ANATOMY AND PHYSIOLOGY
AKI - METABOLIC ACIDOSIS
1.
KIDNEYS - ARKIDNEY
 MAIN ORGAN IN RENAL SYSTEM
KIDNEY FUNCTION - ARKIDNEY
A - ACID-BASE BALANCE REGULATION
 PRODUCE BICARBONATE ALKALINE BUFFER
 TOO ACIDIC - KIDNEY WILL
PRODUCE BICARBONATE
(COUNTERACT)
 NORMAL: 22-26 meqs/L
 >26: ALKALOSIS
 <22: ACIDOSIS
R - RENAL CLEARANCE
 FILTRATION OF WASTE FROM BLOOD
TO URINE
 CREATININE CLEARANCE
 2 MAIN WAYS:
1. BUN
2. CREATININE - MOST ACCURATE
 MALE: 101-139 ml/min
 FEMALE: 81-109 ml/min
 <101 ; <81 - KIDNEYS → IMPAIRED
K - “KONTROL” BLOOD PRESSURE
 ↑↑ FLUID VOLUME = ↑↑ BP →
DIURESIS
 ↓↓ FLUID VOLUME = ↓↓ BP → RAAS
 DIRECTLY PROPORTIONAL - BAD
RAAS - RENIN ANGIOTENSIN
ALDOSTERONE SYSTEM
↓↓ FLUID → ↓↓ BP → KIDNEY = RENIN →
LIVER
→
ANGIOTENSINOGEN
→
ANGIOTENSIN
1
(MILD
VASOCONSTRICTOR) NOT ENOUGH →
LUNGS → ACE → ANGIOTENSIN 2
(STRONG VASOCONSTRICTOR) → ↑↑ BP
ANGIOTENSIN
2
→
POSTERIOR
PITUITARY GLAND → ADH → FLUID
RETENTION → THIRST MECHANISM → ↑↑
FLUID
ANGIOTENSION 2 → ADRENAL CORTEX
→ ALDOSTERONE → ↑↑ NA → FLUID
RETENTION → THIRST MECHANISM → ↑↑
FLUID
I - ILECTROLYTES + H2O REGULATION
 ↑↑ FLUID VOLUME = ↑↑ URINE
OUTPUT → ↓↓ SPECIFIC GRAVITY
 ↓↓ FLUID VOLUME = ↓↓ URINE
OUTPUT → ↑↑ SPECIFIC GRAVITY
SPECIFIC GRAVITY - MEASUREMENT OF
SOLIDS IN THE URINE
 NORMAL: 1.010 - 1.030
 <1.010
↑↑
URINE
OUTPUT
(OVERHYDRATE)
 >1.030
↓↓
URINE
OUTPUT
(DEHYDRATED)
ELECTROLYTES
↑↑ ELECTROLYTES → EXCRETION
↓↓ ELECTROLYTES → RETENTION
D - D-VITAMIN SYSNTHESIS
 KIDNEYS ACTIVATE VITAMIN D
 ABSORPTION OF CALCIUM IN SMALL
INTESTINE
N - NITROGENOUS WASTE EXCRETION
 WASTE IN THE BLOOD = ↑↑ CHON
1. BUN
2. CREATININE
E - ERYTHROPOIESIS REGULATION
 PRODUCTION OF RBC
Y - “YURINE” FORMATION
 NORMAL: 30-60 ml/hr
 <30 ml/hr - OLIGURIA
 >30 ml/hr - POLYURIA
 <10 ml/hr - ANURIA
2.
URETERS
 PASSAGEWAY FROM KIDNEY TO THE
BLADDER
3.
BLADDER
 RESERVOIR OF URINE
 FILLING = SNS
 EMPTYING = PNS
4.
URETHRA
 PASSAGEWAY OF URINE FROM THE
BLADDER TO MEATUS (OUTSIDE OF
BODY)
 MALE: 6-8 INCHES
 FEMALE: 1-1.5 INCHES
1
1.
