Leg 5 Renal Disorders

8/4/2019 Leg 5 Renal Disorders

1/82

V. Renal Disorders

A. INFLAMMATORY DISORDERS


2/82

LETS HAVE AREVIEW


3/82

A. INFLAMMATORY DISORDERS

GLOMERULUS----Tuft of capillaries, capillary network in thekidneys; filters the blood that would pass the kidney

BOWMANS CAPSULE--- cuplike structure that covers

the glomerulus;


4/82

Whats our firstdisease?


5/82

1. Post Streptococcal glomerulonephritis

a. Acute Glomerulonephritis Inflammation of the glomerular capillaries

Complication of streptococcal infection e.g. URTI, middleear infections, strep throat

Occurs 2-3 weeks after the antecedent infection


6/82


a. Acute Glomerulonephritis

CA- Group A beta hemolytic streptococcus

Caused by trapping of antibodies and antigen complexes in

the kidneys


7/82


What should I expect

from a person withAGN?


8/82



1. Edema, generalized-a.k.a anasarca

- As the colloid osmotic pressure of blood drops and sodium is retained


9/82



2. proteinuria

- Due to increased glomerular permeability


10/82



3. Cola-colored urine, coffee -colored

- Due to hematuria; protein ad RBC leaked into it


11/82



4. s/s of anemia

-decreased production of erythropoietin


12/82



5. Increase in BUN and creatinine level

-


13/82



6. Flank pain / back pain

-Due to the swelling of kidney tissues thus stretching the capsule


14/82



7. Hypertension

-due to the increase in renin secretion and decrease in GFR, due to water andsodium retention-----triggered by the decrease in blood flow leading to renin secretion thus HPN


15/82



8. Urine output decreases

-GFR declines, water and sodiumretention


16/82



9. Azotemia

-concentration of urea and other nitrogenous wastes in the blood


17/82


What should I do to a

patient with AGN?


18/82

management


1. penicillin

Drug of Choice for strep infection


19/82

management


2. Corticosteroids

To decrease production of antibodies and antigen complexes


20/82

management


3. Glucocorticoids

To reduce inflammation


21/82

management


4. Anti-hypertensive

Reduce blood pressure


22/82

management


5. Sodium restriction, CHON and fluid intake is reduced

Carbs are given to reduce catabolism of protein


23/82

management


6. Monitor intake and output


24/82


We are done with AGN.Lets proceed to the

Chronic form!!!


25/82


a. Chronic Glomerulonephritis

Due to repeated episodes of acute glomerulonephritis,

hypertensive nephrosclerosis (hardening of renal

arteries), hyperlipidemia


26/82



Kidneys are reduced to as little as one fifth their normal size

Cortex layer shrinks to 1-2 mm in thickness or less

Glomeruli and their tubules become sccarred and the branches of

the renal artery are thickened- severe glumerular damage -ESRD


27/82

management


5. Sodium restriction, CHON and fluid intake is reduced

Carbs are given to reduce catabolism of protein


28/82


What should I expect from aperson with CGN?


29/82

Assessment findings


1. hyperkalemia

Due to decrease potassium excretion, acidosis, catabolism and excessivepotassium intake from foods and medications


30/82

Assessment findings


2. anemiaSecondary to decreased erythropoiesis a.k.a

Production of RBC


31/82

Assessment findings


2. anemiaSecondary to decreased erythropoiesis a.k.a

Production of RBC


32/82

Assessment findings


3. Hypoalbuminemia with edema-

to protein loss through damaged glomerular membrane


33/82

Assessment findings


4. Increase serum phosphorous

Due to decrease renal excretion of phosphorous


34/82

Assessment findings


5. Decreased serum calcium level

Calcium binds to phosphorous to compensate for elevated serum phosphorouslevels


35/82

Assessment findings


6metabolic acidosis

From decreased acid secretion by the kidney and inability to regeneratebicarbonate


36/82

Assessment findings


7. Mental status changes

Headache, dizziness, increasing irritability,


37/82

Assessment findings


8. Digestive disturbancesLoss of weight


38/82

Assessment findings


9. nocturia


39/82

Assessment findings


10. Impaired nerve conduction

due to electrolyte abnormalities and uremia


40/82

What are the diagnosticfindings in pts with

Chronic GN?


