Kidney Disorders Flashcards
Hardening of renal arteries
Nephrosclerosis
Causes of Nephrosclerosis
-Prolonged Hypertension
-Diabetes
Seen commonly in older adults and is associated with atherosclerosis and hypertension
Benign neprhosclerosis
Usually occurs in young adults and is often associated with significant HTN (DBP <130)
Malignant nephrosclerosis
Clinical Manifestations of Nephrosclerosis
-Rare early in disease
- (+) proteinuria
- (+) casts in urine
Later manifestations:
-Renal insufficiency manifestations
Medical Management of Nephrosclerosis
-Aggresive antihypertensive therapy
(ACE Inhibitors, alone or in combination with other antihypertensive)
Is a genetic disorder characterized by the growth of numerous fluid-filled cysts in the kidneys, which destroy the nephrons?
Polycystic kidney disease (PKD)
Two forms of PKD
Autosomal dominant & Autosomal Recessive
Most common symptoms appear between 30-40 years of age
Autosomal dominant
Rare form and symptoms begin in the earliest months of life or in the utero
Autosomal recessive
Clinical Manifestations of PKD
-Hematuria
-Polyuria
- Hypertension
- Kidney stones
- Proteinuria
- Abdominal fullness
- Flank pain
Diagnostics for PKD
UTZ of kidneys
A preferred technique for diagnosis
UTZ of kidneys
Medical Management of PKD
-No cure
- Supportive
-BP control
-Pain control
- Antibiotics for infections
- Renal Replacement, if with kidney failure
It is a type of acute glomerulonephritis
Acute Post Streptococcal Glomerulonephritis
Common among children and young adults, but can affect all age groups
Acute Post Streptococcal Glomerulonephritis
Develops 5 to 21 days after an infection of tonsils, pharynx, or skin by GABHS
Acute Post Streptococcal Glomerulonephritis
Clinical Manifestations of Acute Post Streptococcal Glomerulonephritis
-Hematuria (microscopic or macroscopic)
-Urine may appear as tea-or cola- colored
-Edema
-Azotemia
- Proteinuria
- Hypertension
Abnormal concentration of nitrogenous wastes in blood
Azotemia
APSGN Diagnostics
-Anti-streptolysin O (ASO Titer)
-Urinalysis
- BUN
-Creatinine
Determines the presence of immune response to strep
ASO Titer
Reveals the presence of hematuria
Urinalysis
Prognosis of APSGN
->95% recover completely
-5% to 15% develops chronic glomerulonephritis
-1% develops irreversible renal failure
Medical Management of APSGN
-Bed rest until s/sx of glomerular inflammation and HTN subside
-Diet: low protein, low sodium, fluid restricted
-Antibiotics, only if strep infection is present
Nursing Management of APSGN
-Early detection and prompt treatment of sore throats and skin lesion
- Encourage to take full course of antibiotic
- Encourage good personal hygiene
- Instruct to comply with prescribe diet and fluid restriction
Is a type of kidney disease characterized by increased glomerular permeability and is manifested by massive proteinuria
Nephrotic Syndrome
Nephrotic Syndrome Clinical Manifestations
-Edema
-Massive proteinuria
- Hypertension
- Hyperlipidemia
- Hypoalbuminemia
Nephrotic Syndrome Complications
-Infection
- Thromboembolism (Most commonly affects renal vein)
- Pulmonary embolism
-Acute kidney injury
-Accelerated atherosclerosis
Nephrotic Syndrome Medical Management (Goals)
-Treat underlying cause
-Slow progression of CKD
- Symptomatic relief
Nephrotic Syndrome Medical Management
-Diuretics, as ordered
-ACE inhibitors (to reduce proteinuria)
-Lipid (Lowering agents for hyperlipidemia)
Refers to the stone
Calculus
Refers to stone formation
Lithiasis
More common among men, except for struvite stones
Urinary Tract Calculi
Types of kidney stones
-Calcium stone
- Uric acid stone
- Struvite stone
- Cysteine stone
Small, often possible to get trapped in the ureter
Calcium oxalate stones
Risk factors of calcium oxalate stones
-Idiopathic hypercalciuria
- Hyperxaluria
-Family history
Mixed stones, with struvite or oxalate
Calcium phosphate stones
Predisposing factors of calcium phosphate stones
-Alkaline urine
- Primary hyperparathyroidism
3-4 x more common among women
Struvite stones
Always associated with UTI; large staghorn type
Struvite stones
Predisposing factors of struvite stones
UTIs (Usually Proteus)
Predominant in men, high incidence among Jewish men
Uric Acid Stones
Predisposing factors uric acid stones
-Gout
-Acidic Urine
- Heredity
A sulfur-containing amino acid
Cysteine
Genetic autosomal recessive defect causing a defective absorption of cysteine
Cysteine Stones
Predisposing Factors of Cysteine Stones
Acidic Urine
Clinical Manifestations of Urinary Tract Calculi
-Severe, sharp flank area, back, or lower abdominal pain (renal colic)
-Pain may radiate to groin area + testicular/labial pain
-Nausea and vomiting
-Cool, moist, skin
- Dysuria
- Fever and chills
Medical Management of Urinary Tract Calculi (First Approach- Acute Attacks)
