genitourinary disorders (medical surgical nursing)
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Jan 18, 2016
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About This Presentation
covers most of the nursing management of the renal or genito urinary disorders
Slide Content
Aashish Parihar
Nursing Tutor
College of Nursing
AIIMS, Jodhpur
Nursing Tutor
College of Nursing
AIIMS, Jodhpur
content
Review of anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination
Etiology, pathophysiology, clinical manifestations, diagnosis,
medical and surgical treatment modalities, alternative
therapies, dietetics and nursing management (nursing
process including nursing procedures).
Urological obstructions-
Urethral strictures
Renal calculi
Nephrosis
Review of anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination
Etiology, pathophysiology, clinical manifestations, diagnosis,
medical and surgical treatment modalities, alternative
therapies, dietetics and nursing management (nursing
process including nursing procedures).
Urological obstructions-
Urethral strictures
Renal calculi
Nephrosis
content
Disorders of kidney-
Glomerulonephritis
Nephrotic syndrome
Nephrosis
Acute renal failure
Chronic renal failure
End stage renal disease
Dialysis, renal transplant
Cancer of kidney
Congenital disorder
Disorders of kidney-
Glomerulonephritis
Nephrotic syndrome
Nephrosis
Acute renal failure
Chronic renal failure
End stage renal disease
Dialysis, renal transplant
Cancer of kidney
Congenital disorder
content
Disorders of Ureters, urinary bladder and urethra-
UTI
Cystitis
Urinary incontinence
Urinary retention
Urinary reflux
Bladder neoplasm
Urinary bladder calculi
Urethirtis
Urethral tumors
Ureteritis
Ureteral calculi
Trauma of Ureters, bladder, urethra
Neoplasm of ureters, bladder and urethra
Congenital disorders of ureters, bladder and urethra
Disorders of Ureters, urinary bladder and urethra-
UTI
Cystitis
Urinary incontinence
Urinary retention
Urinary reflux
Bladder neoplasm
Urinary bladder calculi
Urethirtis
Urethral tumors
Ureteritis
Ureteral calculi
Trauma of Ureters, bladder, urethra
Neoplasm of ureters, bladder and urethra
Congenital disorders of ureters, bladder and urethra
anatomy and physiology of
genitourinary system
genitourinary system
anatomy and physiology of
genitourinary system
genitourinary system
anatomy and physiology of
genitourinary system
genitourinary system
anatomy and physiology of
genitourinary system
genitourinary system
physiology of genitourinary
system
system
anatomy and physiology of
genitourinary system
Ureters, Bladder, and Urethra -
Urine, which is formed within the nephrons, flows into the
ureter, a long fibromuscular tube that connects each kidney to
the bladder.
The ureters are narrow, muscular tubes, each 24 to 30 cm long,
that originate at the lower portion of the renal pelvis and
terminate in the trigone of the bladder wall.
There are three narrowed areas of each ureter: the ureteropelvic
junction, the ureteral segment near the sacroiliac junction, and
the ureterovesical junction.
The angling of the ureterovesical junction is the primary means of
providing antegrade, or downward, movement of urine, also
referred to as efflux of urine.
This angling prevents vesicoureteral reflux, which is the
retrograde, or backward, movement of urine from the bladder, up
the ureter, toward the kidney.
genitourinary system
Ureters, Bladder, and Urethra -
Urine, which is formed within the nephrons, flows into the
ureter, a long fibromuscular tube that connects each kidney to
the bladder.
The ureters are narrow, muscular tubes, each 24 to 30 cm long,
that originate at the lower portion of the renal pelvis and
terminate in the trigone of the bladder wall.
There are three narrowed areas of each ureter: the ureteropelvic
junction, the ureteral segment near the sacroiliac junction, and
the ureterovesical junction.
The angling of the ureterovesical junction is the primary means of
providing antegrade, or downward, movement of urine, also
referred to as efflux of urine.
This angling prevents vesicoureteral reflux, which is the
retrograde, or backward, movement of urine from the bladder, up
the ureter, toward the kidney.
anatomy and physiology of
genitourinary system
Ureters, Bladder, and Urethra -
During voiding (micturition), increased intravesical pressure
keeps the ureterovesical junction closed and keeps urine within
the ureters. As soon as micturition is completed, intravesical
pressure returns to its normal low baseline value, allowing efflux
of urine to resume.
Therefore, the only time that the bladder is completely empty is
in the last seconds of micturition before efflux of urine resumes.
The three areas of narrowing within the ureters have a
propensity toward obstruction because of renal calculi
(kidney stones) or stricture.
Obstruction of the ureteropelvic junction is the most serious
because of its close proximity to the kidney and the risk of
associated kidney dysfunction
genitourinary system
Ureters, Bladder, and Urethra -
During voiding (micturition), increased intravesical pressure
keeps the ureterovesical junction closed and keeps urine within
the ureters. As soon as micturition is completed, intravesical
pressure returns to its normal low baseline value, allowing efflux
of urine to resume.
Therefore, the only time that the bladder is completely empty is
in the last seconds of micturition before efflux of urine resumes.
The three areas of narrowing within the ureters have a
propensity toward obstruction because of renal calculi
(kidney stones) or stricture.
Obstruction of the ureteropelvic junction is the most serious
because of its close proximity to the kidney and the risk of
associated kidney dysfunction
anatomy and physiology of
genitourinary system
Ureters, Bladder, and Urethra -
During voiding (micturition), increased intravesical pressure
keeps the ureterovesical junction closed and keeps urine within
the ureters. As soon as micturition is completed, intravesical
pressure returns to its normal low baseline value, allowing efflux
of urine to resume.
Therefore, the only time that the bladder is completely empty is
in the last seconds of micturition before efflux of urine resumes.
The three areas of narrowing within the ureters have a propensity
toward obstruction because of renal calculi (kidney stones) or
stricture.
Obstruction of the ureteropelvic junction is the most serious
because of its close proximity to the kidney and the risk of
associated kidney dysfunction
genitourinary system
Ureters, Bladder, and Urethra -
During voiding (micturition), increased intravesical pressure
keeps the ureterovesical junction closed and keeps urine within
the ureters. As soon as micturition is completed, intravesical
pressure returns to its normal low baseline value, allowing efflux
of urine to resume.
Therefore, the only time that the bladder is completely empty is
in the last seconds of micturition before efflux of urine resumes.
The three areas of narrowing within the ureters have a propensity
toward obstruction because of renal calculi (kidney stones) or
stricture.
Obstruction of the ureteropelvic junction is the most serious
because of its close proximity to the kidney and the risk of
associated kidney dysfunction
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
Multiparous women delivering their children vaginally are
at high risk for stress urinary incontinence
Elderly women and persons with neurologic disorders such
as diabetic neuropathy, multiple sclerosis, or Parkinson’s
disease often have incomplete emptying of the bladder with
urinary stasis, which may result in-
urinary tract infection
increasing bladder pressure leading to overflow
incontinence,
hydronephrosis,
pyelonephritis,
renal insufficiency.
genitourinary system
Nursing assessment: history, and physical examination
Multiparous women delivering their children vaginally are
at high risk for stress urinary incontinence
Elderly women and persons with neurologic disorders such
as diabetic neuropathy, multiple sclerosis, or Parkinson’s
disease often have incomplete emptying of the bladder with
urinary stasis, which may result in-
urinary tract infection
increasing bladder pressure leading to overflow
incontinence,
hydronephrosis,
pyelonephritis,
renal insufficiency.
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
The patient’s chief concern or reason for seeking health
care, the onset of the problem, and its effect on the patient’s
quality of life
The location, character, and duration of pain, if present, and
its relationship to voiding
Factors that precipitate pain, and those that relieve it
History of urinary tract infections, including past treatment
or hospitalization for urinary tract infection
Fever or chills
Previous renal or urinary diagnostic tests or use of
indwelling urinary catheters
genitourinary system
Nursing assessment: history, and physical examination
The patient’s chief concern or reason for seeking health
care, the onset of the problem, and its effect on the patient’s
quality of life
The location, character, and duration of pain, if present, and
its relationship to voiding
Factors that precipitate pain, and those that relieve it
History of urinary tract infections, including past treatment
or hospitalization for urinary tract infection
Fever or chills
Previous renal or urinary diagnostic tests or use of
indwelling urinary catheters
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
Dysuria and when it occurs during voiding (at initiation or
termination of voiding)
Hesitancy, straining, or pain during or after urination
Urinary incontinence (stress incontinence, urge
incontinence, overflow incontinence, or functional
incontinence)
Hematuria or change in color or volume of urine
Nocturia and its date of onset
Renal calculi (kidney stones), passage of stones or gravel in
urine
genitourinary system
Nursing assessment: history, and physical examination
Dysuria and when it occurs during voiding (at initiation or
termination of voiding)
Hesitancy, straining, or pain during or after urination
Urinary incontinence (stress incontinence, urge
incontinence, overflow incontinence, or functional
incontinence)
Hematuria or change in color or volume of urine
Nocturia and its date of onset
Renal calculi (kidney stones), passage of stones or gravel in
urine
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
Female patients: number and type (vaginal or cesarean) of
deliveries; use of forceps; vaginal infection, discharge, or
irritation; contraceptive practices
Presence or history of genital lesions or sexually transmitted
diseases
Habits: use of tobacco, alcohol, or recreational drugs
Any prescription and over-the-counter medications
(including those prescribed for renal or urinary problems)
genitourinary system
Nursing assessment: history, and physical examination
Female patients: number and type (vaginal or cesarean) of
deliveries; use of forceps; vaginal infection, discharge, or
irritation; contraceptive practices
Presence or history of genital lesions or sexually transmitted
diseases
Habits: use of tobacco, alcohol, or recreational drugs
Any prescription and over-the-counter medications
(including those prescribed for renal or urinary problems)
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
genitourinary system
Nursing assessment: history, and physical examination
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
genitourinary system
Nursing assessment: history, and physical examination
anatomy and physiology of
genitourinary system
Nursing assessment: history,
and physical examination
During physical examination
for genitourinary dysfunction
areas of emphasis include the
abdomen, suprapubic region,
genitalia and lower back, and
lower extremities.
Direct palpation of the
kidneys may help determine
their size and mobility
The right kidney is easier to
feel because it is somewhat
lower than the left one
genitourinary system
Nursing assessment: history,
and physical examination
During physical examination
for genitourinary dysfunction
areas of emphasis include the
abdomen, suprapubic region,
genitalia and lower back, and
lower extremities.
Direct palpation of the
kidneys may help determine
their size and mobility
The right kidney is easier to
feel because it is somewhat
lower than the left one
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
Renal dysfunction may produce tenderness over the
costovertebral angle, which is the angle formed by the lower
border of the 12th, or bottom, rib and the spine.
The abdomen is auscultated to assess for bruits (low-
pitched murmurs that indicate renal artery stenosis or an
aortic aneurysm).
The abdomen is also assessed for the presence of peritoneal
fluid, which may occur with kidney dysfunction.
genitourinary system
Nursing assessment: history, and physical examination
Renal dysfunction may produce tenderness over the
costovertebral angle, which is the angle formed by the lower
border of the 12th, or bottom, rib and the spine.
The abdomen is auscultated to assess for bruits (low-
pitched murmurs that indicate renal artery stenosis or an
aortic aneurysm).
The abdomen is also assessed for the presence of peritoneal
fluid, which may occur with kidney dysfunction.
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
The bladder should be percussed after the patient voids to
check for residual urine
Percussion of the bladder begins at the midline just above
the umbilicus and proceeds downward.
The sound changes from tympanic to dull when percussing
over the bladder.
The bladder, which can be palpated only if it is moderately
distended, feels like a smooth, firm, round mass rising out of
the abdomen, usually at midline
Dullness to percussion of the bladder following voiding
indicates incomplete bladder emptying.
genitourinary system
Nursing assessment: history, and physical examination
The bladder should be percussed after the patient voids to
check for residual urine
Percussion of the bladder begins at the midline just above
the umbilicus and proceeds downward.
The sound changes from tympanic to dull when percussing
over the bladder.
The bladder, which can be palpated only if it is moderately
distended, feels like a smooth, firm, round mass rising out of
the abdomen, usually at midline
Dullness to percussion of the bladder following voiding
indicates incomplete bladder emptying.
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
genitourinary system
Nursing assessment: history, and physical examination
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
The prostate gland is palpated by digital rectal examination
(DRE)
Blood is drawn for PSA before the DRE because
manipulation of the prostate can cause the PSA level to rise
temporarily.
The inguinal area is examined for enlarged nodes, an
inguinal or femoral hernia, or varicocele (varicose veins of
the spermatic cord)
genitourinary system
Nursing assessment: history, and physical examination
The prostate gland is palpated by digital rectal examination
(DRE)
Blood is drawn for PSA before the DRE because
manipulation of the prostate can cause the PSA level to rise
temporarily.
