DIGITAL NOTEBOOK

NEPHROLOGY
Submitted by:
Gandulfo, R.A.E.
 DIGITAL NOTEBOOK

ACUTE
GLOMERULONEPHRITIS
WHAT IS IT? ANATOMY AND PHYSIOLOGY

KIDNEYS URINARY TRACT

refers to

inflammation

of the

glomeruli (tiny

filters of the

kidney)

Classified into acute or chronic

1. Acute = sudden, Glomerulo = glomerulus, Nephritis = inflammation
a. symptoms develop suddenly and resolve with treatment
2. Chronic = gradual, Glomerulo = glomerulus, Nephritis = inflammation
a. when the disease process develops slowly, leading to irreversible
failure of the kidneys.

PREDISPOSING VS. PRECIPITATING FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. C3 complement blood test

PREDISPOSING PRECIPITATING 2. Urinalysis
3. Clinical Chemistry Test
4. Blood Study
1. Age 5. C-Reactive Protein test and Erythrocyte
1. Post infection Sedimentation Rate
2. Gender
2. Poor hygiene
3. Autoimmune MEDICATIONS and OTHER TREATMENTS
3. Low
disease
socioeconomic
4. Family history
status
of kidney Benzylpenicillin Phosphate binders Diuretics (Lasix)

disease 4. Obesity

5. Race

Benazepril adequate rest low salt diet

DIGITAL NOTEBOOK

ACUTE
GLOMERULONEPHRITIS
GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

REMEMBER THE MNEMONIC: RATIONALE:

PHAFAGOH 1. protein leak into the urine =
high levels of protein in the
urine.
1. PROTEINURIA 2. tea-colored, reddish brown,
or smoky urine from red
2. HEMATURIA blood cells.
3. due to decreased glomerular

3. AZOTEMIA filtration rate (GFR)

4. due to the decreased protein

4. FATIGUE and albumin in the body.

5. increased capillary
permeability = excretion of
5. ALBUMINURIA
albumin in the urine.
6. loss of the proteins from
6. GENERAL
blood allows fluid to leak out
of the blood vessels into the
EDEMA
nearby tissues causing
swelling.
7. OLIGURIA
7. due to decreased glomerular
filtration rate (GFR)
8. HYPERTENSION
8. due to sodium retention
leading to fluid overload =
RAAS activation

NURSING DIAGNOSIS

Excess fluid volume related to decreased glomerular filtration rate and retention of sodium and
water secondary to acute glomerulonephritis as evidenced by facial and leg edema, proteinuria,
hematuria, and blood pressure level of 190/100.

Impaired urinary elimination related to decreased glomerular filtration rate as evidenced by

decreased urinary output and edema.

Risk for activity intolerance related to increased capillary permeability which leads to
hypoproteinemia and hypoalbuminemia.
NURSING
INTERVENTIONS
Monitor BUN, creatinine, white blood cell (WBC)
count. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate
fluid intake (2–4 L per Instruct patients to
day), avoiding caffeine
and use of aspartame. maintain fluid
restrictions as Assess the level of
indicated. weakness and fatigue
ability to move about in
bed and engage in play
activities.
Encourage
frequent position
changes. Schedule care

and provide rest Refer to a dietician

periods after any for a consultation
Elevate edematous to develop a meal
activity in a quiet
body part while in plan low in sodium,
bed or sitting in a environment. potassium, and
chair.
protein that
includes preferred
foods as allowed.
Monitor VS q4. Auscultate breath sounds for the
presence of crackles. Observe increased work
of breathing, cough, and nasal flaring.
DIGITAL NOTEBOOK

NEPHROTIC SYNDROME
WHAT IS IT? ANATOMY AND PHYSIOLOGY

KIDNEYS URINARY TRACT

kidney disorder

where there is

altered glomerular

permeability due to

an autoimmune

process. The

increased glomerular

permeability to

plasma proteins

results in abnormal

loss of protein in

urine.

The Nephrotic Syndrome occurs in 3 forms; congenital,

secondary, and idiopathic (Primary)

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Urine Dipstick
Primary - include PREDISPOSING 2. 24-hour Urine Test
kidney
Genetic variation, or 3. MRI or Renal Biopsy
diseases such as
mutations 4. ACR (Albumin to Creatinine)
minimal change 5. Clinical Chemistry Test
nephrotic syndrome, Race

membranous Gender
nephropathy, and MEDICATIONS and OTHER TREATMENTS
Age
focal segmental Inherited syndromes
glomerulosclerosis

PRECIPITATING
Secondary - include
Health History of Phosphate binders Diuretics (Lasix)
Benzylpenicillin
systemic diseases
such as diabetes Kidney Diseases

mellitus, lupus Infections

erythematosus, and Systemic Diseases
amyloidosis Certain medications adequate rest low salt diet
DIGITAL NOTEBOOK

NEPHROTIC SYNDROME
GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

REMEMBER THE MNEMONIC: RATIONALE:

PHHAGA
1. increased glomerular
permeability causes less
retention in protein thus
1. PROTEINURIA protein escapes into the
urine
2. HYPERLIPI-
2. liver tries to compensate for
the loss of protein in the
DEMIA
blood by producing
lipoproteins
3. HYPOALBUMI-
3. albumin is lost through urine
- causes a shift in osmotic
NEMIA
pressure
4. shift in Osmotic pressure
4. GENERAL
causes the fluid to shift from
bloodstream to interstitial
EDEMA
tissue
5. feeling of fullness and loss
5. ANOREXIA
of appetite

