HURST Review: Renal

Glomerulonephritis: Acute can lead to chronic Glomerulonephritis: It is an inflammatory reaction in the glomerulus 00:26 01:34 Glomerulonephritis: Antibodies lodge in the ________________, causing _____________________________________ glomerulus; scarring and decreased filtering Glomerulonephritis: Main cause streptococcus (Group A beta) (attacks the valves in the heart) Glomerulonephritis: Signs/Symptoms -flank pain -oliguria -hematuria -proteinuria -periorbital edema -increased BP -FVE -increased urine specific gravity -azotemia -malaise and H/A Glomerulonephritis Signs/Symptoms: Flank pain is costovertebral angle tenderness (CVA tenderness) -tap on back to see how high the infection is in the kidney Glomerulonephritis Signs/Symptoms: Periorbital edema will progress to other areas of the body Glomerulonephritis Signs/Symptoms: Azotemia is abnormally high BUN and creatinine Glomerulonephritis Signs/Symptoms: Why does the client experience malaise and H/A? toxins Glomerulonephritis: Treatment -get rid of the strep or cause -I & O and daily weights -diuretics -monitor BP -restrict fluids -balance activity with rest -dialysis -modify dietary needs Glomerulonephritis Treatment: How is fluid replacement determined? 24 hour fluid loss + 500 mL Glomerulonephritis Treatment: How are dietary needs modified? -increased carbs -decreased sodium -decreased protein (makes BUN go up) 00:01 01:34 Glomerulonephritis Client Teaching: Diuresis begins in 1 to 3 weeks after onset Glomerulonephritis Client Teaching: ____________________ may stay in the urine for _________________ Blood and urine; months Glomerulonephritis Client Teaching: Teach the signs/symptoms of renal failure Glomerulonephritis Client Teaching: Signs/Symptoms of renal failure -malaise -H/A -anorexia -nausea -vomiting -decreased output -weight gain Glomerulonephritis Client Teaching: If you notice s/s of renal failure present.... call the provider Nephrotic Syndrome: These clients lose a lot more protein than clients with glomerulonephritis Nephrotic Syndrome: Pathophysiology -it is an inflammatory response in the glomerulus -big holes form so protein starts leaking out in the urine (proteinuria) -NOW the client is hypoalbuminemic -without albumin you can't hold onto fluid in the vascular space -so the fluid goes out into the tissues -NOW the client has edema -the circulating blood volume is decreased as a result -the kidneys sense this decrease & the want to replace it -the RAS system kicks in -aldosterone is produced and retains sodium and water -but there is no protein (albumin) in the vascular space to hold it -so this fluid goes into the tissues (MORE edema) -this results in ANASARCA Nephrotic Syndrome: What is anasarca? total body edema Nephrotic Syndrome: Problems associated with protein loss -blood clots (thrombosis) -increased cholesterol -increased triglycerides Nephrotic Syndrome: Why would blood clots form as a result of protein loss? they are losing proteins that normally prevent their blood from clotting Nephrotic Syndrome: Why are levels of cholesterol and triglycerides increased with protein loss? the liver compensates by making more albumin causing an increased release of cholesterol and triglycerides Nephrotic Syndrome: Causes are idiopathic (unknown cause), but have been related to -bacteria or viral infections -NSAIDs -cancer and genetic predispositions -systemic diseases such as lupus or diabetes Nephrotic Syndrome: Signs/Symptoms -massive proteinuria -hypoalbuminemia -edema (anasarca) -hyperlipidemia Nephrotic Syndrome: Treatment includes -diuretics -ACE inhibitors -prednisone -cyclophosphamide -diet -lipid lowering drugs -anticoagulation therapy -dialysis Nephrotic Syndrome Treatment: We give ACE inhibitors to block aldosterone secretion Nephrotic Syndrome Treatment: We give prednisone for inflammation Nephrotic Syndrome Treatment: We give cyclophosphamide to decrease the body's immune response Nephrotic Syndrome Treatment: How does cyclophosphamide decrease the immune response? shrink holes so protein can't get out