Renal and Urologic Problems Flashcards
Urinary Tract Infection: Bacterial Count
- Bacterial count of >10^5 CFU/mL
- 10^2 to 10^3 CFU/mL can also be indicative of UTI if present with signs and symptoms
- CFU - colony forming units
Most common pathogen of UTI
Escherichia cole (E. coli)
- also by fungal and parasites - uncommon
Upper UTI
renal parenchyma, renal pelvis, ureters
Lower UTI
bladder, urethra
Clinical Manifestations UTI (6)
- dysuria
- Fever (upper UTI)
- cloudy urine, hematuria
- hesitancy/urgency/frequency
- burning on urination
- upper UTI: flank pain, fever, chills
Diagnosis of UTI
- WBC and nitrites and leukocytesterase (enzyme produced by WBC) in the urinalysis
- Do a CNS after a urinalysis
Management of UTI
Health promotion (preventative)
Full course of antibiotics
Short term: 1-3 days
Longer term: 7-14 days (for UTI caused by obstructions or catheter. more complex)
Acute Pyelonephritis Pathophysiology
- inflammation of renal parenchyma & collecting system
- bacterial infection (most common cause)
- begins with infection of lower urinary tract
- often presence of pre-existing: vesico-ureteral reflux, dysfunction of lower urinary tract infection e.g BPH
Acute Pyelonephritis: clinical manifestations (5)
- flank pain, chills, costovertebral tenderness (where ribs and back meet)
- vomiting, nausea
Acute Pyelonephritis Treatment
mild vs severe
- mild - abx 14-21 days
- severe - hospitalized IV abx so it gets there quicker. Something for pain and fever. Analgesics and a 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, chornic atrophic pyelonephritis, or reflux nephropathy
- loss of functioning nephrons
- level of renal function varies depending on if 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
- difficult to diagnose as urethral discharge may not be present in women
- treatment based on identifying & treating the cause and obtaining symptomatic relief
Purulent discharge in urethritis means:
gonococcal urethritis
Clear discharge in urethritis
non-gonococcal urethritis
Interstitial cystitis
a chronic, painful inflammatory disease of the bladder
Believed to be associated with autoimmune or allergic response
2 primary clinical manifestations of Interstitial Cystitis
pain
lower urinary tract symptoms
Diagnosis of Interstitial Cystitis
- 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
Interstitial Cystitis: dietary and lifestyle alterations
- to relieve pain and decrease voiding frequency and noctura
- eat low acidic foods, avoid coffee, tea, carbonated & alcoholic drinks
- OTC supplement, calcium glycerophosphate, can provide relief from irritating effects of certain foods
Interstitial Cystitis Nursing Management
- 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
Glomerulonephritis
What is it?
Characterized by: (4)
An immune-related inflammation of the glomeruli characterized by proteinuria, hematuria, decreased urine production, and edema
Condition affects both kidneys equally
Tubular, interstitial, and vascular changes also occur
Glomerulonephritis is divided into a number of classifications which may describe:
- extent of damage (diffuse or focal)
- initial cause of disorder (systemic lupus, systemic sclerosis, streptococcal infection)
- extent of changes (minimal or widespread)
Clinical manifestations of Glomerulonephritis (5)
- varying degrees of hematuria (microscopic to gross)
- urinary excretion of RBCs, WBCs, and casts
- Proteinuria, increased BUN, increased creatinine
- Usually, recovery from the acute illness is complete
- If progressive -> destruction of renal tissue and marked renal insufficiency
Acute Poststreptococcal Glomerulonephritis
- most common in children & young adults but all age groups can be affected
- occurs 5-21 days after an infection of pharynx or the skin (strep sore throat, impetigo) by nephrotoxic strains of group B-hemolytic streptococci
Causes inflammation in glomeruli
95% recovery completely
Clinical Manifestations of Acute Poststreptococcal Glomerulonephritis (5)
- Generalized body edema (result of decreased glomerular filtration)
- hypertension (from increased extracellular vol)
- Oliguria
- Smoky urine - indicative of bleeding in upper urinary tract
- Proteinuria
Management of Acute Poststreptococcal Glomerulonephritis
- 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 increased BUN
- Traetment with Abx only if strep infection is still present
Goodpasture’s Syndrome
Uncommon autoimmune disease that affects both the kidney’s and the lungs
Characterized by pulmonary alveolar hemorrhage and glomerulonephritis
Characterized by presence of antibodies circulating against glomerular and alveolar basement membrane (antiGBM(glomerular basement membrane) antibody disease)
Clinical Manifestations of Goodpasture’s Syndrome
Hemoptysis, cough, dyspnea, pallor, crackles and wheezes, hepatomegaly, edema
Pulmonary hemorrhage
Chronic glomerulonephritis
Reflects the end stage of glomerular inflammatory disease
Characterized by proteinuria, hematuria and slow development of uremic syndrome
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
Is a clinical course that can be associated with a number of diseases
Nephrotic-range proteinuria
loss of >3 gms protein/day in urine
Approx 1/3 pts with nephrotic syndrome will have systemic diseases such as… (2)
- diabetes or systemic lupus
Clinical Manifestations of Nephrotic Syndrome (6)
- peripheral edema
- massive proteinuria (increased glomerular membrane permeability)
- Dyslipidemia (decreased serum protein stimulating hepatic lipoprotein synthesis)
- increased cholesterol and low-density lipoproteins
- Altered immune response - as a result infection is a cause of morbidity and mortality
- With nephrotic proteinuria - loss of anticoagulants can result in hypercoagulation state.
Most serious complication of nephrotic syndrome
- hypercoagulability with thrombo-embolism
- because of loss of anticoagulation proteins in proteinuria and increased liver synthesis of clotting factors
Nephrotic Syndrome: Management (7)
- 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
Kidney Cancer: most common type
adenocarcinoma (renal cell carcinoma)
The most significant risk factor for kidney cancer
cigarette smoking
Manifestations of Kidney Cancer (6)
- earliest (3)
- classic (3)
Earliest manifestations:
- weight loss
- weakness
- anemia
Classic manifestations
- gross hematuria
- flank pain
- palpable mass
Treatment of Choice for Kidney Cancer
- radical nephrectomy (RN)
- Radical RN is the surgical removal of the kidney. Adrenal gland, surrounding fascia, part of ureter, and lymph nodes
2 types of Nephrectomy
Radical nephrectomy
Partial nephrectomy
- kidney-sparing surgery
- only removed diseased tissue from a kidney
Types of procedure: Nephrectomy
- laparoscopic surgery
- robot-assisted laparoscopic surgery
- open surgery
Radical Nephrectomy: Indication
- Presence of multifocal renal masses in one kidney, and normal contralateral kidney
Laparoscopic Nephrectomy
- Candidates:
People with a small & non-malignant kidney
Not for people who are overweight
Performed under GA
Kidney is dissected laparoscopically in the peritoneal cavity and placed in an impermeable bag
The kidney is morcellated within the bag, which is removed via a mini incision
Post-Op Care Nephrectomy
- ABC
- VS
- Kidneys are highly vascular - high risk for hemorrhage, observe wound dressing, drainage tube
- pain control, epidural, opioid infusion, PCA
- Accurate I&O
- Risk of resp problems, mobilize DB&C
Complications of Nephrectomy (6)
- hemorrhage
- pneumothorax
- chest infection
- wound infection
- UTI - foley
- DVT
