Urinary System Diseases

and
Nursing Care

1
Function of Kidneys
• The kidneys have two main functions:

They balance the

body's water and
They cleanse blood and
electrolyte
waste products from
composition
food and cell
metabolism
Other Functions of Kidneys

Through the erythropoietin hormone produced,

they stimulate the bone marrow for erythrocyte
production.

They provide calcium and phosphorus balance

with the hormone produced to enable vitamin D
to become active.

Keeps blood pressure under control (RAS)

Evaluation of a Patient with Urinary System Problems

Anamnesis

Physical evaluation

Psychosocial
evaluation

Evaluation of
other systems

Diagnostic
Tests
Urinary system evaluation
Health History
Risk factors are determined by obtaining comprehensive information about the
patient
Good communication with the patient is very important
• How the patient's problem started, how it affects the quality of life
• Does it have pain, its relationship with urination, duration and
characteristics of pain
• History and treatment of urinary tract infection
• Fever or trembling
• Does it have difficulty urinating (pain, burning, incontinence)
• Hematuria in urine, changes in color and quantity
• Is there nocturia
• Anuria history
• Is there a history of kidney stones
 Urinary system evaluation
• Does he take any medications or for kidney problems?
• Smoking, substance abuse
• Have any medications
• Nutrition habits
• Food, medicine etc. Allergy history
• Urinary system surgery, radiotherapy history
• Anorexia, nausea, vomiting, diarrhea, metallic taste in the mouth, distension
etc. GI findings
• Congenital urinary system disease in the family
• Diabetes, hypertension, CAD, SLE, urinary tract infection, presence of contrast
agent
• The habit of evaluating work, training, exercise and free time
• Anxiety, fear, body consciousness, fear of death
 Urinary system assessment
Physical assessment
Complete physical evaluation should be performed as renal diseases affect all systems

Vital signs are assessed (blood pressure is measured from both arms in patient sitting and supine position, heart
rate and peripheral pulse rate, respiratory rate and rhythm, body temperature and weight are evaluated

Irregularities in peripheral and apical pulses may be indicative of electrolyte fluid imbalance

Patient is evaluated for edema and weight change

Urine characteristics are evaluated

Urinary system assessment
Palpation is performed to assess the size and mobility of the
kidneys

Palpation of the right kidney is a bit easier, as the kidney is pushed

down slightly during deep inspiration.

Renal dysfunction may cause sensitivity on costovertebral angle

Abdominal region is auscultated (to assess murmurs) (low volume

murmurs indicating renal artery narrowing or aortic aneurysm)

The presence of acid is evaluated

 Urinary system assessment

It cannot be palpated when For percussion of the

the bladder is empty. bladder, start from the Excess urine in the bladder
Percussion can be upper midline of the navel causes abdominal
performed if there is more and continue downward distension.
than 150 ml of urine. percussion.
Urinary system assessment

The patient is monitored for edema and weight changes.

Edema can also occur in other parts of the body, especially the face, feet
and sacral region.

Mostly, there is an increase in weight with edema.

 Urinary system assessment

Urine tests

Blood tests

Kidney function tests

Radiological examinations

Biopsy
 Urinary system assessment
• Macroscopic and microscopic examination are important

Macroscopic Microscopic
• The amount of urine; (1000-1500 ml) • Leukocyte; (1-2 in men, 3-4 in women is normal
• Appearance of urine (clear) • Erythrocytes; 0-3 is considered normal, inf.
• Color, darker as protein degradation increases, tumor, stone cases increases
light in polyuria) • Urine sediment;
• Density (kidney's ability to concentrate and dilute • epithelium; 1-2 is normal
urine (1015-1025) • Clear Mandir; shows renal damage
• pH; 4.5 to 8. increases in urinary tract infections • Crystal; urine crystal may be seen in pending
• Urine glucose; occurs when blood glucose level urine
increse, refers to tubular damage • Urine culture
• Ketone in urine; seen in diabetic ketoacidosis
• Protein in urine; normally not seen,
• Bilirubin in urine; jaundice and mechanical
jaundice
Urinary system assessment
Blood tests
Decreased glomerular filtration and disruption of the tubules cause
changes in plasma components.

