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CHAPTER 50
RENAL & UROLOGIC PROBLEMS

Infectious and Inflammatory

Disorders of Urinary System

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" URINARY TRACT INFECTION (UTI)

Definition: Most common outpatient infection; E. coli most common cause.
Nitrate UTI
Symptoms: Dysuria, frequency, urgency, suprapubic pain
glucocyte
Diagnosis: Nitrites, WBCs, leukocyte esterase; clean-catch midstream. results
" NCLEX Tips UA lab
in
Teach front-to-back wiping
Increase fluids
b
Void regularly Hygiene hydration
Complete antibiotics A cause
# Red Tags hold muchation
CAUTI = most common healthcare-associated infection
Egter'fluff
Remove the catheter ASAP
T
Nitrites = gram-negative bacteria (E. Coli-common pathogen) 1 fr FaninYantItnotre
need Foley
$ Medications dysfunctionthat
neuro
TMP-SMX, Nitrofurantoin, Cephalexin, Fosfomycin
come
(Table 50.1,2,3,4) full
Nursing assessment and Patient teaching: Table 50.5,6 prevention forbatheter finish
[Link] need
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Sites of Infectious Processes in Upper and

Lower Urinary Tract

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ppelic
Jephson
! ACUTE PYELONEPHRITIS

Definition: Infection of renal parenchyma, collecting

system & pelvis.
Cause: Ascending UTI
Chronic: Recurring infection
Symptoms: Fever, chills, flank pain, vomiting.
! NCLEX Tips
(Table 50.7)
Hydration, Rest, Follow-up urine culture, Antibiotics
" Red Tags

Itheback
Flank pain + fever = upper UTI, Risk of sepsis
IFcheck name heartin
5 can lead to chrome kidney problem
Acne

Urethritis

Urethritis is an inflammation of the urethra,and can be

caused by an infection including sexually transmitted
bacterial or viral infection.
so
Manifestations can include a discharge, particularly in
men, with dysuria, urgency, and frequency.

Treatment is based on the underlying cause and providing

symptomatic relief. antibrotves sterouds

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sac outs
Urethral Diverticula
• Urethral diverticula are outpouchings in the
urethra with the cause typically unknown, but can
0
be due to obstruction and rupture of the
periurethral glands. They are associated with
childbearing, urethral instrumentation, dilation,
and infections.
• Symptoms include dysuria, postvoid dribbling,
frequency, urgency, and dyspareunia.
Jan painful
•
2
Surgery is the best treatment option, although
stress incontinence is a frequent complication.

5ft
• Interstitial cystitis (IC) is a chronic, painful
inflammatory disease of the bladder characterized
Interstitial by symptoms of urgency/frequency and pain in the
bladder and/or pelvis.
Cystitis/Painful O W pelvic floorexerer
Bladder •
Er
Various therapies, including dietary, pelvic
physical therapy, lifestyle changes, and
Syndrome medications, are used to relieve symptoms.
Pentosa is the only approved medication for

DOI
•
treating the symptoms of IC.

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Immunologic Disorders of
Kidney

Nephron structure

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p got
entire of nephone
inflamed infection
autoimume
" GLOMERULONEPHRITIS (Acute post-
streptococcus glomerulonephritis (APSGN)
• Definition: Inflammation of glomeruli; occurs 1–6 weeks after strep.
f
Symptoms: Edema, hypertension, oliguria, cola-colored urine, RBC casts, WBC, protein,
hematuria.
• Types: Diffuse or local, Acute or chronic
• " NCLEX Tips f
• Ask about recent strep
• Daily weights
• Monitor BP not finish antibiotic course
• Limit protein if ↑BUN
• Prevention: Early diagnosis of strep throat and skin lesions.
• # Red Tags bloodon
Edema
• RBC casts = hallmark
• Generalized edema unne
ALERT
• Hypertension expected

11
onsequence edema ITN
fhibaekup
no we

Glomerulonephritis (Anti-glomerular basement membrane disease)

• Def: A rare autoimmune disease characterized by the presence of circulating antibodies against

glomerular and alveolar basement membranes.

• Manifestations: flulike symptoms accompanied by hematuria and can rapidly lead to renal
failure.

o o
• Treatment: corticosteroids, immunosuppressive agents, and for those with end stage renal disease

u
(ESRD), dialysis.

o
• Risk: lung hemorrhage and respiratory failure.

