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54 Cards in this Set
- Front
- Back
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Common fluid and electrolyte disturbances in renal disorders:
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Fluid volume deficit/excess
Sodium deficit/excess Potassium deficit/excess Calcium deficit/excess Bicarbonate deficit/excess |
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Common fluid and electrolyte disturbances in renal disorders:
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PROTEIN DEFICIT
Magnesium deficit/excess Phosphorus deficit/excess |
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Chronic kidney diseases is described as
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kidney damage or decrease in the GFR for 3 months or more.
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Untreated CKD can result in
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end-stage renal disease (ESRD)
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Risk factors for CKD:
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cardiovascular disease
diabetes hypertension obesity |
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Primary cause of CKD
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Diabetes
Type 1 - 25-40% Type 2 - 5-40% |
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Second leading cause of CKD
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hypertension
(followed by glomerulonephritis, pyelonephritis, polycystic, hereditary, or congenital disorders and renal cancers) |
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Early stage of CKD there can be
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significant damage due to prolonged acute inflammation that is not organ specific
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5 Stages of CKD =
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Stage 1: GFR less than or equal to 90mL
Stage 2: GFR = 60-89mL Stage 3 GFR = 30-59mL Stage 4: GFR = 15-29mL Stage 5: GFR less than 15mL |
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Treatment of the following can slow progression of CKD:
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hypertension
anemia hyperglycemia proteinuria |
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Elevated serum creatinine levels indicate
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underlying kidney disease
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As creatinine level increases
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symptoms of chronic kidney disease begin
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Symptoms of CKD:
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Anemia (decreased erythropoietin)
Metabolic acidosis Abnormalities in calcium Abnormalities in phosphorus |
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Additional symptoms of CKD
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Fluid retention (edema & CHF)
Abnormalities in electrolytes Heart failure worsens Hypertension |
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GFR is the
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amount of plasma filtered through the glomeruli per unit of time
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Nephrosclerosis
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Hardening of the renal arteries
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Nephrosclerosis is caused by
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prolonged hypertension and diabetes...major cause of CKD and ESRD
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Two forms of nephrosclerosis:
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malignant (accelerated) and benign
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Malignant nephrosclerosis is often associated with
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significant hypertension (diastolic higher than 130.....often in YOUNG adults and TWICE as often in MEN
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Damage caused by malignant nephrosclerosis is due to
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decreased blood flow to the kidney resulting in patchy necrosis of the renal parenchyma.....over time, fibrosis occurs and glomeruli are destroyed.
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Nephrosclerosis WITHOUT dialysis
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more than half of patients die from uremia
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Uremia
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an excess of urea and other nitrogenous wastes in the blood in a FEW YEARS
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Benign nephrosclerosis is the elderly is associated with
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atherosclerosis and hypertension
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Symptoms are RARE early in nephrosclerosis....
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urine may contain protein and a few casts
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Late in nephrosclerosis....
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renal insufficiency
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Treatment of nephrosclerosis
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aggressive antihypertensive therapy. An angiotensin-converting enzyme (ACE) inhibitor, alone or in combination with other antihypertensive meds
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3rd most common cause of Stage 5:
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diseases that destroy the glomerulus of the kidney....glomerular capillaries primarily involved
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In the glomerular capillaries....
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antigen-antibody complexes form in the blood and become trapped in the glomerular capillaries.....I.NFLAMMATION
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Which immunoglobulin (major immunoglobulin) is detected in the glomerular capillary walls?
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G (IgG)
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Major manifestations of glomerular injury include
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proteinuria
hematuria decreased GFR decreased excretion of sodium edema hypertension |
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Clinical manifestation of glomerular inflammation?
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Acute nephritic syndrome
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Glomerulonephritis
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INFLAMMATION of the glomerular capillaries
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Pathophysiology of acute nephritic syndrome
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Antigen (group A beta-hemolytic streptococcus becomes an antigen-antibody product which is deposited in the glomerulus increasing the production of epithelial cells lining the glomerulus causing leukocyte infiltration of the glomerulus and thickening of the glomerular filtration membrane which causes scarring and loss of glomerular filtration membrane resulting in decreased glomerular filtration rate
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Primary glomerular diseases include
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postinfectious glomerulonephritis, rapidly progressive glomerulonephritis, membrane proliferative glomeruolonephritis and membranous glomerulonephritis.
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Postinfectious causes of glomerular disease are
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group A betahemolytic streptococcal infection of the throat that occurs 2-3 weeks before the onsent of glomerulonephritis
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glomerular disease may also follow
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impetigo (infection of the skin), acute viral infections, mumps, varicella zoster virus, Epstein-Barr virus, hepatitis B and HIV
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Primary presenting features of acute glomerular inflammation are:
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hematuria (may be microscopic or macro)
edema azotemia (abnormal concentration of nitrogenous wastes in the blood) proteinuria |
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Other presenting glomerular inflammation clinical signs are:
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Urine may appear cola-colored (RBC's) and protein plugs or casts
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RBC casts indicate
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glomerular injury
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Marked proteinuria in glomerular inflammation due to increased
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permeability of the glomerular membrane
associated pitting edema hypoalbuminemia hyperlipidemia fatty casts in the urine |
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In the more severe cases of glomerular inflammation, patients may complain of
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headache
malaise flank pain |
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Elderly patients with glomerular inflammation may experience
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circulatory overload with dyspnea, engorged neck veins, cardiomegaly, and pulmonary edema.
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Atypical symptoms of glomerular inflammation include
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confusion, somnolence and seizures
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In acute nephritic syndrome, the kidneys become
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large, edematous, and congested.
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All renal tissues in acute nephritic syndrome including the glomeruli, tubules and blood vessels
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are affected
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Pt's with IgA nephropathy hav and low to normal complement levelse an elevated
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serum IgA
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Complications of acute glomerulonephritis include
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hypertensive encephalopathy
heart failure pulmonary edema |
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Hypertensive encephalopathy is a
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medical emergency.....therapy directed toward reducing the blood pressure without impairing renal function
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Without treatment, ESRD develops....course more severe....
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crescent-shaped cells accumulate in Bowman's space, disrupting the filtering surface
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Acute nephritic syndrome medical management
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corticosteroids, managing hypertension, and controlling proteinuria
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Pharmacologic therapy depends on the cause of acute glomerulonephritis....if residual streptococcal infection is suspected.....
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penicilling is the agent of choice
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Dietary protein is restricted when
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renal insufficiency and nitrogen retention (elevated (BUN) develop
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Sodium is restricted when
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the patient has hyptertension, edema, and heart failure.
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care for patients with acute neprhritic syndrome....
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carbohydrates are given liberally (energy and reduce the catabolism of protein
I&O are measured |
