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o
Nur 265 exam one study guide 2025
nephrotic syndrome:
o ns is a condition of increased glomerular permeability that allows larger
molecules to pass through the membrane into the urine and then be excreted. O
immunological kidney disorder
o This causes massive loss of protein in the urine, edema formation, and decreased
plasma albumin levels.
Proteinuria- severe protein loss more than 3.5 g in 24hour urine sample.
o Key features:
Massive proteinuria >3.5 g / 24hrs
Hypoalbuminemia <3 g/dl
Edema (facial and periorbital)
Lipiduria
Hyperlipidemia
Increased coagulation ( renal vein thrombosis )
Reduced kidney function (↑ bun, ↑ cr, ↓ gfr) o treatment-
immunosuppressant agents (if immunity based).
Ace inhibitors (to decreased protein loss in urine & ↓bp) statins
(improve blood lipid levels).
Heparin (↑ coagulation / risk of thrombosis → treat vascular effects and
improve kidney function) o diet:
If gfr is normal- dietary intake of complete proteins is needed
If gfr is decreased- dietary protein is decreased, diuretics and sodium
restriction.
acute kidney injury:
o Aki is rapid reduction in kidney function resulting in a
failure to maintain fluid and electrolyte balance, and acid-
base balance.
Can occur over a few hours or days o severity of
aki is based on serum creatinine increase, and
decreased urine output- an increase in specific
gravity (meaning urine is more concentrated or the
patient is dehydrated).
o Gfr isn’t used to measure acute injury or illness—only
chronic kidney disease.
o 3 types of aki
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Prerenal - conditions that reduce blood flow /
oxygen to the kidney → decreased perfusion to
kidneys
• Azotemia- nitrogenous waste/toxin build up o effects
loc, mood, change in personality related directly to
reduced perfusion to the kidneys
• Examples of perfusion reduction:
o Blood/fluid loss- (surgery, sepsis, hypovolemic shock)
o Blood pressure drugs resulting in hypotension o mi or hf
→ low ejection fraction → low cardiac
Output
o Nsaids, asa o anaphylaxis o severe burns o severe
dehydration o renal artery stenosis
o Bleeding or clotting in kidney blood vessels o
atherosclerosis (cholesterol deposits obstructing blood
flow to the kidneys)
Intra-renal failure- tissue damage to the actual kidneys
• Intra-renal- reflects injury to the glomeruli, nephrons, or tubules
• Examples of intra-renal failure:
o Bleeding in the kidney
o Glomerulonephritis or inflammation of the glomeruli
o Pyelonephritis
o Thrombi or emboli in the kidney blood vessels o ttp →
platelet disorder ↑ clotting
o Sepsis or local infection
o Lupus
o Multiple myeloma o scleroderma
o Chemo/ abts / nephrotoxic drugs o ischemia in kidney
failure, including hypoxemia from respiratory and cardiac
arrest
Post-renal failure- urine flow obstruction post-renal failure examples: o
bladder cancer o colon cancer o prostate cancer o cervical cancer o
enlarged prostate o kidney stones o blood clots in urinary tract
o Neurogenic bladder →nerve damage
o Mean atrial pressure is important in determining adequate
kidney perfusion!!!
Map= (systolic+ 2[diastolic])/3
Mean atrial pressure of 65 is needed to perfuse the kidney!!
manifestations (s/s) of aki o oliguria
o fluid volume overload
Crackles
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o
Edema
Anasarca (generalized edema)
↓ 02 sats
↑ rr
o Loc changes
o Labs (↑bun, ↑cr, urine specific gravity >1.030)
o Nursing considerations / interventions for aki:
prevention is key! - urge patients to drink 2-3 l of water daily.
• Monitor fluid status (i&o, weight, ↑ hydration, characteristic of
urine)
• Report output <0.5ml/kg/hr if persists >2hr
<30 ml/hr
• Monitor for kidney functions o labs ( bun, cr, gfr, electrolytes,
osmolarity )
O i&os
You want output to be more than input
Sodium, potassium, and specific gravity
determine hydration status.
o Contrast dyes
o Map > 65 mmhg
• Diuretic therapy- happens after aki is starting to be resolved!
(releasing extra fluid through the urine - this is a good sign!!! -
watch for dehydration! - its normal to have fluids hanging during
the diuretic phase! - titrate fluids!) nutrition during aki:
O low protein
because protein molecules are huge and put on the
strain to process
O low sodium
since the body has high sodium concentration due to
aki
• Fluid restriction
If aki was due to anything except for perfusion problem
hemodynamic monitoring
o Temporary kidney replacement therapy
→ for symptomatic uremia (critical electrolytes, toxicity, metabolic
acidosis, fluid overload that inhibits tissue perfusion)
Removes toxins
Requires immediate vascular access
• If rrt occurs for 4 weeks or less, then there is no loss of kidney
function
• If rrt occurs for 3 months or more it is considered kidney failure
Downloaded by NELSON KIIRU ()
o
Nur 265 exam one study guide 2025
nephrotic syndrome:
o ns is a condition of increased glomerular permeability that allows larger
molecules to pass through the membrane into the urine and then be excreted. O
immunological kidney disorder
o This causes massive loss of protein in the urine, edema formation, and decreased
plasma albumin levels.