I. URINARY TRACT INFECTION



ASCEDNING INFECTION - GOING UP
URETHRA (+) OPENING → BLADDER
(CYSTITIS) → URETERS (URETITIS) →
KIDNEYS →
COMMON CAUSATIVE AGENT: E.COLI
(NORMAL FLORA OF GUT)
CONSIDERATION
 SPECIMEN = 5-10 ml
 URINE COLLECTION = CLEAN CATCH
MIDSTREAM URINE - STERILE TO
PREVENT CONTAMINATION
(+) CATHETER
 3-WAY FOLEY CATHETER
 (+) PETRI DISH
RISK FACTORS: UTIs
U - URINARY RETENTION / STASIS
 >2 HOURS
 RETENTION - BLADDER DISTENTION
= IRRITATION
 MOST COMMON FACTOR
T - THONGS / SYNTHETIC UNDERWEAR
 EX. NYLON, POLYESTER, SPANDEX TRAP MOISTURE
  SOEN, COTTON - BREATHABLE
I - IMPROPER HYGIENE
 BACK → FRONT
 (+) BATH TUB
  STAGNANT WATER
S - SEX
 FEMALE
 ACTIVITY
a. INTERCOURSE
(+)
b. TOYS
FRICTION
PUT CONDOM & LUBRICANT
  PROMOTE SAFE SEX
SIGNS AND SYMPTOMS
1.
2.
3.
4.
5.
DYSURIA
 HALLMARK SIGN FOR UTI
 BURNING SENSATION
URINARY FREQUENCY & URGENCY
 HALLMARK SIGN
NOCTURIA
PAIN
a. SUPRAPUBIC / PELVIC = BLADDER
b. COSTOVERTEBRAL / FLANK KIDNEYS
EXUDATES
 PUS, BLOOD CELLS (R + W)
 BACTERIA
DIAGNOSTIC TEST
CULTURE AND SENSITIVITY
 CULTURE: CAUSATIVE AGENT
 SENSITIVITY: DRUG OF CHOICE
2.
URINALYSIS
 GENERAL TEST
 CHECK URINE APPEARANCE AND
CHARACTERISTICS
CONSIDERATION
 S - 30-50 ml / 10 ml (NEW)
 CLEAN CATCH MIDSTREAM URINE
COLLECTION
 RESULTS
1. PYURIA - HAZY / CLOUDY URINE
APPEARANCE
2. HEMATURIA
MANAGEMENT: CLEAN
C - CLEANLINESS
 SHOWER = (+) RUNNING WATER
 FEMALE - FRONT → BACK
 MALE
 HEAD (CIRCULAR MOTION) INNER TO OUTER
 SHAFT - DOWNWARD STROKE
L - LIQUID INTAKE
 ↑↑ FLUID INTAKE - FLUSH-OUT
BACTERIA
 AVOID CAFFEINE (COFFEE & TEA) BLADDER IRRITANT
 AVOID ALCOHOL - BLADDER
DISTENTION
E - ELIMINATION HABITS
 VOID EVERY 2-3 HOURS
 >3 HOURS - BLADDER DISTENTION
A - APPROPRIATE TREATMENT
a. ANTIBIOTICS = C-ANTIBIOTICS
 CEFUROXIME
2


CIPRUFLOXACINE
COTRIMOXAZOLE
NURSING CONSIDERATIONS
1. TEST FOR ALLERGY - SKIN
TEST
2. FINISH ALL
3. EARLIEST SIGN
a) ALLERGIC REACTION RASHES
b) TOXICITY - TINNITUS
(RINGING ON EAR)
b. PHENAZOPYRIDINE
HYDROCHLORIDE (PYRIDIUM) =
ANALGESIC
 S/E: RED-ORANGE URINE
2.