The inguinal area is examined for enlarged nodes, an
inguinal or femoral hernia, or varicocele (varicose veins of
the spermatic cord)
anatomy and physiology of
genitourinary system
Nursing assessment: history, and physical examination
In female, the vulva, urethral meatus, and vagina are
examined
The patient is assessed for edema and changes in body
weight. Edema may be observed, particularly in the face and
dependent parts of the body, such as the ankles and sacral
areas
An increase in body weight commonly accompanies edema.
A 1-kg weight gain equals approximately 1,000 mL of fluid.
genitourinary system
Nursing assessment: history, and physical examination
In female, the vulva, urethral meatus, and vagina are
examined
The patient is assessed for edema and changes in body
weight. Edema may be observed, particularly in the face and
dependent parts of the body, such as the ankles and sacral
areas
An increase in body weight commonly accompanies edema.
A 1-kg weight gain equals approximately 1,000 mL of fluid.
urological obstructions
urethral strictures
A urethral stricture is a scar in or around
the urethra, which can block the flow of
urine, and is a result of inflammation,
injury or infection.
urethral strictures
A urethral stricture is a scar in or around
the urethra, which can block the flow of
urine, and is a result of inflammation,
injury or infection.
Anatomy of the Male Reproductive System
urological obstructions
urological obstructions
urological obstructions
urethral strictures
Risk factors-
Urethral strictures are more common in men because
their urethras are longer than those in women.
Thus men's urethras are more susceptible to disease
or injury.
A person is rarely born with urethral strictures and
women rarely develop urethral strictures.
urethral strictures
Risk factors-
Urethral strictures are more common in men because
their urethras are longer than those in women.
Thus men's urethras are more susceptible to disease
or injury.
A person is rarely born with urethral strictures and
women rarely develop urethral strictures.
urological obstructions
urethral strictures
Etiology -
Stricture disease may occur anywhere from the
bladder to the tip of the penis.
The common causes of stricture are trauma to the
urethra and infections such as sexually transmitted
diseases and damage from instrumentation.
Trauma such as straddle injuries, direct trauma to
the penis and catheterization can result in strictures
of the anterior part of the urethra.
urethral strictures
Etiology -
Stricture disease may occur anywhere from the
bladder to the tip of the penis.
The common causes of stricture are trauma to the
urethra and infections such as sexually transmitted
diseases and damage from instrumentation.
Trauma such as straddle injuries, direct trauma to
the penis and catheterization can result in strictures
of the anterior part of the urethra.
urological obstructions
urethral strictures
Etiology -
In adults, urethral strictures from instrumentation
trauma may occur after prostate surgery and urinary
catheterization.
In children, urethral strictures most often follow
reconstructive surgery for congenital abnormalities
of the penis and urethra, cystoscopy and
occasionally may be congenital.
urethral strictures
Etiology -
In adults, urethral strictures from instrumentation
trauma may occur after prostate surgery and urinary
catheterization.
In children, urethral strictures most often follow
reconstructive surgery for congenital abnormalities
of the penis and urethra, cystoscopy and
occasionally may be congenital.
urological obstructions
urethral strictures
Clinical features -
painful urination.
slow urine stream.
decreased urine output.
spraying of the urine stream.
blood in the urine.
abdominal pain.
urethral discharge.
urinary tract infections in men.
infertility in men.
urethral strictures
Clinical features -
painful urination.
slow urine stream.
decreased urine output.
spraying of the urine stream.
blood in the urine.
abdominal pain.
urethral discharge.
urinary tract infections in men.
infertility in men.
urological obstructions
urethral strictures
Diagnostic evaluation-
Evaluation of patients with urethral stricture
includes a physical examination.
Urethral imaging (X-rays or ultrasound).
The retrograde urethrogram is an invaluable test
to evaluate and document the stricture and
define the stricture recurrence. Combined with
antegrade urethrogram, length of the stricture
can be determined.
urethral strictures
Diagnostic evaluation-
Evaluation of patients with urethral stricture
includes a physical examination.
Urethral imaging (X-rays or ultrasound).
The retrograde urethrogram is an invaluable test
to evaluate and document the stricture and
define the stricture recurrence. Combined with
antegrade urethrogram, length of the stricture
can be determined.
Normal Urethrogram Obstructive Urethrogram
urological obstructions
urethral strictures
urological obstructions
urethral strictures
urological obstructions
urethral strictures
Treatment-
Treatment options for urethral stricture disease are
varied and selection depends upon the length,
location and degree of scar tissue associated with the
stricture.
The main treatment options include enlarging the
stricture by gradual stretching (dilation).
urethral strictures
Treatment-
Treatment options for urethral stricture disease are
varied and selection depends upon the length,
location and degree of scar tissue associated with the
stricture.
The main treatment options include enlarging the
stricture by gradual stretching (dilation).
urological obstructions
urethral strictures
Treatment-
Cutting the stricture with a endoscopic equipment
(urethrotomy) and surgical repair of the stricture
with reconnection and reconstruction called
urethroplasty.
Urethral Stents where a biocompatible hollow tube
is placed on the inside of the stricture to allow for
free passage of urine.
urethral strictures
Treatment-
Cutting the stricture with a endoscopic equipment
(urethrotomy) and surgical repair of the stricture
with reconnection and reconstruction called
urethroplasty.
Urethral Stents where a biocompatible hollow tube
is placed on the inside of the stricture to allow for
free passage of urine.
urological obstructions
renal calculi
Urolithiasis refers to stones (calculi) in the urinary
tract.
Stones are formed in the urinary tract when urinary
concentrations of substances such as calcium
oxalate, calcium phosphate, and uric acid increase.
This is referred to as supersaturation and is depen-
dent on the amount of the substance, ionic strength,
and pH of the urine.
renal calculi
Urolithiasis refers to stones (calculi) in the urinary
tract.
Stones are formed in the urinary tract when urinary
concentrations of substances such as calcium
oxalate, calcium phosphate, and uric acid increase.
This is referred to as supersaturation and is depen-
dent on the amount of the substance, ionic strength,
and pH of the urine.
urological obstructions
renal calculi
Incidence-
The occurrence of urinary stones occurs predomi-
nantly in the third to fifth decades of life and
Affects men more than women.
About half of patients with a single renal stone have
another episode within 5 years.
Most stones contain calcium or magnesium in
combination with phosphorus or oxalate.
Most stones are radiopaque and can be detected by
x-ray studies
renal calculi
Incidence-
The occurrence of urinary stones occurs predomi-
nantly in the third to fifth decades of life and
Affects men more than women.
About half of patients with a single renal stone have
another episode within 5 years.
Most stones contain calcium or magnesium in
combination with phosphorus or oxalate.
Most stones are radiopaque and can be detected by
x-ray studies
urological obstructions
renal calculi
Types of stone-
Calcium stone
Oxalate stone
Cystiene stone
Struvite stone
renal calculi
Types of stone-
Calcium stone
Oxalate stone
Cystiene stone
Struvite stone
urological obstructions
renal calculi
Types of stone-
Calcium stone
Most stones (75%) are composed mainly of calcium
oxalate crystals.
Increased calcium concentrations in blood and urine
promote precipitation of calcium and formation of
stones.
Causes of hypercalcemia (high serum calcium) and
hypercalciuria (high urine calcium) include the
following:
renal calculi
Types of stone-
Calcium stone
Most stones (75%) are composed mainly of calcium
oxalate crystals.
Increased calcium concentrations in blood and urine
promote precipitation of calcium and formation of
stones.
Causes of hypercalcemia (high serum calcium) and
hypercalciuria (high urine calcium) include the
following:
urological obstructions
renal calculi
Types of stone-
Calcium stone
Hyperparathyroidism
Renal tubular acidosis
Cancers
Granulomatous diseases (sarcoidosis, tuberculosis), which
may cause increased vitamin D production by the
granulomatous tissue
Excessive intake of vitamin D
Excessive intake of milk and alkali
Myeloproliferative diseases (leukemia, polycythemia vera,
multiple myeloma), which produce an unusual proliferation of
blood cells from the bone marrow
renal calculi
Types of stone-
Calcium stone
Hyperparathyroidism
Renal tubular acidosis
Cancers
Granulomatous diseases (sarcoidosis, tuberculosis), which
may cause increased vitamin D production by the
granulomatous tissue
Excessive intake of vitamin D
Excessive intake of milk and alkali
Myeloproliferative diseases (leukemia, polycythemia vera,
multiple myeloma), which produce an unusual proliferation of
blood cells from the bone marrow
urological obstructions
renal calculi
Types of stone-
Uric acid stones
5% to 10% of all stones
gout
myeloproliferative disorders
Diet high in purines and abnormal purine
metabolism
renal calculi
Types of stone-
Uric acid stones
5% to 10% of all stones
gout
myeloproliferative disorders
Diet high in purines and abnormal purine
metabolism
urological obstructions
renal calculi
Types of stone-
Struvite stones
15% of urinary calculi
form in persistently alkaline, ammonia-rich urine
caused by the presence of urease splitting bacteria
such as Proteus, Pseudomonas, Klebsiella, Staphy-
lococcus, or Mycoplasma species.
Predisposing factors for struvite stones (commonly
called infection stones) include neurogenic bladder,
foreign bodies, and recurrent UTIs.
renal calculi
Types of stone-
Struvite stones
15% of urinary calculi
form in persistently alkaline, ammonia-rich urine
caused by the presence of urease splitting bacteria
such as Proteus, Pseudomonas, Klebsiella, Staphy-
lococcus, or Mycoplasma species.
Predisposing factors for struvite stones (commonly
called infection stones) include neurogenic bladder,
foreign bodies, and recurrent UTIs.
urological obstructions
renal calculi
Types of stone-
Cystine stones
1% to 2% of all stones
occur in patients with a rare inherited defect in renal
absorption of cystine (an amino acid).
renal calculi
Types of stone-
Cystine stones
1% to 2% of all stones
occur in patients with a rare inherited defect in renal
absorption of cystine (an amino acid).
Urological obstrUctions
renal calcUli
Causes and predisposing factors:
Chronic dehydration, poor fluid intake, and immobility
Living in mountainous, desert, or tropical areas
Infection, urinary stasis, and periods of immobility
Inflammatory bowel disease and in patients with an
ileostomy or bowel resection because these patients
absorb more oxalate.
Medications- antacids, acetazolamide (Diamox),
vitamin D, laxatives, and high doses of aspirin
renal calcUli
Causes and predisposing factors:
Chronic dehydration, poor fluid intake, and immobility
Living in mountainous, desert, or tropical areas
Infection, urinary stasis, and periods of immobility
Inflammatory bowel disease and in patients with an
ileostomy or bowel resection because these patients
absorb more oxalate.
Medications- antacids, acetazolamide (Diamox),
vitamin D, laxatives, and high doses of aspirin
Urological obstrUctions
renal calcUli
Location of stones-
Kidney
Ureter
Bladder
Urethra
renal calcUli
Location of stones-
Kidney
Ureter
Bladder
Urethra
Urological obstrUctions
renal calcUli
Site of obstruction-
renal calcUli
Site of obstruction-
Urological obstrUctions
renal calcUli
Clinical features-
Pain
Heamturia
Dysuria
Oedema
Pyuria
Associated symptoms-
Nausea, vomiting, diarrhea, abdominal discomfort
Chills and fever (may)
renal calcUli
Clinical features-
Pain
Heamturia
Dysuria
Oedema
Pyuria
Associated symptoms-
Nausea, vomiting, diarrhea, abdominal discomfort
Chills and fever (may)
Urological obstrUctions
renal calcUli
Clinical features-
Pain-
Stones in the renal pelvis may be associated with an
intense, deep ache in the costovertebral region
Pain originating in the renal area radiates anteriorly
and downward toward the bladder in the female and
toward the testis in the male.
If the pain suddenly becomes acute, with tenderness
over the costovertebral area, and nausea and
vomiting appear termed as renal colic
renal calcUli
Clinical features-
Pain-
Stones in the renal pelvis may be associated with an
intense, deep ache in the costovertebral region
Pain originating in the renal area radiates anteriorly
and downward toward the bladder in the female and
toward the testis in the male.
If the pain suddenly becomes acute, with tenderness
over the costovertebral area, and nausea and
vomiting appear termed as renal colic
Urological obstrUctions
renal calcUli
Clinical features-
Pain-
Stones lodged in the ureter (ureteral obstruction) cause
acute, excruciating, colicky, wavelike pain, radiating
down the thigh and to the genitalia
It is called ureteral colic
Colic is mediated by prostaglandin E, a substance that
increases ureteral contractility and renal blood flow and
that leads to increased intraureteral pressure and pain
If the stone present in the bladder and obstruct he urine
flow, produces the pain at suprapubic region along with
bladder distension
renal calcUli
Clinical features-
Pain-
Stones lodged in the ureter (ureteral obstruction) cause
acute, excruciating, colicky, wavelike pain, radiating
down the thigh and to the genitalia
It is called ureteral colic
Colic is mediated by prostaglandin E, a substance that
increases ureteral contractility and renal blood flow and
that leads to increased intraureteral pressure and pain
If the stone present in the bladder and obstruct he urine
flow, produces the pain at suprapubic region along with
bladder distension
Urological obstrUctions
renal calcUli
Clinical features-
Hematuria-
Hematuria is often present because of the abrasive
action of the stone.
