Renal Disorders

Renal Disorders
Renal/Urinary
Renal/Urinary
Disorders
Disorders
Renal/Urinary Disorders
Renal/Urinary Disorders
I. I.
Cystitis (lower UTI)
Cystitis (lower UTI)
A. A.
Assessment
Assessment
1. 1.
Definition: inflammation of the bladder wall
Definition: inflammation of the bladder wall
2. 2.
Inidene
Inidene
a. a.
!ore ommon in women" #re$nany" #osition
!ore ommon in women" #re$nany" #osition
of %rethra& #ro'imity to bowel
of %rethra& #ro'imity to bowel
b. b.
(i$h inidene related to indwellin$ %rinary
(i$h inidene related to indwellin$ %rinary
atheters
atheters
. .
)* + nosoomial or hos#ital ind%ed, -. oli
)* + nosoomial or hos#ital ind%ed, -. oli
.redis#osin$/#rei#itatin$ fators
.redis#osin$/#rei#itatin$ fators
a. a.
.oor hy$iene after %rination& defeation
.oor hy$iene after %rination& defeation
b. b.
/e'%al intero%rse
/e'%al intero%rse
. .
Urolo$ial instr%mentation of bladder
Urolo$ial instr%mentation of bladder
d. d.
Urethral obstr%tion
Urethral obstr%tion
e. e.
/tr%t%ral or f%ntional %rinary
/tr%t%ral or f%ntional %rinary
abnormality
abnormality
f. f.
Chroni health #roblems s%h as
Chroni health #roblems s%h as
diabetes& stre# throat ($ro%# A
diabetes& stre# throat ($ro%# A
betahemolyti stre#)
betahemolyti stre#)
/i$ns and sym#toms:
/i$ns and sym#toms:
a. a.
0*+ may be asym#tomati
0*+ may be asym#tomati
b. b.
Ur$eny
Ur$eny
. .
1re2%eny %rination& both day and ni$ht
1re2%eny %rination& both day and ni$ht
(not%ria)
(not%ria)
d. d.
3%rnin$ (dys%ria) 4
3%rnin$ (dys%ria) 4
e. e.
3ladder s#asms (tenesm%s)
3ladder s#asms (tenesm%s)
f. f.
1o%l,smellin$ %rine (hemat%ria)
1o%l,smellin$ %rine (hemat%ria)
$. $.
3loody %rine (hemat%ria)
3loody %rine (hemat%ria)
h. h.
Inreased 53C o%nt
Inreased 53C o%nt
Dia$nosti Tests
Dia$nosti Tests
a. a.
Urinalysis: baterial o%nt more than
Urinalysis: baterial o%nt more than
1*&***/ml for atheter s#eimen
1*&***/ml for atheter s#eimen
b. b.
Urine %lt%re and sensiti6ity: midstream"
Urine %lt%re and sensiti6ity: midstream"
obtain before startin$ antibiotis" leanse
obtain before startin$ antibiotis" leanse
%rethra
%rethra
Com#liations:
Com#liations:
a. a.
Reinfetion
Reinfetion
b. b.
Retro$rade #yelone#hritis
Retro$rade #yelone#hritis
Im#lementation
Im#lementation
a. a.
!ediations
!ediations
(1) /in$le dose antibiotis when infetion
(1) /in$le dose antibiotis when infetion
loali7ed to bladder 8 or$anism antibioti
loali7ed to bladder 8 or$anism antibioti
sensiti6e" amo'iillin& am#iillin&
sensiti6e" amo'iillin& am#iillin&
trimetho#rim& o,trimetho'a7ole
trimetho#rim& o,trimetho'a7ole
(3atrim& /e#tra)
(3atrim& /e#tra)
2. Antimirobials& antise#tis for 9 to 1:
2. Antimirobials& antise#tis for 9 to 1:
days" s%lfiso'a7ole (;antrisin)&
days" s%lfiso'a7ole (;antrisin)&
nitrof%rantoin (1%radantin)& nalidi'i aid
nitrof%rantoin (1%radantin)& nalidi'i aid
(<e$;ram)& methenamine mandelate
(<e$;ram)& methenamine mandelate
(!andelamine)
(!andelamine)
=. Combined antise#tis& anal$esi"
=. Combined antise#tis& anal$esi"
#hena7o#yridine hydrohloride (.yridi%m)"
#hena7o#yridine hydrohloride (.yridi%m)"
stains %rine red,oran$e olor
stains %rine red,oran$e olor
b. Diet
b. Diet
(1) (1)
1ore =*** fl%id #er day to eno%ra$e
1ore =*** fl%id #er day to eno%ra$e
mo6ement of #atho$ens o%t of %rinary
mo6ement of #atho$ens o%t of %rinary
trat
trat
(2) (2)
Cranberry >%ie in lar$e 2%antities to
Cranberry >%ie in lar$e 2%antities to
lower %rine #(
lower %rine #(
(=) (=)
Diso%ra$e affeine #rod%ts (offee&
Diso%ra$e affeine #rod%ts (offee&
