Renal Disorder: What is Nephrotic Syndrome (Nephrosis)?

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Nephrotic syndrome, also known as nephrosis, is considered as one of the major, essential subjects in nursing school. After this, we’ll go into acute glomerulonephritis.

The Nerf Balls

As a kid, you’ve encountered a Nerf toy that is loaded with Nerf balls. When connecting nephrotic syndrome or nephrosis to a Nerf toy, think of the Nerf balls because as the kidney becomes inflamed, the glomeruli become increasingly permeable and the protein (Nerf balls) go through the glomeruli and then goes out from the body through the urine.

Therefore, when talking about the nephrotic syndrome, you always have to keep in mind that the primary element affected will be protein. This is really important especially when you are taking an important nursing exam like the NCLEX®.

Inflamed Kidneys

A human’s kidneys have functional structures known as nephrons, which are primarily responsible for the production of urine. Inside these nephrons are glomeruli that are tasked with filtering hydrogen, urea nitrogen, and creatinine (a by-product of protein) or what we refer to as the acronym, HUC. This situation is supposed to be the normal process of filtering blood, retaining water, and eliminating toxins and wastes from the body.

When your client has an inflamed kidney, the glomerulus becomes a tight mesh, similar to that of a coffee filter or a huge, permeable chain-link fence wherein you can easily push things through it.

Protein, in the form of albumin or creatinine, leaks into the urine. The main indicator of nephrosis is increased protein in a client’s urine output. However, this does not necessarily state that every time creatinine is increased, it’s immediately a sign of nephrosis.

Nephrotic Syndrome: Pathophysiology

Nephrosis is an autoimmune disorder, which means that the condition is of genetic predisposition wherein the body is attacking itself. Here, the body attacks its glomeruli, resulting to inflammation and permeability. Other examples of autoimmune disorders are Parkinson’s disease and Lupus.

During the attack, the body will experience remissions and exacerbations which are due to three S’s – sepsis, stress, and smoking. Infection is another predisposing factor for a flare-up or an exacerbation.

As mentioned, once the glomeruli are inflamed, they become very permeable that there will be increased protein/albumin elimination in the urine.

Nephrotic Syndrome and Edema

Fluid retention causes edema in nephrotic syndrome. How?

Remember that the kidneys are supposed to filter blood and eliminate urine. If the glomeruli become permeable, they will not filter and will retain an increased amount of fluid; this will lead to fluid retention, and the consequence is edema. And if there’s edema, you can expect high blood pressure or hypertension, which is also a considerable risk factor for clients with nephrotic syndrome.

Managing Nephrosis

If you have a client who has nephrosis, there are a couple of ways to manage the condition. The priority is to get rid of the inflammation of the glomeruli while getting rid of the edema.

Aside from client education, medication is advised. What are the usual types of medications given to clients with nephrotic syndrome?

  1. Steroids

Prednisone is the steroid of choice for clients experiencing nephrosis. Prednisone helps in bringing down systemic inflammation. These are not the kind of steroids used by bodybuilders but the ones naturally produced by the adrenal cortex to stop inflammation inside the body.  

  1. Glucocorticosteroids

Another type of medication used for nephrotic syndrome clients is glucocorticosteroids; however, the use of this type of medication makes the client more predisposed to infections and edema. The solution for the edema side effect will be tackled on the next kind of medication.

  1. Diuretic

After managing glomeruli inflammation, the next thing that you want to take care of is the fluid retention which causes edema. As you are aware, there are four different types of diuretics, namely:

  • Osmotic diuretic
  • Potassium-sparing diuretic
  • Loop diuretic
  • Thiazide diuretic

Among these types of diuretics, there’s only one given with clients who have nephrosis, and that is thiazide diuretic.

Thiazide diuretics act on the descending loops of Henle, which is just a fancy word for the tubes inside the kidneys. Thiazides are used instead of the other kinds of diuretics because:

  • It is not potassium-wasting like that of furosemide (Lasix)
  • It does not bring down osmolality or the pressure in the bloodstream
  • It is not potassium-sparing like that of spironolactone

For those who are interested in a more detailed explanation of these types of diuretics, we have an entire lecture dedicated to this topic. You can check that out in SimpleNursing’s YouTube channel or look it up on our website.

Important Pointers

So, here’s a quick summary of what we’ve tackled:

  1. The primary problem with nephrotic syndrome or nephrosis is glomerular inflammation.
  2. The primary indication of nephrosis is increased protein excretion, evident in the urine.
  3. Glomeruli membranes become very permeable.
  4. Managing glomerular inflammation is through the administration of steroids.
  5. Managing edema is through thiazide diuretics.

As promised, our next topic will be glomerular nephritis. Please check this out on our next article by going to SimpleNursing.com.

Causes and Manifestations of Acute Kidney Injury

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What does acute renal failure (ARF) or acute kidney injury mean?

To get a better understanding of what’s really happening when you have acute kidney injury, we’ll go into details about its causes and manifestations. We’ll go into the three stages of acute kidney injury, its manifestations, and how to fix them with the acronym, H-D-T-V. We’ll also discuss the three causes of acute renal failure and how to tell difference between intrarenal and prerenal failure.

Let’s get into it.

The Basics

The kidneys filter three things – hydrogen ions, blood urea nitrogen, and creatinine. These elements are filtered inside the nephrons, and inside the nephrons are glomeruli. Normal glomeruli filtration rate (GFR) is between 85 – 105 ml of blood per minute. If this filtration rate drops to 65 ml/min, it means that the kidneys are in trouble and a diagnosis of acute kidney failure ensues.

Signs and Symptoms

There are three main manifestations of acute kidney injury – oliguric, diuretic, and recovery. What happens during these phases?

  1. Oliguric Phase

In this phase, the kidneys are “insulted” by nephrotoxic medications or components, namely:

  • Vancomycin
  • Gentamicin
  • IV contrast

The oliguric phase can be characterized by:

  • No urine output
  • If there is urine, it would be very little and is very brown
  • High urine specific gravity

What you need to understand is that the kidneys are expected to filter out as much as what you’re consuming or drinking. Therefore, if you drink a gallon of water for a day, it is expected that the kidneys usually are filtering and excreting at least a gallon of water within that day. Which is why, clients who are drinking a gallon of water and are only peeing 100 ml/day, or taking in 135 ounces but excreting only three ounces are already suffering from oliguria.

  1. Diuretic Phase

The second phase of acute kidney injury known as the diuretic phase is when the kidneys are compensating. When injured, the body will try to compensate by getting rid of as much fluid as it can. So, in this phase, you can expect the following:

  • Low specific gravity
  • Very clear urine
  • The body is getting enough fluid and is properly flushing the toxins
  1. Recovery Phase

The last phase of acute kidney injury is referred to as the recovery phase which technically means that the kidneys are adequately producing urine and recovering from the trauma. However, this does not mean that the kidneys are 100% in perfect condition. The recovery phase mainly implies that the kidneys are properly compensating and the glomerular filtration rate is around 30 ml/hour.

Other Causes of Acute Kidney Injury

Other than vancomycin, gentamicin, and IV contrast, there are also diabetic drugs like metformin that can cause acute renal failure. These drugs are very toxic to the kidneys due to their half-life. It takes quite some time for these drugs to be excreted by the kidneys.

Therefore, if your client is taking metformin, it should be discontinued two days before or after the IV contrast so as not to increase insult to the kidneys and prevent acute kidney injury.

For the other causes of acute renal failure, mainly the three Hs, drop by SimpleNursing.com.

See you there!