Week 13: Renal Disorders

Glomerular Diseases

• Acute Glomerulonephritis

  • Inflammation of the glomerular capillaries.

  • Manifestations include:

    • Hematuria: Presence of blood in urine.

    • Edema: Swelling due to excess fluid.

    • Azotemia: Excessive nitrogenous wastes in the blood.

    • Proteinuria: Presence of excess protein in urine.

  • Risks:

  • Treatment:

    • Involves protein and sodium restriction.

    • Antibiotic administration is essential.

  • Complications:

    • Hypertensive encephalopathy.

    • Heart failure.

    • Pulmonary edema.

• Chronic Glomerulonephritis

  • Characterized by:

    • Proteinuria is typically due to repeated episodes of glomerular injury.

    • Leads to renal destruction and broad clinical manifestations.

  • Major Complication: Chronic renal failure or end-stage renal disease (ESRD).

  • Assessment Priorities:

    • Fluid and electrolyte status.

    • Cardiac status.

    • Neurologic status.

• Nephrotic Syndrome

  • A cluster of clinical findings associated with various intrinsic renal diseases or systemic conditions affecting the glomerulus.

  • Major Cause: Diabetic nephropathy, which leads to proteinuria.

  • Treatment: Medication and dietary modifications.

Kidney Failure

• Acute Renal Failure (ARF)

  • Definition: A typically reversible syndrome characterized by abrupt loss of kidney function and GFR over hours to days.

  • Types of ARF:

    • Prerenal ARF: Caused by reduced blood flow to the kidney.

    • Intrarenal ARF: Resulting from parenchymal damage to glomeruli or kidney tubules.

    • Postrenal ARF: Resulting from obstruction.

  • Clinical Phases of ARF:

    • Initiation or onset phase.

    • Oliguric phase.

    • Diuretic phase.

    • Recovery phase.

Question 1

• Scenario: A nurse cares for a patient with acute glomerulonephritis.

• Prioritize Assessments:

  • Daily weights (Identified as the most critical measure).

  • Ankle-brachial index.

  • Pain assessment.

  • Blood glucose levels.

Answer to Question 1

• Correct Answer: A. Daily weights

• Rationale:

  • Patients with acute glomerulonephritis are susceptible to fluid volume excess.

  • The most accurate indicator of fluid loss or gain in acutely ill patients is weight, as accurate intake and output and assessment of insensible losses may be difficult.

  • Blood sugars, ABI, and pain assessment do not address the core manifestations and complications of the disease.

• Chronic Renal Failure (CRF) and ESRD

  • A progressive and irreversible deterioration of renal function over months to years.

  • Accumulation of end products of protein metabolism in the blood.

  • Major Risk Factors:

  • Diabetes.

  • Hypertension.

  • Proteinuria.

  • Family history.

  • Increasing age.

  • Impaction on Body Systems: Virtually every body system is affected by chronic renal failure.

Complications and Treatment in Failure

• Clinical Manifestations:

  • Sodium and water retention.

  • Acidosis.

  • Hyperkalemia.

  • Calcium and phosphorus imbalances.

• Medications:

  • Phosphate-binding agents.

  • Calcium supplements.

  • Antihypertensive and cardiac medications.

  • Antiseizure medications.

  • Erythropoietin.

• Patient Needs:

  • Nutritional support.

  • Dialysis as necessary.

Renal Replacement Therapies

• Hemodialysis:

  • Involves vascular access to circulation via:

    • Arteriovenous fistula.

    • Arteriovenous graft.

  • Essential components include:

    • Blood pressure monitoring.

    • Blood pump.

    • Clot and bubble traps.

    • Semipermeable membrane for filtration.

      

• Monitoring Requirements:

  • Patient, dialyzer, and dialysate bath need constant monitoring for complications.

  • Considerations for medications, fluid balance, and nutritional needs.

  • Awareness of potential complications (hypotension).

  • Clotting risk, therefore, the client will most likely be on anticoagulants (heparin).

Question 2

• True/False Statement: An older adult with benign prostatic hyperplasia (BPH) is at risk for postrenal ARF.

• Answer: True

• Rationale:

  • Postrenal ARF results from obstruction that can occur from the collecting ducts in the kidney to the urethra, with potential blockage from BPH.

Question 3

• Scenario: A patient with ESRD is scheduled for hemodialysis treatment.

• Considerations:

  • Vulnerable to hypotension.

  • Other options: Urosepsis, abdominal pain, and metabolic alkalosis are not common.

Answer to Question 3

• Correct Answer: C. Hypotension

• Rationale:

  • Hypotension occurs due to sudden alterations in blood flow and fluid balance during hemodialysis.

• Peritoneal Dialysis:

  • Types include continuous ambulatory peritoneal dialysis.

    

Kidney Transplantation

• Procedure of Choice: For most patients with ESRD.

• Preoperative Management Goals:

  • Stabilizing metabolic state.

  • Ensuring freedom from infection.

  • Initiating immunosuppressants.

    • The body will see the kidney as foreign and attack it; therefore, immunosuppression is necessary.

• Postoperative Care Priorities:

  • Administer medications.

  • Address psychological issues.

  • Assess for rejection symptoms.

  • Manage potential complications.

  • Prevent infection.

  • Educate the patient.

  • Monitor urinary function.

  • Provide continuing care.

Question 4

• Patient Query: Signs of transplantation rejection.

• Best Response: “Low urine output can be a sign of rejection.”

• Rationale:

  • Signs include: Oliguria, edema, fevers, increased blood pressure, weight gain, and tenderness around the transplanted kidney.

    • The kidney is not doing its job.

Renal Trauma

• Common Renal Injuries:

  • Contusions, lacerations, ruptures, and renal pedicle injuries.

  • Even minor lacerations can lead to severe bleeding.

• Management Goals:

  • Control hemorrhage and pain.

  • Prevent infection.

  • Preserve and restore renal function.

  • Considerations for geriatric patients.