Acute Kidney Injury, Glomerulonephritis (PDF)

# Acute Kidney Injury, Glomerulonephritis, Nephrotic Syndrome ## Key Terms and Concepts - **Oliguria:** Urine output of less than 400 mL/day. - **Anuria:** Urine output of less than 50 mL/day. - **Bladder capacity:** Typically around 400–600 mL. ## Types of Renal Health Challenges 1. **Glomerulo...

# Acute Kidney Injury, Glomerulonephritis, Nephrotic Syndrome ## Key Terms and Concepts - **Oliguria:** Urine output of less than 400 mL/day. - **Anuria:** Urine output of less than 50 mL/day. - **Bladder capacity:** Typically around 400–600 mL. ## Types of Renal Health Challenges 1. **Glomerulonephritis:** Inflammation of glomerular capillaries. 2. **Nephrotic Syndrome:** Increased glomerular permeability causing protein loss. 3. **Acute Kidney Injury (AKI):** Rapid decline in renal function. 4. **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, and supportive care. ### Chronic Glomerulonephritis - **Causes:** Repeated acute glomerulonephritis, hypertension, hyperlipidemia. - **Symptoms:** Fixed specific gravity in urine, proteinuria, electrolyte imbalances. - **Management:** Drugs and dietary therapy. ### Nephrotic Syndrome - **Symptoms:** Proteinuria, hypoalbuminemia, edema. - **Causes:** Diabetes, lupus, renal vein thrombosis. - **Management:** Drugs and dietary therapy. ## Acute Kidney Injury (AKI) ### Causes - **Pre-renal:** Reduced blood flow (e.g., hypovolemia, hypotension). - **Intra-renal:** Direct kidney damage (e.g., acute tubular necrosis, diabetic nephropathy). - **Post-renal:** Urinary obstruction (e.g., prostate enlargement, kidney stones). ### Phases of AKI 1. **Initiation:** Onset of kidney injury. 2. **Oliguric:** Decreased urine output, lasting days to weeks. 3. **Diuresis:** Gradual urine output increase. 4. **Recovery:** Renal function restoration (up to 12 months). ## Clinical Management and Nursing Care - **Fluid Balance:** Monitor intake and output, daily weights. - **Electrolyte Management:** Manage potassium, sodium, calcium, phosphorus levels. - **Medications:** Antibiotics, diuretics, steroids, dialysis for 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 with Answers 1. **Question:** The most accurate indicator of fluid loss or gain in an acutely ill patient is: - A) Abdominal girth - B) Weight - C) Skin turgor - D) Level of consciousness **Answer:** B) Weight 2. **Question:** Is hypercalcemia the most life-threatening fluid and electrolyte change in renal disturbances? **Answer:** False. Hyperkalemia is more life-threatening. 3. **Question:** As kidney injury progresses and GFR falls below 50 mL/min, what occurs? - A) Metabolic acidosis - B) Hypokalemia - C) Hypercalcemia - D) Hypophosphatemia **Answer:** A) Metabolic acidosis 4. **Question:** What would result in the most pronounced elevations in serum potassium and BUN in acute renal failure? - A) Hemorrhage - B) Nephrotoxic drugs - C) Severe crushing injuries - D) Renal vascular obstruction **Answer:** C) Severe crushing injuries 5. **Question:** Clients with acute glomerulonephritis may exhibit: **Answer:** Hematuria, proteinuria, edema, hypertension. 6. **Question:** The cause of postinfectious glomerular disease in a 16-year-old: **Answer:** Group A beta-hemolytic streptococcal infection of the throat. 7. **Question:** A key nursing diagnosis for nephrotic syndrome would include: **Answer:** Excess fluid volume related to generalized edema. 8. **Question:** During the diuresis phase of AKI, what should a client be closely monitored for? **Answer:** Dehydration. 9. **Question:** The nurse's role in caring for an ARF patient includes: **Answer:** Monitoring for complications, managing fluid/electrolyte imbalances, and providing emotional support. 10. **Question:** To assess for bleeding in a postoperative kidney surgery client, include: **Answer:** Skin condition, level of consciousness, urinary drainage. ## Additional Questions 11. **Question:** Which lab finding would suggest an exacerbation of chronic glomerulonephritis? - A) Persistent hypertension and retinal changes - B) Orthostatic hypotension - C) Increased urine specific gravity - D) Increased WBCs in urine **Answer:** A) Persistent hypertension and retinal changes. 12. **Question:** Which phase of AKI is characterized by a severe decrease in urine output? - A) Initiation - B) Oliguric - C) Diuresis - D) Recovery **Answer:** B) Oliguric 13. **Question:** For hyperkalemia, the nurse should anticipate administering: - A) Calcium gluconate - B) Cation exchange resins - exchanges K+ for Na. - C) Erythropoietin - D) Vitamin D supplements **Answer:** B) Cation exchange resins 14. **Question:** Patients with nephrotic syndrome are at increased risk of: - A) Hypercalcemia - B) Hypoalbuminemia - C) Hyperphosphatemia - D) Anemia **Answer:** B) Hypoalbuminemia 15. **Question:** Intra-renal causes of AKI include: - A) Hypovolemia - B) Renal calculi - C) Acute tubular necrosis - D) Prostatic hyperplasia **Answer:** C) Acute tubular necrosis 16. **Question:** A key indicator of fluid overload in AKI is: - A) Weight loss - B) Jugular venous distension - C) Hypotension - D) Increased hematocrit **Answer:** B) Jugular venous distension 17. **Question:** Post-renal AKI is typically caused by: - A) Hypotension - B) Tubular necrosis - C) Urinary obstruction - D) Infection **Answer:** C) Urinary obstruction 18. **Question:** Following kidney surgery, a major complication to monitor for is: - A) Deep vein thrombosis - B) Increased appetite - C) Euphoria - D) Decreased respiratory rate **Answer:** A) Deep vein thrombosis 19. **Question:** Symptoms of nephrotic syndrome often include: - A) Dehydration - B) Edema and proteinuria - C) Increased urination - D) Anuria **Answer:** B) Edema and proteinuria 20. **Question:** In the recovery phase of AKI, lab values generally: - A) Remain abnormal - B) Return to baseline over months - C) Worsen - D) Show increased proteinuria **Answer:** B) Return to baseline over months