The kidneys are vital organs that filter blood, regulate fluids, and maintain electrolyte balance. Their complex structure includes glomeruli for filtration and tubules for reabsorption and secretion. Understanding these components is crucial for grasping how kidney function impacts overall health.
Kidney disorders can affect glomeruli or tubules, leading to various symptoms and complications. Glomerulonephritis and nephrotic syndrome involve glomerular damage, while tubular disorders like renal tubular acidosis disrupt electrolyte balance. Nurses play a key role in assessing, treating, and educating patients with kidney problems.
Renal Structure and Function
Structure and function of renal components
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Glomerulus
Tuft of capillaries surrounded by Bowman's capsule forms filtration unit
Site of blood filtration initiates urine formation process
Composed of endothelial cells, basement membrane, and podocytes create selective permeability barrier
Renal tubules
Proximal convoluted tubule
Reabsorbs most filtered substances (glucose, amino acids, water) maintains blood homeostasis
Loop of Henle
Concentrates urine through countercurrent multiplication mechanism creates osmotic gradient
Distal convoluted tubule
Fine-tunes electrolyte balance regulates sodium and potassium levels
Collecting duct
Final urine concentration under ADH influence determines water reabsorption
Glomerular and Tubular Disorders
Glomerulonephritis and nephrotic syndrome
Glomerulonephritis
Pathophysiology
Inflammation of glomeruli damages filtration barrier
Immune complex deposition or direct antibody attack triggers inflammatory response
Clinical manifestations
Hematuria indicates glomerular damage
Proteinuria reflects increased glomerular permeability
Edema results from fluid retention
Hypertension develops due to fluid overload and renin-angiotensin system activation
Diagnostic tests
Urinalysis detects blood and protein in urine
Serum creatinine and BUN assess kidney function
Complement levels indicate immune system involvement
Renal biopsy confirms diagnosis and determines severity
Nephrotic syndrome
Pathophysiology
Increased glomerular permeability allows protein leakage
Massive protein loss in urine leads to hypoalbuminemia
Clinical manifestations
Severe edema occurs due to decreased oncotic pressure
Hypoalbuminemia results from urinary protein loss
Hyperlipidemia develops as compensatory mechanism
Diagnostic tests
24-hour urine protein (>3.5 g/day) quantifies protein loss
Serum albumin levels assess severity of hypoalbuminemia
Lipid panel evaluates extent of hyperlipidemia
Causes and effects of tubular disorders
Renal tubular acidosis (RTA)
Causes
Genetic defects alter tubular ion transport
Autoimmune diseases damage tubular cells
Certain medications (amphotericin B, lithium) impair tubular function
Consequences
Metabolic acidosis disrupts acid-base balance
Electrolyte imbalances affect potassium and calcium levels
Kidney stones form due to altered urine pH
Growth retardation in children results from chronic acidosis
Fanconi syndrome
Causes
Inherited disorders affect multiple transport proteins
Heavy metal toxicity (lead, mercury) damages proximal tubules
Certain medications (tenofovir, valproic acid) impair tubular function
Consequences
Generalized proximal tubule dysfunction leads to multiple defects
Aminoaciduria results in loss of essential amino acids
Glucosuria occurs despite normal blood glucose levels
Phosphaturia causes bone demineralization
Metabolic acidosis develops due to bicarbonate wasting
Nursing care for renal patients
Assessment
Monitor vital signs, especially blood pressure identifies hypertension early
Track daily weights and fluid balance detects fluid retention
Assess for edema and respiratory distress indicates fluid overload
Interventions
Administer medications as prescribed
Diuretics reduce fluid retention
Antihypertensives control blood pressure
Immunosuppressants manage underlying autoimmune processes
Provide dietary education
Sodium restriction helps manage fluid balance
Protein modification based on disease state prevents further kidney damage
Monitor laboratory values
Electrolytes guide electrolyte replacement
Serum albumin assesses nutritional status
Renal function tests track disease progression
Patient education
Importance of medication adherence ensures treatment efficacy
Signs and symptoms to report enables early intervention
Dietary restrictions maintain fluid and electrolyte balance
Self-monitoring techniques empower patient in disease management
Psychosocial support
Address anxiety and depression improves quality of life
Provide resources for chronic illness management enhances coping skills