The Kidneys and why they Fail

Food for thought

• If you yelled for 8 years, 7 months and 6 days you would’ve produced enough sound energy to heat 1 cup of coffee. (Hardly seems worth it)

• If you farted consistently for 6 years and 9 months, enough gas is produced to create the energy of an atomic bomb. (Now that's more like it)

Areas that I have included

• The Normal Kidney

*Anatomy/Physiology

• The Diseased Kidney

*Common Abnormal Findings

*CRF vs. ARF

*Our ROLE as nurses

The Kidney

• Bean shaped; behind peritoneum; 12T-3L vertebra; right one a little lower; 10-15cm length; 120-170gm; 11x6x3cm size;<1% of body weight

• Blood supply =Renal Blood/plasma flow 20-25% of CO

• 1-1.2M nephrons:

1. Bowman’s capsule

2. Proximal Convoluted Tubule

3. Loop Of Henle

4. Distal Convoluted Tubule

5. Collecting Ducts

Kidney Anatomy and Location

Mechanism of Renal Excretory Function

• Glomerular Ultrafiltration=protein-free ultrafiltrate

• Urine Volume = 1.5L/day (roughly 1ml/min)• small residuum=2 opposing processes:

Ultrafiltration (UF) of >180L (125ml/min)

Reclamation of 99% of ultrafiltrate• Filtration <10,000 molecular weight• Glomerular Capillary Pressure 45mmHg

Urine Production/Rate of Ultrafiltration (GFR)

• Glomerular Capillary Hydrosatic Pressure + Bowman’s space Oncotic Pressure = Glomerular Capillary Oncotic Pressure + Bowman’s Space Hydrostatic Pressure

• Rate of Plasma Flow• Permeability and Total Surface Area

Barrier to Protein filtration:

1.Glomerular Capillary Basement Membrane and Slitlike

diaphragms

2. Eletrostatic Factors

NEPHRON

Food for thought

• A cockroach will live nine days without its head before it starved to death.

CONTENTS OF URINE

• Ions (electrolytes)

• Metabolic wastes

• Drug metabolites

• Other products

1. Excretory: Nitrogenous waste products, drugs, hormones

2. Regulatory: body water volume/osmolality/electrolyte balance/acid base balance/ Blood Pressure

The Juxtaglomerular Apparatus : Tubular component Vascular component Interstitial component

Remember renal function = remove & regulate

KIDNEY FUNCTIONS

3. Metabolic: Activate Vit. D/ Renin production Erythropoietin production.

Types of Renal FailureI. Acute RF ARF: i.e. Bi. Arterial Occlusion Hypovolaemia

Bi. Acute Renal Vein Thrombosis ATN

Acute Uric Acid Nephropathy CV Collapse

RPRF: i.e. Idiopathic Rapidly Progressing GN

Goodpasture’s Synd

Acute Bacterial Endocarditis or Visceral Sepsis

Microscopic Polyarteritis Nodosa

Wegener’s Granulomatosis

II. Chronic Several forms of GN

HTN

DM

• Hb due to Epo production• Hct due to intravascular fluid• Sodium can either be or • Potassium • Urea • Creatinine• Albumin often • Calcium often • Phosphate • Aluminum can be

• HCO3

Common Abnormal Lab Result in Renal Failure

• Pale• Weak• Appettite• DOB/SOB• Can not tolerate activity • Pruritus• Dry skin, Ashen gray appearance• Uraemic breath• BP • Oedema• Sleep• Exacerbation of pre-existing comorbidities

Client Assessment

Nursing Role• Basic Advanced

• Proper and Thorough Assessment

• Early Identification of Problems

• Prompt Referral

• Early Intervention

• Client Advocacy

• Continuous Health Teaching

Food for thought• Priests DonPriests Don’’t Liet Lie 

• A distinguished young woman on a flight from Switzerland asked the priest beside her, "Father, may I ask a favor?" "Of course. What may I do for you?" 

• "Well, I bought an expensive electronic hair dryer that is well over the Customs limits and I'm afraid they'll confiscate it. Is there anyway you could carry it through Customs for me? Under your robes perhaps?" 

• "I would love to help you, dear, but I must warn you I will not lie." • "With your honest face, Father, no one will question you." • When they got to Customs, she let the priest go ahead of her. The official asked,

"Father, do you have anything to declare?" • "From the top of my head down to my waist, I have nothing to declare." • The official thought this answer strange, so he asked, "And what do you have to

declare from your waist to the floor?" 

•"I have a marvellous little instrument designed to be used on a woman, but which is, to date, unused." Roaring with laughter, the official said, "Go ahead, Father. Next!"

Thank You

Any Questions?