Plasma
Creatinine
proteins

Electrolytes BUN

Uric acid
 Kidney function tests

Creatinine clearance
GFR test Urea clearance test; Tubular function tests
test;
• GFR normal value • GFR gives • Amount of plasma • Concentration test;
was 125 ml/ min. information about cleared from urea in urine concentration
• Indicates kidney the function. 1 minute (55-75 ml) of the kidney is
function and kidney • 24 hours urine is measured, the
damage. collected, blood is ability of the kidney
taken from the to concentrate urine
patient, is controlled by fluid
restriction
• Dilution test; to
determine the
ability of tubules to
dilute urine
 Urinary system evaluation
Direct abdominal radiography Radiological examinations
Sonography; • the presence of hydronephrosis, infection, stones, tumors

CT / MR; • is a diagnostic method used in the evaluation of complicated renal cysts in stones
that cannot be imaged by another technique. Contrast agent used

Intravenous pyelography (IVP); • The general appearance of the kidneys, renal pelvis, ureter and bladder is
evaluated. Urinary system obstruction, stone diagnosis

Renal angiography • The radiopaque material given to the renal artery provides information about the
vascular structure of the kidney, atherosclerotic stenosis

Renal scintigraphy • Used to detect kidney function and blood flow

cystoscopy • Visual examination of bladder and lower urinary tract with scopy

Renal biopsy
KIDNEY FAILURE
 Kidney Failure

The kidneys are

unable to dispose
Normally 125 ml of Kidneys can Kidney failure
of metabolic
blood is filtered compensate until develops when it
waste, and fluid
from the glomeruli this amount drops drops below 50 ml
and electrolyte
per minute (GFR) below 50 ml / min. / min.
balance is
disturbed.
 Two typers of Kidney Failure

Acute Kidney Chronic

Failure Kidney Failure
 Acute Renal Failure-1

• Definition: Acute renal failure is a syndrome in which a sudden and severe decrease
in glomerular filtration rate, a 24-hour urine amount below 400 ml, and therefore
serum creatinine and BUN levels are elevated.

• Acute renal failure is associated with sudden loss of renal function.

 Acute Renal Failure-2
Etiology
Prerenal causes: related
Renal causes: Postrenal causes:
to renal perfusion.
• severe bleeding, • disease or destruction • obstruction of the
vasodilatation, of kidney tissue urinary tract from the
glycosuria, severe composed of tubules to the ureter.
polyuria, diarrhea, nephrotoxic The causes of this
hypotension, cardiac substances. The most obstruction are
problems and common renal cause is prostate hypertrophy,
extensive burns. acute tubular necrosis. stones, tumors,
surgical accidents and
retroperitoneal
fibrosis.
 Acute Renal Failure-3
Patients with ARF are examined and followed up in 4 sections for clinical
course

Initial Oliguric Polyuric Recovery

phase stage phase phase
 Acute Renal Failure-4 Pathophysiology
• The amount of urine is below 400 ml per day.
• Urine density is low.
• The tendency to infection has increased.
Oliguric stage:
• In the oliguric stage, three major problems arise, such as
potassium retention, sodium imbalance and metabolic acidosis.
• This stage lasts 8-15 days

• The patient excretes twice as much urine each day as the

previous day and finds one liter on the third day of diuresis.
• Glomerular filtration gradually improves and the amount of
urine exceeds two liters. 5-6 lt
Diuresis (Polyuria) stage: • As the amount of urine increases, potassium, phosphorus,
creatinine and BUN accumulated in the blood decreases.
• During this period, the patient is closely monitored for
dehydration.
• Takes a few days to two weeks
 Acute Renal Failure-5
Symptoms and signs

• The most common symptom of acute renal failure is changes in the amount of
normal urine.
• Usually this is in the form of oliguria or anuria.
• Thirst, polyuria, nocturia, anorexia, itching, fatigue, confusion, oliguria and
dehydration are seen.
• When metabolic acidosis develops, there is Kussmaul respiration in the form of
deep sighing.
 Acute Renal Failure-7
Diagnostic Assessment
Urine analysis is performed. Hematuria is investigated and urine density is examined.

Blood BUN and creatinine levels are measured.

Urinary sediment erythrocyte and renal epithelial cells are investigated.

Complete blood count and hematocrit determination are performed. Anemia may develop because BUN elevation affects
erythropoietin production.

Blood culture is performed to investigate the infection.

ECG is taken to investigate the triggering cause, abdominal ultrasonography is taken, kidney biopsy is performed.
 Acute Renal Failure-8
Treatment

• It is planned according to the cause and stage of failure.

