Renal and urinary system EX 3

most common cause of Acute glomerulonephritis

• most common in strep infection/ streptococcal infection

• Risk factors include infections (e.g., streptococcal, Staphylococcus, Pneumococcus, varicella, malaria, and HIV (from textbook)

signs and symptoms of acute glomerulonephritis

• (Pink or cola-colored urine from red blood cells in your urine (hematuria).

• Foamy or bubbly urine due to excess protein in the urine (proteinuria).

• High blood pressure (hypertension).

• Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen.

• Urinating less than usual.

• Nausea and vomiting.

• Muscle cramps.

• Fatigue.

acute kidney injury conditions 

Prerenal conditions: extremely low BP or blood volume, cardiac dysfunction

Intrarenal conditons: reduced blood supply in kidneys, hemolytic uremic syndrome, renal inflammation, toxic injury

Postreneal conditions: ureter obstruction, bladder obstruction/dysfunction 

acute kidney injury condition Prereneal

hemorrhage, sepsis, dehydration, shock, and traumatic injury (Prerenal)

e.g., myocardial infarction and heart failure (Prereneal) 

acute kidney injury condition Intrarenal

• Toxic injury (usually from alcohol, cocaine, heavy metals, solvents, fuels, chemotherapy drugs, and contrast dyes

• atherosclerosis (blood supply issue)

• associated with infection with certain strains of E. coli (Hemolytic uremic syndrome)

• glomerulonephritis and acute interstitial nephritis (Renal inflammation)

acute kidney injury condition Postrenal

• nephrolithiasis and tumors (Uretral obstruction) 

• BPH, tumors, and nerve innervation disruption (bladder obstruction)

what is acute kidney disease 

sudden loss of renal function (often critically ill hospitalized patients), generally reversible. 

• Risk factors: advanced age, autoimmune disorders, liver disease

what is chronic kidney disease 

gradual loss of renal function that is irreversible. 

Causes: diabetes mellitus, hypertension, urine obstructions, renal diseases, renal artery stenosis, ongoing exposure to toxins and nephrotoxic medications, sickle cell disease, systemic lupus erythematosus, smoking, advancing age

Complications of Chronic Kidney Disease

Acid base disorders, Metabolic, neurologic, Mineral metabolism, endocrine, Gastrointestinal, hematologic, cardiacpulmonary, sensory.

Diagnosis of chronic kidney disease

• urinalysis,

• quantitative urine protein,

• blood chemistry (especially electrolytes, creatinine, and BUN),

• CT,

• MRI,

• renal ultrasound,

• biopsy,

• CBC,

• arterial blood gases.

hydronephrosis

An abnormal dilation of the renal pelvis and the calyces of one or both kidneys that occurs secondary to a disease. obstruct urine flow.

hydroureter

a condition where the ureter, the tube that carries urine from the kidney to the bladder, becomes enlarged and filled with urine

What to do when a renal calculi passes? 

stone size 7-8mm go through surgey and smaller pee through a strainer to catch stones to do biopsy, and increased fluid. 

Follow up with urinalysis, culture, 24hr urine collection, bladder x ray, serum studies. 

treatment for renal stones

Treatment: strain all urine, increase fluid intake to 2.5–3.5 L, extracorporeal
shock wave lithotripsy, percutaneous nephrolithotomy, ureteroscopy, surgery,
pain management, dietary changes, and physical activity

UTI/ Urinary Tract Infections

caused by Escherichia coli/ E. Coli

common in women due to shorter urethra

Diagnostic procedures: urinalysis, urine culture and sensitivity, renal panel, cystoscopy, cystourethrogram, complete blood count, ultrasound, X-ray, CT, and MRI of the kidneys, ureters, and bladder.

Treatment and prevention for UTIs

Antibiotics (make sure they complete the full course of antibiotics!)

Prevention: Wear cotton undies, Increase hydration, avoid irritants, not delaying urination, Performing proper perineal hygiene, Adequately emptying the bladder, Providing appropriate catheter care. 

Benign Prostatic Hyperplasia Manifestations/ symptoms

frequency, urgency, retention, difficulty initiating urination, weak urinary
stream, dribbling urine, nocturia, bladder distension, overflow incontinence, and
erectile dysfunction

Need to know that it goes around the urethra, PSA is a lab value (blood work) we look at  (KNOW THIS)

How to assess BPH/ Benign prostatic hyperplasia

• history, physical examination

• urine flow measures, urinalysis, urine culture,

• prostate-specific antigen (PSA),

• transrectal ultrasound, biopsy,

• urodynamic tests,

• cystoscopy,

• BUN, and creatinine 

Complications from BPH/ Benign Prostatic Hyperplasia

Complications from BPH may include

• UTIs

• bladder calculi

• bladder damage

• hydronephrosis

• renal impairment.

Enuresis (Urinary incontinence)

Involuntary urination by a child after 4–5 years of age
- Nocturnal enuresis: bed-wetting at night
- Causes may be psychological and structural, but usually resolves with or without treatment

-  psychological or structural after 4-5

Stress incontinence 

Loss of urine from pressure exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy

-  Occurs when the sphincter muscle of the bladder is weakened
-  Contributing factors: pregnancy, childbirth, menopause, cystocele, prostate removal, obesity,
and chronic coughing

-Stress incontinence is like jumping on a trampoline, incontinence, laughing

-Pelvic floor therapy is helpful

Overactive bladder/ urge incontinence

Sudden, intense urge to urinate, followed by an involuntary loss of urine

Causes: urinary tract infections, bladder irritants, bowel conditions, smoking, Parkinson’s
disease, Alzheimer’s disease, stroke, injury, and nervous system damage
overactive your body doesn’t tell you your bladder is full !!

reflex incontinence

Urinary incontinence caused by trauma or damage to the nervous system

Detrusor hyperreflexia: increased detrusor muscle contractility that occurs even though, there is no sensation to void

Urgency is generally absent & electrophysiology therapy is helpful to stimulate the bladder

eg: car accident patient

mixed incontinence 

Occurs when symptoms of more than one type of urinary incontinence are experienced

Overflow incontinence (TRUE INCONTINENCE)

• Inability to empty the bladder, or retention

• Other indications include dribbling urine and a weak urine stream.

• Causes: bladder damage, urethral blockage, nerve damage, and prostate conditions
  Chronic overdistension occurs because of a perceived inability to interrupt work to void
  that results in detrusor muscle areflexia and overflow incontinence

BPH !!

Functional incontinence

Occurs in many older adults, especially people in nursing home, who have a physical or mental impairment that prevents toileting in time.

• their legs, wheelchair doesn’t work

Transient (temporary) incontinence

Urinary incontinence resulting from a temporary condition

Causes: delirium, infection, atrophic vaginitis, use of certain medications (e.g., diuretics and sedatives), psychological factors, high urine output, restricted mobility, fecal impaction, alcohol, and caffeine

Gross total incontinence 

A continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volumes of urine

Causes: anatomic defects; spinal cord or urinary system injuries; and fistulas between the bladder and an adjacent structure, such as the vagina.

• Sacrum highest risk area for skin damage/skin break down from peeing on themselves

• redness is the first thing u see  other than by smell