Dysuria-
Painful micturition is termed as dysuria.
Obstruction in urine flow tend to cause the dysuria.
renal calcUli
Clinical features-
Hematuria-
Hematuria is often present because of the abrasive
action of the stone.
Dysuria-
Painful micturition is termed as dysuria.
Obstruction in urine flow tend to cause the dysuria.
Urological obstrUctions
renal calcUli
Clinical features-
Oedema-
When the stones block the flow of urine, obstruction
develops, producing an increase in hydrostatic pressure
and distending the renal pelvis and proximal ureter.
Thereby GFR decreases leads to sodium and water
retetion and gives rise to oedema.
Pyuria-
Obstruction in urine flow, urinary retention and urinary
stasis may cause the UTI and featured as pyuria.
renal calcUli
Clinical features-
Oedema-
When the stones block the flow of urine, obstruction
develops, producing an increase in hydrostatic pressure
and distending the renal pelvis and proximal ureter.
Thereby GFR decreases leads to sodium and water
retetion and gives rise to oedema.
Pyuria-
Obstruction in urine flow, urinary retention and urinary
stasis may cause the UTI and featured as pyuria.
Urological obstrUctions
renal calcUli
Clinical features-
Associated symptoms-
Nausea, vomiting, diarrhea, abdominal discomfort
due to renointestinal reflexes and shared nerve supply
(celiac ganglion) between the ureters and intestine.
and the anatomic proximity of the kidneys to the stomach,
pancreas, and large intestine.
Features of infection-
Due to UTI.
These features may be chill, high grade fever dysuria
etc.
renal calcUli
Clinical features-
Associated symptoms-
Nausea, vomiting, diarrhea, abdominal discomfort
due to renointestinal reflexes and shared nerve supply
(celiac ganglion) between the ureters and intestine.
and the anatomic proximity of the kidneys to the stomach,
pancreas, and large intestine.
Features of infection-
Due to UTI.
These features may be chill, high grade fever dysuria
etc.
Urological obstrUctions
renal calcUli
Diagnostic evaluation-
History
Physical examination
Urinanalysis
Blood studies
Stone chemistry
Radiographic studies
renal calcUli
Diagnostic evaluation-
History
Physical examination
Urinanalysis
Blood studies
Stone chemistry
Radiographic studies
Urological obstrUctions
renal calcUli
Diagnostic evaluation
History -
Diet
Water
Occupation
medication
Past and recent medical history
Collect the informations regarding the reasons for
seeking health care services
renal calcUli
Diagnostic evaluation
History -
Diet
Water
Occupation
medication
Past and recent medical history
Collect the informations regarding the reasons for
seeking health care services
Urological obstrUctions
renal calcUli
Diagnostic evaluation
Physical examination -
Locate, nature and characteristics of pain
Assess the level of pain ,tenderness etc.
Observe for the associated symptoms.
renal calcUli
Diagnostic evaluation
Physical examination -
Locate, nature and characteristics of pain
Assess the level of pain ,tenderness etc.
Observe for the associated symptoms.
Urological obstrUctions
renal calcUli
Diagnostic evaluation
Urinanalysis-
hematuria and pyuria
pH < 5.5 indicates uric acid stone
pH > 7.5 indicates struvite stone
urine culture and drug sensitivity studies to detect
infection.
24-hour urine test for measurement of calcium, uric
acid, creatinine, sodium,citrate and oxalate
renal calcUli
Diagnostic evaluation
Urinanalysis-
hematuria and pyuria
pH < 5.5 indicates uric acid stone
pH > 7.5 indicates struvite stone
urine culture and drug sensitivity studies to detect
infection.
24-hour urine test for measurement of calcium, uric
acid, creatinine, sodium,citrate and oxalate
Urological obstrUctions
renal calcUli
Diagnostic evaluation
Blood studies-
Hyperuracemia
Hypercalcemia
Neutrophilia
Elevated serum parathyroid hormone
renal calcUli
Diagnostic evaluation
Blood studies-
Hyperuracemia
Hypercalcemia
Neutrophilia
Elevated serum parathyroid hormone
Urological obstrUctions
renal calcUli
Diagnostic evaluation
Stone chemistry-
Collection of stone through a strainer is useful.
Analyze the stone chemically to find out the
composition which helps in therapeutic
management.
renal calcUli
Diagnostic evaluation
Stone chemistry-
Collection of stone through a strainer is useful.
Analyze the stone chemically to find out the
composition which helps in therapeutic
management.
Urological obstrUctions
renal calcUli
Diagnostic evaluation
Radiographic studies-
Kidney, ureters, and bladder radiography may show
stone.
Intra venous urogram (intravenous pyelogram) to
determine site and evaluate degree of obstruction
Retrograde pyelography
Ultrasound
Helical or axial CAT Scan
renal calcUli
Diagnostic evaluation
Radiographic studies-
Kidney, ureters, and bladder radiography may show
stone.
Intra venous urogram (intravenous pyelogram) to
determine site and evaluate degree of obstruction
Retrograde pyelography
Ultrasound
Helical or axial CAT Scan
Urological obstrUctions
renal calcUli
Management
General Principles
If small stone (< 4 mm) and able to treat as outpatient,
80% will pass stone spontaneously with hydration, pain
control, and reassurance.
Hospitalized for intractable pain, persistent vomiting,
high-grade fever, obstruction with infection, and solitary
kidney with obstruction.
Medical management
Surgical management
Nursing management
renal calcUli
Management
General Principles
If small stone (< 4 mm) and able to treat as outpatient,
80% will pass stone spontaneously with hydration, pain
control, and reassurance.
Hospitalized for intractable pain, persistent vomiting,
high-grade fever, obstruction with infection, and solitary
kidney with obstruction.
Medical management
Surgical management
Nursing management
Urological obstrUctions
renal calcUli
Management
Medical management
Goal-
Immediate goal-
To relieve the pain until its causes can be eliminated.
Long term goal (basic goal)-
To eradicate the stone
To determine the stone type
To prevent nephron destruction
To control infection
To relieve any obstruction
renal calcUli
Management
Medical management
Goal-
Immediate goal-
To relieve the pain until its causes can be eliminated.
Long term goal (basic goal)-
To eradicate the stone
To determine the stone type
To prevent nephron destruction
To control infection
To relieve any obstruction
Urological obstrUctions
renal calcUli
Management
Medical management
Opioid analgesics or NSAIDs are administered to
prevent shock and syncope that may result from the
excruciating pain.
NSAIDs provide specific pain relief because they
inhibit the synthesis of prostaglandin E.
Hot baths or moist heat to the flank areas may also
be useful.
renal calcUli
Management
Medical management
Opioid analgesics or NSAIDs are administered to
prevent shock and syncope that may result from the
excruciating pain.
NSAIDs provide specific pain relief because they
inhibit the synthesis of prostaglandin E.
Hot baths or moist heat to the flank areas may also
be useful.
Urological obstrUctions
renal calcUli
Management
Medical management
Fluids are encouraged. This increases the
hydrostatic pressure behind the stone, assisting it in
its downward passage.
A high, around-the-clock fluid intake reduces the
concentration of urinary crystalloids, dilutes the
urine, and ensures a high urine output.
renal calcUli
Management
Medical management
Fluids are encouraged. This increases the
hydrostatic pressure behind the stone, assisting it in
its downward passage.
A high, around-the-clock fluid intake reduces the
concentration of urinary crystalloids, dilutes the
urine, and ensures a high urine output.
Urological obstrUctions
renal calcUli
Management
Medical management
Calcium stone-
Cellulose sodium phosphate (Calcibind) may be effective in
preventing calcium stones.
It binds calcium from food in the intestinal tract, reducing the
amount of calcium absorbed into the circulation.
restrict calcium in diet
Therapy with thiazide diuretics may be beneficial in reducing the
calcium loss in the urine and lowering the elevated paratharmone
levels.
The urine may be acidified by use of medications such as
ammonium chloride or acetohydroxamic acid
Sodium and protein restriction diet
renal calcUli
Management
Medical management
Calcium stone-
Cellulose sodium phosphate (Calcibind) may be effective in
preventing calcium stones.
It binds calcium from food in the intestinal tract, reducing the
amount of calcium absorbed into the circulation.
restrict calcium in diet
Therapy with thiazide diuretics may be beneficial in reducing the
calcium loss in the urine and lowering the elevated paratharmone
levels.
The urine may be acidified by use of medications such as
ammonium chloride or acetohydroxamic acid
Sodium and protein restriction diet
Urological obstrUctions
renal calcUli
Management
Medical management
Uric acid stone-
low-purine diet such as shellfish, anchovies,
asparagus, mushrooms, and organ meats are avoided
Allopurinol may be prescribed to reduce serum uric
acid levels and urinary uric acid excretion.
Proteins may be limited in diet
renal calcUli
Management
Medical management
Uric acid stone-
low-purine diet such as shellfish, anchovies,
asparagus, mushrooms, and organ meats are avoided
Allopurinol may be prescribed to reduce serum uric
acid levels and urinary uric acid excretion.
Proteins may be limited in diet
Urological obstrUctions
renal calcUli
Management
Medical management
Cystine stone -
Low-protein diet
Penicillamine is administered to reduce the amount
of cystine in the urine
urine is alkalinized.
renal calcUli
Management
Medical management
Cystine stone -
Low-protein diet
Penicillamine is administered to reduce the amount
of cystine in the urine
urine is alkalinized.
Urological obstrUctions
renal calcUli
Management
Medical management
Oxalate stone -
Encourage the increased fluid intake
Avoid the food contains oxalate such as- spinach,
strawberries, tea, peanuts, wheat bran
renal calcUli
Management
Medical management
Oxalate stone -
Encourage the increased fluid intake
Avoid the food contains oxalate such as- spinach,
strawberries, tea, peanuts, wheat bran
Urological obstrUctions
renal calcUli
Management
Non surgical management-
Ureteroscopy
ESWL (Extra Corporeal Shock wave lithotripsy)
Endoscopic procedures
Electrohydrolic lithotripsy
Chemolysis
renal calcUli
Management
Non surgical management-
Ureteroscopy
ESWL (Extra Corporeal Shock wave lithotripsy)
Endoscopic procedures
Electrohydrolic lithotripsy
Chemolysis
Urological obstrUctions
renal calcUli
Management
Non surgical management-
Ureteroscopy
Ureteroscopy involves visualizing the stone and then destroying it.
Access to the stone is accomplished by inserting a ureteroscope into the
ureter and then inserting a laser, electrohydraulic lithotriptor, or ultrasound
device through the ureteroscope to fragment and remove the stones.
A stent may be inserted and left in place for 48 hours or more after the
procedure to keep the ureter patent
renal calcUli
Management
Non surgical management-
Ureteroscopy
Ureteroscopy involves visualizing the stone and then destroying it.
Access to the stone is accomplished by inserting a ureteroscope into the
ureter and then inserting a laser, electrohydraulic lithotriptor, or ultrasound
device through the ureteroscope to fragment and remove the stones.
A stent may be inserted and left in place for 48 hours or more after the
procedure to keep the ureter patent
Urological obstrUctions
renal calcUli
Management
Non surgical management-
ESWL-
ESWL is a noninvasive procedure used to break up stones in
the calyx of the kidney
In ESWL, a high-energy amplitude of pressure, or shock wave,
is generated by the abrupt release of energy and transmitted
through water and soft tissues.
When the shock wave encounters a substance of different
intensity (a renal stone), a compression wave causes the
surface of the stone to fragment.
Repeated shock waves focused on the stone eventually
reduce it to many small pieces. These small pieces are excreted
in the urine, usually without difficulty.
renal calcUli
Management
Non surgical management-
ESWL-
ESWL is a noninvasive procedure used to break up stones in
the calyx of the kidney
In ESWL, a high-energy amplitude of pressure, or shock wave,
is generated by the abrupt release of energy and transmitted
through water and soft tissues.
When the shock wave encounters a substance of different
intensity (a renal stone), a compression wave causes the
surface of the stone to fragment.
Repeated shock waves focused on the stone eventually
reduce it to many small pieces. These small pieces are excreted
in the urine, usually without difficulty.
Urological obstrUctions
renal calcUli
Management
Non surgical management-
ESWL-
renal calcUli
Management
Non surgical management-
ESWL-
Urological obstrUctions
renal calcUli
Management
Non surgical management-
Endoscopic procedures-
A percutaneous nephrostomy or a percutaneous nephrolithotomy
may be performed, and a nephroscope is introduced through the
dilated percutaneous tract into the renal parenchyma.
