1. Inflammatory Urinary Disorders

2. URINARY TRACT INFECTION The urinary tract infection may be broadly classified as upper and lower urinary tract infections. The urinary tract infection may be broadly classified as upper and lower urinary tract infections. The patient may have both an upper and a lower urinary tract infection. The frequency of urinary tract infections varies with age and sex and may be acute or chronic. The patient may have both an upper and a lower urinary tract infection. The frequency of urinary tract infections varies with age and sex and may be acute or chronic.

3. Risk Factors For Urinary Tract Infection Inability or failure to empty the bladder completely Inability or failure to empty the bladder completely Obstructed urinary flow,from congenital anomalies, from urethral strictures, contracture of the bladder neck, bladder tumors, calculi in the ureters or kidneys compression of the ureters and neurologic abnormalities. Obstructed urinary flow,from congenital anomalies, from urethral strictures, contracture of the bladder neck, bladder tumors, calculi in the ureters or kidneys compression of the ureters and neurologic abnormalities.

4. Contributing conditions as: Contributing conditions as:  diabetes mellitus  Pregnancy  Neurologic disorders  Gout  Urinary stasis Inflammations or abrasions in the urethral mucosa Inflammations or abrasions in the urethral mucosa Instrumentations of the urinary tract Instrumentations of the urinary tract Immunosuppressant's Immunosuppressant's

5. PATHOPHYSIOLOGY OF URINARY TRACT INFECTION Urethrovesical Reflux” back flow of urine “ with: Urethrovesical Reflux” back flow of urine “ with:  Coughing  Sneezing  Straining Routes of infection: Routes of infection:  Ascending infection e.g. Because the female urethra is short, also several Studies show that sexual intercourse is the major precipitating factor of UTI in women.

6. Clinical Manifestations of UTI 1.Urgency 2.Dysuria 3.Slight to gross hematuria 4.Bacteriuria and positive urine cultures as the basis for diagnosing lower urinary the basis for diagnosing lower urinary tract infections. tract infections.

7. Diagnostic findings of UTI Urine cultures Urine cultures Testing methods Testing methods –Leukocyte esterase test is positive “WBCs in urine” –STD”sexual transmitted disease” may be performed Computerized Tomography ”C.T.” to detect pyelonephritis, abscess Computerized Tomography ”C.T.” to detect pyelonephritis, abscess Ultrasonography to detect obstruction, abscess, tumors, cysts. Ultrasonography to detect obstruction, abscess, tumors, cysts. Intravenous pyelography to detect strictures or stones. Intravenous pyelography to detect strictures or stones.

8. Specific Nursing Care for UTI 1. The medication “anti bacterial” must be given on a time on a regular schedule. 2.The nurse must follow complete aseptic technique if instrumentation is indicated. 3.Sitz bath may provide to relieve pain or itching.

9. Pyelonephritis Definition: It is an bacterial infections that involves both the parenchyma and the pelvis of the kidney, it may affect one or both kidneys. It is an bacterial infections that involves both the parenchyma and the pelvis of the kidney, it may affect one or both kidneys. It is frequently secondary to ureterovesical reflux It is frequently secondary to ureterovesical reflux It may be acute or chronic when it is chronic the kidneys are scarred, contracted and non-functioning It may be acute or chronic when it is chronic the kidneys are scarred, contracted and non-functioning

10. Clinical Findings of Acute peylonephritis A.Symptoms : 1.Chills, moderate to high fever. 2.Constant loin pain unilateral or bilateral. 3.Symptoms of cystitis : -frequency -nocturia -urgency -dysuria 4.Nausea, vomiting and diarrhea are common. 5. Young children complain of abdominal discomfort. B.Signs : 1.The patient appears quite ill. 2. Intermittent chills with fever ranging 38.5 : 40  C. 3.Tachycardia (90 beat/m : 140 beat/m). 4.Abdominal distention.

11. Specific Nursing Care for peylonephritis 1.Health promotion and maintenance measures should be applied. 2.Early treatment for cystitis to prevent ascending infections. 3.Encourage the patient to drink at least 2000 ml of fluid everyday. 4.Antibiotic therapy according to results of urine cultures. 5.Serial urine cultures and other evaluation studies must be continued.

12. Chronic Pyelonephritis Repeated attacks of acute pyelonephritis may lead to chronic pyelonephritis Repeated attacks of acute pyelonephritis may lead to chronic pyelonephritis

13. Images of chronic pyelonephritis Stag horn stone x-ray film for renal calculi causing chronic pyelonephritis calculi causing chronic pyelonephritis

14. Pathology of Chronic Pyelonephritis The kidney shows atrophy of variable degree depending upon the severity of the involvement. In minimal involvement, the kidney shows scarring in the renal surfaces while in extensive involvement, there is a fibrosis specially in the pelvic mucosa. The kidney shows atrophy of variable degree depending upon the severity of the involvement. In minimal involvement, the kidney shows scarring in the renal surfaces while in extensive involvement, there is a fibrosis specially in the pelvic mucosa.