tea& and ola) bea%se they e'aerbate
tea& and ola) bea%se they e'aerbate
fre2%eny
fre2%eny
. Teah lient health #romotion
. Teah lient health #romotion
(1) (1)
Teah to:
Teah to:
(a) (a)
Urinate when %r$e to 6oid #resent
Urinate when %r$e to 6oid #resent
(b) (b)
Drin? at least @ $lasses of water #er day
Drin? at least @ $lasses of water #er day
() ()
Cleanse #ro#erly after %rination and
Cleanse #ro#erly after %rination and
defeation (front to ba?)
defeation (front to ba?)
(d) (d)
Identify a%ses and ///' of early UTIs
Identify a%ses and ///' of early UTIs
(e) (e)
Ta?e mediations for #resribed #eriod&
Ta?e mediations for #resribed #eriod&
%s%ally 1* to 1: days
%s%ally 1* to 1: days
(f) (f)
1ollow %# with re#eated %rine tests&
1ollow %# with re#eated %rine tests&
%lt%res
%lt%res
II. .yelone#hritis (U##er UTI)
II. .yelone#hritis (U##er UTI)
A. A.
Assessment
Assessment
1. 1.
Definition: inflammation of ?idney tiss%e
Definition: inflammation of ?idney tiss%e
(renal #el6is& #arenhyma)
(renal #el6is& #arenhyma)
2. 2.
Inidene
Inidene
a. a.
!ost ommonly a%sed by baterial
!ost ommonly a%sed by baterial
in6asion& for e'am#le -.oli
in6asion& for e'am#le -.oli
b. b.
Aften dia$nosed seondary to ystitis
Aften dia$nosed seondary to ystitis
when ?idney already affeted
when ?idney already affeted
. .
!ay be retro$rade or blood,borne in
!ay be retro$rade or blood,borne in
ori$in
ori$in
=. .redis#osin$/#rei#itatin$ fators
=. .redis#osin$/#rei#itatin$ fators
a. a.
!ay follow ystitis
!ay follow ystitis
b. b.
In hildren& assoiated with %rinary trat
In hildren& assoiated with %rinary trat
abnormalities (6esio%rethral refl%')
abnormalities (6esio%rethral refl%')
. .
In ad%lts& ommon #re,e'istin$ fators
In ad%lts& ommon #re,e'istin$ fators
are bladder t%mors& #rostati
are bladder t%mors& #rostati
hy#ertro#hy& strit%res& and %rinary
hy#ertro#hy& strit%res& and %rinary
stones
stones
d. Instr%mentation or tra%ma to %rinary trat
d. Instr%mentation or tra%ma to %rinary trat
e. .re$nany
e. .re$nany
f. Chroni health #roblems& diabetes&
f. Chroni health #roblems& diabetes&
anal$esia ab%se& #olyysti and
anal$esia ab%se& #olyysti and
hy#ertensi6e ?idney disease
hy#ertensi6e ?idney disease
/i$ns and sym#toms: same as ystitis& #l%s
/i$ns and sym#toms: same as ystitis& #l%s
a. a.
1e6er
1e6er
b. b.
Chills
Chills
. .
!alaise
!alaise
d. d.
1lan? #ain
1lan? #ain
e. e.
Costo6ertebral (CBA) tenderness
Costo6ertebral (CBA) tenderness
f. f.
!ost ommon Dys%ria
!ost ommon Dys%ria
Dia$nosti Tests
Dia$nosti Tests
a. a.
Urinalysis: asts& bateria& lar$e amo%nts
Urinalysis: asts& bateria& lar$e amo%nts
of 53Cs& R3Cs& #%s& hi$h al?aline #(
of 53Cs& R3Cs& #%s& hi$h al?aline #(
b. b.
3lood: le%?oytosis& #ositi6e %lt%res
3lood: le%?oytosis& #ositi6e %lt%res
. .
IB.: enlar$ement of in6ol6ed ?idney(s)
IB.: enlar$ement of in6ol6ed ?idney(s)
d. d.
Renal bio#sy: to onfirm dia$nosis
Renal bio#sy: to onfirm dia$nosis
and/or om#liations
and/or om#liations
Com#liations
Com#liations
a. a.
/arrin$ and fibrosis of infeted #art of
/arrin$ and fibrosis of infeted #art of
?idney
?idney
b. b.
Chroni #yelone#hritis
Chroni #yelone#hritis
. .
Chroni renal fail%re:" 1/= of ases ha6e
Chroni renal fail%re:" 1/= of ases ha6e
#yelone#hritis as ori$inal dia$nosis
#yelone#hritis as ori$inal dia$nosis
Im#lementation
Im#lementation
1. 1.
Assist with dia$nosti tests to determine
Assist with dia$nosti tests to determine
%nderlyin$ a%se.
%nderlyin$ a%se.
2. 2.
!onitor %rine for a##earane& olor& and
!onitor %rine for a##earane& olor& and