• The main purpose of treatment in the oliguric phase is to provide fluid control, to regulate
the balance of electrolytes, to eliminate the metabolic residues from the body and reduce
tissue catabolism and to prevent the development of complications in this stage.

• The patient is usually given a high-calorie, low-protein diet. The amount of sodium and
potassium is also reduced.

• Dialysis is mostly used for severe acidosis

 AKF- Diagnosis of Nursing-1
Nursing diagnosis: “fluid-volume imbalance”
Causes: A.Oliguric stage: acute tubular necrosis, “fluid-volume excess due to disruption of regulatory
mechanisms
B. Polyuric stage: “fluid volume due to abnormal fluid loss

A-B Carefully monitoring the amount of fluid removed by the patient,

A. Closely monitoring the signs and symptoms of fluid retention and electrolyte imbalance
A Restriction of potassium in food and liquids
A Patient follow-up for signs of hyperkalemia
A-B Adjusting and monitoring the amount of fluid to be delivered to the patient
A In order to determine the excess volume, the patient is weighed daily with the same clothes, at
the same time and with the same scale,
A Patient needs to be checked for the presence of edema
A-B Taking vital signs
B. Follow-up of the patient in terms of signs and symptoms of dehydration
B. Electrolyte monitoring
 AKF- Diagnosis of Nursing-2

Nursing Diagnosis: Less nutrition due to nausea and dietary

restriction

The patient should be informed about the diet and

complications that may occur when they do not comply,
The patient should be able to choose the foods he likes from the
foods he can eat,
Oral care should be done, the environment should be ventilated
frequently.
 AKF- Diagnosis of Nursing-3

Nursing Diagnosis: Activity intolerance related to biochemical changes

In acute phase, bed rest is taken to reduce metabolic activity

Helps with daily life activities
Assists when ambulation is allowed
 AKF- Diagnosis of Nursing-4

Nursing Diagnosis: Nutritional problems and risk of infection related to decreased immune
response

Invasive procedures should be reduced as much as possible

It should be considered to be sterile material to be used in patients
initiatives should comply with aseptic rules to the patient and visitors should be
restricted
The catheter should be maintained for the implementation of high-risk
Pulmonary functions of the patient should be closely monitored
care should be necessary to ensure the opening of the airways
To prevent atelectasis and pulmonary infections, frequent cycling and deep
breathing should be ensured
 AKF- Diagnosis of Nursing-5

Nursing Diagnosis: Mental confusion, risk of injury related to decreased motor

senses

Patients have a high risk of falling due to changes such as fatigue and
confusion.
Bed edges should be removed when the patient is agitated, restless
Relatives should be informed and attempted to relieve their anxiety
There is a risk of deterioration of tissue integrity due to edema and skin
dryness.
Toxic substances accumulated in the blood can cause itching
Skin cleaning should be given importance,
Circulation should be provided by applying massage to the areas with
pressure, the position of the patient should be changed frequently
 AKF- Diagnosis of Nursing-6

Nursing Diagnosis: Inability to cope with changes in health status, lack of education

It is important to identify the causes of kidney failure, the health and

environmental factors that cause the development of the disease and can be
prevented
Explaining the treatment plan to the patient
Giving information about the proposed diet
Explanation of infection signs and symptoms
By explaining the importance and necessity of regular controls, the patient's
lack of education and anxiety should be tried to be eliminated.
 Chronic Renal Failure-1

• Chronic renal failure (CRF) is a nephrological syndrome characterized by

chronic, progressive and irreversible nephron loss due to various diseases.

• CRF is defined as renal damage and / or glomerular filtration rate (GFR) less
than 60 ml / min / 1.73 m2 lasting at least 3 months, regardless of the
etiology of underlying renal disease.
Chronic Renal Failure-2
• Ethiology

Diabetes mellitus 35.6%

Hypertansiyon 30%
Etiology unknown 17%
Glomerulonephritis 9%
Other 8%
Polycystic kidney diseases 4%
Pyelonephritis 4%
Amyloidosis 2%
Renal vascular disease 1%
 Chronic Renal Failure-5
Symptoms and signs

Respiratory system; Cardiovascular Gastrointestinal Neurological system;

• pulmonary edema due to system; system; • fatigue, lethargy,
fluid retention, Kussmaul • hypertension, congestive • anorexia, nausea, insomnia, irritation,
respiration (often heart failure, pericardial vomiting, uremic taste memory disorders,
breathes because of effusion, pericardial and smell in the mouth, muscle weakness,
insufficient oxygen) tamponade, pericarditis, uremic gastroenteritis irritability, cramps, soles
arteriosclerosis, and GIS hemorrhages, of the feet, paraplegia.
arrhythmia, neck vein constipation, diarrhea,
dilation, systemic edema gastritis, peptic ulceration
Chronic Renal Failure-6 Symptoms and signs
Hematological and • anemia, ecchymosis, purpura, bleeding (nose, gingiva, GIS,
immunological systems; tendency to infection.

