RENAL DISEASES Terms: 1. aldosterone hormone synthesized and released cortex; causes the kidneys to absorb Na 2.

. antidiuretic hormone(AD ! hormone secreted by the "osterior "ituitary #land; causes the kidneys to reabsorb more $ater %. anuria total urine out"ut less than &'m( in 2)hrs. ). bacteriuria * bacteria in the urine; bacterial count hi#her than 1''+''' colonies,m( &. clearance -ol. o. "lasma that the kidneys can clear o. s"eci.ic solute(e#+ creatinine!; ex"ressed in milliliters "er minute /. dysuria "ain.ul or di..icult urination 0. .re1uency -oidin# more .re1uently than e-ery %hrs. 2. 3lomerular .iltration rate(345! -ol. o. "lasma .iltered at the #lomerulus into the kidney tubles each minute; normal rate is a""roximately 12'm(,min 6. hematuria red blood cells in the urine 1'. nocturia a$akenin# at ni#ht to urinate 11. oli#uria * total urine out"ut less than )''m( in 2)hrs. 12. "roteinuria "rotein in the urine 1%. "yuria "us in the urine 1). 7alsal-a (eak 8oint 9aneu-er (7(88! amount o. abdominal "ressure a#ainst the urethra to o"en and leak urine 1&. -esicoureteral re.lux back .lo$ o. urine .rom the bladder into the ureters Anatomy of the Upper and Lower Urinary Tracts :idneys *retro"eritoneal or#ans *12' 10'# *12cm lon#+ /cm $ide and 2.&cm thick *$ith 2 12 "yramids *$ith ) *1% minor calyces *$ith 2 % ma;or calyces *$ith "rotecti-e structures: a. 8ararenal .at b. 3erota<s .ascia c. 8erirenal .at d. 5enal ca"sule Ne"hron *basic structural and .unctional unit o. the kidney =reter+ >ladder+ and =rethra =reter* narro$+ muscular tubes+ each 2) to %' cm lon# that ori#inates at the lo$er "roton o. the renal "el-is * connects each kidney to the bladder >ladder* tem"orary stora#e o. urine =rethra* $here the urine comes out

% 8rocesses o. =rine 4ormation

1. 3lomerular 4iltration* this $here 2?+electrolytes other substance are .iltered 2. Tubular 5eabsor"tion* some o. these substances are reabsorb %. Tubular @ecretion* some o. these substances are secreted in .orm o. urine Test o. =rine @"eci.ic 3ra-ity: 1. ?smolality* no. o. "articles(electrolytes and other molecules! dissol-ed "er kilo#ram o. the urine 2. @"eci.ic #ra-ity* 1.'1' to 1.'2& 5enal .unction be#ins to decrease at a rate o. 1A each year at %'. URINARY DISORDERS A. Acute ye!onephritis *bacterial in.ection o. the renal "el-is+ tubules and interstitial tissue *an ascendin# in.ection *"redis"osin# .actors: a. -esico*ureteral re.lux b. urinary tract obstruction *enlar#ed kidney *$ith abscess on the renal ca"sule and at the cortico*medullary ;unction *s,sx: .e-er and chills costo*-ertebral an#le leucocytosis tenderness bacteriuria and "yuria dysuria .lank "ain inc urinary .re1uency *dx: =TB Nuclear scan CT scan =rine Culture and @ensiti-ity Test D78 *medical mana#ement: a. Acute uncom"licated 8yelone"hritis *no dehydration+ no nausea and -omitin#+ no se"sis E2 $eeks o. oral antibiotics Trimetho"rim*@ul.amethoxazole Ci"ro.loxacin 3entamicin $ith or $ithout Am"icillin Third 3eneration Ce"halos"orins E/ $eeks o. oral antibiotics i. $ith rela"se Furine culture 2 $eeks a.ter antibiotic thera"y b. com"licated *"re#nant "atients Ehos"italization (antibiotics .rom D7 to oral!

". #hronic ye!onephritis *re"eated acute "yelone"hritis E chronic "yelone"hritis *no s,sx unless there<s an acute exacerbation *kidneys scarred+ contracted and non .unctional *commomn cause o. end sta#e renal disease (G@5D! *s,sx: .ati#ue "olyuria headache excessi-e thirst anorexia $ei#ht loss *dia#nosis: creatinine and >=N clearance creatinine le-els intra-enous "yelo#ra"hy *com"lications: a. G@5D b. hy"ertension c. .ormation o. renal stones *may be due to the "resence o. urea s"littin# microor#anisms *medical mana#ement: urine culture and sensiti-ity #uided antibiotic thera"y i. the urine cannot be made bacteria .ree *Nitro.urantoin to su""ress *T98*@9B bacterial #ro$th *nursin# mana#ement: a. monitorin# *DH? b. oral .luids (%*)(,day!* to dilute urine+ dec+. burnin# on urination+ and "re-ent dehydration *unless contraindicated c. monitor tem".e-ery )hrs *anti"yretics d. education *ad-ise bed rest *"re-ention o. =TD #. Acute $!omeru!onephritis *Dn.lammation o. the #lomerular ca"illaries *"rimarily a disease o. children older than 2 years old *may a..ect any a#e *causes: Eautoimmune @(G Estre"tococcal Acute 8ost @tre"tococcal 3lomerulone"hritis *most common

