MODULE II: RENAL ANATOMY AND

PHYSIOLOGY

BY:
Camille M. Espinosa, RN, CNN

The FILTERS

PARTS and
FUNCTIONS

The
KIDNEY
RENAL
CAPSULE

ADIPOSE
CAPSULE

HILIUM

The KIDNEY

Calyx

Structures of the
KIDNEY

NEPRHON
Functional unit of the kidney
Located inside the renal pyramids and

extends down to the medulla

FILTRATION FACTORY - HOMEOSTASIS
Composed of:
1. Renal Corpuscle (Glomerulus, Bowmans
Capsule)
2. FOUR Tubular Structures (Proximal
Convoluted Tubule, Distal Convoluted Tubule,
Loop of Henle, Collecting Tubules)

The GLOMERULUS
Tangled ball of capillaries surrounded by a

membrane called the Bowmans capsule

Tubular stuctures

EXCRETORY FUNCTIONS:
1. Excretion of the end products of metabolism

(urea, creatinine, uric acid, phosphates,

nitrates, sulfates, and phenol)
2. Excretion of excess fluid and electrolyte
components (water, Na, K, HCO3 and Cl)
3. Excretion of certain drugs and other
substances (penicillin, etc)

Endocrine Functions:
Renin, Prostaglandin, ADHenzymes that

regulates blood pressure

Erythropoietin- a hormone that stimulates the
bone marrow to make red blood cells
Active for of vitamin D help maintain calcium
absorption for bone formation, at the same
time maintains calcium balance in the body

Stages of CKD
Sta
ge

Description

GFR
ml/min

Kidney damage
with normal or
increased GFR

Kidney damage
60-89
with mild GFR fall

Estimate progression; treat comorbid conditions

Moderate fall in
GFR

30-59

Evaluate/treat complications;
refer to nephrologist

Severe fall in
GFR

15-29

Educate patients on kidney

replacement options. Prepare for
kidnet replacement therapy

End-Stage-RenalFailure

<15

Kidney replacement by dialysis

or transplant

>= 90

Recommended Action Plan

Diagnose/treat to slow down the
progression
Educate patients on disease
management
Treat comorbid conditions,
cardiovascular disease risk
reduction

Normal values
Urea

15-40mg/dl

BUN

5-20mgdl

Creatinine

0.5 to 1.5 mg/dl

Albumin

3.5 to 5.4 mg/dl

Potassium

3.5 to 5.5 mg/dl

Sodium

135to 145 mEqs

Phosphorus

3.5 to 5.5 mg/dl

Hemoglobin

12-18 MG/DL

What is Dry Weight

Dry weight is currently defined as the lowest

weight a patient can tolerate without the

development of symptoms or hypotension.
The standard HD prescription targets fluid

removal to a clinically derived estimate of dry

weight. (UF goal)
Each patients dry weight must be adjusted

frequently.

CLIENTS WITH RENAL

FAILURE
FLUID MANAGEMENT
a. Once vascular volume and renal perfusion

are restores, fluids are restricted

b. Often in take is calculated by adding output
from previous 24 hours and 500 ml for
insensible losses.
c. Fluid balance monitored by daily weights
and serum sodium level

ANEMIA
CAUSES:

Relative EPO deficiency

Shortened RBC survival
Bone marrow suppression
Iron deficiency
Blood loss
Other substrate deficiency (B12 and Folic
Acid)

ANEMIA MANAGEMENT
Both IRON and EPO needs to be given
Blood Transfusions
Most patients needs IV Iron (Iron Sucrose)
IRON DEFICIENCY is detected when TSAT is

<20% and serum Ferritin is <100ng/ml

WITHHOLD IV IRON when TSAT is > 50% or
Ferritin is >800mg/dl

BONE MANAGEMENT
Control Calcium and phosphorus in the early

stages of CKD
Keep Phosphorus <4.6 mg/dl in the early
stages of CKD
Use of Phosphate binders
Restrict Calcium intakes

Cardiovascular
Management
CKD is considered a Coronary Heart Diseases

risk equivalent.
Hypertension, Hyperlipidemia, CAD, PVD,
stroke
Blood pressure goal is <130/80 mmHg;
<1225/75 mmHg with proteinuria
LDL goal is <100mg/dl
Reduce modifiable risk factors

Diabetic Management
Glycemic control reduces the onset of

microalbuminuria and slows the progression of

nephropathy.
Target HbA1c for DM patients should be
<7.0% irrespective of the presence or
absence of CKD.
ACEs and ARBs delay progression of kidney
dysfunction
Smoking cessation
Protein control

RENAL

PROTEIN Restricted Diet

(-0.2 to 1.2 g/kg/day)
Purposes:
Control of the accumulation of wastes in the
blood
Decreased the work load of the kidneys
Slowdown the deterioration of the renal
function and thereby delay the onset of the
dialysis treatment
Control of the metabolic complications of CKD

protein
Types:
High Biological Value (HBV) protein animal
protein contains ALL essential amino acids
e.g. meat, fish, poultry, tofu, eggs, dairy and
cheese
Low Biological Value (LBV) protein plant
protein contains some amino acid e.g. fruits,
vegetables, legumes, grains
TAKE NOTE: If you are on HD you should aim

for 1.2 grams of protein per kg of body.

SODIUM and FLUID

restriction
Recommended sodium restriction is generally

2 to 3 grams (87 to 135mEqs) per day

A
V
O
I
D

High CALORIC diet

Recommended dietary intake is 30 to 35

kcals/day/kg
Spares body protein
Maintains neutral nitrogen balance
Promotes higher albumin levels
Obese, elderly or sedentary patients may
need as few as 30kcal/day/kg

Potassium restricted diet

An intake of approximately 70mEq or

2730mg/day is safe for HD patients.

A
V
O
I
D

Phosphorus-Calcium Restricted Diet

Phosphorus intake should be limited to 800

upto 1200mg/Day in those CKD stage 5

A
V
O
I
D