Kidney Conditions 1

Pyelonephritis

severe and sudden kidney infection that causes inflammation and triggers an immune response in the kidneys.

• This condition can potentially lead to permanent kidney damage and may be life threatening if not treated promptly.

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Pyelonephritis Patho

develops from a lower UTI where the bacteria has entered the urethra, spread to the bladder while multiplying, then spreads to the kidneys by traveling up the ureters.

Pyelonephritis Cause

• E.coli

• Klebsiella, Enterobacter, and Proteus

• Female

• Renal stones

• Kidney or bladder disorders

• Immunosuppression

• Enlarged prostate

• Use of catheters

• Diabetes

Pyelonephritis Complications

• emphysematous pyelonephritis (patients with diabetes are high risk)

• formation of renal abscesses

• thrombosis in the renal vein

• acute renal failure

Pyelonephritis Sx

Sx occur 48 hrs after start of infection

• Fever over 102° F

• Pain in side, back, or groin

• Dysuria

• Cloudy or bloody urine

• Fishy odor to urine

• Chills

• N/V

• Mental alteration

• Edema + wt gain = renal failure

Pyelonephritis Labs

• Urinalysis

• Renal ultrasound

• dimercaptosuccinic acid (DMSA) test

Pyelonephritis Nursing Interventions

• ongoing assessments, managing symptoms such as fever and flank pain, administering prescribed medications, and documenting the client’s response to treatment.

• maintain adequate hydration

• promote ABX adherence and using it exactly as Rx

• Wiping front to back

• Voiding after sex

Pyelonephritis Tx

• ABX: levofloxacin, ciprofloxacin, co-trimoxazole, and ampicillin

Polycystic Kidney Disease (PKD)

inherited disorder that causes fluid-filled cysts to develop in the kidneys.

• There are two types of PKD: autosomal dominant (ADPKD) and autosomal recessive (ARPKD).

PKD Patho

Cysts continue to grow and multiply, the kidney structures become damaged, and the renal functions are impaired.

• Progressive and leads to renal failure.

PKD Causes

Genetic mutation, inherited recessive disease (both parents need the gene)

• Family history main risk factor

• ARPKD is dx pre or post birth

• ADPKD is dx in adults

PKD Comorbidities / Complications

• Cyst development in liver or pancreas

• Renal calculi

• Cardiac disease

• Cerebral aneurysms

• Colonic diverticula

• Mitral valve collapse

• Ventricular hypertrophy

• UTIs and pyelonephritis

PKD Sx

• Flank pain

• Polyuria

• Nocturia

• Palpable kidney mass

• Hematuria

• Proteinuria

PKD Labs

• CT or MRI to confirm

• Genetic testing

• Family screening

PKD Education

• Taking meds as Rx’d

• Low protein diet

• Low sodium diet

• Refrain from smoking

• Avoid all NSAIDs

• Education on support groups

PKD Tx

• Antihypertensives

  • ACE Inhib. or ARBs

• Low sodium diet and adequate hydration

•  Tolvaptan

  • adverse effects = dizziness, elevated blood glucose, hypovolemia, liver toxicity, and allergic reactions

Glomerulonephritis

group of renal diseases in which immune-mediated damage occurs to portions of the glomerulus and results in proteinuria, azotemia, and hematuria

• Acute glomerulonephritis can be caused by a primary renal cause or by an illness that impairs renal function. 

Acute Glomerulonephritis Patho

Caused by streptococcus or unknown cause

• inflammation thickens the glomerular membrane causing a decreased GFR

Progressive Glomerulonephritis Patho

sharp decline in glomerular function as antibodies form against the glomerular membrane, and there is cell proliferation into the Bowman’s capsule

Glomerulonephritis Cause

• Streptococcus (if dx within two weeks of having strep or impetigo)

• Endocarditis

• Hepatitis B and C

• HIV

• Lupus

• Good pasture’s syndrome

• Polyarteritis or Wegener’s granulomatosis (vessel inflammation)

• Poorly controlled hypertension and diabetic nephropathy

• Alport Syndrome

Glomerulonephritis Sx

• Periorbital edema

• Dark frothy urine

• HTN

• Weakness or malaise

• Fever

• Abd. discomfort

• Proteinuria

• Hematuria

Glomerulonephritis Labs

• Electrolyte = elevated K+

• Elevated BUN and creatinine

• Decreased GFR

• Urinalysis = specific gravity greater than 1.020 with red blood cells (RBCs) and casts present

• 24 hr urine test (proteinuria)

• Kidney biopsy

Glomerulonephritis Education

• Restrict sodium, potassium, and protein

• Smoking cessation

• Diabetes and HTN control

• Pneumococcal vaccine

Glomerulonephritis Tx

• High dose corticosteroids (immunosuppression)

• rituximab

• Cytotoxic agents, like cyclophosphamide w/corticosteroids

• Plasma Exchange

Renal Calculi

(kidney stones, nephrolithiasis, or urolithiasis) created by accumulations of minerals and salts and can lodge in the kidney or any portion of the urinary tract and causing pain and blood in the urine.

Renal Calculi Patho

Calcium plaques in interstitial tissue of renal papilla

• plaques grow until they break through membrane of renal pelvis coming in direct contact with urine

Renal Calculi Risk Factors

• Hyperparathyroidism

• 43+ yrs

• Men

• Obesity

• Fluid Electrolyte imbalance

  • like from extreme heat and sun exposure

  • dehydration

• High protein low carb diet or high calcium high sodium diet

Renal Calculi Comorbidities

• HTN

• CKD

• T2DM

• Gout (increased serum uric acid)

Renal Calculi Sx

• Acute onset flank pain

• N/V

  • if systemic sx…suspect pyelonephritis

Renal Calculi Labs

• Urinalysis (detect hematuria, infection, or crystals in urine)

• Kidney Blood tests (BUN, creatinine, GFR)

• CBC

• Calcium, uric acid, and parathyroid hormone levels

• KUB X-ray

• Ultrasound

Renal Calculi Education

• DASH Diet

• Causes of stone formation, Sx report, diagnostic testing, treatment options, and to prevent recurrence.

• Strain their urine

• Avoid foods high in calcium and to restrict salt/protein intake

• Increase water intake and activity levels

Renal Calculi Tx

• Tamsulosin, nifedipine, or alfuzosin

• Strained urine

• Extracorporeal shockwave lithotripsy (ESWL) destroy stones in the kidney and upper ureter.

• For stones in the lower ureter, ureteroscopy with laser lithotripsy is used