41/82

Diagnostic Tests


1. Blood tests

Increased serum urea Increased creatinine Decreased GFR


42/82

Diagnostic Tests


2. Blood levels

Presence of streptococcal antibodies, Antistreptolysin O exoenzyme


43/82

Diagnostic Tests


3. urinalysis

Presence of proteinuria Gross hematuria Erythtrocyte


44/82

management


1. CHON restrictionIf there is renal insufficiency and nitrogen retention


45/82

management


2. Sodium restriction

For patients with HPN, edema and heart failure


46/82

management


3. MIO

Plus daily weight monitoring


47/82

management


4. Dialysis


48/82

management


5. Diuretic

Treat fluid overload


49/82

What is the next diseasethat we will discuss?


50/82

Nephrotic Syndrome

Primary glomerular disease


51/82

Nephrotic Syndrome

Marked proteinuria

Hypoalbuminemia

Edema

hyperlipidemia


52/82

Nephrotic Syndrome

Marked proteinuria

- Increased protein or albumin in the urin


53/82

Nephrotic Syndrome

hypoalbuminemia

1. Decreased albumin in the blood


54/82

Nephrotic Syndrome

edemaIncreased permeability


55/82

Nephrotic Syndrome

hyperlipidemiaHigh serum cholesterol and low density

lipoprotein


56/82

Nephrotic Syndrome

Hyperlipidemia

Results from

increased hepatic llipoprotein synthesis in response todecreased serum albumin


57/82

Will someone do me a

discussion on the causes

of the disease?


58/82


59/82

Causes

2. Nephrotic syndrome

1. Chronic glomerulonephritis2. DM with intercapillary glomerulosclerosis3. Amyloidisis of the kidney ( infiltrated with amyloid, a starch-like

substance


60/82

Causes


4. Multiple myeloma (malignant, in the bone marrow)5. Systemic lupus erythematosus ( chronic inflammatory disease)6. Renal vein thrombosis- can obstruct blood flow


61/82

Clinical manifestations


1. Urinalysis

Marked proteinuria Lipiduria and casts (fatty, epithelial hyaline) Frothy urine


62/82



2. Edema

Soft and pitting Commonly occurs:-- around the eyes (periorbital

edema),----in dependent areas ( sacrum, ankles,

hands)----abdomen (ascites)


63/82



2. Irritability3. Headachemalaise


64/82



3. Weight gain and pallor

li i


65/82

complications


66/82

Complication


1. Skin breakdown Because of impaired arterial flow and capillary exchange

C


67/82

Complication


2. infection Due to a deficient immune response

C li i


68/82

Complication


2. thromboembolism Especially in the renal vein

C li i


69/82

Complication


4. Pulmonary emboli

C li ti


70/82

Complication


5. ARF

Due to hypovolemia

C li ti


71/82

Complication


6. Accelerated atherosclerosis

Due to hyperlipidemia

t


72/82

management

t


73/82

management

1. diuretics

Prescribed for severe edema

management


74/82

g

2. Angiotensin- converting enzyme( ACE) inhibitors plus loop diuretics Taken for 4-6 weeks to be effective Ex. Ramipril- decrease CHON loss in the urine

management


75/82

g

3. Corticosteroids

To decrease the immune response

management


76/82

g

4. Diet

Low sodium + Liberal potassium- for those who have no hyperkalemia Enhances the Na-K pump mechanism and assists in elimination of sodium to reduce

edema

Low fat low protein Help lower lipidemia

management


77/82

g

5. glucocorticoids

Prednisone To reduce inflammation Other meds including antineoplastic agents, immuno-suppressants and

cyclosporine

Nursing management


78/82

g g

1. Early stages of nephrosis Similar to AGN

2. If nephrosis Worsens, Similar to Chronic Renal Failure


79/82

Nursing management

3. If receiving corticostroids, instruct about about meds

s/s that should be reported to physician including s/s of

infection


80/82

Nursing management

4. Dietary instructions

Low protein. Low fat low sodium liberal potassium


81/82


82/82

The end

Documents

Leg 5 Renal Disorders