s#eifi $ra6ity" monitor tem#erat%re and
s#eifi $ra6ity" monitor tem#erat%re and
administer anti#yretis" monitor I8A&
administer anti#yretis" monitor I8A&
wei$ht& ///' of fl%id and eletrolyte
wei$ht& ///' of fl%id and eletrolyte
imbalanes" #ro6ide relief of flan? #ain
imbalanes" #ro6ide relief of flan? #ain
with anal$esis& rest& and massa$e
with anal$esis& rest& and massa$e
=. Administer orally for 1* to 1: days (if
=. Administer orally for 1* to 1: days (if
mild) or IB (if se6ere) antibiotis s%h as
mild) or IB (if se6ere) antibiotis s%h as
s%lfametho'a7ole (3atrim& /e#tra)&
s%lfametho'a7ole (3atrim& /e#tra)&
tetrayline& am#iillin& e#halos#orins
tetrayline& am#iillin& e#halos#orins
:. Rest
:. Rest
0. -no%ra$e fl%id inta?e at least =C #er day
0. -no%ra$e fl%id inta?e at least =C #er day
D. Teah lients im#ortane of follow,%#
D. Teah lients im#ortane of follow,%#
%rinalysis e6ery 2 wee?s for a month then
%rinalysis e6ery 2 wee?s for a month then
monthly %ntil %rine is sterile
monthly %ntil %rine is sterile
9. Teah lient to re#ort hills" sym#toms of
9. Teah lient to re#ort hills" sym#toms of
UTI s%h as fre2%eny& b%rnin$& %r$eny
UTI s%h as fre2%eny& b%rnin$& %r$eny
III. ;l%mer%lone#hritis
III. ;l%mer%lone#hritis
A. A.
Assessment
Assessment
1. 1.
Definition: non baterial inflammation of
Definition: non baterial inflammation of
$lomer%li of both ?idneys& whih in6ol6es
$lomer%li of both ?idneys& whih in6ol6es
an anti$en,antibody reation
an anti$en,antibody reation
2. 2.
Inidene
Inidene
a. a.
!ost ommon in #reshool and $rade,
!ost ommon in #reshool and $rade,
shool a$ed hildren
shool a$ed hildren
b. b.
Commonly follows by 1,= wee?s a
Commonly follows by 1,= wee?s a
res#iratory infetion (sore throat or
res#iratory infetion (sore throat or
tonsillitis) or s?in infetion (im#eti$o)
tonsillitis) or s?in infetion (im#eti$o)
.redis#osin$/#rei#itatin$ fators
.redis#osin$/#rei#itatin$ fators
a. a.
1re2%ently follows
1re2%ently follows
group A hemolytic
group A hemolytic
strep or staph aureus
strep or staph aureus
infetion
infetion
b. b.
C%#%s erythema
C%#%s erythema
. .
(y#ertension
(y#ertension
d. d.
Diabetes mellit%s
Diabetes mellit%s
e. e.
Disseminated intra6as%lar oa$%lation
Disseminated intra6as%lar oa$%lation
(DIC)
(DIC)
f. f.
-'#os%re to dr%$s or imm%ni7ations
-'#os%re to dr%$s or imm%ni7ations
/i$ns and sym#toms
/i$ns and sym#toms
a. a.
/hortness of breath (/A3)
/hortness of breath (/A3)
b. b.
(eadahe
(eadahe
. .
1e6er& hills
1e6er& hills
d. d.
1ati$%e& wea?ness
1ati$%e& wea?ness
e. e.
Anore'ia& na%sea& 6omitin$
Anore'ia& na%sea& 6omitin$
f. f.
Ra#idly swellin$ fae and feet
Ra#idly swellin$ fae and feet
$. $.
.ains in ba?
.ains in ba?
h. h.
(y#ertension
(y#ertension
i. /mo?y brown %rine
i. /mo?y brown %rine
>. Ali$%ria
>. Ali$%ria
?. .rotein%ria
?. .rotein%ria
l. (emat%ria
l. (emat%ria
Dia$nosti tests
Dia$nosti tests
a. a.
Urinalysis: #rotein%ria& hemat%ria& ell
Urinalysis: #rotein%ria& hemat%ria& ell
debris& hi$h s#eifi $ra6ity
debris& hi$h s#eifi $ra6ity
b. b.
C3C: anemia
C3C: anemia
. .
/er%m 3U<& reatinine& alb%min
/er%m 3U<& reatinine& alb%min
d. d.
A/A titers
A/A titers
e. e.
Renal bio#sy& if indiated
Renal bio#sy& if indiated
Com#liations
Com#liations
a. a.
Chroni $lomer%lone#hritis
Chroni $lomer%lone#hritis
b. b.
Con$esti6e heart fail%re
Con$esti6e heart fail%re
. .
.%lmonary edema
.%lmonary edema
d. d.
Renal fail%re
Renal fail%re
Im#lementation
Im#lementation
1. 1.
Relie6e /' of headahe and fe6er with
Relie6e /' of headahe and fe6er with
a##ro#riate anal$esis and massa$e"
