Kidney and Bladder

In Hebrew and ancient Egyptian tradition, the kidneys are regarded as vital organs alongside the heart.
Egyptians believed the kidneys were connected to the heart.
The kidneys and bladder are considered the organs of anxiety.

Function: Remove waste from the blood and return cleaned blood to the body.
Regulation: Manages and balances the body's blood pressure through fluid balance.

Biggest Complication: Obstruction of urine flow can hinder kidney function.
Surgeries:
- Kidney Transplant: Replacement of a failing kidney with a healthy kidney from a donor.
- Nephrectomy: Surgical removal of a kidney.
- Cystoscopy: A procedure to examine the bladder and urethra.

Types:
- Kidney Stones: Known as renal calculi or nephrolithiasis.
- Bladder Stones: Known as urolithiasis.
Formation: Can occur anywhere in the urinary tract.
Effects: Cause pain, obstruction, tissue trauma, hemorrhage, and infection.
Diagnostics: Use of CT scans, ultrasound, and urinalysis.
Consequences of Obstruction:
- If a stone blocks urine flow, the ureter dilates (hydroureter).
- If obstruction is not removed, it can lead to urinary stasis, infection, renal function impairment, hydronephrosis, and irreversible kidney damage.

It is estimated that 12% of Americans will develop a kidney stone in their lifetime.

Common Symptom: Pain is the predominant symptom experienced by patients with stones.

Risk Factors:
- Family history of kidney stones.
- Diet high in calcium, vitamin D, proteins, purines, and alkali.
- Dehydration increases the risk of stone formation.
- Use of diuretics and prolonged catheterization.
- Immobilization, elevated uric acid levels, hypercalcemia, and hyperparathyroidism.

Symptoms:
- Sharp, severe, sudden onset pain at the site of the stone.
- Dull, aching pain in the kidney area may also occur.
- Other symptoms include nausea/vomiting (N/V), pallor, diaphoresis, alternating urinary frequency and retention, signs of urinary tract infection (UTI), low-grade fever.
Urinalysis Findings: Presence of red blood cells (RBCs), white blood cells (WBCs), bacteria, and hematuria.

Monitoring:
- Monitor vital signs and signs of infection.
- Monitor input and output (I&O).
- Assess for fever, chills, N/V/D (nausea/vomiting/diarrhea).
Fluid Management:
- Encourage fluid intake up to 3,000 mL/day.
- Administer intravenous fluids (IVF) and analgesics as necessary.
- Apply heat to the flank area for pain relief.
- Encourage ambulation if the patient is able.
- For immobile patients, maintain proper repositioning.
Dietary Management: Implement dietary restrictions as necessary.
Surgical Preparation: Prepare for surgery if indicated based on condition severity.

Pain Relief:
- Manage severe pain, which is often distressing and requires immediate intervention.
- Administer opioids as prescribed.
- Encourage the patient to assume a comfortable position.
Dehydration Management: Monitor and manage levels of dehydration.
Urine Monitoring: Strain all urine to capture any stone fragments.
Patient Education:
- Provide education on causes of stones and recommendations to prevent recurrence.

Dietary Modifications: Based on the type of calculi, modify diet to limit foods high in substances that contribute to stone formation.
Foods High in Purines:
- High: Sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads.
- Moderate: Chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham.
Foods High in Calcium:
- High: Dairy products (milk, cheese, ice cream, yogurt), beans (except green beans), lentils, fish with fine bones, dried fruits, nuts, cocoa powder, chocolate.
Foods High in Oxalate:
- High: Dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, chocolate, tea.
- Note: Uric acid is a waste product resulting from purines found in food.

Cystoscopy: A procedure using a camera to examine the bladder and urethra for stones.
Extracorporeal Shock Wave Lithotripsy (ESWL): A noninvasive procedure to break up stones in the kidney or upper ureter; stones may pass spontaneously or be removed manually.
Percutaneous Nephrolithotripsy: An invasive procedure where a catheter is inserted to remove or disintegrate stones in the kidney.
Ureterolithotomy: Invasive surgical procedure to remove stones if other methods fail.
Partial or Total Nephrectomy: Removal of a kidney due to nonfunctionality or significant damage.

Indications for Surgery: Conducted typically for incontinence, stones, or tumors.
Incontinence Treatments: Include urethral/bladder slings, periurethral bulking, and artificial urinary sphincters.
- Slings: Surgically lift the bladder or urethra into correct position.
- Periurethral Bulking: Involves injecting collagen into the urethral walls.
- Artificial Urinary Sphincter: A device that closes the urethra.
Neurogenic Bladder Management: Suprapubic catheterization, conducted to drain urine from the bladder.

Reasons for Urinary Diversion: Conducted due to bladder damage, trauma, incontinence, spinal cord injury (SCI), or congenital issues.
Urostomy Types: Ileal Conduit, where a segment of the ileum is used to create a stoma for urine output.

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