Please enable JavaScript.
Coggle requires JavaScript to display documents.
Renal System - Coggle Diagram
Renal System
Acute Renal Failure: Rapid breakdown of kidney function that occurs when high levels or uremic toxins (waste products) accumulate in the blood. ARF occurs when the kidneys are unable to excrete the daily load of toxins in the urine.
- occurs when the kidneys are unable to excrete over a 24 hour period, pt's with ARF are separated into oliguric and non oliguric
Signs and Symptoms:
- edema of the face and extremities
- Lack of urine output
- Dyspnea if pulmonary edema present
- Confusion, sleepiness, stupor, or coma if nitrogenous wastes are high
- Easy bruising if thrombocytopenia is present
- Fatigue, weakness, palpitations if anemia is present
Assessment Findings:
- Oliguria
- Fluid overload
- edema in the face and extremities
- Pulmonary edema can develop causing respiratory distress
- hypervolemia leads to HTN.
signs of uremia can develop
Diagnostic Findings: hyperkalemia, hyponatremia, hyperphosphatemia, metabolic acidosis
Treatment:
- blood volume expanders
- diuretics
- high carbo diet that is low in protein, sodium, and potassium
- Fluid restriction
- Dialysis
- Oliguric: pt's who excrete less than 500 mL per day
- Nonoliguric: pt's who excrete more than 500 mL per day, the urine is poor quality (contains little waste) because the blood is not well filtered, despite the adequate urine output.
both kidneys are failing when ARF occurs
Prerenal ARF: characterized by inadequate blood perfusion to the kidneys, when leaves them unable to clean the blod properly. Mainly pt's with prerenal ARF are critically ill and experience shock (v low BP)
--- hyopvolemia and cardiovascular failure
- Postrenal ARF: caused by an acute obstruction that affects the normal flow of urine output out of both kidneys. the blockage causes presuure to build in all of the renal nephron. The excessive fluid pressure ultimately causes the nephrons to shut down. The degree of renal failure directly corresponds with the degree of obstructions.
Glomerulonephritis: Bilateral inflammation of the capillary loops of the glomeruli (often following a strep infection).
-Acute or chronic
-Acute post streptococcal glomerulonephritis is the most common.
Assessment Findings:
- HTN
- proteinuria
- hematuria
-edema (periorbital regoin common)
Acute: circulating antigen- antibody immune complexes are formed and trapped in the glomerular membrane; causes inflammation and edema causes glomerular capillaries to allow plasma proteins and blood cells to escape into the urine.
Signs and Symptoms:
- Back pain (CVA tenderness)
- Edema (commonly periorbital)
- Fever
- Cola-colored urine
- Malaise
chronic: slow progressive, destruction of the glomeruli with impaired renal function; kidneys increased in size symmetrically and become granular; eventually all nephrons are destroyed (causes: lupus, diabetes, unknown)
Diagnostics: throat cultures, sed rate, BUN and creatinine, electrolytes, kidney, scan, biopsy
Treatment:
- dietary restrictions of sodium and protein
- Antibiotics, NSAIDS, analgesics
- Diuretics
- Antihypertensives
- Fluid restrictions
Urinary Tract Infection: infection of the bladder, kidney, urethra, or prostate.
- UTI's are classified according to region and primary site infected.
Manifestations: - Dysuria painful or difficult urination
- urination frequency or urgency
- Nocturia (2 or more awakenings a night)
- urine may be cloudy and foul smelling
- voiding in small amounts
-pyuria (excess mucous and RBCs in urine)
- hematuria (bloody urine)
- malaise, chills, fever, N, V
- low back, subrapubic pain
- older patients may not have classic symptoms but may present with: nocturia, incontinence, confusion, behavior change, lethargy, anorexia
Treatments:
- Meds: Bactrim, Sulfa, Macrobid, Keflex,
-Pyridium (urinary tract analgesic- urine turns orange)
- Increase fluid intake
cranberry juice (maintains acidic urine which inhibits bacterial growth)
- void every 2-4 hours
- cleanse perineal area front to back (crucial for women)
-
- uncomplicated: isolated incidence of UTI
- complicated: more than 2 UTI's per year, related to functional, anatomic, metabolic, neurological disorders, related to antibiotic resistant pathogen. ANY UTI in a male is considered complicated.