a##ro#riate anal$esis and massa$e"
monitor tem#erat%re
monitor tem#erat%re
2. 2.
3edrest& for %# to se6eral months& %ntil
3edrest& for %# to se6eral months& %ntil
3. normal& and #rotein%ria& hemat%ria&
3. normal& and #rotein%ria& hemat%ria&
and edema s%bside
and edema s%bside
=. =.
Red%e edema by restritin$ fl%ids and
Red%e edema by restritin$ fl%ids and
sodi%m and by administerin$ di%retis,
sodi%m and by administerin$ di%retis,
for e'am#le& f%rosemide (Casi')"
for e'am#le& f%rosemide (Casi')"
meas%re I8A& monitor wei$ht
meas%re I8A& monitor wei$ht
:. Control 3. by fre2%ent monitorin$ and by
:. Control 3. by fre2%ent monitorin$ and by
administration of antihy#ertensi6es E for
administration of antihy#ertensi6es E for
e'am#le& lonidine (Cata#ress)& hydrala7ine
e'am#le& lonidine (Cata#ress)& hydrala7ine
(A#resoline) and methyldo#a (Aldomet)" also&
(A#resoline) and methyldo#a (Aldomet)" also&
administer di%retis and monitor FG
administer di%retis and monitor FG
0. Dietary
0. Dietary
a. a.
<aG restrition for moderate to se6ere edema
<aG restrition for moderate to se6ere edema
b. b.
.rotein restrition while oli$%ria& #rotein%ria&
.rotein restrition while oli$%ria& #rotein%ria&
and ele6ated 3U</reatinine #resent
and ele6ated 3U</reatinine #resent
. 1l%id inta?e aordin$ to %rine o%t#%t
. 1l%id inta?e aordin$ to %rine o%t#%t
d. (i$h alories and arbohydrates
d. (i$h alories and arbohydrates
D. Administer #eniillin treatment (he? for
D. Administer #eniillin treatment (he? for
aller$ies) for %# to 2 months: a6oid
aller$ies) for %# to 2 months: a6oid
e'#os%re to infetions and ati6ities that
e'#os%re to infetions and ati6ities that
o%ld #otentiate reinfetion
o%ld #otentiate reinfetion
9. Teah lient health maintenane
9. Teah lient health maintenane
a. a.
Im#ortane of #rom#t medial treatment
Im#ortane of #rom#t medial treatment
for sore throats and %##er res#iratory or
for sore throats and %##er res#iratory or
s?in infetions" %lt%res to be ta?en and
s?in infetions" %lt%res to be ta?en and
when indiated& a##ro#riate antibiotis
when indiated& a##ro#riate antibiotis
b. b.
Re#ortin$ ///' of hemat%ria& ele6ated
Re#ortin$ ///' of hemat%ria& ele6ated
3.& edema& and headahe
3.& edema& and headahe
. .
Im#ortane of om#liane with treatment
Im#ortane of om#liane with treatment
inl%din$ mediations& bedrest& dietary
inl%din$ mediations& bedrest& dietary
restritions
restritions
Renal 1ail%re
Renal 1ail%re
A%te Renal 1ail%re
A%te Renal 1ail%re
1. 1.
Assessment
Assessment
A. Definition: s%dden loss of ?idneyHs ability
A. Definition: s%dden loss of ?idneyHs ability
to e'rete %rine (oli$%ria) and
to e'rete %rine (oli$%ria) and
nitro$eno%s waste #rod%ts (a7otemia)
nitro$eno%s waste #rod%ts (a7otemia)
and to maintain fl%id and #( balane"
and to maintain fl%id and #( balane"
#otentially re6ersible disease in whih
#otentially re6ersible disease in whih
0*+ reo6er with onser6ati6e
0*+ reo6er with onser6ati6e
mana$ement
mana$ement
3. Inidene
3. Inidene
1. 1.
Us%ally o%rs in #re6io%sly healthy
Us%ally o%rs in #re6io%sly healthy
indi6id%als
indi6id%als
2. 2.
1ollows identifiable tra%ma or ontrat
1ollows identifiable tra%ma or ontrat
with ne#hroto'i a$ent
with ne#hroto'i a$ent
=. =.
Aften follows s%r$ial #roed%res
Aften follows s%r$ial #roed%res
.rei#itatin$/#redis#osin$ fators
.rei#itatin$/#redis#osin$ fators
1. 1.
.rerenal a%ses: are derease in renal
.rerenal a%ses: are derease in renal
blood flow that may inl%de dehydration&
blood flow that may inl%de dehydration&
