Disorders of the Kidneys

Acute Nephritic Syndrome

Chronic Glumerulonephritis
Tumors of the Kidney
ACUTE NEPHRITIC SYNDROME

IS THE CLINICAL MANIFESTATION

OF GLOMERULAR INFLAMMATION

PRIMARY disease is mainly in glomeruli

SECONDARY glomerular disease that
are consequence of systemic disease
GLOMERULONEPHRITIS

Is an inflammation of the glomerular

capillaries
Acute chronic
 - flank pain
Increase BUN and creatinine

Cola colored urine

Acute Glomerulonephritis

The term nephritis describes a group of

inflammatory but NONINFECTIOUS
disease characterized by wide-spread
kidney damage.
Glomerulonephritis is a type of nephritis
that occurs most frequently in children and
young adults; however, it can affect
individuals at any age.
Acute GN can be a response to an infection such as
strep throat or an abscessed tooth.
Patho

Symptoms of acute glomerulonephritis

appear about 2 to 3 weeks after a group A
beta-hemolytic streptococci upper
respiratory infection.
The relationship between the infection &
acute glomerulonephritis is not clear;
microorganisms are not present in the
kidney when symptoms appear, but the
glomeruli are acutely inflamed.
Acute Glomerulonephritis S/S

About 50% are symptom free.

the onset is sudden with pronounced
symptoms such as
Fever
nausea
Malaise
headache
Paleness
generalized edema, or periorbital edema
Ankle edema in the evening
Primary presenting features of AGN

Hematuria Hypoalbuminemia
Edema Hyperlipidemia
Azotemia BUN increase
Proteinuria Serum Creatinine
Cola colored urine Increase
Some degree of HPN UO decreases
anemia
Diagnostic Findings

Gross or microscopic hematuria gives

the urine a dark, smoky, or frankly
bloody appearance.
 strep throat systemic lupus erythematosus (SLE)

Goodpastures syndrome, which is a rare autoimmune disease in which

antibodies attack your kidneys and lungs

Wegeners granulomatosis, which is a rare disease that causes inflammation

of the blood vessels

polyarteritis nodosa, which is a disease in which cells attack arteries

Heavy use of non-steroidal anti-inflammatory drugs

(NSAIDs), such as ibuprofen and naproxen

Deposition of Antigen- antibody complex in the glomerulus

Increased production of epithelial linings in theglomerulus

 Leukocytes infiltration of the glomerulus

Thickening of the glomerular filtration membrane

Scarring and loss of glomerular filtration membrane

Decreased GFR
Medical Management

No specific treatment exists for acute

glomerulonephritis and treatment is guided
by the symptoms and their underlying
abnormality.
Treatment may consist of bed rest, a
sodium-restricted diet (if edema or HPN is
present), and antimicrobial drugs to
prevent a superimposed infection in the
already inflamed kidney.
Medical Management

The client is not considered cured

until the urine is free of protein and
red blood cells for 6 months.
Return to full activity usually is not
permitted until the urine is free of
protein for 1 month.
Nursing Management

Maintain bed rest when the blood pressure

is elevated and edema is present
Collect daily urine specimens to assist with
evaluating the clients response to TX.
Assess the BP q 4 hours or prn
Encourage adequate fluid intake and
measure I & O.
Encourage carbohydrate intake to prevent
the catabolism of body protein stores (may
be restricted in sodium and protein)
Chronic Glomerulonephritis

A slowly progressive disease characterized

by inflammation of the glomeruli that
causes irreversible damage to the kidney
nephrons.

Maybe due to repeated episodes of AGN,

hyperlipidemia
Patho

The chronic inflammation leads to

ever-increasing bands of scar tissue
that replace nephrons
Reduced kidney size 1/5 of normal
Decreased glomerular filtration can
eventually lead to renal failure.
Chronic glomerulonephritis accounts
for approx. 40% of people on dialysis.
Chronic S/S

Some experience no symptoms of this

disorder until renal damage is severe.
Generalized edema known as ANASARCA is
a common finding.
Maybe discovered with HPN or elevated
BUN and serum creatinine
S/S

Clients remain markedly edematous for

months or years.
The client may feel relatively well, but the
kidney continues to excrete albumin.
The fluid burden and subsequent renal
failure contribute to fatigue, headache,
hypertension, dyspnea, and visual
disturbances, nocturia, loss of weight
Diagnostic Findings

Azotemia, accumulation of nitrogen waste

products in the blood, is evidenced by
elevated BUN, serum creatinine, and uric
acid levels.
The urine contains protein (albumin),
sediment, cast (deposits of minerals that
break loose from the walls of the tubules),
and red and white blood cells.
Medical Management

Treatment is nonspecific and symptomatic

Management goals include
(1) controlling HPN with medications and sodium
restriction
(2) correcting fluid and electrolyte imbalance,
(3) reducing edema with diuretic therapy
(4) preventing congestive heart failure
(5) eliminating urinary tract infections with
antimicrobials.
May necessitate dialysis or kidney transplantation
Nursing Management
Fluid Volume Excess
Weigh daily at the same time on the same
scale while wearing similar clothing.
Measure I & O
Monitor BP, HR, lung and heart sounds each
shift
Assess for pitting edema, tight rings or
shoes, clothes that do not fit comfortably
Educate on low sodium restriction
Administer prescribed diuretics
Nursing Management
Fatigue & Activity Intolerance
Avoid clustering nursing tasks and physical
activities
Provide periods of rest and promote
uninterrupted sleep at night
Eliminate any activities of daily living that
are not necessary.
Assist the client with activities when
evidence of tachycardia or dyspnea is
present.
Tumors of the Kidney

A hypernephroma (renal adenocarcinoma) is

the most common malignant tumor of the
kidney in adults.
Squamous cells tumors are second.
May be associated with carcinogenic
effects of long-term cigarette smoking,
environmental toxin (asbestos) or volatile
solvents (gasoline)
Because the kidneys are deeply protected
in the body, tumors can become quite large
before causing symptoms.
S/S

The classic triad of renal cancer is

PAINLESS hematuria, flank pain, and
the presence of a palpable mass.
Additional symptoms include weight
loss, malaise, and unexplained fever.
Later, there is colic-like discomfort
during the passage of blood clots
Medical Management

Nephrectomy, including removal of

the surrounding perinephric fat, is
the treatment for a malignant renal
tumor.
Surgery, chemotherapy, and radiation
done
If extensive metastases are found,
only palliative treatment is given.