CG

Block 3 Renal

Renal Anatomy and Function

  • Kidney Structure

    • Renal Cortex

    • Renal Columns

    • Renal Medulla

    • Renal Pyramids

    • Renal Papilla

    • Minor Calyx

    • Major Calyx

    • Renal Pelvis

    • Ureter: Where urine collects and heads out of the kidney

Kidney Function: "A WET BED"

  • A - Acid-base balance

  • W - Water balance

  • E - Electrolyte balance

  • T - Toxin removal

  • B - Blood Pressure control

  • E - Erythropoietin production

  • D - Vitamin D metabolism

Key Concepts in Renal Function

Serum Creatinine

  • Most sensitive indicator of renal function.

Glomerular Filtration Rate (GFR)

  • Estimates how much blood is filtered by the glomeruli each minute; helps determine the stage of kidney disease.

Creatinine Clearance

  • Used to evaluate kidney health, diagnose kidney dysfunction, and detect decreased blood flow to kidneys.

Blood Urea Nitrogen (BUN)

  • Measures amount of urea nitrogen in blood; evaluates kidney health and monitors effectiveness of dialysis.

Glomerulonephritis

  • Definition: Inflammation of the glomeruli, affecting both kidneys equally.

  • Primary Site: The glomerulus is the main site of inflammation.

  • Changes also occur in tubular, interstitial, and vascular areas.

Causes and Risk Factors

  • Infections:

    • Poststreptococcal glomerulonephritis

    • Infective endocarditis, Syphilis

    • Viral infections (e.g., HIV)

  • Immune Diseases:

    • Systemic Lupus Erythematosus (SLE)

    • Scleroderma

  • Other Factors:

    • Scarring of glomeruli, Diabetic nephropathy, Hypertension

Acute Poststreptococcal Glomerulonephritis

  • Most common type of acute GN; prevalent in kids and young adults.

  • Develops 1-2 weeks after infections (e.g., tonsils, pharynx, skin).

  • Symptoms:

    • Hypertension, Decreased GFR, Swelling in face/eyes, Tea-colored urine, Recent Strep infection, Elevated BUN and Creatinine, Proteinuria.

Management of Glomerulonephritis

  • Acute Management:

    • Rest and preserve renal function.

    • Rest and treat symptoms.

    • Urinalysis shows erythrocytes and protein.

    • Blood tests for BUN and serum creatinine.

    • Medications:

      • Antibiotics, Loop diuretics, Anti-HTN meds.

    • Edema Management:

      • Sodium and fluid restriction, Diuretics.

Chronic Glomerulonephritis

  • Represents the end stage of glomerular inflammatory disease (ESRD).

  • Symptoms develop slowly; often unnoticed until diagnostics.

  • Characterized by proteinuria, hematuria, fatigue, and uremia symptoms.

  • Diagnosis via US, CT scan, or renal biopsy; supportive treatment.

Chronic Kidney Disease (CKD) Facts

  • 26 million US adults have CKD.

  • Early detection is crucial to prevent progression to kidney failure.

  • GFR is the best estimate of kidney function.

  • Risk Factors:

    • Diabetes (50% of CKD patients), Hypertension (25%).

    • Persistent proteinuria is indicative of CKD presence.

    • Higher risk in African Americans, Hispanics, Pacific Islanders, American Indians, and seniors.

Detection Tests

  • Three tests for CKD:

    • Blood pressure measurement

    • Urine albumin assessment

    • Serum creatinine levels

Stages of CKD

Stage 1

  • GFR >90 mL/min; diagnosis and treatment with CVD risk reduction.

Stage 2

  • GFR 60-89 mL/min; estimation of progression.

Stage 3

  • GFR 30-59 mL/min; evaluation and management of complications.

Stage 4

  • GFR 15-29 mL/min; preparation for renal replacement therapy.

Stage 5

  • GFR <15 mL/min; renal replacement therapy needed if symptoms of uremia are present.

Clinical Manifestations of CKD

Urinary System

  • Oliguria, anuria.

Metabolic Disturbances

  • Waste product accumulation, altered metabolism, elevated triglycerides.

Electrolyte and Acid-base Imbalances

  • Issues with potassium, sodium, calcium, phosphate, and metabolic acidosis.

Hematologic System

  • Anemia, bleeding, increased infection risk.

Cardiovascular System

  • Traditional and non-traditional risk factors; hypertension is both a cause and consequence.

Musculoskeletal and Other Systems

  • Impaired calcium absorption leading to various mineral and reproductive system imbalances.

Nursing Considerations and Pharmacotherapy

  • Monitor lab values, ensure prompt interventions, evaluate dietary changes, and manage medications effectively.

Dialysis Overview

  • Purpose: Cleansing blood of accumulated waste products and correcting imbalances.

  • Administered by certified dialysis nurses; not a cure but a necessary intervention.

Types of Dialysis

  • Hemodialysis

  • Peritoneal Dialysis (PD): Involves infusing dialysate into the peritoneal cavity, with key phases being inflow, dwell, and drain.

Complications and Nursing Considerations of PD and HD

  • Monitor vital signs, lab values, psychosocial impacts, and overall patient comfort during procedures.