blood loss& sho?& tra%ma& b%rns
blood loss& sho?& tra%ma& b%rns
2. 2.
Intrarenal a%ses: are those that res%lt
Intrarenal a%ses: are those that res%lt
from #rimary dama$e to ?idney& s%h as
from #rimary dama$e to ?idney& s%h as
$lomer%lone#hritis& #yelone#hritis& and
$lomer%lone#hritis& #yelone#hritis& and
blood transf%sion reations
blood transf%sion reations
=. =.
.ostrenal a%ses: are related to
.ostrenal a%ses: are related to
obstr%tions of %rinary trat distal to
obstr%tions of %rinary trat distal to
?idneys& s%h as al%li or 3.(
?idneys& s%h as al%li or 3.(
/i$ns and sym#toms
/i$ns and sym#toms
1. 1.
Initiatin$/oli$%ria sta$e: time from #rei#itatin$
Initiatin$/oli$%ria sta$e: time from #rei#itatin$
e6ent to an%ria (%rine less than 1** #er
e6ent to an%ria (%rine less than 1** #er
day)
day)
2. 2.
Ali$%ria/an%ria sta$e: lasts 1 to 2 wee?s
Ali$%ria/an%ria sta$e: lasts 1 to 2 wee?s
a. a.
Dereased s?in t%r$or& #etehiae& #r%rit%s
Dereased s?in t%r$or& #etehiae& #r%rit%s
b. b.
Dried m%o%s membranes
Dried m%o%s membranes
. .
.allor& disolored s?in
.allor& disolored s?in
d. d.
5ei$ht han$es& edema
5ei$ht han$es& edema
e. e.
Aidoti breath odor
Aidoti breath odor
f. Anore'ia& na%sea& 6omitin$
f. Anore'ia& na%sea& 6omitin$
$. Drowsiness& lethar$y& onf%sion& oma
$. Drowsiness& lethar$y& onf%sion& oma
h. Restlessness& tetany& sei7%res
h. Restlessness& tetany& sei7%res
=. Di%reti& early sta$e
=. Di%reti& early sta$e
a. a.
3U< sto#s risin$
3U< sto#s risin$
b. b.
Urine o%t#%t : to 0 C #er day
Urine o%t#%t : to 0 C #er day
. .
Inrease in both mental and #hysial
Inrease in both mental and #hysial
ati6ity le6el
ati6ity le6el
:. Reo6ery& late sta$e
:. Reo6ery& late sta$e
a. a.
3U< starts fallin$ to within normal limits
3U< starts fallin$ to within normal limits
b. b.
Urine o%t#%t : to 0 C #er day
Urine o%t#%t : to 0 C #er day
. .
Inrease in both mental and #hysial
Inrease in both mental and #hysial
ati6ity le6el
ati6ity le6el
0. Con6alesent sta$e
0. Con6alesent sta$e
a. a.
!ay ta?e months to reo6er f%lly when
!ay ta?e months to reo6er f%lly when
3U< and %rine both within normal limits
3U< and %rine both within normal limits
b. b.
!ay de6elo# hroni renal fail%re (CR1)
!ay de6elo# hroni renal fail%re (CR1)
Dia$nosti tests
Dia$nosti tests
1. 1.
/er%m tests show ele6ated 3U<&
/er%m tests show ele6ated 3U<&
reatinine& FG& sodi%m& #(& and CA2"
reatinine& FG& sodi%m& #(& and CA2"
dereased Ca2G and R3C
dereased Ca2G and R3C
2. 2.
Urine tests show o%t#%t of less than 2*
Urine tests show o%t#%t of less than 2*
#er ho%r" fi'ed s#eifi $ra6ity of
#er ho%r" fi'ed s#eifi $ra6ity of
1.*1*" e'retion of #rotein& R3Cs&
1.*1*" e'retion of #rotein& R3Cs&
53Cs& and asts
53Cs& and asts
=. =.
!iroso#i e'ams show that basement
!iroso#i e'ams show that basement
membrane of t%b%les destroyed and that
membrane of t%b%les destroyed and that
$lomer%li filter at m%h slower rate
$lomer%li filter at m%h slower rate
:. I,rays may show an enlar$ed or normal,
:. I,rays may show an enlar$ed or normal,
si7ed ?idney on FU3 and will r%le o%t
si7ed ?idney on FU3 and will r%le o%t
obstr%tion
obstr%tion
0. -C; may show #ea?ed T,wa6es if there
0. -C; may show #ea?ed T,wa6es if there
is an ele6ated FG
is an ele6ated FG
Com#liations
Com#liations
1. 1.
Cardia fail%re
Cardia fail%re
2. 2.
.%lmonary edema
.%lmonary edema
=. =.
/e#ti sho?
/e#ti sho?
:. :.
Chroni renal fail%re
Chroni renal fail%re
Treatment
Treatment
1. 1.
Re6erse a%se
Re6erse a%se
2. 2.
Cow #rotein diet
Cow #rotein diet
=. =.
/%##orti6e are
/%##orti6e are

