Renal & Urological Disorders PDF

z Renal & Urological Disorders z Urological Disorders: Overview Factor Characteristic Organs Ureter, bladder, urethra, also prostate Obstructive uropathy Blockage Hydronephrosis Fluid buildup kidneys Lower UTI...

z Renal & Urological Disorders z Urological Disorders: Overview Factor Characteristic Organs Ureter, bladder, urethra, also prostate Obstructive uropathy Blockage Hydronephrosis Fluid buildup kidneys Lower UTI Urinary tract infection More common in women Urolithiasis Stones BPH Benign prostatic hyperplasia Oliguria 100,000 colony-forming units (CFU)/mL  Usually indicate infection  For samples collected with minimal contamination (i.e., catheters)  Results of 1,000 to 100,000 CFU/mL may be considered significant Imaging Studies Kidney-ureter-bladder (KUB) x- CT scan and MRI Ultrasound ray Cystoscopy Bladder’s neuromuscular status Scope to view urethra and bladder Examine bladder filling and emptying Voiding cystourethrogram (VCUG) Bladder function as person urinating Intravenous pyelogram (IVP)  z Treatments Infections Antibiotics Calculi Pain medications, increased fluid intake, lithotripsy Cystoscopic surgery Kegel exercises Lower Urinary Tract Infection (UTI’s) Proteus, Pseudomonas, and Klebsiella also E. coli: Common Proteus more commonly associated with cause, from bowel catheterization or use of urinary instrumentation Women at higher risk Healthy urinary tract Bacteria in urethral opening only Stagnant urine increases infection risk  Female Risk Factors for Lower UTI  Improper perineal  Sexual intercourse hygiene  Urinary catheterization  Tight, restrictive  Use of contraceptive clothing  Chronic dehydration diaphragms and spermicides  Diabetes  Pregnancy commonly  Use of irritating bath causes asymptomatic products bacteriuria (ASB)  z Male Risk Factors for Lower UTI  Chronic dehydration  Diabetes  BPH: Obstructs free flow of urine  LUTS: Lower urinary tract symptoms  Weak urinary stream, hesitancy, frequency, dribbling after urination, and feeling of incomplete bladder emptying  Bladder cancer  Urinary catheterization  Note: UTI very uncommon in young male  Cause should be investigated z Hospital-Acquired UTI  Catheterization  Multi-drug resistant pathogens  Polymicrobial infection Symptoms of Lower Urinary Tract Infection Increased frequency, dysuria, and urgency Hematuria (not all cases) Fever not present with lower UTI Diagnosis RBC’s Positive leukocyte esterase, Urinalysis which indicates WBC’s Nitrates, which indicate bacteria Urine Greater than 100,000 colony- forming units (CFU)/mL culture z Treatment of UTI Cranberry juice Antibiotics Hydration important shown to decrease bacterial adherence Nitrofurantoin or trimethoprim- sulfamethoxazole (Bactrim) Fluoroquinolones Phenazopyridine (Pyridium) Pain relief Can turn urine a red/orange color  z Urosepsis Serious complication of UTI Bacteremia with bacterial endotoxins Acute, severe illness Fever, chills, confusion, disorientation, and hypotension Elderly, catheterized, and immunocompromised individuals are most at risk Asymptomatic Bacteriuria (ASB) Colony count greater than 100,000 bacteria Two consecutive urine cultures E. coli is most common organism Patient lacks UTI symptoms Treatment with antibiotics has not been found to improve outcomes  z AKA: Painful bladder syndrome (PBS) Pathophysiology/etiology are unclear Key: Interstitial Urgency and frequency of urination, bladder fullness, pain Cystitis (IC) Need to urinate greater than 50 times per day Two different types Ulcerative (Hunner’s ulcer) Ulcer apparent with bladder distention Nonulcerative: 90% of cases Bladder wall basically intact Interstitial Cystitis: Possible Etiology Factor Effect Diminished glucosaminoglycan Loss of protective barrier of (GAG) layer epithelium Altered permeability Dysfunction of detrusor