NURSING DIAGNOSIS

Excess fluid volume related to fluid accumulation in tissues and third spaces as evidenced
by abdominal ascites

Imbalanced nutrition, less than body requirements, related to inability to absorb nutrients
evidenced by Edema of Intestinal tract affecting absorption

Fatigue related to edema and disease as evidenced by weakness, and lethargy

NURSING
INTERVENTIONS
Explain the need to use anti-embolic stockings
or bandages, as ordered. Advise patient to
follow required
medications/
Balance the activity treatment regimen.
with rest periods and
encourage to rest Instruct patients to
when fatigued; plan maintain fluid
quiet, age-appropriate
activities. restrictions as Assess the level of
indicated. weakness and fatigue
ability to move about in
bed and engage in play
Assess for crackles in activities.
the lungs, changes in
respiratory pattern,
shortness of breath, Inspect all skin
and orthopnea. surfaces regularly
for breakdown; turn Monitoring fluid intake
and position every 2 and output. Accurately
hours; protect skin monitor and document
surfaces from intake and output;
Elevate edematous
pressure by means weigh patient at the
body part while in
bed or sitting in a of pillows and same time every day,
chair. padding. on the same scale in
the same clothing;
measure the abdomen
daily at the level of the
Offer a visually appealing and nutritious diet; umbilicus.
consult the patient and the family to learn which
foods are appealing; serving six small meals may
help increase the total intake better.
DIGITAL NOTEBOOK

WILMS TUMOR
WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM

Wilms tumor or nephroblastoma is a type of childhood

cancer that starts in the kidneys - most common type

of kidney cancer in children. It can develop in one or

both kidneys and usually grows slowly.

RISK FACTORS
DIAGNOSTIC/LABORATORY TESTS

1. Age 1. Abdominal Computed

Tomography (CT or CAT) Scan
2. Gender
2. Urinalysis
3. Family history of kidney disease
3. Hematology
4. Race 4. Serum alkaline phosphatase test
5. Certain genetic syndromes/birth defects

a. WAGR syndrome - a condition that causes a number of MEDICATIONS and OTHER TREATMENTS
birth defect; it stands for: Wilms tumor, Aniridia (no iris

in the eye), Genitourinary abnormalities, and Intellectual

disability

b. Beckwith-Wiedemann syndrome - causes enlarged Analgesics Chemotherapy drugs Antipyretics

internal organs and limbs

c. Denys-Drash syndrome - a rare condition in which

male genital organs do not develop correctly and there

is an increased risk of developing a Wilms tumor Nephrectomy adequate rest low salt diet
DIGITAL NOTEBOOK

WILMS TUMOR
GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. LARGE PAPABLE
1. sign of growing tumor

UNILATERAL 2. pain in the abdomen from

pressure on other organs
FLANK MASS near the tumor
3. due to kidney
2. ABDOMINAL PAIN
hemihypertrophy
3. CONSTIPATION 4. invasion of the renal pelvis or
hypertension from
4. HEMATURIA
compression of the renal

5. SYSTEMIC artery
5. body is trying to fight off
RESPONSES inflammation and growing
tumor cells
(FEVER, NAUSEA,
6. an increased plasma
WEAKNESS) concentration of renin, which
is produced by areas of the
6. RENIN SECRETION
kidney cortex entrapped
within the tumor

NURSING DIAGNOSIS

Acute pain related to disease process secondary to wilms tumor as evidenced by

flank and abodminal pain

Anxiety-related to change in health status and the threat of death as evidenced by "takot
man ako mamatay dahil sa sakit ko"

Ineffective protection related to antineoplastic agents, radiation therapy, or leukopenia

NURSING
INTERVENTIONS
Avoid any palpation of abdominal mass. Advise patient to
follow required
medications/
treatment regimen.
Provide Assess the source and
nonpharmacological
comfort level of anxiety and
measures. need for information Assess for bleeding
and support that will from any site and febrile
relieve it. episodes; Monitor WBC,
platelet count,
hematocrit, absolute
Encourage neutrophil count.
frequent position
changes. Schedule care

and provide rest Assess oral cavity

periods after any for pain ulcers,
Prevent transfer of lesions, gingivitis,
microorganisms. activity in a quiet
Perform hand
mucositis or
washing prior environment. stomatitis and
giving care. effect on the
ability to ingest
food and fluids.
Monitor VS q4. Auscultate breath sounds for the
presence of crackles. Observe increased work
of breathing.
DIGITAL NOTEBOOK

ACUTE RENAL FAILURE

WHAT IS IT? ANATOMY AND PHYSIOLOGY

KIDNEYS URINARY TRACT

sudden decline in
renal function that
occurs when
kidneys suddenly
become
unable to filter
waste products
from your
blood

3 types of acute renal failure

Prerenal - occurs when the blood supply to the kidneys is compromised or
reduced; most common type occurring in almost 60 to 70% (hypovolemia,
burns)
Intrarenal - includes conditions that cause direct injury or damage to the
kidneys (ischemia, toxins, immunologic process)
Postrenal - conditions that cause blockage or obstruction to urine flow