Cow #rotein foods Cow #rotein foods

1r%its& fresh or anned 1r%its& fresh or anned
;reen 6e$etables ;reen 6e$etables
Carrots Carrots
.otatoes .otatoes
!ar$arine !ar$arine
3reads 3reads
1arina 1arina
/herbet /herbet
Corn starh Corn starh
5heat starh 5heat starh

(i$h #rotein foods (i$h #rotein foods

!eats !eats
-$$s -$$s
1ish 1ish
!il? !il?
/oybeans /oybeans
;elatin ;elatin
.rotein s%##lement .rotein s%##lement
Jo$%rt Jo$%rt
.ean%t b%tter .ean%t b%tter
Cheese Cheese
Ce$%mes Ce$%mes
.rotein,fortified ereals .rotein,fortified ereals
Im#lementation
Im#lementation
A. A.
3e alert to onditions that may
3e alert to onditions that may
#rei#itate renal fail%re and #re6ent them
#rei#itate renal fail%re and #re6ent them
3. 3.
Assist in determinin$ a%se of renal
Assist in determinin$ a%se of renal
fail%re
fail%re
C. C.
-no%ra$e a low,#rotein diet to derease
-no%ra$e a low,#rotein diet to derease
wor? of ?idneys" inrease alories& either
wor? of ?idneys" inrease alories& either
by mo%th or T.<" restrit <aG and FG
by mo%th or T.<" restrit <aG and FG
aordin$ to eletrolytes" restrit fl%ids to
aordin$ to eletrolytes" restrit fl%ids to
e2%al o%t#%t
e2%al o%t#%t
D. Administer mediations to treat sym#toms
D. Administer mediations to treat sym#toms
1. 1.
Anti,infeti6es to treat or$anisms
Anti,infeti6es to treat or$anisms
2. 2.
Antaids s%h as Am#ho$el to bind
Antaids s%h as Am#ho$el to bind
#hos#hates
#hos#hates
=. =.
Al?aly7ers s%h as <a(CA= to treat aidosis
Al?aly7ers s%h as <a(CA= to treat aidosis
:. :.
Antihy#ertensi6es
Antihy#ertensi6es
0. 0.
Di%retis
Di%retis
D. D.
FG,lowerin$ a$ents s%h as ins%lin& $l%ose& 8
FG,lowerin$ a$ents s%h as ins%lin& $l%ose& 8
<a(CA= by IB& Faye'alate& by <; t%be or
<a(CA= by IB& Faye'alate& by <; t%be or
enema& or dialysis
enema& or dialysis
-. /%##orti6e are
-. /%##orti6e are
1. 1.
/trit monitorin$ of I8A
/trit monitorin$ of I8A
2. 2.
3edrest with side rails %#
3edrest with side rails %#
=. =.
Aral hy$iene
Aral hy$iene
:. :.
Control for #otential infetion" s?in are
Control for #otential infetion" s?in are
for dryness and #r%rit%s
for dryness and #r%rit%s
0. 0.
Calm en6ironment
Calm en6ironment
Chroni Renal 1ail%re
Chroni Renal 1ail%re
Assessment
Assessment
A. A.
Definition: slow& insidio%s& irre6ersible&
Definition: slow& insidio%s& irre6ersible&
on$oin$ deterioration of ?idney f%ntion
on$oin$ deterioration of ?idney f%ntion
res%ltin$ in %remia
res%ltin$ in %remia
3. 3.
Inidene
Inidene
1. 1.
!ay follow AR1
!ay follow AR1
2. 2.
!ore ommon in women
!ore ommon in women
=. =.
Aften follows $l%mer%lone#hritis
Aften follows $l%mer%lone#hritis
.redis#osin$/#rei#itatin$ fators
.redis#osin$/#rei#itatin$ fators
1. 1.
Re%rrent infetions& e'aerbations& of
Re%rrent infetions& e'aerbations& of
ne#hritis& or obstr%tions
ne#hritis& or obstr%tions
2. 2.
Destr%tion of blood 6essels from lon$,
Destr%tion of blood 6essels from lon$,
standin$ (.< or diabetes
standin$ (.< or diabetes
=. =.
Diret ins%lt or tra%ma to ?idney
Diret ins%lt or tra%ma to ?idney
/i$ns and sym#toms
/i$ns and sym#toms
1. 1.
/ame with AR1
/ame with AR1
2. 2.
A7otemia /' s%h as lethar$y&
A7otemia /' s%h as lethar$y&
headahe& fati$%e& wei$ht loss& irritability&
headahe& fati$%e& wei$ht loss& irritability&
de#ression
de#ression
=. =.
18- /' s%h as fl%id retention& edema&
18- /' s%h as fl%id retention& edema&
anore'ia& na%sea& 6omitin$& /A3
anore'ia& na%sea& 6omitin$& /A3
:. :.
Alterations in %rine o%t#%t
Alterations in %rine o%t#%t
0. (y#ertension
0. (y#ertension
D. Inreased #i$mentation of s?in
D. Inreased #i$mentation of s?in
9. !%s%lar twithin$
9. !%s%lar twithin$
@. <%mbness of feet& le$s
@. <%mbness of feet& le$s
Dia$nosti tests
Dia$nosti tests
1. 1.
/ame as AR1
/ame as AR1
2. 2.
(y#er%riemia& ele6ated ser%m
(y#er%riemia& ele6ated ser%m
#hos#hate and ali%m
#hos#hate and ali%m
Com#liations: same as those of AR1
Com#liations: same as those of AR1
Treatment
Treatment
1. 1.
(emodialysis
(emodialysis
2. 2.
.eritoneal dialysis
.eritoneal dialysis
=. =.
Renal trans#lant
Renal trans#lant
Im#lementation
Im#lementation
A. A.
/imilar to AR1
/imilar to AR1
3. 3.
/%##orti6e meas%res: s?in are& oral
/%##orti6e meas%res: s?in are& oral
hy$iene& rest& alm atmos#here
hy$iene& rest& alm atmos#here
C. C.
1l%id and eletrolytes
1l%id and eletrolytes
1. 1.
Renal dietary restritions #er lab 6al%es
Renal dietary restritions #er lab 6al%es
and ///'
and ///'
2. 2.
!onitor I8A" wei$h lient daily
!onitor I8A" wei$h lient daily
=. =.
!onitor e'tent of edema
!onitor e'tent of edema
:. Bital si$ns (B/)& inl%din$ breath so%nds
:. Bital si$ns (B/)& inl%din$ breath so%nds
0. Restrit fl%ids
0. Restrit fl%ids
D. Diet: hi$h in arbohydrates and within
D. Diet: hi$h in arbohydrates and within
#resribed limits for #rotein& <aG& FG& and
#resribed limits for #rotein& <aG& FG& and
#hos#hate
#hos#hate
9. ;i6e 3aso$el or am#ho>el to bind
9. ;i6e 3aso$el or am#ho>el to bind
#hos#hate
#hos#hate
D. .ro6ide treatment for %nderlyin$
D. .ro6ide treatment for %nderlyin$
on%rrent disorders
on%rrent disorders
-. .re6ent infetion& in>%ry
-. .re6ent infetion& in>%ry
1. Assist with dialysis
1. Assist with dialysis
1. 1.
To orret fl%id and eletrolyte #roblems
To orret fl%id and eletrolyte #roblems
2. 2.
To remo6e waste #rod%ts and dr%$s
To remo6e waste #rod%ts and dr%$s
from system
from system
;. Dis%ss #ossibilities of ?idney trans#lant
;. Dis%ss #ossibilities of ?idney trans#lant
with lient and family
with lient and family
1. 1.
Rei#ient are similar to any ma>or
Rei#ient are similar to any ma>or
s%r$ery
s%r$ery
2. 2.
Donor are as with ne#hretomy #l%s
Donor are as with ne#hretomy #l%s
imm%nos%#ression mana$ement
imm%nos%#ression mana$ement
<e#hroti /yndrome
<e#hroti /yndrome
I. I.
Definition: is a a ondition of inreased
Definition: is a a ondition of inreased
$lomer%lar #ermeability that allows
$lomer%lar #ermeability that allows
lar$er mole%les to #ass thro%$h the
lar$er mole%les to #ass thro%$h the
membrane into the %rine and be
membrane into the %rine and be
remo6ed from the blood.
remo6ed from the blood.
II. II.
Ca%se: imm%ne or inflammatory
Ca%se: imm%ne or inflammatory
#roess
#roess
III. /i$ns and sym#toms
III. /i$ns and sym#toms
a. massi6e #rotein%ria
a. massi6e #rotein%ria
b. hy#oalb%minemia
b. hy#oalb%minemia
. edema (asites& srotal& an?le)
. edema (asites& srotal& an?le)
d. hy#erli#idemia
d. hy#erli#idemia
e. Anore'ia& 6omitin$ and diarrhea
e. Anore'ia& 6omitin$ and diarrhea
f. #allor& lethar$y
f. #allor& lethar$y
$. he#atome$aly
$. he#atome$aly

