Urology and nephrology

1. Urology & Urology &
NephrologyNephrology

2. SectionsSections
Anatomy and Physiology
General Mechanisms of
Nontraumatic Tissue Problems
General Pathophysiology,
Assessment, and Management
Renal and Urologic Emergencies

3. Anatomy & PhysiologyAnatomy & Physiology
The Urinary
System
Female
Male
Urology &
Nephrology
The Kidneys

4. Anatomy & PhysiologyAnatomy & Physiology
The
Kidneys
Hilum
Medulla
Pyramids
Papilla
Renal Pelvis

5. Anatomy & PhysiologyAnatomy & Physiology
Nephrons
Glomerulus
Bowman’s
capsule
Proximal Tubule
Loop of Henle
Distal Tubule
Collecting Duct

6. Anatomy & PhysiologyAnatomy & Physiology
Functions of the Kidneys
Forming and Eliminating Urine
Maintaining blood volume with proper balance of
water, electrolytes, and pH.
Retaining key compounds such as glucose, while
excreting wastes such as urea.
Controlling Arterial Blood Pressure
Regulating Erythrocyte Development

7. Anatomy & PhysiologyAnatomy & Physiology
Formation of Urine
Glomerular Filtration
GFR
Reabsorption & Secretion
Simple diffusion and osmosis
Facilitated diffusion
•Active transport

8. Anatomy & PhysiologyAnatomy & Physiology
Tubular Handling of Water and
Electrolytes
Diuresis and Antidiuresis
Tubular Handling of Glucose and
Urea
BUN and Creatinine
Control of Arterial Blood Pressure
The Renin-Angiotensin System
Control of Erythrocyte Production
Erythropoietin

9. Anatomy & PhysiologyAnatomy & Physiology
Ureters
Urinary
Bladder
Urethra
Testes
Epididymus
and Vas
Deferens
Prostate Gland
Penis

10. Inflammatory or Immune-Mediated
Disease
Infectious Disease
Physical Obstruction
Hemorrhage
General Mechanisms of General Mechanisms of
Nontraumatic Tissue ProblemsNontraumatic Tissue Problems

11. Differentiating GI and Urologic
Complaints
Pathophysiologic Basis of Pain
Causes of Pain
Types of Pain
Visceral pain
Referred pain
General Pathophysiology, General Pathophysiology,
Assessment and ManagementAssessment and Management

12. Scene Size-up
Initial Assessment
Focused History
OPQRST History
Prior History of Similar Event
History of Nausea, Vomiting, and Weight Loss
Change in Bowel Habits and Stool
Last Oral Intake
Presence of Chest Pain
Assessment and Assessment and
ManagementManagement

13. Physical Exam
Appearance
Uncomfortable appearance.
Posture
Lying with knees drawn up.
Relief with walking.
Level of Consciousness
Determine if changes are acute or chronic.
Assessment and Assessment and
ManagementManagement

14. Apparent State of Health
Skin Color
Examination of the Abdomen
Inspection for distention, ecchymosis, or scarring
Pain associated with percussion of abdomen
Palpation
•Normal or ectopic pregnancy
•Masses
Assessment Tools
Vital Signs
Assessment and Assessment and
ManagementManagement

15. Management
Airway, Breathing Circulation
Pharmacologic Interventions
IV access and analgesics.
Nonpharmacological Interventions
Nothing by mouth (NPO).
Maintain position of comfort.
Reassess mental status and vital signs frequently.
Transport Considerations
Assessment and Assessment and
ManagementManagement

16. Risk Factors
Older Patients
History of Diabetes
History of Hypertension
Multiple Risk Factors
Renal and Urologic Emergencies
Acute Renal Failure
Chronic Renal Failure
Renal Calculi
Urinary Tract Infection
Renal and Urologic Renal and Urologic
EmergenciesEmergencies

17. Acute Renal FailureAcute Renal Failure
Pathophysiology
Prerenal Acute Renal Failure
Dysfunction before the level of kidneys
•Most common and most easily reversible
Renal Acute Renal Failure
Dysfunction within the kidneys themselves
Postrenal Acute Renal Failure
Dysfunction distal to the kidneys

