Ascending - from urethra

 Hematogenous - from blood stream (other infection)

 Direct Extension from Intestines (Fistula- r/t diverticulitis)

Elderly, women, chronic illness,

Foley Catheter, cancer, pregnant women

Dysuria, Burning, Frequency,

Urgency, Nocturia,

Hematuria, Back Pain

Chills, Fever, Leukocytosis,

Bacteriuria, Pyuria,

 Low back pain, Flank pain,

 Nausea, Vomiting, Headache,

 Malaise, Dysuria

Fatigue,

Lethargy,

Change in mental status,

new incontinence,

hyperventilation,

low grade fever

Urine culture 10-5th colonies/ml on clean catch, midstream;on a catherized specimen - any bacteria

Ua dipstick for WBC's & bacteria

 Tests for STD's

Ct scans & Ultrasounds

 IV urogram

cinoxacin(Cinobac)

 norfloxacin (Noroxin)

nitrofurantoin (Furadantin)

methenamine

-

Hiprex methylene blue - Urolene Blue

 (stains tissues and can cause GI upset)

Phenazopyridime (Azo-Standard, Pyridium)

 SE's - GI upset, headache, reddish-orange coloring of the urine

DON'T TAKE FOR MORE THAN 2 DAYS IF USED W/URINARY ANTIBIOTICS

MAY INC. TOXIC EFFECTS

Fluids (2000 -m3000 ml/day),

teach pts. to finish antibiotics

Infection of the renal pelvis

Renal failure

Ct scan or ultrasound of the kidney

 Urine C & S

 IVP

WBC Scan(Indium Scan)

Relieve Cause

 Mild to Mod. infection -

Outpatient w/ oral antibiotics (Bactrim/Septra)

Severe:

Systemic antibiotic therapy;

often Aminoglycoside (Gentimicin)

potentially toxic to kidneys

What is Primary Glomerular Disease

 and what are the symotoms?

Antigen-antibody injury to glomerular capillaries

Result of injury from a variety of causes

 Loss of proteins

SX:

Hematuria (cola-colored urine),

Edema, Azotemia, & HTN

What is Acute Glomerulonephritis

 and what causes it?

Inflammation of glomerular capillaries;

 over age 2

Causes:

 inciting antigen,

 postinfectious (after Strep A)

 viral - varicella,

HIV,

 autoimmune

 Antigens outside body : medication

Increased IgA

Kidney biopsy

BUN & Creatinine levels - INCREASED

What is treatment and nursing care for

 Acute Glomerulonephritis?

Treat Cause

 Antibiotic therapy for Strep A

Dietary restrictions ( inc. carb./ dec. protein) Plasmaphoresis Corticosteroids,

Cytotoxic agents,

Antihypertensives

May need temporary dialysis

 NEED STRICT I & O RECORDS!

Hypertensive Encephalopathy

 CHF

 Pulmonary Edema

 ESRD

(rapidly progressive glomerulonephritis)

Repeates episodes of acute glomerulonephritis, hypertensive nephrosclerosis

, hyperlipidemia,

lupus,

DM

What are the symptoms of

 Chronic Glomerulonephritis?

Protenuria, Hematuria,

 SLOW DEVELOPMENT OF UREMIA,

slight edema,

weight loss, increased irritibility,

 retinal changes,

signs of CHF

OFTEN FOUND COINCIDENTALLY

What is the treatment of

 Chronic Glomerulonephritis?

Dialysis to support the kidney temporarily

 Diuretics

High density protein (eggs/dairy)

What is Nephrotic Syndrome (Nephrosis)

 and what are the causes?

Glomerular disease( actually a syndrome) found primarily in children;

marked by loss of proteins, edema, increased cholesterol, and hyperlipidemia

Causes:

Chronic glomerulonephritis,

DM, Lupus, Myeloma

 May occur at any age especially in the elderly

What are the Signs and Symptoms of

 Nephrosis and how is it Diagnosed?

Hypoalbuminemia, Albuminuria, High serum cholesterol,High low-density lipoproteins,

 PERIORBITAL EDEMA AND PITTING EDEMA OF DEPENDANT AREAS & ASCITES

 Irritability, headache, malaise

 DX:

Protenuria, Hypoalbuminuria, Hyperlipidemia, Needle biopsy of the kidney

What is post infarction syndrome?

 What are the symptoms and treatment of it?

Lasts 2-3 days following renal artery embolization

 S/S:

pain localized to flank and abdomen Inc. temp. GI symptoms

 TX:

Treat pain w/ parenteral analgesic agents Acetomenaphrin for fever

antiemetics,

decrease oral intake for GI symptoms