a) ALKALINE STONES
i. CALCIUM OXALATE
 MOST COMMON COMPOSITION
 DIET
↑↑ CALCIUM
 MILK, GLV - ANCHOVIS /
SARDINES, DAIRY (MGAD)
↑↑ OXALATE
 SOFTDRINKS, JUNKFOOD,
NUTS, CHOCOLATE
DISORDERS
 HYPERPARATHYROIDIS
M - ↑↑ PARATHORMONE
ii. STRUVITE STONES
 MOST DANGEROUS
 CAUSED BY: BACTERIA
N - NUTRITION AND DIET (MCEP-BROW)
 ACID-ASH DIET = ↓↓ pH - URINE
(ACIDIC)
M - MEAT
C - CRANBERRIES / JUICE - COMMON
E - EGGS
P - PRUNES
B - BARLEY
R - RYE
O - OATS
W - WHEAT
BASED ON COMPOSITION (COMMON)
b) ACID STONES
iii. URIC-ACID STONES
 DIET: ↑↑ PURINE
ORGAN MEAT, POULTRY, FISH,
RED WINE
 GOUT
 RENAL FAILURE
 STARVATION + ALCOHOL
(CATABOLISM)
iv. CYSTIC STONES
 RAREST
 BUILD UP OF AMINO ACIDS
 RARE GENETIC ABNORMALITY
IN CHON (PROTEIN)
METABOLISM
AVOID: CITRUS
 ACIDIC
 BECOMES ALAKALINE WHEN
DIGESTED BY THE BODY
 ORANGES, LEMON, TANGERINE,
CALAMANSI
SIGNS AND SYMPTOMS
II. RENAL CALCULI


STONE (CRYSTAL) FORMATION IN THE
URINARY TRACT AND KIDNEYS
MOST COMMON CAUSE:
DEHYDRATION
TYPES
1.
1.
BASED ON LOCATION
a) NEPHROLITHIASIS - KIDNEY
STONE
b) URETEROLITHIASIS - URETERS
c) CYSTOLITHIASIS - BLADDER
d) URETHROLITHIASIS - URETHRA
2.
3.
4.
5.
SEVERE PAIN - NO. 1 CONCERN
a) RETROPERITONEAL - KIDNEY
STONE
b) ABDOMEN DOWN TO SCROTUM /
TESTES / VAGINA - BLADDER /
URETHRAL STONE
DYSURIA
HEMATURIA
FREQUENCY - SCANT / DRIBBLING
URINE OUTPUT
 (-) OBSTRUCTION
URGENCY - (+) OBSTRUCTION
DIAGNOSTIC TEST
1.
URINALYSIS
3
 RESULT
 ↑↑ SPECIFIC GRAVITY
 pH LEVEL: ALKALINE - ↑↑
ACID - ↓↓
 RBC, WBC → UTI
2.
SERUM TEST
 ↑↑ CALCIUM + OXALATE
 ↑↑ URIC ACID
 ↑↑ BACTERIA (PROTEUS) - AMMONIA
BASED
3.
KUB XRAY (KIDNEY-URETERBLADDER)
 TO VISUALIZE STONES
 CONSIDERATIONS
 FULL BLADDER = FORCE FLUIDS
 (+)CATHETER - CLAMP
 FRONT ONLY
4.
ULTRASOUND
 TO VISUALIZE STONES
 CONSIDERATIONS
 FULL BLADDER = FORCE FLUIDS
 (+) CATHETER - CLAMP
 H2O-BASED LUBRICANT
 NOT SENSITIVE TO URETERS
(URETERAL STONES)
5.
CT SCAN
 CONFIRMATORY TEST
 XRAY
 CONSIDERATIONS
 (+) CLAUSTROPHOBIA SEDATIVE
 REMOVE METALS IN AFFECTED
AREA
 (-) TATTOOS - OBSTRUCT
VISUALIZATION
  VISUALIZATION OF THE
SURROUNDING AREA
MANAGEMENT: RSTONES
R - REST
 TO PROMOTE HEALING
S - STRAIN THE URINE
 TO DETERMINE THE COMPOSITION
OF THE STONE
 CHEESE CLOTH
T - TEACH DIET TREATMENT
 ACID-ASH DIET = ALKALINE STONES
 MCEP-BROW
 ALKALINE-ASH DIET = ACID STONES
 MGAD-C (CITRUS)
O - OBSERVE URINE OUTPUT
 TO DETECT OBSTRUCTION
N - NARCOTICS
 MORPHINE SULFATE
 CNS DEPRESSANT
  ASSESS RR
 <12 - DO NOT GIVE
 12 - GIVE, CLOSE
MONITORING
 >20 - GIVE
 BEDSIDE: NALAXONE (NARCAN)
 STORAGE: LOCKED CABINET
 IF (+) ADDICTED - METHADONE
(SAME EFFECTS BUT LESS
ADDICTIVE)
 MEPERIDINE
E - ESWL (ELECTROCORPOREAL SHOCK
WAVE LITHOTRIPSY)
 SHATTER STONES THROUGH
ULTRASONIC WAVE
 PAINFUL
 CONSIDERATIONS
 LOCAL ANESTHESIA CREAM = 45
MINS PRIOR TO PROCEDURE
 SPINAL OR GENERAL
 AFTER PROCEDURE - GIVE
NSAIDS
 TO RELIEVE PAIN
 EXPECTED OUTCOME
 (+) BRUISING
 (+) MICROSCOPIC
HEMATURIA
 ↑↑ FLUID INTAKE = FLUSH-OUT
 STRAIN THE URINE
S - SURGERY
 NEPHROLITHOTOMY - DIRECTLY TO
THE KIDNEY
 PYELOLITHOTOMY
 CONSIDERATIONS
 MAINTAIN FLUID INTAKE
 MONITOR - BLEEDING (INCISION
OR URINE)
 STRAIN THE URINE
III. ACUTE KIDNEY INJURY


INJURY - IMPAIRMENT
REVERSIBLE
4
 2-3 WEEKS
TYPES
1.