PREDISPOSING VS. PRECIPITATING FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Serum creatinine and BUN

PREDISPOSING PRECIPITATING 2. Urinalysis
3. Renal ultrasonography
1. Advanced age 4. Glomerular Filtration Rate test
5. Clinical Chemistry Test
2. Cardiovascular
1. Obesity
Disease
2. Smoking MEDICATIONS and OTHER TREATMENTS
3. Autoimmune
3. Diabetes
disease
mellitus
4. Family history
Phosphate binders Diuretics (Lasix)
Benzylpenicillin
of kidney 4. Liver disease

disease

5. Race
hemodialysis adequate rest low salt diet
DIGITAL NOTEBOOK

ACUTE RENAL FAILURE

GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

REMEMBER THE MNEMONIC: RATIONALE:

PHAFAGOH
1. decrease in renal perfusion
and glomerular filtration
1. EDEMA causing fluid overload.
2. ARF may lead to a buildup of

2. DYSPNEA fluid in your lungs, which can

cause shortness of breath.
3. kidneys lose the ability to
3. DECREASED filter out waste materials
from the body due to tubular
URINE OUTPUT damage, resulting in a
decrease in the production
of urine.
4. CHEST PAIN 4. if the lining that covers the
heart (pericardium) becomes
5. NAUSEA inflamed = may experience
chest pain
6. MUSCLE 5. blood has too much acid due
to acute kidney failure = end
up with nausea.
WEAKNESS 6. body's fluids and
electrolytes are out of
balance = muscle weakness

NURSING DIAGNOSIS

Excess fluid volume related to compromised regulatory mechanisms

Risk for decreased cardiac output related to compromised regulatory mechanism (fluid
overload)

Risk for deficient fluid volume related to excessive urinary output, vomiting, hemorrhage

Imbalanced nutrition; less than body requirements related to Increased metabolic

needs as evidenced by weight loss
NURSING
INTERVENTIONS
Monitor BUN, creatinine, GFR., serum
electrolytes. Advise patient to
follow required
medications/
treatment regimen.
Monitor weight Assess and
daily. monitor intake
and output
accurately. Encourage bed rest
and plan moderate
activity.
Encourage and
provide small but
frequent
meals. Assess for signs

and symptoms Refer to a dietician

for a consultation
of to develop a meal
Elevate edematous
body part while in plan low in sodium,
bed or sitting in a dehydration.
potassium, and
chair.
protein that
includes preferred
foods as allowed.
Watch for cardiac dysrhythmias and heart failure
from hyperkalemia, electrolyte imbalance, or fluid
overload. Have resuscitation equipment available in
case of cardiac arrest.
DIGITAL NOTEBOOK

ACUTE
PYELONEPHRITIS
WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM

an ascending

urinary tract

infection that

causes

inflammation of the

kidneys and the

renal pelvis.

Classified into acute or chronic

a. Acute pyelonephritis - sudden infection of the kidney that results
in inflammation, local edema, and even necrosis.
b. Chronic pyelonephritis - usually results from recurrent episodes
of acute pyelonephritis = lead to fibrosis and scarring of the
kidney.

PREDISPOSING VS. PRECIPITATING FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Urinalysis
PREDISPOSING PRECIPITATING 2. Complete Blood Count and
differential
1. Suppresed 3. Blood Urea Nitrogen and Creatinine
4. Urine Culture
1. Congenital immunity

defect (Diabetes, MEDICATIONS and OTHER TREATMENTS

2. Age HIV/AIDS,

3. Gender Cancer)
Analgesics Antipyretics
(women) 2. Hygiene Ampicillin

3. Renal calculi

4. Urinary retention
hydration nephrectomy low salt diet
DIGITAL NOTEBOOK

ACUTE
PYELONEPHRITIS
GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. DYSURIA 1. when urine comes in contact

with the inflamed or irritated

2. POLYURIA urethral mucosal lining.

2. due to poor emptying of the

3. NOCTURIA
bladder.

4. FLANK 3. due to poor emptying of the

bladder.
PAIN 4. bacteria stay at the renal

epithelium causing flank

5. HYPERTHER
pain.

MIA 5. body response to pathogen

through fever, fatigue,

6. FATIGUE nausea, and vomiting

6. body response to pathogen

through fever, fatigue,

nausea, and vomiting

NURSING DIAGNOSIS

Acute pain related to inflammation of the renal tissues secondary to pyelonephritis as

evidenced by flank and abdominal pain with 8/10

Impaired Urinary Elimination r/t infection of the upper urinary tract as evidenced by dysuria,
nocturia

Hyperthermia related to infection secondary to pyelonephritis as evidenced by

38.8°C, sweating, and weakness.
NURSING
INTERVENTIONS
Monitor the patient’s pattern of voiding. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate
fluid intake (2–4 L per
day), avoiding caffeine Examine urine
and use of aspartame. properties of the
patient. Monitor for signs of
dehydration and
perform tepid
sponge bath.
Weigh the patient
regularly - as
baseline data. Schedule care

and provide rest Refer to a dietician

periods after any for a consultation
Ask the patient to re- to develop a meal
rate pain 30 mins to 1 activity in a quiet
hour after
plan low in sodium,
administering environment. potassium, and
analgesic. protein that
includes preferred
foods as allowed.
Monitor input and output of the patient
accurately.
DIGITAL NOTEBOOK

PROTEINURIA
WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM
also known as

albuminuria, is

elevated protein in

the urine. It is not a

disease in and of

itself but a symptom

of certain conditions

affecting the kidneys.

