NURS 314: Diseases of the Kidney, Part One

What are the 7 functions of the KIDNEY?

1.) Filter and clean blood of toxins

2.) Urine production

3.) Salt mineral balance

4.) Maintain blood pressure and volume

5.) Vitamin D production

6.) Hormone production

7.) Plasma pH balance

What hormone does the KIDNEYS make?

erythropoietin

What are the 4 things that can cause KIDNEY FAILURE?

1.) Filters in the kidney

2.) Blood vessels

3.) Trauma

4.) Urine backup

What is OLIGURIA?

decreased urine production; less than 500 mL/day

What is ANURIA?

absence of urine production; less than 50 mL a day

What is AZOTEMIA?

excess nitrogenous product of protein metabolism in the blood; INCREASED BUN

What is BUN?

blood urea nitrogen

What is the BUN level of AZOTEMIA?

7 to 20 mg/dL

What is UREMIA?

increased level of urea in the blood

What is the "normal" creatinine level?

0.6 to 1.3 mg/dL

What are the two pitfalls of "normal" creatinine levels?

1.) dependent on muscle mass

2.) falsely elevated by medications

What is GLOMERULONEPHRITIS?

inflammation of the glomeruli

What is the GLOMERULI?

tiny filters in the kidneys that filter waste from the blood

What are the two classifications of GLOMERULONEPHRITIS?

1.) PRIMARY: starts in glomeruli

2.) SECONDARY: glomeruli are affected by systemic disease

What is ACUTE GLOMERULONEPHRITIS?

symptoms develop suddenly and resolve with treatment

What is CHRONIC GLOMERULONEPHRITIS?

occurs when acute disease not treated; disease process develops slowly

What is the result of CHRONIC GLOMERULONEPHRITIS?

irreversible failure of kidneys

What is the main etiology for primary and secondary GLOMERULONEPHRITIS?

immune mechanisms

What is the archetype (standard presentation) of GLOMERULONEPHRITIS?

acute post-streptococcal glomerulonephritis

What is the pathophysiology of GLOMERULONEPHRITIS?

the presence of antistreptococcal (ASO) antibodies form an antigen-antibody complex which activates the complement system and results in an inflammatory response in the glomeruli

What occurs during the inflammation response for GLOMERULONEPHRITIS?

- INCREASED capillary permeability: leakage of protein and erythrocytes

- Congestion and proliferation of cells

- DECREASED GFR: Retention of fluid and wastes

What are the two major signs of GLOMERULONEPHRITIS?

1.) HEMATURIA: red blood cells, dark urine

2.) PROTEINURIA

What is PROTEINURIA?

urine exceeding 3 to 5 g/day with macroalbuminuria as the major protein

What are the signs and symptoms of GLOMERULONEPHRITIS?

1.) HEMATURIA

2.) PROTEINURIA

3.) Oliguria: low urine output

4.) Edema: generalized, facial, periorbital

5.) Metabolic acidosis

6.) Flank or back pain

7.) General inflammation

What is the cause of BACK/FLANK PAIN?

edema and stretching of renal capsule

What is CAST?

microscopic, cylinder-shaped structures (cylindruria) formed in the kidney's tubules when protein solidifies, often trapping cells or debris

What does CAST reveal?

serve as vital diagnostic markers for kidney disease, indicating dysfunction when detected in urine microscopy

What is CAST composed of?

tamm-horsfall mucoprotein

What does WBC CAST indicate?

interstitial nephritis, pyelonephritis

What does RBC CAST indicate?

glomerulonephritis

What does RENAL TUBULAR EPITHELIAL CELL CAST indicate?

acute tubular necrosis (ATN)

What does GRANULAR CAST indicate?

chronic renal failure; muddy brown = ATN

What does BROAD OR WAXY CAST reveal?

chronic renal failire

What does HYALINE CAST reveal?

exercise, diuretics, concentrated urine

What does FATTY CAST reveal?

nephrotic syndrome

What are the diagnostic tests for GLOMERULONEPHERITIS?

1.) BLOOD TESTS: ELEVATED serum urea, creatinine, anti-DNase B, streptococcal antibodies, anti-streptolysin, anti-streptokinase. DECREASED complemental levels

2.) URINALYSIS: proteinuria, hematuria, erythrocyte casts, no evidence of infection

What is the treatment for GLOMERULONEPHRITIS?

low sodium diet

What is the treatment for GLOMERULONEPHRITIS in extreme cases?

decreased protein and fluid intake

What are the drug treatments for GLOMERULONEPHRITIS?

- glucocorticoids: prednisone

- antihypertensves

- antibiotics