of the kidney

• Ureteral diversion or reimplantation of ureter(s) to restore proper bladder drainage

Preventing chronic kidney disease

• Antibiotic therapy

• Blood pressure control

• Hydration

Acute kidney injury

• Rapid reduction in kidney function resulting in:

  • Failure to maintain waste elimination

  • Fluid and electrolyte imbalance

  • Acid-base imbalance

Conditions for having an acute kidney injury

• Increase in serum creatinine by 0.3 mg/dL or more within 24 hrs

• Increase in serum creatinine > or = to 1.5x baseline

• Urine output less than 0.5 mL/kg/hr for 6 hrs

Uremia azotemia

• Build up waste in waste in your blood

AKI Risk Factors

• Older adults

• Adults with chronic illnesses

• 20% of hospitalized patients and 60% of patients in ICU develop AKI

• Anything that causes decreased perfusion

Prerenal

• Caused by source outside of kidney

  • Before the kidney

Intrarenal (Intrinsic)

• Occurs inside the kidney

Postrenal

• Caused by urinary flow or obstruction

Prerenal

Ex:

• Dehydration

• Heart failure

• Liver failure

• Failure from nephrotoxic drugs

Intrarenal

• Intrinsic renovascular disease

  • Hypertensive emergency

  • Small vessels vasculitis

  • TTP/HUS

Intrarenal

• Glomerular disease

  • Post infectious glomerulonephritis

Intrarenal

• Tubulointerstitial disease

  • Acute tubular necrosis (ATN)

    • (Causes: sepsis, meds, contrast, rhabdo, prolonged prerenal AKI)

  • Acute interstitial nephritis (AIN)

Postrenal

• Ureteral obstruction (usually requires bilateral obstruction)

• Neurogenic bladder

• UTI

• Medications

• Benign prostatic hypertrophy

2 to 3

• Patients should drink _ to _ L of water daily for AKI

Metformin and Vancomycin

• Drugs to avoid when having an AKI

Assessment for AKI

• History

  • Changes in urine

  • Drug history

    • NSAIDS

    • Antibiotics

• 
  

Assessment for AKI

• HIstory

  • Immunity-mediated AKI

    • Acute allergic reaction or acute illness

  • Obstructive problems

  • Anticipate after hypotension or shock AKI could happen

Physical assessment for AKi

• < 0.55 mL/kg/hr of urine output for 2 or more hours

• Fluid overload

  • Dependent edema & crackles in lungs

• Evaluate vitals → Hypoxemia (02 < 88%) & Hypoperfusion

Signs of hypoperfusion

• Arterial pressure (MAP) < 65mmHg

• Tachycardia

• Weak pulses

• Decreased cognition

Labs for AKI

• BUN/Cr = elevated

• Electrolytes will have to be monitored

  • Calsium

  • Chloride

  • Potassium

  • Sodium

Imaging Assessment for AKI

• Ultrasound

• CT

• X-Ray

• MAG3

Other diagnostic assessments for AKI

• Kidney biopsy

Drug therapy for AKI

• Diuretics (to get rid of retained body fluid and electrolyte since kidney isn’t working)

• Fluid challenge (500-1000mL/hr)

Nutrition for AKI

• Daily protein intake dependent on dialysis

• Nutritional support

• Increased calorie intake

Kidney Replacement Therapy

• Emergency hemodialysis

  • Removing toxins from blood with catheter

• Temporary dialysis catheter

  • Avoiding catheter associated bloodstream infections

  • Informed consent and a “time out”

  • Don’t use this to acquire blood samples

    • Give drugs or fluids

    • Or to monitor central venous pressure

  • Give site care