renal system disorder

8/6/2019 Renal System Disorder

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The student will be able to:

List clinical manifestation of nephritis.

Discuss the pathophysiology of nephroticsyndrome.

Differentiate between nephritis and nephrotic

syndrome.Formulate the nursing care plane for patient withcommon renal disease such as nephritis andnephrotic syndrome.


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Dysuria: Difficulty or pain onmicturation.

Anuria: Absence of urine.

Oliguria: Decreases in the amountof urine excreted.

Polyuria: Abnormal increase in thevolume of urine.


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Normal Findings:Structure of the Kidney:

Each kidney contains 1 million nephrons(nephron = glomerulus +associated tubule).Number of nephrons is complete at birth, but

functional maturation occurs later.


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Glomerulo-nephritis may vary in intensity

from a mild illness to a severe illnesshaving a sudden onset.

In the usual case:

Evidence of recent streptococcal infection.Mild edema around the eyes rarely isgeneralized (periorbital puffiness).

Temperature is elevated (40 C) but within

a week falls to (37.5 C).


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A urine analysis reveals hematuria with red cellcasts and Proteinuria is also present but notsevere.

Elevated Blood Urea Nitrogen and creatininelevels.

Electrolyte disturbances.

Complete blood count reveals mild anemia


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Low Serum Complement (C3).

Positive antistreptolysin O titer (ASO).

Culture of the throat or skin lesion.

Chest x-ray shows cardiac enlargement,

pulmonary congestion, or pleural effusion.


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Other causes of hematuria (infection- exercise-traumatic- stones hematologic- congenitalabnormalities- tumors- drugs..).

Other cases of edema and proteinuria (e.g.,minimal changes nephrotic syndrome: see thefollowing table)

Differential diagnosis


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Nephrotic syndrome is characterizedby heavy proteinuria,hypoalbuminemia,

hypercholesterolemia, and edema.


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Common inpreschool years.

The average age is 2-3 years (2years).

Boys more than girls are affected(2:1).


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The cause is unknown.

Secondary cause such as

chronic nephritis, syphilis,and nephrotoxic agent.


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This reduces the serum albumen

level(hypoalbuminemia) ,decreasingthe colloid pressure in the capillaries.as a result, the vascular hydrostaticpressure exceed the pull of the colloid

osmotic pressure, causing fluid toaccumulates in interstitial spaces(edema) and body cavity (ascities) .


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The shift of the fluid to the interstitial

spaces reduce the vascular fluidvolume(hypovolemia) which in turnstimulates the rennin-angiotensin

system and the secretion ofantidiuretic hormone andaldosterone.tubular reabsorption ofsodium and water is increasedintravascular volume.


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Edema appears first around the eyesand at the ankles and later isgeneralized. The common sites of

collection are peritoneal cavity(ascites), the thorax (hydrothorax)and the scrotum (hydrocele).

Increased body weight due to edema. Diminished urinary output: may occur

with development of edema


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Manifestation of complication:

Infection

Thrombosis.

Hypovolemic shock Side effect of corticosteroid.


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Diagnostic evaluation

Proteinuria 3 + to 4+.

Hypoalbuminemia (


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1-Increased susceptibility toinfection (Peritonitis Sepsis,

pneumonia, cellulites and urinarytract infection.), related to:

Edema fluid in tissues is a good

culture medium. Hypoproteinemia

Decreased immunoglobulin level.

Decreased splenic function.

Immunosuppressive therapy.


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3-Hypovolemic shock due to :

Vomiting, diarrhea.

Septicemia


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Corticosteroids are the first line oftherapy.

Diuretics, possible albuminadministration.

Antibiotics to prevent infection.


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Nursing care plan for child with

acute post-streptococcalglomerulonephritis

renal system disorder

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