Acute Kidney Injury and Glomerular Diseases

Acute Kidney Injury, Glomerulonephritis, Nephrotic Syndrome

• Key Terms and Concepts
  • Oliguria: Urine output less than 400 mL/day
  • Anuria: Urine output less than 50 mL/day
  • Bladder capacity: Typically 400-600 mL
• Types of Renal Health Challenges
  • Glomerulonephritis: Inflammation of glomerular capillaries
  • Nephrotic Syndrome: Increased glomerular permeability causing protein loss
  • Acute Kidney Injury (AKI): Rapid decline in renal function
  • Chronic and End-Stage Renal Failure: Progressive loss of kidney function
• Glomerular Diseases
  • Acute Glomerulonephritis
    • Causes: Post-infection, lupus nephritis, diabetic nephropathy
    • Symptoms: Hematuria, edema, azotemia, proteinuria, hypertension
    • Management: Antibiotics, corticosteroids, supportive care
  • Chronic Glomerulonephritis
    • Causes: Repeated acute glomerulonephritis, hypertension, hyperlipidemia
    • Symptoms: Fixed specific gravity in urine, proteinuria, electrolyte imbalances
  • Nephrotic Syndrome
    • Symptoms: Proteinuria, hypoalbuminemia, edema
    • Causes: Diabetes, lupus, renal vein thrombosis
    • Management: Drug and dietary therapy
• Acute Kidney Injury (AKI)
  • Causes
    • Pre-renal: Reduced blood flow (hypovolemia, hypotension)
    • Intra-renal: Direct kidney damage (acute tubular necrosis, diabetic nephropathy)
    • Post-renal: Urinary obstruction (prostate enlargement, kidney stones)
• Phases of AKI
  • Initiation: Onset of kidney injury
  • Oliguric: Decreased urine output (days to weeks)
  • Diuresis: Gradual urine output increase
  • Recovery: Renal function restoration (up to 12 months)
• Clinical Management and Nursing Care
  • Fluid balance: Monitor intake, output, daily weights
  • Electrolyte management: Manage potassium, sodium, calcium, phosphorus levels
  • Medications: Antibiotics, diuretics, steroids, dialysis (severe cases)
  • Nutritional support: Protein restriction, adequate caloric intake
• Complications
  • Metabolic acidosis, hyperkalemia, anemia, fluid overload
  • Hyperkalemia: Life-threatening if serum potassium > 5.5 mmol/L; treat with cation exchange resins (like Kayexalate)
• Postoperative Care in Kidney Surgery
  • Risks: Bleeding, infection, deep vein thrombosis
  • Interventions: Pain relief, deep breathing exercises, monitoring for signs of DVT
• Patient Education
  • Care of drainage systems, signs of complications, follow-up care
• Practice Questions
  • The most accurate indicator of fluid loss/gain in an acutely ill patient is weight.
  • Hyperkalemia is more life-threatening than hypercalcemia.
  • Metabolic acidosis occurs as kidney function declines below 50 mL/min.
  • Severe crushing injuries can cause pronounced elevations in serum potassium and BUN in acute renal failure.
  • Patients with acute glomerulonephritis may exhibit hematuria, proteinuria, edema, and hypertension.
  • Post-infectious glomerulonephritis is caused by group A beta-hemolytic streptococcal infection.
  • A key nursing diagnosis for nephrotic syndrome is excess fluid volume.
  • During AKI diuresis phase, monitor for dehydration.
  • Nurses caring for ARF patients need to monitor complications, manage fluids/electrolytes, and provide emotional support.
  • Assess for bleeding in postoperative kidney surgery clients by checking skin condition, level of consciousness, and urinary drainage.
  • Chronic glomerulonephritis exacerbation is suggested by specific lab findings.
  • Persistent hypertension and retinal changes indicate chronic kidney injury progression.
  • The oliguric phase of AKI is characterized by a severe decrease in urine output.
  • Hyperkalemia in kidney patients requires administering cation exchange resins.
  • Nephrotic syndrome patients are at increased risk of hypoalbuminemia.
  • Intra-renal AKI causes include acute tubular necrosis.
  • Fluid overload in AKI is indicated by weight gain.
  • Post-renal AKI is caused by urinary obstruction.
  • A major complication to monitor post-kidney surgery is deep vein thrombosis.
  • Symptoms of nephrotic syndrome include edema and proteinuria.
  • In the AKI recovery phase, lab values typically return to baseline over months.