GENITO URINARY SYSTEM

2. GENITO URINARY SYSTEM

3. OBJECTIVES At the end of the class students will be able to • explain glomerulonephritis and its management • enlist the congenital anomalies • list down the features of renal failure • explain nephrotic syndrome • enumerate UTI

4. HELLO K I D N E Y G l o m e r u l o n e p h r I t I s

5. What is glomerulonephritis? • Glomerulonephritis is is a kidney condition that involves damage /inflammation to the glomeruli.

6. Incidence and etiology • More in males • Between 5-8yrs • Peak age 7yrs • Beta Hemolytic streptococcus • Primary site or infection is usually the throat or skin after nephritis.

7. Types of glomerulonephritis • Acute glomerulonephritis - begins suddenly • Chronic glomerulonephritis -develops gradually over several years.

9. Sign and symptoms

10. Kidney pain normally happens in the “flank” region, which is just below the bottom of rib cage.

11. Sign and symptoms • Cola-colored or diluted, iced-tea-colored urine from red blood cells in your urine (hematuria) • Foamy urine due to excess protein (proteinuria)

12. High blood pressure (hypertension) • Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen • Fatigue from anemia or kidney failure. • Less frequent urination than usual.

13. Diagnosis • Urine analysis • Blood investigation • Culture • Renal biopsy

14. Management • Treatment depends on the cause of the disorder, and the type and severity of symptoms. • High blood pressure may be hard to control. Controlling high blood pressure is usually the most important part of treatment. • Dialysis and Transplant

15. Medications • Diuretics to reduce fluid retention • Medications to suppress the immune system Lifestyle Changes • Restrict salt and water intake. • Restrict intake of potassium, phosphorous, and magnesium. • Cut down on protein in the diet. • Maintain a healthy weight through diet and exercise. • Take calcium supplements.

16. Physiotherapytreatment • Patient education • Endurance Exercise • Walking test • walking, swimming, bicycling, aerobic dancing • Circulatory exercise

17. Exercise program during dialysis

18. Precautions • Do not give an exercise to patient with consideration of these condition: • Changed their dialysis schedule • Changed their medicine schedule • Overeaten • Physical condition has changed; • Fever • Have joint or bone problems • Do not give exercises in an indoor, air-conditioned environment.

19. Discontinue routine earlier if experience any of the following: • shortness of breath • fatigue, • rapid or irregular heartbeat, • chest pain, • nausea, • leg cramps or dizziness.

20. NURSINGMANAGEMENT • History collection • Monitor fluid status • Prevention from infection • Prevent skin breakdown • Meet nutritional needs • Emotional support

21. NURSINGDIAGNOSIS • Fluid volume excess related to decreased urine output secondary to damaged nephrons • Activity intolerance related to fatigue • Imbalanced nutrition less than the body requirement related to anorexia • Fatigue related to increased metabolic demands and anemia • Risk for impaired skin integrity related to edema

22. COMPLICATION • Hypertensive encephalopathy • Acute cardiac decompensation • Acute renal failure

23. NEPHROTIC SYNDROME

24. DEFINITION • It is a clinical state that includes massive proteinuria, hypoalbumineamia, hyperlipidemia and edema.

25. INCIDENCE • 2-6yrs of age • More in males

26. TYPES/CAUSES • Primary nephrotic syndrome • Primary disease known as idiopathic nephrosis, childhood nephrosis, or minimal change nephrotic syndrome.(MCNS) • 80% of cases with MCNS • Non specific illness (viral infection , URI) • Disease limited to kidney • Protenuria and edema

27. Secondary nephrotic syndrome: • Acute/chronic glomerular nephritis • Toxicity of drugs (trimethdione) • Rare • Sickle cell disease • Hepatitis • Malaria • TB, • Renal vein thrombosis • AIDS, • lymphoma, • infective endocarditis

28. Congenital nephrotic syndrome: • Hereditary • Recessive gene and autosomal disease. • Gene mutation

29. Pathophysiology

30. CLINICAL FEATURES • Edema around eyes, legs and labia • Anasarca (generalized body edema)

31. Ascites • Hydrothorax and hydrocele • Decrease urine output, urine appears to be frothy • Hematuria • Fever, rashes and joint pain • Pallor, Irritability • Loss of appetite but weight gain • Susceptibility of infection

32. DIAGNOSTICEVALUATION • 24Hrs urine total protein • Blood investigation: elevated cholestrol, albumin, urea

33. Therapeutic management • General measures • Prednisolone is the drug of choice 2mg/Kg/day orally in divided doses for 6 weeks Then 1.5mg/Kg single dose on alternate days for 6 weeks • Diuretic and salt poor albumin indicated –severe edema • Well balanced diet rich in proteins • Sodium, water restriction

34. NURSINGMANAGEMENT • Monitoring intake output • Urine examination • Daily weight measurement • Measurement of abdominal girth • Assessment of edema • Monitoring the vitals signs • Protect children from contact with infected roommates • Recreational therapy • Parental education • Serve alternative meals

35. NURSING DIAGNOSIS • Excess fluid volume related to retention of urine • Imbalanced nutrition less than the body requirement related to anorexia • Fatigue related to loss of protein • Disturbed body image related to edema • Activity intolerance related to fatigue • Risk for impaired skin integrity related to edema

36. COMPLICATIONS • Acute renal failure • Chronic kidney disease • Fluid overload • Infection • Pulmonary edema • Congestive cardiac failure • Growth retadation

37. Urinary Tract Infection (UTI) Concept of “asymptomatic bacteria” in urinary tract

38. Causes • E. coli most common pathogen • Streptococci • Staphylococcus saprophyticus • Occasionally fungal and parasitic pathogens

39. Classificationof UTI • Upper tract: involves renal parenchyma, pelvis, and ureters • Typically causes fever, chills, flank pain • Lower tract: involves lower urinary tract • Usually no systemic manifestations

40. Classification of UTI Lower tract • Cystitis • Urethritis Upper tract • Pyelonephritis • Glomerulonephritis

41. Classification of UTI • Uncomplicated infection • Complicated infections • Stones • Obstruction • Catheters • Diabetes or neurologic disease • Recurrent infections

42. Types of UTIs • Recurrent—repeated episodes • Persistent—bacteriuria despite antibiotics • Febrile—typically indicates pyelonephritis • Urosepsis—bacterial illness; urinary pathogens in blood

43. Etiology and Pathophysiologyof UTI • Physiologic and mechanical defense mechanisms maintain sterility • Emptying bladder • Normal antibacterial properties and urine and tract • Ureterovesical junction competence • Peristaltic activity

44. Alteration of defense mechanisms increases risk of UTI • Organisms usually introduced via ascending route from urethra • Less common routes • Bloodstream • Lymphatic system

45. Contributing factor: urologic instrumentation • Allows bacteria present in opening of urethra to enter urethra or bladder • Sexual intercourse promotes “milking” of bacteria from perineum and vagina • May cause minor urethral trauma

46. UTIs rarely result from hematogenous route • For kidney infection to occur from hematogenous transmission, must have prior injury to urinary tract • Obstruction of ureter • Damage from stones • Renal scars

47. UTI is a common nosocomial infection • Often E. coli • Seldom Pseudomonas • Urologic instrumentation common predisposing factor

48. Clinical Manifestations of UTI • Symptoms • Dysuria • Frequent urination (>q2h) • Urgency • Suprapubic discomfort or pressure

49. Urine may contain visible blood or sediment (cloudy appearance) • Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)

50. Pediatric Manifestations • Frequency • Fever in some cases • Odiferous urine • Blood or blood-tinged urine • Sometimes NO symptoms except generalized sepsis