Depending on its size, the stone may be extracted with forceps or by
a stone retrieval basket. Alternatively, an ultrasound probe may be
introduced through the nephrostomy tube.
renal calcUli
Management
Non surgical management-
Endoscopic procedures-
A percutaneous nephrostomy or a percutaneous nephrolithotomy
may be performed, and a nephroscope is introduced through the
dilated percutaneous tract into the renal parenchyma.
Depending on its size, the stone may be extracted with forceps or by
a stone retrieval basket. Alternatively, an ultrasound probe may be
introduced through the nephrostomy tube.
Urological obstrUctions
renal calcUli
Management
Non surgical management-
Electrohydraulic lithotripsy-
an electrical discharge is used to create a hydraulic
shock wave to break up the stone.
A probe is passed through the cystoscope, and the
tip of the lithotriptor is placed near the stone
This procedure is performed under topical
anesthesia.
renal calcUli
Management
Non surgical management-
Electrohydraulic lithotripsy-
an electrical discharge is used to create a hydraulic
shock wave to break up the stone.
A probe is passed through the cystoscope, and the
tip of the lithotriptor is placed near the stone
This procedure is performed under topical
anesthesia.
Urological obstrUctions
renal calcUli
Management
Non surgical management-
Chemolysis-
Chemolysis, stone dissolution using infusions of
chemical solutions (eg, alkylating agents, acidifying
agents)
A percutaneous nephrostomy is performed, and the
warm irrigating solution is allowed to flow
continuously onto the stone.
renal calcUli
Management
Non surgical management-
Chemolysis-
Chemolysis, stone dissolution using infusions of
chemical solutions (eg, alkylating agents, acidifying
agents)
A percutaneous nephrostomy is performed, and the
warm irrigating solution is allowed to flow
continuously onto the stone.
Urological obstrUctions
renal calcUli
Management
Surgical management-
Nephrolithotomy - Incision into the kidney with
removal of the stone
Nephrectomy – removal of kidney
Pyelolithotomy - removal of stone from renal pelvis
Ureterolithotomy - removal of stone from ureter
Cystostomy – removal of stone from bladder
Cystolitholapaxy - an instrument is inserted through
the urethra into the bladder, and the stone is crushed in
the jaws of this instrument
renal calcUli
Management
Surgical management-
Nephrolithotomy - Incision into the kidney with
removal of the stone
Nephrectomy – removal of kidney
Pyelolithotomy - removal of stone from renal pelvis
Ureterolithotomy - removal of stone from ureter
Cystostomy – removal of stone from bladder
Cystolitholapaxy - an instrument is inserted through
the urethra into the bladder, and the stone is crushed in
the jaws of this instrument
DisorDers of kiDney
glomerUlonephritis ,acUte
(acUte nephritic synDrome )
Definition –
Acute glomerulonephritis refers to a group of
kidney diseases in which there is an
inflammatory reaction in the glomeruli.
It is not an infection of the kidney, but rather
the result of the immune mechanisms of the
body
glomerUlonephritis ,acUte
(acUte nephritic synDrome )
Definition –
Acute glomerulonephritis refers to a group of
kidney diseases in which there is an
inflammatory reaction in the glomeruli.
It is not an infection of the kidney, but rather
the result of the immune mechanisms of the
body
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome )
Risk factors –
Group A beta- hemolytic streptococcal infection of the
throat
Impetigo (infection of the skin)
Acute viral infections- upper respiratory tract infections,
mumps, varicella zoster virus, Epstein-Barr virus, hepatitis
B, and human immunodeficiency virus [HIV] infection).
Antigens outside the body (eg, medications, foreign serum)
In other patients, the kidney tissue itself serves as the
inciting antigen.
glomerUlonephritis , acUte
(acUte nephritic synDrome )
Risk factors –
Group A beta- hemolytic streptococcal infection of the
throat
Impetigo (infection of the skin)
Acute viral infections- upper respiratory tract infections,
mumps, varicella zoster virus, Epstein-Barr virus, hepatitis
B, and human immunodeficiency virus [HIV] infection).
Antigens outside the body (eg, medications, foreign serum)
In other patients, the kidney tissue itself serves as the
inciting antigen.
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome )
Categories –
Primary: Disease is mainly in glomeruli
Secondary: Glomerular diseases that are the
consequence of systemic disease
Idiopathic: Cause is unknown
Acute: Occurs over days or weeks
Chronic: Occurs over months or years
Rapidly progressing: Constant loss of renal function
with minimal chance of recovery
glomerUlonephritis , acUte
(acUte nephritic synDrome )
Categories –
Primary: Disease is mainly in glomeruli
Secondary: Glomerular diseases that are the
consequence of systemic disease
Idiopathic: Cause is unknown
Acute: Occurs over days or weeks
Chronic: Occurs over months or years
Rapidly progressing: Constant loss of renal function
with minimal chance of recovery
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome )
Categories –
Diffuse: Involves all glomeruli
Focal: Involves some glomeruli
Segmental: Involves portions of individual
glomeruli
Membranous: Evidence of thickened glomerular
capillary walls
Proliferative: Number of glomerular cells involved
is increasing
glomerUlonephritis , acUte
(acUte nephritic synDrome )
Categories –
Diffuse: Involves all glomeruli
Focal: Involves some glomeruli
Segmental: Involves portions of individual
glomeruli
Membranous: Evidence of thickened glomerular
capillary walls
Proliferative: Number of glomerular cells involved
is increasing
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
glomerUlonephritis , acUte
(acUte nephritic synDrome)
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Clinical features-
Hematuria - The urine may appear cola-colored be- cause of
red blood cells (RBCs) and protein plugs or casts; RBC casts
indicate glomerular injury.
Edema and hypertension
Oliguria
Anemia from loss of RBCs into the urine
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Clinical features-
Hematuria - The urine may appear cola-colored be- cause of
red blood cells (RBCs) and protein plugs or casts; RBC casts
indicate glomerular injury.
Edema and hypertension
Oliguria
Anemia from loss of RBCs into the urine
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Clinical features-
In the more severe form of the disease, patients also
complain of headache, malaise, and flank pain.
Elderly patients may experience circulatory overload
with dyspnea, engorged neck veins, cardiomegaly, and
pulmonary edema.
Atypical symptoms include confusion, somnolence, and
seizures, which are often confused with the symptoms of
a primary neurologic disorder
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Clinical features-
In the more severe form of the disease, patients also
complain of headache, malaise, and flank pain.
Elderly patients may experience circulatory overload
with dyspnea, engorged neck veins, cardiomegaly, and
pulmonary edema.
Atypical symptoms include confusion, somnolence, and
seizures, which are often confused with the symptoms of
a primary neurologic disorder
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Diagnostic evaluation-
History
On examination- kidney is large, tender, edematous and congested
Urinanalysis- protienuria, hematuria , oliguria
Blood studies-
Serum creatinine, BUN increased
Hypoalbuminemia, hyperlipidemia
Elevated serum IgA level
Antistreptolysin O titers are usually elevated in post streptococcal
glomerulonephritis
Electron microscopy and immunofluorescent analysis help identify the
nature of the lesion
Kidney biopsy may be needed for definitive diagnosis.
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Diagnostic evaluation-
History
On examination- kidney is large, tender, edematous and congested
Urinanalysis- protienuria, hematuria , oliguria
Blood studies-
Serum creatinine, BUN increased
Hypoalbuminemia, hyperlipidemia
Elevated serum IgA level
Antistreptolysin O titers are usually elevated in post streptococcal
glomerulonephritis
Electron microscopy and immunofluorescent analysis help identify the
nature of the lesion
Kidney biopsy may be needed for definitive diagnosis.
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Complications-
Hypertensive Encephalopathy
Heart Failure
Pulmonary Edema
ESRD
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Complications-
Hypertensive Encephalopathy
Heart Failure
Pulmonary Edema
ESRD
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Management-
Goal-
To conserve renal function
To treat complication adequately
Types of management-
Non pharmacological management
Dietary management
Pharmacological management
Nursing management
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Management-
Goal-
To conserve renal function
To treat complication adequately
Types of management-
Non pharmacological management
Dietary management
Pharmacological management
Nursing management
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Non pharmacological management-
Complete bed rest – as excessive activity may increase the
protienuria and hematuria. It should be encouraged until the
urine clears and BUN, creatinine and BP return to normal.
Strict intake out put charting.
Fluid restrictions
Plasmapheresis to decrease the serum anti body level
Dialysis if, uremic symptoms are severe.
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Non pharmacological management-
Complete bed rest – as excessive activity may increase the
protienuria and hematuria. It should be encouraged until the
urine clears and BUN, creatinine and BP return to normal.
Strict intake out put charting.
Fluid restrictions
Plasmapheresis to decrease the serum anti body level
Dialysis if, uremic symptoms are severe.
DisorDers of kiDney
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Dietary management-
Protein restricted diet as the level of BUN and creatinine is
high in blood
Low fat diet due to hyperlipidemia
Sodium restriction if hypertension, edema or congestive
heart failure are present.
Increased carbohydrate diet to provide energy and to
prevent the catabolism of protein.
glomerUlonephritis , acUte
(acUte nephritic synDrome)
Dietary management-
Protein restricted diet as the level of BUN and creatinine is
high in blood
Low fat diet due to hyperlipidemia
Sodium restriction if hypertension, edema or congestive
heart failure are present.
Increased carbohydrate diet to provide energy and to
prevent the catabolism of protein.
DisorDers of kiDney
Glomerulonephritis , acute
(acute nephritic synDrome)
Pharmacological management-
Residual streptococcal infection is suspected, penicillin is
the agent of choice.
Diuretics and antihypertensive agents may be given to
control hypertension.
Corticosteroids and cytotoxic agents are used to reduce
the inflammation.
H
2
blockers (to prevent stress ulcers)
Phosphate binding agents (to reduce phosphate and
elevate calcium).
Glomerulonephritis , acute
(acute nephritic synDrome)
Pharmacological management-
Residual streptococcal infection is suspected, penicillin is
the agent of choice.
Diuretics and antihypertensive agents may be given to
control hypertension.
Corticosteroids and cytotoxic agents are used to reduce
the inflammation.
H
2
blockers (to prevent stress ulcers)
Phosphate binding agents (to reduce phosphate and
elevate calcium).
DisorDers of kiDney
Glomerulonephritis , acute
(acute nephritic synDrome)
Nursing management-
Monitor vital signs, intake and output, and maintain dietary
restrictions during acute phase.
Encourage rest during the acute phase as directed until the
urine clears and BUN, creatinine, and blood pressure
normalize. (Rest also facilitates diuresis.)
Administer medications as ordered, and evaluate patient's
response to antihypertensives, diuretics, H
2
blockers,
phosphate-binding agents, and antibiotics (if indicated).
Glomerulonephritis , acute
(acute nephritic synDrome)
Nursing management-
Monitor vital signs, intake and output, and maintain dietary
restrictions during acute phase.
Encourage rest during the acute phase as directed until the
urine clears and BUN, creatinine, and blood pressure
normalize. (Rest also facilitates diuresis.)
Administer medications as ordered, and evaluate patient's
response to antihypertensives, diuretics, H
2
blockers,
phosphate-binding agents, and antibiotics (if indicated).
DisorDers of kiDney
Glomerulonephritis , acute
(acute nephritic synDrome)
Nursing management-
Carefully monitor fluid balance
Replace fluids according to the patient's fluid losses (urine,
respiration, feces)
Daily body weight as prescribed.
Monitor pulmonary artery pressure and CVP, if indicated.
Monitor for signs and symptoms of heart failure: distended neck
veins, tachycardia, gallop rhythm, enlarged and tender liver,
crackles at bases of lungs.
Observe for hypertensive encephalopathy, any evidence of
seizure activity.
Glomerulonephritis , acute
(acute nephritic synDrome)
Nursing management-
Carefully monitor fluid balance
Replace fluids according to the patient's fluid losses (urine,
respiration, feces)
Daily body weight as prescribed.
Monitor pulmonary artery pressure and CVP, if indicated.
Monitor for signs and symptoms of heart failure: distended neck
veins, tachycardia, gallop rhythm, enlarged and tender liver,
crackles at bases of lungs.
Observe for hypertensive encephalopathy, any evidence of
seizure activity.
DisorDers of kiDney
Glomerulonephritis , acute
(acute nephritic synDrome)
Nursing management-
Regular monitoring of blood pressure, urinary
protein, and BUN concentrations to determine if
there is exacerbation of disease activity.
Encourage patient to treat any infection promptly.
Tell patient to report any signs of decreasing renal
function and to obtain treatment immediately.
Glomerulonephritis , acute
(acute nephritic synDrome)
Nursing management-
Regular monitoring of blood pressure, urinary
protein, and BUN concentrations to determine if
there is exacerbation of disease activity.
Encourage patient to treat any infection promptly.
Tell patient to report any signs of decreasing renal
function and to obtain treatment immediately.