muscle of the bladder epithelium Uroinflammation Activation of mast cells Neural upregulation Increase sensitivity z Interstitial Cystitis (IC): Diagnosis  Diagnosis  Cystoscopy can confirm  Urodynamic studies  Evaluate bladder function  Interstitial Cystitis Symptom Index (ICSI)  Eight question assessment tool  Rule out: Infectious causes, endometriosis  IC: May occur with IBS/fibromyalgia z Interstitial Cystitis (IC): Treatment Treatment Treatment (continued) No single treatment Intravesical therapy: Medication directly into bladder Several options available Bladder training Anticholinergic agents Kegel exercises Intradetrusor injection botulism toxin Avoid certain food Pentosan polysulfate sodium Amitriptyline: Tricyclic Immunosuppressants antidepressant Hydrodistention of bladder Urolithiasis Ureterolithiasis Nephrolithiasis (stones in the (renal calculus) ureter) Risks Cystolithiasis Genetics, diet, metabolic (vesical calculi) in abnormalities the bladder Lack of adequate hydration z Main Types of Renal Calculi Calcium Struvite Uric acid Cystine Most common; Magnesium and Foods high in Rare, disorder of hypercalcemia ammonium purines; gout cystine metabolism phosphate; occurs in Proteus UTI Patients with spinal cord injuries more at risk Urolithiasis: Risks and Signs and Symptoms Risks Signs and Symptoms Family history Costovertebral angle (CVA) pain, “flank” Medical history: Recurrence Abdominal pain Medications/herbal supplements Severe and intermittent pain: Renal colic Pain in waves 20–60 minutes Disorders of hypercalcemia and Nausea, vomiting, fever hyperuricemia Frequent UTIs Hematuria, pyuria Urinary stasis Painful urination z Costovertebral Angle  Urolithiasis: Diagnosis and Treatment Diagnosis Treatment  Hydration >3 L/day  Pain medications Hematuria and Ultrasound crystalluria  Diuretic  Lithotripsy  Ureterorenoscopy CT scan Collection of stone and stone analysis are key (URS) z Urinary Incontinence Type Characteristic Stress Most common Women more at risk Childbirth, abdominopelvic surgery Low estrogen Overactive bladder (OAB) Urge incontinence Detrusor muscle overactivity Overflow Detrusor muscle loses strength and elasticity Overdistention and urine retention Neurogenic Spinal cord disorders Functional Cannot retain urine (stroke, delirium)  Urinary Incontinence Risk Factors  Increasing age  Stroke  Pregnancy  Neurological  Childbirth impairment  Obesity  Prostate disease and its treatments  Diabetes z Urinary Incontinence: Diagnosis X-ray of the kidney, ureter, and bladder Ultrasound, CT scan Cystoscopy, urodynamic testing 3-day voiding diary Review medications as some may contribute to incontinence z Urinary Incontinence: Diagnosis (continued_2) Simple urinary cough test Cotton swab test Patient asked to forcefully Assesses mobility and cough with a full bladder in strength of the bladder the standing position sphincter Sterile cotton swab lubricated with lidocaine and inserted transurethrally into the bladder Patient asked to cough Angle of the cotton swab can indicate stress incontinence z Urinary Incontinence: Treatments Kegel exercises Anticholinergic drug: Decrease bladder activity Selective antimuscarinic agents Beta-3 adrenergic agents Botox injections into overactive bladder  Clinical Concept Example Chronic Results in irreversible hydronephrosis damage Clean-catch If not done properly, urine sample contaminated: Skin flora, vaginal flora Lower UTI Women at greater risk due to proximity urethra and rectum z Clinical Fever Not common in lower UTI Concept May occur with pyelonephritis Examples Struvite stones Common stone in patients with spinal cord injuries Dehydration Contributes to urolithiasis Alert! Painless Phenazopyridine hematuria Must be Can turn urine evaluated, as to red color, possible sign of may alter color bladder cancer of contact lenses