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NRSNG.com | Renal and GU Disorders 1
Renal and Genitourinary Disorders
Acute Kidney Injury
1. Overview
a. Sudden loss of renal function due to poor circulation or renal cell damage
b. usually reversible may resolve on its own, can lead to permanent damage if not reversed
quickly
c. Causes
i. Prerenal: decreased blood flow to kidneys, accounts for majority of cases
ii. Intrarenal: within the kidney due to tubular necrosis, infection, obstruction,
prolonged ischemia
iii. Postrenal: damage between the kidney and urethral meatus generally caused by
infection, calculi, obstruction
d. Phases
i. Progresses in phases
1. Onset
2. Oliguric
a. decreased urine output <400 mL/day
b. signs of hypervolemia (HTN, HF, edema, pericardial effusion)
c. pericarditis
d. Therapeutic Management
i. restrict fluid intake
ii. identify cause
iii. diuretics
3. diuretic
a. gradual urine output increase followed by diuresis
b. Therapeutic Management
i. replace fluids and electrolytes
4. Recovery
ii. Can progress to chronic kidney injury if not reversed
iii. Signs and symptoms result from kidneys inability to regulate fluid and
electrolytes
2. NCLEX® Points
a. Assessment
i. Azotemia (retention of nitrogen waste in blood)
ii. monitor urine output
iii. monitor weight daily
iv. monitor for infection
v. monitor for fluid overload (edema, crackles, wheezes)
, NRSNG.com | Renal and GU Disorders 2
vi. monitor for acidosis
vii. prepare for dialysis
Chronic Kidney Disease
1. Overview
a. Progressive, irreversible loss of renal function with associated decline in GFR
b. all body systems affected dialysis is required
c. ESKD occurs with GFR <15mL/min
d. Causes
i. DM
ii. HTN
iii. unreversed AKI
iv. glomerulonephritis
v. autoimmune disorders
2. NCLEX® Points
a. Assessment
i. azotemia
ii. ↑BUN, creatinine
iii. Cardio
1. HTN, hypervolemia, CHF
iv. Hematologic
1. anemia
2. thrombocytopenia
v. Gastrointestinal
1. anorexia
2. N/V
vi. Neurological
1. lethargy
2. confusion
3. coma
vii. Urinary
1. ↓ urine output
2. proteinuria
viii. Skeletal
1. osteoporosis
b. Therapeutic Management
i. epoetin alfa aids in countering anemia
ii. avoid administering aspirin
iii. monitor potassium levels
1. ↑ potassium can lead to EKG changes (peaked T waves, flat P, wide
QRS, blocks, asystole)
NRSNG.com | Renal and GU Disorders 1
Renal and Genitourinary Disorders
Acute Kidney Injury
1. Overview
a. Sudden loss of renal function due to poor circulation or renal cell damage
b. usually reversible may resolve on its own, can lead to permanent damage if not reversed
quickly
c. Causes
i. Prerenal: decreased blood flow to kidneys, accounts for majority of cases
ii. Intrarenal: within the kidney due to tubular necrosis, infection, obstruction,
prolonged ischemia
iii. Postrenal: damage between the kidney and urethral meatus generally caused by
infection, calculi, obstruction
d. Phases
i. Progresses in phases
1. Onset
2. Oliguric
a. decreased urine output <400 mL/day
b. signs of hypervolemia (HTN, HF, edema, pericardial effusion)
c. pericarditis
d. Therapeutic Management
i. restrict fluid intake
ii. identify cause
iii. diuretics
3. diuretic
a. gradual urine output increase followed by diuresis
b. Therapeutic Management
i. replace fluids and electrolytes
4. Recovery
ii. Can progress to chronic kidney injury if not reversed
iii. Signs and symptoms result from kidneys inability to regulate fluid and
electrolytes
2. NCLEX® Points
a. Assessment
i. Azotemia (retention of nitrogen waste in blood)
ii. monitor urine output
iii. monitor weight daily
iv. monitor for infection
v. monitor for fluid overload (edema, crackles, wheezes)
, NRSNG.com | Renal and GU Disorders 2
vi. monitor for acidosis
vii. prepare for dialysis
Chronic Kidney Disease
1. Overview
a. Progressive, irreversible loss of renal function with associated decline in GFR
b. all body systems affected dialysis is required
c. ESKD occurs with GFR <15mL/min
d. Causes
i. DM
ii. HTN
iii. unreversed AKI
iv. glomerulonephritis
v. autoimmune disorders
2. NCLEX® Points
a. Assessment
i. azotemia
ii. ↑BUN, creatinine
iii. Cardio
1. HTN, hypervolemia, CHF
iv. Hematologic
1. anemia
2. thrombocytopenia
v. Gastrointestinal
1. anorexia
2. N/V
vi. Neurological
1. lethargy
2. confusion
3. coma
vii. Urinary
1. ↓ urine output
2. proteinuria
viii. Skeletal
1. osteoporosis
b. Therapeutic Management
i. epoetin alfa aids in countering anemia
ii. avoid administering aspirin
iii. monitor potassium levels
1. ↑ potassium can lead to EKG changes (peaked T waves, flat P, wide
QRS, blocks, asystole)
