RENAL FINAL

Lower UTI S/S

• Dysuria

• Burning w/ urination

• Hematuria

• cloud or foul smelling urine

• Frequency, urgency

• Suprapubic pain

Upper UTI (pyelonephritis) S/S:

• Flank pain

• Fever, chills

• N/V

• CVA (costovertebral angle tenderness)

• Malaise

• Dysuria, urgency frequency

UTI Labs

• UA - leukocytes, nitrites

• WNC increase

UTI Treatment

• antibiotics (nitrofurantoin, ciprofloxacin)

UTI Uncomplicated Drug Therapy

• TMP-SMX

• Nitrofurantoin Cephalexin

• Fosfomycin

• Ampicillin, amoxicillin, or cephalosporins

Complicated and Fungal UTI Drug Therapy

• Fluoroquinolone

• Fungal - Fluconazole

Urinary analgesic

Phenazopyridine (azo dye)

UTI Education

• Hydration

• Wipe front to back

• urinate after sex

AKI Causes

• Pre-renal

• Intra-renal

• Post-renal

Pre-Renal Causes

• Cardiac Failure

• Sepsis

• Blood loss

• Dehydration

• Vascular occlusion

Inter Renal Causes

• Drugs

• Toxins

Post Renal

• Urinar calculi

• Retroperitoneal fibrosis

• Benign Prostatic Enlargement

• Cervical Cancer

• Urethral Stricture

AKI Labs

• Creatinine increase (0.6-1.3)

• BUN increase (10-20)

• K increase (3.5-5.0)

AKI Phases

• Oliguric

• Diuretic

• Recovery

Oliguric Phase S/S

• <400mL/Day output

• UA = RBCs, WBCs, elevate SG

• Hyperkalemia and hyponatremia

• Elevated BUN and Creatinine

• Fatigue and Malaise

Diuretic Phase S/S

• Gradual increase in urine output 1-3L/day

• Hypovolemia, dehydration

• hypotension

• BUN levels begin to normalize

Recovery Phase S/S

• GFR increases

• BUN/Creatinine plateau then drop

AKI Treatment

• Fluids (pre-renal)

• Dialysis if severe

Nephrolithiasis S/S

• Severe flank pain

• hematuria

• N/V

Nephrolithiasis priority

• pain control

• strain urine

Nephrolithiasis Teaching

• increase fluids

• reduce sodium, oxalates

Complicated UTI

• structural abnormalities

• urinary obstruction

• indwelling catheter

• Diabetes

• Kidney stones

• immunocompromised

• pregnancy

Uncomplicated UTI

• healthy, non pregnant females