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alone
Rickey

Glomerulonephritis (Acute and Chronic) Table 50:8

•
eRapidly progressive glomerulonephritis (RPGN) is glomerular disease associated with acute
kidney injury where there is rapid, progressive loss of renal function over days to weeks.
• It is associated with several infections and inflammatory and systemic diseases.

• Manifestations: edema, hypertension, proteinuria, hematuria, and RBC casts.

Treatment: corticosteroids and cyclophosphamide, and for those with end-stage renal disease,

8
•
dialysis or renal transplant.

Chronic glomerulonephritis is a syndrome that reflects the end stage of glomerular inflammatory
disease.

• Manifestations: proteinuria, hematuria, and the slow development of uremia.

• Treatment: supportive and symptomatic.

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nonfan
inane
" GOODPASTURE SYNDROME agony

Inge
Definition: Autoimmune attack on glomerular + alveolar membranes.
Symptoms: Hematuria + respiratory symptoms.
" NCLEX Tips I
Monitor respiratory status

F
Prepare for immunosuppressants
# Red Tags
Risk of lung hemorrhage
Rapid renal failure

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body
swollen up
511
TEST 0ᵗʰ

very common in children

" NEPHROTIC SYNDROME
Definition: Massive proteinuria → hypoalbuminemia → severe edema,

Table 50.9ok
ascites, anasarca.
m
Symptoms: Edema, hyperlipidemia, hypercoagulability.
Associated: Systemic illness like diabetes or lupus.
" NCLEX Tips
• Daily weights Ist things dot tinny
• Strict I&O
• Low-sodium diet
• Monitor for infection
# Red Tags
[Link]
• High risk for DVT , Foamy urine, Severe edema dots
problems

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Obstructive Uropathies

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backed
Obstructive uropathies all wine up rephronefilled
urine
• Any blockage of urine flow → hydronephrosis. with its own
• Damaging effects from urinary tract obstruction affect the urinary
system above the level of the obstruction.
• These may include hydroureter, vesicoureteral reflux, and
hydronephrosis.
• The severity of these effects depends on the location, duration of
obstruction, amount of pressure or dilation, presence of urinary
stasis, and whether infection is present.
NCLEX Tips:
• Monitor for flank pain
Red Tags:
• Obstruction + infection = emergency

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calculi
Sites and Causes of Upper and stones
Lower Urinary Tract Obstruction i tumors cancer
pregnancy

stone

start met
Op here
0 OVER any part
thatname

now
18

Junction
18

this is Most comm sites of obstruction site

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Hydronephrosis

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MAIN concerns
" KIDNEY STONES (urinary tract CALCULI)
a sinfections
IT if
• Definition: Stones formed from Ca, uric acid, cystine, and struvite. Table 50.10, 11

ILIE
Symptoms: Severe flank pain, hematuria, renal colic.

• Cause: metabolic, dietary, genetic, climatic, lifestyle, and occupational influences. Other factors are
to
IT
obstruction with urinary stasis and UTI
• Table 50.13-nursing assessment

" NCLEX Tips # Red Tags

Fluids to produce 2.5 L/day urine Patient cannot sit still = renal colic
Strain all urine Struvite stones = infection-related
Pain management priority
morphine
00
UPJ & UVJ = common obstruction sites
bladderlevel
management
least to
pain at
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[Link] h IE stone tittle
death
Ide
surguation
big 10
if too
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Renal Staghorn Stone

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Strictures
. Narrowing of the lumen of the ureter/urethra
• Types: Ureteral, urethral
• Treatment: Stent, surgical resection, or dilation
• Causes: trauma, urethritis, iatrogenic, or a congenital defect.
NCLEX Tips:
• Monitor urine flow
• Red Tags:
• Acute obstruction = emergency

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" KIDNEY STONES (urinary tract CALCULI)

to pass out
so now smallenough
• Treatment: Lithotripsy - Shock waves break stones.
f
• Goals: Relieve pain, no obstruction, and understanding of measures to prevent
showurine

D
further recurrence of stones.
reasonisCa
• NCLEX Tips:
• Expect bruising Diet Nca og
acid
urine
• Red Tags:
• Report fever
Ca ly
• Table 50.12-Nutrition therapy

EEE
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Renal Trauma

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Renal Trauma

• Renal trauma may occur from violent crimes, motor vehicle

accidents, falls, and sports injuries.
• The severity of the trauma depends on the extent of injury.
• Treatments range from bed rest, fluids, and analgesia to
surgical repair and nephrectomy.

