obstructive uropathies Flashcards
Urinary obstruction
anatomic or functional condition that blocks or impedes flow of urine
congenital or acquired
damage occurs above level of obstruction
-severity depends on location, duration, amt of pressure or dilation, and presence of urinary stasis or infection
-may affect only one kidney and the other kidney may compensate
Obstructive uropathies of the bladder neck, prostate, and bladder outlet
Bladder neck or prostate:
-detrusor muscle hypertrophy
-eventual large, residual urine
Bladder outlet
-increased pressure with filling or storage
-vesicoureteral reflux, hydroureter, and hydronephrosis
-chronic pyelonephritis and renal atrophy
Partial obstruction of ureter or ureteropelvic junction
low to moderate pressure - kidney dilates without noticeable loss of func
-urinary stasis and reflux - increases risk of pyelonephritis
Obtructive uropathies
Result of both or 1 kidney involved
treatment
-Changes in renal func occur and BUN and creatinine increase –> progressive obstruction can lead to renal failure
Treatment - find and relieve blockage
-insertion of tube, surgery, or urinary diversion
Urinary Tract Calculi
Nephrolithasis = kidney stone diseases
-in US 13% men and 7% women
-mid age –> risk goes up with age
-more frequent in:
* whites than blacks, hispanics, asians
* those with fam history
* SE US, then SW, then midwet
* Summer (hot/dehydrated)
* uric acid stones in Jewish men
Risk factors for kidney stones
how to reduce risk?
metabolic
climate
dietary
genetic
lifestyle (HIGH PROT DIET)
Concentration of supersaturated crystals precipitate and form stone –> reduce resk by keeping urine dilute and free flowing
Kidney stone formation influencing factors
Urinary pH
-high pH = calcium and phosphate less soluble
-low pH = uric acid and cysteine less soluble
Solute load
inhibitors of urine
obstruction with urinary stasis
infection with urea-splitting bacteria (struvite)
infected stones - staghorn configuration
-renal infection, hydronephrosis, loss of kidney func
Types of urinary stones NOPE
Calcium oxalate
calcium phosphate
cystine
struvite
uric acid
calcium is most common –> can be mixed and in various locations
Clinical manifestations of kidney stones
common sites of kidney stones
First symptom = sudden ,severe pain (renal colic)
-flank area, back, or lower abdomen
-ureter stretches, dilates, and spasms
-may see: nausea and vomiting; “kidney stone dance”; dysuria, fever, chills; moist, cool skin
Common sites of obstruction
-ureteropelvic junction (UPJ) –> dull costovertebral flank pain or renal colic
-ureterovesical junction –> lower abdominal pain; testicular or labial pain
Diagnostic studies for kidney stones
noncontrast helical (spiral) CT scan
Ultrasound
urinalysis
24 hr urine
retrieval and analysis of stones - imp to determine problem contributing to stone formation
Interprofessional care for kidney stones: 2 concurrent approaches
- manage acute attack (pain, infection, obstruction)
-opiods, NSAIDS, alpha-adrenergic blockers - Evaluate cause of stone formation and prevent further development
-fam history; geographic residence; nutritional assessment; fluid intake; vits A, C, and D; activity pattern
-History of: prolonged illness, GI or GU disease or surgery, previous stones, prescribed and OTC meds, and dietary supplements
Treatment of kidney stones (generic) and patient teaching
adequate hydration
sodium restriction
dietary changes
Drugs
-alter pH of urine, prevent excess urinary secretion of
a substance or correct primary disease
Struvite stones: antibiotics and acetohydroxamic acid; surgery
Little kidney stones vs big ones
Stons of 4 mm or less may pass spontaneously (can take weeks)
Endourologic, lithotripsy, or open surgical stone removal might happen if stones:
-are too big (7+ mm) to pass
-are associated with bacteruria or symptomatic infection
-impair renal function
-cause persistent pain, nausea, or paralytic ileus
Or if patient can’t be treated medically or has just one kidney
Endourologic procedures
cystoscopy - remove stone in bladder
cystolitholapaxy - break up stones with lithotrite
cystoscopic lithotripsy - ultrasonic waves break stones
Complications: hemorrhage, retained stone fragments, infection
Ultrasonic, laser, or elecrohydraulic lithotripsy = used during
-flexible ureteroscopes - remove stones frmo renal pelvis and UUT
-Percutaneous nephrolithotomy - nephroscope insrted through skin into pelvis of kidney - stone freagmented and removed - irrigation
Complications: bleeding, injury to adjacent structures, infection
Lithotripsy NOPE
Procedure to eliminate stones from urinary tract:
laser lithotripsy
extracorporeal shock wave lithotripsy (ESWL)
Percutaneous ultrasonic ithotripsy
Electrohydraulic lithotripsy
-ureteral stent placed to facilitate passage of sand; removed in 2 weeks
-postprocedure: hematuria; prphylactic antibiotics –> encourage fluids to dilute urine and reduce pain
-complications (rare) = hemorrhage, infection, obstruction
