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  • Kidney

    1. 1. Common Kidney Diseases Ma. Tosca Cybil A. Torres, RN
    2. 2. Common Kidney Diseases Polycystic Kidney Disease Hypertensive Nephrosclerosis Glomerulonephritis / Glomerulosclerosis Urinary Tract Infection (UTI) Kidney Stones Diabetic Kidney Disease Analgesic nephropathy
    3. 3. Polycystic Kidney Disease <ul><li>Genetically acquired </li></ul><ul><li>2 forms - dominant and recessive </li></ul><ul><li>In the dominant PKD form, one parent has the disease and passes it to the child. The chance of passing the gene to the offspring is 50%. </li></ul><ul><li>Cysts are abnormal pouches containing fluid. Eventually the cysts replace normal kidney tissue -> suffers ESRD </li></ul>
    4. 4. Polycystic Kidney Disease <ul><li>Signs and Symptoms </li></ul><ul><li>Dull pain at the side of the abdomen and back </li></ul><ul><li>Blood in the urine </li></ul><ul><li>Frequent urine tract infection </li></ul><ul><li>High blood pressure (often before cysts appear) </li></ul><ul><li>Upper abdominal discomfort (liver and pancreatic cysts) </li></ul>
    5. 5. Polycystic Kidney Disease <ul><li>Treatment </li></ul><ul><li>Blood pressure - controlled and treated </li></ul><ul><li>Kidney failure - supportive therapy until end-stage is reached when dialysis or transplantation is then required </li></ul><ul><li>Urine tract infection - treatment with antibiotics </li></ul><ul><li>Pain - analgesics are used. Alternatively, surgery to shrink or resect the cysts. </li></ul>
    6. 6. Hypertensive Nephrosclerosis <ul><li>Poorly controlled high blood pressure (hypertension) can lead to kidney failure </li></ul><ul><ul><li>Thickening of blood vessels </li></ul></ul>
    7. 7. Hypertensive Nephrosclerosis <ul><li>Signs and Symptoms </li></ul><ul><li>Headache </li></ul><ul><li>Giddiness (sometimes related to posture) </li></ul><ul><li>Neck discomfort </li></ul><ul><li>Easily tired </li></ul><ul><li>Nauseous and/or vomiting </li></ul><ul><li>Protein in urine </li></ul>
    8. 8. Hypertensive Nephrosclerosis <ul><li>Treatment </li></ul><ul><li>Medications to control blood pressure (anti-hypertensive) </li></ul><ul><li>Lowering of dietary salt (2g/day) </li></ul><ul><li>Exercise regularly </li></ul>
    9. 9. Glomerulonephritis / Glomerulosclerosis <ul><li>Glomerulonephritis - An inflammatory condition that affects predominantly the glomeruli. </li></ul><ul><li>Causes </li></ul><ul><ul><li>IgA nephropathy </li></ul></ul><ul><ul><li>Streptococcus bacteria </li></ul></ul><ul><ul><li>Autoimmune </li></ul></ul><ul><li>Glomerulosclerosis - scarring of the glomeruli </li></ul>
    10. 10. Glomerulonephritis / Glomerulosclerosis <ul><li>Signs and Symptoms </li></ul><ul><li>Blood or protein in urine </li></ul><ul><li>Frothy urine (signifying protein in urine) </li></ul><ul><li>Dark or pink-coloured urine </li></ul><ul><li>Leg swelling </li></ul><ul><li>Systemic disease like diabetes or autoimmune disease will have systemic manifestations, e.g. weight loss, arthritis, or skin rash </li></ul>
    11. 11. Glomerulonephritis / Glomerulosclerosis <ul><li>Treatment </li></ul><ul><li>Specific </li></ul><ul><li>Suppression of inflammation may be achieved by certain medications (eg steroids). </li></ul><ul><li>General </li></ul><ul><li>Medications to decrease excretion of urinary protein </li></ul><ul><li>Control of blood pressure </li></ul><ul><li>Dietary modifications </li></ul>
    12. 12. Urinary Tract Infection (UTI) <ul><li>Disease of the urinary tract </li></ul><ul><ul><li>Infection occurs when microorganisms attach themselves to the urethra and begins to multiply. </li></ul></ul><ul><li>May lead to infection of the kidneys (pyelonephritis) and cause permanent kidney damage, if left untreated. </li></ul><ul><li>Women are especially prone to get urinary tract infection. </li></ul>
    13. 13. Urinary Tract Infection (UTI) <ul><li>Conditions that increases risk of UTI </li></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Situations where a urine catheter is needed </li></ul></ul><ul><ul><li>Abnormalities of the urinary tract </li></ul></ul><ul><ul><li>Obstructed urine flow (large prostate or stone) </li></ul></ul><ul><ul><li>Being pregnant </li></ul></ul>
