Renal diseases
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Renal diseases. HLTAP502A Analyse Health Information. Urolithiasis. Urinary stones, they vary in size from microscopic crystals to calculi that are several centimetres in diameter.

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Renal diseases

Renal diseases


Analyse Health Information



  • Urinary stones, they vary in size from microscopic crystals to calculi that are several centimetres in diameter.

  • They can be found in the pelvis of the kidney (the largest being a staghorn), the ureter and the urinary bladder.

The formation of stones relates to factors that

The formation of stones relates to factors that:

  • Increase the supersaturation of urine with calculus forming salts eg

    • Over-excretion of salt (oxalate)

    • Urine acidity

    • Low urine volume

  • Preformed nuclei eg

    • Uric acid crystallites

Types of stones

Types of stones

  • 75% - 80% are composed of calcium (mainly calcium oxalate – found in rhubarb, spinach, cocoa, nuts, pepper, tea)

  • 5%-10% uric acid crystals – uric acid is a by-product of protein metabolism. It crystallises in acidic environments.

  • 2% are cystine – due to an inherited defect in the renal tubules which impairs the reabsorption of the amino acids cystine.

  • The rest are struvite (magnesium ammonium phosphate). Struvite stones are a result of UTI. These stones need to be treated as infected foreign bodies.

Causes of hypercalcaemia

Causes of hypercalcaemia

  • Hyperparathyroidism

  • Renal tubular acidosis

  • Cancer – multiple myeloma, bony metastases

  • Excessive intake of vitamin D

Medications known to cause stones

Medications known to cause stones

  • Antacids

  • Diamox

  • Vitamin D

  • Laxatives

  • Aspirin

Signs and symptoms

Signs and symptoms

  • Commonly cause pain, bleeding, obstruction and secondary infections.

  • Renal colic – typically excruciating and intermittent

    • Originating in the flank, radiating across the abdomen

    • Also into the genital region and inner thigh

    • Calculi in the bladder may cause suprapubic pain

Signs and symptoms cont

Signs and symptoms (cont)

  • GI symptoms such as nausea, vomiting and abdominal distention

  • Chills, fever

  • Haematuria

  • Pyuria

  • Frequency of urination



  • History – family, medical, dietary

  • X-Rays – plain, IVP, urogram, MRI, CT

  • Ultrasound

  • Blood chemistries

  • 24-hour urine collection – calcium, creatinine, uric acid, pH

  • Analysis of stones to assess for underlying disorder

Medical treatment

Medical treatment

  • Uteroscopy

  • Chemolysis

  • Nephrostomy

  • Electrohydraulic lithrotripsy

  • Surgical removal

Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy

  • Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract.

  • Ultrasonic waves are passed through the body until they strike the dense stones.

  • Pulses of sonic waves pulverize the stones, which are then more easily passed through the ureter and out of the body in the urine.

Extracorporeal shock wave lithotripsy1

Extracorporeal shock wave lithotripsy

Percutaneous nephrolithotomy

Percutaneous nephrolithotomy

  • The surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney.

  • Using an instrument called a nephroscope, the surgeon locates and removes the stone.

    • For large stones, some type of energy probe (ultrasonic or electrohydraulic) may be needed to break the stone into small pieces.

    • Generally, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

    • One advantage of percutaneous nephrolithotomy over ESWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the kidney

Percutaneous nephrolithotomy1

Percutaneous nephrolithotomy

Nursing interventions

Nursing interventions

  • Assessments – vitals, pain, urine

  • Relieve pain

    • Medication

    • Positioning

    • Apply heat

  • FBC – input/output

  • Urine observations

    • Straining

    • Testing – blood, UTI

    • Volume

  • Treat other symptoms – fever, N/V, abdominal distension

Acute renal failure

Acute renal failure



  • Decreased blood flow – shock, burns, dehydration

  • Over exposure to metals, solvents, radiographic contrast, some antibiotics

  • Myoglobinuria

  • Direct injury to the kidney

  • Infections – pyelonephritis, septicaemia

  • Urinary tract obstruction – tumours, stones

  • Disorders of the blood – transfusion reactions

Clinical manifestations

Clinical Manifestations

  • Decreased urinary output

    • Oliguria – less than 100mls per day

    • Anuria – no urine passed

  • Hypertension

  • Oedema

  • Anorexia

  • Metallic taste in mouth

  • Persistent hiccoughs

  • Changes in mental status or mood

  • Nausea, vomiting

  • Bleeding – bruising, GIT, urinary

  • Pain – flank

  • Halitosis

Phases of arf

Phases of ARF

  • Initial period – ends when oliguria develops

  • Period of oliguria – show uraemic symptoms

  • Period of diuresis

  • Period of recovery – may take 3-12 months



  • Treat the cause

  • Maintain fluid balance

  • Restore and maintain chemical balance

  • Dietary

    • Restrict sodium, potassium, proteins

    • Increase carbohydrates

  • Diuretics may be used to initiate diuresis

  • Prevent complications

  • Dialysis – peritoneal, haemodialysis

Complications of arf

Complications of ARF

  • End stage renal failure

  • Cardiovascular – CCF, pericarditis

  • Pulmonary system – APO

  • Nervous system – generalised seizures, coma

  • Chronic renal failure

  • GIT – blood loss, stress ulcers, gastritis

  • Hypertension

  • Electrolyte imbalances – hyperkalaemia, hyponatraemia

Peritoneal dialysis

Peritoneal dialysis

Continuous ambulatory peritoneal dialysis capd

Continuous ambulatory peritoneal dialysis (CAPD)

  • The patient has a permanent access port in the abdomen.

  • Dialysis fluid (1.5-3litres) is drained into the peritoneal cavity and left there for 4-5 hours

  • The dialysate with wastes is then drained from the peritoneal cavity, and more fluid added.

  • This is repeated about 4-5 times a day



Vascular access

Vascular access

  • There are three basic kinds of vascular accesses for haemodialysis:

    • an arteriovenous (AV) fistula,

    • an AV graft, and

    • a venous catheter.

  • The AV fistula is considered the best long-term vascular access for haemodialysis because it provides adequate blood flow for dialysis, lasts a long time, and has a complication rate lower than the other access types.

  • The fistula takes 6-8 weeks to mature

Arteriovenous fistula

Arteriovenous fistula

Care of access site

Care of access site

  • Check access site before each treatment.

  • Be careful of trauma to access.

  • Don't take blood pressure on arm with access.

  • Patient not to wear jewellery or tight clothes over access site.

  • Patient not to sleep with access arm under head or body.

  • Patient not to lift heavy objects or put pressure on access arm.

  • Patient to check the pulse in access every day.

Kidney transplant

Kidney transplant

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