Kidney & Urinary Tract Function

What is the functional unit of the kidney?

The nephron.

What forces are responsible for filtration in the kidneys?

Hydrostatic pressure (pushes fluid out) and osmotic pressure (pulls fluid in).

What waste product do the kidneys excrete from protein metabolism?

Urea.

What are the main functions of the renal system?

Fluid volume regulation, acid-base balance, blood pressure regulation (RAAS), and red blood cell production.

What happens to kidney function in older adults?

Decreased GFR, slower drug clearance, altered acid-base balance, decreased thirst.

Why are older adults at higher risk for UTIs?

Incomplete bladder emptying → urinary stasis.

What should be included in a renal health history?

Voiding patterns, pain, fluid intake, hygiene, history of diabetes or hypertension.

Which kidney sits lower in the body?

The right kidney.

How can a distended bladder be assessed?

Light palpation above the pubic symphysis and bladder scan.

What does a urinalysis evaluate?

Specific gravity, color, protein, blood, sugar, WBCs.

What is the normal specific gravity range?

1.005–1.025.

What do protein, blood, or WBCs in urine indicate?

Infection or kidney damage.

What do BUN and creatinine measure?

Kidney function.

What does a 24-hour urine collection measure?

Creatinine clearance and kidney disease progression.

What do ultrasounds and X-rays assess?

Kidney size, structure, and stones.

What is IVP?

Imaging using contrast dye to view urinary tract structure and flow.

What must be assessed before contrast dye procedures?

Allergy to iodine or contrast.

What is a cystoscopy?

Camera inserted through urethra to view bladder and obtain biopsies.

What do urodynamic tests evaluate?

Bladder and sphincter function.

What should patients be taught before urodynamic testing?

Catheters and electrodes will be used.

What symptoms may occur after urodynamic testing?

Frequency, urgency, dysuria.

What should patients avoid after urodynamic testing?

Caffeine and alcohol.

What is a UTI?

Infection of the lower urinary tract (cystitis).

What are common UTI symptoms?

Frequency, urgency, suprapubic pain, dysuria.

What is often the first sign of UTI in older adults?

Confusion.

Why are females at higher risk for UTIs?

Shorter urethra.

What increases UTI risk?

Diabetes, gout, obstruction, urinary stasis, pregnancy.

What is pyelonephritis?

Infection of the kidney (upper UTI).

What causes pyelonephritis?

Untreated lower UTI spreading upward.

Symptoms of acute pyelonephritis?

Fever, chills, nausea, vomiting, flank pain.

What can untreated pyelonephritis lead to?

Sepsis.

What is chronic pyelonephritis?

Recurrent infections causing kidney scarring.

How are UTIs treated?

Antibiotics, analgesics, antispasmodics, IV fluids.

Key UTI prevention teaching?

Hydration, wipe front-to-back, void after intercourse, avoid tight clothes, avoid irritants.

What is glomerulonephritis?

Inflammation of the glomeruli.

When does glomerulonephritis often occur?

2–3 weeks after infection (strep/viral).

Symptoms of glomerulonephritis?

Headache, hypertension, edema, oliguria.

What is nephritic syndrome?

Glomerular inflammation with hematuria.

What color is urine in nephritic syndrome?

Cola or tea-colored.

Common cause of nephritic syndrome?

IgA nephropathy (Berger’s disease).

What is nephrotic syndrome?

Severe protein loss in urine.

Key features of nephrotic syndrome?

Proteinuria, hypoalbuminemia, hyperlipidemia, edema.

What does nephrotic urine look like?

Frothy/foamy.

Why are nephrotic patients at clot risk?

Thickened blood from fluid shifts.

Complications of nephrotic syndrome?

PE and DVT.

Treatment for nephrotic syndrome?

Steroids, diuretics, albumin, ACE inhibitors.

What are urinary calculi?

Kidney stones.

What are most kidney stones made of?

Calcium.

Symptoms of kidney stones?

Severe colicky pain, hematuria, oliguria.

Where does kidney stone pain radiate?

Genital area.

Treatment for kidney stones?

Analgesics, anti-inflammatories, IV fluids.

Nursing role for kidney stones?

Strain urine to collect stones.

Dietary teaching for kidney stones?

Reduce sodium and protein.

Is urinary incontinence a normal part of aging?

No.

What is stress incontinence?

Leakage with coughing/laughing/lifting.

Treatment for stress incontinence?

Kegel exercises.

What is urge incontinence?

Sudden urge, can’t reach bathroom in time.

What is functional incontinence?

Due to physical or cognitive impairment.

Nursing interventions for incontinence?

Bladder retraining and timed voiding.

What is urinary retention?

Inability to empty bladder.

Causes of urinary retention?

Surgery, anesthesia, diabetes, enlarged prostate, trauma, medications.

What is BPH?

Enlarged prostate compressing urethra.

Symptoms of BPH?

Nocturia and dribbling.

Treatment for BPH?

Alpha-blockers or TURP.

What is TURP?

Surgical removal of prostate tissue.

What catheter is used post-TURP?

Three-way Foley catheter.

Why is continuous bladder irrigation needed after TURP?

Prevent clots.

Nursing priority after TURP?

Monitor intake/output and adjust irrigation.

What indicates a clot after TURP?

Slowed drainage.

What is prostatitis?

Inflammation of the prostate.

Common cause of prostatitis?

E. coli.

Symptoms of prostatitis?

Flu-like symptoms, pelvic pain, cloudy urine.

Treatment for prostatitis?

Antibiotics.

What is a continent urinary diversion?

Internal pouch with no external bag.

Example of continent diversion?

Indiana pouch.

How is urine removed in continent diversion?

Self-catheterization.

What is a cutaneous diversion?

External stoma with drainage bag.

Example of cutaneous diversion?

Ileal conduit.

Nursing care for cutaneous diversion?

Ostomy care and skin monitoring.

What should a healthy stoma look like?

Red (not pale).