Urinary System Disorders PDF

URINARY SYSTEM DISORDERS NEPHROTIC SYNDROME Is a type of renal failure characterized by increased glomerular permeability and is manifested by PROTEINURIA. THIS SYNDROME IS APPARENT IN ANY CONDITION THAT SERIOUSLY DAMAGES THE CONDITIONS THAT DAMAGES THE GLOMERULAR CAPILLARY MEMBRANE Chron...

URINARY SYSTEM DISORDERS NEPHROTIC SYNDROME Is a type of renal failure characterized by increased glomerular permeability and is manifested by PROTEINURIA. THIS SYNDROME IS APPARENT IN ANY CONDITION THAT SERIOUSLY DAMAGES THE CONDITIONS THAT DAMAGES THE GLOMERULAR CAPILLARY MEMBRANE Chronic glomerulonephritis a disease of the kidneys in which there is Loading… inflammation of the filtering units, called glomeruli. This inflammation can cause protein and red blood cells to leak into the urine CONDITIONS THAT DAMAGES THE GLOMERULAR CAPILLARY MEMBRANE Diabetes mellitus with intercapillary glomerulosclerosis Diabetes can lead to kidney damage (diabetic nephropathy) that affects the glomeruli. Amyloidosis of the kidney This disorder occurs when amyloid proteins accumulate in your organs. Amyloid buildup often damages the kidneys' filtering system. CONDITIONS THAT DAMAGES THE GLOMERULAR CAPILLARY MEMBRANE Systemic Lupus Erythematous This chronic inflammatory disease can lead to serious kidney damage. Multiple Myeloma Loading… Multiple myeloma (MM) is a plasma cell disorder characterized by clonal proliferation of malignant plasma cells producing monoclonal proteins and causing organ damage. The involvement of the kidney in MM and other plasma cell dyscrasias is very common. Renal vein thrombosis **Although the liver is capable of increasing the production of albumin, it cannot keep up with the daily loss of albumin through the kidneys. Thus, hypoalbuminemia results CLINICAL FINDINGS: Marked increase in protein (particularly albumin) in the urine (proteinuria) Decrease in albumin in the blood (hypoalbuminemia) Diffuse edema High serum cholesterol and low-density lipoproteins (hyperlipidemia) CLINICAL MANIFESTATIONS The major manifestation of nephrotic syndrome is EDEMA It is usually soft, pitting, and commonly occurs around the eyes (periorbital), in dependent areas (sacrum, ankles, and hands), and in the abdomen (ascites). Patients may also exhibit irritability, headache, and malaise. CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS PATHOPHYSIOLOGY Loading…  ASSESSMENT AND DIAGNOSTIC FINDINGS Hallmark of the diagnosis of nephrotic syndrome: Proteinuria (predominately albumin) exceeding 3.5 g/day Protein electrophoresis and immunoelectrophoresis - performed on the urine to categorize the type of proteinuria.  ASSESSMENT AND DIAGNOSTIC FINDINGS The urine may also contain increased white blood cells (WBCs) as well as granular and epithelial casts. A needle biopsy of the kidney - histologic examination of renal tissue to confirm the diagnosis  COMPLICATIONS INFECTION- due to a deficient immune response. the loss of immunoglobulins my increase susceptibility to infection THROMBOEMBOLISM-especially of the renal vein The inability of the glomeruli to filter blood properly can lead to loss of blood proteins that help prevent clotting. This increases your risk of developing a blood clot in your veins. PULMONARY EMBOLISM Neprotic syndrome produced an acquired hypercoagulable state that led to the pulmonary embolus.  COMPLICATIONS ACUTE RENAL FAILURE /ACUTE KIDNEY INJURY -due to hypovolemia Nephrotic syndrome can cause your kidneys to lose their function over time. If kidney function falls low enough, you might need dialysis or a kidney transplant. ACCELERATED ATHEROSCLEROSIS -due to hyperlipidemia When the level of the protein albumin in your blood falls, your liver makes more albumin. At the same time, your liver releases more cholesterol and triglycerides.  MEDICAL MANAGEMENT Treatment is focused on addressing the underlying disease state causing proteinuria, slowing progression of CKD and relieving symptoms  MEDICAL MANAGEMENT Diuretics - prescribed for the patient with severe edema caution must be used because of the risk of reducing the plasma volume to the point of impaired circulation with subsequent prerenal ARF. The use of angiotensin-converting enzyme (ACE) inhibitors in combination with loop diuretics often reduces the degree of proteinuria but may take 4 to 6 weeks to be effective. Problems of drug resistance also arise with long-term use of diuretics.  MEDICAL MANAGEMENT Antineoplastic agents (cyclophosphamide [Cytoxan]) or immunosuppressant medications (azathioprine [Imuran], chlorambucil [Leukeran], or cyclosporine [Neoral]). It may be necessary to repeat treatment with corticosteroids if relapse occurs. Treatment of the associated hyperlipidemia is controversial. The usual medications used to treat hyperlipidemia are often ineffective or have serious consequences, including muscle injury.  MEDICAL MANAGEMENT The patient who does not have hyperkalemia may be placed on a low-sodium diet containing liberal amounts of potassium. This type of diet enhances the sodium–potassium pump mechanism and assists in elimination of sodium to reduce edema. Dietary restrictions of protein and cholesterol help lower lipidemia.  NURSING MANAGEMENT As the condition worsens, management is similar to that of the patient with chronic renal failure( End Stage Kidney Disease) The patient who is receiving corticosteroids or cyclosporine requires instructions about the medications and signs and symptoms that should be reported to the physician. Dietary instructions may also be necessary  NURSING MANAGEMENT Patients with nephrotic syndrome need adequate instruction about the importance of following all medication and dietary regimens so that their condition can remain stable as long as possible.  NURSING MANAGEMENT Patients must be made aware of the importance of communicating any health-related change to their health care providers as soon as possible so that appropriate medication and dietary changes can be made before further changes occur within the glomeruli. When indications of an acute infection, such as an acute respiratory tract infection, are first apparent, increased maintenance doses of corticosteroids have been found to decrease the risk of relapse. POLYCYSTIC KIDNEY DISEASE A genetic disorder characterized by growth of numerous cysts in the kidney These fluid filled cysts destroys the nephrons resulting in reduced kidney function and leading to kidney failure. TWO MAJOR INHERITED FORM OF PKD: AUTOSOMAL DOMINANT PKD – 90% most common inherited form symptoms usually develop between 30 and 40 years of age but can begin earlier requires dialysis or kidney transplantation TWO MAJOR INHERITED FORM OF PKD: AUTOSOMAL RECESSIVE PKD Rare Begin in the earliest month of life or in utero CLINICAL MANIFESTATION Hematuria Polyuria Hypertension Development of renal calculi and associated UTIs Proteinuria Reports of abdominal fullness Flank pain (back and lower sides) CLINICAL MANIFESTATION Signs and symptoms of PKD results from Hematuria loss of renal function and increasing size of Polyuria the kidneys as the cysts grow Hypertension Development of renal calculi and associated UTIs Proteinuria Reports of abdominal fullness Flank pain (back and lower sides) ASSESSMENT AND FINDINGS A genetic disease therefore careful evaluation of family is necessary Loading… Palpation: Enlarged cystic kidneys Diagnosis is usually made with ultrasound imaging of the kidneys MEDICAL MANAGEMENT PKD has NO CURE Treament is largely supportive: Blood pressure control Pain control Antibiotic agents to resolve infections Kidney failure : RENAL REPLACEMENT THERAPY Genetic testing and counselling may be indicated