DisorDers of kiDney
acute pyelonephritis
Definition-
Pyelonephritis is a bacterial infection of the renal
pelvis, tubules, and interstitial tissue of one or both
kidneys.
acute pyelonephritis
Definition-
Pyelonephritis is a bacterial infection of the renal
pelvis, tubules, and interstitial tissue of one or both
kidneys.
DisorDers of kiDney
acute pyelonephritis
Etiology-
upward spread of bacteria from the bladder or spread from
systemic sources reaching the kidney via the bloodstream.
Systemic infections (such as tuberculosis) can spread to the
kidneys and result in abscesses.
Pyelonephritis can result from urinary obstruction such as
vesicoureteral reflux (incompetence of ureterovesical valve,
which allows urine to regurgitate into ureters, usually at time
of voiding), other renal disease, trauma, or pregnancy
acute pyelonephritis
Etiology-
upward spread of bacteria from the bladder or spread from
systemic sources reaching the kidney via the bloodstream.
Systemic infections (such as tuberculosis) can spread to the
kidneys and result in abscesses.
Pyelonephritis can result from urinary obstruction such as
vesicoureteral reflux (incompetence of ureterovesical valve,
which allows urine to regurgitate into ureters, usually at time
of voiding), other renal disease, trauma, or pregnancy
DisorDers of kiDney
acute pyelonephritis
Commonest microorganism-
Enteric bacteria, such as E. coli, is most common pathogen
other gram-negative pathogens include Proteus species,
Klebsiella, and Pseudomonas.
Gram-positive bacteria are less common, but include
Enterococcus and Staphylococcus aureus
acute pyelonephritis
Commonest microorganism-
Enteric bacteria, such as E. coli, is most common pathogen
other gram-negative pathogens include Proteus species,
Klebsiella, and Pseudomonas.
Gram-positive bacteria are less common, but include
Enterococcus and Staphylococcus aureus
DisorDers of kiDney
acute pyelonephritis
Pathophysiology-
acute pyelonephritis
Pathophysiology-
DisorDers of kiDney
acute pyelonephritis
Clinical features-
Fever, chills, headache, malaise
Flank pain (with or without radiation to groin)
Nausea, vomiting, anorexia
Costovertebral angle tenderness
Urgency, frequency, and dysuria may be present
acute pyelonephritis
Clinical features-
Fever, chills, headache, malaise
Flank pain (with or without radiation to groin)
Nausea, vomiting, anorexia
Costovertebral angle tenderness
Urgency, frequency, and dysuria may be present
DisorDers of kiDney
acute pyelonephritis
Diagnostic evaluation-
History – urinary obstruction, systemic infection
Physical examination- pain and tenderness in the area of the
costovertebral angle
Urinalysis- pyuria, bactriuria, RBCs and WBCs in urine
Hematology- elevated WBC count
An ultrasound study or a CT scan may be performed to
locate any obstruction in the urinary tract.
An IV pyelogram may be indicated with pyelonephritis if
functional and structural renal abnormalities are suspected
Urine culture and sensitivity tests are performed to
determine the causative organism
acute pyelonephritis
Diagnostic evaluation-
History – urinary obstruction, systemic infection
Physical examination- pain and tenderness in the area of the
costovertebral angle
Urinalysis- pyuria, bactriuria, RBCs and WBCs in urine
Hematology- elevated WBC count
An ultrasound study or a CT scan may be performed to
locate any obstruction in the urinary tract.
An IV pyelogram may be indicated with pyelonephritis if
functional and structural renal abnormalities are suspected
Urine culture and sensitivity tests are performed to
determine the causative organism
DisorDers of kiDney
acute pyelonephritis
Management-
For severe infections (dehydrated, cannot tolerate oral
intake) or complicating factors (suspected obstruction,
pregnancy, advanced age), inpatient antibiotic therapy is
recommended.
Usually immediate treatment is started with a penicillin or
aminoglycoside I.V. to cover the prevalent gram-negative
pathogens; subsequently adjusted according to culture
results.
An oral antibiotic may be started 24 hours after fever has
resolved and oral therapy continued for 3 weeks.
acute pyelonephritis
Management-
For severe infections (dehydrated, cannot tolerate oral
intake) or complicating factors (suspected obstruction,
pregnancy, advanced age), inpatient antibiotic therapy is
recommended.
Usually immediate treatment is started with a penicillin or
aminoglycoside I.V. to cover the prevalent gram-negative
pathogens; subsequently adjusted according to culture
results.
An oral antibiotic may be started 24 hours after fever has
resolved and oral therapy continued for 3 weeks.
DisorDers of kiDney
acute pyelonephritis
Management-
Oral therapy antibiotic therapy is acceptable for
outpatient treatment.
Co-trimoxazole (Bactrim, Septran) or a
fluoroquinolone is used; 10 to 14 days is the usual
length of treatment.
Repeat urine cultures should be performed after the
completion of therapy.
Supportive therapy is given for fever and pain
control and hydration.
acute pyelonephritis
Management-
Oral therapy antibiotic therapy is acceptable for
outpatient treatment.
Co-trimoxazole (Bactrim, Septran) or a
fluoroquinolone is used; 10 to 14 days is the usual
length of treatment.
Repeat urine cultures should be performed after the
completion of therapy.
Supportive therapy is given for fever and pain
control and hydration.
DisorDers of kiDney
acute pyelonephritis
Complication-
Bacteremia with sepsis
Papillary necrosis leading to renal failure
Renal abscess requiring treatment by percutaneous
drainage or prolonged antibiotic therapy
Perinephric abscess
Paralytic ileus
acute pyelonephritis
Complication-
Bacteremia with sepsis
Papillary necrosis leading to renal failure
Renal abscess requiring treatment by percutaneous
drainage or prolonged antibiotic therapy
Perinephric abscess
Paralytic ileus
DisorDers of kiDney
acute pyelonephritis
Nursing Management-
Administer or teach self-administration of
antibiotics as prescribed, and monitor for
effectiveness and adverse effects.
Assess vital signs frequently, and monitor intake
and output; administer antiemetic medications to
control nausea and vomiting.
Administer antipyretic medications as prescribed
and according to temperature.
acute pyelonephritis
Nursing Management-
Administer or teach self-administration of
antibiotics as prescribed, and monitor for
effectiveness and adverse effects.
Assess vital signs frequently, and monitor intake
and output; administer antiemetic medications to
control nausea and vomiting.
Administer antipyretic medications as prescribed
and according to temperature.
DisorDers of kiDney
acute pyelonephritis
Nursing Management-
Report fever that persists beyond 72 hours after initiating
antibiotic therapy; further testing for complicating factors
will be ordered.
Use measures to decrease body temperature if indicated;
cooling blanket, application of ice to armpits and groins, and
so forth.
Correct dehydration by replacing fluids, orally if possible,
or I.V.
Monitor CBC, blood cultures, and urine studies for
resolving infection.
acute pyelonephritis
Nursing Management-
Report fever that persists beyond 72 hours after initiating
antibiotic therapy; further testing for complicating factors
will be ordered.
Use measures to decrease body temperature if indicated;
cooling blanket, application of ice to armpits and groins, and
so forth.
Correct dehydration by replacing fluids, orally if possible,
or I.V.
Monitor CBC, blood cultures, and urine studies for
resolving infection.
DisorDers of kiDney
nephrotic synDrome
Definition-
Nephrotic syndrome is a clinical disorder characterized by
marked increase of protein in the urine (proteinuria),
decrease in albumin in the blood (hypoalbuminemia),
edema, and excess lipids in the blood (hyperlipidemia).
These occur because of increased permeability of the
glomerular capillary membrane.
nephrotic synDrome
Definition-
Nephrotic syndrome is a clinical disorder characterized by
marked increase of protein in the urine (proteinuria),
decrease in albumin in the blood (hypoalbuminemia),
edema, and excess lipids in the blood (hyperlipidemia).
These occur because of increased permeability of the
glomerular capillary membrane.
DisorDers of kiDney
nephrotic synDrome
Classification of nephrotic syndrome-
ETOLOGICAL CLASSIFICATION
Primary NEPHROTIC syndrome.
Disease limited to kidney
Secondary NEPHROTIC syndrome.
Other systems involved
HISTOLOGICAL CLASISIFICATION
MCD (Minimal change disease )
FSGN (Focal segmental glomerulosclerosis )
MN (Membranous nephropathy)
MPGN (membranous proliferative glomerulonephrosclerosis)
nephrotic synDrome
Classification of nephrotic syndrome-
ETOLOGICAL CLASSIFICATION
Primary NEPHROTIC syndrome.
Disease limited to kidney
Secondary NEPHROTIC syndrome.
Other systems involved
HISTOLOGICAL CLASISIFICATION
MCD (Minimal change disease )
FSGN (Focal segmental glomerulosclerosis )
MN (Membranous nephropathy)
MPGN (membranous proliferative glomerulonephrosclerosis)
DisorDers of kiDney
nephrotic synDrome
Etiology-
Membranous nephropathy (MN)
Hepatitis B
Sjogren's syndrome
Systemic lupus erythematosus (SLE)
Diabetes mellitus
Sarcoidosis
Syphilis
Drugs
Malignancy (cancer)
nephrotic synDrome
Etiology-
Membranous nephropathy (MN)
Hepatitis B
Sjogren's syndrome
Systemic lupus erythematosus (SLE)
Diabetes mellitus
Sarcoidosis
Syphilis
Drugs
Malignancy (cancer)
DisorDers of kiDney
nephrotic synDrome
Etiology-
Focal segmental glomerulosclerosis (FSGS)
Hypertensive Nephrosclerosis
Human immunodeficiency virus (HIV)
Diabetes mellitus
Obesity
Kidney loss
Minimal change disease (MCD)
Drugs
Malignancy, especially Hodgkin's lymphoma
nephrotic synDrome
Etiology-
Focal segmental glomerulosclerosis (FSGS)
Hypertensive Nephrosclerosis
Human immunodeficiency virus (HIV)
Diabetes mellitus
Obesity
Kidney loss
Minimal change disease (MCD)
Drugs
Malignancy, especially Hodgkin's lymphoma
DisorDers of kiDney
nephrotic synDrome
pathophysiology-
nephrotic synDrome
pathophysiology-
DisorDers of kiDney
nephrotic synDrome
Clinical features-
The major manifestation of nephrotic syndrome is
edema.
It is usually soft and pitting and commonly occurs
around the eyes (periorbital), in dependent areas
(sacrum, ankles, and hands), and in the abdomen
(ascites).
Patients may also exhibit irritability, headache, and
malaise.
nephrotic synDrome
Clinical features-
The major manifestation of nephrotic syndrome is
edema.
It is usually soft and pitting and commonly occurs
around the eyes (periorbital), in dependent areas
(sacrum, ankles, and hands), and in the abdomen
(ascites).
Patients may also exhibit irritability, headache, and
malaise.
DisorDers of kiDney
nephrotic synDrome
Diagnostic evaluation-
Urinalysis- marked proteinuria, microscopic hematuria,
24-hour urine for protein (increased) and creatinine
clearance (decreased)
Protein electrophoresis and immunoelectrophoresis of
the urine to categorize the proteinuria
Needle biopsy of kidney for histologic examination of
renal tissue to confirm diagnosis
Serum chemistry- decreased total protein and albumin,
normal or increased creatinine, increased triglycerides,
and altered lipid profile
nephrotic synDrome
Diagnostic evaluation-
Urinalysis- marked proteinuria, microscopic hematuria,
24-hour urine for protein (increased) and creatinine
clearance (decreased)
Protein electrophoresis and immunoelectrophoresis of
the urine to categorize the proteinuria
Needle biopsy of kidney for histologic examination of
renal tissue to confirm diagnosis
Serum chemistry- decreased total protein and albumin,
normal or increased creatinine, increased triglycerides,
and altered lipid profile
DisorDers of kiDney
nephrotic synDrome
Complications-
Complications of nephrotic syndrome include-
Infection (due to a deficient immune response)
Thromboembolism (especially of the renal vein)
Pulmonary emboli
ARF(due to hypovolemia)
Accelerated atherosclerosis (due to hyperlipidemia)
nephrotic synDrome
Complications-
Complications of nephrotic syndrome include-
Infection (due to a deficient immune response)
Thromboembolism (especially of the renal vein)
Pulmonary emboli
ARF(due to hypovolemia)
Accelerated atherosclerosis (due to hyperlipidemia)
DisorDers of kiDney
nephrotic synDrome
Management-
Treatment of causative glomerular disease
Diuretics (used cautiously) and angiotensin converting
enzyme inhibitors to control proteinuria
Corticosteroids or immunosuppressant agents to decrease
proteinuria
General management of edema
Sodium and fluid restriction; liberal potassium
Infusion of salt-poor albumin
Dietary protein supplements
Low-saturated-fat diet
nephrotic synDrome
Management-
Treatment of causative glomerular disease
Diuretics (used cautiously) and angiotensin converting
enzyme inhibitors to control proteinuria
Corticosteroids or immunosuppressant agents to decrease
proteinuria
General management of edema
Sodium and fluid restriction; liberal potassium
Infusion of salt-poor albumin
Dietary protein supplements
Low-saturated-fat diet
DisorDers of kiDney
nephrotic synDrome
Nursing Management-
Monitor daily weight, intake and output, and urine specific
gravity.
