RENAL VASCULAR PROBLEMS P 1142 NEPHROSCLEROSIS Consists of sclerosis of the small arteries and arterioles of the kidneys o Decreased blood flow patchy necrosis of renal parenchyma o Ischemic necrosis glomeruli destruction and fibrosis may occur Benign nephrosclerosis o From HTN and atherosclerosis vascular changes o Normal renal function in early stages may only detect HTN o Treat like normal HTN Accelerated malignant nephrosclerosis o Associated with malignant HTN sharp increase in BP with diastolic 130 o Renal insufficiently progresses rapidly o Aggressive anti HTN therapy Complications renal failure and dysfunction due to HTN Prognosis is poor if untreated RENAL ARTERY STENOSIS Partial occlusion of one or both renal arteries and their major branches Due to atherosclerotic narrowing or fibromuscular hyperplasia Should be considered is HTN suddenly occurs especially in patients 30 50 Renal arteriogram to identify renal artery stenosis Goal is to treat HTN and restore kidney perfusion Renal ischemia or renovascular hypertension surgical intervention to restore renal blood flow RENAL VEIN THROMBOSIS Unilateral or bilateral Due to trauma extrinsic compression tumor or aortic aneurysm renal cell carcinoma pregnancy contraceptive use and nephrotic syndrome Flank pain hematuria fever or nephrotic syndrome Treatment o Anticoagulation heparin or warfarin avoid pulmonary emboli o Corticosteroids for nephrotic syndrome o Surgical thrombectomy HEREDITARY RENAL DISEASES P 1142 1143 POLYCYSTIC KIDNEY DISEASE PKD Most common life threatening genetic disease Involves both kidneys the cortec and medulla are filled with large thin walled cysts that range from mm to cm o The cysts enlarge and destroy surrounding tissue may be filled with fluid blood or pus Childhood manifestation rare due to autosomal recessive disorder rapidly progressive o Has been found in newborns Adult manifestation autosomal dominant disorder latent then appears around 30 40 Clinical manifestation o Early no S S symptoms begin with cyst enlargement some never have S S and are never diagnosed o First clinical manifestation can be UTI or renal calculi o Later HTN hematuria cyst rupture feeling of heaviness in the back side or abdomen o Chronic pain can be constant and severe o Bilateral kidneys are often palpable Diagnosis clinical manifestations family history ultrasound best screening measure or CT Progressive loss of kidney function ESRD 50 by age 60 Can affect the liver liver cyst heart valve abnormalities blood vessels aneurysm and intestines diverticulosis Most serious complication is cerebral aneurysm Nursing and collaborative interventions o Aim to prevent infection or prompt infection treatment o Possible nephrectomy is pain bleeding or infection becomes choric o Dialysis or transplant may be necessary o Similar nursing management as for ESRD Diet modification and fluid retriction Antihypertensives Assist patient to accept chronic disease process Assist patient and family to cope with financial and heredity concerns MEDULLARY CYSTIC DISEASE Autosomal recessive o Renal failure before 20 Autosomal dominant o Renal failure after 20 Most cysts are in the medulla asymmetric shaped kidneys with signifant scarring Polyuria progressive renal failure severe anemia metabolic acidosis and poor sodium conservation defects in concentration abilities ESRD interventions HTN is often a terminal event ALPORT SYNDROME AKA chronic hereditary nephritis Classic Alport syndrome o Inherited as a sex linked disorder with hematuria sensorineural deafness and anterior surface lens deformities Nonclassic Alport syndrome o Autosomal trait causing hematuria but no deafness or lens defects Men are effect earlier and more severely o Usually diagnosed before age 10 Gene mutation altering synthesis of GBM Hematuria and progressive uremia is most common o Does not reoccur after transplantation Treatment is supportive because corticosteroids and cytotoxic drugs do not work
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