Renal: OLD UTI: I.

Manifestation: -+ Bacteria -Hematiria, Pyuria, nocturia, Dysuria -Cloudy urine -frequency, Urgency, Sm Voids -Flank/back pain -Change MS in elderly II. Mgt: -Acid-ash Diet -Avoid coffee, citris, tea, cola, spices -Increase fluid -Urine frequently good hygene good cath care PYLONEPHRITIS: I. Bacteria infection from assesnding bladder infection to one kidney II. Manifestation: -Acute constant or collicky flank pain that increases with palp -Fever, chills, N/V, cloudy foul smelling urine, dysuria, frquency urgenecy -+WBC: neuts, ESR, +RBC, +Bacteria III. Dx Tests: - Cystography: Contrast -IVP: Contrast No low crt, shellfish allergy -Pt NPO, Bowl cleansing, hydrate after -Cystoscopy: NO Contrast -Expect pink tinged blood in urineNOT bright, Clots ACUTE GLOMERULONEPHRITIS: Immune response BOTH kidneys after (3wks) URI or Skin I. Manifestation: (sudden or insideous) -INCREASE: Urine SG, BUN, Crt -DECREASE: GFR=oli (<500/25hr) /anuria (<50/24hr), Crt Clearence=Fluid overload -Smokey urine, Hemouria, Protienuria -HTN-Edema II. Medication Mgt: -NA, Fluid Restricted, Protien restricted de[ending on BUN increase -Loop/thiazide Diuretics -Steriods decrease inflam -PCN for months -BR until BP declines III. Nursing Mgt: -Asses for decreaing renal function *I/O, Everday weight, VS, Labs, Lytes *RESTRICT: Fluid, Salt, K+, mod. protien

*INCREASE: Carbs *BS-Crackles with fluid retention *+Pitting Edema *AVOID INFECTION CHRONIC GLOMERULONEPHRITIS: Gradual course leading to kidney atrophies I. Hallmark Manifestation: -Severve HTN, SG 10:10 II. Manifestation: -H/A, nose bleeds from HTN -SOB, Edema d/t Fluid overload -Nocturia, Polyuria III. Mgt: -Control HTN, Edema, Dialysis, Transplant NEPHROTIC SYNDROM: Group of sx. That impairs glom capillary filt membrane I. Key Manifestations: -protienuria, hyperlipidemia, hypOalbuminemia, pitting edema -INCREASE: BUN, Crt, Tryclicerides, Chol -DECREASE: Albumin -+protien, + lipid=foggy urine II. Management: -Diet: INCREASE-protien, Calcium DECREASE: K+, If RF fluid restricted HYDONEPHROSIS: Urine produced but being obstructed=Pressure of urine destroy nephrons I. Management after Obstruct removed: -INCREASE HR --- DECREASE BP d/t fluid shift RENAL FAILURE: I. DM, HTN, Family Hx increase risk huge II. Renal Dysfuntion Patho *Renal impair: asymptomactic sm decrease of function RENAL INSUFF: amenia, uremia, notcuria, polyuria, wt loss, fatigue, n/v RENAL FAILURE ESRD: Irreversible ACUTE RENAL FAILURE: Cant excrete waste, balance lytes or fluid-Reversible if Tx I. Catagories: 1. PRE-RENAL: No blood to the kidneys, Most common cause ARF, MAP<60 -Cause: decrease perfussion/BP decrease CO (MI, HF) -Manifestation: Decrease u/o, Urine concentrated, Increase SG & Osmo, -protien, increase BUN : Crt Ratio 20:1 (normal 10:1) 1. INTRA-RENAL: sloughling clogs tube=ATN *Cause: Inscmia, Nephrotoxic drugs, Transfusion reaction-burn=RBC hemolosis, Muscles necrosis symvistatin, MI, Fall *CASTS WILL BE IN URINE (hallmark d/t breakdown), hemopysis d/t edema, HTN II. Consequences ARF *Infection platelete dystructiom

*GI n/v/d, anorexia *F/E Imbalance Fluid overload, INCREASE: K+, Mag DECREASE: Na, Ca *Metabolic Acidosis *Eremic Encephelopathy d/t excess urea Tremors, apathy, seizures, coma, low STM III. Phases ARF 1. ONSET- IMMEDIATE prevention IVF 2. OLIGOTIC(<500ml/day)(10-20 days)-STRICT I/O Recognize & Treat=Reversible -Fluid challenges done at this stage: lg IVF in short time - Great mouth care d/t fluid restricted - Mgt: careful FR, watch decrease BP Inc HR, Phosphate binder: CaCO3, Amfogel Hyperkalemia-Peaked T wave treat with Kayexalate, IV D50& Insulin, IV Ca Gluconate, IV NaHCO3 Hyponatremia-FR, free H2O = U/O past 24hrs + 600ml 3. DIURETIC(1-2 wks)- U/O increases to 500cc/24hours-REPORT >3000cc/24hours - Monitor volume deficit, lytes Urine dilute low SG BUN,Crt may rise still 1. RECOVERY(months-years)-BUN stable, avoid EXCESS protien - Protect kidney from other insult = hypotension, dehydration

RENAL: NEW RENAL CALCULI I. Factors: Decrease fluid and movement-- High Ca, purine, uric acid diets-Foley Cath II. Prevention: Frequent turning immoble pt High Fluid Decrease Na III. Types of Calculi: 1. Calcium-MOST COMMON by dehydration, hyperparathyroid, hypercalcuremia, diet *N/I: Force fluids, restricte Vit D, protien, NA, Oxalate(choco, strawberry, spina), thiazides 2. Struvite-Infection, alkoline urine tx abx, fluids acidify urine 3. Uric Acid- Gout, high purines diet (sardine, legumes, shellfish) * N/I: Allopurinol, force fluids, restrict purines IV. Complications: -Hydronephosis Pylonephritis Infection Local tissue irritation V. Manifestation: Nephrolathias dull aching constant pain at CV, N/V/D, low/0 BS illius - URETERAL: Excrussiating pain, increse frequency/desire to void w little urine - BLADDER: S/sx of infection, irritating pain

- URETHRA: Collicky excrushiating pain VI. Diagnosis: Great assessment and KUB VII. Management: Stones <6mm can pass -Warm moist packs, baths, ambulation, antienemics, FORCE FLUID, STRAIN ALL URINE VIII. Management: Stones >6mm -