Professional Documents
Culture Documents
Renal Disorders
1.
Nephrotic Syndrome
Aetiology
Causes
o
Diabetes
Symptoms
o
o
Hypoalbuminaemia
Generalised oedema
Hyperlipidaemia
o
o
Hypertension
Lipiduria
Blood results
o
Pathophysiology
1.
2.
3.
4.
5.
Symptom management
Goals
o
Relieve oedema
Assessment
Medications
ACE inhibitors
NSAIDs
Diet
exceeds 10g/day
Cure/control the primary disease
Hyperlipidaemia
Thrombosis
Drug therapy
o
o
o
Manage diabetes
Treat oedema
Caused by
Immune disorders
Infection
Symptoms
Hypertension
Haematuria
Pathophysiology
1.
2.
3.
4.
5.
6.
7.
3.
Prednisolone
2.
Early stages
Characterise and describe the causes and disease progression of the different types of
glomerulonephritis.
Distinguish between acute and chronic glomerulonephritis.
Glomerulonephritis inflammation of the glomeruli
o
Glomerulus is PRIMARY site of inflammation, but tubular, interstitial and vascular changes
occur also
Characterised by
OR
reaction of basement membrane with an exogenous agent
(virus)
Antibodies react with circulating non glomerular antigens and are randomly
deposited as immune complexes on GBM
o deposits appear lumpy
o
OR
exogenous sources (bacteria, viruses)
Manifestations
Haematuria
Proteinuria
Types
Pathophysiology
1.
2.
3.
4.
5.
Early diagnosis via a renal biopsy can lead to early intervention to slow the
process down
Acute Post-Streptococcal Glomerulonephritis (APSGN)
Pathophysiology
1.
2.
3.
4.
5.
6.
7.
Hypertension
Oliguria
o
o
Fluid retention
Diagnosis
o
Urinalysis
o
o
o
Proteinuria
Confirmation of disease
Management/treatment
o
Rest
reduce
Sodium and fluid restriction & diuretics
Antibiotics
Antihypertensive therapy
Prevention
streptococcal infections
Rapidly progressive glomerulonephritis (RPGN)
Manifestations
o
Hypertension
Oedema
Proteinuria
Haematuria
RBC casts
as an idiopathic disease
Chronic Glomerulonephritis
Characterised by
o
Proteinuria
Haematuria
Causes
Lupus nephritis
Diabetic nephropathy
Rapidly, progressive GN
Pathophysiology
o
4.
Characterise and describe the causes and complications of acute and chronic pyelonephritis.
Pyelonephritis
o
ACUTE
Inflammatory disorder affecting renal pelvis and functional portion of kidney tissue
Risk Factors:
Pregnancy
UTI
Blood-borne infections
Urinary calculi
Congenital malformations
Causes
Pathophysiology
CHRONIC
Two forms:
Reflux
Pathophysiology
1.
2.
3.
4.
5.
6.
7.
8.
Differentiate between acute renal failure and chronic kidney disease, in terms of aetiology,
clinical course and diagnostic criteria.
Outline the management of a patient with chronic kidney disease.
Discuss the difference between peritoneal dialysis and haemodialysis, in terms of indications and
nursing responsibilities.
Discuss the criteria for renal transplantation for a patient in end stage renal failure.
Acute Renal Failure
o
Characterised by:
development of azotaemia.
Changes to electrolytes and fluid status
o
o
Oliguria is associated with Acute renal failure. people with no oliguria, have less
complications and are more likely to recover quicker
RIFLE, tool used to classify severity and outcome, as well as looking at urine output and
the increase in serum creatinine table 46-3 page 1294
Risk
Injury
Failure
Loss
PRE-RENAL
o
Hypovolaemia
myocardial infarction
Decreased peripheral vascular resistance
INTRA-RENAL
o
Nephrotoxic injury
Interstitial nephritis
Other
POST-RENAL
o
Bladder cancer
Calculi formation
Neuromuscular disorders
Prostate cancer
Strictures
Trauma
Extra-renal tumours
Pre-renal
1.
2.
3.
4.
Major surgery,
Trauma or burns
Development of sepsis
tubular epithelium.
Nephrotoxins that are associated with ATN include:
Aminoglycoside antibiotics
Contrast media
Pathophysiology:
1.
2.
3.
4.
