GFR-24 hour urine -
how
manym are going through Kidneys
Adult Health 2 Exam 2
Renal Diet/Restrictions
GFR >90 GFR <90
High calories High calories
high need calories to
reduce protein breakdown
keep Kidneys
flushing Normal to increased fluid volume; 2-4 L/day Low protein and sodium (prepackaged foods high in sodium)
-
May need dietician consult No salt substitutes – potassium
Potassium, phosphorus, & magnesium restrictions
Fluid restrictions
Dialysis requires greater restrictions
Dietician consult is a must!
Lab values and fluid status guide treatment
INCREASED CARBS !
Polycystic Kidney Disease (PKD)
Pathophysiology
- Genetic disorder characterized by the growth of numerous fluid-filled cysts in kidneys
o Cyst growth – destroy nephrons -
destroying functional
unit of
Kidney
Clinical Manifestations
- Abdominal distention, flank pain, increased abdominal girth, hematuria, constipation
from rupture of cysts
stool softners &high fiber to pull in fluid
Diagnostics
- Genetic testing for family, personal history, labs (urinalysis, proteinuria), ultrasound
H TN Size of Kidneys
Medical-Surgical
- Managing blood pressure – Antihypertensives (ACE-I or ARB) RAAS System- HiN
- Managing pain, preventing constipation, slowing progression, graft or shunt replacement, renal replacement
(dialysis), transplant > still have
- polycystic disease
Nursing Interventions
- Weight, fluid/Na restrictions, dietary restriction, pain management, medication administration
DAILY =
fluid volume
- Assessment – fluid overload, lab values (Cr, BUN, electrolytes), neurological smallbloodVessels in a is
risk for excess fluid volumea
electrolyte imbalance
Glomerulonephritis
Pathophysiology
- Common Etiology – post infection usually already treated
o Group A beta-hemolytic streptococcal; Autoimmune disease
o Diabetic Glomerulosclerosis
- Acute or chronic fluid overload due to
failing Kidneys
- Complications – hypertensive encephalopathy, heart failure/pulmonary edema
HiN ischemia ,
,
Clinical Manifestations
- Azotemia (an abnormal concentration of nitrogenous wastes in blood, elevated BUN, Cr)
- Edema/HTN, fluid volume excess, hematuria, proteinuria/decreased serum albumin -
from peeing out albumin
- Severe: AKI, oliguria
Diagnosis
- Urinalysis – hematuria, proteinuria
, - EKG – high potassium tall peaked I wave
- CXR ·
fluid in
lungs
- Laboratory values – BUN, Cr, electrolytes, protein
- CT/MRI – sizing
- Biopsy – cause
Medical Surgical
tflushgetmorning
- Antihypertensive medications, immunosuppressant, antibiotics, diuretics, EKG, dialysis, Epogen, laboratory
if need
RBC production
values (BUN, Cr, electrolytes, protein)
Nursing Interventions
- Administer medications, monitor I&O/labs, assess fluid status, daily weight, fluid/Na restriction, high carb
uvilemic
diet – energy prevent catabolism of protein, assess for pain and treat, monitor for complications
risk for excess fluid volume electrolyte imbalance confusion imbalanced nutrition acute
,
, , , pain
Nephrotic Syndrome
Pathophysiology
- Serious damage to glomerular capillary membrane
- Increased glomerular permeability and loss of protein in urines
- Due to altered immunity and inflammation
- Acute vs. chronic
Clinical Manifestations
HALLMARK
- Proteinuria greater than 3.5g/day
- Hypoalbuminemia – serum interstitial fluid
- Massive edema/periorbital, HTN
Complications
- Thromboembolism, pulmonary edema, hyperlipidemia
easier to clot
liver releases lots of
protein - fats
Diagnostics
- Urinalysis, protein electrophoresis, immunoelectrophoretic (categorize type proteins), needle biopsy of the
kidney (confirm diagnosis)
Medical-Surgical
- Treat underlying cause, slow progression to CKD, relieve symptoms, diuretics – edema, ACEI-reduce protein
loss, antihyperlipidemic, heparin therapy thin blood in
vessels to make
Nursing Interventions circulation easier
- Monitor I&O, edema, weight, HTN, vascular dehydration
- Assess fluid/electrolyte balance
- Cardiac and neuro status -
thromboembolis
stroke heart attack
can lead to
- Patient education – follow all med/dietary regimens, signs of complications
risk for excess fluid volume (extracellular) , imbalanced nutrition ,
fatigue ,
infection
, activity intolerance, disturbed body image
Renal Cell Carcinoma
Pathophysiology
- Adenocarcinoma kidney
- Replaces healthy kidney tissue with cancer
Risk Factors
how
manym are going through Kidneys
Adult Health 2 Exam 2
Renal Diet/Restrictions
GFR >90 GFR <90
High calories High calories
high need calories to
reduce protein breakdown
keep Kidneys
flushing Normal to increased fluid volume; 2-4 L/day Low protein and sodium (prepackaged foods high in sodium)
-
May need dietician consult No salt substitutes – potassium
Potassium, phosphorus, & magnesium restrictions
Fluid restrictions
Dialysis requires greater restrictions
Dietician consult is a must!
