Renal Disorders Concept Map

Renal Disorders Concept Map — Gould’s Pathophysiology for Health Professions, 7th Edition

Acute Renal Failure (ARF)

• Pathophysiology:

  • Sudden loss of kidney function characterized by decreased Glomerular Filtration Rate (GFR) and accumulation of nitrogenous wastes in the body.

  • This condition is reversible if treated promptly.

• Etiology/Causes:

  • Ischemia (reduced blood flow to kidneys).

  • Nephrotoxins: substances that can cause damage to the kidneys, including nonsteroidal anti-inflammatory drugs (NSAIDs) and aminoglycosides.

  • Obstruction in urinary flow due to conditions such as kidney stones or tumors.

• Risk Factors:

  • Advanced age.

  • Dehydration.

  • Surgery.

  • Infection.

  • Use of nephrotoxic drugs.

• Signs & Symptoms:

  • Oliguria (reduced urine output) or anuria (absence of urine output).

  • Elevated levels of Blood Urea Nitrogen (BUN) and creatinine in the blood.

  • Edema (swelling from fluid retention).

  • Metabolic acidosis (increased acidity in the blood).

  • Hyperkalemia (elevated potassium levels).

  • Fatigue.

• Complications:

  • Cardiac arrhythmias due to electrolyte imbalances.

  • Uremia (presence of urea and other nitrogenous wastes in the blood).

  • Potentially fatal outcomes if left untreated.

• Treatment/Management:

  • Identify and treat the underlying cause of ARF.

  • Restore fluid balance in the body.

  • Discontinue nephrotoxic medications.

  • Initiate dialysis if deemed necessary.

• Key Concept/NCLEX Tip:

  • The condition is reversible if caught early; therefore, it is critical to monitor urine output and creatinine levels daily.

Chronic Renal Failure (CRF)

• Pathophysiology:

  • A progressive and irreversible condition characterized by the destruction of nephrons leading to uremia.

• Etiology/Causes:

  • Diabetes mellitus (both Type 1 and Type 2).

  • Hypertension.

  • Chronic glomerulonephritis.

  • Polycystic kidney disease.

• Risk Factors:

  • Presence of diabetic nephropathy.

  • Vascular disorders affecting blood flow to the kidneys.

  • Exposure to nephrotoxic agents.

• Signs & Symptoms:

  • Initially, polyuria (excessive urine production); this may later lead to oliguria.

  • Anemia due to reduced erythropoietin production.

  • Uremic frost (deposits of urea in the skin).

  • Pruritus (itching due to buildup of waste in the body).

  • Bone pain from secondary hyperparathyroidism associated with renal failure.

  • Edema from fluid retention.

• Complications:

  • Increased risk of cardiovascular disease.

  • Metabolic acidosis.

  • Electrolyte imbalances (e.g., hyperkalemia).

  • Potentially fatal outcomes if not managed properly.

• Treatment/Management:

  • Dialysis to perform the work of the kidneys in filtering blood.

  • Renal transplant as a potential curative option.

  • Dietary restrictions on sodium (Na), potassium (K), and protein intake to reduce the workload on remaining kidney function.

  • Administration of erythropoietin therapy to manage anemia.

• Key Concept/NCLEX Tip:

  • Focus on slowing the progression of the disease and managing systemic complications that arise from renal failure.

Glomerulonephritis (Poststreptococcal)

• Pathophysiology:

  • Inflammatory damage to the glomeruli following streptococcal infection caused by the deposition of immune complexes.

• Etiology/Causes:

  • Group A beta-hemolytic streptococcal infections, particularly from throat or skin wounds.

• Risk Factors:

  • Commonly seen in children, particularly associated with post-infectious immune reactions.

• Signs & Symptoms:

  • Hematuria (presence of blood in urine).

  • Proteinuria (presence of protein in urine).

  • Periorbital edema (swelling around the eyes).

  • Hypertension (high blood pressure).

  • Oliguria (reduced urine output).

  • Dark colored urine.

• Complications:

  • Development of chronic renal failure.

  • Nephrotic syndrome (protein loss leading to edema).

  • Persistent hypertension.

• Treatment/Management:

  • Treat the underlying infection appropriately with antibiotics.

  • Manage hypertension as per patient's condition.

  • Restrict fluid and sodium intake to reduce blood pressure and fluid overload.

• Key Concept/NCLEX Tip:

  • Monitor for recurrence of symptoms; urine color and blood pressure are key indicators of disease progression.

Nephrotic Syndrome

• Pathophysiology:

  • Increased permeability of the glomerular membrane results in massive protein loss in urine.

• Etiology/Causes:

  • Can be idiopathic, related to diabetes mellitus, systemic lupus erythematosus (lupus), or exposure to drug toxicity.

