NUR 2163 RENAL NURSING TOPIK 1

Treatment / Management

1. Treatment depends on the underlying cause.
2. Corticosteroid may relieve symptoms in some cases.
3. Monitor renal function.
4. Monitor electrolytes levels.
5. Monitor vital signs.
6. Administer diuretics to remove excess fluids.
7. Administer antihypertensive medication to control BP.
8. Restrict fluid intake –measure output,intake should

match 24hr .
9. Dietary restriction of sodium (salt), fluids, potassium.
10. Plasmapheresis if due to autoimmune cause.

Possible complications

1. Congestive heart failure
2. Pulmonary edema
3. Hyperkalemia
4. Acute renal failure
5. Chronic renal failure
6. End-stage renal failure

Nursing management

a) Edema
- Restrict patients’ fluid intake to reduce the status of

edema.
- Weigh pts’ daily to assess the progress of edema.

(increased 1kg may indicate 1 ltr of fluid retained in body).
- Administer infusion diuretic (frusemide) to encourage

diuresis.
- Reduce salt intake to limit the water retention in

extracellular space.
- Monitor progress of edema continuosly to detect any any

signs of pulmonary edema and heart failure.

Nursing management

b) Risk of infection
- Patient can take immunosuppresive and steroid

medication to control the progress of disease.
- Apply aseptic technique for all sterile procedure.
- Practice proper hand washing when handling pts.
- Observe the signs of infection.

Nursing management

c) Health education
- Advise pt to take precaution to prevent infection.
- Avoid going to crowded areas such as cinema.
- Wash hands before eating and after going to toilet.
- Ensure correct method on food preparation.
- Avoid taking raw vegetables and meat.
- Shower daily and change clothes.
- Get doctor treatment if signs of infection are present, for

example fever, sore throat, cloudy urine, diarhoea and
others.

Childhood AGN

Most children,AGN follows an infection of the pharynx,
tonsil or skin with group A beta hemolytic streptococcus.
(podtdtreptococcal AGN).

Children between 3-10 years are most common affected.
Male to female , 2:1
Antigens localise in the kidney in the capillary wall.
Kidney –edematous & enlarged. Inflamation,obstruction

and injury to the tissue occur, glomerular filtration rate is
impaired.



Symptoms

• 50% of children are asymptomatic.
• Discovered during routine urinalysis. (Rudolph et al 1991).
• In severe cases- symptoms develop 10-14 days after

streptococcal infection:
1. Low grade fever
2. Headache
3. Malaise
4. Periorbital edema
5. Proteinuria
6. Decreased urine output
7. Hematuria
8. Urine is brown or tea-colored
9. May also be hypertensive.

Treatment

1. Administration of antihypertensive and diuretic
2. Low sodium & low protein diet.
3. Bed rest during acute phase
4. Antibiotics –if the streptococcal infection still present.

Nursing care

1. Provide emotional support to the parents and child.
2. Monitor fluid intake and output.
3. Maintain low sodium & low protein diet.
4. Provide diversional therapy while the child is on bed

rest.

NEPHROTIC SYNDROME

Adult
nur2163

Nephrotic syndrome

• Membrane of capsule Bowman is damaged- causing them to
leak large amounts of protein from the blood into the urine.

• Signs & symptoms
• Puffiness around the eyes – morning.
• Edeme over the legs
• Fluid in the pleural cavity – pleural effusion
• Fluid in peritoneal cavity – ascites.
• HPT – due to water retention
• Foamy urine – proteinuria
• Rash associated with SLE/ neuropathy associated with

diabetes



Pathogenesis

• Glomeruli normally filter the blood.
-consist of capillaries that are fenestrated and allow fluid,
salt and small solutes, but normally not proteins.
-glomeruli become damaged due to inflammation &
hyalinisation so that small proteins, such as albumins
immunoglobulins and antithrombin can pass through the
kidneys into urine.
-albumin is the major protein in the blood, maintains colloid
osmotic pressure, prevent leakage of blood from vessels
into tissue.



Investigations

• 24hours urine shows proteinuria
• Comprehensive metabolic panel (CMP) shows

hypoalbunemia
• High level of cholesterol (hypercholesterolemia)
• Urea and Creatinine (EUCS) to elevate renal function.

• Further investigation
• If the cause is not clear:
- Biopsy of kidney
- Auto-immune markers (ANA, ASOT,C3,

cryoglobulins,serum electrophoresis).

