Class Objectives:
1. Relate pathophysiology to the normal processes of formation, concentration, and flow of urine.
2. Describe the etiology, pathophysiology, clinical manifestations, medical, pharmacological and nursing management, and client teaching associated with cystitis, urethritis, pyelonephritis, urinary tract infections, and urinary calculi.
3. Differentiate among the problems of pyelonephritis, glomerulonephritis, nephrotic syndrome, acute renal failure, and chronic renal failure.
4. Describe the etiology, pathophysiology, clinical manifestations, medical, pharmacological and nursing management, and client teaching associated with acute renal failure and chronic renal failure.
5. Differentiate among peritoneal dialysis, hemodialysis, and hemo-filtration in terms of purpose, action, indications for use, advantages and disadvantages, client learning needs and nursing responsibilities.
6. Discuss the pre-operative and post-operative considerations for clients undergoing renal and urological surgery including nephrectomy, urinary diversion, and renal transplant.
Content Outline
I. Functional Anatomy of the Kidney: Nephron
A. Function is urine production via Filtration & Reabsorption
B. Enzyme production: Renin, Erythropoietin , Renal prostaglandins
C. Electrolyte regulation: Na, K, Ca, Phosphate, Cl:
D. Regulation of acid-base balance
E. Excretion of Metabolic Waste Products: Urea, Creatinine-
II. ASSESSMENT OF RENAL FUNCTION
A. History & physical
B. Diagnostic Tests: UA-
Blood Chemistry- Creatinine 0.6-1.2
BUN - 10-20 normal
Creatinine clearance
Imaging- KUB, IVP, Renal arteriography, Ultrasound, CT scans & MRI
Cystoscopy
Biopsy
III. PROBLEMS OF URINARY EXCRETION
A. Infection --
1. Cystitis usually E coli (80%) & ascending
2. Pyelonephritis: Result of cystitis moving upward.
3. Treatment: Urinary analgesics & antiseptics, antibiotics
B. Obstruction
1. Benign Prostatic hypertrophy (BPH)
2. Renal Stones:
Types of stones
Primary treatment = local stones & visualize, hydration, adjust pH; 10% require surgical intervention
3. Cancers: Renal adenocarcinoma, Bladder tumors
C. Glomerulonephritis: immune, no infection
1. auto-immune: Systemic; SLE or scleroderma
2. antibodies react with circulating antigens; Post-streptoccal glomerulonephritis.
3. Symptoms
4. Treatment- nonspecific, monitor and support.
D. Nephrotic Syndrome: Group of symptoms with heavy proteinuria after glomerular damage.
1. Manifestations: proteinuria, anasarca: generalized edema, hypoalbuminemia, hyperlipidemia
2. Rx: identify underlying cause & treat. Control edema
IV. Renal Failure: continuum
Impairment- inability to concentrate urine output
Insufficiency- inability to excrete waste products
Failure- inability to excrete waste products
A. Acute Renal Failure
1. Oliguria (<400 cc/day) usual & Azotemia progressing to uremia
2. Etiology :
Prerenal: inadequate blood flow to kidneys renal ischemia
Intrarenal: primary renal diseases
Postrenal: obstruction and back pressure on kidneys
3, Phases:
Oliguric, Diuretic, Recovery
4. Treatment
a. Define cause & correct it, maintain pt while kidneys heal:
b. Fluid balance
c. Potassium: major concern
d. Nutrition: increased CHO; Protein, K & Na reduced.
e. Infection
B. Chronic Renal Failure: Can lose 80% of function before Sx.
1. Manifestations:
a. Metabolic: uremia (LOC-urea is toxin). CHO intolerance
b. Cardiovascular: hypertension -- CHF, K imbalances, Uremic Pericarditis
c. Electrolytes: Hyperkalemia, metabolic acidosis, Na can go either way, Mg
d. Dermatologic: pruritus + sensory neuropathies. Dry skin & hair, Yellowish discoloration .
e. Hematologic: anemia. Platelets bleeding.
f. GI: stomatitis, esophagitis, & GI bleeding. anorexia. Nausea & vomiting.
g. Neuro: changes in mentation, peripheral neuropathy.
h. Musculoskeletal: renal osteodystrophy:
i. Reproductive: infertility & libido. Amenorrhea.
j Respiratory: increased resp infections.
2. Management: treat reversible causes, preserve renal function, treat symptoms, prevent complications, provide comfort.
a. Modification of drug dosage
b. Hyperkalemia.
c. Hypertension
d. Renal osteodystrophy
e. Anemia
f. Fluid overload.
g. Protein catabolism -- urea production
C. Dialysis
1. Principles: Diffusion, Osmosis, Ultrafiltration
3. Peritoneal dialysis
3. Hemodialysis Vascular access necessary:
D. Renal Transplantation
1. Sources of kidneys: Living related, Cadaver
2. Tissue typing: ABO blood first, HLA (human leukocyte antigen)
3. Rejection: Hyperacute, Acute, Chronic
Review Immunosuppressives