• paleness, itching, ecchymosis, dryness of the skin,

reduction in skin turgor, hair breakage and shedding,
Dermatology;
thinning and breakage of the nails, uremic frost (drying of
white urea crystals excreted through sweat).

• metabolic acidosis, growth and developmental delay,

Metabolic and endocrine
sexual dysfunction, oligospermia, anovulation, oligo /
system;
anamenorrhea.

• polyuria, nocturia, dehydration, hyponatremia /

hypernatremia, edema, hypopotasemia / hyperpotasemia,
Fluid electrolyte balance
hypocalcemia, activity and mobilization difficulty, pain,
disorders;
deformity (phosphate retention, vitamin D deficiency,
parathyroid hyperplasia due to low Ca).
 Chronic Renal Failure-7 Diagnostic Evaluation

Polyuria, nocturia, anorexia, nausea,

generalized pruritus, nosebleeds,
enuresis, vomiting,

presence of
acute nephritis or osteomyelitis, chronic occurrence of familial to have occupation
frequent fever, tbc, rheumatoid kidney disease, based on toxic works,
arthritis,

presence of periodic
fever and abdominal
drug habit,
pain should suggest
CRF
 Chronic Renal Failure-8
Physical examination
• Uremic odor • Acidotic respiration • Retinopathy • Jugular and venous • Presence of other
fullness, edema symptoms of
congenital
syndromes involving
kidney

• Abdominal mass • Presence of • Skin findings • Bone pain, growth • Hypertension or

formation hepatosplenomegaly retardation and Hypotension
rickets
 Chronic Renal Failure-9
Laboratory Tests

Urine examination and culture if necessary

Blood count and peripheral smear

Renal function tests (especially BUN, creatinine and creatinine clearance test)

Serum calcium, phosphorus and alkaline phosphatase values

Blood pH and blood gases

Radiological and nuclear medicine imaging methods (especially direct abdominal radiography, abdominal
ultrasonography, CT and nuclear imaging methods)
 Chronic Renal Failure-10
Treatment;

II. Elimination of
I. Correction of III. Treatment of IV. Replacement
factors that accelerate
etiological factors Uremic Syndrome Therapy
progression
• Blood pressure • Fluid electrolyte • Hemodialysis
control (ACE balance • Peritoneal dialysis
Inhibitors) • Acid-base balance • Transplantation
• Glucose control • Treatment of
• Treatment of anemia
hyperlipidemia • Prevention of Ca-P
• Diet balance and uremic
bone disease
 Chronic Renal Failure-12

Nursing care; The evaluation of the patient with chronic renal failure should be
performed in many ways.

Nursing assessment and care in patients with CRF;

Nursing assessment and diagnosis
Evaluating the complications of whole body systems,
Giving information about diagnostic tests and treatment methods,
Evaluating the difficulties of patient and family to cope with the disease,
To evaluate the appropriate treatment method for the patient.
 Chronic Renal Failure-13
• Nursing Diagnosis

• Excess fluid volume (due to decreased urinary excretion, excessive intake of sodium and water,
and low oncotic pressure)
• Nutritional changes, less nutrition than body requirements (due to loss of appetite, nausea,
vomiting, dietary restriction and changes in the oral membrane)
• Activity intolerance (due to fatigue, anemia, accumulation of metabolic residues and dialysis)
• Risk of trauma and bleeding (due to high urea suppressing bone marrow)
• Deterioration of skin integrity (due to dryness, itching, edema)
• Change in breathing (due to insufficient enlargement of lungs)
• Diarrhea due to urea irritation of intestinal mucosa
• Risk of infection (high BUN, invasive procedures, immune system disorder)
• Impairment of self-esteem (change in body image, dependence on others, role change and
sexual dysfunction)
• Fear and Anxiety (disease process, treatment program)
• Lack of knowledge (about the process of the disease, treatment, prognosis, diet)
 Renal Replacement Treatment Options
Transplantation Dialysis

Renal Tx Hemodialysis Peritoneal Dialysis

48
Dialysis-1

• It is a treatment based on fluid-solute exchange between the patient's

blood and the appropriate dialysis solution via a semi-permeable
membrane.

