kidney conditions

Pyelonephritis

  • Bacterial infection in kidney and renal pelvis

  • Can be acute or chronic

  • Local and systemic inflammatory symptoms

  • Higher prevalence in women 20–30 years old

Recognizing Cues: Assessment (General)

  • Ask about: recurrent UTIs, diabetes, stone disease, GU defects, reduced immunity, kidney function, urine changes, fever

  • Inspect flanks; look for tenderness at the costovertebral angle (CVA)

  • Psychosocial cues: confusion, anxiety, embarrassment, guilt

Laboratory Assessment

  • Urinalysis with culture & sensitivity (C&S)

  • C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)

  • Blood urea nitrogen (BUN) and creatinine; baseline glomerular filtration rate (GFR)

  • Blood cultures; white blood cell count (WBC)

Diagnostic Imaging / Other Imaging Assessment

  • KUB (kidneys, ureters, bladder) radiography or CT

  • Cystourethrogram

  • Other diagnostics: examine antibody-coated bacteria in urine

  • Renal scan; kidney biopsy considered in certain cases

Interventions: Nonsurgical Management

  • Drug therapy as primary approach

  • Pain management

  • Antibiotics (antibiotic therapy as prescribed; complete course)

  • Catheter replacement as needed

  • Nutrition therapy

Interventions: Surgical Management

  • Pyelolithotomy

  • Nephrectomy

  • Ureteral diversion

  • Reimplantation of ureter

  • Focus on preventing chronic kidney disease

  • COMPLETE ABX THERAPY AS PRESCRIBED

  • Importance of diet/fluid intake

  • Post-treatment follow-up and signs/symptoms of infection

  • Monitor blood pressure (BP)

Care Coordination

  • Home care management

  • Self-management education

  • Health care resources

Acute Glomerulonephritis

  • Injury/inflammation to the glomerulus

  • Findings: proteinuria, hematuria, decreased urine production

  • Onset of symptoms is typically about 10 days after infection

Recognizing Cues: Assessment (Acute GN)

  • Ask about recent infections, surgery, or lupus

  • Assess presence of skin lesions or body piercings

  • Edema assessment (face, eyelids, hands)

  • Assess for fluid overload/weight gain

  • Mild–moderate BP elevation

  • Changes in urinary elimination; fatigue, anorexia, N/V

GLOMERULONEPHRITIS (Pathophysiology & Presentation)

  • Antigen–antibody complexes form in glomeruli

  • Causes inflammation and decreased GFR

  • From recent strep infection (antigen–antibody complexes)

  • Symptoms: headache, elevated BP, facial/peri-orbital edema, lethargy, low-grade fever, weight gain (edema)

  • Urinary findings: proteinuria, hematuria; possible oliguria; dysuria

Laboratory Assessment (Glomerulonephritis)

  • Urinalysis: hematuria, proteinuria

  • 24-hour urine collection

  • BUN/creatinine; GFR

  • Kidney biopsy; ultrasound

  • Note: GFR values and imaging help differentiate stages and causes

  • Visual references: cross-sections show biopsy needle entering kidney; normal GFR around ~ ext{GFR} o 120 ext{ mL/min/1.73 m}^2

Interventions: Glomerulonephritis (GN)

  • Manage infections with appropriate antibiotics when indicated

  • Personal hygiene to prevent infections

  • Prevent complications: fluid overload treated with diuretics; sodium and fluid restrictions

  • Antihypertensive medications

  • Dialysis if needed; plasmapheresis in select cases

  • Measures to conserve energy

Chronic Glomerulonephritis

  • Noninfectious disease of the glomeruli

  • Develops over years to decades

  • Slow progression leading to end-stage kidney disease (ESKD)

Recognizing Cues: Assessment (Chronic GN)

  • Health history; recent infection or elimination patterns

  • Mild proteinuria and hematuria

  • Hypertension; fatigue; occasional edema

  • Uremic symptoms

  • Neurologic signs: slurred speech, ataxia, tremors, asterixis; yellow skin

Diagnostic Assessment (Chronic GN)

