Renal System and Disorders

Renal System Overview

  • Electrolyte Imbalances

  • Key Structures:

    • Inferior Vena Cava

    • Renal System Components:

    • Right Kidney

    • Left Kidney

    • Renal Artery

    • Renal Vein

    • Ureter

    • Urethra

    • Iliac Vein

    • Iliac Artery

    • Urinary Bladder

    • Aorta

    • Adrenal Gland

Renal System and Internal Structure of a Kidney

  • Structure of a Kidney:

    • Fibrous Capsule: Protective outer layer

    • Cortex: Outer region containing nephron structures

    • Medulla: Inner region with renal pyramids and collecting ducts

    • Renal Pyramid: Cone-shaped tissues that house nephrons

    • Renal Column: Extensions of cortical tissue between renal pyramids

    • Renal Pelvis: Funnel-shaped cavity that collects urine

    • Calyx: Chamber that collects urine from the renal pyramids

    • Hilus: Entry point for blood vessels and nerves

    • Ureter: Tube carrying urine from kidneys to bladder

Renin-Angiotensin-Aldosterone System (RAAS)

  • Components:

    • Kidneys (juxtaglomerular cells)

    • Liver: Produces angiotensinogen

    • Lungs: Produce ACE (Angiotensin-Converting Enzyme)

    • Adrenal Cortex: Releases aldosterone

  • Process:

    1. Renin is secreted from kidneys which converts angiotensinogen to Angiotensin I.

    2. Angiotensin I is converted to Angiotensin II by ACE in the lungs.

    3. Angiotensin II:

    • Constricts blood vessels (vasoconstriction)

    • Stimulates adrenal cortex to release aldosterone.

    1. Aldosterone acts on kidneys to retain sodium ( ext{Na}) and water ( ext{H2O}), increasing blood pressure (BP) by restoring blood volume.

    2. Low potassium levels (K+K^+) are also influenced by aldosterone action.

Urinary System Assessment

  • Percussion Check: Assess for costovertebral angle (CVA) tenderness indicating possible hydronephrosis or inflammation.

  • Landmarks:

    • Costovertebral Junction: located at the back

    • Costochondral Angle: where rib joins the cartilage

    • 12th Rib

  • Common Assessments:

    • Hydronephrosis indicates a blockage leading to kidney swelling due to urine accumulation.

Diagnostic Imaging Techniques

  • KUB (Kidneys, Ureters, Bladder) Radiograph:

    • An x-ray for urinary system visualization, useful in detecting urinary calculi (stones).

  • Bladder Ultrasonography:

    • Noninvasive technique for measuring bladder urine volume; helpful in assessing urinary frequency/inability to urinate.

    • Best when the patient is supine.

  • Intravenous Pyelogram (IVP):

    • Evaluates kidney and ureter function by using a radiopaque dye injected intravenously.

    • Pre-Procedure: Assess for allergies to shellfish, kidney function, and expected reactions.

    • Post-Procedure: Monitor for reactions such as metallic taste, fever, hives, and hydrating the patient.

Cystoscopy and Bladder Biopsy

  • Procedure:

    • Bladder mucosa examined through a cystoscope for inflammation, calculi, or tumors.

    • Possible tissue sample taken for biopsy, especially to check for kidney cancer.

  • Pre-Procedure Interventions:

    • Obtain consent form.

    • Withhold food/fluids post-midnight.

    • Administer enemas if prescribed.

Renal Biopsy

  • Procedure:

    • Needle insertion into kidney to obtain tissue sample.

    • Important landmarks include:

    • 12th rib

    • Renal capsule

    • Iliac crest

Disorders of the Urinary-Renal System

  • Disorders Include:

    • Infections (UTIs)

    • Kidney failure

    • Electrolyte imbalances

  • Components of the Urinary System:

    • Includes kidney, ureter, bladder, urethra.

Urinary Tract Infection (UTI)

  • Definition: Inflammation of bladder and/or urethra, commonly referred to as cystitis.

  • Common Organism: E. coli is the most prevalent cause.

Clinical Manifestations of UTI

  • Symptoms Include:

    • Burning sensation during urination

    • Urgency and frequency of urination

    • Cloudy or foul-smelling urine

    • Hematuria (blood in urine)

    • Lower back or pubic pain

    • Absence of CVA tenderness and fever in uncomplicated cases.