2.
PRE-RENAL INJURY
 BEFORE THE KIDNEYS
 ↓↓ BLOOD FLOW OR ↓↓ OXYGEN
 FLUID LOSS - HEMORRHAGE +
GI)
 HYPOPERFUSION - HF + MI
 PERFUSION - CIRCULATION
 HYPOPERFUSION - ↓↓
CIRCULATION
 SHOCK - CARDIAC, ANAPHY,
HYPOVOLEMIC
 ↓↓ BLOOD FLOW, ↓↓O2
 EX. DIABETES MELLITUS, ARDS
INTRA-RENAL FAILURE
 AT KIDNEY - ATTACKS THE KIDNEY
 TRAUMA - DIRECT +
RHABDOMYOLISIS
 NEPHROTOXIC DRUGS AMINOGLYCOSIDE ANTIBIOTICS,
MERCURY, LEAD, NSAIDS
 INFECTION - ACUTE GLOMERULAR
NEPHRITIS
RHABDOMYOLISIS
TRAUMA IN MUSCLE → DAMAGED
MUSCLE CELLS → RELEASE MYOGLOBIN
IN BLOOD → SHOULD BE EXCRETED →
TOO BIG (MAY CAUSE KIDNEY DAMAGE)
3.
POST-RENAL INJURY
 AFTER THE KIDNEYS
 OBSTRUCTION / BACKFLOW
 STONES
 CLOTS
 INFLAMMATION
 EX. UTI
PHASES
1.
INITIAL PHASE
 INITIAL INSULT → ONSET OF S/SX
 (-) KIDNEY PROBLEM
2.
OLIGURIC PHASE
 ↓↓ URINE OUTPUT - <720 ml/day (<30
ml/hr)
 1-2 WEEKS (>2 WEEKS = CKD)
 MOST CRUCIAL PHASE
 KIDNEY START TO ↓↓ FUNCTION
3.
DIURETIC PHASE
 STARTS HEALING
 ↑↑ URINE OUTPUT - 4-5 L/DAY
4.
RECOVERY / CONVALASCENT
 HEALED
 NORMAL URINE OUTPUT: 30-60
ML/HR (720-1440 ML/DAY)
 6-12 MONTHS
SIGNS AND SYMPTOMS
1.
2.
3.
4.
5.
↑↑ BLOOD PRESSURE
AZOTEMIA - ↑↑ BUN + CREATININE
METABOLIC ACIDOSIS - ↓↓
BICARBONATE
a) (+) KUSSMULS BREATHING - DEEP +
RAPID (RESPIRATORY ALKALOSIS A COMPENSATION)
OLIGURIA
FLUID AND ELECTROLYTE IMBALANCE
a) FLUID VOLUME EXCESS - EDEMA
(ANASARCA)
b) DILUTIONAL HYPONATREMIA
c) HYPOCALCEMIA - TETANY SIGNS
d) HYPERPHOSPHOTEMIA
e) HYPERKALEMIA
f) ANEMIA → HYPOXIA S/SX
DIAGNOSTIC TEST
1.
SERUM TEST
 BUN + CREATININE = ↑↑
2.
