NCLEX Review & Nursing School

Glomerulonephritis

Glomeronephritis (Immunological Renal Disorder)

Acute Glomerulonephritis
– An infection occurs before the renal manifestations of acute glomeronephritis
– the onset of symptoms is about 10 days from the time of infection.
– Usually clients recover quickly and completely from acute GN.

Chronic Glomerulonephritis
– chronic nephritic syndrome- develops over 20 to 30 years. Or even longer.
– mild protienuria and hematuria, hypertension and occasional edema are the only manifestations

Renal Cell Carcinoma

– also known as adenocarcinoma of the kidney

Staging of Renal Tumors

Stage 1- Tumors up to 2.5 cm. are situated within the capsule of the kidney, the renal vein, perinephric fat, and adjacent lymph nodes have no tumor.
Stage 2- Tumors are larger than 2.5 cm. and extend beyond the capsule but are within Gertoa’s fascia.
Stage 3- Tumors extend into the renal vein, lymph nodes or both
Stage 4- Tumors include invasion of adjacent organs beyond Gerota’s fascia or metastasize to distant tissues.

– Paraneoplastic syndromes- systemic effects occurring with this cancer, and includes anemia, erythrocytes, hypocalcaemia, liver dysfunction and elevated liver enzymes, hormonal effects and increased sedimentation rate and hypertension.
– Parathyroid hormone produced by tumor cells can cause hypocalcaemia.

Manifestations
– only 5- 10% of clients with renal cancer has flank pain, gross hematuria and palpable renal mass
– clients often describe the pain as dull and aching
– a renal bruit may be heard during auscultation.

Diagnostic Test
– Urinanalysis may show red blood cells

Interventions
– Non Surgical Management- Radiofrequency Ablation
– Chemotherapy has limited effectiveness

Surgical Management
– Renal cell carcinoma is usually treated surgically by nephrectomy (Kidney Removal)
– Before surgery, the arteries supplying the kidney maybe occluded (embolized) by radiation to
Reduce bleeding during nephrectomy.

Operative Procedure
– When a radical nephrectomy is performed, the per aortic lymph nodes are also removed.
– The surgical approach maybe Tran thoracic, lumbar or through the abdomen depending on the size and location of the tumor. Radiation therapy may follow a radical nephrectomy

 

 

Pyelonephritis (INFECTIOUS DISORDER)

– Pylelonephritis- is a bacterial infection in the kidney and renal pelvis (upper) urinary tract.
– In pyelonephritis, organisms ascend from the lower urinary tract into the renal pelvis

Manifestations:
– High Fever
– Chills
– Nausea
– Flank Pain and Malaise

• Acute pylelonephritis usually result from the entry of bacteria associated with pregnancy, obstruction with reflux
• Chronic pylelonephritis results from repeated or continued upper urinary tract infections.

Manifestations:
– Hypertension
– inability to conserve sodium
– Impaired Renal Function
– Chronic pyelonephritis results from structural deformities.

Reflux– is the reverse or upward flow of urine toward the renal pelvis
– Most common pyelonephritis causing organism is Eschericia Coli
– If infection is blood borne, staph is the culprit
– Primary diagnosis is Acute Pain (Flank and Abdominal) related to inflammation and infection

Lab Assessment
– Urinanalysis shows a positive leukocyte esterase and nitrite dipstick test and the presence of white
Blood cells and bacteria.

Drug Therapy
– Antibiotics are prescribed to treat infection
Operative Procedures
– Pyelolithotomy (stone removal from the kidney)- is needed for removal of a large stone in the
renal pelvis that blocks urine flow and causes infection.
– Nephrectomy (removal of the kidney)