Nursing Interventions for UTI

  • Fluid Intake: 2-3 liters daily, including cranberry juice to acidify urine.

  • Urine Culture: Gold standard for testing specific microorganisms, guiding antibiotic treatment.

Client Education for UTI Prevention

  • General Measures:

    • Encourage voiding every 2-3 hours.

    • Maintain strict aseptic technique for catheter insertion.

    • Provide meticulous perineal care for patients with indwelling catheters.

Urosepsis

  • Definition: A gram-negative bacteremia originating from the urinary tract.

  • Common Organism: Escherichia coli.

  • Risk Groups: Elderly patients are particularly at risk.

Clinical Manifestations of Urosepsis

  • Fever as the earliest symptom.

  • Nursing Interventions:

    • Perform urine culture.

    • Push fluids and administer IV antibiotics as needed.

KIDNEY DISORDERS

Pyelonephritis

  • Definition: Inflammation of the renal pelvis and parenchyma due to bacterial infection.

  • Common Causative Agent: E. coli.

Complications of Pyelonephritis

  • Untreated infections can lead to bacteremia, chronic pyelonephritis, or renal failure.

Glomerulonephritis

Causes

  • Immunological or Autoimmune Diseases

  • Post-streptococcal infections following pharyngitis or tonsillitis.

Types of Glomerulonephritis

  • Acute: Typically follows streptococcal infection.

  • Chronic: Develops slowly, may follow acute phase.

Clinical Features

  • Symptoms: Proteinuria, hematuria, fluid retention, and elevated BP.

Nursing Interventions for Glomerulonephritis

  • Monitor symptoms and administer medications as prescribed (e.g., corticosteroids).

Nephrotic Syndrome

  • Definition: A clinical syndrome characterized by massive proteinuria, lipiduria, and edema caused by diffuse glomerular damage.

Clinical Features of Nephrotic Syndrome

  • Symptoms: Proteinuria, hypoalbuminemia, edema, hyperlipidemia, anemia.

Nursing Interventions for Nephrotic Syndrome

  • Monitor vital signs, daily weights, administer diuretics, and volume expanders as needed.

Hydronephrosis

  • Definition: Distention of renal pelvis due to urine collection from obstruction.

Clinical Manifestations of Hydronephrosis

  • Symptoms: Hypertension, headache, flank pain, and electrolyte imbalances.

Urolithiasis and Nephrolithiasis

  • Definition: Formation of calculi or stones within the urinary tract, commonly in the kidneys.

Types of Stones

  1. Calcium Phosphate Stones: Preventive measures include limit calcium and phosphate intake.

  2. Calcium Oxalate Stones: Avoid oxalate-rich foods.

  3. Struvite Stones: Linked to urinary infections; dietary changes to control phosphate levels.

  4. Uric Acid Stones: Form in acidic urine; limit purine-rich foods and consider medication to lower uric acid levels.

Nursing Interventions

  • Encourage fluid intake and monitor stone passage. Pain management is critical.

Kidney Surgery Procedures

Extracorporeal Shock Wave Lithotripsy (ESWL)

  • Definition: Noninvasive procedure breaking up kidney stones using ultrasonic waves while visualized by fluoroscopy.

Percutaneous Lithotripsy

  • Insertion of renal catheter for irrigation and monitoring complications such as infection.

Kidney Transplantation

  • Criteria for Donors:

    • Living Related Donors: Preferable due to better compatibility and health.

    • Cadaver Donors: Must meet stringent health criteria, including absence of serious infections or malignancies.

Postoperative Care for Kidney Transplant

  • Monitor functional status of the graft, prevent infections, and manage medications (antibiotics, immunosuppressants).

Types of Rejections

  1. Hyperacute Rejection: Occurs within hours to days; management includes kidney removal.

  2. Acute Rejection: Usually reversible with increased immunosuppressive therapy.

  3. Chronic Rejection: Develops over months/years, mimicking chronic renal failure.

Client Education for Transplant Patients

  • Importance of lifelong immunosuppressive therapy and recognizing signs of rejection or infection.