Review on function of the

kidney
Nephrons are the functional
unit of the kidneys

Insert fig 23-4

 Three Basic
Processes to
Produce Urine:

FILTRATION
 the movement of water
and solutes from the
plasma in the glomerulus,
across the glomerular
capsule membrane and
into the capsular space
of the Bowman’s capsule.
REABSORPTION- movement of
molecules out of the tubule and into
the peritubular blood;
 about 80% of water, sodium, potassium,
chloride, and most other substances is
reabsorbed.
 about 20% of the glomerular filtrate enters
the loop of Henle.

 Descending limb of the loop of Henle>>water is

reabsorbed;
 Ascending limb>>sodium is reabsorbed.
 Distal Tubule>>sodium is reabsorbed
 Final reabsorption of water>>distal tubule and
small collecting tubules.

 The remaining water and solutes are now

appropriately called urine.
SECRETION- movement of
molecules out of the
peritubular blood and into
the tubule for excretion.
 Proximal tubule - uric
acid, creatinine,
hydrogen ions, and
ammonia are
secreted;
 Distal tubule -
potassium ions,
hydrogen ions, and
ammonia are
secreted.
DIURETICS
 Produces increased urine flow by
inhibiting sodium and water
reabsorption from the kidney
tubules.

2 main purposes:
 To decrease hypertension

 To decrease edema
INDICATIONS:
 Congestive heart failure
 Pulmonary edema

 Liver failure & cirrhosis

 Renal diseases

 Hypertension

 Glaucoma
 CONTRAINDICATIONS:
 Allergy
 Fluid & electrolyte imbalances

 Severe renal diseases

 SLE

 DM
 I. Thiazide Diuretics
 MOA: increase Na & water excretion by inhibiting
Na reabsorption in the distal tubule of the kidney
 ** not effective for immediate diuresis
 Uses: mild- moderate HPN, edema associated
with CHF, cirrhosis with ascites
 Warning: decrease K, renal/ hepatic dysfunction,
gout
 DI: + lithium = lithium toxicity
+ digoxin = digoxin toxicity ( bradycardia,
N/V, visual changes)
+ corticosteroids, amphotericin, ticarcillin =
hypokalemia
+ sulfonamides = cross sensitivity
 SE/ AE: hypokalemia, hyponatremia,
hypomagnesemia, hypotension,
bicarnonate loss, hypercalcemia,
hyperglycemia,hyperuricemia, N/V,
constipation, rashes, dizziness, weakness,
increase LDL, photosensitivity, H/A,
dehydration, blood dyscrasias

 Eg: chlorothiazide (Diuril)

chlorthalidone ( Thalitone)
hydrochlorothiazide ( Hydrodiuril)
indapamide ( Lozol)
metolazone ( Zaroxolyn)
 Nursing Responsibilities:
• Monitor BP, wt OD, urine output, edema
• Monitor K, Na, Ca, blood glucose, LDL,
triglycerides
• Change position slowly
• No alcohol
• Take with meals preferably in AM
• Eat foods high in K ( banana, avocado,
broccoli, dried fruits, oranges,
nuts ,potato, prunes, tomato)
• Manage photosensitivity
Signs of hypokalemia (muscle weakness, cardiac
dysrhythmias, cramps, dizziness, N/V, tingling
sensation, “U” wave on the ECG (3.5 – 5.1 mEq/L)
 T-ake time to check VS
 H-yperglycemia, hypokalemia,
hyperuricemia monitoring
 I-nstruct to weigh in daily
 A-void sudden position changes
 Z-ugar monitoring
 I- &O monitoring
 D-iuresis is expected: I&O
 E-at potassium rich foods
 II Loop Diuretics
 MOA: inhibits Na & Cl absorption from the
loop of henle and distal tubules , causes
rapid diuresis, little effect on glucose
 USES: HPN, edema associated with CHF,
cirrhosis with ascites, hypercalcemia
 DI: same with thiazides
 SE/AE : hypokalemia, hyponatremia,
hypocalcemia, hypomagnesemia,
hypochloremia, hyperuricemia, orthostatic
hypotension, constipation, N/V
 decrease platelet, ototoxicity ( IV bumetanide),
dehydration, photosensitivity, thiamine deficiency,
hyperglycemia (glycogenolysis), elevated BUN &
creatitine
 Eg: furosemide (Lasix)

torsemide ( Demadex)
ethacrynic acid (Edecrin)
bumetanide (Bumex)
Nursing Responsibilities:
 Monitor VS, edema, urine output, serum K. Na,
Ca, Cl, thiamine, blood glucose & platelet levels,
Mx of digoxin & lithium toxictiy
 Potassium rich foods