15. Clinical manifestations of chronic peylonephritis It does not have symptoms of infection It does not have symptoms of infection Fatigue Fatigue headache headache Poor appetite Poor appetite Polyuria Polyuria Excessive thirst Excessive thirst Weight loss Weight loss

16. Complications of Chronic Pyelonephritis ESRD ESRD Bacteremia Bacteremia Hypertension Hypertension Renal stones Renal stones

17. Specific Nursing Care for chronic Pyelonephritis 1.The nurse must instruct the patient to continue antibiotic and antimicrobial therapy even after symptoms resolve. 2.Encourage the patient to drink 3 liters/day of fluids unless otherwise instructed. 3.Monitor urinary output and report if there is oliguria or intake more than output.

18. 4.Weighing daily and instruct the patient to report immediately about weight gain. 5. Teach the patient measures to prevent infection and early seek for medical advice if there are signs of urinary infection. 6.Continue with medical follow-up and get follow-up urine cultures as instructed.

19. Interstitial Cystitis It is a Chronic inflammatory condition of bladder wall, frequently remained undiagnosed It is a Chronic inflammatory condition of bladder wall, frequently remained undiagnosed It can be occur at any age, in both genders It can be occur at any age, in both genders Almost 90% of the affected patients are women why? Almost 90% of the affected patients are women why?

20. Pathology o f chronic cystitis In chronic cystitis, the bladder mucosa becomes move edematous, erythematous and friable. It may lead to ulceration of the bladder mucosa then fibrosis and becomes inelastic and thick. In chronic cystitis, the bladder mucosa becomes move edematous, erythematous and friable. It may lead to ulceration of the bladder mucosa then fibrosis and becomes inelastic and thick.

21. Clinical manifestations of chronic cystitis Severe,irritable voiding at day and night Severe,irritable voiding at day and night  Frequency  Nocturia  Urgency Pain “ suprapubic pressure Pain “ suprapubic pressure Irritable bowl syndrome Irritable bowl syndrome Chronic tension type headache Chronic tension type headache

22. Treatment of chronic cystitis Anti-microbial therapy based on culture and sensitivity testing. Anti-microbial therapy based on culture and sensitivity testing. Appropriate correction of contributing factors when possible. Appropriate correction of contributing factors when possible.

23. Primary Glomerular Diseases A variety of diseases can affect the glomerular capillaries, including acute and chronic glomerulonephritis A variety of diseases can affect the glomerular capillaries, including acute and chronic glomerulonephritis Acute Glomerulonephritis It is an inflammation of the glomerular capillaries It is primarily occurs with children but it can occurs at any age.

24. Clinical Manifestations Clear hematuria” either micro/macroscopic” Clear hematuria” either micro/macroscopic” RBCs and protein plugs or casts “indicate glomerular injury” RBCs and protein plugs or casts “indicate glomerular injury” Proteinuria due to increased permeability of the glomerular membrane Proteinuria due to increased permeability of the glomerular membrane BUN, creatinine BUN, creatinine urine output urine output Headache, malaise, flank pain Headache, malaise, flank pain Some degree of edema Some degree of edema Hypertension in 75% of the cases Hypertension in 75% of the cases in old age ; circulatory overload in old age ; circulatory overload

25. Assessment and Diagnostic Findings A: Kidney: large, swollen, and congested A: Kidney: large, swollen, and congested ASOT: Anti Streptolysin O Titre due to streptococcal infection ASOT: Anti Streptolysin O Titre due to streptococcal infection D: Kidney: biopsy D: Kidney: biopsy If the patient improves,urine increases and urinary protein diminish If the patient improves,urine increases and urinary protein diminish If not, dialysis will be needed for survival If not, dialysis will be needed for survival

26. Complications Hypertensive encephalopathy Hypertensive encephalopathy Heart failure Heart failure Pulmonary edema Pulmonary edema Optic neuropathy ”rare” Optic neuropathy ”rare” ERSD ” in poor prognosis ” ERSD ” in poor prognosis ”

27. Medical Management Treating symptoms Treating symptoms Treating complications Treating complications Treat streptococcal infection by penicillin Treat streptococcal infection by penicillin Corticosteroids and immunosuppressant for rapidly progressive acute glomerulonephritis Corticosteroids and immunosuppressant for rapidly progressive acute glomerulonephritis protein and salt in diet in case of edema and hypertension protein and salt in diet in case of edema and hypertension Diuretics to control hypertension Diuretics to control hypertension

