Anatomical Overview Report

7/29/2019 Anatomical Overview Report

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: Renal function

ANATOMICAL OVERVIEW



ANATOMICAL OVERVIEW



• Structural and functional unit of thekidneys.

NEPHRONS



• Urine formation• Regulation of water excretion

• Vitamin D synthesis

• Erythropoietin production

• Stimulates ADH release

•Regulate electrolyte secretion• Regulates acid base balance

• Auto-regulation of blood pressure

KIDNEY FUNCTIONS:



• Urine is formed in the nephrons through acomplex three step process which are:

1. Glomerular filtration

2. Tubular Reabsorption

3. Tubular secretion

URINE FORMATION



• With high fluid intake, a large volumeof diluted urine is excreted.Conversely, with a low fluid intake a

small volume of concentrated urine isexcreted.

WATER REGULATION:



• Secreted by the posterior portion of thepituitary gland in response to changes inosmolality of the blood. With a decrease inwater intake, blood osmolality tends toincrease, stimulating the release of ADH.

STIMULATION OF ADH



• The kidneys are also responsible for thefinal conversion of vitamin D to itsactive form, which is necessary for

maintaining normal calcium balance inthe body.

VITAMIN D SYNTHESIS



• When kidneys detect a decrease inoxygen tension in renal blood flow,

they release erythropoietin aglycoprotein from the kidney thatstimulates the bone marrow to produceRBC.

ERYTHROPOIETIN

PRODUCTION



• When the kidneys are functioningnormally, the volume of electrolytesexcreted per day is equal to the amount

ingested.

REGULATES ELECTROLYTESECRETION



• The normal serum pH is about 7.35-7.45 and must be maintained withinnarrow range for optimal physiologic

function.

Regulates Acid-Base balance



• Specialized vessels of the kidney, calledvasa recta, constantly monitor bloodpressure as blood begins its passage

into the kidney.• RENIN-ANGIOTENSIN-

ALDOSTERONE SYSTEM

AUTOREGULATION OF BLOODPRESSURE



: Abrupt onset & Reversible

Acute renal failure



• Acute renal failure is the rapid loss ofrenal function due to damage to thekidneys. Depending on duration and

severity of acute renal failure, a widerange of potential complications canoccur. (Med. Surgical Nursing by

Brunner and Suddarths)

Definition:



• Pre-renal- Hypo-perfusion of kidneys

• Intra-renal- Actual damage to thekidneys

• Post-renal- Obstruction to urine flow

CLASSIFICATIONS:



•Hypovolemia

•Hypotension

•Reduced cardiac output•Heart failure

Reduced blood flow to the kidneys:



• Bilateral obstruction of renalarteries/veins

• Renal stones• Renal Tumor

• Blood clot

Obstruction of kidney or lowerurinary tract



• Acute tubular necrosis

Trauma/Damage to kidney tissue:



PHASES OF ARF

• INITIATION - Initial insult and ends whenoliguric develops.

• OLIGURIC-↑ serum concentration ofsubstances usually excreted by kidneys.

• DIURESIS- Gradual increase in urine output,which signals that glomerular filtration has

started to recover.

• RECOVERY- improvement of renal function,may take 3-12 months.



PATHOPHYSIOLOGY



• Patient history

• Urinalysis (osmolality, concentration)

• Blood studies (ABG, BUN, CREAT.,Electrolytes)

• Kidney function test

Diagnostic examination:



• Fluid & Electrolyte imbalances

• Acidosis (metabolic)

• Increase risk for secondary

• Anemia

• Uremic encephalopathy

• Edema• Fatigue

Clinical Manifestations:



• HEMODIALYSIS

- used for patients whoare acutely ill and require

short-term dialysis (days toweeks) and for patients withadvanced CKD and ESRDwho require long term orpermanent renal replacementtherapy.

RENAL REPLACEMENTTHERAPIES: DIALYSIS



• CONTINUOUS RENAL REPLACEMENT

THERAPY

- May be indicated for patients with acute or

chronic renal failure who are too clinicallyunstable for traditional hemodialysis, patientswith fluid overload secondary to oliguric renalfailure and for patients whose kidneys cannot

handle their acutely high metabolic ornutritional needs.



•PERITONEAL DIALYSIS

- Treatment of choice for patients withrenal failure who are unable or unwilling

to undergo traditional hemodialysis orkidney transplant. Patients who aresusceptible to the rapid fluid, electrolyteand metabolic changes that occur duringhemodialysis experience fewer of thisproblems with the slower rate of PD.



• Renal replacement therapies• Restore fluid & electrolytes (Diuretics)

• Prevent infections - monitor for infectious

process• Maintain Nutritional Status - high calorie,

low protein

Medical Management:(Treatunderlying cause)



• Monitor for complications• Assist in treatment & monitoring of fluid

& electrolytes• Asses progress & response to treatment• Provide emotional support to patient &

family• Keep family informed about the condition

• Monitor cardiac function & musculo-skeletal status• Monitor intake and output, ABGs, and

urine concentration s.

Nursing Management:



• Fluid volume deficit

• Impaired fluid & electrolyte balance

• Imbalanced nutrition, less than bodyrequirement

Nursing Diagnoses



The end….

thank you!



1.Mr. A developed Acute Renal Failure dueto his benign prostatic hyperplasia, among

what categories of Acute renal failure doesthis fall?

a. Prerenal

b. Intrarenal

c. Postrenal

d. None of the above



2. Mrs. Apple developed Anemiasecondary to Acute renal failure, this is

because of?

a. Impaired RAAS activation

b. Impaired Erythropoietin productionc. Hyperkalemia

d. Oliguria



3. A patient with Acute renal failurehas a urine output of less than 30ml of

urine from 9am to 10am , what phaseof acute renal failure falls themanifestation of the patient?

a. Initiation

b. Diuresis

c. Recoveryd. Oliguric



4.A patient developed Acute renal failuredue to use of aminoglycosides, a

nephrotoxic agent, what type of sodiumimbalance would most likely to occur?

a. Hyponatremia

b. Hpernatremia

c. Bothd. neither



5. What type of acid-base imbalancewould develop to a patient with Acute

renal failure?

a. Metabolic alkalosis

b. Respiratory alkalosisc. Metabolic Acidosis

d. Respiratory Acidosis



6. During Diuresis phase of acute renal

failure, Urinary output is markedly?

a. Normal b. low

c. high

d. none of the choices



7. What laboratory procedure will be used to determine blood pH

levels?

a. Pulse oximetry

b. Arterial Blood Gases

c. MRI

d. Blood Culture



8.What electrolyte imbalance wouldcontribute to cardiac dysrhythmias?

a. Hypocalcemia

b. Hypernatremia

c. Hyperkalemiad. hyperphophatemia



9. A patient is suspected to have Acute

renal failure, what is the best diagnosticexam to confirm this?

a. Creatinine clearance and serumcreatinine

b. Urinalysis and ECG

c. Arterial Blood Gasd. Fasting blood sugar



10. It is a hormone secreted by the juxtamedullary apparatus for blood

pressure regulation.

a. Erythropoietin

b. Anti diuretic hormonec. Renin

d. Angiotensinogen

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