RENAL CLEARANCE
 CREATININE CLEARANCE = ↓↓
MANAGEMENT - ACUTE RD
A - APPROPRIATE DIET
 ↓↓ PROTEIN (CHON) - TO PREVENT ↑↑
OF BUN AND CREATININE
 ↑↑ SODIUM - TO PREVENT
HYPONATREMIA
 ↓↓ POTASSIUM - TO PREVENT
HYPERKALEMIA
 ↑↑ CHO - CALORIE NEEDS
C - CONTROL HYPERKALEMIA
 TO PREVENT CARDIAC
ABNORMALITIES
1. DIURETICS - POTASSIUM WASTING
 AVOID SPIRONOLACTONE,
TRIAMETREN - POTASSIUM
SPARRING
2. INSULIN - REGULAR, IV, + GLUCOSE
(TO PREVENT HYPOGLYCEMIA)
3. NA POLYSTERENE SULFONATE
(KAYAXELATE = ORAL ENEMA)
5

  SODIUM
NA = K+
U - URINE OUTPUT MONITORING
T - TOTAL REST TO PROMOTE HEALING
E - EDEMA MANAGEMENT
 ASSESSMENT - WEIGHT, GIRTH, V/S
(BP)
 WEIGHT: SAME - TIME, WEIGHING
SCALE, CLOTHES, PATIENT
 GIRTH: USE TAPE MEASURE OR
METER STICK + STRING
 BEST TIME:
1. UPON WAKING UP, BEFORE 1ST
MEAL
2. IN THE MORNING, BEFORE
BREAKFAST
 RESTRICT FLUID INTAKE
 MONITOR I&O
 GIVE DIURETICS - LASIX / LOOP /
FUROSEMIDE
 MONITOR: HYPOKALEMIA
R - REPLACEMENTS
 NA BICARBONATE - IV, TO ADDRESS
METABOLIC ACIDOSIS
 CA GLUCONATE - IV, TO ADDRESS
HYPOCALCEMIA
 ALPHA-EPOETIN (EPOGEN) - TO
ADDRESS ANEMIA
D - DIALYSIS
 REMOVES WASTE AND EXCESS
FLUIDS
 NO EFFECT ON THE FOLLOWING:
 BLOOD CELLS
 HEMOGLOBIN
 FATS
IV. CHRONIC KIDNEY DISEASE
(CRF)




IRREVERSIBLE
↓↓ URINE OUTPUT: >2 WEEKS
END STAGE RENAL DISEASE - LAST
STAGE OF CRF
 5% KIDNEY = <15 ml/min OF
GLOMERULAR FILTRATION RATE
(NORMAL: 125 ML/MIN)
 GFR: >90 ML/MIN = GOOD
AKI
DILUTIONAL

HYPONATREMI
A
CRF
HYPERNATREMIA
  SODIUM
SIGNS AND SYMPTOMS
1.
2.
3.
SEVERE ACUTE RENAL FAILURE S/SX
(↑↑ NA - HYPERNATREMIA)
SEVERE AZOTEMIA
UREMIA - URINE IN THE BLOOD
 MANIFESTATIONS
a. NAUSEA AND VOMITING
b. UREMIC FROST
 PRURITUS - GIVE OLIVE OIL,
CALAMINE
 ↓↓ LOC - ENCELOPATHY,
COMA
DIAGNOSTIC TEST
1.
2.
SERUM - BUN + CREA = ↑↑
CLEARANCE - CREATININE ↓↓
MANAGEMENT
1.
2.
ACUTE RD - ↓↓ SODIUM
KIDNEY TRANSPLANT
a) LEAVE OLD KIDNEY - EXCEPT IF (+)
POLYCYSTIC KIDNEY DISEASE PKD IS ENLARGED AND PAINFUL
 REMOVING KIDNEY MAY CAUSE
MORE COMPLICATIONS
(BLEEDING + INFECTION)
b) TRANSPLANT = 1 ONLY
 TO LIMIT ACUTE REJECTION LIMIT INFLAMMATION
c) PLACEMENT: ILIAC FOSSA
d) NEW KIDNEY ATTACHED: RENAL
ARTERY
e) CHECK:
 BLOOD + TISSUE
COMPATIBILITY
1ST DEGREE AFFINITY - DIRECT
FAMILY (IDENTICAL TWIN)
 IMMUNOSUPPRESSANTS
(CYCLOPOSPHONIE)- BEFORE,
DURING, AND AFTER
TRANSPLANT
 STEROIDS - 2ND CHOICE
 1ST COME 1ST SERVE = SOCIAL
JUSTICE
GRAFT REJECTION S/SX
1. FEVER
2. PAIN ON AFFECTED AREA
3. WEIGHT GAIN (24 HOURS)
4. EDEMA
6
5.
