1. Renal Disorders NUR 171 Professor Losicki R.N. MSN

2. Kidney Structure & Function

3. Structure & Function: The Transformation of Filtrate to Urine  Step 1: Glomerular Filtration  160-180L / 24 hr @ app 125mL/min  1-3L/day excreted as urine  Step 2: Tubular Reabsorption  Controls volume of filtrate  Controls composition of filtrate  End result is 1mL/min or 60 mL/hr  Further explanation see below  http://www.khanacademy.or g/science/biology/v/the- kidney-and-nephron http://www.khanacademy.or g/science/biology/v/the- kidney-and-nephron

4. Kidney Job Description 1. Water excretion: 2. Acid/base balance 3. Filtration of metabolic waste BUN:Protein by product regulation Creatinine Electrolyte 5. Blood Pressure regulation: RAAS 6. Activation of Vitamin D 7. Synthesis of Erythropoetin

5. Kidney Jobs RAAS System

6. Urinary System Structure & Function

7. Urinary Tract Pathophysiology Inflammation/Infection : – Cystitis, pyelonephritis, urosepsis Autoimmune/Vascular: – Glomerulonephritis Obstruction: – Calculi [ureteral,renal], tumor, cysts, – structural abnormalities, BPH Neuroptathy/Insufficiency Cystectomy: Continent & incontinent urinary diversions

8. Who is at risk?

9. Uncomplicated Lower Urinary Tract Infection (LUTS) AKA: Cystitis

10. Complicated Upper Urinary Tract Infection: Pyelonephritis

11. Obstruction: urolithiasis/nephrolithiasis  What wrong?  Who’s at risk?  S/S http://www.georgetownuniversityhospital.org/documents/Urology/Food_Souces _Oxalate.pdf

12. http://www.youtube.com/watch?v=V-IfEf944Uo Obstruction: Stricture/Tumor/BPH

13. Impaired Renal Function  Stage 1: asymptomatic, normal bun & cr (healthy tissue compensates) GFR >90  Stage 2: renal insufficiency: GFR 60-89, normal BUN, CR ↑, mild anemia, polyuria, nocturia HA  Stage3-4 gfr decreases bun cr increase by stage by stage 4 begin prep for renal replacement tx  Stage 5: ESRD gfr<10 text says 15% severe azotemia (acumulation of nitrogenous waste and createnine),

14. Systemic Infection: Urosepsis  The systemic inflammatory response to a urinary tract infection.  It is a form of nephritis.  It can also be called pyelitis.  Definition :

15. Autoimmune/Vascular

16. Chronic Complications Diabetic nephropathy – Microvascular damage to small blood vessels that supply the glomeruli of the kidney – Most common cause of chronic kidney failure and end-stage kidney disease in the United States. – Leading cause of end-stage renal disease among white people in North America

17. Renal Insufficiency STAGE OF CHRONIC KIDNEY DISEASE (CKD) ESTIMATED GLOMERULAR FILTRATION RATE INTERVENTION Stage 1 >90 mL/min Screening for risk factors Uncontrolled hypertension Diabetes mellitus Chronic kidney or urinary tract infection Presence of genetic kidney diseases Exposure to nephrotoxic substances At risk; normal kidney function (early kidney disease may or may not be present) Stage 2 60-89 mL/minFocus on reduction of risk factors Mild CKD Stage 3 30-59 mL/min Implement strategies to slow disease progression Moderate CKD Stage 4 15-29 mL/min Manage complications, and prepare for eventual renal replacement therapy Severe CKD Stage 5 <15 mL/min Implement renal replacement therapy/kidney transplantation End-stage kidney disease (ESKD) TABLE 71-6 PROGRESSION OF CHRONIC KIDNEY DISEASE