Too much protein in the urine means that the kidneys’ filters
(glomeruli) are not working properly and are allowing too much
protein to escape in the urine.
The level and type of protein reveals the degree of the damage, as
well as the risk for developing kidney failure.
Minimally elevated = microalbuminuria
Worse, more protein = full blown albuminuria

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Urinalysis
PREDISPOSING
1. Dehydration 2. Dipstick urine test
3. BUN and Creatinine test
2. Development of Race 4. Complete Blood Count

proteinuria and Gender (Women)

hypertension in Age MEDICATIONS and OTHER TREATMENTS

a pregnant
PRECIPITATING
3. Acute kidney

inflammation Health History of ACE inhibitors ARBs (angiotensin

Diuretics (Lasix)
receptor blockers)
Kidney Diseases
4. Intravascular
Infections
hemolysis
Obesity
hydration low protein diet low salt diet
DIGITAL NOTEBOOK

PROTEINURIA
GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:

1. DYSURIA 1. too much protein irritates mucosal

lining of the urethra

2. EDEMA 2. loss of the proteins from blood

allows fluid to leak out of the blood

3. FOAMY/ vessels into the nearby tissues

causing swelling.

FROTHY 3. albumin has a soap-like effect that

reduces the surface tension of

URINE urine - reacts with the air to create

foam

4. POLYURIA 4. high levels of protein in urine

triggers individual to void more

5. FLANK often

5. indicates that proteinuria has

PAIN decreased kidney function

NURSING DIAGNOSIS

Impaired Urinary Elimination related to impaired renal function secondary to proteinuria

as evidenced by dysuria, nocturia

Altered comfort related to excess fluid accumulation secondary to proteinuria as

evidenced by pitting edema

Risk for excess fluid volume related to impaired renal function as evidenced by
proteinuria, dysuria, swelling
NURSING
INTERVENTIONS
Monitor BUN, creatinine, white blood cell (WBC)
count. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate
fluid intake (2–4 L per Note reports of urinary
day), avoiding caffeine frequency, urgency, burning,
and use of aspartame. incontinence, nocturia, and
size or force of urinary
stream. Palpate bladder after Assess voiding pattern
voiding. (frequency and amount).
Compare urine output
with fluid intake. Note
specific gravity.
Elevate
edematous parts Educate patient
of the body.
about the
Refer to a dietician
importance of
for a consultation
limiting intake of to develop a meal
Promote continued alcohol and plan low in sodium,
mobility. potassium, and
caffeine.
protein that
includes preferred
foods as allowed.
Monitor input and output of the patient
accurately.
DIGITAL NOTEBOOK

URINARY TRACT INFECTION

WHAT IS IT? ANATOMY AND PHYSIOLOGY

URINARY SYSTEM
are common

infections that

happen when

bacteria, often from

the skin or rectum,

enter the urethra, and

infect the urinary

tract

Classified into acute or chronic

a. Acute pyelonephritis - sudden infection of the kidney that results
in inflammation, local edema, and even necrosis.
b. Chronic pyelonephritis - usually results from recurrent episodes
of acute pyelonephritis = lead to fibrosis and scarring of the
kidney.

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Urinalysis
PREDISPOSING 2. Urodynamic testing
Occurs mainly 3. Blood Urea Nitrogen and Creatinine
Congenital
4. Urine Culture
because of 5. CBC and blood culture
deformities
pathogens,
Gender (Women)
MEDICATIONS and OTHER TREATMENTS
specifically
Age
bacterias
PRECIPITATING
(commonly E.coli, Health History of

Kidney Diseases Analgesics Antipyretics

rarely Ceftriaxone

Obstructed urinary
U.urealyticum,
flow (infections)
M.hominis)
STIs/ HIV/AIDS
lots of water cranberry juice low salt diet
Poor hygiene
DIGITAL NOTEBOOK

URINARY TRACT INFECTION

GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. DARK-RED OR
1. can occur when bacteria
COCA COLA
cause bleeding as they
COLORED invade and inflame the lining

of your urinary tract.

URINE WITH
2. when urine comes in contact
STRONG with the inflamed or irritated

ODOR urethral mucosal lining.

