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1

Radiologic study to evaluate structure, function of KUB

Using radiographs and radiopaque dye


Force fluids after to excrete dye

Intravenous pyelography

2

Visualization of complete ureter, renal pelvis needed.


Performed during cystoscopy

Carries risk of sepsis, severe UTI

Retrograde pyelography

3

Evaluates the bladder structure abnormalities, filling.

Cystogram

4

Rapid series of x rays while voiding

Contradicted in UTI

Voiding cystourethrography

5

Evaluate bladder, renal function, assess cause of reduced urinary flow, urinary retention or incontinence.


Uroflowmetry, cystometrography

Urodynamic studies

6

BUN normal range

7-20

7

GFR normal range

90 or greater

8

Inflammation in glomeruli believed to be from antigen antibody stimulation in the glomerular membrane which changes the membrane permeability. More common in males

More common in children and young adults.


Proceeded by strep or viral inf

Acute glomerulonephriris/ Bright’s disease

9

Hematuria and proteinuria is a S/S of

Acute glomerularnephritis/Brights disease

10

How do you dx acute glomerularnephritis/brights disease

Proteinuria

Elevated ASO titer

Percutaneous renal biopsy

11

Tx for acute glomerularnephritis/Bright’s disease

Tx SS

Bed rest until BUN decreases and hematuria decreases

Low sodium diet and dec fluids if needed

Diuretics/ antihypertensives/ steroids

i&O and weights

12

Nursing care for acute glomerularnephritis/ Bright’s disease

Inc urine output and dec wt means patient is improving.

VS monitor BP

Sodium and protein diet restriction

BR

Pt not cured till urine free of protein and RBC for 6 mo

13

Causes of ____ ____ causes are autoimmune connective tissue disorders (lupus) resulting in scar tissue that replaces nephrons and may progress in renal failure

Slow progressive disease in which there is inflammation of the glomeruli that causes irreversible damage to nephrons

Chronic glomerulonephritis

14

S/S of ___ ___ may not have SS for years

Anasarca- which is caused by a fluid shift and protein (albumin) is lost in urine.

Ss of renal failure

DX- dec RBC
Azotemia- nitrogenous waste in blood
Protein and casts in urine
Early stages percutaneous kidney bx

TX: symptomatic
Dec edema, and bp
Prevent CHF, correct fluid and electrolyte prob, eliminate UTI
May eventually require dialysis or kidney transplant

Chronic glomerulonephritis

15

___ ___ ___ inherited as autosomal dominant trait, infantile (rare) and adult forms, formation of multiple bilateral kidney cysts. They cause kidneys to greatly enlarge as cysts accumulate fluids

*hypertension, pain, colic. Hematuria, renal stones

Dx findings:
Abd US, CT, MRI, IVP, labs

Tx- no cure, tx HTN, *avoid all nephrotoxic meds-nsaids/cephalosporins
Surgical removal of kidney, dialysis, transplant
Monitor BP, I&O and labs

Polycystic renal disease

16

Stones in urinary tract

Urolithiasis

17

Stone in kidneys

Nephrolithiasis

18

Stones in ureters

Ureterlithiasis

19

Chronic ureteral stone formation; compressive congenital anomalies of conditions

S/S flank pain or discomfort, tenderness

DX: voiding cystourethrogram, ultrasonography

Tx: dilation ureteroplasty(remove narrow section of ureter and put good parts together)

Typical post op care, I&O, assess for shock pain SS of UTI

Ureteral stricture

20

___ ___ are typically malignant

*painless hematuria, flank pain, palpable mass.

Tumor cells often metastasize to *lungs, bone, lymph, liver, and brain by way of renal vein and vena cavae

Dx finding/ PE, radiography, IVP, cystoscopy w retrograde pyleogram, ultrasonography, MRI, CT, renal angiography

Med management: nephrectomy; radiation therapy; chemotherapy, palliative tx for metastases
*wilms rumor in children do not palpate

Kidney tumors

Nurse care: discourage laying on operative side, monitor I&O, pain, bleeding. Encourage fluids, irrigate tubes/catheter or ordered

21

___ ___ is the inability of nephrons in kidneys to maintain fluid/electrolyte & acid base balance: excrete waste products and to perform their regulation of body


Acute: ARF, sudden, rapid decrease in renal function


Chronic: CRF, progressive, irreversible, takes years to develop

Renal failure

22

__ ___ ___ develops due to prerenal, intrarenal, and post renal disorders.

Acute renal failure

23

___ ___ ___ usuAlly is caused by intrarenal conditions or systemic diseases

ESRD- less than 10% of kidney function and pt require dialysis. GFR less than 15

Damage to nephrons is slow and often do not notice declining renal function.

Uremia, hyponatremia, electrolyte imbalances-metabolic acidosis, uremic frost-skin acts as excretory organ and precipitation-irritation of skin and smells bad.

Chronic renal failure

SS
H/A blurred vision,
Tiredness
Inability to concentrate
Inc BP
Dec urine output
Facial puffiness
Dry itchy skin
Odor of urine

24

Dx of chronic renal failure

Inc BUN, creatine, K, MG, Ph
Dec GFR
Dec CA, RBC, h&h, GFR
blood ph is acidotic
Renal Bx

Tx: prevention
ARF promptly tx cause
Hemodialysis/peritoneal dialysis
Kidney transplant

Medical TX
IV fluids, vasodilator, diuretic, dopamine, temp hemodialysis while tubules regenerate, protein K, NA, ph restriction.
-protein restriction helps decrease urea build up in body. NA polystyrene sulfonate (po/rectal)
IV glucose and insulin to move K back into the cells
Epogen inj- inc o2 compacity of RBC