1. INTERVENTIONS FOR CLIENTS WITH RENAL DISORDERS

2. Renal Nephrons Basic functional unit of the kidney
Major nephron functions
Filtration of materials in blood
Reabsorption of needed substances
Secretion of hydrogen ions to maintain acid-base balance
Excretion of waste materials
Additional functions
Renin secretion (for body water balance)
Erythropoietin secretion (for red cell production)
Vitamin D activation
What are the key parts of the nephron?
How many nephrons are present at birth?
Why would anemia be linked to kidney disease?
Why are kidneys referred to as “master chemists”?

3. Nephron Structures Glomerulus Cluster of branching capillaries
Cup-shaped membrane at the head of each nephron forms the Bowman’s capsule
Filters waste products from blood
Glomerular filtration rate (GFR): preferred method of monitoring kidney function
Tubules
Proximal tubule
Loop of Henle
Distal tubule
Collecting tubule
How does osmotic pressure relate to kidney structure and function?
What is the GFR, and why is it a useful indicator of kidney function?
What is another name for antidiuretic hormone?
Who discovered the function of the glomerulus?
What doe s the Latin word “glomus” mean?

4. Anatomy of the Kidney
Identify the parts of the kidney and their functions.

6. Simple Cyst

7. Polycystic Disease Genetic Fairly common
Usually not symptomatic until after 30
Hematuria, chronic UTI, HTN

8. GLOMERULUS
Normal histological structure of a glomerulus. On the right, is a 3-D illustration of a glomerulus.
Left one shows AA = affrent arteriole, EA= Efferent arteriole, BC= Bowman’s capsule, US= Urinary space 8

9. Glomerulonephritis

10. Nursing Management- Acute Glomerulonephritis
Patient assessment
Maintain fluid balance
Fluid and dietary restrictions
Patient education
Follow-up care

11. Nursing Management: Chronic Glomerulonephritis
Assessment
Potential fluid and electrolyte imbalances
Cardiac status
Neurologic status
Emotional support
Teaching self-care

13. Nephrotic Syndrome

14. Nephrotic Syndrome
Clinical symptoms: massive edema, ascites, proteinurea, distended abdomen, reduced plasma protein level, body tissue wasting
Nutrition therapy
Protein intake to meet nutritional/growth needs (without excess)
Increased caloric intake
Possible moderate reduction of sodium
No need for potassium restriction
Possible need for iron, vitamin supplements
What is ascites?
Why is the abdomen distended?
How is protein intake calculated?
How does dietary management of nephrotic syndrome differ with other renal disorders?

15. Nephrotic Syndrome Caused by various glomerular diseases
Marked proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia

16. Benign Nephrosclerosis

17. Malignant Nephrosclerosis
In patients with malignant HTN
Vicious cycle of renin release
Renal failure, vascular stress, increased intracranial pressure
Medical emergency
About 25% die within 5 yrs

18. Acute Tubular Necrosis
Most common cause of acute renal failure
Consequence of shock or chemicals

19. Tubulointerstitial Nephritis

21. Hydronephrosis

24. Urinary Tract Infection
Common & tend to recur
Women > men
Acquired during
sexual intercourse
catheterization
Pyelonephritis
bacterial infection of kidney
Gram neg fecal bacteria

25. Acute Pyelonephritis Secondary to lower UTI
Acute neutrophilic inflammatory exudates
Small abcesses
Presents as
flank pain
fever
high WBC
pyuria

26. Kidney Stones Basic cause is unknown
Factors relating to urine or urinary tract environment contribute to formation
Present in 5% of U.S. women and 12% of U.S. men
Major stones are formed from one of three substances:
Calcium
Struvite
Uric acid
Why are men more predisposed to stone formation?
How does genetics relate to creation of kidney stones?

27. Kidney Stones
Compare and contrast the different appearances of the stones.
Why is pain a primary manifestation with kidney stones?
What parts of the kidney may have stones present?

28. Renal Stones Calcium Infection Uric acid Symptoms hematuria
renal colic

29. Staghorn Calculus

31. Renal Cell Carcinoma About 90% of renal malignancies
2X risk in smokers
Usually presents as hematuria
Metastasizes to lung & bone
5 yr survival
75% without metastasis
50% with metastasis
15% with renal vein invasion