Monitor CVP (if indicated), vital signs, orthostatic blood
pressure, and heart rate to detect hypovolemia.
Monitor serum BUN and creatinine to assess renal function.
Administer diuretics or immunosuppressants as prescribed,
and evaluate patient's response.
Infuse I.V. albumin as ordered.
Encourage bed rest for a few days to help mobilize edema;
however, some ambulation is necessary to reduce risk of
thromboembolic complications.
nephrotic synDrome
Nursing Management-
Monitor daily weight, intake and output, and urine specific
gravity.
Monitor CVP (if indicated), vital signs, orthostatic blood
pressure, and heart rate to detect hypovolemia.
Monitor serum BUN and creatinine to assess renal function.
Administer diuretics or immunosuppressants as prescribed,
and evaluate patient's response.
Infuse I.V. albumin as ordered.
Encourage bed rest for a few days to help mobilize edema;
however, some ambulation is necessary to reduce risk of
thromboembolic complications.
DisorDers of kiDney
acute renal failure
Definition-
Acute renal failure is a sudden and almost complete
loss of kidney function caused by failure of renal
circulation or by glomerular or tubular dysfunction.
acute renal failure
Definition-
Acute renal failure is a sudden and almost complete
loss of kidney function caused by failure of renal
circulation or by glomerular or tubular dysfunction.
DisorDers of kiDney
acute renal failure
Etiology-
Pre – renal (hypoperfusion of kidney)
Intra – renal (actual damage to the kidney tissue)
Post – renal (obstruction to urine flow)
acute renal failure
Etiology-
Pre – renal (hypoperfusion of kidney)
Intra – renal (actual damage to the kidney tissue)
Post – renal (obstruction to urine flow)
DisorDers of kiDney
acute renal failure
Etiology-
Pre – renal
Volume depetion
Hemorrhage
Renal loses
GI losses
Impaired cardiac efficiency
Vasodilation
sepsis
Anaphylaxis
Antihypertensive medications
acute renal failure
Etiology-
Pre – renal
Volume depetion
Hemorrhage
Renal loses
GI losses
Impaired cardiac efficiency
Vasodilation
sepsis
Anaphylaxis
Antihypertensive medications
DisorDers of kiDney
acute renal failure
Etiology-
Intra – renal
Prolonged renal ischemia
Pigment nephropathy
Myoglobinuria
Hemoglobinuria
Nephrotoxic agents
Aminoglycosides agents
Radiopaque contrast agents
Heavy metals
Solvents and chemicals
NSAIDs
Renal infections
acute renal failure
Etiology-
Intra – renal
Prolonged renal ischemia
Pigment nephropathy
Myoglobinuria
Hemoglobinuria
Nephrotoxic agents
Aminoglycosides agents
Radiopaque contrast agents
Heavy metals
Solvents and chemicals
NSAIDs
Renal infections
DisorDers of kiDney
acute renal failure
Etiology-
Post – renal
Urinary tract obstructions
Renal calculi
Tumors
BPH
Blood clots
Strictutres
acute renal failure
Etiology-
Post – renal
Urinary tract obstructions
Renal calculi
Tumors
BPH
Blood clots
Strictutres
DisorDers of kiDney
acute renal failure
RISK FACTORS
Advanced age
Blockages in the blood vessels in your arms or legs
Diabetes
High blood pressure
Heart failure
Kidney diseases
Liver disease
acute renal failure
RISK FACTORS
Advanced age
Blockages in the blood vessels in your arms or legs
Diabetes
High blood pressure
Heart failure
Kidney diseases
Liver disease
DisorDers of kiDney
acute renal failure
RISK FACTORS
Advanced age
Blockages in the blood vessels in your arms or legs
Diabetes
High blood pressure
Heart failure
Kidney diseases
Liver disease
acute renal failure
RISK FACTORS
Advanced age
Blockages in the blood vessels in your arms or legs
Diabetes
High blood pressure
Heart failure
Kidney diseases
Liver disease
DisorDers of kiDney
acute renal failure
PHASES OF ARF
Initiating phase
Oliguric phase
Diuretic phase
Recovery phase
acute renal failure
PHASES OF ARF
Initiating phase
Oliguric phase
Diuretic phase
Recovery phase
DisorDers of kiDney
acute renal failure
PHASES OF ARF
Initiating phase
Begins with the initial insult and ends when oliguria develops
Oliguric phase
Urine output less than 400 ml/day
Diuretic phase
Urine out put become normal but nitrogenous waste products
still remain elevated in blood
Recovery phase
It signifies the improvement of renal function
It takes 3-12 months to return normal
acute renal failure
PHASES OF ARF
Initiating phase
Begins with the initial insult and ends when oliguria develops
Oliguric phase
Urine output less than 400 ml/day
Diuretic phase
Urine out put become normal but nitrogenous waste products
still remain elevated in blood
Recovery phase
It signifies the improvement of renal function
It takes 3-12 months to return normal
DisorDers of kiDney
acute renal failure
Clinical features-
Vomiting and/or diarrhea, which may lead to dehydration.
Nausea.
Weight loss.
Nocturnal urination.
pale urine.
Less frequent urination, or in smaller amounts than usual,
with dark coloured urine
Haematuria.
Pressure, or difficulty urinating.
Itching.
acute renal failure
Clinical features-
Vomiting and/or diarrhea, which may lead to dehydration.
Nausea.
Weight loss.
Nocturnal urination.
pale urine.
Less frequent urination, or in smaller amounts than usual,
with dark coloured urine
Haematuria.
Pressure, or difficulty urinating.
Itching.
DisorDers of kiDney
acute renal failure
Clinical features-
Bone damage.
Non-union in broken bones.
Muscle cramps (caused by low levels of calcium which can
cause hypocalcaemia)
Abnormal heart rhythms.
Muscle paralysis.
Swelling of the legs, ankles, feet, face and/or hands.
Shortness of breath due to extra fluid on the lungs
Pain in the back or side
Feeling tired and/or weak.
acute renal failure
Clinical features-
Bone damage.
Non-union in broken bones.
Muscle cramps (caused by low levels of calcium which can
cause hypocalcaemia)
Abnormal heart rhythms.
Muscle paralysis.
Swelling of the legs, ankles, feet, face and/or hands.
Shortness of breath due to extra fluid on the lungs
Pain in the back or side
Feeling tired and/or weak.
DisorDers of kiDney
acute renal failure
Clinical features-
Memory problems.
Difficulty concentrating.
Dizziness.
Low blood pressure.
Anorexia
Pruritus
Seizures (if blood urea nitrogen level is very high)
acute renal failure
Clinical features-
Memory problems.
Difficulty concentrating.
Dizziness.
Low blood pressure.
Anorexia
Pruritus
Seizures (if blood urea nitrogen level is very high)
DisorDers of kiDney
acute renal failure
Diagnostic evaluation-
History regarding the etiological factors and risk factors.
Physical symptoms
Urine out put – scanty, bloody, and low specific gravity
Increased BUN and creatinine level in blood
Hyperkalemia
Metabolic acidosis
Hyperphoshatemia
Hypocalcemia
Anemia
acute renal failure
Diagnostic evaluation-
History regarding the etiological factors and risk factors.
Physical symptoms
Urine out put – scanty, bloody, and low specific gravity
Increased BUN and creatinine level in blood
Hyperkalemia
Metabolic acidosis
Hyperphoshatemia
Hypocalcemia
Anemia
DisorDers of kiDney
acute renal failure
Prevention-
Provide adequate hydration to patient at high risk
for dehydration
Prevent and treat shock with blood and fluid
replacement therapy
Manage hypotension
Monitor critically ill patient for central venous and
arterial pressures and hourly urine output to detect
the onset of renal failure as early as possible.
Continuously assess the renal function
acute renal failure
Prevention-
Provide adequate hydration to patient at high risk
for dehydration
Prevent and treat shock with blood and fluid
replacement therapy
Manage hypotension
Monitor critically ill patient for central venous and
arterial pressures and hourly urine output to detect
the onset of renal failure as early as possible.
Continuously assess the renal function
DisorDers of kiDney
acute renal failure
Prevention-
Prevent and treat infections
Cautiously administer the blood
Closely monitor the all medications that
metabolized and excreted by the kidney for dosage
and blood levels for the toxic effects.
Pay special attention to wound, burns and other
precursors of sepsis.
acute renal failure
Prevention-
Prevent and treat infections
Cautiously administer the blood
Closely monitor the all medications that
metabolized and excreted by the kidney for dosage
and blood levels for the toxic effects.
Pay special attention to wound, burns and other
precursors of sepsis.
DisorDers of kiDney
acute renal failure
COMPLICATIONS
ARF can affect the entire body in the form of –
Infection
Hyperkalaemia, Hyperphosphataemia, Hyponatraemia
Water overload
Pericarditis
Pulmonary oedema.
Reduced level of consciousness.
Immune deficiency
acute renal failure
COMPLICATIONS
ARF can affect the entire body in the form of –
Infection
Hyperkalaemia, Hyperphosphataemia, Hyponatraemia
Water overload
Pericarditis
Pulmonary oedema.
Reduced level of consciousness.
Immune deficiency
DisorDers of kiDney
acute renal failure
Management-
To correct fluid and electrolyte balance.
To correct dehydration.
To Keep other body systems working properly
acute renal failure
Management-
To correct fluid and electrolyte balance.
To correct dehydration.
To Keep other body systems working properly
DisorDers of kiDney
conGenital DisorDers of Genitourinary system
Common Renal anomalies
• Abnormal number: agenesis
• Abnormal form or position: horseshoe kid.
Common ureteral & renal pelvis anomalies
• UPJ obstruction.
• Vesico-uretral reflux.
• Duplication.
• Uretrocele.
• Ectopic ureter.
conGenital DisorDers of Genitourinary system
Common Renal anomalies
• Abnormal number: agenesis
• Abnormal form or position: horseshoe kid.
Common ureteral & renal pelvis anomalies
• UPJ obstruction.
• Vesico-uretral reflux.
• Duplication.
• Uretrocele.
• Ectopic ureter.
DisorDers of kiDney
conGenital DisorDers of Genitourinary system
Common Bladder anomalies
• Bladder Extrophy.
Common Urethral & penile anomalies
• Hypospadias.
• Epispadias.
conGenital DisorDers of Genitourinary system
Common Bladder anomalies
• Bladder Extrophy.
Common Urethral & penile anomalies
• Hypospadias.
• Epispadias.
DisorDers of kiDney
Congenital DisorDers of
genitourinary system
Renal agenesis
Bilateral renal agenesis
• both mesonephric ducts fail to
develop.
• Incompatible with life.
Unilateral renal agenesis
• the mesonephric duct fails to develop.
• Usually there is absent ureter, trigone,
kidney and (in boys) vas deferens.
Congenital DisorDers of
genitourinary system
Renal agenesis
Bilateral renal agenesis
• both mesonephric ducts fail to
develop.
• Incompatible with life.
Unilateral renal agenesis
• the mesonephric duct fails to develop.
• Usually there is absent ureter, trigone,
kidney and (in boys) vas deferens.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Horseshoe kidney
• both metanephros are fused together.
• both kidneys rotated & their lower poles are joined in the
shape of a horseshoe.
• As the fetus grows, the joined kidneys are held up by the
inferior or superior mesenteric arteries at L3.
Congenital DisorDers of genitourinary system
Horseshoe kidney
• both metanephros are fused together.
• both kidneys rotated & their lower poles are joined in the
shape of a horseshoe.
• As the fetus grows, the joined kidneys are held up by the
inferior or superior mesenteric arteries at L3.
DisorDers of kiDney
Congenital DisorDers of
genitourinary system
Pelviureteric junction obstruction
Obstruction of the junction between the
renal pelvis & ureter.
Aetiology
• aperistaltic segment of ureter due to
absent muscles.
or
• crossing vessels over UPJ.
Congenital DisorDers of
genitourinary system
Pelviureteric junction obstruction
Obstruction of the junction between the
renal pelvis & ureter.
Aetiology
• aperistaltic segment of ureter due to
absent muscles.
or
• crossing vessels over UPJ.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Clinical features-
may present at any time (before birth, in childhood, or in adulthood)
by:
• abdominal mass.
• abdominal pain.
• Haematuria after fairly minor abdominal trauma.
Diagnostic evaluation-
IVU - shows delay in appearance of contrast and dilated renal
pelvis and calices.
Renal scan -shows differential renal function and confirms
obstruction.
Congenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Clinical features-
may present at any time (before birth, in childhood, or in adulthood)
by:
• abdominal mass.
