Class Notes (835,244)
Canada (509,045)
BIOC33H3 (127)

Renal and Urologic Problems

6 Pages
Unlock Document

Biological Sciences
Stephen Reid

Chapter 46: Renal and Urologic Problems URINARY TRACT INFECTIONS  Urinary tract infections (UTIs) are the second most common bacterial disease, and the most common bacterial infection in women.  UTIs include cystitis, pyelonephritis, and urethritis.  Risk factors for UTIs include pregnancy, menopause, instrumentation, and sexual intercourse. Escherichia coli (E. coli) is the most common pathogen causing a UTI.  UTIs that are hospital-acquired are called nosocomial infections.  UTI symptoms include dysuria, frequent urination (more than every 2 hours), urgency, and suprapubic discomfort or pressure. Flank pain, chills, and the presence of a fever indicate an infection involving the upper urinary tract (pyelonephritis).  UTIs are diagnosed by dipstick urinalysis to identify the presence of nitrites (indicating bacteriuria), WBCs, and leukocyte esterase (an enzyme present in WBCs indicating pyuria). A voided midstream technique yielding a clean-catch urine sample is preferred.  Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin (Macrodantin) is often used to empirically treat uncomplicated or initial UTIs. Additional drugs may be used to relieve discomfort.  Health promotion activities include teaching preventive measures such as (1) emptying the bladder regularly and completely, (2) evacuating the bowel regularly, (3) wiping the perineal area from front to back after urination and defecation, and (4) drinking an adequate amount of liquid each day. PYELONEPHRITIS  Pyelonephritis is an inflammation of the renal parenchyma and collecting system (including the renal pelvis). The most common cause is bacterial infection which begins in the lower urinary tract. Recurring infection can result in chronic pyelonephritis.  Clinical manifestations vary from mild fatigue to the sudden onset of chills, fever, vomiting, malaise, flank pain, and the lower UTI characteristics.  Interventions include teaching about the disease process with emphasis on (1) the need to continue drugs as prescribed, (2) the need for a follow-up urine culture to ensure proper management, and (3) identification of risk for recurrence or relapse. INTERSTITIAL CYSTITIS  Interstitial cystitis (IC) is a chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency/frequency and pain in the bladder and/or pelvis. IMMUNOLOGIC DISORDERS OF THE KIDNEY Glomerulonephritis  Immunologic processes involving the urinary tract predominantly affect the renal glomerulus (glomerulonephritis).  Clinical manifestations of glomerulonephritis include varying degrees of hematuria (ranging from microscopic to gross) and urinary excretion of various formed elements, including RBCs, WBCs, proteins, and casts.  Acute poststreptococcal glomerulonephritis (APSGN) develops 5 to 21 days after an infection of the tonsils, pharynx, or skin (e.g., streptococcal sore throat, impetigo) by nephrotoxic strains of group A -hemolytic streptococci. Manifestations include generalized body edema, hypertension, oliguria, hematuria with a smoky or rusty appearance, and proteinuria.  APSGN management focuses on symptomatic relief. This includes rest, edema and hypertension management, and dietary protein restriction when an increase in nitrogenous wastes (e.g., elevated BUN value) is present.  One of the most important ways to prevent the development of APSGN is to encourage early diagnosis and treatment of sore throats and skin lesions.  Goodpasture syndrome is a rare autoimmune disease characterized by the presence of circulating antibodies against glomerular and alveolar basement membrane.  Rapidly progressive glomerulonephritis (RPGN) is glomerular disease associated with acute renal failure where there is rapid, progressive loss of renal function over days to weeks.  Chronic glomerulonephritis is a syndrome that reflects the end stage of glomerular inflammatory disease. It is characterized by proteinuria, hematuria, and development of uremia. Treatment is supportive and symptomatic.  Nephrotic syndrome results when the glomerulus is excessively permeable to plasma protein, causing proteinuria that leads to low plasma albumin and tissue edema. o Nephrotic syndrome is associated with systemic illness such as diabetes or systemic lupus erythematosus. o Treatment is focused on symptom management. o The major nursing interventions for a patient with nephrotic syndrome are related to edema. Edema is assessed by weighing the patient daily, accurately recording intake and output, and measuring abdominal girth or extremity size. OBSTRUCTIVE UROPATHIES Urinary Stones  Factors involved in the development of urinary stones include metabolic, dietary, genetic, climatic, lifestyle, and occupational influences. Other factors are obstruction with urinary stasis and urinary tract infection.  The five major categories of stones (lithiasis) are (1) calcium phosphate, (2) calcium oxalate, (3) uric acid, (4) cystine, and (5) struvite.  Urinary stones cause clinical manifestations when they obstruct urinary flow. Common sites of complete obstruction are at the UPJ (the point where the ureter crosses the iliac vessels) and at the ureterovesical junction (UVJ).  Management of a patient with renal lithiasis consists of treating the symptoms of pain, infection, or obstruction.  Lithotripsy is used to eliminate calculi from the urinary tract. Outcome for lithotripsy is based on stone size, stone location, and stone composition.  The goals are that the patient with urinary tract calculi will have (1) relief of pain, (2) no urinary tract obstruction, and (3) an understanding of measures to prevent further recurrence of stones.  To prevent stone recurrence, the patient should consume an adequate fluid intake to produce a urine output of approximately 2 L/day. Additional preventive measures focus on reducing metabolic or secondary risk factors. Urethral Stricture  A stricture is a narrowing of the lumen of the ureter or urethra. Ureteral strictures can affect the entire length of the ureter.  A urethral stricture is the result of fibrosis or inflammation of the urethral lume
More Less

Related notes for BIOC33H3

Log In


Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.