 Give slow IVTT (2 mins) to prevent hearing loss

 With food, in AM
 C-heck for weight gain
 E-nsure VS prior to administration

 I-& O monitoring

 L-aboratory values assessment

 I-nstruct to rise slowly

 N-octuria prevention:

 G-ive it with meals

 III Osmotic Diuretics
 MOA: increase osmotic pressure in the
glomerular filtrate, preventing reabsorption of
water & electrolyes
 USES: increase ICP, edema, prevention of
renal failure, oliguria, inducing diuresis during
chemotherapy
 CI: anuria
 DI: increase hypokalemia which may increase
digoxin toxicity
 SE/ AE: pulmonary edema d/T rapid fluid
shifting, NV, tachycarida, decrease Na, K, Cl,
Ca, dehydration
 Eg: mannitol (Osmitrol)
urea (Ureaphil)
glycerin ( Osmoglyn) = dec IOP
isosorbide (Ismotic)
 Nursing Responsibilities:
• Monitor VS, wt, urine output, serum NA, K, Cl,
Ca
• Watch for rapid inc in BP & rapid sympathetic
overactivity ( inc HR, tremor, agitation)
• Assess lung and heart sounds
• Check skin turgor, LOC, Mx of dec ICP
• Mannitol: check bottle or vial for crytallization,
warm bottle & shake vigorously to dissolve
crystals, if it doesn’t dissolve= DO NOT
administer
: use IV line with filter
: infuse for 30- 60 minutes
O liguria, edema, inc. ICP(indication)
S tops reabsoprtion of water
M annitol
O utput of urine, electrolytes - monitor
T issue dehydration UE
I ncreased frequency/volume of urination
C irculatory overload UE
 IV Potassium Sparing Diuretics
 MOA: acts on the distal tubule to promote Na and
water excretion & prevent potassium excretion;
AKA: Aldosterone antagonist
 USES: HPN, edema = CHF, nephrotic syndrome
to counteract hypokalemia caused by other
diuretics
 CI: severe renal disease, severe hyperkalemia

 DI: + lithium = lithium toxicity

+ ACE inhibitor = hyperkalemia
+ digoxin = digoxin toxicity
+ K supplements (eg kalium durule) =
hyperkalemia
SE/AE: hyperkalemia, N/V, diarrhea, dry mouth,
rash, dizziness, weakness, bluish colored urine
(triamterene) hypotension, increase potassium
level result in peaked T wave on ECG
 AE: HA, photosensitivity, anemia,
decrease platelet
 Eg: spironolactone (Aldactone)
: amiloride (Midamor)
: triamterene (Dyrenium)
 Nursing Responsibilities:
• Monitor VS, urine output, serum K level
• Inform client that hypotensive effects may not
be seen for 2 weeks
• Avoid potassium rich foods
• Manage photosensitivity
• Avoid salt substitutes
• Take with meals
• Bluish colored urine is harmless
• Administer in Am
 Interventions for DIURETICS
 D-iet: decrease  T-ake early in the
sodium intake day; with meals
 I-ntake & output  I-nteractions:digoxin
monitoring  C-ause/aggravate
 U-ndesirable diabetes
effects  S-ensitivity to
 R-eduction of sunlight
edema
 E-lectrolytes
review
 Food Sources
 Potassium Rich foods: banana, avocado,
broccoli, dried fruits, oranges, nuts
,potato, prunes, tomato
 Sodium Rich Foods: buttermilk,
margarine, canned goods, processed
foods, fast foods, preserved foods, tomato
ketchup
 Calcium rich foods: broccoli, dairy & milk
products, seafoods, spinach