• Fluid and solute movement is usually from the patient's blood to

dialysate, and by removing this dialysate the fluid-solute imbalance
present in the patient is approximated to the normal value
Dialysis
Dialysis can perform some functions of the kidneys

With dialysis; With dialysis;

• A certain amount of fluid can be • Erythropoietin production,
removed from the body • Regulation of calcium-
• A certain amount of toxic waste phosphorus balance
can be removed • Hormonal balance cannot be
• Acid base balance can be achieved
achieved
• Electrolyte balance can be
achieved
• Blood pressure can be controlled
by fluid and sodium excretion
Dialysis

A synthetic Peritoneal
membrane membrane
(hemodialysis) (peritoneal dialysis)
 Dialysis-4

• There are two basic principles of fluid

and solute exchange

• Diffusion

• Osmosis / Ultrafiltration
 Peritoneal Dialysis

• Peritoneal dialysis is a treatment method that

mimics some functions of normal kidney.

• With the use of peritoneal membrane took this

name.

• Peritoneal dialysis uses the peritoneal cavity,

peritoneal membrane, and dialysates.
 Peritoneal Dialysis
• The peritoneum membrane acts as a semipermeable
membrane that transfers toxic substances accumulated
in the body to the dialysate in the abdominal cavity.

• There are numerous pores on which small molecules can

pass.

• In accordance with the known rules of diffusion and

osmosis, a balance is established between the
concentrations of matter on both sides of the
peritoneum.
 Peritoneal Dialysis
• After the dialysis solution is introduced into the peritoneal
cavity, a gradient occurs between this solution, which does not
contain uremic toxins and the blood in which uremic toxins
accumulate.

• Molecules are rapidly migrating from very dense medium to less

dense medium in connection with density differences.

• As the concentration of uremic toxins in the blood decreases and

their concentration in dialysis fluid increases, the passage of
molecules decreases and the passage stops when the density on
both sides of the peritoneum is the same.

• It is also possible to draw liquids on the same basis. This is

achieved by the glucose contained in the dialysis solution.
Glucose increases the osmolarity of the dialysis fluid and passes
to a high osmotic pressure in accordance with the liquid Osmosis
rule.
Peritoneal Dialysis
 Peritoneal Dialysis

Dialysis Connection
Kateter
solutions sets
Dialysis solutions Sodyum
• 132-134 mmol/L

Potasyum • 0 mmol/L

Klor • 95-106 mmol/L

Magnezyum • 0,25-0,75 mmol/L

Kalsiyum
• 1,0-1,75 mmol/L

Bicarbonate • 35-40 mmol/L

• 1,36
Glukoz (dekstroz) • 2,27
• 3,86 g/dL
Specifications
 Peritoneal Dialysis Methods

• Continuous Ambulatory Peritoneal Dialysis (CAPD)

• 7.00-11.00-18.00-22.00

• Automated Peritoneal Dialysis (APD)

• Continuous Cyclic Peritoneal Dialysis-SSPD
• Night Intermittent Peritoneal Dialysis-NIPD
• Tidal Peritoneal Dialysis-TPD
• Intermittant Peritoneal Dialysis-IPD
 CAPD

• Change of PD solution between 3-5 per day

• infusion and discharge by gravity
• Single change during the night

7.00-11.00-18.00-22.00
APD

• Performed with the help of the

device

• The treatment is carried out with

the aid of a device to deliver and
discharge the liquid into the
peritoneum

• Treatment is applied at night

The advantages of PD treatment are;
• treatment facilities at Home
• Easy to learn
• Ease of travel, convenience for employees and students,
more free diet and fluid intake
• More appropriate treatment option in children, elderly and
diabetic patients *
• Better anemia control *
• Better hypertension control
• Continuous solute and fluid exchange
• Longer residual renal function *
• Very low risk of hepatitis *
*DOQI
*Snyder 2002
*Ates
*Akpolat
Disadvantages of Peritoneal Dialysis Treatment

Risk of
Obligation to
infection
make 4-5
(peritonitis
changes per
or catheter
day in CAPD
induced)

The patient is
dependent Dyslipidemia
on the and risk of
machine at obesity
night in APD
 Hemodialysis

• Hemodialysis is the process whereby the patient

blood is cleaned from unwanted substances
through the hemodialysis membrane/dialyser and
given back to the patient.

