...eMedicine article/238798 MeSH D007676 Chronic kidney disease (CKD), also known as chronic renal disease (CRD), is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.[1] It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small...
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...HONOURS COURSE TITLE: RENAL NURSING CONTENTS NO | TITLE | PAGES | 1 | INTRODUCTION * URINARY SYSTEM * WHAT DO NORMAL KIDNEYS DO? | 3 | 2 | RENAL REPLACEMENT THERAPY * HEAMODIALYSIS * PERITONEAL DIALYSIS | 4 - 7 | 3 | RENAL TRANSPLANTATION * TRANSPLANT PROCEDURE * TISSUE TYPING * CONTRAINDICATION OF TRANSPLANTATION * TYPES OF TRANSPLANT * DONOR WORK UP * RECIPIENT WORK UP | 8 - 14 | 4 | PRE OPERATIVE MANAGEMENT | 14 - 15 | 5 | INTRA OPERATIVE MANAGEMENT | 16 | 6 | POST OPERATIVE MANAGEMENT | 16 - 17 | 7 | COMPLICATIONS OF KIDNEY TRANSPLANT | 17 - 18 | 8 | NURSING PROCESS | 18 - 21 | 9 | HEALTH EDUCATION FOR PATIENT | 22 | 10 | CONCLUSION | 23 | 11 | REFERENCES | 24 | INTRODUCTION URINARY SYSTEM The urinary system consists of the kidneys, ureters, urinary blabber and urethra. The kidneys produce the urine and account for the other functions attributed to the urinary system. The ureters convey the urine away from the kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to outside of the body. WHAT DO NORMAL KIDNEYS DO? * Remove extra water. * Remove waste products. * Balance chemicals in the body. * Help control blood pressure. * Help make red blood cell. * Help build strong bones. When the kidneys no longer able to perform normal functions and starts to deteriorate, renal failure will occur, this...
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...Renal Disease Study Guide What is renal disease? Do all of the nephrons need to be functional within the kidney? What are the testing parameters needed to check for renal disease? When does renal disease progress to renal failure? When are changes to USG seen during renal failure? Does it increase or decrease? What are some signs of renal insufficiency? What is azotemia? What is pre-renal azotemia? What are some of the reasons that renal azotemia occurs? What are some of the reasons that post-renal azotemia occur? How is uremia characterized? What are the 2 categories of renal failure? Which one is reversible? What are some signs of ARF? What would a U/A show? How about blood work? What are some signs of CRF? What would a U/A show? How about blood work? Does bacteria in a urine sample always equal an infection? Why or why not? What is pyelonephritis? What are some signs of pyelonephritis? What would a U/A show? What would blood work show? What is a urinary tract infection? What are some signs of a UTI? What is an uncomplicated UTI? What is a complicated UTI? What is a relapsing infection? What is a recurrent infection? What are superinfections? What are the indications for antimicrobial susceptibility tests? What are some potential problems that may occur if bacterial UTI’s are left untreated? What is FLUTD? Why does it happen? What are some signs of FLUTD? What would a U/A look like? How about...
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...Renal hypertension is an elevated blood pressure caused by kidney disease. It is caused by a narrowing in the artery that delivers blood to the kidney. Renal hypertension usually causes no symptoms. The narrowing in the arteries can't be felt. Unless it's dangerously high, high blood pressure causes no symptoms either. Symptoms of severely elevated blood pressure include: • Headache • Confusion • Blurry or double vision • Bloody (pink-colored) urine • Nosebleed The vast majority of people with renal hypertension never experience these (or any) symptoms. High blood pressure is dangerous partly because there are no symptoms, so organ damage can occur slowly without being recognized.Renal hypertension can cause chronic kidney disease. This is a slow decline in kidney function. Until the condition is well advanced, chronic kidney disease also causes no symptoms.Because there are usually no symptoms, a doctor may suspect renal hypertension when someone has uncontrolled high blood pressure despite multiple medications or has unexplained chronic kidney disease. With Renal hypertension due to renal artery narrowing, medications can effectively control blood pressure. In some people with renal hypertension due to narrowing of the renal artery, even taking three or more medications every day cannot adequately control blood pressure. In these situations, a procedure to improve blood flow to the kidneys can often help. Possible procedures include the following: Angioplasty, Stenting...