Post-renal
1.
2.
1.
2.
3.
4.
o
Clinical Course
Four phases:
Initiating phase
o
Time of insult
Hrs to days
Maintenance phase
o
event
If the cause is ischaemia, oliguria may occur within 24 hours
Pre-renal
Urinary changes
dysfunction
Fluid volume excess
occurs.
Severe acidosis = Kussmal respirations (rapid deep
Sodium balance
mmol/kg.
Proteinuria may be present glomerular membrane
levels increases
Haematological disorders
erythropoietin
WBCs are altered causing numerous systemic and local
infections
Calcium deficit and phosphate excess
Neurological disorders
Diuretic Phase
o
Recovery Phase
o
10
take up to 12 months
The outcome of Acute Kidney Disease is influenced by
o
o
Diagnostic Studies
Client history
Urine sediment containing abundant cells, casts or protein suggests intrarenal disorders
Renal scan
Assesses renal blood flow and the integrity of the collecting system
abnormalities
Renal ultrasound
system
Multidisciplinary care
GOAL
Assessment
Involves
Kidney damage
GFR
Normal is 125mL/min/1.73m2
Stages
Stage 1 = 90
Stage 2 = 60-80
Stage 3 = 30-59
Stage 4 = 15-29
Causes
Diabetes mellitus
Glomerulonephritis
Hypertension
Early stages
Stage 3
Stage 4
Stage 5
Age
Male
Ethnicity
Behavioural factors
o
Smoking
12
Biomedical factors
o
Clinical Manifestations
Uraemia
Psychological
Neurological
o
Cardiovascular
o
Peripheral neuropathy
o
Haematological
o
Metabolic
o
Integumentary
o
Endocrine/reproductive
o
Gastrointestinal
o
Hypertensive retinopathy
Pulmonary
o
Ocular
o
Urinary system
Polyuria - nocturia
Metabolic disturbances
Elevated triglycerides
o
Potassium
o
Hyperkalaemia
13
Sodium
o
Normal low
Magnesium
Metabolic acidosis
o
Anaemia
o
Bleeding tendencies
o
Infection
o
Cardiovascular
Respiratory
Gastrointestinal
Stomatitis
Neurological
Musculoskeletal
and phosphate, which bind together and deposit into muscles, lungs, skin
and subcutaneous tissues, GIT, eyes.
Integumentary
pruritis.
Reproductive
Women
o
Men
o
Endocrine
Both sexes
hypothyroidism
Psychological
Diagnosis
Urinalysis
Person with1+ proteinuria shown 2-3 times in 3 months should have further
protein
ACR of >300mg of albumin per 1g creatinine - CKF
GFR
Better than serum creatinine alone. Serum creatining could be the same for
CT Scan
Renal Biopsy
15
Management
Conservative therapy
GOAL
o
Prevent complications
Control of:
o
Hyperkalaemia
Drug therapy
ACUTE
o
Stage 4
o
Dietary/nutritional
Hypertension
Target BP is 130/80
Drug therapy
Antihypertensive drugs
o
Diuretics (frusemide)
o
o
o
DASH diet
Hyperparathyroidism
Anaemia
16
IV iron supplements
Administered IV or SC
If plasma ferritin concentrations fall below 100
ng/mL
Blood transfusions should be avoided
Hyperglycaemia
Dyslipidaemia
Nutritional therapy
o
Protein restriction
Water restriction
Dialysis
o
Indications
Hemodialysis
Process:
o
Excess water
patient
Haemodialysis takes approx 4 hours and
is required 3 times per week
Complications of dialysis
o
Hypotension
Muscle cramps
Blood loss
Sepsis
Disequilibrium syndrome
Nursing Responsibilites
o
with a fistula
Observation of fistula thrill and bruit
Vital signs
Peritoneal dialysis
Benefits
o
Contraindications
o
diverticulitis
History of multiple abdominal surgeries
Hernias
Obesity
Catheter
o
Exchange
o
and involves
Inflow approx 2L over 10 minutes
Drain 15 minutes
Types
o
Complications
o
19
Peritonitis
abdominal pain
Outflow problems
Hernias
Bleeding
Pulmonary complications
Protein loss
Nursing Responsibities
o
Education of patients
Renal Transplant
Exclusion criteria
Age
Co-morbidities
smoking
Obesity
Process
20