Acute Pyelonephritis

Acute infection of the kidney.

Pregnancy major risk factor. Others include DM and obstructive causes.

E. Coli is the main causative organism.

Inflammatory mediators and bacterial toxins cause kidney damage.

Sudden onset. Fever, chills, CVA tenderness, UTI symptoms.

Dec. renal fxn occurence is low.

Diagnosis confirmed through UA showing significant bacteria, WBC's and RBC's.

Tx w/ antimicrobial therapy.

Renal Calculus

AKA: Nephrolithiasis or kidney stones.

Most frequently occur when during the warm weather season.

Urine becomes supersaturated with the specific solute; certain solutes form crystals when supersaturated.

Crystallization inhanced when dehydrated.

Calcium-oxalate stones most common.

Primary risk factors: hypercalciuria/hypercalcemia.

S/S: flank pain, spasmodic sharp pain as stone moves, N/V, diaphoresis, tachycardia and tachypnea.

Tx medical or surgical depending on size/position of stones.

Acute Glomerulonephritis

Inflam. of the glomeruli.

Insult to body tissues causes infammation, lysosomal enzymes degrade glomerular walls, causing loss of selective permeability.

Dec. GFR, Inc. Na and H2O absorption.

Manifestations: Hematuria, proteinuria, azotemia, oliguria.

Diagnosed w/ UA, Inc. BUN and creatinine.

Tx: treat causative factor, dialysis, restrict Na intake.

Nephrotic Syndrome

Urinary elimination of more than 3 g. of protein per day due to glomerular damage.

DM most common cause.

Inc. permeability of glomerulus allows lg amts of protein to leave bloodstream.

Manifestations: hypoalbuminemia, proteinurea, hyperlipidemia, edema, propensity for thrombus formation. Edema most common.

Tx: gradual removal of fluid w/ diuretics to tx edema.

Prerenal Acute Renal Failure

Develops due to diminished perfusion of the kidney.

Causes: Fever, vomiting, diarrhea, burns, hemorrhage, inc. diuretic use can cause FVD leading to prerenal ARF.

Any dec. in glomerular perfusion pressure can cause prerenal ARF.

Prerenal oliguria is kidneys normal response to a dec. in perfusion.

Persistant prerenal ARF will result in hypoxic renal cells; this can progress to acute tubular necrosis (intrarenal ARF)

Postrenal Acute Renal Failure

Obstruction of the normal outflow of urine from the kidneys can cause postrenal ARF.

Least common ARF and msot amenable to intervention.

Persistant postrenal ARF can lead to acute tubular necrosis, which if left untreated for days or weeks will lead to irreversible kidney damage.

Intrarenal Acute Renal Failure

Most common cause is acute tubular necrosis.

ATN is the result of tubular cell injury due to ischemia or toxins.

Most common cause of ischemia is prolonged prerenal ARF.

GFR is dec. and kidneys become hypoxic which can lead to irreversible kidney damage.

Inc in BUN, Creat. Dec in Na, Ca, pH, H and H. in serum.

Oliguric Phase

1st phase in ARF.

Lasts 1-2 weeks.

UO less than 500mL/24 hrs.

Renal fxn monitored by serum creatinine and GFR.

Metabolic acidosis develops.

Body water is retained since it is not excreted.

Edema, HTN and other signs of FVE develop.

Hyperkalemia is of greatest concern.

Diuretic Stage

2nd phase of ARF.

Lasts 2 days-2 weeks.

Many people can die during this stage. Can't concentrate urine so they can't filter the toxins.

UO usually more than 1L/day; sometimes 4-5L.

FVD can occur if fluids are not promptly replaced.

Recovery Stage

(Convalescent Phase)

3rd phase of ARF.

Lasts 3-12 months.

Kidneys regain normal fxn.

Full recovery indicated when serum creatinine returns to normal range.

Dec. Renal Reserve

1st stage of Chronic renal failure.

Less than 75% of nephrons have been lost.

No S/S present. BUN/Creat. is normal.

Interventions for at risk pts should be initiated to help slow disease process.

May be small amts of protein in the urine.

Renal Insufficiency

2nd stage of chronic renal failure.

75-90% of nephrons have been lost.

Slight elevation in BUN/Creat.

Polyuria/nocturia present.

May be controlled by diet/meds.

Polyuria due to kidneys inability to concentrate filtrate, which can cause nocturia.

End Stage Renal Disease

(ESRD)

3rd stage of chronic renal failure.

More than 90% of nephrons have been lost.

W/o interventions, death is inevitable.

Manifestations: azotemia, uremia, F/E imbalances, renal osteodystrophy

Dialysis or transplant necessary.

ESRD Manifestations

Anuria leads to fluid overload, also causes by renin.

JVD, rales, bounding pulse, HTN, peripheral edema, megalies.

Renal diabetes-glucagon cant metabolize in the kidneys

Hormone irregularities-infertility, impotence, amenorrhea, dec. libido.

Osteodystrophies-causes bone/joint pain, bone fractures.

Chronic Renal Failure

Etiologies

ATN (acute renal failure)

Congenital kidney conditions

Polycystic kidney disease

Infections

Renal cancer, benign renal tumors

DM, HTN, lupus.

Urge Incontinence

Most common-sudden sensation of urgency to urinate/involuntary leakage of urine. Due to overreactive detrusor muscle.

Termed overactive bladder when associated w/ frequency and nocturia.

Causes include bladder infections, radiation therapy, and tumors or stones in urinary tract, or idopathic.

Stress Incontinence

Occurs when small amts of urine is involuntarily lost w/ increases in intraabdominal pressure.

Often caused by coughing/sneezing/laughing/lifting.

Also caused by weak pelvic floor muscles.

Childbearing predisposes women to this type.

Mixed Incontinence

Combo of stress and urge incontinence.

Overflow Incontinence

Bladder becomes so full that it leaks urine.

Functional Incontinence

Related to physical or environmental limitations resulting in an inability to access a toilet in time.

Cystitis

Inflam. of bladder lining.

Causes: bacteria, fungus, parasite, chemicals, stones, trauma.

Bacteria most common (E. coli.)

S/S: frequency/urgency, dysuria, suprapubic pain.

Untreated may lead to renal damage secondary to progression of the infection to upper urinary tract.

UA shows bacteria, RBC, WBC.

Tx: antibiotics. course determined by age.

Determinents of GFR

Filtration pressure in the glomerulus

Permeability of glomerular membrane.

(main force for filtration pressure is hydrostatic pressure in glomerular capillaries)