• Hemodialysis (HD) is used in acute or chronic

kidney diseases, fluid electrolyte imbalances, and
situations that require the immediate elimination
of excess toxic substances from the body.
 Hemodialysis
• HD is a treatment based on the fluid-solute exchange
between the patient's blood and the appropriate dialysis
solution (based on the diffusion principle) through a
semipermeable membrane.

• Diffusion is the movement of the solute from the high

side to the lower side due to the concentration
difference on both sides of the membrane.

• The fluid-solute movement during HD treatment is

generally directed to the dialysis solution from the
patient's blood and by removing the dialysate the fluid-
sol imbalance present in the patient is approximated to
the normal value.
 Components of hemodialysis:

Vascular Access Dialysis Device

Catheter Dialysis Solutions in Pump for blood and
Dialysis Membrane
Suitable Compounds dialysate
or (Dialyzer) and sets
(Dialysate) Pressure, air and blood
A-V fistula monitors
 Vascular Access
• Temporary vascular access and adequate blood flow rate should be provided for
successful HD treatment. 300ml/min
• For this purpose, the most common method used today is a double lumen catheter;
internal jugular vein, subclavian vein or femoral vein
 Hemodialysis

Temporary vascular access

Permanent vascular access
Femoral
Arteriovenous graft
subclavian
Arteriovenous fistula
Internal jugular catheter
 Hemodialysis
• A fistula is the direct connection of an artery and a vein (anastomosis).
• Subcutaneous arteriovenous anastomosis is required in patients who will
undergo long-term dialysis and kidney transplantation.
 Hemodialysis

Patients with A-V fistula should know:

After the fistula is formed, the patient should keep his arm in elevation and
avoid placing his arm under his head.
The patient is taught exercises to improve the fistula (gauze rolls, ball spinning,
etc.)
The patient is told how the fistula works and how to do the control (the fistula
will hear the thrill sound from the pressure of the venous wall. This thrill sound
indicates blood flow)
The patient should not take blood from the arm with fistula, should not be
given serum, should not wear clothes that squeeze the arm, wear a watch,
carry heavy objects, and have blood pressure measured.
Dialysis Membrane (Dialyzer) and sets
 Hemodialysis
Nursing Diagnosis

Deficiency in fluid volume (impaired renal function, rapid fluid intake during
dialysis and potential blood loss)
Risk of infection (presence of fistula / shunt, invasive procedures, risk of
hepatitis B due to frequent contact with blood)
Ki Risk of injury / injury yerinde at the cannula insertion site
Less nutrition than body requirements (due to nausea, vomiting and changes in
metabolic status)
Risk of skin deterioration (edema, skin dryness, itching)
Constipation (due to lack of activity and fluid restriction)
 Hemodialysis

• Weakness (depending on the need for treatment to survive, although it affects

lifestyle)
• Fatigue (due to anemia and changes in metabolic status)
• Impairment of body consciousness (due to the need for machine-dependent life
due to chronic renal failure and loss of work)
• Impairment of thought process (due to dialysis Disequilibrium syndrome or dialysis
dementia)
• Change in the family process as a need for hemodialysis
• Impairment of body image (impaired renal function, changes in other body
systems, necessity of dialysis and possibility of kidney transplant)
• Lack of knowledge (about the purpose of treatment, care of the cannula site, pre-
treatment recommendations, and the daily assessment of the disease and
treatment process)
 IMMUNOLOGICAL
DISORDERS OF KIDNEY
 Acute Glomerulonephritis-1

Definition: Etiology and pathophysiology

• It is a group of kidney diseases that cause • Immunological reaction to antigens

inflammation of the capillary wall in renal • The antigen-antibody complex retains the
glomeruli. glomeruli by producing an inflammatory
response that disrupts the glomeruli.
• The most common after beta hemolytic
streptococcal infection.
• Upper respiratory tract inf. skin inf.
Autoimmune process (SLE) increases
susceptibility
• Vascular damage (hypertension),
• Metabolic diseases (diabetes mellitus),
• Disseminated intravascular coagulation (DIC)
 Acute Glomerulonephritis-2
Signs and symptoms

Hematuria and proteinuria.