Treatment

• Monitoring urine output, BP regularly
• Restrict fluid to 1L
• Diuretics (iv furosemide)
• Monitoring kidney function- urea & creatine daily
• Prevent & treat any complications ( venous thrombosis,

infection, pulmonary edema etc)

Dietary recommendations

• Reduce salt intake
Reduce sodium intake to 1000-2000mg daily.
Foods high in sodium- canned soups,cannedvegetables

containing saltblogna and salami, prepared foods, fast foods,
soy sauce, salad dressing etc.
Sodium should be less than or equal to calories per serving.
Avoid saturated fats such as butter, cheese, fried foods,red
meat, egg yolks and poultry skin.
Increase unsaturated fat intake, including olive oil, canola oil,
peanut butter, avocado, fish and nuts. Eat low-fat desserts.
Encourage intake fruits and vegetables. Monitor fluid intake.

Complications

1.Venous thrombosis:
-due to leak of anti-thrombin 3, which helps prevent thrombosis.
-occurs in the renal veins
-treatment is with oral anticoagulants

2.Infection:
-due to leakage of immunoglobulin, encapsulated bacteria such as.

Haemophilus influenzae & Streptococcus pneumonia can cause

infection.

3.Acute renal failure:
-due to hypovolemia. Decreased blood flow to the kidney causes them
to shutdown.

4. Pulmonary edema:
-due to fluid leak, leaks into lungs causing hypoxia and dyspnea.

CHILDHOOD NEPHROTIC
SYNDROME

Two major categories of NS

PRIMARY – congenital NS.
- Present at very early in life and do not respond to steroid

or cytotoxic therapy
- Early unilateral or bilateral nephrectomy minimises or

eradicates nephrosis
- After bilateral nephrectomy is done –pt should be on

dialysis for next 3 month.
- Intensive nutrition therapy is conducted to correct protein

malnutrition before renal transplantation.

SECONDARY

- Systemic Lupus Erythematosus

- Post streptococcus glomerulonephritis
- Imunoglobulin A nephropathy (IgAN) or Berger’s disease,

is a condition that damages the glomeruli.
Immunoglobulin A is a protein that helps your body fight
infections. IgA nephropathy occurs when IgA protein gets
stuck in kidneys causing inflammation.

What is IgA Nephropathy?

• Immunoglobulin A Nephropathy, called IgAN for short, or
Berger’s disease, is a condition that damages the
glomeruli inside your kidneys and can cause kidney
disease.

What causes IgA Nephropathy?

• It is a response from your immune system (your body’s
defense system) to outside irritation (like viruses).

• The immune response releases Immunoglobulin A (IgA).
Immunoglobulin A is a protein that helps your body fight
infections.

• IgA nephropathy occurs when IgA protein gets stuck in
kidneys causing inflammation. The inflammation causes
your kidneys to leak blood and protein (usually
immediately)

What are the signs and symptoms of
IgA nephropathy?

• The most common signs are
• Hematuria: Having blood in your urine that can

sometimes make it dark brown or cola colored.
• Proteinuria: Foamy urine due to large amounts of protein

leaking into your urine.

How is IgA Nephropathy treated?

• Efforts to slow the process of kidney damage may include
the following:

• Corticosteroids (often called “steroids”)
• Immunosuppressive drugs
• ACE inhibitors and ARBs
• Diet change
• Fish oil supplements

Cont.

• Corticosteroids and immunosuppressive drugs: These
medications are used to calm your immune system (your
body’s defense system) and stop it from attacking your
glomeruli.

• ACE inhibitors and ARBs: These are blood pressure
medications used to reduce protein loss and control blood
pressure.

• Diet change: Some diet changes may be needed, such as
reducing salt (sodium) and protein in your food choices to
lighten the load of wastes on the kidneys.

• Your healthcare provider may recommend the use of vitamin
supplements in the form of fish oil. Some studies have shown
this may help with treatment of IgAN. Before starting any
supplements or vitamins, you should always speak with your
healthcare provider.







MEDICAL TREATMENT
& CARE OF PT WITH
ALTERED GUS

1. CONTINUOS BLADDER DRAINAGE
2. BLADDER IRRIGATION
3. PERITONEAL DIALYSIS

CBD

• DEFINITION:

Flexible tube that collects urine from the bladder and leads
to a drainage bag.
Types:

1. Rubber

2. Plastic (PVC)

3. Silicone
Catheters are generally necessary when someone can’t
empty their bladder.
If the bladder isn’t emptied urine can build up and
lead to pressure in the kidneys Pressure can lead to
kidney failure.

Why are urinary catheter used?

