Urinary and Renal Conditions

• The study notes cover various urinary and renal conditions

Urinary Incontinence

• Involuntary leakage of urine is the primary clinical manifestation
• Functional incontinence occurs in geriatric patients needing assistance to reach the bathroom
• Neurogenic incontinence is associated with spinal cord injuries, leading to a lack of bladder control
• Urgency incontinence can result from loop diuretic use or infection
• Overflow incontinence arises from bladder emptying issues, often due to urethral blockage, as seen in BPH
• Geriatric patients experience more frequent urination needs, decreased bladder capacity, and nocturia
• Pregnancy with vaginal delivery increases the risk
• Management includes reducing coffee intake, quitting smoking, preventing constipation, and scheduled voiding every 2-4 hours

Lower UTI: Cystitis / Urethritis

• Infection can stem from bacteria, fungus, parasite, chemical irritants, foreign bodies, or trauma
• Cystitis involves bladder infection with urine stasis
• Urethritis may result from STIs, immunosuppression, poor hygiene (always wiping front to back), and impaired protective mechanisms
• Natural defenses include one-way urine flow, epithelial cells lining the urinary tract, and acidic environment
• Common symptoms include urinary frequency, urgency, dysuria, pain, and pink or cloudy urine
• Geriatric patients may present with delirium
• Pelvic pain is a common symptom
• Diagnosis involves labs such as CBC and CMP
• Treatment includes antibiotics such as trimethoprim/ sulfamethoxazole (2 tabs every 12 hours x 14 days) and urinary analgesics like phenazopyridine (200mg 3x day)
• Encourage drinking 8 glasses of water daily, and to use sunscreen
• Phenazopyridine causes urine to turn orange

Acute Pyelonephritis

• Obstruction or ureteral reflux causes contaminated urine to backflow into the kidney
• Renal calculi can be a cause
• Clinical signs are Costovertebral angle tenderness, fever, chills, nausea/vomiting, and dehydration
• Diagnosis and monitoring involve IV Pyelogram and monitoring BUN/Creatinine due to contrast use
• Treatment includes IV fluids with normal saline (0.9% sodium chloride) to address dehydration
• Monitor creatinine levels, an increase greater than 2x the normal amount (0.9 mg/dL) is concerning

Chronic Pyelonephritis

• Chronic reflux of contaminated urine leads to smaller, inflamed kidneys
• Obstruction from renal calculi contributes to urinary stasis and bacterial growth
• Infected urine backflows into the kidneys, leading to scarring and atrophy
• Symptoms are often vague and inconsistent
• Monitor BUN/Creatinine levels
• Manage with urinary analgesics, antipyretics, and antibiotics
• Aim for a minimum daily intake of 1500ml, or 3-4L per day, if not restricted and similar output

Renal Calculi (Nephrolithiasis / Urolithiasis)

• High concentrations of particles in urine cause stone formation and obstructions
• Renal colic, dull and localized flank pain, nausea/vomiting, and hematuria are common symptoms
• Pain management includes opioid medications
• Drink 2 glasses of water at bedtime
• Preventative measures include avoiding excessive sweating, reducing protein intake, and avoiding oxalate-containing foods like spinach, strawberries, and wheat bran

Acute Glomerulonephritis

• Infection (virus/bacteria) elsewhere in the body triggers the immune system to attack glomeruli walls, increasing permeability and GFR
• Coffee-colored urine, headache, hypertension, and periorbital edema are characteristic symptoms
• Edema and shortness of breath may occur
• Monitor VS Q4H, CBC, CMP daily
• Treatment includes fluid restriction to prevent overload
• Eat Carbohydrates for energy and reduce protein breakdown

Chronic Glomerulonephritis

• Kidneys become hard and small due to chronic proteinuria and hypertension, leading to renal damage (scarring, atrophy) and CKD
• Weight loss, decreased strength, nocturia, hyperkalemia, metabolic acidosis, headache, anemia, and pericardial rub are potential symptoms
• High protein diet is recommended
• Diuretics and antihypertensives are used
• Dialysis may be necessary
• Strict monitoring of I/O is crucial

