W6.

2 KIDNEY DISORDERS
Hypertensive Kidney Disease
Nephrosclerosis Hypertensive Nephrosclerosis
Nephroangiosclerosis
Kidney Failure
 Hardening of the walls of the small arteries and arterioles (small arteries that
convey blood from arteries to the even smaller capillaries) of the kidney.

Causes:
 Diabetes
 High Blood Pressure
Forms of Nephrosclerosis
Benign Nephrosclerosis Malignant Nephrosclerosis
 Renal damage resulting from  Develops as a consequence of
essential hypertension, usually malignant hypertension (DBP Cl
defined as a diastolic blood pressure > 130 mmHg) inical Manifestations
in excess of 90 mmHg.  Common in young adults  Hematuria (microscopic or  Azotemia- abnormal
 Pathogenesis is multifactorial macroscopic) - present in all cases, and concentration of
is gross in 30% of cases. nitrogenous wastes in
Signs and Symptoms Clinical Manifestations  Urine may appear as tea- or cola- blood
colored  Proteinuria
 Impaired vision  Rare early in disease
 Edema  Hypertension
 Blood in the urine  (+) proteinuria
 Loss of weight  (+) casts in urine Diagnostics
 Accumulation of urea and other  Later manifestations:  Anti-streptolysin O  Urinalysis - Reveals presence of
nitrogenous waste products in the  Renal insufficiency (ASO) titer - Determines hematuria
blood manifestations presence of immune  BUN
Medical Management response to strep  Serum creatinine
Aggressive antihypertensive therapy Medical Management
 ACE inhibitors, alone or in combination with other antihypertensives Treatment focuses on managing swelling, blood pressure
 Low-dose thiazides  Bed rest  Antibiotics -People with PSGN
 Calcium channel blockers  Diet (Lowprotein, who still have group A
Polycystic Kidney Disease lowsodium,fluid-restricted) strepbacteria in their throat are
 A genetic disorder characterized by  Good hygiene often provided antibiotics.
the growth of numerous fluid-filled Nursing Management
cysts in the kidneys, which destroy  Early detection and prompt treatment of sore throats and skin lesion
the nephrons.  Encourage to take full course of antibiotic
 May lead to kidney failure  Encourage goodpersonalhygiene
Forms Of Pkd  Instruct tocomplywithprescribediet andfluidrestriction
Autosomal Dominant Autosomal Recessive Nephrotic Syndrome
 Most common form of PKD.  Rare form of PKD  A kidney disorder that causes your body to pass too much protein in your
 You can get the PKD gene  Cysts start to form in infancy or urine.
mutation, or defect, from only even in the womb.  A combination of symptoms that can occur due to different causes. Among
one parent adults, the Syndrome is most often caused by rare kidney Diseases.
Clinical Manifestations
 Proteinuria  Polyuria
 Abdominal fullness  Hypertension
 Flank pain  Kidney stones
 Hematuria
Diagnostics
 Ultrasound. During an ultrasound, a  CT scan. As you lie on a
wandlike device called a transducer is movable table, you're guided
placed on your body. It emits sound into a big, doughnut-shaped
waves that are reflected back to the device that projects thin X-
transducer — like sonar. A computer ray beams through your
translates the reflected sound waves body. Your doctor is able to
into images of your kidneys. see cross-sectional images of
your kidneys.
 MRI scan. As you lie inside a large cylinder, magnetic fields and radio
waves generate cross-sectional views of your kidneys.
Medical Management
 Nocure
 Supportive
- BloodPressure control(ACE Inhibitors,ARBs)
- Paincontrol
- Antibiotics for infections
- Renal replacement, ifwithkidney failure
Acute Post Streptococcal Glomerulonephritis (Apsgn)
 Inflammatory disease of the kidneys
 Common among children and young adults, but
can
 affect all age - groups
 Develops 5 to 21 days after an infection of the Clinical Manifestations
tonsils, pharynx, or skin by GABHS  Edema - swelling in parts of your body
 Massive proteinuria - too much protein in your urine
 Hypoalbuminemia - low levels of a protein called albumin in your blood
 Hyperlipidemia - high levels of cholesterol and other lipids (fats) in your large bladder stones
blood A ureteroscope is inserted to
 Hypertension gain access to stones
Goals A small fiber in inserted up
 Treat underlying  Slowprogressiono  Symptomatic the endoscope
cause f CKD relief Holmium laser is used to
Medical Management break stone into small pieces
Medications may include: – does not affect other
 Diuretics, asordered tissues
 ACE inhibitors – toreduce proteinuria LASERLITHOTRIPSY
 Lipid-lowering agents for hyperlipidemia ENDOUROLOGICPROCEDURES
Urinary Tract Calculi EXTRACORPOREALSHOCKWAVELITHOTRIPSY (ESWL)
 Calculus- refers to the stone Uses high-energy shock waves to
 Lithiasis- refers to stone formation shatter kidney stones without
 Nephrolithiasis is the term employed for kidney stones, also known as damaging surrounding tissues
Non-invasive, but uses
renal calculi. Hard deposits made of minerals and salts that form inside
spinal/general anesthesiato
your kidneys.
ensure that patient maintains the
Calcium Stones
same position throughout
Calcium Oxalate Calcium Phosphate
procedure
 Small stones  Mixed stones (struvite or ENDOUROLOGICPROCEDURES
 Often get trapped in the ureters oxalate) PERCUTANEOUSULTRASONICLITHOTRIPSY
 Risk factor: Family history,  Risk factors: Alkaline urine, An ultrasonic probe is placed in the renal
hypercalcemia  hyperparathyroidism pelvis via a percutaneous nephroscope
Uric Acid Stone STRUVITE stone inserted through a small incision in the
 Predominant in men, high  3-4x more common among flank, and is then positioned against the
incidence women stone
 among Jewish men  Always associated with UTI Patient is given spinal/general anesthesia
 Risk Factors: Heredity, acidic  Large, staghorn type The probe produces ultrasonic waves
urine which breaks stones into sand-like
Cystine Stone particles
ENDOUROLOGICPROCEDURES
Cysteine - a sulfur-containing amino acid
ELECTROHYDRAULICLITHOTRIPSY
 Genetic autosomal recessive defect causing a defective absorption of
The probe is positioned directly on a stone, but it breaks the stone into small
cysteine
fragments that are removed by forceps or by suction.
