NUR 265 EXAM ONE STUDY GUIDE
• Nephrotic Syndrome:
o NS is a condition of increased glomerular permeability
that allows larger molecules to pass through the
membrane into the urine and then be excreted.
o Immunological Kidney disorder
o This causes massive loss of protein in the urine,
edema formation, and decreased plasma
albumin levels.
▪ Proteinuria- severe protein loss more than 3.5 g in 24-
hour urine sample.
o Key features:
▪ Massive proteinuria >3.5g / 24hrs
▪ Hypoalbuminemia <3g/dL
▪ Edema (facial and periorbital)
▪ Lipiduria
▪ Hyperlipidemia
▪ Increased coagulation (renal vein thrombosis)
▪ Reduced kidney function (↑ BUN, ↑ Cr, ↓ GFR)
o Treatment- immunosuppressant agents (if immunity
based).
▪ ACE inhibitors (to decreased protein loss in urine & ↓BP)
▪ Statins (improve blood lipid levels).
▪ Heparin (↑ coagulation / risk of thrombosis → treat
vascular effects and improve kidney function)
o Diet:
▪ If GFR is normal- dietary intake of complete proteins
is
needed
▪ If GFR is decreased- dietary protein is decreased,
diuretics and sodium restriction.
• Acute Kidney Injury:
o AKI is rapid reduction in kidney function resulting in a
failure to maintain fluid and electrolyte balance, and
acid-base balance.
▪ Can occur over a few hours or days
o Severity of AKI is based on serum creatinine increase,
and decreased urine output- an increase in specific
gravity (meaning urine is more concentrated or the
patient is dehydrated).
o GFR isn’t used to measure acute injury or illness—
only chronic kidney disease.
1
,o 3 types of AKI
▪ prerenal - conditions that reduce blood flow /
oxygen to the kidney → decreased perfusion to
kidneys
• azotemia- nitrogenous waste/toxin build up
o effects LOC, mood, change in personality
2
, o related directly to reduced perfusion
to the kidneys
• examples of perfusion reduction:
o blood/fluid loss- (surgery, sepsis,
hypovolemic shock)
o blood pressure drugs resulting in
hypotension
o MI or HF → low ejection fraction → low
cardiac output
o NSAIDs, ASA
o Anaphylaxis
o Severe burns
o Severe dehydration
o Renal artery stenosis
o Bleeding or clotting in kidney blood vessels
o Atherosclerosis (cholesterol
deposits obstructing blood flow
to the kidneys)
▪ Intra-renal failure- tissue damage to the actual
kidneys
• Intra-renal- reflects injury to the glomeruli,
nephrons,
or tubules
• Examples of intra-renal failure:
o Bleeding in the kidney
o Glomerulonephritis or inflammation
of the glomeruli
o Pyelonephritis
o Thrombi or emboli in the kidney blood
vessels
o TTP → platelet disorder ↑ clotting
o Sepsis or local infection
o Lupus
o Multiple myeloma
o Scleroderma
o Chemo/ ABTs / nephrotoxic drugs
o Ischemia in kidney failure, including
hypoxemia from respiratory and cardiac
arrest
▪ Post-renal failure- Urine flow obstruction
• Post-renal failure examples:
o Bladder cancer
3
, o Colon cancer
o Prostate cancer
o Cervical cancer
o Enlarged prostate
o Kidney stones
o Blood clots in urinary tract
4
• Nephrotic Syndrome:
o NS is a condition of increased glomerular permeability
that allows larger molecules to pass through the
membrane into the urine and then be excreted.
o Immunological Kidney disorder
o This causes massive loss of protein in the urine,
edema formation, and decreased plasma
albumin levels.
▪ Proteinuria- severe protein loss more than 3.5 g in 24-
hour urine sample.
o Key features:
▪ Massive proteinuria >3.5g / 24hrs
▪ Hypoalbuminemia <3g/dL
▪ Edema (facial and periorbital)
▪ Lipiduria
▪ Hyperlipidemia
▪ Increased coagulation (renal vein thrombosis)
▪ Reduced kidney function (↑ BUN, ↑ Cr, ↓ GFR)
o Treatment- immunosuppressant agents (if immunity
based).
▪ ACE inhibitors (to decreased protein loss in urine & ↓BP)
▪ Statins (improve blood lipid levels).
▪ Heparin (↑ coagulation / risk of thrombosis → treat
vascular effects and improve kidney function)
o Diet:
▪ If GFR is normal- dietary intake of complete proteins
is
needed
▪ If GFR is decreased- dietary protein is decreased,
diuretics and sodium restriction.
• Acute Kidney Injury:
o AKI is rapid reduction in kidney function resulting in a
failure to maintain fluid and electrolyte balance, and
acid-base balance.
▪ Can occur over a few hours or days
o Severity of AKI is based on serum creatinine increase,
and decreased urine output- an increase in specific
gravity (meaning urine is more concentrated or the
patient is dehydrated).
o GFR isn’t used to measure acute injury or illness—
only chronic kidney disease.
1
,o 3 types of AKI
▪ prerenal - conditions that reduce blood flow /
oxygen to the kidney → decreased perfusion to
kidneys
• azotemia- nitrogenous waste/toxin build up
o effects LOC, mood, change in personality
2
, o related directly to reduced perfusion
to the kidneys
• examples of perfusion reduction:
o blood/fluid loss- (surgery, sepsis,
hypovolemic shock)
o blood pressure drugs resulting in
hypotension
o MI or HF → low ejection fraction → low
cardiac output
o NSAIDs, ASA
o Anaphylaxis
o Severe burns
o Severe dehydration
o Renal artery stenosis
o Bleeding or clotting in kidney blood vessels
o Atherosclerosis (cholesterol
deposits obstructing blood flow
to the kidneys)
▪ Intra-renal failure- tissue damage to the actual
kidneys
• Intra-renal- reflects injury to the glomeruli,
nephrons,
or tubules
• Examples of intra-renal failure:
o Bleeding in the kidney
o Glomerulonephritis or inflammation
of the glomeruli
o Pyelonephritis
o Thrombi or emboli in the kidney blood
vessels
o TTP → platelet disorder ↑ clotting
o Sepsis or local infection
o Lupus
o Multiple myeloma
o Scleroderma
o Chemo/ ABTs / nephrotoxic drugs
o Ischemia in kidney failure, including
hypoxemia from respiratory and cardiac
arrest
▪ Post-renal failure- Urine flow obstruction
• Post-renal failure examples:
o Bladder cancer
3
, o Colon cancer
o Prostate cancer
o Cervical cancer
o Enlarged prostate
o Kidney stones
o Blood clots in urinary tract
4
