Immunlogic Renal Disease

1. Immunlogic Renal Disease NPN 200 Medical Surgical Nursing I

2. Glomerulonephritis • 3rd leading cause of renal disease • Inflammation of the capillary loops in the glomeruli • May have underlying genetic component • May be primary or secondary • May follow and infection of group A strep • Exposure to drugs also may precipitate event • Systemic disease and infections may be a precursor • Can be acute or chronic • An antigen-antibody reaction occurs

3. Glomerulonephritis, cont. • Onset may be 10 days after time of infection • Inflammation and scarring is followed by increased permeability of the glomeruli • BUN and Creatinine rises • Nitrogenous wastes accumulate in the blood

4. Glomerulonephritis, cont • History and Physical • ? Recent infectious disease, travel, surgery, invasive procedures • Inspect skin for recent lesions or incisions • Assess for fluid overload and circulatory congestion • Look for dyspnea, crackles, and neck vein distention • Ask about changes in UOP • Check for hypertension due to NA and fluid retention • May have fatigue, anorexia, N/V if uremia from renal failure is present

5. Glomerulonephritis, cont • Lab Diagnosis • Observe urine for hematuria • Urinalysis may show hematuria or proteinuria, as well as casts • A 24 hour urine for creatinine clearance may show a decrease • A 24 hour urine for total protein may show and increase and a serum protein may be decreased • A strep titer may be performed • Blood, skin, and throat cultures may also be obtained • Renal biopsy may confirm problem

6. Glomerulonephritis, cont • Treatment • Antibiotics • Diuretics • Antihypertensives • May need to treat fluid overload by dietary and fluid restrictions • Bedrest or activity reduction until urine and B/P return to baseline • May develop chronic disease and need watching for long term • May need dialysis and or plasmaphoresis (removal of antibiodies)

7. Glomerulonephritis, cont • Assessment • Fluid • Skin turgor • Respiratory function for abnormal breath sounds • Heart rate and B/P • Accurate I/O and daily weights • ABD girths if ascites

8. Glomerulonephritis, cont • Interventions • Give meds as ordered – diuretics, antibiotics, anti-hypertensives, • May need to be on fluid restriction- teach reason to client and family • I/O • Check for edema – sacral, pedal, orbital • Skin care • Watch for risk of skin integrity problems • TCDB • Assist with ADL’s

9. Chronic Glomerulonephritis • Develops over 20-30 years • Cause may not be known • Changes in renal tissue result from infection, hypertension, inflammation, or poor blood flow to the kidneys • Kidney tissue atrophies and nephrons cease to function • May have mild symptoms the progress to severe • Assessment is same as above • Treatment is based on severity of disease

10. Nephrotic Syndrome • Increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and be removed from the blood • This causes massive loss of protein in the urine, edema formation, and decreased plasma albumin levels • Most common cause is changes in the immune or inflammatory processes • Altered liver activity may result in increased lipid production and hyperlipidemia

11. Key Features Massive proteinuria Hypoalbuminemia Edema Lipiduria Hyperlipidemia Increased coagulation Renal insufficiency Treatment Depends on causative agent Immunosuppressive agents and steriods ACE inhibitors Treat hyperlipidemia Dietary changes Diuretics Nephrotic Syndrome

12. Glomeruloneophritis or Nephrotic Syndrome in Peds • Includes same diagnostic tests and same symptoms • Treatment requires adjustment for pediatric dosages of medications • Much family support and teaching • Diversion may be necessary and quiet activities • Dietary changes

13. Nephrosclerosis and Renovascular Disease • Nephrosclerosis –thickening of the nephron blood vessels which decreases renal blood flow and kidney tissue becomes hypoxic, followed by ischemia and fibrosis occurs with hypertension and diabetes may progress to end stage renal disease(ESRD) • Hypertension is the 2nd leading cause of ESRD • Can be reversed if caught if hypertension treated early • Diuretics, anti-hypertensives and ACE inhibitors may be used

14. Nephrosclerosis and Renovascular Disease • Renovascular disease • Renal artery stenosis, Athrosclerosis, and Thrombosis • Often appear with new onset hypertension • Changes are often located where the aorta and the renal artery connect • Treatment • Treat hypertension • Angioplasty/stent • Renal artery bypass

15. Polycystic Kidney Disease • Inherited disorder in which fluid filled cyste develop in the nephrons • 2 types – childhood (begins at birth) and adult (usually by 30-40 years of age) • Over time, cysts become larger and more widely distributed • With the progression the cyste enlarge and the nephron becomes less productive

16. Polycystic Kidney Disease • Each kidney may enlarge to the size of a football • This causes displacement of other organs and causes pain • These cysts may rupture, become infected and bleed • Most clients have hypertension • Heart and liver problems also occur as well as colon diverticuli • Cysts may also occur in other tissue • Liver, blood vessels in the brain, cardiac blood vessels

17. Polycystic Kidney

18. Polycystic Kidney Disease • Treatment is aimed to preserve kidney function • Control UTI • Treat hypertension • Watch for kidney stones • Treat and control constipation • Control pain • Regulate diet • May need dialysis and transplant

19. Polycystic Kidney Disease • Nursing interventions • Teaching- • B/P. • measuring urine, • daily weight, • medication administration, • diet changes (low Na, low protein), • energy management • Refer to: Polycystic Kidney Research Foundation