 Predisposing factors:
A continuous saline irrigation flushes out the stone particles, and all of the
- Acidic urine
outflow drainage is strained so that the particles can be analyzed.
CLINICAL MANIFESTATIONS
(POST-OP EXPECTATIONS)
Severe, sharp flank area, back, or lower abdominal pain – renal
(+) moderate to severe colicky pain
colic
Bright red urine on first few urinations
Pain may radiate to groin area + testicular/labial pain
Urine becomes dark red as bleeding subsides
Nausea and vomiting
Antibiotics will be ordered to prevent infection
Cool, moist skin
SURGICAL MANAGEMENT
Dysuria
Nephrolithotomy- an incision into the kidney to remove a
Fever and chills
stone
medical management
Pyelolithotomy- an incision into the renal pelvis for stone
FIRST APPROACH - ACUTE ATTACKS
removal
Opioidanalgesics for renal colic
Ureterolithotomy- for stones located within the ureter
α– adrenergicblockers
DIETTHERAPY
Tamsulosin(Flomax)
Encourage high fluid intake (approx. 3L/day)
Terazosin(Hytrin)
Water is preferred
MOA: relaxes smoothmuscles intheureters, thereby facilitating
Colas, coffee, and tea increases risk of recurring urinary calculi
stonepassage
and therefore should be limited
Increaseoralfluids
Low - sodium diet
medical management
High sodium intake increases calcium excretion in urine
SECOND APPROACH – IDENTIFICATION OF CAUSE AND PREVENTION
NURSING management
OF FURTHER STONE FORMATION
Encourage fluidintake – consultwithphysicianfor volume
Increaseoralfluids
Facilitatemobility forpatientsonbedrest – tomaximizeurinary flow
Dietary restrictions
Turntosidesq2H
Limit salt intake
Assistwithdanglingor standing
Increase citrus intake
Strainallurine toensure that any spontaneouslypassedstones are
Avoidcoladrinks
retrieved
Pharmacotherapy
Encourage ambulationtopromotemovementof the stone fromthe
ENDOUROLOGICPROCEDURES
upper tothe lowerurinary tract.
Cystoscopy – for small stones inside the bladder
URINARY TRACTINFECTIONS(UTI)
Cystolitholapaxy – for large stones
UTIs are common infections that happen
A lithotrite breaks up stones
when bacteria, often from the skin or
Bladder is then irrigated
rectum, enter the urethra, and infect the
ENDOUROLOGICPROCEDURES
urinary tract. The infections can affect
LITHOTRIPSY
several parts of the urinary tract, but the
a procedure used to eliminate calculi from the
most common type is a bladder infection
urinary tract.
(cystitis).
Laser lithotripsy
TYPES
ESWL
Lower UTI
Percutaneous ultrasonic lithotripsy
Cystitis- inflammation of the urinary bladder
Electrohydraulic lithotripsy
Prostatitis- inflammation of the prostate gland
ENDOUROLOGICPROCEDURES
Urethritis- inflammation of the urethra
Used to fragment ureteral and
Upper UTI
Pyelonephritis- inflammation of the renal pelvis
Nephritis- inflammation of the kidney
Uncomplicated UTI
Community- acquired infection
Common in young women
Not usually recurrent
men•Not usually recurrent
UTICLASSIFICATIONS
Complicated UTI
Hospital- acquired (commonly
related to catheterization)
Occur in patients with urologic
abnormalities, pregnancy,
immunosuppression, diabetes, and
obstructions
Often recurrent
CAUSATIVE MICROORGANISMS
Klebsiella
E. coli – most common
Enterococcus – patients who have been previously
treated with antibiotics
Proteus
Pseudomonas
Staphylococcus
Clinical Manifestations(Lower UTI)“BURICAT”
C - Confusion (older adults),
Chills
A - Awaken at night to
urinate (nocturia)
T - Temperature elevated
B - Burning on urination
U - Urinary frequency and urgency
R - Red urine (Hematuria)
I - Incontinence
CLINICAL MANIFESTATIONS(UPPERUTI)
• Same as Lower UTI
• Flank pain
• Pain at costovertebral angle
MEDICAL MANAGEMENT
Antibiotic Therapy
Short- course (3 days)* or
7-day regimen
MEDICAL MANAGEMENT
Daily intake of cranberry juice- helps prevent and control
symptoms of UTI
Prevents bacterial adhesion to uroepithelium (Hisano et al., 2012)
NURSING MANAGEMENT
Encourage patient to drink fluids
Administer antibiotic as ordered
Encourage patient to void frequently
Educate patient on proper wiping (from front to the back)
Educate patient on drinking acidic juices which help deter growth
of bacteria
Take antibiotics as prescribed
Void as soon as possible after sexual intercourse
PATIENTEDUCATION TOPREVENTUTI
Keep your genital area clean and avoid sitting in wet or soiled
undergarments for prolonged periods of time.
After urinating or having a bowel movement, cleanse thoroughly
and always wipe front to back.
Drink plenty of fluids to keep well hydrated.
Don't hold off urinating when you need to go and don't rush to
finish; give yourself time to completely empty your bladder.
Always urinate after having intercourse.