22. Renal 4 Kidney Disorders PDF

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● Polycystic Kidney Disease PKD An inherited disorder where fluid filled cysts develop in the nephrons ○ Cysts give the appearance of grape clusters as the kidney as the kidney tissue is replaced Over time, small cysts grow, and the number of cysts increases which increases the size of the kidney ○ The kidney is 2-3x the normal size As this occurs, the nephrons and kidney function diminish The patient is at risk for ○ Infection ○ Rupture ○ Bleeding ■ As the fluid filled cysts develop and grow in size There is no way to prevent the disease GOAL ○ Early detection and management of hypertension to preserve kidney function for as long as possible ● Clinical Manifestations of PKD Hypertension r/t kidney ischemia Abdominal or flank pain Constipation and increased abdominal girth r/t enlargement of the kidney Nocturia - EARLY SYMPTOM Sodium wasting and inability to concentrate urine - EARLY SYMPTOM Progression to kidney failure, anuria, and increasing hypertension - LATE SYMPTOM If an infection is present or a cyst ruptures, the patient may have bloody - cloudy urine and dysuria Diagnostics ○ Proteinuria ○ Hematuria ○ Increase in BUN & Creatinine - as kidney function decreases ○ Renal ultrasounds, CT scan, and MRI will detect the cysts and show an enlarged kidney with the appearance of grape clusters Electrolyte imbalance may also occur ● Interventions for PKD Pain management ○ NSAIDS are used cautiously d/t they may reduce the blood flow to the kidney ○ Aspirin containing products are avoided d/t risk for bleeding ○ Antibiotics such as Bactrim and Cipro and dry heat work well for cyst pain ○ For severe pain ■ Cysts may be drained by needle aspiration (temporary - cysts will refill) Prevention of infection Preventing constipation - r/t pressure on the intestines and fluid imbalance ○ Stool softeners, laxatives, bulk forming foods ○ Increase fluid intake Controlling HTN ○ This slows the progression of the kidney dysfunction and prevents cardiovascular complications ○ Antihypertensives ○ Diuretics Patient education of the progression to ESKD ○ Early stages - drink at least 2 L of fluid per day to prevent dehydration ○ Restricting sodium intake can control blood pressure ○ GOAL - maintain kidney function for as long as possible

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Dietary restrictions will change depending on the extent of the kidney disease and whether or not the client is in ESKD ○ Teach the patient and family on how to measure and record blood pressure, administering medication and knowing the potential side effects of the medication along with monitoring daily weights and dietary restrictions ● Glomerulonephritis (Nephritic Syndrome) Syndrome as a result of an infection that causes glomerular inflammation or injury MOST COMMON CAUSE - Streptococcus Other causes ○ Staphylococcal bacteremia ○ Sepsis ○ Pneumonia ○ Endocarditis ○ Measles ○ Mumps ○ Hepatitis B ○ Varicella ○ Any bacterial, parasitic, fungal, or viral infection places the patient at risk for glomerulonephritis antigen/antibody immune complexes from the infection clog the glomeruli leading to inflammation and decrease in the glomerular filtration rate Onset ○ 10 days after infection has occurred A thorough recent history of infections or illnesses aid in in the diagnosis Can be acute or chronic Acute ○ Recent illness or infection ○ The patient develops fluid overload and circulatory congestion r/t the decrease in the kidney function ■ Edema, SOB, Crackles in the lungs ○ Increases in BUN & Creatinine are noted with kidney dysfunction ○ Microscopic blood in the urine ■ Cola or rust colored urine ○ Hematuria & Proteinuria ○ Fluid and sodium retention occurs ■ Mild hypertension Acute Interventions ○ Manage infection or illness ○ FIRST - TREAT THE UNDERLYING CAUSE - THE INFECTION ■ Antibiotic therapy, aseptic technique, good hand hygiene ■ Finish entire course of antibiotic treatment ○ Monitor and prevent complications from ■ Fluid overload, HTN, and edema ■ Patient may be on a sodium or water restricted diet ■ Diuretics may address the fluid overload and HTN ■ Monitor I&O, BUN & Creatinine and Potassium levels ■ Potassium and protein restrictions may be ordered to prevent hyperkalemia and uremia ■ Prepare for short term dialysis if uremic manifestations like fluid overload cannot be controlled ■ Plasmapheresis may be necessary to remove and filter the plasma to eliminate antibodies Chronic - develops gradually over 20-30 years (cause unknown)

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Changes in the kidney are a direct result from hypertension, infection, inflammation, and poor blood perfusion to the kidney ○ Edema, Fluid overload ○ HTN ○ Mild hematuria and proteinuria ○ The MAJOR symptom difference is with chronic kidney dysfunction ■ Uremic symptoms d/t the kidneys inability to filter the blood over longer periods of time leading to accumulation of toxins ● Slurred speech, ataxia, tremors, asterixis, and yellowing of the skin ■ Fatigue, lack of energy ■ Anorexia ■ N/V ○ Electrolyte imbalances Chronic Interventions ○ Disease will continue to progress until dialysis or transplant is required ○ Teach patients about medications, diet and fluid restrictions, monitoring weight and blood pressure

● Renal Cell Carcinoma (Adenocarcinoma) Most common kidney cancer Risk Factors ○ #1 - Tobacco use ○ Being exposed to lead, phosphate, cadmium, and asbestos ● Renal Cell Carcinoma Clinical Manifestations Causes systemic effects Hypercalcemia d/t parathyroid hormone produced by cancer cells Anemia caused by erythropoietin produced by cancer cells Increased renin level causing HTN Flank pain/ abdominal discomfort Skin changes ○ Darken nipples ○ Pallor ○ Gynecomastia (enlarged boobs in boys) Late changes ○ Hematuria ○ Weight loss ○ Muscle wasting ○ Weakness Common metastasis sites ○ Lung ○ Liver ○ Long bones ● Renal Cell Carcinoma Interventions Non-Surgical Management ○ Radiofrequency or Cryoablation ■ Can slow the tumor growth ■ Most common for poor surgical candidates or those who have only one kidney ○ Chemotherapy ■ Limited effectiveness

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Biological Response Modifiers (BRMs) ■ Have been found to extend the survival rate by targeting the cancer tissue Surgical Management ○ Nephrectomy ■ Removal of the kidney ■ Kidney is highly vascular so blood loss during the surgery is a concern ○ Post-Operative Care ■ Assess for hemorrhage and adrenal insufficiency ● Hypotension ● Decreased urine output ● Altered LOC ■ Pain management ● IV opioids as the surgical incision is large across the flank and abdominal muscle, these muscles are used for breathing and movement ● Pain control is ESSENTIAL ■ Infection is prevented with prophylactic antibiotics ■ With removal of the adrenal gland, adrenal insufficiency is always a concern ■ The other kidney kicks in to cover the loss, but this doesn't always happen ● Steroid replacement may be used to supplement the adrenal loss...