28. Nursing Management carbohydrate in diet to provide energy carbohydrate in diet to provide energy Fluid balance chart carefully Fluid balance chart carefully Daily weighing to patient Daily weighing to patient Fluid intake according loss considering insensible loss Fluid intake according loss considering insensible loss Teach patient how to care him/her self at home Teach patient how to care him/her self at home Care of edema Care of edema Care of Skin Care of Skin

29. Chronic Glomerulonephritis Repeated attacks of acute Glomerulonephritis due to: Repeated attacks of acute Glomerulonephritis due to:  Hy pertensive nephrosclerosis  Hyperlipidemia  Glomerular sclerosis Clinically: Clinically:  the kidneys shrinks  reduce its size  It has rough and irregular surface  Thickened renal artery Glomerular damage ESRD ESRD

30. Clinical Manifestations Most of cases has no symptoms until hypertension or BUN/ creatinine elevation can be detected Most of cases has no symptoms until hypertension or BUN/ creatinine elevation can be detected The disease may be discovered during routine eye examination The disease may be discovered during routine eye examination The first indication might be : The first indication might be :  Severe Nose Bleeds  Stroke  Seizure General symptoms as: General symptoms as:  Loss of weight  Increase irritability  Headache  Dizziness  Nocturia  GIT disturbances  Swollen feet specially at night

31. The patient appears poorly nourished The patient appears poorly nourished Blood pressure may be normal or severely elevated Blood pressure may be normal or severely elevated Mucous membranes are pale because of anemia Mucous membranes are pale because of anemia Peripheral neuropathy occurs late in the disease Peripheral neuropathy occurs late in the disease

32. Assessment and Diagnostic Findings A: A:  Chest x-ray shows  Cardiomegaly*Pulmonary edema  Distended neck veins  Crackles can be heared in the lungs D:  Urine analysis …  specific gravity is 1.010 * Proteinuria  Urinary casts due to glomerular damage

33.  Impaired nerve conduction due to uremia  Blood chemistry…  Hyperkalemia  Anemia”lack of erythropoiesis”  Hypoalbuminemia due to protein loss  Increased phosphorus and decreased calcium in blood

34. Medical Management Treat hypertension Treat hypertension Restrict sodium and water Restrict sodium and water Monitor weight daily Monitor weight daily Diuretics to overcome fluid overload Diuretics to overcome fluid overload Increase protein in diet Increase protein in diet Initiation of dialysis as early as possible “benefits”: Initiation of dialysis as early as possible “benefits”:  Optimal physical condition  Minimize risk of complications  Prevent fluid and electrolyte imbalances

35. Nursing Management Observe signs of fluid and electrolyte imbalances Observe signs of fluid and electrolyte imbalances Report changes in fluid and electrolyte status, cardiac and neurologic status. Report changes in fluid and electrolyte status, cardiac and neurologic status. Emotional support to alleviate anxiety Emotional support to alleviate anxiety Teach patient self care Teach patient self care

36. Nephrotic Syndrome It is a primary glomerular disease characterized by the following: It is a primary glomerular disease characterized by the following:  Marked increase in protein in the urine  Decrease in albumin in the blood  Edema  High serum cholesterol

37. Pathophysiology of nephrotic syndrome Damage glomerular capillary membrane Loss of plasma protein ”albumin” Stimulate synthesis of lipoproteins hyperlipedemia hypoalbuminemia Activation of renin-angiotensin system Sodium retention Edema

38. Clinical Manifestations of nephrotic syndrome Edema Edema  Pitting  Soft  Commonly around eyes Malaise Malaise Headache Headache Irritability Irritability fatigue fatigue

39. Diagnostic Findings of nephrotic syndrome Needle biopsy of the kidney may be performed for histologic examination of renal tissue

40. Complications of nephrotic syndrome Infection ”low immune response” Infection ”low immune response” Thromboembolism” renal vein” Thromboembolism” renal vein” Pulmonary emboli Pulmonary emboli Acute renal failure Acute renal failure Accelerated athrosclerosis Accelerated athrosclerosis ”due to hyperlipedemia”

41. Management of Nephrotic Syndrome Diuretics for edema Diuretics for edema Immunosupprsant medications Immunosupprsant medications Low salt diet Low salt diet Protein in diet around 0.8 gm g/kg/day Protein in diet around 0.8 gm g/kg/day Patients with nephrotic syndrome need instructions towards: Patients with nephrotic syndrome need instructions towards:  Dietary regimen  Referral system  medications

42. Thanks for your attention