Urinary and Renal Disorders (Part 4)

Urinary Diversions

Types:

1. Bladder catheterization

2. Cystostomy

3. Nephrostomy

4. Urostomy

5. Ureteral stent

6. Continent urinary diversion

Bladder catheterization

involves inserting a thin, flexible tube (catheter) into the bladder to drain urine, urine drains

into a collection bag outside the body

Urinary catheters

types:

1. Foley catheter

2. Suprapubic catheter

Foley catheter

inserted into the bladder through the urethra

Cystostomy

- a surgical procedure where a doctor inserts a small tube into your bladder through the skin of the lower abdomen

- the tube allows urine to drain from your bladder into a bag outside your body

Nephrostomy

- a surgeon or radiologist makes a tiny incision and inserts a small tube, called a nephrostomy tube, through the skin of your back into your kidney

- nephrostomy tube allows urine to drain from your kidney into a bag outside your body

urostomy

- a stoma, or opening, in your abdomen that connects to your urinary tract to allow urine to drain freely from your body

- types: ileal conduit and cutaneous uretorostomy

urostomy pouch

- small bag where urine is collected and stored

- attached to the skin around your stoma and worn outside your body

ileal conduit

- A surgeon removes a piece of your intestine to create a passageway for urine

- ureters are attached to the piece of intestine, then the intestine is attached to an opening in your abdomen, creating a stoma

- urine flows from the ureters, through the piece of intestine, and out the stoma

Cutaneous ureterostomy

A surgeon attaches one or both ureters

directly to a stoma in your abdomen.

Ureteral stent

- a thin flexible tube

that is inserted into the ureter to help urine flow from the kidney to the bladder

- guided with a

cystoscope into your ureter, one end = kidney, other end = bladder

Continent urinary diversion

- collects and stores urine inside the body until you drain the urine using a catheter or you urinate through the urethra

- urine flows through the ureters and is stored in an internal pouch created from part of your bowel or in your bladder

- allows you to control when urine leaves your body

Extracorporeal Shockwave Lithotripsy (ESWL)

a non-invasive medical treatment used to break down kidney stones into smaller pieces that can then be passed out of the body more easily

Extracorporeal Shockwave Lithotripsy (ESWL)

Benefits:

- non-invasive

- low risk of complications

- quick recovery

- high success rate

Extracorporeal Shockwave Lithotripsy (ESWL)

Contraindications:

- pregnant or breastfeeding women

- Patients with certain medical conditions, such as bleeding disorders or severely compromised kidney function

- Patients with large or complex kidney stones

Extracorporeal Shockwave Lithotripsy (ESWL)

Risk and side effects:

- pain

- hematuria

- nausea and vomiting

- fatigue

- infection

Kidney Transplant

- treatment of choice for select and appropriately screened patients with ESKD

- not considered a cure

- will not continue to function for the entire lifespan of most recipients

Kidney Transplant

involves transplanting a kidney from a living or deceased donor to a recipient who no longer has renal function

living donor

a person who is alive at the time of donation and may or may not be related to the recipient

deceased transplant/cadaveric transplant

comes from someone who has died and donated their organs

paired donor exchange

- A contemporary development in kidney transplantation

- recipients essentially swap willing donor

paired donor exchange

- Although medically eligible to donate a kidney, a willing

donor may be incompatible with the intended recipient due to blood

type or antigens.

- The donor then agrees to donate the kidney to a compatible and unknown recipient, with the intention that the donor's originally intended organ recipient will be part of the donation chain and be the recipient of a donated kidney through organized donor and recipient matches.

iliac fossa

site where transplanted kidney is placed

Kidney Transplant

1. The transplanted kidney is placed in the iliac fossa.

2. The renal artery of the donated kidney is sutured to the iliac artery, and the renal vein is sutured to the iliac vein.

3. The ureter of the donated kidney is sutured to the bladder or to the patient's ureter

Kidney Transplant

Medical Management:

- Immunosuppressive therapy = to reduce risk of rejection

- combinations of corticosteroids = minimize reaction

Astragalus

- has anti-inflammatory and immune-boosting properties

- help reduce proteinuria in kidney disease patients

- commonly used in traditional Chinese medicine

Dandelion root

acts as a diuretic and may help improve fluid balance and support kidney function

Ginger

- often used to reduce inflammation and nausea

- can help alleviate some symptoms associated with kidney disease

Acupuncture

- used in traditional Chinese medicine to balance energy flow and improve kidney function

- can help relieve symptoms like fatigue, pain, and nausea in CKD patients and improve blood flow to the kidneys

Yoga

help improve physical strength, flexibility, and stress management

Meditation

- mindfulness practices

- helpful in reducing anxiety

Stress reduction

can indirectly kidney function by improving overall well-being

Massage

- can alleviate stress, reduce pain, and promote relaxation

- particularly useful for patients experiencing muscle cramps or discomfort due to dialysis or fluid retention

Hydrotherapy

- using water-based treatments, such as baths or compresses, to improve circulation and reduce symptoms like swelling and pain

- believed to support the detoxification processes in the body, including kidney function

Nutrition and Diet Therapy

- plays a pivotal role in managing renal disturbances, especially in CKD and kidney related problems

- can help slow the progression of kidney disease, manage symptoms, and prevent complications

Nutrition and Diet Therapy

Goals:

- Reduce kidney workload

- Manage symptoms

- Prevent complications

- Maintain overall health

Renal Diet

Key Nutritional Components:

- Protein Management

- Sodium Restriction

- Potassium Management

- Phosphorus Control

Renal Diet

Key Nutritional Components:

- Fluid Intake

- Calcium and Vitamin D

- Carbohydrates and Fats