• Risk Factors:

  • Individuals with chronic kidney disease or autoimmune disorders.

• Signs & Symptoms:

  • Proteinuria (greater than 3.5 grams per day).

  • Edema (swelling due to fluid retention).

  • Hyperlipidemia (elevated levels of lipids in the blood).

  • Lipiduria (presence of lipids in urine).

  • Weight gain due to fluid retention.

• Complications:

  • Infection risk due to loss of proteins that are essential for immune function.

  • Thromboembolism due to increased coagulation tendencies.

  • Malnutrition as a result of protein loss.

• Treatment/Management:

  • Use of corticosteroids to reduce inflammation and proteinuria.

  • ACE inhibitors to manage blood pressure and reduce protein loss in urine.

  • Low-sodium, moderate-protein diet to minimize kidney workload.

• Key Concept/NCLEX Tip:

  • A key feature is the presence of generalized edema and frothy urine indicative of significant protein loss.

Pyelonephritis

• Pathophysiology:

  • Infection specifically affecting the renal pelvis and medulla, typically due to ascending bacteria from the bladder.

• Etiology/Causes:

  • Primarily caused by E. coli or other gram-negative bacteria ascending from the urinary bladder.

• Risk Factors:

  • Female gender due to anatomical predisposition (short urethra).

  • History of catheterization.

  • Pregnancy (due to hormonal and anatomical changes).

  • Presence of urinary obstruction or diabetes mellitus.

• Signs & Symptoms:

  • Flank pain that may be severe.

  • Fever and chills indicating systemic infection.

  • Dysuria (painful urination).

  • Costovertebral tenderness (pain upon palpation of the back near the kidneys).

  • Cloudy urine, indicative of infection.

• Complications:

  • Renal scarring leading to chronic pyelonephritis.

  • Risk of renal failure if infection persists or is severe.

• Treatment/Management:

  • Administration of appropriate antibiotics to eliminate the infection.

  • Supportive care including hydration.

  • Addressing and removing any underlying causes contributing to infection.

• Key Concept/NCLEX Tip:

  • Important to differentiate from cystitis: systemic symptoms and flank pain are significant features of pyelonephritis.

Cystitis

• Pathophysiology:

  • Inflammation of the bladder's mucosa due to an infectious process.

• Etiology/Causes:

  • Most commonly caused by E. coli, alongside contributing factors such as poor hygiene, catheterization, and obstruction in the urinary tract.

• Risk Factors:

  • Predominantly affects females due to shorter urethra.

  • Urinary stasis leading to infection risk.

  • Sexual activity that may introduce bacteria into the urinary tract.

• Signs & Symptoms:

  • Increased frequency of urination.

  • Urgency in urination.

  • Burning sensation during urination.

  • Suprapubic pain (pain located above the pubic bone).

  • Cloudy and foul-smelling urine indicating infection.

• Complications:

  • Risk of ascending infection leading to pyelonephritis if untreated.

• Treatment/Management:

  • Prescribing antibiotics to treat the infection.

  • Encouraging increased fluid intake to dilute urine and flush out bacteria.

  • Education on hygiene practices to prevent recurrence.

• Key Concept/NCLEX Tip:

  • Cloudy urine and dysuria are classic features of cystitis.

Renal Calculi (Kidney Stones)

• Pathophysiology:

  • Crystals form in the urine due to supersaturation which obstruct urinary flow and cause renal colic painful symptoms.

• Etiology/Causes:

  • High levels of calcium or uric acid in the urine.

  • Dehydration.

  • Infection which may alter urine pH.

  • Imbalance in urine pH contributing to stone formation.

• Risk Factors:

  • Predominantly occurs in males.

  • Immobility which can affect metabolism and fluid balance.

  • Recurrent urinary tract infections (UTIs).

  • Gout, which is associated with uric acid stone formation.

• Signs & Symptoms:

  • Severe flank pain radiating to the groin area.

  • Hematuria (blood in urine).

  • Nausea and vomiting due to pain response.

  • Sweating related to intense discomfort.

• Complications:

  • Hydronephrosis (swelling of a kidney due to a build-up of urine).

  • Increased risk of infection.

  • Risk of renal failure if obstruction is prolonged.

• Treatment/Management:

  • Pain control for symptomatic relief during episodes.

  • Lithotripsy (a procedure to break stones into smaller pieces).

  • Encouraging increased fluid intake to dilute urinary concentration.

  • Identifying and correcting any underlying causes of stone formation.

• Key Concept/NCLEX Tip:

  • Struvite stones are commonly linked with UTIs; calcium stones are the most prevalent type of kidney stones.