The color of urine is like cola due to erythrocyte and protein debris.
Edema is a typical finding, especially on the face and periorbital swelling.
Fever, weakness, pallor, loss of appetite, nausea and vomiting may occur.
Headache\ hypertension
Abdominal or side pain.
Oliguria and even anuria may last for several days.
 Acute Glomerulonephritis-3

Diagnostic evaluation; Treatment;

• Urine analysis is performed. • Bed rest.

*hematuria and proteinuria. • Medical treatment
• Blood test • to maintain the patient's
• BUN and creatinine levels in the immune balance,
blood. • slow down or reduce
• Changes in serum electrolytes inflammation
• prevent further kidney damage
• improve renal function.
Acute Glomerulonephritis-4
Nursing care;

anamnesis

Vital signs and edema are evaluated.

The fluid balance measured and daily weight control is done.

If the patient is being treated at home, explanations are made

to the patient and the family member responsible for the care.
 Acute Glomerulonephritis-5
Nursing Diagnosis
Nutritional changes (undernutrition, loss of appetite, change in renal
function; less protein, salt-free diet due to proteinuria and edema).

Liquid volume excess (accumulation of fluid in the body due to

oliguria, anuria and edema).

Activity intolerance (due to fatigue, weakness, wilt and pain).

Risk of skin deterioration (due to edema).

Risk of infection development (due to treatment-impaired immune

response and streptococcal infection).
 Chronic Glomerulonephritis-1
Definition: Signs and symptoms:

• Chronic glomerulonephritis is a • Hematuria,

syndrome that reflects the end • proteinuria,
stage of glomerular inflammatory • weight loss,
diseases.
• fatigue
• headache, especially in the morning
• various degrees of edema,
• dyspnea with exertion,
• uremic syndrome develops as renal
function decreases.
 Chronic Glomerulonephritis-3
Treatment:
• Supportive and symptomatic.
• Medication; antibiotics for infection, analgesics to relieve pain, electrolyte
replacement
• Dietary regulation, protein and salt restriction,
• Fluid restriction if oliguria,
• İntake-output of fluid tracking,
• Antihypertensive treatment,
• Protection from UTI,
• Regular use of drugs,
• Regular check
 Nephrotic syndrome-1

1 2 3
Definition: Renal disease a syndrome in which Syndrome is an increase
characterized by diffuse many groups of diseases in permiability due to
edema and albuminuria. coexist. severe damage of the
glomerular capillary
membrane for any
reason.
 Nephrotic Syndrome-2
Etiology and Pathophysiology
• It occurs in renal-related conditions that cause glomerular capillary membrane damage.
• Glomerulonephritis, amyloidosis, SLE
• Plasma proteins are excreted in the urine.
• Edema due to water and salt retention may develop

hypoalbuminemia

Oncotic pressure reduction in plasma,

Fluid transfer from intravascular to interstitial

Edema
Nephrotic Syndrome-3
Symptoms and signs:
• generalized edema
• Sparkling urine
• Proteinuria (> 3.5 g / dl per day), hypoalbuminemia
• Hypertension
• Hyperlipidemia
• Anorexia, malaise, irritability, fatigue and headache
• Muscle loss and weakness
• Female patients may have amenorrhea and abnormal menstrual bleeding
• Abdominal and side pain
• Anemia
• Diarrhea
 Nephrotic Syndrome-4

• Detection of abundant proteinuria in urine analysis is definitive.

• Blood tests
Diagnostic • increased BUN and creatinine. Decreased blood albumin
evaluation

• Treatment and care in nephrotic syndrome have two purposes.

These:
• 1) Replacing protein loss
Treatment • 2) Prevent edema formation
 Nephrotic Syndrome-5
Specific treatment: Nonspecific treatment:

• Immunosuppressive agents • Edema control; diuretic drugs, salt

• Glucocorticoid treatment (for 12 restriction, high protein diet, IV
weeks) albumin,
• Cytotoxic agents • High calorie diet, high protein diet in
edema range,
• Treatment of Hyperlipidemia,
hypertension
• Bed rest
• Lab. And follow-up of diagnostic tests
• Fluid monitoring
• Daily weight monitoring
Nephrotic Syndrome-6
Nursing care;

