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.