Nephrotic Syndrome

• Increased glomerular permeability leads to massive proteinuria, damaging the glomerular membrane, that can be caused by diseases like lupus, infection, cancer, vasculitis, and DM
• Edema results from albumin loss, decreasing oncotic pressure and causing fluid to escape
• Hepatocytes increase lipid synthesis, causing hyperlipidemia
• Hypoalbuminemia occurs due to poor kidney function and albumin loss
• Increased risk for thrombus formation
• Generalized edema is evident
• Monitor skin integrity (sacral area) for breakdown
• Monitor for thrombus/PE
• Diagnosis involves UA to check for protein and WBCs
• Treatment may include ACE inhibitors, diuretics, and lipid-lowering medications

Polycystic Kidney Disease

• Genetic disease with recessive or dominant forms
• Dominant form can spread to other structures and organs; a liver biopsy can differentiate between recessive and dominant
• Recessive: respiratory distress, enlarged kidneys, systemic hypertension
• Dominant: typically manifests at 40-50 y/o, decreased urine concentration, hypertension, proteinuria, hematuria, pain
• Supportive care is the primary approach
• Heat application to the abdomen helps decrease discomfort
• Prevent dehydration with adequate fluid intake
• Avoid NSAIDs

Acute Kidney Injury

• Acute loss of renal function due to perfusion issues (MI, DM, HTN, CA, BPH, nephrotoxic drugs)
• Pre-renal: Reduced blood flow to the kidney like peripheral vascular disease
• Intra-renal: Nephron constriction or blockage disrupts flow inside the kidneys
• Post-renal: Obstruction
• Example: Cardiac Infarction leading to pre-renal injury due to decreased kidney perfusion
• RAAS attempts to compensate with fluid and dilation; if uncorrected, pre-renal injury can progress to intra-renal injury
• Clinical manifestations are electrolyte and ABG imbalances
• Stages include Oliguric (no urine), Diuretic (hypovolemia/urine not concentrated), and Recovery (electrolyte normalization) phases
• Acute Tubular Necrosis: Damage to tubules is seen in intra-renal injuries and vasoconstriction
• Hemorrhage increases risk due to decreased volume and kidney perfusion
• Limit NSAIDs, contrast, and nephrotoxic medications
• Strict monitoring of I/O is essential
• High carb diet, avoid potassium and phosphorus

Chronic Kidney Disease

• Damage to nephrons impairs their function, causing other nephrons to compensate and ultimately fail
• Common in patients with uncontrolled hypertension, DM, smoking, and long-term impaired circulation
• Patients typically require dialysis
• Risk of anemia due to decreased erythropoietin production
• End-Stage Renal Disease (CKD Stage 5) increases risk of bone disorders due to vitamin D deficiency, increased phosphorus, and decreased calcium
• Clinical signs include edema, pulmonary congestion, and pericardial friction rub
• Types of Dialysis: Hemodialysis, Peritoneal Dialysis, Continuous Renal Replacement Therapy (CRRT)
• Monitor for weight gain >2lbs in one nursing shift (fluid restriction)
• Notify the provider of decreased or minimal UOP
• Hold BP and Cardiac meds for dialysis as they will be removed from the system with dialysis
• Avoid Ketorolac
• Avoid potassium/ phosphorus
• High Carb diet
• Diuretics, calcium binders, antihypertensives are used to avoid complications

Kidney Labs

• BUN (Increased): 10- 20mg/dL
• Serum Creatinine (Increased): 0.6-1.2 mg/dL
• GFR (decreased): 90-120 ml/min.
• Hbg (Low / Anemia): Male 14-18 g/dL, Female 12-16 g/dL
• RBC (Low): Male 4.7- 6.1, Female 4.2- 5.4
• Triglycerides (high): Male 40- 60mg / dL, female 35- 135 mg/dL
• Potassium (increased): 3.5-5 mEq/L
• ABG / Ph: Acidosis (pH7.35)