  • Decreased urine output; decreased GFR

  • Increased BUN/creatinine

  • Fluid and electrolyte imbalances

  • Urine specific gravity around 1.010

Interventions (Chronic GN)

  • Diet changes

  • Drug therapy

  • Dialysis or transplant when indicated

Nephrotic Syndrome

  • Immunologic kidney disorder

  • Massive loss of protein: approximately 3.5 ext{ g/24 h}

  • Edema formation

  • Decreased albumin levels: albumin < 3 ext{ g/dL}

  • Renal thrombosis; reduced kidney function

Interventions (Nephrotic Syndrome)

  • Renal biopsy to diagnose

  • ACE inhibitors

  • Cholesterol-lowering agents

  • Heparin (where indicated)

  • Diet changes; mild diuretics; sodium restriction

  • Monitor for dehydration; maintain adequate kidney perfusion to avoid AKI

Nephrosclerosis

  • Degenerative changes in kidney vessels

  • Associated with hypertension, atherosclerosis, and diabetes mellitus

  • Hypertensive changes may be irreversible or progress to ESRD

Interventions (Nephrosclerosis)

  • ACE inhibitors

  • Diuretics to maintain fluid and electrolyte balance

  • Emphasize patient understanding and medication adherence

Polycystic Kidney Disease (PKD)

  • Genetic disorder with fluid-filled cysts in nephrons

  • Dominant form: often affects people in their 30s

  • Recessive form: cysts present from birth in nearly all nephrons

  • Kidney function is replaced by nonfunctioning cysts; cysts resemble grape clusters

Recognizing Cues: Assessment (PKD)

  • Family history

  • Pain, constipation, urine changes, hypertension, headaches

  • Ultrasound/ MRI / urinalysis

Interventions (PKD)

  • Manage blood pressure

  • Manage pain

  • Prevent constipation

  • Slow disease progression

Obstructive Disorders

  • Examples: stone, hydronephrosis, hydroureter, urinary bladder stone

  • Affects urinary tract from kidney to bladder

Recognizing Cues: Assessment (Obstructive Disorders)

  • Urinary elimination problems

  • Medical history

  • Inspect flanks

  • Diagnostic tests: UA, BUN/Cr, GFR; IV urography; CT scan; renal ultrasound

Interventions (Obstructive Disorders)

  • Urologic: cystoscopy or retrograde urogram

  • Radiologic: nephrostomy

NURSING SAFETY PRIORITY: Post-op nephrostomy

  • Monitor for complications: decreased/absent drainage, cloudy/foul-smelling drainage, leakage at nephrostomy site, back pain

  • Notify physician immediately if complications arise

Renovascular Disease

  • Process affecting renal arteries; narrowing of lumen reduces renal blood flow

  • Often presents with sudden onset hypertension

Recognizing Cues: Assessment (Renovascular Disease)

  • Difficult to control hypertension

  • Poorly controlled diabetes

  • Elevated serum creatinine; decreased GFR

  • Imaging: MRA, ultrasound, renal arteriography

Interventions (Renovascular Disease)

  • Drug therapy: antihypertensives

  • Endovascular techniques: stent placement

  • Renal artery bypass surgery

  • Catheter and balloon procedures

  • Anatomical references: abdominal aorta, femoral artery, kidney, stent, graft

Diabetic Nephropathy

  • Vascular complication of type 1 or type 2 diabetes

  • Leading cause of ESKD

  • Severity linked to degree of hyperglycemia

  • Management parallels CKD management

Renal Cell Carcinoma

  • Adenocarcinoma of the kidney

  • Risk factors: smoking or chemical exposure; family history of related cancers

  • Paraneoplastic syndromes: anemia, erythrocytosis, hypercalcemia, liver dysfunction, hormone effects, increased ESR, hypertension

Kidney Cancer (Spread & Staging)