IB. .atho#hysiolo$y
IB. .atho#hysiolo$y
a. a.
.rotein%ria o%rs bea%se inreased
.rotein%ria o%rs bea%se inreased
$lomer%li #ermeability leads to #rotein
$lomer%li #ermeability leads to #rotein
loss. This res%lts in hy#oalb%minemia.
loss. This res%lts in hy#oalb%minemia.
5ith a low le6el of #rotein in the
5ith a low le6el of #rotein in the
bloodstream& osmoti #ress%re a%ses
bloodstream& osmoti #ress%re a%ses
fl%id to shift from the bloodstream into
fl%id to shift from the bloodstream into
interstitial tiss%e& a%sin$ edema.
interstitial tiss%e& a%sin$ edema.
b. b.
The hy#erli#idemia o%rs bea%se the
The hy#erli#idemia o%rs bea%se the
li6er inreases #rod%tion of li#o#roteins
li6er inreases #rod%tion of li#o#roteins
to try to om#ensate for #rotein loss.
to try to om#ensate for #rotein loss.
. Ci#ids are too lar$e to be lost in %rine and
. Ci#ids are too lar$e to be lost in %rine and
th%s rise to hi$h le6els in the blood
th%s rise to hi$h le6els in the blood
ser%m.
ser%m.
IB. !edial mana$ement
IB. !edial mana$ement
a. a.
Cortiosteroids to resol6e edema
Cortiosteroids to resol6e edema
b. b.
Antibiotis for baterial infetions
Antibiotis for baterial infetions
. .
Thia7ide di%retis in edemato%s sta$e
Thia7ide di%retis in edemato%s sta$e
B. <%rsin$ inter6entions
B. <%rsin$ inter6entions
a. a.
.ro6ide bed rest
.ro6ide bed rest
b. b.
.ro6ide hi$h #rotein& low sodi%m diet
.ro6ide hi$h #rotein& low sodi%m diet
d%rin$ edema #hase only
d%rin$ edema #hase only
. .
!aintain s?in inte$rity
!aintain s?in inte$rity
d. d.
T%rn fre2%ently
T%rn fre2%ently
e. e.
A6oid I! in>etions (mediation is not
A6oid I! in>etions (mediation is not
absorbed into edemato%s tiss%e)
absorbed into edemato%s tiss%e)
f. f.
!onitor inta?e and o%t#%t& 6ital si$ns 8
!onitor inta?e and o%t#%t& 6ital si$ns 8
wei$h daily
wei$h daily
.olyysti Fidney Disease
.olyysti Fidney Disease

