Results from a lesion of the nervous sysytem

Two Types: Spastic (upper lesion); Flaccid (lower lesion)

no perception of bladder fullness

Can result in possible kidney damage

Interventions: Urocholine administration, Crede's method, voiding programs, catherterization

Distention of renal pelvis due to obstruction

Ache in back or flank, chills, tenderness, pyuria, hematuria

Interventions: Correct the obstruction, monitor for post obstructive diuresis

Infection of renal pelvis

dysuria, fever, chills, CVA tenderness

Urine is cloudy and foul-smelling; hematuria

Urine cultures must be obtained

Encourage adequate fluids (8 glasses/day)

Rest

Antibiotics for 14-21 days

NSAIDS

Sitz Baths/heating pads for pain

Teach manifestations of reoccurance

Follow up urine culture in 2 weeks

Kidney losses function

Repeated bouts of acute pyelonephritis

Fatigue, headache, polyuria, anorexia

Diagnosed by radiologic imagine and histologic testing

Can progress to end-stage renal disease

Bedrest during acute phase

adequate fluid intake (3-4 liters/day)

Antibiotics

NSAIDS

If BUN elevated, restrict protein; High calorie diet

Follow up urine culture in 2 weeks

Inflammation of the glomerulus

Typically caused by group A strep (throat infection)

Symptoms occur 2-3 weeks after infection

Decrease in GFR resulting in:

Hematuria, proteinuria, elevated BUN / Creatinine

Headache, malaise, periorbital edema, flank pain, HTN, CVA tenderness

Antibiotics (if strep is present)

Rest

Restrict Na, and fluid intake; diuretics (Edema)

Restrict protein; High calorie diet (elevated BUN)

Antihypertensive drugs (HTN)

Kidneys shrink in size and become fibrous

Causes severe damage resulting in ESRD

May be asymptomatic

HTN, elevated BUN/ creatinine, proteinuria, hematuria, peripheral edema, nocturia, dizziness, weight loss,

Rest

Restrict Na, protein, and fluid intake; diuretics (edema)

Antihypertensive drugs (HTN)

Dialysis (fluid/electrolyte balance)

Emotional support

Glomerulus becomes permeable to plasma proteins

Decreased oncotic pressure

Peripheral edema, proteinuria, hypoalbuminemia, HTN, hyperlipidemia

Hypocalcemia may occur

Hypercoaguability (possible thromboembolism)

Steriods (Prednisone; Cytoxan; Imuran)

Low Na diet (2-3 g/day); High calorie diet

Low protein diet (0.5-0.6 g/kg/day); Diuretics

Bedrest until edema subsides

Proper exercise to decrease protein breakdown

Avoid ACE-inhibitors and NSAIDS

If urine protein excedes 10g/day, supplement may be needed

Abrupt loss of kidney function

Oliguria (output less than 400-500ml/day)

Azotemia (uremic toxins)

Elevated BUN/ creatinine/ K+

Acute Renal Failure

PRERENAL

Causes / Interventions

(Patient will have high specific gravity/ low urine Na)

 Decreased cardiac output; hemorrhage

Hypovolemic shock

Dehydration

Vascular obstruction (calculi, BPH, strictures)

 Maintain BP at normal levels

Catheterize

MONITOR FOR POST OBSTRUCTIVE DIURESIS-

Input restrictions should = output + 600ml/day

Acute Renal Failure

POSTRENAL

Acute Renal Failure

INTRARENAL

Causes

Prolonged prerenal ischemia (acute tubular necrosis)

Nephrotoxic injury

 Drugs; Hemorrhage; Burns;

Pulmonary emboli; Allergies 

Infections; Malignant HTN

Chemical exposure (lead, arsenic)

Acute Renal Failure

POSTRENAL

Causes

Mechanical obstruction of urinary flow causing urine reflux into the kidneys, impairing function

BPH ; Calculi; Trauma; Extrarenal tumors

Acute Renal Failure

Neurological Manifestations

Nitrogenous waste products accumulate in the brain

Decreased alertness, energy, and thought processes

Decreased LOC that leads to coma

Seizures

Itching, tingling, numbness, twitching of extremeties

Acute Renal Failure

Cardiovascular Manifestations

Volume overload

Heart failure

Hypotension (early)

Hypertension / Cardiac arrythmias

Acute Renal Failure

Respiratory Manifestations

Pulmonary Edema

Kussmaul Respirations

Pleural Effusion

Findings on Assessment:

adventitous breath sounds

thick secretions

Acute Renal Failure

GI Manifestations

Weight loss / Anorexia

Positive guaiac stool tests (bleeding)

Nausea/ Vomiting

Constipation or diarrhea

Acute Renal Failure

Hematopoetic Manifestations

Anemia (impaired erythropoietin production)

Increased susceptability to infection

Leukocytosis

Findings on Assessment:

pale mucous membranes

fatigue, weakness

Acute Renal Failure

Integumentary Manifestations

Pale, dry, dull, yellow skin

Uremic frost

Bruising

Pruritus

Thin, brittle hair

Thick nails

Acute Renal Failure

Fluid and Electrolyte Balance

K+= hyperkalemia

ECG will show peaked T waves, wide QRS complex, and ST segment depression 

Na= hyponatremia

Ca= hypocalcemia (from decreased GI absorption)

Phos= hyperphosphatemia

Mg= hypermagnesemia

Metabolic acidosis from decreased excretion of H+ ions

Decreased production of buffers (bicarbonate)