Complex Renal Disorders

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Complex Renal Disorders

• Manny Ramos RN, MSN

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Glomerular Disorder

• Primary
• a. immunologic
• b. idiopathic
• Secondary
• a. diabetes mellitus
• b. SLE
• c. Good Pastures syndrome

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Physiology

• 20 of cardiac output flows thru kidneys
• 99 of filtrate reabsorbed in renal tubules
• GFR controlled by
• 1. Pressure volume of blood
• 2. Bowmans capsule pressure and
• colloid osmotic pressure

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Pathophysiology

• Glomerular disease affects filtration and
  permeability
• Manifestations
• Hematuria Proteinuria
• Edema Azotemia
• Oliguria Hypertension

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Acute Glomerulonephritis

• Glomeruli inflamed
• Poststreptococcal glomerulonephritis
• Increased permeability
• Manifestations
• hematuria, proteinuria
• edema, azotemia
• nausea/vomiting

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Rapidly progressive glomerulonephritis (RPGN)

• Diffuse glomerular damage
• Irreversible renal damage
• S/Sx
• flulike illness, oliguria, pain,
• HTN, hematuria, proteinuria

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Chronic glomerulonephritis

• End stage of other glomerular disorders
• Insiduous onset
• Hypertension, impaired renal function

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Nephrotic syndrome

• Proteinuria
• Hypoalbuminuria
• Hyperlipidemia
• Edema
• Increased risk for atherosclerosis

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Diabetic nephropathy

• Leading cause of ESRD
• microproteinuria
• glomerulosclerosis

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Lupus nephritis

• Immune complexes trigger glomerular injury
• Hematuria, proteinuria
• Dialysis and transplantation

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Collaborative Care

• Identify underlying disease process
• Preserve renal function

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Diagnostic tests

• Throat/ skin cultures
• ASO titer
• ESR
• KUB
• Kidney scan
• Biopsy
• BUN, crea, crea clearance, electrolytes
• Urinalysis, urine protein

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Medications

• Treat underlying disorders
• Symptom management
• Antibiotics
• Immunosuppressive therapy

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Treatment

• Bed rest
• Sodium restriction
• Protein restriction
• Plasmapheresis
• dialysis

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Health promotion

• Treat streptococcal infectioins
• Manage chronic conditions DM,SLE,HTN
• Avoid nephrotoxic medications

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Nursing diagnoses

• Excess fluid volume
• Fatigue
• Increased risk for infection
• Ineffective role performance

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Home Care

• Glomerular disorders are self limiting or
  progressive
• Lengthy course
• Self management

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Vascular Kidney Disorder
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Hypertension

• Results from or causes kidney disease
• Atherosclerosis
• Decline in renal function

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Renal artery occlusion

• Risk factors
• Abdominal trauma
• Vessel trauma
• Aortic or renal artery aneurysms
  atherosclerosis
• emboli

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Manifestations

• Slow onset may be asymptomatic
• Acute occlusion pain, n/v, fever, htn,
  hematuria, oliguria

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Diagnostic tests

• WBC
• Renal enzymes
• Treatment
• Surgery
• Anticoagulant treatment
• hypertension control

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Renal Vein Occlusion

• Occurs with nephrotic syndrome
• Deterioration of renal function
• Pulmonary embolism
• Diagnosis Renal venography
• TreatmentThrombolytic drugs,
• anticoagulant therapy

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Renal Artery Stenosis

• Causes atherosclerosis of renal artery
• fibromuscular dysplasia
• Manifestation
• Hypertension
• Epigastric bruit

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• Diagnostic tests
• Renal ultrasound
• Captopril test
• Renal angiography
• Treatment
• Percutaneous transluminal angioplasty
• Bypass graft of renal artery

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Kidney Trauma

• Blunt force or penetrating injury
• Minor injuriesContusion, hematoma,,
• capsule or cortex
  laceration
• Major injuries Kidney may shatter
• Renal artery or vein tear
• laceration

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Manifestations

• Hematuria
• Pain
• Localized swelling, tenderness, ecchymoses
• Turners sign
• Acute blood loss

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Diagnostic tests

• Hgb/ Hct
• Urinalysis
• AST
• Renal ultrasound
• CT scan, IVP, renal arteriography

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Treatment

• Minor kidney injuries bedrest, observation
• Major kidney injuries
• control hemorrhage
• prevent and treat shock
• Surgery
• Percutaneous arterial embolization

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Nursing care

• Assessment
• Interventions
• Prevention of complications

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Renal Failure
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Renal failure

• Kidneys unable to remove accumulated metabolites
• Altered fluid, electrolyte and acid-base balance
• 5 year survival rate on dialysis 31.3

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Acute renal failure

• Abrupt onset, rapid decline
• maybe reversible
• High mortality
• Risk factors major surgery or trauma
• Infection
• Hemorrhage