3. due to poor emptying of the

2. DYSURIA
bladder.

3. POLYURIA 4. an inflamed bladder causes

pressure or pain in the lower

4. PELVIC PAIN
belly and pelvis.

5. HYPERTHERM 5. body response to pathogen

through fever, fatigue,

IA
nausea, and vomiting

NURSING DIAGNOSIS

Acute pain related to inflammation and infection of the urinary tract as evidenced by
burning on urination, facial grimace and guarding behavior

Impaired Urinary Elimination related to inflammation and infection of urinary tract as

evidenced by urinary frequency and urgency

Hyperthermia related to infection secondary to urinary tract infection as evidenced

by 38.8°C, sweating, and weakness
NURSING
INTERVENTIONS
Monitor the patient’s pattern of voiding. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate
fluid intake (2–4 L per
day); drink water or Encouraged the client to
cranberry juice. void frequently and do
not hold if he/she feels
the urge to urinate.
Monitor for signs of
dehydration and
perform tepid
sponge bath.
Instruct to avoid
coffee, tea, spices, Use of non-
alcohol, and sodas.
pharmacological
Refer to a dietician
techniques for
for a consultation
Ask the patient to pain to develop a meal
observe proper plan low in sodium,
handwashing and management as
hygiene; wipe from potassium, and
front to back. appropriate.
protein that
includes preferred
foods as allowed.
Monitor and assess patient's elimination
pattern.
DIGITAL NOTEBOOK

KIDNEY STONES
WHAT IS IT? ANATOMY AND PHYSIOLOGY

also known as renal RENAL SYSTEM

calculi,
nephrolithiasis or
urolithiasis - are hard
deposits made of
minerals and salts
that form inside the
kidneys.

TYPES OF KIDNEY STONES:

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Urinalysis
Form when the urine
PREDISPOSING 2. Abdominal ultrasound
contains more crystal-
3. Blood Urea Nitrogen and Creatinine
forming substances — Congenital deformities 4. Computed tomography
such as calcium, 5. Blood testing
Family history of
oxalate and uric acid —
kidney diseases
than the fluid in your MEDICATIONS and OTHER TREATMENTS
urine can dilute. Metabolic disorders

Urine may lack

PRECIPITATING
substances that

prevent crystals from Recurrent UTIs Xanthine oxidase Analgesics Potassium citrate
inhibitors
sticking together, Obesity/unhealthy
creating an ideal diet
environment for kidney Surgery
stones to form.
Dehydration hydration uteroscopy low salt diet
DIGITAL NOTEBOOK

KIDNEY STONES
GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. a shared nerve connection between

1. STOMACH the kidneys and the GI tract can

cause an upset stomach

PAIN 2. if a kidney stone becomes lodged in

the ureters, it blocks the flow of

urine, kidneys swell and ureter

2. BACKACHE
spasms = back pain

3. shared nerve connections between

3. VOMITING the kidneys and the GI tract

4. kidney stones may block passage of

4. FEVER urine, and infect the kidney, hence. a

fever occurs as a result of the

5. DIZZINESS infection

5. sensors in the semicircular canal are

6. HEMATURIA triggered by the stones, which causes

a feeling of dizziness

6. direct impact of stone on lining cells

of the urinary tract results in

destruction, ultimately allowing blood

to leak into urine

NURSING DIAGNOSIS

Acute pain related to increased frequency or force of ureteral contractions secondary to

kidney stones as evidenced by pain scale of 9/10, and guarding behavior

Impaired Urinary Elimination related to mechanical obstruction secondary to kidney stones as

evidenced by hematuria, and polyuria

Hyperthermia related to disease process causing infection secondary to kidney

stones as evidenced by 38.8°C, sweating, and weakness.
NURSING
INTERVENTIONS
Monitor the patient’s pattern of voiding. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate
fluid intake (2–4 L per Check laboratory
day), avoiding caffeine
and use of aspartame. studies
(electrolytes, BUN,
Creatinine). Apply warm
compresses to
back.
Implement
comfort measures
(back rub, restful Monitor vital signs.
environment).
Evaluate pulses,

capillary refill, skin Encourage

Ask the patient to re-
rate pain 30 mins to 1 turgor, and mucous appropriate diet,
hour after clear liquids,
administering membranes.
analgesic. bland foods as
tolerated.

Monitor input and output of the patient

accurately.
DIGITAL NOTEBOOK

LUPUS NEPHRITIS
WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM
a type of kidney disease

caused by systemic lupus

erythematosus - occurs

when lupus

autoantibodies affect

structures in kidneys that

filter out waste.

TYPES OF LUPUS NEPHRITIS

I. - minimal mesangial
IV. - diffuse proliferative
glomerulonephritis
V. - membranous glomerulonephritis
II. - mesangial proliferative
VI. - advanced sclerosing lupus
glomerulonephritis
nephritis
III. - focal glomerulonephritis

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS
1. Urinalysis
one of the most serious
PREDISPOSING 2. Blood tests
a. glomerular filtration rate
complications of systemic Congenital deformities
b. antiphospholipid antibodies and
lupus erythematosus
Family history of kidney anti-nuclear antibodies
(SLE)
3. Kidney biopsy
inflammation of the diseases
kidneys can harm the
Gender MEDICATIONS and OTHER TREATMENTS
ability of the overall renal