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Renal Vascular Problems

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Renal Vascular Problems

• Vascular problems involving the kidney include (1) nephrosclerosis, (2) renal artery stenosis, and (3) renal vein

thrombosis.

• Nephrosclerosis consists of sclerosis of the small arteries and arterioles of the kidney, which often is associated

with hypertension.

• Renal artery stenosis is a partial occlusion of 1 or both renal arteries and their major branches caused by

atherosclerotic narrowing. The goals of therapy are control of BP and restoration of perfusion to the kidney.
• Renal vein thrombosis is typically treated with anticoagulation and thrombectomy.

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Hereditary Renal Diseases

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" POLYCYSTIC KIDNEY DISEASE (PKD)

• Definition: Genetic disorder → kidney cysts; no cure.
Progression: 85% reach ESRD by age 65.
• " NCLEX Tips
• Genetic counseling
• BP control
• Prevent UTIs
• Report hematuria or severe pain
• # Red Tags
• Progressive → ESRD
• Cysts compress and destroy tissue

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Polycystic Kidney
• A. Polycystic Kidney and Normal Kidney, B. Cysts in the Liver

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Medullary Cystic Disease

• Medullary cystic disease is a autosomal dominant rare

hereditary disorder with loss of renal function often starting

in the teens.
• There is no cure and can progress to ESRD by the 40’s-70’s.

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Alport Syndrome
• Alport syndrome (chronic hereditary nephritis) is an inherited disease

that results in altered synthesis of the glomerular basement

membrane.

• Manifestations include hematuria and can progress to uremia.

Treatment is supportive and often includes kidney transplantation.

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Urinary Tract Tumors

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Kidney Cancer
• Renal cell carcinoma (adenocarcinoma) is the most common type of kidney cancer.

• Cigarette smoking is the most significant risk factor for renal cell cancer.

• Since there are no early symptoms of kidney cancer, many patients go undiagnosed until the disease is advanced. About 33% of

patients have metastasis at the time of diagnosis.

• Common presenting manifestations are hematuria and flank pain.

• The treatment of choice for some kidney cancers is a partial, simple total, or total nephrectomy and lymph node dissection as

indicated.
• Other treatment options include cryoablation and radiofrequency ablation.

• Chemotherapy is used as a treatment in metastatic disease, but the tumors are often resistant to most chemotherapy drugs.

• Immunotherapy and targeted therapy are used to treat metastatic kidney cancer.

• Table 50.14 interprofessional care

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Renal Cell Carcinoma

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" BLADDER CANCER

• Definition: Smoking = biggest risk factor.
Symptoms: Painless hematuria.
• " NCLEX Tips
• After BCG therapy:
• Sit to void
• Avoid public toilets for 24 hrs
• Clean toilet with bleach
• Increase fluids
• # Red Tags
• Painless hematuria = #1 sign
• BCG = treatment of choice

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Bladder Cancers
A. Papillomatous transitional cell carcinoma
B. Opened bladder with advanced stage cancer

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Surgery of the Urinary Tract

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SURGERY OF THE URINARY TRACT -NEPHRECTOMY

• Indication: renal tumor, PKDs that are bleeding or severely infected, massive

traumatic injury to the kidney, and the elective removal of a kidney from a donor.
• postoperative period: urine output, respiratory status, and abdominal distention.
• Surgery involving the ureters and kidneys is most often done to remove stones that
become obstructive, correct congenital anomalies, and divert urine when necessary.

