INTRODUCTION

• When urine outflow is obstructed a large

fluctuating collection or mass of urine
forms in the kidney .This mass subsides as
retained .Urine finally passes into the
ureter and bladder .Stagnation of urine in
the kidney leads to infection .
Hydronephrosis is distension of the kidney
with urine that leads to progressive atrophy
and eventual destruction of the kidney.
 DEFINITION
• It is a non –inflammatory degenerative
disease of kidney.
• (or)
• It is a kidney disease characterized
by edema and the loss of urine due to
increased glomerular permeability.
 EPIDEMOLOGY
• Nephrosis is present as many as 7 children
per 10,000 population younger than 9 years
of age.
• The average age onset is 2.5 years with most
cases occurring between ages 2 and 6 years.
• In u.s the reported annual incidence rate of
nephrosis is 2-7 cases per 100,000 .
• There is a male predominance in the
occurrence of nephrosis.
 ETIOLOGY
• Structural abnormalities causes backward
pressure on the kidney when urine outflow
is obstructed .
 Birth causes
 BPH
 Cancer
 Pregnancy
 Rectal inspection
 Scarring of ureters
 Diabetes Mellitus
 ETIOLOGY (CONT.)
• Diabetes mellitus
• Hepatitis b
• Syphilis
• Carcinoma
• Leukemia
• Infectious disease
• Amyloidosis
 RISK FACTORS
• Diabetes
• Lupus
• Amyloidosis
• Reflux nephropathy
• Recent surgery of the urinary
tract
>Immune system disease (eg. Lupus)
AMYLOIDOSIS
PATHOPHYSIOLOGY
URETER CALCULI BPH

OBSTRUCTION OF URINE FLOW

URINARY RETENTION

COLLECTION OF URINE IN THE KIDNEY

SEVERE PAIN IN THE RETROPERITONEAL REGION

CHRONIC RETENTION LEADS TO PALPABLE MASS IN

THE KIDNEY
 CLINICAL
MANIFESTATIONS
• Acute extreme flank pain on the affected
side , pain may radiate to groin.
• Chronic mild discomfort on over affected
side.
• Chronic mild discomfort over the affected
side due to the blockage of urethra or
ureter .
• Urinary tract infections
• Nausea , vomiting , abdominal pain.
• Thromboebolism
• Edema
• Malnutrition
• Protein urea
• Irritability and loss of appetite
• Respiratory tract infections
 DIETARY MANAGEMENT
• A low salt diet (2 to 3g/day) help with
swelling in the hands and legs.
• Low protein diet (1 to 2 kg /day) may or
may not be helpful .
• Reduce the amount of fat and cholesterol
in diet .
 MEDICAL MANAGEMENT
• Immediate drainage of urine via needle
directly into the kidney through skin.
• Antibiotic therapy .
• Antibiotic to treat infection.
• Corticosteroid Therapy
• Diuretic Therapy
• Home monitoring of urine and Fluid
status
 SURGICAL
MANAGEMENT
• Surgery to remove obstruction.

• Urethral stent – bypass obstruction (this

is used in chronic nephrosis).
 PHARMACOLOGICAL
MANAGEMENT
• Prednisone – first line therapy.
Glucocorticoids-Prednisone, (prednisolone)
• Diuretics
• Plasma proteins
• Immunosuppressive Agents
 NURSING MANAGEMENT

• Monitor daily weight , intake and output and urine

specific gravity.
• Monitor CVP ,vital signs urethrostatic BP and
heart rate to detect hypovolemia.
• Monitor serum creatine to access renal function.
• Administer diuretics or immunosuppressive agents
as prescribed and evaluate patients response .
• Enforce mild to moderate sodium and fluid
restriction if edema is severe.
• Maintain fluid and electrolyte balance.
 NURSING DIAGNOSIS
• Risk for deficient fluid volume related to
disease process .
• Risk for infection related to treatment with
immunosuppressive agents.
• Imbalanced nutrition less than body
requirement related to damaged
metabolism .
1. RISK FOR DEFICIENT FLUID VOLUME
RELATED TO DISEASE PROCESS

IN TERVENTIONS
• Increase circulating volume and decreasing
edema.
• Monitor daily weight , intake and output and urine
specific gravity .
• Monitor CVP ,vital signs ,orthostatic BP and heart
rate to detect hypovolemia.
• Monitor serum BUN and creatine to assess renal
function.
• Administer diuretics or
immunosuppressive agents as prescribed
and evaluate patients response.
• Infuse iv ,albumin as ordered .
• Encourage bed rest for a days to help
mobilize edema .
 2.RISK FOR INFECTION RELATD
TO TREATMENT WITH IMMUNO
SUPPRESSIVE AGENTS

• Monitor for signs and symptoms of

infection.
• Monitor temperature relatively .
• Use aseptic technique for all invasive
procedures.
• Assess the nutritional status
– Encourage patients to take high caloric , low
protein , low sodium and low potassium snacks.
3.RISK FOR IMBALANCED NUTRITION
RELATED TO LOSS OF APPETITE

• Assess the nutritional status

• Encourage patients to take high

caloric , low protein , low sodium
and low potassium snacks.
 NURSING RESPONSIBILITY

• The nursing responsibility include

monitoring daily weight, intake and output
and urine specific gravity .
• Encouraging bed rest for few days to help
in mobilizing edema .
• Promote skin integrity , turn positions
every 2 hours.
 COMPLICATIONS
• End stage renal disease
• Infection
• Hypovolemia
• Altered drug metabolism due decrease in
plasma proteins
• Thrombo embolic complications , renal
vein thrombosis , arterial thrombosis and
cerebral artery thrombosis.
 PREVENTION
• Monitor for signs and symptoms of
infection.
• Monitor temperature routinely . Check
laboratory values for neutropenia.
• Use aseptic technique foe all invasive
procedures and strict hand washing by
patients.
 DIAGNOSTIC EVALUATION
• Physical examination- distended kidney is
palpable
• Bladder catheterization – detects the sites if
obstruction.
• Urine analysis –Indicates white blood cells and
red blood cells.
• Ultra sound – detects the cause of the obstruction.
• Creatinine clearance test
• Protein electrophoresis
 SUMMARY
Any degenerative disease of the kidney
tubules . The tiny canals that makeup
much of the substance of the kidney .
Nephrosis can be caused by kidney
disease or it may be a complication of
another disorder.