N 1 RENAL DISORDERS

C 1 Lecturer: DOLLIMAR YOGORE, RN, MAN

M2 By: kaye

KIDNEY & URINARY FUNCTION THE KIDNEYS AND THE

URINARY SYSTEM
Assessment of kidney & urinary function
In this module, we will discuss the causes, the management
MANAGEMENT OF PATIENT strategies to prevent damage and preserve renal conditions
KIDNEY DISORDERS URINARY DISORDERS requiring dialysis, CRRT, transplantation, & kidney surgery.
• Nephrosclerosis • Lower UTI Nurses also care for patients with urologic disorders in all
• Chronic • Upper UTI settings. The urinary system is responsible for providing the
glomerulonephritis route for drainage of urine formed by the kidneys. In caring
• Nephrotic syndrome • Acute for patients with urinary disorders, we need to learn about
pyelonephritis anatomy, physiology, diagnostic testing, medical, and
nursing care. In this module, we will have to focus on nursing
• Renal cancer • Chronic
management of patients with urinary diversions,
pyelonephritis
dysfunctional voiding patters, urolithiasis, genitourinary
• Acute kidney injury • Urinary
trauma, cancer & urinary diversions.
incontinence
• End-stage kidney disease/ • Urinary retention
NEPHROSCLEROSIS
CKD • Neurogenic
bladder • Hardening of renal
• Urolithiasis & arteries due to
nephrolithiasis prolonged HPN & DM.
• Genito-urinary Major cause of CKD &
trauma ESKD
• HPN affecting
arteries, small
LEARNING OBJECTIVES arteries and
At the end of kidney disorders management lecture, the glomeruli
learner will be able to:
1. Describe the key factors associated with the PATHO ASSESSMENT/DIAGN MEDICAL
development of kidney disorders OSTIC FINDINGS MGT.
2. Explain the pathophysiology, clinical
manifestations, medical management, and nursing 2 forms: • Early Anti-HPN:
management for patients with kidney disorders • ACE-
1. MALIGNA - symptom
3. differentiate between the causes of chronic kidney rarely inhibitors
NT-HPN
disease (CKD) & acute kidney injury (AKI appears. alone or
diastolic
4. Understand the nursing management of patients
pp. > • Urine in
with CKD & AKI
130mmhg - protein & combinat
5. Compare & contrast renal replacement therapies
due to occasional ion with
including hemodialysis (HD), peritoneal dialysis
decrease casts. the anti-
(PD), continuous renal replacement therapies HPN to
blood flow • Late
(CRRT) & kidney transplantation reduce
to the - renal
6. Identify the nursing management of the patient on incidenc
kidneys. insufficiency
dialysis e.
Without
dialysis,
patients die
with
uremia.

BSN 3 | BLOCK 1 | MIDTERM

1 | 10
 Individuals with glomerulonephritis might experience:
2. BENIGN- → blood or protein in the urine
associated → high blood pressure
with → swollen ankles or face, because of water retention
atheroscler → urinating frequently during the night, bubbles or
osis & HPN foam in the urine, caused by excess protein
(older) WATCH VIDEO:
https://www.youtube.com/watch?v=R6gCVnQVSxA
WATCH VIDEO https://www.youtube.com/watch?v=kRs60qXNFYI

BLOOD SUPPLY TO THE KIDNEYS

GLOMERULONEPHRITIS

• ACUTE GLOMERULONEPHRITIS may appear suddenly,

BSN 3following
| BLOCK 1a|throat or skin infection.
MIDTERM
Symptoms include:
→ puffiness of the face on waking up
→ urine that is brown or contains traces of blood
→ decreased urination
→ fluid in the lungs leading to coughing and shortness
of breath
→ high blood pressure

• CHRONIC GLOMERULONEPHRITIS develops over a

long time, often without obvious symptoms. However,
complete kidney failure can result.