    14. 14. Urinary Tract Infection (UTI) <ul><li>Signs and Symptoms </li></ul><ul><li>Painful urination (burning sensation) </li></ul><ul><li>Hot and foul smelling urine </li></ul><ul><li>Blood in urine </li></ul><ul><li>Fever (sometimes with chills) </li></ul><ul><li>Painful lower abdomen </li></ul><ul><li>Increased urgency/frequency of wanting to pass urine </li></ul><ul><li>Nausea and/or vomiting </li></ul>
    15. 15. Urinary Tract Infection (UTI) <ul><li>Treatment </li></ul><ul><li>Appropriate antibiotics </li></ul><ul><li>Drink plenty of water </li></ul>
    16. 16. Kidney Stones <ul><li>Start as salt/chemical crystals that precipitate out from urine </li></ul><ul><li>Occurs when substance in urine that prevents crystalisation are ineffective </li></ul>
    17. 17. Kidney Stones <ul><li>Various forms of kidney stones - the most common is calcium in combination with either phosphate or oxalate </li></ul><ul><li>More common in </li></ul><ul><ul><li>Males </li></ul></ul><ul><ul><li>20-40 yo </li></ul></ul>
    18. 18. Kidney Stones <ul><li>Signs and Symptoms </li></ul><ul><li>Extreme pain at the site where the stone is causing the irritation </li></ul><ul><li>Blood in the urine (abrasion along the urinary tract as the stone travels) </li></ul><ul><li>Painful and/or difficult urination </li></ul><ul><li>Unable to pass urine if the stone is large enough to obstruct the outlet completely </li></ul>
    19. 19. Kidney Stones <ul><li>Treatment </li></ul><ul><li>With plenty of water, most stones can pass through if small </li></ul><ul><li>Pain-killers (as prescribed by the doctor) </li></ul><ul><li>Some medications may help 'breakdown' larger stone </li></ul><ul><li>Shockwave therapy (F-SWL) to break the stone </li></ul><ul><li>Surgical intervention - cystoscopy or open surgery </li></ul>
    20. 20. Diabetic Kidney Disease <ul><li>Common in chronic and poorly controlled diabetics </li></ul><ul><li>Diabetes damages blood vessels in the kidneys </li></ul><ul><li>Occurs in both types of diabetes </li></ul><ul><li>Occurrence of high blood pressure in diabetics is a strong predictor for diabetic nephropathy </li></ul><ul><li>Most common cause of ESRD in many developed countries </li></ul>
    21. 21. Diabetic Kidney Disease <ul><li>Signs and Symptoms </li></ul><ul><li>Frothy urine (signifying protein in urine) </li></ul><ul><li>Leg swelling (worse after walking/standing) </li></ul><ul><li>High blood pressure </li></ul><ul><li>Itching </li></ul><ul><li>Nausea and/or vomiting </li></ul><ul><li>Losing weight </li></ul><ul><li>Lethargy </li></ul><ul><li>Increased need to urinate at night </li></ul>
    22. 22. Diabetic Kidney Disease <ul><li>Treatment </li></ul><ul><li>Good control of diabetes </li></ul><ul><li>Good control of blood pressure (aiming for < 130/85 or lower in younger patients) </li></ul><ul><li>Medications to decrease protein excretion and preserve the function of kidneys </li></ul><ul><li>Lower protein diet </li></ul><ul><li>Treat any urine tract infection (which is common in diabetics) </li></ul>
    23. 23. Analgesic Nephropathy <ul><li>Chronic kidney disease that occurs when there is a long period of painkiller/s ingestion (usually years) </li></ul><ul><li>Associated with conditions which require constant need for painkiller medications </li></ul><ul><li>May lead to ESRD </li></ul>
    24. 24. Analgesic Nephropathy <ul><li>Signs and Symptoms </li></ul><ul><li>Blood in the urine </li></ul><ul><li>Protein in the urine </li></ul><ul><li>Signs and symptoms related to kidney failure such as nausea, vomiting, lethargy, swelling, and poor appetite. </li></ul>
    25. 25. Analgesic Nephropathy <ul><li>Treatment </li></ul><ul><li>Avoid long-term consumption of analgesics </li></ul><ul><li>Those already with kidney disease of other kinds should certainly refrain from harmful analgesics as much as possible. </li></ul>
    26. 26. In the wards… <ul><li>Look out for… </li></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><ul><li>BP </li></ul></ul></ul><ul><ul><ul><li>Temp </li></ul></ul></ul><ul><ul><ul><li>HR </li></ul></ul></ul><ul><ul><li>Catheterisation? </li></ul></ul><ul><ul><li>Dialysis </li></ul></ul><ul><ul><ul><li>When? </li></ul></ul></ul><ul><ul><ul><li>Eventful? </li></ul></ul></ul><ul><ul><li>Other electrolyte values </li></ul></ul><ul><ul><ul><li>Na </li></ul></ul></ul><ul><ul><ul><li>K </li></ul></ul></ul><ul><ul><ul><li>Creatinine </li></ul></ul></ul><ul><ul><ul><li>Urea </li></ul></ul></ul><ul><ul><ul><li>Etc </li></ul></ul></ul><ul><ul><li>Blood count </li></ul></ul><ul><ul><ul><li>Hb </li></ul></ul></ul>