-Opioid analgesics for renal colic
-Alpha Adrenergic Blockers
Tamsulosin (Flomax)
Terazosin (Hytrin)
-Increase oral fluids
Medical Management of Urinary Tract Calculi (Second Approach)
Identification of cause and prevention of further stone formation
-Increase oral fluids
-Dietary restrictions
- Pharmacotherapy
For small stones inside the bladder
Cystocopy
For large stones
Cystolitholapaxy
A lithotrite breaks up stones
Cystolitholapaxy
Bladder is then irrigated
Cystolitholapaxy
is a procedure used to eliminate calculi from the urinary tract
Lithotripsy
Used to fragment ureteral and large bladder stones
Laser Lithotripsy
is inserted to gain access to stones
Ureteroscope
Is used to break stone into small pieces
Holmium laser
Uses high-energy shock waves to shatter kidney stones without damaging surrounding tissues
Extracorporeal Shockwave Lithotripsy (ESWL)
It produces high-energy acoustic shock waves
High voltage spark generator
Stone is broken down into
Fine sand and excreted in urine
An ultrasonic probe is placed in the renal pelvis via a percutaneous nephroscope inserted through a small incision in the flank and is then positioned against the stone
Percutaneous Ultrasonic Lithotripsy
In percutaneous ultrasonic lithotripsy, the anesthesia given is
spinal/general anesthesia
The probe is positioned directly on a stone, but it breaks the stone into small fragments that are removed by forceps or by suction
Electrohydraulic Lithotripsy
A continuous saline irrigation flushes out the stone particles, and all the outflow drainage is strained so that the particles can be analyzed
Electrohydraulic Lithotripsy
Electrohydraulic Lithotripsy (post-op expectations)
(+) moderate to severe colicky pain
Bright red urine on first few urinations
Urine becomes dark red as bleeding subsides
Antibiotics will be ordered to prevent infection
An incision into the kidney to remove a stone
Nephrolithotomy
An incision into the renal pelvis for stone removal
Pyelolithotomy
For stones located within the ureter
Ureterolithotomy
Urinary Tract Calculi Dietary Therapy
-Encourage high fluid intake (approx. 3L/day)
-Water is preferred
- Colas, coffee, and tea increases risk of recurring urinary calculi and therefore should be limited
-Low-sodium diet
-High sodium intake increases calcium excretion in urine
Urinary Tract Calculi Nursing Management
-Encourage fluid intake (consult with physician for volume)
- Facilitate mobility for patients on bed rest (to maximize urinary flow)
- Turn to sides every 2 hours
- Assist with dangling or standing
- Strain all urine to ensure that any spontaneously passed stones are retrieved
- Encourage ambulation to promote movement of the stone from the upper to the lower urinary tract
are caused by pathogenic microorganisms in the urinary tract
Urinary Tract Infection
Second most common infection in the body
Urinary Tract Infection
Types of lower UTI
-Cystitis
-Prostatitis
- Urethritis
Types of upper UTI
-Pyelonephritis
- Nephritis
inflammation of the urinary bladder
cystitis
inflammation of the prostate gland
Prostatitis
Inflammation of the urethra
Urethritis
Inflammation of the renal pelvis
Pyelonephritis
Inflammation of the kidney
Nephritis
UTI classifications
Uncomplicated UTI
Complicated UTI
A community-acquired infection , common in young women and not usually recurrent
Uncomplicated UTI
Hospital-acquired (commonly related to catheterization); occur in a patient with urologic abnormalities, pregnancy, immunosuppression, diabetes, and obstructions; often recurrent
Complicated UTI
Causative microorganisms of UTI
-Klebsiella
-E.coli (most common)
-Enterococcus
-Proteus
- Pseudomonas
- Staphylococcus
Patients who have been previously treated with antibiotics
Enterococcus
Clinical Manifestations (Lower UTI) “BURICAT”
B- Burning on urination
U- Urinary frequency and urgency
R- Red urine (Hematuria)
I- Incontinence
C- Confusion (older adults), Chills
A- Awaken at night to urinate (nocturia)
T- Temperature elevated
Clinical Manifestation (Upper UTI)
-Same as lower UTI
-Flank pain
- Pain at costovertebral angle
Nursing Management of UTI
-Encourage liberal amounts of WATER
- Avoid urinary tract irritants (coffee, tea, citrus, spices; colas, alcohol)
-Instruct to empty bladder completely (void every 2-3 hours)
-If patient is with indwelling catheter, use strict aseptic technique and maintain a closed system
Patient education to prevent UTI
-Shower rather than bathe in the tub
- Wipe from front to back
- Increase oral fluid intake to avoid urinary tract irritants
- Urinate every 2-3 hours during the day, and completely empty the bladder
-Take medications exactly as prescribed
-Acidify urine with ascorbic acid (vitamin C) 1 gram once daily for recurrent infections
-Notify physician if fever occurs or if with persistent s/sx
- Consult physician regular for follow-up