• abdominal pain.
• Haematuria after fairly minor abdominal trauma.
Diagnostic evaluation-
IVU - shows delay in appearance of contrast and dilated renal
pelvis and calices.
Renal scan -shows differential renal function and confirms
obstruction.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Management-
Surgery is indicated for:
1. obstructive symptoms,
2. stone formation,
3. recurrent urinary infection,
4. progressive renal impairment.
• Pyeloplasty is the treatment of choice
• Nephrectomy is performed if the affected kidney is <10% of
total renal function.
Congenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Management-
Surgery is indicated for:
1. obstructive symptoms,
2. stone formation,
3. recurrent urinary infection,
4. progressive renal impairment.
• Pyeloplasty is the treatment of choice
• Nephrectomy is performed if the affected kidney is <10% of
total renal function.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Management-
alternative techniques:
1.Antegrade endopyelotomy .
2.Laparoscopic pyeloplasty
Congenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Management-
alternative techniques:
1.Antegrade endopyelotomy .
2.Laparoscopic pyeloplasty
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Vesicoureteric junction reflux
• Reflux can be defined as the retrograde flow of urine into
upper urinary tract.
• incidence of reflux is equal in both sexes.
• Reflux can be classified into 5 grades -
Congenital DisorDers of genitourinary system
Vesicoureteric junction reflux
• Reflux can be defined as the retrograde flow of urine into
upper urinary tract.
• incidence of reflux is equal in both sexes.
• Reflux can be classified into 5 grades -
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Vesicoureteric junction reflux
• Evaluation
•Micturating cystourethrography is the gold standard for
diagnosis and evaluation of VUR grade.
•Diuretic Renal scan (DMSA) is used to visualize scarring and
quantify differential renal function.
Congenital DisorDers of genitourinary system
Vesicoureteric junction reflux
• Evaluation
•Micturating cystourethrography is the gold standard for
diagnosis and evaluation of VUR grade.
•Diuretic Renal scan (DMSA) is used to visualize scarring and
quantify differential renal function.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Vesicoureteric junction reflux
Management
•antibiotic prophylaxis is recommended for children with
reflux of grades I-II.
•Surgery (uretro - vesical reimplantation or endoscopic
injection) is recommended in reflux of grades III-V and
persistent reflux despite a trial of antibiotics.
Congenital DisorDers of genitourinary system
Vesicoureteric junction reflux
Management
•antibiotic prophylaxis is recommended for children with
reflux of grades I-II.
•Surgery (uretro - vesical reimplantation or endoscopic
injection) is recommended in reflux of grades III-V and
persistent reflux despite a trial of antibiotics.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Duplication of urinary system
• Ureteral duplication is the most frequent anomaly of urinary
tract
• Female: male = 2 : 1
• The orifice draining the upper segment is often obstructed.
• The orifice of the lower segment generally refluxes.
• Duplication is usually discovered on an IVU .
• Management is according to segment affected and its
function.
Congenital DisorDers of genitourinary system
Duplication of urinary system
• Ureteral duplication is the most frequent anomaly of urinary
tract
• Female: male = 2 : 1
• The orifice draining the upper segment is often obstructed.
• The orifice of the lower segment generally refluxes.
• Duplication is usually discovered on an IVU .
• Management is according to segment affected and its
function.
DisorDers of kiDney
Congenital DisorDers of
genitourinary system
Ectopic ureter
• An ectopic ureter is one that opens in some
location other than the bladder.
80% associated with duplicated system.
20% associated with single system.
• Most common sites (in female): urethra,
vestibule, and vagina
• In female present as urinary incontinence.
• Most common sites (in male): posterior
urethra and seminal vesicles.
Congenital DisorDers of
genitourinary system
Ectopic ureter
• An ectopic ureter is one that opens in some
location other than the bladder.
80% associated with duplicated system.
20% associated with single system.
• Most common sites (in female): urethra,
vestibule, and vagina
• In female present as urinary incontinence.
• Most common sites (in male): posterior
urethra and seminal vesicles.
DisorDers of kiDney
Congenital DisorDers of
genitourinary system
Uretrocele
• A congenital cystic ballooning of the
terminal submucosal ureter.
• It is classified as simple or ectopic.
• Simple ( Orthotopic ) Ureterocele :
in trigone.
•Ectopic Ureterocele : can obstruct
bladder neck or even prolapse from
female urethra.
Congenital DisorDers of
genitourinary system
Uretrocele
• A congenital cystic ballooning of the
terminal submucosal ureter.
• It is classified as simple or ectopic.
• Simple ( Orthotopic ) Ureterocele :
in trigone.
•Ectopic Ureterocele : can obstruct
bladder neck or even prolapse from
female urethra.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Hypospadias
• It is a condition in which the opening of the urethra is on
the underside of the penis, instead of at the tip.
• congenital condition results in underdevelopment of urethra.
• affects 3 per 1000 male infants.
• Consists of 3 anomalies:
( 1 ) Abnormal ventral opening of the urethral meatus.
( 2 ) Ventral curvature of the penis ( chordee ).
( 3 ) Deficient prepuce ventrally
Congenital DisorDers of genitourinary system
Hypospadias
• It is a condition in which the opening of the urethra is on
the underside of the penis, instead of at the tip.
• congenital condition results in underdevelopment of urethra.
• affects 3 per 1000 male infants.
• Consists of 3 anomalies:
( 1 ) Abnormal ventral opening of the urethral meatus.
( 2 ) Ventral curvature of the penis ( chordee ).
( 3 ) Deficient prepuce ventrally
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Hypospadias
• Site Of the meatus
Congenital DisorDers of genitourinary system
Hypospadias
• Site Of the meatus
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Hypospadias
Treatment
• The child should be referred for urological assessment and
surgical treatment.
• The ideal age for surgery is 6–12 months.
Congenital DisorDers of genitourinary system
Hypospadias
Treatment
• The child should be referred for urological assessment and
surgical treatment.
• The ideal age for surgery is 6–12 months.
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Epispadias
• Congenital condition in which the urethra opens on dorsal
surface of penis..
• Usually associated with bladder extrophy (ectopia vesicae).
Congenital DisorDers of genitourinary system
Epispadias
• Congenital condition in which the urethra opens on dorsal
surface of penis..
• Usually associated with bladder extrophy (ectopia vesicae).
DisorDers of kiDney
Congenital DisorDers of genitourinary system
Bladder Extrophy (Ectopia vesicae)
• Failure of development of the lower abdominal wall.
• Anomaly include defect in anterior abdominal wall, defect in
anterior bladder wall and epispadias (dorsal penile opening).
Congenital DisorDers of genitourinary system
Bladder Extrophy (Ectopia vesicae)
• Failure of development of the lower abdominal wall.
• Anomaly include defect in anterior abdominal wall, defect in
anterior bladder wall and epispadias (dorsal penile opening).
DisorDers of kiDney
CanCer of kiDney
Incidence-
Cancer of the kidney accounts for about 3.7% of all cancers
in adults.
It affects almost twice as many men as women.
The most common type of renal tumor is renal cell or renal
adenocarcinoma, accounting for more than 85% of all kid-
ney tumors.
These tumors may metastasize early to the lungs, bone,
liver, brain, and contralateral kidney.
The incidence of all stages of kidney cancer has increased in
last two decades.
CanCer of kiDney
Incidence-
Cancer of the kidney accounts for about 3.7% of all cancers
in adults.
It affects almost twice as many men as women.
The most common type of renal tumor is renal cell or renal
adenocarcinoma, accounting for more than 85% of all kid-
ney tumors.
These tumors may metastasize early to the lungs, bone,
liver, brain, and contralateral kidney.
The incidence of all stages of kidney cancer has increased in
last two decades.
DisorDers of kiDney
CanCer of kiDney
Risk factors-
Gender: Affects men more than women
Tobacco use
Occupational exposure to industrial chemicals, such as petroleum products,
heavy metals, and asbestos
Obesity
Unopposed estrogen therapy
Polycystic kidney disease
regular use of NSAIDs such as ibuprofen and naproxen,
faulty genes;
a family history of kidney cancer;
having kidney disease that needs dialysis;
being infected with hepatitis C;
previous treatment for testicular cancer or cervical cancer.
CanCer of kiDney
Risk factors-
Gender: Affects men more than women
Tobacco use
Occupational exposure to industrial chemicals, such as petroleum products,
heavy metals, and asbestos
Obesity
Unopposed estrogen therapy
Polycystic kidney disease
regular use of NSAIDs such as ibuprofen and naproxen,
faulty genes;
a family history of kidney cancer;
having kidney disease that needs dialysis;
being infected with hepatitis C;
previous treatment for testicular cancer or cervical cancer.
DisorDers of kiDney
CanCer of kiDney
Types-
Most ocuuring renal cancer are renal cell carcinoma and renal pelvis
carcinoma, other, less common types of kidney cancer include:
Squamous cell carcinoma
Juxtaglomerular cell tumors (reninoma)
angiomyolipoma
Renal ancocytoma
Bellini duct carcinoma
Clear cell sarcoma of the kidney
Mesoblastic nephroma
Wilm’s tumor, usually is reported in children under the age of 5.
Mixed epithilial stromal cell tumors
CanCer of kiDney
Types-
Most ocuuring renal cancer are renal cell carcinoma and renal pelvis
carcinoma, other, less common types of kidney cancer include:
Squamous cell carcinoma
Juxtaglomerular cell tumors (reninoma)
angiomyolipoma
Renal ancocytoma
Bellini duct carcinoma
Clear cell sarcoma of the kidney
Mesoblastic nephroma
Wilm’s tumor, usually is reported in children under the age of 5.
Mixed epithilial stromal cell tumors
DisorDers of kiDney
CanCer of kiDney
Clinical features-
Many renal tumors produce no symptoms and are discovered on a
routine physical examination as a palpable abdominal mass.
The classic triad of signs and symptoms, comprises hematuria, pain,
and a mass in the flank.
The usual sign that first calls attention to the tumor is pain- less
hematuria, which may be either intermittent and microscopic or
continuous and gross.
There may be a dull pain in the back from the pressure produced by
compression of the ureter, extension of the tumor into the perirenal
area, or hemorrhage into the kidney tissue.
Colicky pains occur if a clot or mass of tumor cells passes down the
ureter.
weight loss, increasing weakness, and anemia.
CanCer of kiDney
Clinical features-
Many renal tumors produce no symptoms and are discovered on a
routine physical examination as a palpable abdominal mass.
The classic triad of signs and symptoms, comprises hematuria, pain,
and a mass in the flank.
The usual sign that first calls attention to the tumor is pain- less
hematuria, which may be either intermittent and microscopic or
continuous and gross.
There may be a dull pain in the back from the pressure produced by
compression of the ureter, extension of the tumor into the perirenal
area, or hemorrhage into the kidney tissue.
Colicky pains occur if a clot or mass of tumor cells passes down the
ureter.
weight loss, increasing weakness, and anemia.
DisorDers of kiDney
CanCer of kiDney
Assessment and Diagnostic Findings-
The diagnosis of a renal tumor may require
intravenous urography,
cystoscopic examination,
nephrotomograms,
renal angiograms, ultrasonography,
CT scan.
CanCer of kiDney
Assessment and Diagnostic Findings-
The diagnosis of a renal tumor may require
intravenous urography,
cystoscopic examination,
nephrotomograms,
renal angiograms, ultrasonography,
CT scan.
DisorDers of kiDney
CanCer of kiDney
Management-
Goal-
The goal of management is to eradicate the tumor before
metastasis occurs.
CanCer of kiDney
Management-
Goal-
The goal of management is to eradicate the tumor before
metastasis occurs.
DisorDers of kiDney
CanCer of kiDney
Management-
Surgical management-
A radical nephrectomy is the preferred treatment if the
tumor can be removed. This includes removal of the kidney
(and tumor), adrenal gland, surrounding perinephric fat and
Gerota’s fascia, and lymph nodes.
Radiation therapy, hormonal therapy, or chemotherapy may
be used along with surgery.
Immunotherapy
Nephron-sparing surgery
CanCer of kiDney
Management-
Surgical management-
A radical nephrectomy is the preferred treatment if the
tumor can be removed. This includes removal of the kidney
(and tumor), adrenal gland, surrounding perinephric fat and
Gerota’s fascia, and lymph nodes.
Radiation therapy, hormonal therapy, or chemotherapy may
be used along with surgery.
Immunotherapy
Nephron-sparing surgery
DisorDers of kiDney
CanCer of kiDney
Management-
pharmacological management-
use of biologic response modifiers such as interleukin-2 (IL-
2) and topical instillation of bacillus Calmette-Guerin (BCG)
Patients may be treated with IL-2, a protein that regulates
cell growth. This may be used alone or in combination with
lymphokine-activated killer cells
Interferon, another biologic response modifier, appears to
have a direct antiproliferative effect on renal tumors.