(kidney) system to Age

properly remove waste
PRECIPITATING
from blood, maintain the

correct amount of body Exposure to Corticosteroids Immunosuppressive Monoclonal

drugs antibodies
fluids, and regulate
teratogens
hormone levels for

controlling blood pressure Certain medications

and blood volume. Recurrent infections

ACE inhibitors kidney diuretics (Lasix)
transplant
DIGITAL NOTEBOOK

LUPUS NEPHRITIS
GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. HEMATURIA 1. can cause the glomeruli to leak

blood into the urine - may look

2. PROTEINUR pink or light brown from blood

2. glomerular disease can cause

IA the glomeruli to leak protein into

the urine - may be foamy

3. EDEMA because of the protein.

3. extra fluid that your kidneys

4. WEIGHT cannot remove that causes

swelling in body parts i.e., legs,

GAIN
ankles, or eyes

4. due to the fluid your body is not

5. HYPERTENS
able to get rid of

5. due to kidney inflammation that

ION
leads to blood in the urine,

protein in the urine, high blood

pressure

NURSING DIAGNOSIS

Acute pain related to exacerbation of disease process secondary to lupus nephritis as

evidenced by pain scale of 8/10, redness, oral and nasal ulcer, guarding behavior

Impaired skin integrity related to inflammation secondary to lupus nephritis as evidenced by oral
ulcers, loss of discrete patches of scalp hair

Risk for deficient knowledge related to complexity of disease treatment secondary to

lupus nephritis
NURSING
INTERVENTIONS
Encourage adequate nutrition and hydration. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate
fluid intake (2–4 L per Instruct the client to
day), avoiding caffeine keep ulcerated skin
and use of aspartame. clean and dry. Apply
dressings as Remind the client to
needed. avoid prolonged
periods of inactivity.
Recommended
prophylactic
pressure-relieving Encourage the client to
devices (e.g., special
mattress, elbow pads). assume an anatomically
correct position with all
Educate the disease
joints. Suggest that the
process information:
client uses a small flat
Encourage the use of pillow under the head
unknown cause,
nonpharmacological chronicity of SLE,
measures of pain and not use a knee
control such as gatch or pillow to prop processes of
relaxation, distraction, the knee. inflammation and
or guided imagery.
fibrosis, remissions
and exacerbations,
control versus cure.
Instruct in lifestyle activities that can help
reduce flare-ups such as eating a balanced
diet of fruits, grains, and vegetables.
DIGITAL NOTEBOOK

CHRONIC KIDNEY DISEASE

WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM
also known as
chronic renal disease
or CKD, is a condition
characterized by a
gradual loss of kidney
function over time.

Chronic kidney disease includes conditions that damage

the kidneys and decrease their ability to keep an individual
healthy by filtering wastes from the blood. If kidney
disease worsens, wastes can build to high levels in the
blood and make an individual feel sick

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Urinalysis
PREDISPOSING
2. Albumin to creatinine ratio test
Kidney and urinary tract
two thirds of 3. Blood Urea Nitrogen and Creatinine
abnormalities before birth 4. Glomerular filtration rate
chronic kidney
Family history of kidney
disease are caused
diseases MEDICATIONS and OTHER TREATMENTS
by diabetes
Autoimmune diseases
melltius and
Gender
hypertension
Age
other causes calcium acetate HMG-CoA
PRECIPITATING SGLT2 inhibitors
reductase inhibitors
include
Certain medications
glomerulonephritis,
Recurrent infections

kidney Loop diuretics

ACE inhibitors
transplant
DIGITAL NOTEBOOK

CHRONIC KIDNEY DISEASE

GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. kidneys have a hard time
1. DECREASED
getting rid of extra water.

URINE 2. loss of kidney function can

cause a buildup of fluid or

OUTPUT
body waste or electrolyte

2. NAUSEA AND problems = make one feel

nauseous and vomit

VOMITING 3. kidneys not being able to

remove excess fluid from body

3. EDEMA
4. in an immune response to
4. SEVERE CKD, the body may attack

itself and become inflamed

ITCHING
and itchy.

5. WEIGHT LOSS 5. CKD is associated with a range

of complex deleterious

alterations in physiological and

metabolic function

NURSING DIAGNOSIS

Excess fluid volume related to kidney dysfunction secondary to chronic renal failure as
evidenced by oliguria, edema

Impaired Urinary Elimination related to chronic kidney disease as evidenced by oliguria,

urinary retention

Risk for electrolyte imbalance related to chronic renal failure

NURSING
INTERVENTIONS
Assess lung sounds and monitor for pulmonary
congestion. Advise patient to
follow required
medications/
treatment regimen.
Restrict fluids as Assess the patient’s
indicated. urinary elimination
patterns and
problems. Monitor input and
output accurately
every hour.
Weigh the patient
regularly - as
baseline data. Schedule care

and provide rest Educate the

periods after any
patient about
Provide care to activity in a quiet
edematous
extremities as environment. signs of high
needed.
potassium and

other risks.
Assess laboratory work ups amd monitor
vital signs.
DIGITAL NOTEBOOK

DIABETIC KIDNEY DISEASE

WHAT IS IT? ANATOMY AND PHYSIOLOGY

also known as RENAL

diabetic SYSTEM
nephropathy - a

decrease in kidney

function that

occurs in people

who have diabetes.

DID YOU KNOW?

High blood glucose, also called blood sugar, can damage the
blood vessels in the kidneys. When the blood vessels are
damaged, they don’t work as well.