Lab values and fluid status guide treatment
INCREASED CARBS !
Polycystic Kidney Disease (PKD)
Pathophysiology
- Genetic disorder characterized by the growth of numerous fluid-filled cysts in kidneys
o Cyst growth – destroy nephrons -
destroying functional
unit of
Kidney
Clinical Manifestations
- Abdominal distention, flank pain, increased abdominal girth, hematuria, constipation
from rupture of cysts
stool softners &high fiber to pull in fluid
Diagnostics
- Genetic testing for family, personal history, labs (urinalysis, proteinuria), ultrasound
H TN Size of Kidneys
Medical-Surgical
- Managing blood pressure – Antihypertensives (ACE-I or ARB) RAAS System- HiN
- Managing pain, preventing constipation, slowing progression, graft or shunt replacement, renal replacement
(dialysis), transplant > still have
- polycystic disease
Nursing Interventions
- Weight, fluid/Na restrictions, dietary restriction, pain management, medication administration
DAILY =
fluid volume
- Assessment – fluid overload, lab values (Cr, BUN, electrolytes), neurological smallbloodVessels in a is
risk for excess fluid volumea
electrolyte imbalance
Glomerulonephritis
Pathophysiology
- Common Etiology – post infection usually already treated
o Group A beta-hemolytic streptococcal; Autoimmune disease
o Diabetic Glomerulosclerosis
- Acute or chronic fluid overload due to
failing Kidneys
- Complications – hypertensive encephalopathy, heart failure/pulmonary edema
HiN ischemia ,
,
Clinical Manifestations
- Azotemia (an abnormal concentration of nitrogenous wastes in blood, elevated BUN, Cr)
- Edema/HTN, fluid volume excess, hematuria, proteinuria/decreased serum albumin -
from peeing out albumin
- Severe: AKI, oliguria
Diagnosis
- Urinalysis – hematuria, proteinuria
, - EKG – high potassium tall peaked I wave
- CXR ·
fluid in
lungs
- Laboratory values – BUN, Cr, electrolytes, protein
- CT/MRI – sizing
- Biopsy – cause
Medical Surgical
tflushgetmorning
- Antihypertensive medications, immunosuppressant, antibiotics, diuretics, EKG, dialysis, Epogen, laboratory
if need
RBC production
values (BUN, Cr, electrolytes, protein)
Nursing Interventions
- Administer medications, monitor I&O/labs, assess fluid status, daily weight, fluid/Na restriction, high carb
uvilemic
diet – energy prevent catabolism of protein, assess for pain and treat, monitor for complications
risk for excess fluid volume electrolyte imbalance confusion imbalanced nutrition acute
,
, , , pain
Nephrotic Syndrome
Pathophysiology
- Serious damage to glomerular capillary membrane
- Increased glomerular permeability and loss of protein in urines
- Due to altered immunity and inflammation
- Acute vs. chronic
Clinical Manifestations
HALLMARK
- Proteinuria greater than 3.5g/day
- Hypoalbuminemia – serum interstitial fluid
- Massive edema/periorbital, HTN
Complications
- Thromboembolism, pulmonary edema, hyperlipidemia
easier to clot
liver releases lots of
protein - fats
Diagnostics
- Urinalysis, protein electrophoresis, immunoelectrophoretic (categorize type proteins), needle biopsy of the
kidney (confirm diagnosis)
Medical-Surgical
- Treat underlying cause, slow progression to CKD, relieve symptoms, diuretics – edema, ACEI-reduce protein
loss, antihyperlipidemic, heparin therapy thin blood in
vessels to make
Nursing Interventions circulation easier
- Monitor I&O, edema, weight, HTN, vascular dehydration
- Assess fluid/electrolyte balance
- Cardiac and neuro status -
thromboembolis
stroke heart attack
can lead to
- Patient education – follow all med/dietary regimens, signs of complications
risk for excess fluid volume (extracellular) , imbalanced nutrition ,
fatigue ,
infection
, activity intolerance, disturbed body image
Renal Cell Carcinoma
Pathophysiology
- Adenocarcinoma kidney
- Replaces healthy kidney tissue with cancer
Risk Factors