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...An Overview of Renal Failure and Its Treatment Option Renal failure can affect any population in society with no discrimination to age or race. There are several different types of renal failure and a multitude of treatment options depending on the severity or complexity of the disease process. With a change in healthcare on the horizon an examination into the area and the current school of thought is a must. While renal failure is just one small area of the healthcare sector, it is rapidly growing and affecting more and more every day. According to the data from the CDC more than 4.4 million Americans are diagnosed with some form of kidney disease (CDC). Renal Failure is best defined when the kidneys no longer work properly. Now one might ask, what do the kidneys do? The kidney’s simply remove metabolic waste and water from the human body and maintain homeostasis. Without the kidneys functioning properly the body will no longer make urine and dangerous electrolyte abnormalities can occur. One must realize there are several categories of renal failure. The two main classifications are Acute and Chronic Renal Failure. Acute Renal Failure is best defined as rapid and new onset renal failure sometimes reversible when treated appropriately while Chronic Renal Failure long term and irreversible unless treated via transplant. Now that a basic foundation definition of Renal Failure has been established, one must gain knowledge of what causes Renal Failure. Now that...
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...Structural and Functional Parameters Are IndependentPredictors of Renal Function at 3 Months | 202(111 biopsied) | | A donor preimplantation biopsy with sufficient material forevaluation was available in 111 cases. Mean global glomerularsclerosis was 1.2% _ 3.5% and in seven cases globalglomerular sclerosis was greater than 10%. Mean donorchronic damage score was 0 in 77 cases; 1 in 15 cases; 2 in13 cases; and _3 in five cases(LOW PERCENTAGE OF GLOMEROSCLEROSIS) | | Histopathologic Evaluation of Pretransplant Biopsy as a Factor InfluencingGraft Function After Kidney Transplantation: A 1-Year Observation | 92 | We observed a significant correlation between immediate graft function (IGF)and lack of ATN in the pre-0 biopsy. We observed no correlation between renal functionand arterial hyalinization and fibrosis, inflammatory infiltration, tubular atrophy. In thepostoperative period, we observed a significant correlation between IGF and lack ofinterstitial fibrosis with significantly lower levels of creatinine, urea, and potassium andhigher urine output early after transplantation. IGF and better function of the right kidneywas correlated with shorter time to reach a creatinine level of 2 mg%. In the postoperativeperiods, we also observed a difference between renal function depending on gender. Thepresence of acute tubular necrosis, arterial fibrosis, lack of inflammatory infiltration in thepre-0 biopsy correlated with worse late renal function. Among explantation biopsies 65.5%showed signs of CAN...
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...to glomerulonephritis. The injured and defective glomeruli in the kidneys lead to the release of too much protein in the urine resulting in nephrosis. 2. Use JH’s laboratory values to determine if he is still experiencing nephrosis or if his condition is progressing to renal failure. JH’s lab values indicate that the PaCO2, HCO3-, and Hct, and Na levels are all below normal limits. His potassium level was increased at 5.4 mEq/L. There was also an increase in JH’s BUN (58 mg/dl), creatinine (3.9 mg/dl), and albumin (2.0 g/dl) levels. Traces of protein were found in his urine suggesting that JH’s condition is progressing to renal failure. 3. What additional physical or laboratory findings would be helpful in determining JH’s degree of renal impairment? Creatinine clearance is helpful in determining general kidney function. A level above 1.2 is reduced and indicates renal impairment. The kidneys' ability to handle creatinine is called the creatinine clearance rate, which helps to estimate the glomerular filtration rate (GFR). This rate will give a general overview of how the kidney is functioning. Physical assessment findings of joint pain, tenderness, redness and swelling are all indicative of renal impairment from hyperuremia. Skin nodules, generalized itching/pruritus may be present upon assessment of the integument. Patient may also complain of flank pain. Decrease in urine...
