What bacterial infection can cause damage to heart valves and the kidneys?
Strep
What is the patho of glomerulonephritis?
Inflammatory reaction in the glomerulus. Antibodies lodge in the glomerulus, causing scarring and decreased filtering. The main cause is infections by group A strep.
What happens when strep attacks the kidneys?
Strep causes “holes” to form which allows proteins to leak out, resulting in proteinuria.
S/S of glomerulonephritis?
Flank pain (costovertebral tenderness), oliguria, hematuria, proteinuria, periorbital edema, increased BP, fluid volume excess, increased urine specific gravity, azotemia (abnormally high BUN/creatinine), malaise and headaches (from toxins)
Treatment for glomerulonephritis?
1) Treat the cause (strep)
2) I & O and daily weights
3) Diuretics
4) monitor BP
5) fluid restrictions
6) Rest
7) Dietary changes: increase carbs, decrease Na+ and protein
8) dialysis
How is fluid replacement determined?
24 hour fluid loss + 500 mL (to replace insensible fluid loss)
When does diuresis begin with glomerulonephritis?
1-3 weeks after onset
How long can blood and protein remain in the urine of patients with glomerulonephritis?
Months
S/S of renal failure?
Malaise, headache, anorexia, weight gain, nausea and vomiting, decreased urinary output
Patho of nephrotic syndrome?
Holes form and protein begins leaking into the urine (proteinuria) which produces hypoalbumemia. Without albumin, fluid cannot be held in the vascular space, so fluid shifts into the tissues (edema).
Low circulating volume signals the renin-angiotensin system and aldosterone is produced resulting in retention of water and sodium. Alas, there is still no albumin to hold it in the vascular space and more and more fluid accumulates in the tissues. This can lead to anasarca (total body edema).
What are some problems associated with protein loss?
- Blood clots (thrombosis) - this happens because so many proteins that normally prevent blood clotting are being lost.
- High cholesterol and triglycerides - the liver compensates for the loss of albumin by making more albumin, which causes an increased release of cholesterol and triglycerides.
What is the cause of nephrotic syndrome?
Idiopathic, but has been linked to:
- bacterial or viral infections
- NSAIDs
- cancer and genetic predisposition
- systemic diseases such as lupus or diabetes (1/3 of patients)
S/S of nephrotic syndrome?
- massive proteinuria
- hypoalbuminemia
- anasarca
- hyperlipidemia
Treatment for nephrotic syndrome?
1) diuretics
2) ACE inhibitors to block aldosterone secretion
3) prednisone to reduce inflammation
4) cyclophosphamide (cancer drug) to decrease immune response
5) dietary changes - moderate protein, decreased Na+
6) lipid lowering drugs
7) anticoagulation therapy for up to 6 months
8) dialysis
Kidney patients should limit protein in the diet except with what condition?
Nephrotic syndrome
Nursing considerations with nephrotic syndrome?
- daily weights and I/O
- measure abdominal girth or extremity size
- good skin care
What is pre-renal failure?
A cause of acute kidney injury. Blood can’t get to the kidneys. Some causes of pre-renal failure:
- hypotension
- arrhythmia
- hypovolemia
- any type of shock
Shock kills ____!
Kidneys!
What is intra-renal failure?
A cause of AKI. Damage has occurred inside the kidney.
Causes of intra-renal failure:
- glomerulonephritis or nephrotic syndrome
- malignant hypertension
- diabetes mellitus
- acute tubular necrosis (damage to filtering bodies)
- hypotension, drugs or sepsis
- drugs like aminoglycosides “mycin”, NSAIDs, dyes
What is post-renal failure?
A cause of AKI. Urine cannot get out of the kidneys. An obstructive form. Some causes of post-renal failure:
- enlarged prostate
- kidney stones
- tumors
- ureteral obstruction
- edematous stoma
What are the 4 phases of AKI?
1) Initiation (damage occurs)
2) Oliguric (urine output decreases)
3) Diuretic (kidney recovering)
4) Recovery (3-12 months)
S/S of AKI?
- BUN/Creatinine increased
- specific gravity increased
- HTN and heart failure (retaining fluid)
- anorexia, nausea and vomiting
- itching frost (uremic frost)
- osteoporosis (retained phosphorus decreases serum calcium, causing calcium to shift out of bones
- anemia
- hyperkalemia
- metabolic acidosis (inability to filter or retain hydrogen or bicarb)
Treatment for AKI?
1) prevent infection
2) manage symptoms
3) eliminate the cause of injury
- bedrest to decrease metabolism
- turn, cough, deep breathe
- I/Os
- daily weights
- monitor vitals closely
- increase carbs and fats in diet, decrease protein
- avoid foods high in potassium (bananas, citrus, coffee)
- NO CATHETER if possible
- mouth care/skin care
- prevent pressure ulcers
Medications used to treat AKI?
- loop or osmotic diuretics
- IV glucose and insulin (to treat hyperkalemia)
- IV calcium gluconate (dysrhythmias)
- polystyrene sulfonate (Keyexalate) to decrease K+
- phosphate binders to prevent hypocalcemia
- give IV meds in SMALLEST amount possible
