Nephrolithiasis & Pyelonephritis

Nephrolithiasis (Kidney Stones)

• Signs and Symptoms include; Pain, Nausea/vomiting, and Hematuria
• If suspected, conduct an immediate UA, Labs to check Calcium/WBC, and CT scan.
• If present, administer pain medications.
• Treatment includes; Ondansetron, Opioids like Oxycodone, Alpha adrenergic blockers like Tamsulosin (Flomax), increase fluids, surgery, Extracorporeal shock wave lithotripsy (ESWL), and strain urine

Pyelonephritis (Kidney Infection)

• Patho: Bacterial infection of the kidney and renal pelvis
• Acute: Active bacterial infection
• Chronic: Repeated or continued UTI causing deformity of the ureter (obstruction)
• Reflux: Backward flow of urine into the kidneys
• Incidence/ Prevalence: Most common in young, sexually active women trying to get pregnant
• Assessment includes asking about history, UTI, assessing if the patient is young or trying to get pregnant.
• Assess for Fever, chills, burning or urgency as well as embarrassment
• Labs to conduct UA, which will confirm the presence of WBC and protein
• Imaging to conduct CT (KUB – Kidneys, ureter, or bladder)
• Intervention; Drugs BS ABX until C/S
• Surgical management is needed if there is a deformity, the patient might need a urethroplasty
• Education includes; Take medications exactly as prescribed, increase fluid intake, teach S/S with awareness of what has previously worked, and teach the patient to void after sex & wipe front to back

Glomerulonephritis

• Inflammation of the glomeruli and of small blood vessels
• Acute: Sudden and excessive immune response by kidney tissue, most commonly to strep – Patients can recover completely
• Primary: Starts in glomeruli
• Secondary: Multi-system diseases affect glomeruli; HTN & Diabetes
• Chronic: Develops over years or decades if acute isn't properly treated
• Assessment includes any immune disease or recent infection (skin – tattoos or respiratory)
• Symptoms include; Skin or incisions and lesions that are not healing, FVO (sodium retention), Elimination (COCA: frequency, pain, hematuria)
• Labs: Creatinine, BUN, GFR
• Diagnostics: Kidney biopsy
• Interventions: Manage infection (ABX), prevent complications, and implement dialysis if needed

Nephrotic Syndrome

• Renal permeability increases
• Larger molecules pass through
• Massive loss of protein and albumin
• Most common cause is altered immunity with inflammation
• Key features include; severe proteinuria, hyperlipidemia, and edema (facial/pitting)
• Diagnostic: Kidney biopsy
• Management includes; Maintain blood flow to kidneys (to prevent AKI), teach patients recognition, as there is no cure
• Medications include; ACEs which decrease the protein loss
• Statins, which improve blood lipid levels
• Heparin, which reduces vascular defects to increase kidney function
• Diuretics that control HTN and edema

Renal Cell Carcinoma

• Patho: Most common kidney cancer
• Assessment includes family history
• Symptoms include; Flank pain, abdominal mass, hematuria, skin changes (dull and darkening), Gynecomastia (men will produce breast tissue because HCG is released)
• Diagnosis includes; Urinalysis, CBC, Hormones to check HCG, BUN / Cr, CT / MRI / US, Kidney BX
• Intervention; Chemo to increase survival time
• Surgical management: Nephrectomy
• The kidneys are vascular, therefore, blood loss is a concern which means the patient will be in ICU for monitoring
• Vitals Q4, significant change in BP is an early sign of hemorrhage
• Pain management includes 4/5 days of opioids
• Prevent complications such as infections

Bladder Cancer

• Patho: Urothelial tumors in the uRuninary tract
• Risks: Tobacco use
• Assessment includes; Hematuria, COCA changes, Changes in frequency, and abdominal discomfort
• Diagnostics; Hematuria (straight cath), biopsies, cystoscopy
• Intervention: Nonsurgical management (Bacille Calmette-Geurin)
• Patient Education: Don't share a toilet for 24 hours, bleach, wash clothes separately, no sex
• Surgical management: TURBT, Segmental cystectomy, which is when a portion of the bladder is removed
• Complete cystectomy, is when the complete bladder is removed
• Ureterostomy
• If the drain is completely removed, the priority is to call the doctor
• if drain is partially removed, secure it in place
• Patient Education: Infection signs and symptoms, system management should be taught, to learn how to keep new ostomy clean, how to change it, skin care, self-cath
• Patients should consume a regular diet that avoids gassy foods
• Psych: Toileting to empty before leaving house, sexual health, and WOCN nurse consult in hospital or home