10.2 Glomerular and Tubular Disorders

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