DISEASES OF THE URINARY SYSTEM
(NSC 413)
DR. NGOZI MAKATA
Kidneys, ureters and the bladder
ANATOMICAL VIEW OF THE KIDNEY
The Nephron
Urine Formation
This has 3 phases
Filtration (simple filtration)
Selective re-absorption and
concentration
Secretion
Functions of the kidneys
Formation of urine
Excretion of waste product of
metabolism
Maintenance of fluid balance
Maintenance of electrolyte balance
Maintenance of Acid-base balance
Helps to increase the blood pressure by
the action of ADH and Renin
Clinical manifestations
Urine Retention
Retention with overflow In this case,
there is constant dribbling of urine, with
the bladder remaining disintended
Anuria (no urine) - less than 250mls
Incontinence
Polyuria
Oliguria - urine below 500mls in 24
hours
Blood pressure is often elevated
Clinical manifestations contd.
Frequency
Strangury- constant and urgent desire
to micturate pain & passage of only few
drops of urine
Heamaturia
Proteinuria (Albuminaemia)
Casts
Abnormal Urine Colour
Oedema
Uraemia, etc.
Diagnostic measures in renal
condition(Functional & Imaging)
Urinalysis
Urine culture and sensitivity
Kidney function tests
Creatinine clearance test
Blood urea nitrogen (BUN)
estimation
X-ray of the abdomen
Ultrasonography
Diagnostic measures in renal
condition(Functional & Imaging
Computed Tomography scan (CT Scan) -
evaluate kidney masses
Intravenous Urography- uses
radiopaque dye to provide an image of
the kidneys, ureters and bladder
Retrograde Urography – use a
radiopaque dye similar to
intravenous urography
PYELONEPHRITIS
Definition: Pyelonephritis is
inflammation of renal pelvis,
parenchymal tissues and tubules of
the kidneys due to bacterial
infections. It does not have clear
involvement of blood vessels.
Causes/Predisposing factors
Ascending infection from the ureters
Blood borne pathogens such as
staphylococcus or streptococcus (rare)
Urinary stasis due to bladder urethral
infection
Urinary tract obstruction e.g stricture, urinary
stones, prostatic hyperplesia, neoplasm
Causes/Predisposing factors
contd.
Reflux of urine from the bladder into the
ureters
It may occur following uretheral
catheterization
defective drainage associated with enlarged
prostrate (BPH).
It occurs in pregnant women due to atoning
of the ureters following effect of
progesterone, and also due to stasis of urine
resulting from pressure from the enlarged
uterus.
Causes/Predisposing factors
contd.
It occurs in women with increased
sexual activity, women who use
diaphragm, use of spermicide,
Failure to void after sexual intercourse
History of recent UTI
Men who perform anal intercourse,
Types/classification
Acute
chronic
Incidence
More common in females than males
and relatively high in female infants
and children. This is attributed to
faecal soiling and Escherichia coli
contamination of urethral meatus.
Pathophysiology
If there is ureterovesical reflux of infected
urine into the pelvis of the kidney(s)
inflammation occurs with enlarged kidney
and interstitial infiltration of inflammatory
cells.
This leads to fever and chills
Abscesses may be noted on the renal
capsule and at the corticomedullary junction
Pathophysiology contd.
Abscess formation may lead to appearance
of pus in the urine (pyuria).
In continual attempt to destroy the
microorganism brings about increased level
of white blood cells leading to
leucocythosis.
With this condition over time, the renal
capsule shrinks leading to pain in the kidney
area (Costo Vatebral Area tenderness).
Pathophysiology contd.
Where the condition is not properly
treated the kidney undergoes
irreversible degenerative changes
and atrophies.
Destruction of tubules and glomeruli
may result with destruction of many
nephrons and subsequent renal
failure may develop.
Clinical manifestations
Patient appears acutely ill with chills and
fever
Malaise
Pain in the kidney areas (CVA tenderness)
Frequent and burning sensation on
urination may be present if cystitis is
present i.e dysuria with frequency of
micturition
Pyuria
Leukocytosis
Diagnostic investigations
Computerized Tomography(CT) Scan
to locate any obstruction in the
urinary tract
Urine culture and sensitivity to
identify causative m-organism
Serum creatinine level estimation
Blood Urea Nitrogen level estimation
Creatinine clearance test
Nursing management
Admit patient on a comfortable bed and
allow him/her to assume a comfortable
position
Observe the vital signs especially the
temperature
Monitor the frequency of urination and
dysuria
Reassure patient and involve him in his care
Diet – Serve adequate nutritive diet, high in
protein and carbohydrate.
Fluid intake is increase and proper input and
output chart is maintained
Nursing management contd.
Investigations should be carried
out as ordered especially culture and
sensitivity which might be repeated.
Drugs – administer prescribed
antibiotics accordingly with enough
fluid e.g Caps Ampiclox 500mg qds x
5/7
Serve prescribed analgesics e.g tabs
paracetamol 100mg tds x 3/7.
Advice/education on discharge
To continue the prescribed
antibiotics because this is needed
beyond the disappearance of acute
signs and symptoms
He should come to the hospital on
appointment date
He should continue high fluid intake
to ensure total flushing of the micro
organisms.
Medical management
Treatment of pyelonephritis is carried out
in out-patient basis if there is no sign of
dehydration, nausea or vomiting and
signs or symptoms of sepsis.
Pregnant women may be admitted for 2-
3days for parental therapy and oral drugs
substituted once they show signs of
clinical improvement and a febrile.
Culture and sensitivity test is carried out
Appropriate antibiotic is prescribed using
the culture and sensitivity results.
Complications
Renal (kidney) failure
Hypertension
Kidney stones
Prevention
Encourage patient to ↑se fluid intake
Teach patient signs of recurring/worsening
pylonephitis or lower urinary tract infect. E.g
frequency, urgency, burning, cloudy urine.
Women should wipe from front to back after
defecation and wear cotton under wears.
Client should void every 2-3 hrs when awake
Nursing diagnosis
Hyperthermia related to presence of
microrganism in the renal pelvis as evidenced by
patient’s elevated body temperature
Pain related to the shrinking of the renal capsule
as evidenced by patient’s verbalization
Anxiety related to unknown outcome of the
disease as evidenced by patient’s facial
expression
Deficient knowledge related to cause,
management and prognosis of the disease as
evidenced by patient’s numerous questions about
the cause, management and prognosis of the
disease
Assignment
From the identified nursing
problems, draw nursing care plan
using three of the problems
End
Thank you
for listening
