Renal and Urologic Problems Flashcards
Urinary tract infection
Bacterial count of > 105 CFU/mL
- 102 to 103 CFU/mL can also be indicative of UTI if present with signs and symptoms
The most common pathogen – Escherichia coli (E. coli )
- also, by fungal and parasites – uncommon
Classification of uti
Upper: renal parenchyma, renal pelvis,
ureters (more risks)
Lower: bladder, urethra
Specific terms are used to delineate location of UTI or inflammation:
Pyelonephritis
Cystitis
Urethritis
Manifestations of UTI
Pain, burning, urgency, pressure in bladder area (pubic area)
Cloudy, blood in urine
In kidneys: flank pain, chills, fever,
Older adults: delirium
Dx of UTI
Nitrates, protein, leukocytes esterase – enzyme produced by WBC
Management of UTI
Health promotion (preventative)
- What instructions will you give to prevent a UTI?
Do not hold pee
Wipe front to back
Adequate amount of fluids (cranberry juice)
Avoid caffeine, alcohol, high spice foods
ion (preventative)
- full course of abx
- short term 1-3 days
- longer term 7-14 days
Patho of acute pyelonephritis
Inflammation of renal parenchyma & collecting system
Bacterial infection (most common cause)
Begins with infection of lower urinary tract
Often presence of pre-existing factor:
- vesico-ureteral reflux, or
- dysfunction of lower urinary tract infection e.g., BPH
Manifestations of acute pyelonephritis
- hematuria
- flank pain
- chills
- sick and nauseous
- tenderness of affected side (costovertebral)
Tx of Acute Pyelonephritis
- abx for 14-24 days (IV)
- NSAIDS, antipyretics
- hospitalization
- urinary analgesics
- follow up culture
Chronic Pyelonephritis
Shrunken kidney whose function is lost d/t scarring or fibrosis
Outcome of recurring infection in upper urinary tract
aka – interstitial nephritis, chronic atrophic pyelonephritis, or reflux nephropathy
Loss of functioning nephrons
Level of renal function varies depending or 1 or both kidneys are involved
Often progresses to end-stage renal disease
Urethritis
Inflammation of urethra from bacterial or viral infection
♂ = usually from sexual transmission
- Purulent discharge ⇨ gonococcal urethritis
- Clear discharge ⇨ non-gonococcal urethritis
♀ = difficult to diagnose as urethral discharge may not be present
Treatment based on identifying & treating the cause and obtaining symptomatic relief
Interstitial cystitis
A chronic, painful inflammatory disease of the bladder
Believed to be associated with autoimmune or allergic response
Ratio of women ♀ to men ♂ = 10 -12:1
2 primary clinical manifestations 1. pain 2. lower urinary tract symptoms
Diagnosis is by exclusion:
Cystitis suspected when pt experiences symptoms of a UTI despite absence of bacteriuria, pyuria, or a positive urine culture
Careful history and physical examination required
Because etiology is unknown, no single treatment
Care for Interstitial cystitis
Dietary and lifestyle alterations
- To relieve pain and ↓ voiding frequency and nocturia
- Eat low acidic foods, avoid coffee, tea, carbonated & alcoholic drinks
- OTC supplement, calcium glycerophosphate, can provide relief from
irritating effects of certain foods
Assessment focuses on characterization of the pain associated with IC
Data collection – voiding diary kept over a period of at least 3 days to
determine voiding frequency & patterns of nocturia
Glomerulo-nephritis
An immune-related inflammation of the glomeruli characterized by proteinuria, hematuria, ↓ urine production, and edema
Condition affects both kidneys equally
Tubular, interstitial, and vascular changes also occur
Glomerulo-nephritis is divided into a number of classifications which may describe:
- Extent of damage (diffuse or focal)
- Initial cause of disorder, e.g., systemic lupus erythematosus, systemic sclerosis, streptococcal infection, or
- Extent of changes (minimal or widespread)
Manifestations of Glomerulo-nephritis
Varying degrees of hematuria (microscopic to gross)
Urinary excretion of RBCs, WBCs, and casts
Proteinuria, ↑BUN, ↑creatinine
Usually, recovery from the acute illness is complete
If progressive ⇨ destruction of renal tissue and marked renal insufficiency
Acute Poststreptococcal Glomerulo-nephritis
Most common in children & young adults but all age groups can be affected
Occurs after 5-21 days of an infection of pharynx or the skin (strep sore throat, impetigo) by nephrotoxic strains of group β-hemolytic streptococci
Causes inflammation in glomeruli
Manifestations of Acute Poststreptococcal Glomerulo-nephritis
Generalized body edema (result of ↓ glomerular filtration)
Hypertension (from ↑extracellular vol.)
Oliguria
Smoky urine – indicative of bleeding in upper urinary tract
Proteinuria
Care of Acute Poststreptococcal Glomerulo-nephritis
Focus is on symptomatic relief
Rest until signs of glomerular inflammation (proteinuria, hematuria) and hypertension subside
Restrict Na+ and fluid intake & admin diuretics
May need to restrict dietary protein if evidence of ↑BUN
Treatment with Abx only if strep infection is still present
Goodpasture’s syndrome
Uncommon autoimmune disease that affects both the kidneys & lungs
Characterized by pulmonary alveolar hemorrhage and glomerulonephritis
Characterized by presence of antibodies circulating against glomerular and alveolar basement membrane – currently the term used is “anti-GBM antibody disease”
Hemoptysis, cough, dyspnea, pallor, crackles and wheezes, hepatomegaly, edema
Pulmonary hemorrhage
Chronic glomeruo-nephritis
Reflects the end stage of glomerular inflammatory disease
Characterized by proteinuria, hematuria, slow development of uremic syndrome (build up of waste products in the blood due ti inability for kidneys to excrete waste products)
does not usually follow an acute course; progresses insidiously toward renal failure over a few to 30 years
Nephrotic syndrome
The combination of nephrotic-range proteinuria with a low serum albumin level and edema
- nephrotic-range proteinuria = loss of > 3 gms protein/day in urine
Is a clinical course that can be associated with a number of diseases
Approx. 1/3 pts with nephrotic syndrome will have systematic diseases such as diabetes or systemic lupus erythematosus.
Clinical manifestations nephrotic syndrome
Peripheral edema
Massive proteinuria (↑ glomerular membrane permeability)
Dyslipidemia (↓ serum proteins stim hepatic lipoprotein synthesis)
- ↑ Cholesterol and low-density lipoproteins
Altered immune responses
- As a result, infection is a cause of morbidity & mortality
With nephrotic proteinuria → loss of clotting factors can result in hypercoagulation state
Hypercoagulability with thrombo-embolism = most serious complication of nephrotic syndrome
Management of nephrotic syndrome
Focus is symptomatic relief
Relieve edema
cure or control primary disease
Low Na+, low to moderate protein
Restriction of salt
Lipid lowering agents
Steroids in severe cases of nephrotic syndrome