3.
 IF OUTFLOW ↓↓ - TURN THE PATIENT
SIDE TO SIDE
 IF CLOUDY (+ PUS) OUTFLOW,
REBOUND TENDERNESS,
ABDOMINAL PAIN = PERITONITIS
HYPERTENSION
DIALYSIS
TYPES
a. PERITONEAL DIALYSIS
 INDIRECT FILTRATION
 NATURAL MEMBRANE PERITONEAL MEMBRANE
 (+) DIALYSATE SOLUTION
PROCESS INVOLVED:
1. DIFFUSION = TRANSFER OF
SOLIDS (ELECTROLYTE, BUN,
CREATININE, NITROGENOUS
WASTE) FROM GREATER TO
LOWER CONCENTRATION
2. OSMOSIS = TRANSFER OF
FLUIDS FROM LOWER TO
GREATER CONCENTRATION
TYPES OF PERITONEAL DIALYSIS
1. REGULAR (AUTOMATED PD)
(+) MACHINE - INFUSION OF
DIALYSATE THEN
EXCRETION
PATIENT IS LYING DOWN
2.
CONTINUOUS AMBULATORY
PD
MANUAL
INFUSION (GRAVITY), CLAMP,
WAIT (1-4 HOURS), THEN
UNCLAMP AND EXCRETE
NURSING CONSIDERATIONS
(PERITONEAL DIALYSIS) - ABDOM
A - ASSESS WEIGHT, GIRTH, V/S (BP)
 S/E: HYPOTENSION
B - BE SURE TO WARM DIALYSATE
 PROMOTE EXCRETION
 PREVENT CRAMPING
 (+) CRAMPING - STOP
D - DIALYSIS TIME
 MINIMUM OF 30 MINS
 MAXIMUM OF 4 HOURS
O - OBSERVE STERILE TECHNIQUE
 SURGICAL
M - MONITOR THE OUTFLOW
 NORMAL: MORE OUTFLOW
b. HEMODIALYSIS
 DIRECT FILTRATION
 ARTIFICIAL MEMBRANE +
DIALYSATE
 ACCESS:
SHUNT → TEMPORARY
FISTULA → PERMANENT



SHUNT
TEMPORARY
OUTER
2 TUBES FOR
VEIN
AND
ARTERY




FISTULA
PERMANENT (+)
INCISION)
FOREVER
INNER
ANATOMOSIS OF
VEIN + ARTERY
ADVANTAGES
SHUNT
1. CAN
BE
USED 1.
IMMEDIATELY
2. EASILY USED
2.
3. PAINLESS
DISADVANTAGES
SHUNT
1.
1. ↑↑ INFECTION
2. ↑↑ BLEEDING
3. DISLODGEMENT 2.
3.