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Urinalysis
smoke 2. Complete Blood Count and
two thirds of differential
don’t follow diabetes 3. Clinical chemistry test
chronic kidney
a. GFR, Creatinine
eating plan
disease are caused

by diabetes eat foods high in salt MEDICATIONS and OTHER TREATMENTS

mellitus and are not active
hypertension
are overweight
a serious
have heart disease
complication of type SGLT2 inhibitors ARBs (angiotensin dialysis
receptor blockers)
have a family history
1 diabetes and type
of kidney failure
2 diabetes

nephrectomy Loop diuretics

ACE inhibitors
DIGITAL NOTEBOOK

DIABETIC KIDNEY DISEASE

GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. signifies evidence of glomerular

damage, and may be viewed as a

1. PROTEINUR
measure of the severity of diabetic

glomerulopathy.
IA 2. occurs when you have excess levels

of sugar in the blood. Normally, when

2. POLYURIA the kidneys create urine, they

reabsorb all of the sugar and direct it

3. EDEMA back to the bloodstream

3. damage to the glomeruli causes

4. DYSPNEA blood and protein, mainly albumin,

loss through the urine. Low albumin in

the blood with a secondary decrease

5. APPETITE in plasma oncotic pressure causes

fluid to leak out of the bloodstream,

LOSS 4. kidney failure may lead to a buildup of

fluid in your lungs, which can cause

shortness of breath.

5. compounds build in the blood that

suppresses appetite and can affect

your sense of taste.

NURSING DIAGNOSIS

Excess fluid volume related to kidney dysfunction secondary to diabetes as evidenced by

pitting edema

Impaired Urinary Elimination related to diabetic nephropathy as evidenced by polyuria

Risk for imbalanced nutrition, less than body requirements related to disease
conditon and process
NURSING
INTERVENTIONS
Monitor the patient’s pattern of voiding. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate
fluid intake (2–4 L per Examine urine
day), avoiding caffeine
and use of aspartame. properties of the
patient- assess for Evaluate presence of
proteinuria. peripheral edema,
vascular congestion
and reports of
dyspnea.
Weigh the patient
regularly - as
baseline data. Schedule care

and provide rest

Refer to a dietician
periods after any
for a consultation
Monitor laboratory and activity in a quiet to develop a meal
diagnostic studies and
glucose environment. plan low in sugar,
levels. salt, and include
preferred foods
as allowed.

Monitor input and output of the patient

accurately.
 DIGITAL NOTEBOOK

RENAL ARTERY STENOSIS

WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM
is the narrowing of one
or more arteries that
carry blood to the
kidneys (renal arteries).
Narrowing of the
arteries prevents
enough oxygen-rich
blood from reaching the
kidneys.

DID YOU KNOW?

Renal artery stenosis (RAS) is usually the result of
atherosclerosis. It is a serious condition that can lead to
chronic kidney disease or kidney failure.

ETIOLOGY RISK FACTORS

DIAGNOSTIC/LABORATORY TESTS

1. Doppler ultrasound
PREDISPOSING 2. Renal arteriography
2 main causes of
3. Magnetic resonance angiography
renal artery Age (MRA)
stenosis: 4. Clinical Chemistry test
Gender
Buildup on
kidney A family history of
MEDICATIONS and OTHER TREATMENTS
(renal) arteries.
cardivoascular
Fats,
cholesterol and diseases
other substances
(plaque) can build PRECIPITATING Renal angioplasty
low salt diet ACE inhibitors
up in High cholesterol and stenting

and on your kidney

Obesity
artery walls
(atherosclerosis) Smoking

Sedentary lifestyle
ARBs (angiotensin receptor blockers)
DIGITAL NOTEBOOK

RENAL ARTERY STENOSIS

GENERAL PATHOPHYSIOLOGY SYMPTOMATOLOGY

RATIONALE:
1. HIGH
1. narrowing of the arteries

prevents enough oxygen-rich

BLOOD
blood from reaching the kidneys

PRESSURE = reduced blood flow to kidneys

may injure kidney tissue and

2. FLANK increase blood pressure

throughout body

PAIN 2. acute complete occlusion of one

or both renal arteries causes

3. PROTEINUR steady and aching flank pain

3. renal artery stenosis (RAS) is

IA frequently associated with

hypertension and renal

4. BRUIT insufficiency

4. due to occlusive arterial disease

in the aortoiliac vessels

NURSING DIAGNOSIS

Decreased cardiac output related to compromised regulatory mechanism as evidenced by

bruit, high blood pressure

Acute pain related to occlusion of renal arteries secondary to renal artery stenosis
evidenced by flank and abdominal pain with 8/10

Risk for excess fluid volume related to occlusion of renal arteries secondary to renal
artery stenosis
NURSING
INTERVENTIONS
Monitor and assess VS q4. Assess for lung
sounds. Advise patient to
follow required
medications/
treatment regimen.
Encourage adequate Examine urine
fluid intake (2–4 L per
day), avoiding caffeine. properties of the
patient; BUN, Crea, Assess skin, face,
Protein. dependent areas for
edema. Evaluate
degree of edema (on
scale of +1–+4).
Weigh the patient
regularly - as
baseline data. Schedule care

and provide rest Refer to a dietician

periods after any for a consultation
Provide non- to develop a meal
pharmacological activity in a quiet
measures to relieve plan low in sodium,
flank pain i.e., guided environment. potassium, and
imagery, and relaxing
music. protein that
includes preferred
foods as allowed.
Monitor input and output of the patient
accurately.
DIGITAL NOTEBOOK

ANTI-GBM (GOOD
PASTURE'S DISEASE)
WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM

also known as anti-glomerular basement

membrane - a disorder in which the body’s

immune system creates antibodies that attack

the kidneys and lungs.