• Edema
• The amount of liquid it extracts,
• Daily weight,
• Abdominal sircumstance,
• The condition of the skin (severe edema may damage the skin),
• Respiratory status (have symptoms of pulmonary edema),
• It is investigated whether there are signs and symptoms related to
infection.
 Nephrotic Syndrome-7
Nursing Diagnosis

Nutritional change:
High risk of Lack of knowledge
less nutrition than
Excess fluid volume infection (due to about inability to
body requirement
due to impaired malnutrition, remember and
(depending on loss
renal function immobility and isolation due to
of appetite and
edema) illness
pay)
INFECTIOUS DISEASES OF
THE URINARY TRACT
 Urinary Tract Infections
• is seen in 1/3 of women
• The most common bacterial origin is inf. (E. coli is the most common
bacteria)
• Classification; upper urinary tract infection (including renal parenchyma,
pelvis and ureter) and lower urinary tract infection

Pyelonephritis (renal
cystitis (inflammation of the Urethritis inflammation of the
parenchyma and collecting
bladder wall urethra
system inf)
 Cystitis-1

Definition: 2. Etiology and Pathophysiology

• Inflammation of the bladder wall. • Urethral infection
• Radiation, chemical agents, metabolic
diseases
• Lower GIS-derived gram-bacteria
• Women are more prone to cystitis (the
urethra is short and straight, the urinary
meatus is close to the anus and vagina,
trauma-contamination during sexual
intercourse, individual hygiene failure
and bladder retention
• In men, urinary retention and inf.
development
 Cystitis-2
Signs and symptoms:
Leukocytes
are found.
Urine is
turbid,
Nocturia
smelly.
Burning
sensation
Pain when
urinating
Frequent
(stranguria)
and low
Suprapubic ,
urination
or pelvic
(pollacuri)
pain,
 Cystitis-3

Diagnosis: Treatment: Protection:

• Urine culture and urine • Antibiotic is given according • Perineal hygiene is important
analysis to the lab/ result. in the prevention of lower
• In addition, urinary tract urinary tract infections.
antiseptics may be
administered.
• It is recommended to take
plenty of fluid and empty the
bladder frequently.
• Pain can be relieved by
applying warm water to the
perineum.
 Pyelonephritis-1

Definition: Etiology and pathophysiology:

• Pyelonephritis is a bacterial infection • The pelvis and parenchyma of the

of the renal pelvis and parenchyma. kidney are affected (functional part of
• It may be acute or chronic. the kidney)
• Infection develops widely, spreading
from renal pelvis to cortex,
• Escherichia coli bacteria are the most
common causative agent of
pyelonephritis (85%).
• Coli bacteria are transmitted to the
urethra through feces and spread
upwards
Pyelonephritis-2
Acute Chronic
Pyelonephritis; Pyelonephritis;

may temporarily
recurrent
affect renal
inflammation
function.

usually after
permanently
bacterial
destroys kidney
contamination of
tissue
the urethra

catheterization or
scar formation.
cystocopy.
 Pyelonephritis-3
Signs and symptoms: Diagnostic evaluation; Treatment;

• High fever, chills, • Diagnosis is made by • To treat pyelonephritis,

weakness, fatigue, side urinalysis and urine antibiotics are
pain, headache, culture. administered and
muscle pain and • Ultrasound or renal monitored, taking into
general exhaustion. scintigraphy is used to account existing
• Frequent and painful localize the location of bacteria.
urination. urinary obstruction. • It can be taken orally
• Urine is cloudy, with or the general method
leukocytes and includes parenteral
bacteria. antibiotics for 3 to 5
• Bacteriuria may be the days.
only symptom
Pyelonephritis-4
Nursing Diagnosis
High fever, nausea, vomiting and possible lack of fluid volume
due to diarrhea.
Pain (headache, muscle pain, side pain)

Changes in urinary elimination (dysuria, pyuria, polycuria).

Risk of infection due to leukocytosis, pyuria, bacteriuria.

Lack of knowledge in preventing frequent infections.

 Pyelonephritis- 5
Nursing care and education;
The patient is allowed to drink plenty of fluids and the reason is explained.

The amount of liquid that it takes in and out is recorded.

The patient's fever is checked every four hours, the antibiotic ordered is given.

Bed rest recommended in the acute phase of the disease

Patient education is very important to prevent recurrence of pyelonephritis.

Training should include adequate fluid intake, complete emptying of the bladder, and perineal
hygiene practices as recommended.