CHAPTER 22 Renal Disorders 559
Making the Connections—cont’d
Signs and Symptoms Treatment Nephrotic Syndrome | Any disorder that causes glomerular injury. When glomeruli are injured, they become highly per- meable and allow proteins to filter out of blood. Albumin leaves the blood and is excreted in the urine, called proteinuria or albuminuria. Hypoalbuminemia causes edema. Glomerulonephritis caused by infection and immunological inflammatory disease is a cause of nephrotic syndrome. Edema, especially of periorbital region and face. Edema of the face is common, especially in the periorbital region. HTN. With severe albu- Assessment Findings Diagnostic Tests Diet low in sodium. Adequate protein and fluid. ACE inhibitors or ARBs may be used.
Albuminuria. Hypoalbuminemia. Hematuria. Hyperlipidemia. Hypertriglyceridemia. Elevated serum creatinine and BUN. 24-hour urine collection shows more than 3 grams of protein /dL. ANAs may be positive if etiology is an autoimmune disease. Blood may show high calcium, uric acid, or purines, depending on the etiology of nephrolithiasis. Elevated blood pressure and tachycardia are caused by pain. Urinalysis shows RBCs and crystals. Abdominal x-ray, CT, or ultrasound can show calculi.
min loss, edema of lower extremities, pleural effusion, and ascites can develop.
Nephrolithiasis | The formation of calculi in the kidney, which can cause obstructive uropathy. Calculi are commonly com- posed of calcium. Severe back pain with
IV fluid. Analgesics. Strain urine. Urinalysis needed. Increase oral fluid intake to more than 3 liters/day. Lithotripsy. Ureterocystoscopic surgery.
CVA tenderness. Hematuria. Crystalluria.
radiation into the groin. Severe abdominal pain. Chills.
Pyelonephritis | Infection of the upper urinary tract, commonly caused by an ascending lower UTI. Back pain. Fever. Malaise. Chills. Dysuria. Frequency. CVA tenderness. Fever. Elevated WBC count. Microscopic hematuria. Pyuria. Bacteriuria. Proteinuria.
Antibiotics. Antipyretics and analgesics may be necessary.
Polycystic Kidney Disease | Disease causing multiple cysts in the kidneys and dysfunction caused by genetic mutation at 16p13.3 or 4q21-22. Back pain. Fever (if infection). CVA tenderness, if infection. Hematuria.
Supportive treatment: low- sodium diet, physical activity, smoking cessation, and normal body weight maintenance. Tolvaptan. ACE inhibitors or ARBs to treat HTN. Prevention and treatment of UTIs. Hemodialysis if necessary. Renal transplant.
Hematuria. Crystalluria. Bacteriuria. Ultrasound or CT scan can show cysts within kidneys.
Continued
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