UNIT 8 RENAL AND UROLOGICAL DISORDERS
CHAPTER 22
Renal Disorders
Learning Objectives
After completion of this chapter, the student will be able to: • Describe the various actions of the kidney and how these actions are affected in renal dysfunction. • Identify causes of prerenal, intrarenal, and postrenal dysfunction of the kidney. • Explain the signs and symptoms of major causes of kidney dysfunction.
• Recognize assessment modalities and laboratory tests used to diagnose kidney dysfunction. • Differentiate between acute kidney injury and chronic kidney disease. • Discuss pharmacological and nonpharmacological treatment modalities used in renal dysfunction.
Key Terms
Acute kidney injury (AKI) Acute tubular necrosis (ATN)
End-stage renal disease (ESRD) Erythropoietin Glomerular filtration rate (GFR) Goodpasture’s syndrome Hematuria Hemodialysis Hydronephrosis Intrarenal dysfunction Nephrolithiasis
Oliguria Peritoneal dialysis (PD) Postrenal dysfunction Prerenal dysfunction Proteinuria Pyelonephritis Renal osteodystrophy Renin–angiotensin–aldosterone system (RAAS) Urea Vesicoureteral reflux
Albuminuria Aldosterone Antiglomerular basement membrane (anti-GBM) disease Azotemia Continuous renal replacement therapy (CRRT) Costovertebral angle (CVA) tenderness Creatinine clearance (CrCl)
Nephrotic syndrome Obstructive uropathy
The kidneys are commonly recognized as the organs of excretion because they filter the bloodstream of waste products and excrete urine. However, they also per- form many other functions essential for life. The kid- neys play a major role in controlling blood pressure, regulating red blood cell (RBC) production, breaking down drugs, metabolizing hormones, synthesizing vitamin D, managing electrolytes, conserving and excreting water, and balancing the pH of the blood- stream. The kidneys influence every system of the body from brain to bone, and it is only in their failure that we can appreciate the kidneys’ multiple actions and far-reaching effects on the body.
Epidemiology The incidence of kidney disease continues to grow in the United States. As of 2021, according to the Cen- ters for Disease Control (CDC), one in seven—15% or 37 million—adults in the U.S. have chronic kidney dis- ease (CKD). Also, as many as 9 in 10 adults with CKD do not know they have this disorder. It is most common in persons over age 65. Adults with diabetes mellitus (DM), hypertension (HTN), or both have a high risk of developing kidney disease. One in three adults with DM and one in five adults with HTN have kidney disease.
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