(ereditary disorder
(ereditary disorder

Two ty#es: hildhood and ad%lt

Two ty#es: hildhood and ad%lt

In ad%lts %s%ally manifested by a$e :* years

In ad%lts %s%ally manifested by a$e :* years

;ra#eli?e ysts in #lae of normal ?idney tiss%e

;ra#eli?e ysts in #lae of normal ?idney tiss%e

Cysts enlar$e& om#ress f%ntional renal tiss%e&

Cysts enlar$e& om#ress f%ntional renal tiss%e&
and res%lt in renal fail%re
and res%lt in renal fail%re

/i$ns and sym#toms

/i$ns and sym#toms

D%ll& ahin$ abdominal& lower ba? or flan? #ain& or D%ll& ahin$ abdominal& lower ba? or flan? #ain& or
oli?y #ain that be$ins abr%#tly oli?y #ain that be$ins abr%#tly
.olyysti Fidney Disease
.olyysti Fidney Disease

!edial treatment
!edial treatment

/%##orti6e treatment is reommended to

/%##orti6e treatment is reommended to
#reser6e ?idney f%ntion& treat UTI& and
#reser6e ?idney f%ntion& treat UTI& and
ontrol hy#ertension
ontrol hy#ertension

Infetions treated #rom#tly with antibiotis

Infetions treated #rom#tly with antibiotis

Dialysis& ne#hretomy& and trans#lantation

Dialysis& ne#hretomy& and trans#lantation
one end,sta$e renal disease de6elo#s
one end,sta$e renal disease de6elo#s
3ladder Caner
3ladder Caner

!ost ommon mali$nany of %rinary trat

!ost ommon mali$nany of %rinary trat

Ureteral orifies and bladder ne? are the

Ureteral orifies and bladder ne? are the
most ommon sites
most ommon sites

Tars in smo?in$ tobao& aniline dyes in

Tars in smo?in$ tobao& aniline dyes in
ind%strial om#o%nds& and try#to#han
ind%strial om#o%nds& and try#to#han
ha6e been im#liated in de6elo#ment of
ha6e been im#liated in de6elo#ment of
bladder aner
bladder aner
3ladder Caner
3ladder Caner

/i$ns and sym#toms

/i$ns and sym#toms

.ainless& intermittent hemat%ria

.ainless& intermittent hemat%ria

Ather si$ns and sym#toms: bladder irritability"

Ather si$ns and sym#toms: bladder irritability"
infetion& with dys%ria& fre2%eny& and
infetion& with dys%ria& fre2%eny& and
%r$eny" and dereased stream of %rine
%r$eny" and dereased stream of %rine

!edial dia$nosis
!edial dia$nosis

Urinalysis& IB.& CT san& and ystoso#y

Urinalysis& IB.& CT san& and ystoso#y
3ladder Caner
3ladder Caner

!edial treatment
!edial treatment

/%r$ery is the treatment of hoie

/%r$ery is the treatment of hoie

Cystoso#i resetion and f%l$%ration or laser Cystoso#i resetion and f%l$%ration or laser
#hotooa$%lation #hotooa$%lation

/e$mental bladder resetion and radial /e$mental bladder resetion and radial
ystetomy ystetomy

Urinary di6ersion
Urinary di6ersion
,-<D,
,-<D,