BSN 3 | BLOCK 1 |MIDTERM 2 | 10

 N 1 RENAL DISORDERS
C 1 Lecturer: DOLLIMAR YOGORE, RN, MAN
M2 By: kaye

CHRONIC GLOMERULONEPHRITIS
PATHO CLINICAL ASSESSMENT / MED. MGT NSG. MGT
MANIFESTATIONS DIAGNOSTIC FINDINGS
• Kidneys reduced to Discovered: • Urinalysis • Reduce BP: sodium & • observe for fluid &
1/5 of their normal • hypertension, fixed specific gravity water restriction, electrolyte imbalance
Due to repeated episodes size elevated BUN & 1.010, variable hypertensive meds • report cardiac &
of acute nephritic • Cortex layer shrinks creatinine proteinuria, urinary • monitor weight daily neurologic status
syndrome, hypertensive 1-2 mm • loss of weight & casts (proteins • prescribed with • provide emotional
nephrosclerosis, • Glomeruli & tubules strength secreted by damaged diuretic meds to treat support, explore
hyperlipidemia & etc. • Become scarred • increasing irritability kidney tubules) fluid overload options, have their
• Branches of renal • increased need to • high biologic protein questions answered
artery thickened urinate at night GFR below 50 ml/min: (dairy products, eggs, • Educate on self-care:
• Severe damage (nocturia) - Hyperkalemia meats) • Follow up: labs, BP,
(stage 5) • headaches - Metabolic acidosis • Treat UTIs promptly casts for protein &
• dizziness - Anemia secondary to Dialysis initiated in casts
• Requiring renal
decreased eryhropoieis early course of the •
replacement therapy • digestive Access site (dialysis)
- Hypoalbunemia disease to keep
disturbances • dietary restriction
-decreased s. phosphorus patient in optimal • lifestyle modification
-decreased s. calcium physical condition &
Progresses to:
-mental changes minimize
• periorbital &
-impaired nerve complications
peripheral edema
conduction due to
• Anemia
electrolyte imbalance &
• cardiomegaly (gallop
uremia
rhythm) to distended
neck veins (HF signs)
• Chest x-rays
• peripheral
cardiac enlargement &
neuropathy with
pulmonary edema
diminished deep
tendon reflexes
• CT & MRI
(confused & limited
decrease renal cortex size
attention span)

3 | 10
 N 1 RENAL DISORDERS
C 1 Lecturer: DOLLIMAR YOGORE, RN, MAN
M2 By: kaye

BASIC CANNULATION OF FISTULA

BSN 3 | BLOCK 1 | MIDTERM

4 | 10
 N 1 RENAL DISORDERS
C 1 Lecturer: DOLLIMAR YOGORE, RN, MAN
M2 By: kaye

NEPHROTIC SYNDROME
Clinical Assessment / Med. Mgt. Nsg. mgt
PATHO manifestations Diagnostic findings
Type of kidney disease • GLOMERULAR Major manifestation: • Protein exceeding 3.5 Address underlying • Early: similar to AGN
characterized by DAMAGE • EDEMA (soft, pitting) g/day-hallmark of disease causing mgt.
increased glomerular • Increased around eyes, diagnosis proteinuria, slowing • Later: ESKD
permeability marked by permeability to dependent in sacrum, • protein progression of CKD, Medication & dietary
massive increase in protein (proteinuria ankles, & hands), electrophoresis relieving symptoms changes
protein, decrease >3.5 g/24H) abdomen (ascites) • Immunoelectro • Diuretic
albumin, diffuse edema, • HYPOPROTEINEMIA • Irritability phoresis • ACE inhibitors
high s,. Cholesterol, low • 1-Decreased plasma • Headache • Increased WBCs • reduce proteinuria
density lipoprotein oncotic pp. to EDEMA • malaise (granular & epithelial • lipid-lowering agents
(hyperlipidemia) • 2-Compensatory casts) for hyperlipidemia
synthesis of proteins • needle biopsy
by liver to
HPERLIPIDEMIA

• Occurs with many

intrinsic kidney
diseases & systemic
diseases that cause
glomerular damage
• Not a specific disease
but a constellation of
clinical findings
• Resulting in
glomerular damage