  • Typical spread patterns: through vena cava to other organs; lymph nodes involvement; Stage I–IV progression

Recognizing Cues: Assessment (Kidney Cancer)

  • Weight loss; changes in urine color; abdominal/flank pain (dull or aching)

  • Palpable kidney mass; abdominal mass

  • Renal bruit may be heard; fever; gross hematuria is a late sign

  • Skin color changes: pallor; man-related signs like gynecomastia in some men; muscle wasting, weakness

Diagnostics (Kidney Cancer)

  • Urinalysis: may show red blood cells (RBCs)

  • Hemoglobin/hematocrit: decreased; ESR may be increased

  • Metabolic markers may show hypercalcemia; elevated BUN/creatinine

  • Imaging: ultrasound, CT scan; biopsy for targeted therapy selection

Interventions (Kidney Cancer)

  • NON-SURGICAL: chemotherapy, radiation therapy, microwave ablation (MWA), biologic response modifiers, targeted therapy

  • SURGICAL: nephrectomy (partial or radical)

  • Pre-operative risks: blood loss, type and crossmatch

  • Post-operative concerns: bleeding, hypotension, decreased urine output, altered level of consciousness

Partial Nephrectomy vs Radical Nephrectomy

  • Partial nephrectomy preserves more renal tissue; radical nephrectomy removes the entire kidney

Kidney Trauma

  • Grading (I–V) describes damage severity from capsule, subcapsular hematoma, lacerations to collecting system, to renal hilum avulsion

  • Grade I: minor subcapsular hematoma or non-penetrating injury

  • Grade II–III: larger lacerations or hematoma

  • Grade IV–V: extensive lacerations, renal artery/vein injury, or kidney shattered

Assessment (Kidney Trauma)

  • Obtain health history; assess pain, urine output, circulation

  • Tests: urinalysis, H&H, ultrasound, CT, KUB

Interventions (Kidney Trauma)

  • Drug therapy; fluid therapy

  • Monitor signs of shock; ensure urine output > 30 ext{-}50 ext{ mL/hr}

  • Angiographic embolization or exploratory laparotomy as indicated

Care Coordination (General)

  • Assess for infection and complications

  • Watch for urine leakage, delayed bleeding, worsening hematuria

  • Monitor for chills/fever, lethargy, cloudy or foul-smelling urine, hypertension

Case Study (Page 44–46)

  • Case 1: 35-year-old with fever, chills, severe right flank pain; tachycardia and tachypnea; recent UTI; CVA tenderness

    • Diagnosis nurse would expect: Acute pyelonephritis

    • Laboratory tests anticipated: Urinalysis with culture, CBC, BUN/Cr, electrolytes; possibly CRP/ESR

  • Case 1 imaging: Abdominal CT scan is expected

  • Case 2: Two days later, patient embarrassed about not completing antibiotics

    • Best nurse response: an open-ended, nonjudgmental approach such as "Can you tell me more about why you didn’t take all of your antibiotics?"

NCLEX Practice Highlights

  • PKD: Immediate intervention required for severely elevated BP (e.g., a BP like 170/90 is concerning) or severely reduced urine output (< 30 mL/hr) as urgent signs

  • Chronic GN: Select all that apply – findings include Proteinuria, Hematuria, Serum creatinine markedly elevated (e.g., > 6 mg/dL), Signs of fluid overload; Increased urinary output is not typical

  • Care assignment safety: Typically, the nurse (RN) handles first-dose immunomodulating therapy for acute GN; LPN/CNA support may assist with stable tasks

Diagnostics & Treatments Summary

  • Common diagnostic tools across conditions: UA with C&S, BUN/Cr, GFR, imaging (US/CT/KUB), biopsy when indicated

  • Common interventions span: hydration and electrolyte management, BP control (ACE inhibitors/antihypertensives), dialysis/transplant planning, infection control, pain management, and patient education on medications and lifestyle

  • Emphasis on monitoring: BP, fluid status, urine output, signs of infection or bleeding, and post-procedure complications