Indications

1. To drain the bladder prior to, during, or after surgery
2. For investigations
3. To relieve retention of urine
4. To accurately measure the urine output
5. To relieve urinary incontinence when no other means is

practical

The reason why pt not be able to
urinate:

1. Blocked urine flow due to bladder or kidney stone, blood
clots in the urine, or severe enlargement of the prostate
gland.

2. Surgery on prostate gland.

3. Surgery in the genital area, such as hip #, repair or
hysterectomy.

4. Injury to the nerves of the bladder.

5. SCI

6. Dementia.

7. Spina bifida.

Types of urinary catheter

1. Indwelling catheters (urethral or suprapubic)

- Also be known as a Foley catheter.
- A nurse usually insert an indwelling catheter into the

bladder through the urethra.
- Healthcare provider can insert into the bladder through a

tiny hole in the abdomen (SPC).
2. External catheters (condom catheters)
-placed outside the body
- For men who don’t have urinary retention but mental

disabilities, such as dementia.
- Lower risk of infection.
- Need to be changed daily

Foley Catheter Risks

1. The balloon can break while the catheter is being
inserted. In this case, the doctor will remove all the
balloon fragments.

2. The balloon does not inflate after it is in place. Usually
balloon inflation will be check before inserting the
catheter into the urethra. If the balloon still does not
inflate after its placement into the bladder, then another
Foley catheter will be insert.

3. Urine stops flowing into the bag. The doctor will check
for correct positioning of the catheter and bag or for
obstruction of urine flow within the catheter tube.

4. Urine flow is blocked. The doctor will have to change
the bag or the Foley catheter or both.

5. The urethra begins to bleed. The doctor will have to
monitor the bleeding.

6. The Foley catheter may introduce an infection into the
bladder. The risk of infection in the urine increases with
the number of days the catheter is in place.

7. If the balloon is opened before the Foley catheter is
completely inserted into the bladder, bleeding, damage
and even rupture of the urethra can occur. In some
individuals, long-term permanent scarring and strictures
of the urethra could occur.

8. Bladder spasms can occur when a catheter is placed.
This is a sudden intense urge to urinate and can be
painful. Often, urine will leak around the outside of the
catheter when a spasm occurs. Medication can be
prescribed for bladder spasms.



Short-term catheters (intermittent
catheters)

- In-and-out catheter.
- After surgery until the bladder empties.
- Trained to apply themselves/ caregiver.
- Through urethra / a hole created in the lower abdomen.

• Complications indwelling catheter:

1. Infection
2. Leaking
3. Blockage
4. Bladder spasm



Hasil pembelajaran

• Di akhir sesi pembelajaran, pelajar seharusnya
dapat:

1. Menyatakan tujuan memasukkan CBD.
2. Melakukan prosedur dengan teknik yang betul.
3. Mencatat data untuk menilai fungsi renal dan

melihat sebarang keabnormalan dan perawatan
selanjutnya dapat dilakukan.

Memasukkan kateter

Tujuan

1. Melegakan retensi urin.
2. Mendapatkan spesimen urin yang steril.
3. Mengukur jumlah urin residual.
4. Mengosongkan pundi kencing sebelum,semasa dan

selepas pembedahan major.
5. Mengawasi pengeluaran urin.

Asesmen pesakit

1. Tahap kesedaran- ikut dan faham arahan.
2. Tahap keupayaan fizikal – membantu prosedur
3. Berat badan.
4. Kehadiran alat-alat rawatan (cth : splint/cast)
5. Prosedur ini memerlukan pembantu atau tidak.

Asesmen persekitaran

1. Kawasan kerja yang selesa dan selamat:
2. Lapang
3. Bersih
4. Pencahayaan mencukupi
5. Ketinggian katil yang sesuai
6. Kunci katil
7. Privasi

Perancangan

Persediaan peralatan:

Implimentasi

1. Teknik membersihkan bahagian genitalia.
2. Teknik memasukkan kateter.
3. Teknik mengekalkan kateter in situ.

Penyediaan peralatan

• Sediakan peralaan:
1. Atur dan tambah peralatan.
2. Keluarkan dan letakkan kateter,sarung tangan dan

syringe.
3. Tuang larutan pencuci ke dalam mangkuk losyen steril.
4. Tuang larutan air distil ke dalam galipot.
5. Picit KY Jelly ke atas gauze.

Persediaan pesakit

1. Baringkan ke posisi dorsal.
2. Tutup bahagian bawah abdomen dengan meletakkan

drawsheet di di atas lutut hingga paras lutut.
3. Letakkan pengalas getah/ underpad di bawah

punggung.
4. Keluarkan sarung pesakit.