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...The Functions of Kidneys Kidneys perform many functions essential to the bodies functioning. The strain that is put on kidneys opens them up to many problems that can occur. Childhood sicknesses can result in failure of the kidneys to perform dialysis in later years of a person's life. Also, excessive minerals in the blood stream can cause kidney stones, which are very painful. Kidneys perform the basic functions of removing water and waste from the bloodstream, this process is called dialysis. After removing the water and waste from the bloodstream, it excretes them through the urine. The kidney's jobs never ends, whenever you take a drink of water or take a bite of food it will pass through the kidneys and the kidneys will filter out the unneeded particles in the bloodstream ("Body's own filter material replaces kidneys," 171). Childhood sicknesses can scar the kidneys. These scars can slowly deteriorate the kidneys until they cannot function correctly. There is no way anyone can repair the scarring of the kidneys, and it is just a matter of time before they cease to function. Lee Foster, an editor for Reader's Digest, had a childhood sickness and his kidneys eventually scarred over. He now has no use of his kidneys. He has dialysis three times a week for five hours. Before he went on dialysis he was very anemic and could not take twenty steps without resting (Lee, 99). Excessive minerals in the bloodstream can also cause problems. One of these problems that it...
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...ACUTE RENAL FAILURE Overview Acute renal failure is the most common disease in the acute care setting. It is estimated that acute renal failure occurs in up to 25% of all patients admitted to the hospital with a critical illness (Broden, 2009). It is even noted that patients who are admitted to the intensive care unit with no prior renal insufficiencies seem to have worse outcomes than do patients who have preexisting acute renal failure (Broden, 2009). Acute renal failure is a rapid decrease in kidney function, leading to collection of metabolic waste in the body. The pathophysiology of acute renal failure is reduced blood flow to the kidneys, toxins, infections and obstruction (Broden, 2009). There are three types of acute renal failure. They are pre-renal azotemia. This is caused by poor blood flow to the kidneys. The most common causes of this are hypovolemic shock and heart failure. The second type is intra-renal acute renal failure. This is caused by infections, drugs, tumors, glomerulonephritis, and obstruction. The third type is post-renal azotemia. It is caused by an obstruction outside of the kidneys (Dirkes, 2011). Assessment Data Ongoing comprehensive assessments are critical for the acute renal failure patient. The nurse must be attentive to the signs and symptoms of renal disease as well as complications with other organs and systems. The primary effect of acute renal failure is a decrease in urinary output that leads to fluid retention and edema. Oliguria...
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...Associate Level Material Appendix D Read each scenario and write a 25- to 50-word answer for each question following the scenarios. Use at least one reference per scenario and format your sources consistent with APA guidelines. Scenario A Acute renal failure: Ms. Jones, a 68-year-old female, underwent open-heart surgery to replace several blocked vessels in her heart. On her first day postoperatively, it was noted that she had very little urine output. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom? Acute Kidney failure occurs when your kidneys suddenly become unable to filter waster products from your blood.(www.mayoclinic.org). Acute kidney failure fails into three categories such as prerenal, postrenal, and renal. Mrs. Jones suffers from Acute Renal Failure which means that the kidneys itself that prevent filtration of blood or production or urine. Kidneys is what filter the body's blood, it produces roughly about one milliliter of urine a minute and when the urine changes it is expected to shut down of the kidneys. Mrs. Jones body may have went into shock due to the surgery that she underwent, and an abnormal amount of urine is also known as oliguria. What other symptoms and signs might occur? The other symptoms that Mrs. Jones may suffer are breath odor, mood changes, decreased appetite, decreased sensation, fatigue, flank pain, tremor in the hands, high blood pressure, Nausea, nosebleeds, hiccups, seizures, shortness of breath...
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...1) Nephrosclerosis is the hardening of the walls of the arterioles and small arteries as well as a tightening or blocking of the lumina of the blood vessels in the kidneys. Over time, this change in the blood supply will cause the kidneys to become ischemic which will become grounds for the destruction of the renal tissue. The kidneys will also become atrophic which will deteriorate the overall function that they possess. With the kidneys being deprived of the adequate blood supply and decline in health/function, the body will try to compensate for this by increasing the blood pressure in order to get the proper amount of blood to the kidneys. This will all happen in a slow and gradual manner, but by the time a person realizes that there is something wrong, the damage has already been done (Gould & Dyer, 2011). 2) Mr. H. has been experiencing edema and weight gain due to the fact that he has been losing protein in his urine and just the fact that his kidneys are not functioning properly. The loss of protein in the urine causes the concentration of album in the blood to drop as well. A drop in albumin will cause a drop in blood volume in the blood vessels. The kidneys will sense this drop in blood volume and begin to retain salt. Fluid will then start to move into the interstitial spaces in the body, thus causing Mr. H. to become swollen. Another cause of the edema may be due to impaired kidney function and they can’t effectively excrete sodium into the urine. If Mr. H. is...
