Renal Disorders

RENAL DISORDERS

·         Renal Calculi

·         Acute renal failure

1. Renal Calculi

Classification

·            Urolithiasis and nephrolithiasis

Causes

·            Urinary stasis

·            Super saturation of urine

Risk factors

·            Immobility

·            Sedentary life style

·            Dehydration

·            Metabolic disturbances

·            Increases calcium

·            A diet high in purine oxalates calcium and animal proteins

Signs & Symptoms

·            Renal colic or ureteric colic

·            Sharp severe pain originates deep in the lumbar region and radiate around the sides and down towards the genital or thigh

·            Nausea

·            Vomiting

·            Pallor

·            Increased blood pressure and pulse

·            Urgency and frequency of urine  Hematuria

·            Fever and chills

Investigations

·            USG - Abdomen

·            Intravenous pyelogram

·            X- ray KUB (Kidney, Urethra, Bladder) or

·            CT KUB

·            Blood test may shows increased WBC, uric acid, serum Calcium and Phosphorous

·            Cystoscopy

Management

Medical management

·            Pain management

·            Analgesics and anti spasmodic drugs  Hydration with oral fluids and IV fluids

·            Minimize the calculus formation by dietary changes (less calcium diet)

Surgical Management

·            URSL (Ureteroscopic Lithotripsy)

·            Intra corporeal Lithotripsy (crushing the stones)

·            Laser lithotripsy

·            ESWL (extracorporeal shock wave lithotripsy)

·            PCNL (Percutaneous Nephrolithotomy)

·            Ureterolithotomy

·            Cystolithotomy

·            Nephrolithotomy

·            Nephrectomy

Nursing Management

·            Pain control

·            Minimize the vomiting by antiemetics

·            Increased fluid intake and relaxation technique

·            Provide comfortable position

·            Maintain fluid intake chart (intake output)

·            Advice dietary modification

2. Acute Renal Failure

Acute renal failure is a syndrome of varying causation that results in a sudden decline in renal function.

Kidneys are a pair of organs located toward lower back. One kidney is on each side of spine. They filter blood and remove toxins from body. Kidneys send toxins to your bladder. Later body removes toxins during urination. Kidney failure occurs when kidneys abruptly lose their function of filtering waste products from the blood.

Causes

·            Pre–renal causes: It results from the condition that decreases renal blood flow (e.g. Hypovolemia, shock, hemorrhage, burns, diuretic therapy)

·            Post–renal causes: It comes from obstruction or distruption of urine flow anywhere along the urinary tract

·            Intra – renal causes: It results from injury in the renal tissue and is usually associated with intra renal ischemia, toxins immunologic process, systematic and vascular disorders

Signs and Symptoms

·            Decreased tissue turger, dryness of mucous membrane, weight loss, hypotension, oliguria

·            Difficulty in voiding and changes in urine flow

·            Fever and skin rashes, edema

·            Changes in urine volume, increases blood urea, creatinine, uric acid, potassium levels etc

Investigations

·            Urine analysis: Reveals protenuria, haematuria

·            Raise of Serum creatinine in blood  Urine culture

·            Renal ultrasonography

·            Renal biopsy

Management

·            Correct any reversible cause of acute renal failure E.g: Improve renal perfusion maximize cardiac output, surgical release of obstruction

·            Be alert for fluid excess or deficit

·            Monitor the signs of hypovolemia or hypervolemia

·            Monitor Intake and output chart  Weigh the patient daily

·            Monitor vital signs

·            Correct and control biochemical imbalances  Restore and maintain B/P  Maintain nutrition

·            Initiate haemodialysis

·            Renal replacement therapy

Prevention

·            Maintaining healthy lifestyle – performing regular physical activity, limiting alcohol intake, and refraining from smoke can keep you away from illness

·            Be attentive while taking over the counter (OTC) medications, especially NSAIDs as they can be nephrotoxic

·            Undergo urine test and blood test at least once in 6 months to monitor kidney disease

·            Consult a doctor immediately if you find any changes in your urine output

Complication

·            Infection

·            Arrhythmias due to hyperkalemia  Electrolyte abnormalities

·            Gastrointestinal bleeding  Multiple organ system failure