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URINARY DIVERSION
• Urinary diversions are performed when normal urine flow is ! RED-TAG SAFETY ALERT
blocked due to: Decreased urine output = possible obstruction
• Bladder cancer, Congenital anomalies, Strictures, Trauma → report immediately.
• Chronic inflammation, Bright red urine or large clots post-op →
Diversions may be: possible bleeding.
• Incontinent (e.g., ileal conduit), Continent (catheterizable Fever, flank pain, foul urine → infection risk.
pouch) Stoma should be red, moist, protruding —
• Orthotopic neobladder (voids through urethra) dusky or black = ischemia.
• Extensive pre- and postoperative teaching, especially regarding
stoma care and infection prevention.
• ⭐ NCLEX Priority Teaching
⭐ NCLEX-Integrated Essentials
• Ileal conduit: continuous drainage into an external pouch; Increase fluids to prevent mucus buildup and
highest risk for skin breakdown. obstruction.
• Continent diversion (Kock pouch): patient self-catheterizes Empty pouch when 1/3 full to prevent leakage.
every 4–6 hours. Clean skin thoroughly and ensure proper pouch
• Orthotopic neobladder: patient voids normally but may have seal.
incontinence initially.
Teach signs of obstruction: no urine, abdominal
• Common stoma issues: dermatitis, yeast infection, product
allergy, shearing/excoriation. distention, flank pain.
• Teach patients to monitor urine color, consistency, and output. After ileal conduit: expect mucus in urine —
. normal finding.

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Methods of Urinary Diversion

Shown is Fig. 50.11 from the textbook: Methods Shown is Fig. 50.11 from the textbook: Methods of
of urinary diversion. A, urinary diversion. C, Ureterostomy (transcutaneous
Ureteroileosigmoidostomy. B, Ileal loop (ileal ureterostomy and bilateral cutaneous
conduit). ureterostomies). D, Nephrostomy.
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Methods of Urinary Diversion

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Kock Pouch
Urinary Stoma Shown is Fig. 50.13 from the textbook: Creation
Figure 50.12 Urinary stoma. Symmetric, no skin breakdown, of a Kock pouch with implantation of ureters
protrudes about 1.5 cm. Mucosa is healthy red. This into one intussuscepted part of the pouch and
configuration is flat when the patient is upright or supine
creation of a stoma with the other
intussuscepted part.

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Bladder Dysfunction
(Self-study, as it was covered in
level 1)

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" URINARY INCONTINENCE & RETENTION

• Definition: Involuntary leakage or inability to empty bladder.
• " NCLEX Tips
• Pelvic floor exercises Table 50.16 types
Table 50.17 Interventions
• Bladder training
Table 50.19 –drug therapy
• Avoid bladder irritants Table 50.20
• Keep bladder log Nursing management
• # Red Tags
• Acute urinary retention = emergency
• Overflow incontinence = dribbling

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Urinary Retention
• Urinary retention is the inability to empty the bladder or the accumulation of urine due to inability
to void.
Common causes include:
• Neurologic impairment, Bladder outlet obstruction (BPH, strictures), Weak detrusor muscle
(aging, meds)
• Evaluation: history, physical exam, urinalysis, bladder log, post-void residual (PVR).
⭐ NCLEX-Integrated Essentials
• PVR > 100 mL = incomplete emptying; > 300–400 mL = significant retention.
• High-risk meds: anticholinergics, opioids, antihistamines.
• Chronic retention → overflow incontinence, UTIs, hydronephrosis.
• Preferred management: scheduled voiding, bladder retraining, pelvic floor exercises,
alpha-blockers for BPH, intermittent catheterization.

" RED-TAG SAFETY ALERT

• Acute urinary retention = medical emergency → immediate catheterization.
• Severe suprapubic pain + inability to void → act immediately.
• Post-op patients must void within 6–8 hours.
• Retention + fever → suspect UTI or pyelonephritis.

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Acute Urinary Retention

• Symptoms: severe suprapubic pain, distention, inability to void.
Treatment: rapid bladder drainage, identify cause, monitor for
post-obstructive diuresis.
•

• ⭐ NCLEX Priority Teaching

• Void every 3–4 hours; don’t “hold it.”
• Avoid large fluid intake at once.
• Report: weak stream, dribbling, incomplete emptying.
• After catheter removal: first void expected within 6 hours.

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" CATHETERIZATION - Table 50. 21, 22

• Definition: Used short-term; long-term increases infection risk.
• " NCLEX Tips
• Maintain closed system
• Bag below bladder
• Routine perineal care
• # Red Tags
• Never clamp nephrostomy tube
• CAUTI prevention is priority

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" PHENAZOPYRIDINE (PYRIDIUM)

• Definition: Urinary analgesic for dysuria.
• " NCLEX Tips
• Take with meals
• Short-term use only
• # Red Tags
• Turns urine bright orange
• Does NOT treat infection

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