FISTULA
LESSER
INFECTION
LESS
BLEEDING
FISTULA
CANNOT
USE
IMMEDIATELY
REQUIRE SKILLS
PAINFUL
NURSING CONSIDERATIONS - BLOODS
B - BLEEDING PRECAUTION D/T
HEPARINIZED SYSTEM
 PREVENT CLOTS
 CONSIDERATIONS
 BEDSIDE: ANTIDOTE →
PROTAMINE SO4
 INFUSION PUMP (CONTROL
AMOUNT) - TO PREVENT
BLEEDING
L - LET PATIENT USE EXTREMETIES
WITH SITE
 STRESS BALL
O - OBSERVE PATENCY
 BRUIT - AUSCULTATE →
WHOOSHING SOUND
 THRILL - PALPATE → VIBRATION
O = OBSERVE STERILE TECHNIQUE
7
 STERILE TECHNIQUE
 SURGICAL ASEPSIS
D - DO NOT USE SITE FOR PROCEDURE
S - STRICTLY NO CONSTRICTION AT SITE
COMPLICATIONS
FLUID SHIFTING
→ CEREBRAL
1. DISEQUILIBRIUM SYNDROME
EDEMA → ↑↑ ICP
 CAUSES:
 RAPID INFUSION →
VASOCONSTRICT
 PROLONGED DIALYSIS
ION → ↓↓ O2 → ↓↓
LOC → COMA →
DEATH
V. ACUTE
GLOMERULONEPHRITIS

MASSIVE HEMATURIA D/T ↑↑
GLOMERULI PERMEABILITY
GLOMERULI - FILTRATION
 SEMI-PERMEABLE - SMALL PARTICLES
CAN PASS THROUGH
 FILTERS:
 WATER
 ELECTROLYTES
 BUN + CREATININE
  BLOOD AND PROTEIN - BIG
MOLECULES (MASSIVE HEMATURIA)
 CAUSE: IMMUNE MEDIATION
 HX: RESPIRATORY INFECTION (SORE
THROAT) / PHARYNGITIS - 2-3 WEEKS
AFTER ONSET OF SIGNS AND
SYMPTOMS
 CAUSATIVE AGENT: GROUP A BETAHEMOLYTICS STREPTOCOCCUS (GABHS)
 GABHS + IMMUNE SYSTEM = ANTIGENANTIBODY COMPLEX
 ANTIGEN-ANTIBODY COMPLEX →
KIDNEY → DAMAGE GLOMERULI
SIGNS AND SYMPTOMS - BODSTREP
B - BP INCREASE - EXCESS FLUID VOLUME
O - OLIGURIA
D - DYSURIA
S - SWELLING OF FACE AND HANDS
 MILD EDEMA, MILD PROTEINURIA
T - TEA / COLA COLOR URINE - BECAUSE OF
BLOOD
 TEA - SMALL BLOOD
 COLA - MASSIVE HEMATURIA
R - RUSTY COLOR URINE
E - ELEVATED BUN AND CREATININE
P - PROTEINURIA (MILD)
DIAGNOSTIC TEST
1.
2.
3.
URINALYSIS - (+) RBC, (+) PROTEIN TEA / COLA URINE
SERUM TEST - ↑↑ BUN AND
CREATININE
STREPTOLYSIN-O TITER - ↑↑
MANAGEMENT - ACUTES-P
A - APPROPRIATE TREATMENT
 DIURETICS (LOOP) - TO LOWER
EDEMA
 ANTI-HYPERTENSIVE - ↓↓ BP
C - CONTROL DIET
 ↓↓ SODIUM, ↓↓ K, ↓↓ CHON, ↑↑ CHO
U - UNYEILDING INFECTION
 ANTIBIOTICS- DOC: PENICILLIN /
ERYTHROMYCIN / AZITHROMYCINE
T - TONE DOWN FLUID INTAKE
E - EDEMA ASSESSMENT
S - STEROIDS / IMMUNOSUPPRESSANT
P - PLASMAPHERESIS
VI. NEPHROTIC SYNDROME

MASSIVE PROTEINURIA D/T ↑↑
GLOMERULI PERMEABILITY
CAUSE:
1. UNKNOWN
2. AUTOIMMUNE DISEASES - SLE
SIGNS AND SYMPTOMS - NEPHRO
N - NORMAL TO LOW BP
E - EDEMA (GENERAL)
P - PROTEINURIA, LIPIDURIA
H - HYPOALBUMINEMIA, HYPERLIPIDEMIA
R - (F)ROTHY URINE
O - OLIGURIA
DIAGNOSTIC TEST
1.
URINALYSIS
 (+) PROTEIN - FROTHY URINE
2.
KIDNEY BIOPSY - INFLAMMED +
SCARRING
MANAGEMENT
8
1.
2.
3.
EDEMA ASSESSMENT
DIET - ↓↓ NA, FLUID RESTRICTION,
NORMAL → LOW PROTEIN
MEDICATIONS
a. CORTICOSTEROIDS /
IMMUNOSUPPRESSANTS
b. ACE - INHIBITOR (-PRIL)
 TO ↓↓ PROTEINURIA BY ↓↓
INTRAGLOMERULAR FORCE
c. ANTI-LIPIDS (-STATIN)
d. DIURETICS (LOOP) - TO LOWER
EDEMA
9