Renal and Urology Problems

urinary tract infections (uti) an clinical manifestations 

-most common pathogen e.coli

-cystitis=bladder

-urethritis=urthra

-urosepsis=systemic

^life threatening

^emergency treatment

-if there is a complicated UTI the pt. is at risk for pyelonephritis, urosepsis, renal damage

CLINICAL MANIFESTATIONS

-lower urinary tract symptoms (LUTS)

^emptying symptoms and storage symptoms

^hematuria and/ or cloudy appearance

-upper urinary tract symptoms

^flank pain, chills, fever

^fatigue, anorexia, asymptomatic

^older adults classic manifestations are absent (abdominal discomfort, cognitive impairment, or generalized deterioration often afebrile)

urinary tract infection (uti) diagnostic studies + interprofessional care

Diagnostic Studies

initial: dipstick for nitrates, WBC, and leukocyte esterase 

-urine culture/ sensitivity 

-history 

-imaging: ultrasound or CT scan

Interprofessional Care

-management uncomplicated: phenazopyridine and antibiotics (empiric) for 3 days 

-recurrent uti

^antibiotics 7 to 14 days loner 

-drug therapy uncomplicated or initial utis

^trimethoprim/ sulfamethoxazole (TMP-SMX)

^nitrofurantoin cephalexin

^fosfomycin

^ampicillin, amoxicillin or cephalosporins

-complicated: fluconazole

-urinary analgesic: phenazopyridine (azo dye)

pyelonephritis + clinical manifestations + diagnostic studies 

-initial colonization and infection of lower urinary tract from urethra

Clinical Manifestations

-classic:fever, cills, nausea, vomiting, malaise, flank pain 

-dysuria, urgency, frequency 

-costovertebral angle (CVA) tenderness 

Diagnostic Studies 

-urinalysis: pyuria, bacteriuria, hematuria; WBC cast

-urine cultures and sensitivities 

-blood cultures

-decreased kidney and function tests

-ultrasound

-ct scan- preferred imaging study

pyelonephritis interprofessional care

Interprofessional Care

-mild symptoms (outpatient or short in patient)

^fluids, NSAIS, follow up cultures and imaging 

^antibiotics oral= 5 to 14 days; IV= 14 to 21 days 

-severe symptoms (as above except)

^IV fluids until oral tolerated 

^combination parenteral antibiotics 

*relapses=6 weeks antibiotics 

*recurrent= prophylactic antibiotics 

*urosepsis= monitor for and treat septic shock to prevent irreversible damage or death 

chronic pyelonephrtis

-kidneys inflamed cause scarring leading to loss of renal function

diagnosis: radiologic imaging and biopsy

treatment: treat infection and underlying contributing factors 

urethritis 

-inflammation of the urethra to bacterial or viral infection 

^trichomonas or monilia, chlamydia, or gonorrhea 

Clinical Manifestations

-males= sexually transmitted, see discharge, dysuria. urgency, and frequency 

-females= diagnosis difficult, see LUTS

Treatment

-antimicrobials, sitz baths

Patient Education

-avoid vaginal sprays, perineal hygiene, no sex for 7 days, and contact partners

interstitial cystitis (IC)/ painful bladder syndrom (PBS) clinical manifestations 

IC= chronic, painful, inflammatory disease of the bladder, IC causes PBS

Clinical Manifestations

*pain and bothersome LUTS*

-severe: void more than 60 times/ day-night

-pain:usually suprapubic but may involve perineum

-increase pain with bladder filling, postponed urination, physical exertion, suprapubic pressure, certain foods, emotional distress

-decreased pain when voiding (temporary)

interstitial cystitis (IC)/ painful bladder syndrome (PBS): treatment

-reduce intake of bladder irritants

-calcium glycerophosphate—- reduces irritation 

 Stress management strategies

 Tricyclic antidepressants, analgesics, antihistamines

 Physical therapy and bladder hypo-distention

 Botox; cyclosporine A

 Surgery—with debilitating pain (sacral neuromodulation or

fulguration: using high-frequency energy to destroy a lesion

interstitial cystitis (IC)/ painful bladder syndrome (PBS): nursing management

 Pain assessment

 Diet/lifestyle factors that increase or decrease pain

 Bladder/voiding log for 3 days; pain record

 Monitor for UTI with diagnostic studies

 Monitor nutrition

 Avoid restrictive clothing

 Coping strategies/reassurance

glomerulonephritis

-inflammation of the glomeruli

acute: sudden symptoms, temporary or reversible

chronic: slow, progressive, irreversible renal failure 

APSGN + clinical manifestations 

-common type of acute glomerulonephritis

-develops 1 to 6 weeks after an infection of tonsils, pharynx, or skin by nephrotoxic strains of group B-hemolytic streptococci

Clinical Manifestations 

-generalized edema, hypertension, oliguria, hematuria, degrees of proteinuria, fluid retention 

-periorbital edema first then progresses into ascites and peripheral edema 

-smoky urine: bleeding in upper urinary tract 

-abdominal flank pain 

-may be asymptomatic: found on routine urinalysis 

APSGN diagnostics

-h& p

-antistreptolysin- O (ASO) titers

-decreased complement components

-renal biopsy

-dipstick urinalysis ad urine sediment microscopy

-BUN and serum creatinine- renal impairment

-with a positive streotococci culture= antibiotics

chronic glomerulonephritis

-syndrome of permanent and progressive renal fibrosis can progress to ESRD

-symptoms develop slowly; unaware

-decreased renal function causes ESRD (over several years)

Clinical Manifestations

- Hematuria, proteinuria, urinary excretion of formed elements (RBCs, WBCs, casts)

 Increased BUN and creatinine

Diagnosis

 H&P, exposure to drugs (NSAIDs), microbial infections, and viral infections

 Evaluate for immune disorders

 Ultrasound and CT scan; renal biopsy

 Treatment: depends on cause

 Symptomatic and supportive car

ASPGN interprofessional management

 Rest—decreased inflammation and HTN

 Restrict Na+ & fluids/ administer diuretics—decreased edema

 Restrict protein—decreased BUN

 Antibiotics—if streptococcal infection present

rapidly progressive glomerulonephritis (RPGN) + clinical manifestations

-loss of renal function in days to months

Clinical Manifestations 

-hTN, edema, proteinuria, hematuria, RBC cast 

Treatments 

-correct fluid overload, HTN, uremia, and injury to kidney 

-corticosteroids, cyclophosphamide, plasmapheresis

-last resort/ worse case dialysis and transplant 

nephrotic syndrome

Clinical Manifestations

-peripheral edema, massive proteinuria, HTN, hyperlipidemia, hypoalbuminemia, foamy urine 

^ Decreased albumin; ascites and anasarca when severe

hypoalbuminemia is present

 Immune response altered results in infection

 Hypocalcemia and skeletal abnormalities

 Hypercoagulability

Treatment (depends on cause)

-corticosteroids and cyclophosphamide

-manage diabeyes 

-ACE inhibitors, ARB, diuretics

-antihyperlipidemic drugs

-anticoagulants

-low sodium, modrate protein diet, small frequent meals