Causes: bowel incontinence, procedures requiring instrumentation, sexual activity, urinary obstruction/calculi, improper cleaning.
Urinary Calculi (Kidney Stones): Masses of crystals composed of minerals that are normally excreted in the urine.
- stones may develop and cause obstruction at any point in the urinary system.
Causes: dehydration, imobility, excess dietary intake of calcium
Manifestations:
- vary with location and size
- sudden, severe, intermittent pain of the flank and upper outer abdomen on the affected side.
- pain may radiate to the suprapubic region.
- N, V, pallor, cool clammy skin
- urgency and frequency (when lodged where ureter joins the bladder)
3 Factors present to form stones:
- saturated urine
- urinary organic materials (mucoproteins)
- deficiency of substances that hinder stone formation.
Diagnostic tests: KUB x-ray, IVP (intravenous, pyelography), ultrasound, CT scan
Treatment:
- pain meds (narcotics and NSAIDS); antiemetics
- antimicrobials
-increased fluid intake
-strain urine
- lithotripsy
- surgical removal of stone
Chronic Renal Failure: Gradual loss of entire nephron units (over months to years) leading to an inability of the kidneys to produce sufficient urine.
- GFR < 20% of normal.
- functional capacity of the entire nephron is lost and renal mass is reduced.
Assessment Findings:
- hypertension
-oliguria
- edema
- pallor
- dyspnea
- muscle spasms of seizures
Diagnostic findings: Elevated BUN and creatinine, Electrolytes (hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia), CBC (severe anemia and thrombocytopenia, Metabolic acidosis
Signs and symptoms:
- confusion, stupor, or coma caused by high nitrogenous wastes affecting brain.
- bruising caused by thrombocytopenia
- fatigue and dyspnea on exertion caused by anemia.
- edema caused by fluid overload
- lack of urine output
- Muscles spasms or seizures caused by hypocalcemia
- amenorrhea male or female infertility
- Sex hormones negatively feedback to the organs.
Treatment:
- diuretics, antihypertensives, sodium bicarb, calcium supplements, vit D, iron and folic acid.
- High carb, low sodium, potassium, and protein diet.
-transfusions
-dialysis
-renal transplant.
3 Stages or Renal Failure:
- early stage (renal impairment): unaffected nephrons compensate for lost nephrons (free of symptoms, BUN and creatinine are normal)
- Second stage (renal insufficiency): more than 75% of functional renal tissue is destroyed (BUN and creatinine rise, oliguria)
- Third stage (end stage renal disease ESRD): GFR < 20% ( Sharp increase in BUN and creatinine, oliguria and uremia)
Pyelonephritis: Inflammatory disorder affecting the renal pelvis and the functional portion of the kidney tissue.
- acute and chronic
- most common cause is e.coli
- Spread through blood or ascend through urinary tract (most common)
- inflammatory response in kidney; grossly edematous and localized abscesses may form; tissue damage occurs primarily of the tubules.
Signs and symptoms:
onset is rapid
- back pain
- fever
- malaise
- chills
- dysuria
- frequency
- older pt's may present with behavior changes, confusion, incontinence, or general deterioration.
-
Diagnostics: Elevated WBC count, pyuria, bacteruria, proteinuria, microscopic hematuria
Treatment:
- antibiotics
- analgesics for pain
- pyridium (urinary tract analgesic)
- increased fluid intake
-proper perineal hygiene
Polycystic Kidney Disease: Hereditary disease characterized by cyst formation and massive kidney enlargement
- 2 forms: autosomal dominant (adult type) and autosomal recessive (infant type)
- Adult polycystic kidney disease is slow, progressive
-
Diagnostics: Hematuria, crystalluria, bacteriuria, Ulatrasound or CT scan
Signs and Symptoms:
- back pain
- fever (if infection)
-hypertension
- widening abdominal girth
- swollen or tender abdomen
Treatment:
-Supportive treatment: low-sodium diet, physical activity, smoking cessation, and normal body weight maintenance.
- antibiotics for infection
- hydration to maintain fluid balance
- surgical drainage of cyst