D. Acute ost Streptococca! $!omeru!onephritis *2 to % $eeks a.ter Eim"eti#o Esore throat *s,sx: hematuria hy"ertension tea colored urine headache+ malaise+ .lank "ain "roteinuria (I! kidney "unch inc serum >=N and creatinine con#estion anemia con.usion+ somnolence and seizures edema 3rou" A >eta* emolytic @tre"tococcal Dn.ection Anti#en*Antibody 5eaction De"osition in the 3lomerulus Dncreased 8roduction o. G"ithelial Cells in the 3lomerulus J>C Dn.iltration Thickenin# @carrin# Decreased 345 *dia#nosis: a. kidney bio"sy b. electron microsco"y c. immuno.lourescence analysis d. Anti*@tre"tolysin ? Titer Anti*DNAse > Titer e. @erum Com"lement Determination *decreased *$ill normalize in 2 2 $eeks E. #hronic $!omeru!onephritis *re"eated acute #lomerulone"hritis *com"onents: re"eated acute #lomerulone"hritis hy"ertensi-e ne"hrosclerosis hy"erli"idemia chronic tubulo*interstitial in;ury hemodynamically mediated #lomerular sclerosis *contraction o. the kidneys to 1,& o. its ori#inal size

*de.ormed kidneys *may result to G@5D *s,sx: may be asym"tomatic hy"ertension or inc >=N and Creatinine edema 5outine eye exam. (o"hthalmosco"y!: retinal hemorrha#es "a"illedema 3en. sym"tom: $ei#ht loss $eakness and irritability nocturia 3DT disturbances anemia heart .ailure "eri"heral neuro"athy+ decreased DT5 "ulsus "aradosus *dia#nosis: 1. =rinalysis* .ixed s". 3ra-ity at 1.'1' "roteinuria; urinary casts("rotein "lu#s secreted by dama#ed kidney tubules! 345 .alls belo$ &'m(,min 2. electrolyte imbalances *hy"erkalemia due to dec. "otassium excretion,excessi-e intake *hy"oalbuminemia $ith edema secondary to "rotein loss(dama#ed #lomerlar membrane! *hy"er"hos"hatemia due to dec.renal excretion o. "hos"orus *hy"ocalcemia (cal. >inds to"hos"orus tocom"ensate .or ele-ated serum "hos"orus le-el! *hy"erma#nesemia dec exceretion inad-ertent in#estion o. antacids containin# ma#nesium %. C>C *anemia ). Chest K*5ay *cardiome#aly *"ulmonary edema &. GC3 *le.t -entricular hy"ertro"hy *mana#ement: 1. treatment o. hy"ertension 2. $ei#ht monitorin# %. #i-e "roteins o. hi#h biolo#ic -alue ). ade1uate calories &. dialysis

*nursin# mana#ement: 1. monitorin# %. Acute Rena! %ai!ure *sudden and almost com"lete loss o. renal .unction *Dec. in 345 *s,sx: *oli#uria *normal urine -ol.(not as common! *anuria *risin# serum creatinine and >=N #ate&ories of AR% 1. 8rerenal *ocuur as a result o. im"aired blood .lo$ *shock 2. Dntrarenal *the result o. actual "arenchymal dama#e to the kidney tubules *use o. ne"hrotoxic dru#s (N@ADDs and ACG inh! %. 8ostrenal *obstruction some$here in distal kidney %our #!inica! hases of AR% 1. Dnitiation *be#ins $ith the initial insult and ends $hen oli#uria de-elo"s 2. ?li#uria *rise in the serum o. $aste "roducts o. metabolism *rise in serum "otassium and ma#nesium %. Diuresis *$ith #radually increasin# urine out"ut *renal .unction may still be markedly abnormal ). 5eco-ery 8eriod *im"ro-ement o. renal .unction *may take %*12 months *$ith normal laboratory -alues *$ith "ermanent 1*%A reduction in 345 *assessment and dia#nostic .indin# *chan#es in urine (scanty to normal! *chan#es in contour(=tz! *Azotemia * y"erkalemia *metabolic acidosis *hy"er"ho"hatemia and hy"ocalcemia *anemia