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...Pathophysiology: Neoplasia and Renal System School of Nursing 1. Cancer Staging Cancer staging describes the severity of a person’s cancer based on the person’s initial tumor, and whether or not the cancer has metastasized (American Cancer Society, 2012, www.cancer.org). Knowledge of the stage is very important in that is can be used to explain prognosis to the patient, and can be used by the doctor and the patient to plan treatment. Staging of cancer is based on knowledge of the way in which cancer progresses in the body. Malignant cells grow and reproduce without any control or order, and they do not die when they should. In most cases the cancer cells will form a mass called a tumor. As the tumor grows it can invade tissues and organs that are close to it. The malignant cells can also break away from the tumor and enter the bloodstream (Lemone, 2004, p. 284). There are five common elements considered in most staging systems: site of the primary tumor, tumor size and number, lymph node involvement, cell type, and the presence or absence of metastasis. A common staging system is called TNM, which stands for Tumor, lymph Nodes, and Metastasis. When staging a number is added to each letter to indicate the size of the primary tumor and the extent of the cancer spread. (Lemone, 2004, p. 284) Infection, immunity and inflammation in cancer patients are all interrelated. They form what could be...
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...The economics of end-stage renal disease Introduction According to the Centers for Disease Control and Prevention (CDC) 2010, 10% of adults in the United States have chronic kidney disease (CKD). That is estimated at about 20 million people. People with CKD may not feel any symptoms in the early stages, so treatment most likely has not been started. When a person often finds out they are in need of treatment, they may already be in kidney failure or end stage renal disease (ESRD). This paper will discuss the reimbursement mechanisms presented in the Sullivan article, the economics of providing ESRD treatment from the organization's point of view, patients options and potential trade-offs related to cost, quality, and access to treatment, and the ethical implications of treatment options based on cost evaluation. Reimbursement Mechanisms The major reimbursement mechanism presented in article End Stage Renal Disease Economics and the Balance of Treatment Modalities is Medicare. The system in place at this time is the fee for service with additional charges for medication and medical testing (Sullivan, 2010). The current reimbursement structure is based on a three times a week structure, because hemodialysis (HD) is the primary treatment for ESRD (Sullivan, 2010). According to Sullivan (2010) "The most ideal treatment for patients with ESRD is transplantation" (p.45). The reimbursement for peritoneal dialysis (PD) is the same as that of HD. With the passing of The Medicare...
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...1.Describe process of referral and management of renal dialysis patients. Nephrology referral is especially indicated when there is a rapid decline in kidney function, and elevated albumin and creatinine in stage four of chronic kidney disease. Also, when the kidney function is severely reduced. 2. Discuss the nursing role in care and management of clients in renal dialysis center. The nursing role in nursing care and management of clients in renal dialysis center: assess vital signs including blood pressure, respirations, apical pulse, and lung sounds. Record weight before and after treatment, assess vascular access site for a palpable pulsation or vibration and an audible bruit. Also, alert all personal to avoid using the extremity with...
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...1. What are possible factors predisposing Mr. K. G. for acute renal failure? Possible predisposing factors for Mr. K.G. include his past medical history of hypertension and diabetes mellitus type 2, which can cause renal ischemia and cell injury (Moore, 2013). His myocardial infarction two years ago is also a predisposing factor because it has reduced his cardiac output, which could result in hypoperfusion of the kidneys. Mr. K.G.’s age also puts him at risk since after age 40, “renal blood flow gradually diminishes at a rate of 10% per decade” (Sole et al., 2013, p. 434). Additionally, decreased renal mass, number of glomeruli, and peritubular density often occur with advanced age (Sole et al., 2013). Mr. K.G. takes an NSAID and an ACE inhibitor,...
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