WATCH VIDEO:
https://www.youtube.com/watch?v=ZGPa_4FN9M4

5 | 10
 POLYCYSTIC KIDNEY DISEASE (PKD)
Genetic disorder PATHO
Characterized by growth of
numerous fluid-flied cysts in the
kidneys (destroys nephrons PKD cysts enlarged kidneys
(replacing normal structure)
FAILURE
2 major forms inherited:
1. Autosomal dominant
(30-40 y.0), can beigin
early in childhood,
about 90%
2. Autosomal recessive
(rare)
BSN 3 | BLOCK 1 | MIDTERM
CLINICAL MANIFESTATIONS
• Kidney damage result in
HEMATURIA, polyuria,
hypertension, development
of renal calculi, associated
UTIs, proteinuria
• abdominal fullness
• flank pain
WATCH VIDEO https://www.youtube.com/watch?v=JmFpL3WLTAM
Assessment / Med. Mgt.
Diagnostic findings
• Check family history NO CURE
• palpation of abdomen: Supportive treatment:
enlarged cystic kidneys • BP control
• UTZ-preferred • pain control
• antibiotic agents
• renal replacement therapy-
once kidneys fail
• Genetic linkage studies &
counseling (screening
family members for
potential kidney donation)
6 | 10
 RENAL CANCER
PATHO Clinical Assessment / Med. Mgt. Nsg. mgt
manifestations Diagnostic findings
Renal carcinoma-most Risk factors: • Discovered as • IV urography Nephrectomy - preferred • Surgery, radiation &
common type (85%) • genser-men palpable abdominal • Cystoscopic Immunotherapy medications.
-may metastasize • obesity mass. examination Partial nephrectomy- • Post-op drain
• polycystic kidney • Mostly-no symptoms • Renal angiograms nephron-sparing surgery • pain & muscle
disease • Hematuria • UTZ (lesions) soreness mgt.
• tobacco use • pain (dull), colicky (if • CT scan Laparoscopic • immunosuppressants
• clot metastasize) nephroureterectomy- •
unopposed estrogen • monitor for analgesia
therapy • Mass in flank upper tract transitional (acetaminophen)
dehydration &
cell carcinoma
exhaustion • assistance with
RENAL ARTERY
turning, coughing,
EMBOLIZATION
incentive spirometry,
- renal artery
deep breathing
occluded to
exercises
impede blood
supply to tumor
(kill tumor).
Interlukin 2 (IL-2)
- after
percutaneous
partial r radical
nephrectomy

WATCH VIDEO https://www.youtube.com/watch?v=3J9FhRLb35s

BSN 3 | BLOCK 1 | MIDTERM 7 | 10

 ACUTE KIDNEY INJURY (AKI)
PATHO CLINICAL ASSESSMENT / COMPLICATION MED. MGT. NSG. MGT.
MANIFESTATIONS DIAGNOSTIC FINDINGS
Rapid loss of Reduce blood flow: Classification criteria: • scanty to normal Patients taking nephrotoxic • Maintain • Monitor
kidney function 1. hypovolemia RIFLE u.o. meds: fluid for fluid &
due to damage to 2. hypotension Risk • hematuria • aminoglycosides, balance electrolyte
kidneys. 3. reduce C.O. Injury • low spec. gravity gentamycin, • Avoid fluid balance
Treatment aim: & HF Failure 1.010-1.025) ie tobramycin, excess • Bed rest to
replacing renal 4. obstruction Loss the earliest amphotericin B, • Provide reduce
function of kidney or ESKD indication of amikacin, cyclosporine renal metabolic
Life threatening: lower UT by Categories: tubular damage (renal function replacement rate
metabolic tumor • pre-renal (hypoperfusion) (inability to monitoring) therapy • CDEto
acidosis(fluid & 5. bilateral • intra-renal (actual concentrate urine) • Long term analgesic • Pre-renal reduce
electrolyte obstruction damage) • dec. amt. of Na+ use (NSAIDS) reduce azotemia- atelectasis
imbalance) (arteries/ • ATN levels greater than renal blood flow treating wiyh • Asepsis on
Vein) • post-renal (urine flow 40mEq/l with • Hyperkalemia-is optimizing invasive
obstruction) urinary casts treated with cation renal lines &
INCREASED BUN & Phases: initiation, oliguria, • hyperkalemia exchange resin prefusion catheters
CREA diuresis, & recovery (kayexalate) orally or • •
• progressive Post-renal- Skin care
metabolic acidosis retention enema- relieving • Provide
• Inc. phosphate, exchange sodium for obstruction. psycho
anemia potassium ions in the • Dialysis social
intestinal tract initiated or support
Peritoneal
dialysis,
CRRTs

