Topic 6 part 1

urinary obstruction

condition that blocks/impedes flow of urine and damage occurs above the level so infection makes the damage worse

hydronephrosis

partial obstruction of ureter or the ureteropelvic junction in the renal pelvic, ureeter, bladder neck, prostate, or bladder outlet that can cause calculi, tumors, and scar tissues

• HTN

• HA

• flank pain that moves to the groin

• increased BUN and Cr

• If severe: renal failure

• Low to moderate pressure due to kidney dilation

• Urinary stasis and reflex (risk for pyelonephritis) 

what are the S/S of hydronephrosis

nephrolithiasis

kidney stone disease

men usually work outside and don’t drink lots of water, drink energy drinks 

why does nephrolithiasis usually affect more men than women

Jewish men due to the foods they eat (purines: organ meats, processed foods, pickled foods)

what are RF for uric acid stones

• men

• drinking energy drinks

• white people

• family hx/genetics

• hot, humid, dehydrated climates

• more common in the summer

• diet: phosphorus (green leafy veggies) and purines

• lifestyle

what are RF for nephrolithiasis

keeping urine dilute and free flowing by drinking water

What are the ways to reduce the risk of nephrolithiasis

nephrolithiasis

concentration of supersaturated crystals precipitate and form stone

calcium oxalate (MC), struvite (UTI), cysteine, calcium phosphate, uric acid (from purine foods)

what are the different types of kidney stones 

• 1st sign: sudden, severe pain (renal colic)

• N/V

• kidney stone dance (restless, cannot sit still, due to pain)

• blood in the urine

what are the S/S of nephrolithiasis

• get a urine specimen

• strain the urine: want to know what the stone is made of

• Opioids

• NSAIDs

• alpha adrenergic blockers: dilate the ureters, PNS activation

  • Flomax or tamsulosin helps relax the muscles (can be used in men with BPH)

• adequate hydration

• sodium restriction

• antibiotics and acetohydroxamic acid for struvite stones (due to UTI)

• Stones 4 mm or less may pass spontaneously (may take weeks)

• lithotripsy for stones > 4 mm

• nephrostomy tubes

what is the interprofessional care for nephrolithiasis

flomax or tamsulosin

meds used for nephrolithiasis that help relax the muscles which allows for dilate the ureters, can also be used for men with BPH

antibiotics, acetohydroxamic acid, surgery 

how are patients with struvite stones (due to infection (UTI)) treated

4 mm

what size of stones are passes spontaneously, which may take weeks

lithotripsy

ultrasound shock waves by which kidney stone is broken into smaller pieces to be able to pass the stones used for stones greater than 7 mm and other more serious issues

bleeding, injury to adjacent structure, infection (give prophylactic antibiotics)

What are the complications of a percutaneous nephrolithotomy

flexible uteroscope

lithotripsy that is used to remove stones from renal pelvic and upper urinary tract

extracorporeal shock wave lithotripsy

lithotripsy that is noninvasive but patients are sedated

electrohydraulic lithotriopsy

A uteral stent is placed during lithotripsy and used to facilitate passage of sand, removed in 2 weeks

Hematuria is normal for a while, but then it should go away. Prophylactic antibiotics for 30 days, encourage fluids to dilute the urine and reduce pain, and pain management

What are the post op considerations for an electrohydraulic lithotripsy

hemorrhage, infection, obstruction

what are the post op complications (rare) of electrohydraulic lithotriopsy

• adequate fluids to avoid dehydration

  • do not FORCE fluids which can increase pressure and fluid build up in the kidney → increased pain

• after a urolithiasis:

  • high intake of at least 3L or fluid a day to produce 2.5 L urine/day

  • water is best

    • colas, coffee, tees lead to increased stone formation because they cause dehydration

  • low sodium diet

• diet restriction depending on the type of stone

what is nutrition therapy for nephrolithiasis

milk, cheese, fish, sardines, ice cream, yogurt

what are diet restrictions for someone with a calcium kidney stones

dark greens, spinach, cabbage, rhubarg, nuts, celery, parsley, chocolate

what are diet restrictions for someone with a oxalate kidney stones

purines: sardines, liver, kidney, venison, chicken, salmon, crab, ham

what are diet restrictions for someone with a uric acid kidney stones

renal cell carcinoma

what is the most common renal cancer that affects males more than females

smoking, ACKD, obesity

what are RFs for renal cancer

• usually asymptomatic and often an incidental finding for an unrelated condition

• hematuria

• flank pain

• palpable mass in flank/abdomen

• weight loss

• fever

• HTN

• anemia (EPO affected)

what are the s/s of renal cancer

1

how many kidneys support normal renal function

• hourly urine output (need a minimum of 30 mL/hr)

• never clamp the catheter

• assess drainage for infection

• daily weights

• abdominal distention: paralytic ileus, restrict PO until BS return but can do IV fluid replacement

what are post op considerations for renal surgery to remove renal cancer

suspect paralytic ileus, so restrict PO until BS return but can do IV fluid replacement 

what should you do if someone has abdominal distention post op renal surgery for renal cancer

hematuria

what are the S/S of renal trauma

best rest, monitor for hematuria and myoglobinuria (protein in the urine that can damage the kidneys)

what is the treatment for renal trauma