RISK FACTORS
DIAGNOSTIC/LABORATORY TESTS

1. Age 1. Serologic Testing

2. Antineutrophil Cytoplasm Antibody
2. Gender Testing
3. Histopathology
3. Family history of kidney disease 4. Deposited Antibody Testing

4. Race

5. Teratogen exposure MEDICATIONS and OTHER TREATMENTS

6. Smoking

7. Infections like influenza

8. Exposure to metallic dust

9. Use of certain drugs, such as cocaine

10. Tobacco smoking

Corticosteroids Immunosuppressive
11. Viral infections drugs
DIGITAL NOTEBOOK

ANTI-GBM (GOOD
PASTURE'S DISEASE)
CLINICAL MANIFESTATIONS
GENERAL PATHOPHYSIOLOGY
1. DRY COUGH- unproductive cough

doesn't produce mucus

2. DYSURIA - discomfort or burning

with urination

3. EDEMA - swelling caused by excess

fluid trapped in body's tissues

4. HEMATURIA- blood in urine

5. OLIGURIA- urinary output less than

400 ml per day or less than 20 ml

per hour

6. HYPERTHERMIA - body temperature

greater than 37°C

NURSING DIAGNOSIS

Impaired gas exchange related to disease process secondary to good pasture's disease as
eveidenced by shortness of breath and dry cough

Impaired urinary elimination related to disease process secondary to good pasture's

disease as eveidenced by hematuria

Hyperthermia related to disease process secondary to good pasture's disease as

evidenced by 38.8°C, sweating, and weakness.
NURSING
INTERVENTIONS
Administer blood
Monitor the patient’s pattern of voiding. transfusions to treat
severe iron deficiency
anemia, and administer
corticosteroids, as
Assess and ordered.
auscultate
respiratory rate, Provide humidified
pattern, rhythm. oxygen as
indicated. Provide care to
client with
plasmapheresis as
ordered.
Weigh the patient
regularly - as
baseline data. Instruct client

Encourage to do deep
breathing techniques
to control coughing.
about the
Instruct patient to
possibilities for
follow dietary
dialysis and
regimen i.e., low
kidney transplant.
protein and watch
closely for adverse
reaction of drugs.

Monitor input and output of the patient

accurately.
DIGITAL NOTEBOOK

POLYCYSTIC KIDNEY
DISEASE
WHAT IS IT? ANATOMY AND PHYSIOLOGY

RENAL SYSTEM

a genetic disorder that causes many fluid-filled cysts to

grow in the kidneys. Unlike the usually harmless simple

kidney cysts that can form in the kidneys later in life, PKD

cysts can change the shape of the kidneys, including making

them much larger.

RISK FACTORS
DIAGNOSTIC/LABORATORY TESTS

1. Serologic tests
2. CT scan
1. Age 3. Ultrasound
4. MRI scan
2. Gender

3. Family history of kidney disease MEDICATIONS and OTHER TREATMENTS

4. Diet

5. Certain medications

6. Hypertension ARBs (angiotensin ACE inhibitors

receptor blockers)

7. Diabetes kidney
transplant
DIGITAL NOTEBOOK

POLYCYSTIC KIDNEY
DISEASE
GENERAL PATHOPHYSIOLOGY
SYMPTOMS

1. KIDNEY PAIN

2. URINARY TRACT

INFECTIONS

3. INFECTED OR

BLEEDING

CYSTS

4. KIDNEY STONES

5. ABDOMINAL

DISCOMFORT

AND BLOATING

6. HIGH BLOOD

PRESSURE

NURSING DIAGNOSIS

Excess fluid volume related to renal failure secondary to PKD as evidenced by hyperkalemia

Acute pain related to rupture of cysts secondary to PKD as evidenced by hematuria, pain
scale of 8/10

Risk for hypovolemic shock related to rupture of cysts secondary to PKD

NURSING
INTERVENTIONS
Notify the healthcare provider immediately if the client develops
signs of bleeding like bloody urine, severe pain, pallor, or Advise patient to
unstable vital signs, including hypotension or tachycardia,
follow required
medications/
treatment regimen.
Prepare the patient
Monitor your client’s liver
for dialysis or renal
replacement therapy function tests for
as indicated. increasing levels, and

assess them for symptoms Provide comfort
like abdominal pain and measures, including
distension, opioid analgesics; assist
the patient with
Teach them to empty their
relaxation techniques
bladder regularly, avoid and the use of TENS.
alcohol and caffeinated
beverages that can irritate Obtain specimens for
the bladder, and keep their urinalysis and culture
genital area clean. and sensitivity as
ordered to evaluate Provide fluids and
for hematuria,
foods based on the
proteinuria, and
infection; obtain patient’s condition,
Monitor renal function specimens for encourage increased
and urine elimination, laboratory tests, such
hydration, fluid and fluids if the patient
as electrolyte levels, has a urinary tract
electrolyte balance.
as ordered.

infection, and restrict
fluids if the patient
has renal failure.

Monitor input and output of the patient

accurately.
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