18. Acute Renal FailureAcute Renal Failure

19. Acute Renal FailureAcute Renal Failure
Assessment
Focused History
Change in urine output
Swelling in face, hands, feet, or torso
Presence of heart palpitations or irregularity
Changes in mental function

20. Acute Renal FailureAcute Renal Failure
Physical Assessment
Altered mental status
Hypertension
Tachycardia
ECG indicative of hyperkalemia
Pale, cool, moist skin

21. Acute Renal FailureAcute Renal Failure
Physical
Assessment
Edema of face,
hands, or feet
Abdominal
findings
dependent on
the cause of
ARF

22. Acute Renal FailureAcute Renal Failure
Management
Airway, Breathing, Circulation
IV Access
Protect fluid volume.
Positioning and Transport

23. Chronic Renal FailureChronic Renal Failure
Chronic Renal Failure
Permanent Loss of Nephrons
End-Stage Renal Failure (ESRF)
Pathophysiology
Similar to Renal ARF
Microangiopathy, glomerular injury
Tubular cell injury
Insterstitial injury

24. Chronic Renal FailureChronic Renal Failure

25. Chronic Renal FailureChronic Renal Failure
Impairment of Kidney Functions
Maintenance of blood volume with proper balance
of water, electrolytes, and pH
•Increased sodium, water, and potassium retention
Retention of key compounds such as glucose with
excretion of wastes such as urea
•Loss of glucose and buildup of urea within the blood
Control of arterial blood pressure
•Disruption of the renin-angiotensin loop resulting in HTN
Regulation of erythrocyte development
•Development of chronic anemia

26. Chronic Renal FailureChronic Renal Failure
Assessment
Differentiate chronic and acute problems.
Focused history and physical exam.
Gastrointestinal complaints
Changes in mental status
Marked abnormalities during physical exam
Uremic frost

27. Chronic Renal FailureChronic Renal Failure

28. Chronic Renal FailureChronic Renal Failure
Immediate Management
Monitor and support ABCs.
Establish IV access.
Regulate fluid volume.
Monitor vital signs and cardiac rhythm.
Expedite transport to an appropriate facility.

29. Chronic Renal FailureChronic Renal Failure
Long-Term
Management
Renal Dialysis
Hemodialysis
Common
complications

30. Chronic Renal FailureChronic Renal Failure
Long-Term
Management
Renal Dialysis
Peritoneal dialysis
Common
complications

31. Renal CalculiRenal Calculi
Pathophysiology
Results when “too
much insoluble stuff”
accumulates in the
kidneys.
Stone types
Calcium salts
Struvite stones
Uric acid
Cystine

32. Renal CalculiRenal Calculi
Assessment
Focused History
Severe pain in one flank that increases in intensity
and migrates from the flank to the groin
Painful, frequent urination with visible hematuria
Prior history of calculi
Physical Exam
Difficult due to patient discomfort
Tachycardia with pale, cool, and moist skin

33. Renal CalculiRenal Calculi
Management
Maintain ABCs.
Maintain position of comfort.
Establish IV access.
Fluid bolus may promote stone movement and urine
formation.
Consider medication administration.
Parenteral narcotic analgesics may be indicated.

34. Urinary Tract InfectionUrinary Tract Infection
Pathophysiology
Risk Factors
Increased risk in female or catheterized patients
Sexual activity
Lower and Upper UTIs
Urethritis
Cystitis
Prostatitis
Pyelonephritis
Community-acquired vs. nosocomial infections

35. Urinary Tract InfectionUrinary Tract Infection
Assessment
Focused History
Abdominal pain
Frequent, painful urination
A “burning sensation” associated with urination
Difficulty beginning and continuing to void
Strong or foul-smelling urine
Similar past episodes

36. Urinary Tract InfectionUrinary Tract Infection
Physical Exam
Restless, uncomfortable appearance.
Presence of a fever.
Vital signs vary with degree of pain.
Management
Maintain ABCs.
Establish IV access.
Consider analgesics.
Transport to appropriate facility.

37. Urology and NephrologyUrology and Nephrology
Anatomy and Physiology
General Mechanisms of
Nontraumatic Tissue Problems
General Pathophysiology,
Assessment, and Management
Renal and Urologic Emergencies