Proteinuria- severe protein loss more than 3.5 g in 24hour urine sample.
o Key features:
Massive proteinuria >3.5 g / 24hrs
Hypoalbuminemia <3 g/dl
Edema (facial and periorbital)
Lipiduria
Hyperlipidemia
Increased coagulation ( renal vein thrombosis )
Reduced kidney function (↑ bun, ↑ cr, ↓ gfr) o treatment-
immunosuppressant agents (if immunity based).
Ace inhibitors (to decreased protein loss in urine & ↓bp) statins
(improve blood lipid levels).
Heparin (↑ coagulation / risk of thrombosis → treat vascular effects and
improve kidney function) o diet:
If gfr is normal- dietary intake of complete proteins is needed
If gfr is decreased- dietary protein is decreased, diuretics and sodium
restriction.
acute kidney injury:
o Aki is rapid reduction in kidney function resulting in a
failure to maintain fluid and electrolyte balance, and acid-
base balance.
Can occur over a few hours or days o severity of
aki is based on serum creatinine increase, and
decreased urine output- an increase in specific
gravity (meaning urine is more concentrated or the
patient is dehydrated).
o Gfr isn’t used to measure acute injury or illness—only
chronic kidney disease.
o 3 types of aki
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
Prerenal - conditions that reduce blood flow /
oxygen to the kidney → decreased perfusion to
kidneys
• Azotemia- nitrogenous waste/toxin build up o effects
loc, mood, change in personality related directly to
reduced perfusion to the kidneys
• Examples of perfusion reduction:
o Blood/fluid loss- (surgery, sepsis, hypovolemic shock)
o Blood pressure drugs resulting in hypotension o mi or hf
→ low ejection fraction → low cardiac
Output
o Nsaids, asa o anaphylaxis o severe burns o severe
dehydration o renal artery stenosis
o Bleeding or clotting in kidney blood vessels o
atherosclerosis (cholesterol deposits obstructing blood
flow to the kidneys)
Intra-renal failure- tissue damage to the actual kidneys
• Intra-renal- reflects injury to the glomeruli, nephrons, or tubules
• Examples of intra-renal failure:
o Bleeding in the kidney
o Glomerulonephritis or inflammation of the glomeruli
o Pyelonephritis
o Thrombi or emboli in the kidney blood vessels o ttp →
platelet disorder ↑ clotting
o Sepsis or local infection
o Lupus
o Multiple myeloma o scleroderma
o Chemo/ abts / nephrotoxic drugs o ischemia in kidney
failure, including hypoxemia from respiratory and cardiac
arrest
Post-renal failure- urine flow obstruction post-renal failure examples: o
bladder cancer o colon cancer o prostate cancer o cervical cancer o
enlarged prostate o kidney stones o blood clots in urinary tract
o Neurogenic bladder →nerve damage
o Mean atrial pressure is important in determining adequate
kidney perfusion!!!
Map= (systolic+ 2[diastolic])/3
Mean atrial pressure of 65 is needed to perfuse the kidney!!
manifestations (s/s) of aki o oliguria
o fluid volume overload
Crackles
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
o
Edema
Anasarca (generalized edema)
↓ 02 sats
↑ rr
o Loc changes
o Labs (↑bun, ↑cr, urine specific gravity >1.030)
o Nursing considerations / interventions for aki:
prevention is key! - urge patients to drink 2-3 l of water daily.
• Monitor fluid status (i&o, weight, ↑ hydration, characteristic of
urine)
• Report output <0.5ml/kg/hr if persists >2hr
<30 ml/hr
• Monitor for kidney functions o labs ( bun, cr, gfr, electrolytes,
osmolarity )
O i&os
You want output to be more than input
Sodium, potassium, and specific gravity
determine hydration status.
o Contrast dyes
o Map > 65 mmhg
• Diuretic therapy- happens after aki is starting to be resolved!
(releasing extra fluid through the urine - this is a good sign!!! -
watch for dehydration! - its normal to have fluids hanging during
the diuretic phase! - titrate fluids!) nutrition during aki:
O low protein
because protein molecules are huge and put on the
strain to process
O low sodium
since the body has high sodium concentration due to
aki
• Fluid restriction
If aki was due to anything except for perfusion problem
hemodynamic monitoring
o Temporary kidney replacement therapy
→ for symptomatic uremia (critical electrolytes, toxicity, metabolic
acidosis, fluid overload that inhibits tissue perfusion)
Removes toxins
Requires immediate vascular access
• If rrt occurs for 4 weeks or less, then there is no loss of kidney
function
• If rrt occurs for 3 months or more it is considered kidney failure
Downloaded by NELSON KIIRU ()