CanCer of kiDney
Management-
pharmacological management-
use of biologic response modifiers such as interleukin-2 (IL-
2) and topical instillation of bacillus Calmette-Guerin (BCG)
Patients may be treated with IL-2, a protein that regulates
cell growth. This may be used alone or in combination with
lymphokine-activated killer cells
Interferon, another biologic response modifier, appears to
have a direct antiproliferative effect on renal tumors.
DisorDers of kiDney
CanCer of kiDney
Management-
Renal Artery Embolization-
In patients with metastatic renal carcinoma, the renal artery
may be occluded to impede the blood supply to the tumor
and thus kill the tumor cells.
CanCer of kiDney
Management-
Renal Artery Embolization-
In patients with metastatic renal carcinoma, the renal artery
may be occluded to impede the blood supply to the tumor
and thus kill the tumor cells.
DisorDers of kiDney
CanCer of blaDDer
Cancer of the urinary bladder is more common in people
aged 50 to 70 years.
It affects men more than women (3:1)
There are two forms of bladder cancer: superficial (which
tends to recur) and invasive. About 80% to 90% of all
bladder cancers are transitional cell (which means they arise
from the transitional cells of the bladder);
the remaining types of tumors are squamous cell and ade-
nocarcinoma.
CanCer of blaDDer
Cancer of the urinary bladder is more common in people
aged 50 to 70 years.
It affects men more than women (3:1)
There are two forms of bladder cancer: superficial (which
tends to recur) and invasive. About 80% to 90% of all
bladder cancers are transitional cell (which means they arise
from the transitional cells of the bladder);
the remaining types of tumors are squamous cell and ade-
nocarcinoma.
DisorDers of kiDney
CanCer of blaDDer
Risk factors-
Cigarette smoking: risk proportional to number of packs
smoked daily and number of years of smoking
Environmental carcinogens: dyes, rubber, leather, ink, or
paint
Recurrent or chronic bacterial infection of the urinary tract
Bladder stones
High urinary pH
High cholesterol intake
Pelvic radiation therapy
Cancers arising from the prostate, colon, and rectum in
males
CanCer of blaDDer
Risk factors-
Cigarette smoking: risk proportional to number of packs
smoked daily and number of years of smoking
Environmental carcinogens: dyes, rubber, leather, ink, or
paint
Recurrent or chronic bacterial infection of the urinary tract
Bladder stones
High urinary pH
High cholesterol intake
Pelvic radiation therapy
Cancers arising from the prostate, colon, and rectum in
males
DisorDers of kiDney
CanCer of blaDDer
Clinical Manifestations
Bladder tumors usually arise at the base of the bladder and
involve the ureteral orifices and bladder neck.
Visible, painless hematuria is the most common symptom of
bladder cancer.
Infection of the urinary tract is a common complication,
producing frequency, urgency, and dysuria.
Any alteration in voiding or change in the urine, however,
may indicate cancer of the bladder.
Pelvic or back pain may occur with metastasis.
CanCer of blaDDer
Clinical Manifestations
Bladder tumors usually arise at the base of the bladder and
involve the ureteral orifices and bladder neck.
Visible, painless hematuria is the most common symptom of
bladder cancer.
Infection of the urinary tract is a common complication,
producing frequency, urgency, and dysuria.
Any alteration in voiding or change in the urine, however,
may indicate cancer of the bladder.
Pelvic or back pain may occur with metastasis.
DisorDers of kiDney
CanCer of blaDDer
Assessment and Diagnostic Findings
The diagnostic evaluation includes –
cystoscopy (the mainstay of diagnosis),
excretory urography,
a CT scan,
ultrasonography,
bimanual examination with the patient anesthetized.
Biopsies of the tumor and adjacent mucosa
CanCer of blaDDer
Assessment and Diagnostic Findings
The diagnostic evaluation includes –
cystoscopy (the mainstay of diagnosis),
excretory urography,
a CT scan,
ultrasonography,
bimanual examination with the patient anesthetized.
Biopsies of the tumor and adjacent mucosa
DisorDers of kiDney
CanCer of blaDDer
Management- surgical
Transurethral resection or fulguration (cauterization) may be per-
formed for simple papillomas (benign epithelial tumors).
eradicate the tumors through surgical incision or electrical
current with the use of instruments inserted through the urethra.
After this bladder-sparing surgery, intravesical administration of
BCG is the treatment of choice.
A simple cystectomy (removal of the bladder) or a radical
cystectomy is performed for invasive or multifocal bladder
cancer.
Radical cystectomy in men involves removal of the bladder,
prostate, and seminal vesicles and immediate adjacent perivesical
tissues.
CanCer of blaDDer
Management- surgical
Transurethral resection or fulguration (cauterization) may be per-
formed for simple papillomas (benign epithelial tumors).
eradicate the tumors through surgical incision or electrical
current with the use of instruments inserted through the urethra.
After this bladder-sparing surgery, intravesical administration of
BCG is the treatment of choice.
A simple cystectomy (removal of the bladder) or a radical
cystectomy is performed for invasive or multifocal bladder
cancer.
Radical cystectomy in men involves removal of the bladder,
prostate, and seminal vesicles and immediate adjacent perivesical
tissues.
DisorDers of kiDney
CanCer of blaDDer
Management- pharmacological
Chemotherapy with a combination of methotrexate, 5-fluorouracil,
vinblastine, doxorubicin (Adriamycin), and cisplatin
Intravenous chemotherapy may be accompanied by radiation therapy.
Topical chemotherapy (intravesical chemotherapy or instillation of
antineoplastic agents into the bladder, resulting in contact of the agent
with the bladder wall) is considered when there is a high risk for
recurrence, when cancer in situ is present, or when tumor resection has
been incomplete.
Topical chemotherapy de- livers a high concentration of medication
(doxorubicin, mitomycin, ethoglucid, and BCG) to the tumor to promote
tumor destruction.
BCG is now considered the most effective intravesical agent for recurrent
bladder cancer because it enhances the body’s immune response to
cancer.
CanCer of blaDDer
Management- pharmacological
Chemotherapy with a combination of methotrexate, 5-fluorouracil,
vinblastine, doxorubicin (Adriamycin), and cisplatin
Intravenous chemotherapy may be accompanied by radiation therapy.
Topical chemotherapy (intravesical chemotherapy or instillation of
antineoplastic agents into the bladder, resulting in contact of the agent
with the bladder wall) is considered when there is a high risk for
recurrence, when cancer in situ is present, or when tumor resection has
been incomplete.
Topical chemotherapy de- livers a high concentration of medication
(doxorubicin, mitomycin, ethoglucid, and BCG) to the tumor to promote
tumor destruction.
BCG is now considered the most effective intravesical agent for recurrent
bladder cancer because it enhances the body’s immune response to
cancer.
DisorDers of kiDney
CanCer of blaDDer
Management- radiation therapy
Radiation of the tumor may be performed preoperatively to reduce
microextension of the neoplasm and viability of tumor cells,
CanCer of blaDDer
Management- radiation therapy
Radiation of the tumor may be performed preoperatively to reduce
microextension of the neoplasm and viability of tumor cells,
DisorDers of kiDney
CanCer of ureter
Ureteral cancer is usually transitional cell carcinoma.
Transitional cell carcinoma is "a common cause of ureter
cancer and other urinary (renal pelvic) tract cancers.“
Cancer of the ureter begins in the cells that line the inside of
the tubes (ureters) that connect your kidneys to your bladder.
Cancer of the ureter is uncommon.
It occurs most often in older adults and in people who have
previously been treated for bladder cancer.
Men>women
Whitish>black
CanCer of ureter
Ureteral cancer is usually transitional cell carcinoma.
Transitional cell carcinoma is "a common cause of ureter
cancer and other urinary (renal pelvic) tract cancers.“
Cancer of the ureter begins in the cells that line the inside of
the tubes (ureters) that connect your kidneys to your bladder.
Cancer of the ureter is uncommon.
It occurs most often in older adults and in people who have
previously been treated for bladder cancer.
Men>women
Whitish>black
DisorDers of kiDney
CanCer of ureter
Risk factors-
Increased age
Treatment of bladder cancer
Tobacco smoking
Analgesics nephropathy
Industrial exposures
CanCer of ureter
Risk factors-
Increased age
Treatment of bladder cancer
Tobacco smoking
Analgesics nephropathy
Industrial exposures
DisorDers of kiDney
CanCer of ureter
Clinical features-
Symptoms of ureteral cancer may include –
blood in the urine (hematuria);
diminished urine stream and straining to void (caused by urethral
stricture);
frequent urination and increased nighttime urination (nocturia);
hardening of tissue in the perineum, labia, or penis;
itching;
incontinence;
pain during or after sexual intercourse (dyspareunia);
painful urination (dysuria);
recurrent urinary tract infection;
urethral discharge and swelling.
CanCer of ureter
Clinical features-
Symptoms of ureteral cancer may include –
blood in the urine (hematuria);
diminished urine stream and straining to void (caused by urethral
stricture);
frequent urination and increased nighttime urination (nocturia);
hardening of tissue in the perineum, labia, or penis;
itching;
incontinence;
pain during or after sexual intercourse (dyspareunia);
painful urination (dysuria);
recurrent urinary tract infection;
urethral discharge and swelling.
DisorDers of kiDney
CanCer of ureter
Diagnostic evaluation-
Diagnosis may include-
computed tomography urography (CTU),
magnetic resonance urography(MRU),
intravenous pyelography (IVP)
x-ray,
Ureteroscopy
biopsy
CanCer of ureter
Diagnostic evaluation-
Diagnosis may include-
computed tomography urography (CTU),
magnetic resonance urography(MRU),
intravenous pyelography (IVP)
x-ray,
Ureteroscopy
biopsy
DisorDers of kiDney
CanCer of ureter
Management-
Treatment methods include -
surgery
Chemotherapy
radiation therapy
medication.
CanCer of ureter
Management-
Treatment methods include -
surgery
Chemotherapy
radiation therapy
medication.
DisorDers of kiDney
CanCer of urethra
Urethral cancer is cancer originating from the urethra.
Cancer in this location is rare, and the most common
type is papillary transitional cell carcinoma
Having a history of bladder cancer
Having conditions that cause chronic, swollen,
reddened part in the urethra.
Being 60 or older.
Being a white female.
CanCer of urethra
Urethral cancer is cancer originating from the urethra.
Cancer in this location is rare, and the most common
type is papillary transitional cell carcinoma
Having a history of bladder cancer
Having conditions that cause chronic, swollen,
reddened part in the urethra.
Being 60 or older.
Being a white female.
DisorDers of kiDney
CanCer of urethra
Clinical features-
Bleeding from the urethra or blood in the urine.
Weak or interrupted flow of urine.
Urination occurs often.
A lump or thickness in the perineum or penis.
Discharge from the urethra.
Enlarged lymph nodes in the groin area.
Most common site being bulbomembranous urethra
CanCer of urethra
Clinical features-
Bleeding from the urethra or blood in the urine.
Weak or interrupted flow of urine.
Urination occurs often.
A lump or thickness in the perineum or penis.
Discharge from the urethra.
Enlarged lymph nodes in the groin area.
Most common site being bulbomembranous urethra
DisorDers of kiDney
CanCer of urethra
Diagnostic evaluation-
Diagnosis is established by transurethral biopsy
Types-
transitional cell carcinoma
squamous cell carcinoma
adenocarcinoma
melanoma
CanCer of urethra
Diagnostic evaluation-
Diagnosis is established by transurethral biopsy
Types-
transitional cell carcinoma
squamous cell carcinoma
adenocarcinoma
melanoma
DisorDers of kiDney
CanCer of urethra
Management-
Surgery-
Open excision surgery.
Electro-resection with flash surgery.
Laser surgery
Cystourethrectomy surgery.
Cystoprostatectomy surgery.
Anterior body cavity surgery.
Incomplete or basic penectomy surgery.
CanCer of urethra
Management-
Surgery-
Open excision surgery.
Electro-resection with flash surgery.
Laser surgery
Cystourethrectomy surgery.
Cystoprostatectomy surgery.
Anterior body cavity surgery.
Incomplete or basic penectomy surgery.
DisorDers of kiDney
CanCer of urethra
Management-
chemotherapy-
Chemotherapy involves using drugs to destroy urethral
cancer cells.
It is a systemic urethral cancer treatment (i.e., destroys
urethral cancer cells throughout the body) that is
administered orally or intravenously (through a vein;
IV).
Medications are often used in combination to destroy
urethral cancer that has metastasized.
Commonly used drugs include vincristine, cisplatin and
methotrexate
CanCer of urethra
Management-
chemotherapy-
Chemotherapy involves using drugs to destroy urethral
cancer cells.
It is a systemic urethral cancer treatment (i.e., destroys
urethral cancer cells throughout the body) that is
administered orally or intravenously (through a vein;
IV).
Medications are often used in combination to destroy
urethral cancer that has metastasized.
Commonly used drugs include vincristine, cisplatin and
methotrexate
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