WATCH VIDEO https://www.youtube.com/watch?v=MH1DCCqLGps

BSN 3 | BLOCK 1 | MIDTERM 8 | 10

 END-STAGE KIDNEY DISEASE OR CKD
PATHO CLINICAL ASSESSMENT / COMPLICATION MED./ NSG. MGT.
the 5th & final stage of MANIFESTATIONS DIAGNOSTIC FINDINGS
CKD
1. End product of Severe pain & discomfort • Creatine & BUN • Anemia due to reduce • Calcium &
protein Restless leg syndrome & incrase erythropoietin phosphorus binders
metabolism burning feet (general • Na+ & water production, to treat
accumulate in neuropathy) retention decreased RBC hyperphosphatemia
the blood • Acidosis lifespan, blood loss & hypocalcemia-
2. Uremia develops • Anemia during dialysis binds dietary
3. Build-up of waste • Calcium & • Bone disease & phosphorus in GI
products phosphorus metastatic & vascular tract.
4. Decline in renal imbalance calcifications, • e.g. calcium
function abnormal vit D carbonate or calcium
→ HPN metabolism, & acetate
→ protein inc. elevated aluminum • Sevelamer hcl a
• Hyperkalemia due to polymeric phosphate
decreased excretion, binder given if
metabolic acidosis, calcium ishigh
excessive intake • Erythropoeitin
(diet, meds, fluids) (epoetin alfa IV/SQ 3x
• Pericarditis, wk (takes 2-6 wks for
pericardial effusion hct to increase
due to retention of • mgt. of lines (heparin
uremic waste to prevent clotting
products & during dialysis
inadequate dialysis iron supplementation
• 500-600 ml fluid
intake a day
• high biologic value
protein
• Dialysis

BSN 3 | BLOCK 1 | MIDTERM 9 | 10

 N 1 RENAL DISORDERS
C 1 Lecturer: DOLLIMAR YOGORE, RN, MAN
M2 By: kaye

TREATMENT OPTIONS: ESRD 1. When is the best time to administer calcium acetate to a
patient with ESKD?
a. With food
b. 2 hours before meals
c. 2 hours after meals
d. At bedtime with 8 ounces of fluid

2. What are the two blood levels that are significantly

increased in acute kidney injury (AKI)?

• Hemodialysis cleans the blood by cycling your blood

through a machine that removes waste and toxins. It
then returns the blood to your body.

• Peritoneal dialysis lets

you perform dialysis at
home

WATCH VIDEO
https://www.youtube.com/watch?v=4Q2qQTWTaYc

• Unlike regular dialysis, which takes 3-4 hours,

continuous dialysis runs 24 hours a day and is
increasingly used in intensive care units for patients with
acute kidney failure because it is far gentler on the body.
CRRT provides more gentle solute (waste) and fluid
removal than standard dialysis techniques.

• CRRT - WATCH VIDEO:

https://www.youtube.com/watch?v=H6JfCxUnDmw

• As with any surgery, complications can occur. Some

complications may include:
• Bleeding, Infection, Blockage of the blood vessels to the
new kidney, Leakage of urine or blockage of urine in the
ureter, Lack of function of the new kidney at first

• KIDNEY TRANSPLANTATION - WATCH VIDEO

https://www.youtube.com/watch?v=BstUHzNAm2I

BSN 3 | BLOCK 1 | MIDTERM

10 | 10