*"re-ention: *"re-ention o. ex"osure to ne"hrotoxic dru#s *amino#lycosides+ cyclos"orine+ am"hotericin > *serum >=N and creatinine monitorin# *mana#ement: a. restore chemical balance and "re-ent com"lications b. Any "ossible casue is identi.ied c. maintain .luid balance *>8+ C78+ serum and urine electrolyte. 4luid loses d. monitorin# .or o-er hydration *dys"nea+ crackles+ distended neck -eins *4urosemide+ Gthacrynic Acid e. dialysis *to "re-ent serious com"lications Fhy"erkalemia Fse-ere metabolic acidosis F"ericarditis F"ulmonary edema .. "harmacolo#ic *cation exchan#e resin (sodium "olystyrene sul.onate*kayexalate! *retention enema *diuretic thera"y *lo$ do"amine dose (1*%#,k#! *"hos"hate bindin# a#ents (Al? ! #. nutritional thera"y *#i-e additional "roteins (1#,k#,day durin# the oli#uric "hase! *hi#h "otassium and "hos"hate .oods are restricted (banana+ citrus and co..ee! *"otassium restricted to 2'*)'mG1,day *sodium restricted to 2#,day *may re1uire "arenteral nutrition *nursin# mana#ement: a. monitorin# .luid and electrolyte balance b. reducin# metabolic rate *bed rest+ "re-ention o. .e-er and in.ection c. "romotin# "ulmonary .unction *assistance in chan#in# "ositions *ad-ise to cou#h and dee" breath d. "re-entin# in.ection *ase"sis *a-oid insertin# an ind$ellin# urinary catheter

e. "ro-idin# skin care .. "ro-idin# su""ort $. #hronic Rena! %ai!ure 'END(STA$E RENAL DISEASE) *is a "ro#ressi-e irre-ersible deterioration in renal .unction *maintain metabolic and .luid and electrolyte balance .ails resultin# in uremia or azotemia (retention o. urea and other nitro#enous $astes in the blood! *"ro#nosis $ill be determined by the "resence or absence o. hy"ertension and "roteinuria *causes: diabetes mellitus* most common hy"ertension chronic #lomerulone"hritis obstruction o. the urinary tract "olycystic kidney disease in.ections ne"hrotoxic medications * sta#es: @ta#e 1 *5educed 5enal 5eser-e *)'A*0&A loss o. ne"hron .unction *usually asym"tomatic @ta#e 2 *5enal Dnsu..iciency *0&A*6'A loss o. ne"hron .unction *increase in serum >=N and creatinine *inability to concentrate urine *anemia may de-elo" *$ith "olyuria and nocturia @ta#e % *Gnd @ta#e 5enal Disease *L1'A o. ne"hron .unction remainin# *re#ulatory+ excretory and hormonal .unctions are lost *re1uires dialysis *s,sx: cardio-ascular hy"ertension "ulmonary edema heart .ailure "ericarditis dermatolo#ic F"ruritus Furemic .rost (de"osit o. urea crystals!

3D and Neurolo#ic sHsx *assessment and dia#nosis a. #lomerular .iltration rate creatinine clearance b. Na retention and $ater c. Acidosis d. Anemia *com"lications a. y"erkalemia b. 8ericarditis+ 8leural G..usion and Cardiac Tam"onade c. y"ertension d. Anemia e. >one Disease *medical mana#ement: a. maintain kidney .unction and homeostasis b. treat the underlyin# cause and contributory .actors *medications Edialysis *diet thera"y 8harmacolo#ic Thera"y a. antihy"ertensi-es *includes intra-ascular -olume control F.luid restriction Fsodium restriction b. sodium bicarbonate c. erythro"oietin *thera"y G"o#en(recombinant erythro"oietin! D7 or subcutaneous+ may take 2*/ $eeks to increase ct. d. iron su""lementation e. antiseizure a#ents EDiaze"am E8henytoin .. antacids .or hy"er"hos"hatemia and hy"ocalcemia *aluminum based antacids Toxicity my result to: *neurolo#ic sym"toms *osteomalacia *calcium carbonate Nutritional Thera"y *re#ulation o. "rotein intake *re#ulation o. .luid intake (&''*/''ml more than the "re-ious day<s 2) hour =?! *re#ulation o. sodium intake *re#ulation o. "otassium *ade1uate calories and -itamins

%. Dialysis *to "re-ent hy"erkalemia *nursin# mana#ement: a. a-oid the com"lications o. reduced renal .unction b. assess .luid status c. identi.y "otential sources o. the imbalance d. im"lement a dietary "ro#ram e. encoura#e sel. care and inde"endence