CMA Chapter 20

• Renal failure


  Acute or chronic disorder of kidney function manifested by the inability of the kidney to excrete wastes, concentrate urine, and aid in homeostatic electrolyte conservation
• Acute renal failure


  • Patient has oliguria and a corresponding rise in nitrogen-containing wastes in the blood
  • Causes include serious loss of fluid due to severe burn or hemorrhage, trauma, toxic injury to the kidney, and an obstruction beyond the level of the collecting tubules
• Chronic renal failure


  • Gradual loss of nephrons with corresponding inability of the kidney to perform its functions
  • May result from another disease process, such as systemic lupus erythematosus, diabetic nephropathy, radiation, or renal tuberculosis
  • Patient has general weakness, edema of the lungs and tissues, and neurologic symptoms such as confusion progressing to seizures and coma as the wastes, or toxins, not filtered by the kidneys build up in the blood
• Treatment for renal failure


  1. Renal dialysis to remove nitrogenous waste products and excess fluid from the body

  2. Dialysis dependence may be short term in an acute illness or long term in end-stage renal disease
• Hemodialysis


  Toxins are removed from the blood by routing the patient's blood through a dialysis machine containing synthetic filters and a dialysate, a substance used to balance the electrolyte concentration in the blood
• Peritoneal dialysis


  An appropriately balanced dialysate is administered through a catheter into the abdominal cavity, allowed to remain in the abdominal cavity for a specified time, and then drained into a collecting bag
• Neither type of dialysis is a cure for the underlying renal dysfunction, but both can prolong life almost indefinitely
• Calculi


  Stone formations that may be found anywhere in the urinary system and may range from granular particles to staghorn structures that fill the renal pelvis
• Stones seem most likely to form if the urine is alkaline
• Treatment for calculi


  1. May not be needed if the stones are small enough to be flushed out with increased fluid intake

  2. Large stones may require surgery or lithotripsy, a procedure in which ultrasound is used to crush the stones
• Hydronephrosis


  Distention of the renal pelvis and calyces resulting from an obstruction in the kidney or ureter that causes a backup of urine
• Symptoms of hydronephrosis


  • Flank pain, hematuria, pyuria, fever, and chills
• Treatment for hydronephrosis


  1. The stricture must be corrected, if possible, through cystoscopy

  2. If it is not possible to restore the flow of urine to the urinary bladder, it may be necessary to perform a nephrostomy or ureterostomy
• Glomerulonephritis


  Inflammation of the glomerulus, or filtering unit, of the kidney
• Symptoms of glomerulonephritis


  • Range from very mild edema of the extremities, proteinuria, hematuria, and oliguria to complete renal failure
• Pyelonephritis


  Inflammation of the renal pelvis and the body of the kidney, usually resulting from an ascending infection from the ureters
• Symptoms of pyelonephritis


  • Chills and fever, nausea, vomiting, flank pain, and pyuria (pus in the urine)
• Cystitis


  Inflammation of the urinary bladder
• Symptoms of cystitis


  • Urinary frequency, dysuria, and urgency progressing to chills, fever, nausea, vomiting, and flank pain
• Urethritis


  Inflammation of the urethra that may occur before the signs and symptoms of cystitis appear, or it may indicate a sexually transmitted disease
• Women are more likely than men to have cystitis because a woman's urethra is shorter
• Urethritis


  Inflammation of the urethra that may occur before the signs and symptoms of cystitis appear, or it may indicate a sexually transmitted disease, such as gonorrhea or nongonococcal urethritis
• The treatment for cystitis is also effective for urethritis
• Other signs and symptoms of the urinary system and the possible causes


  • Listed in Table 20-1
• A 5-year-old girl has burning on urination


  • Ask if she urinates when she feels the urge or holds her urine, and caution her to go to the bathroom when the need arises
  • Ask the mother if she uses bubble bath in the child's bath water, as young girls have a very short urethra and are prone to urethritis if they bathe in water with certain types of bubble bath
  • Explain that the child must learn to wipe from front to back to avoid urinary tract infections
• As most men reach their middle years, the prostate begins to enlarge, or hypertrophy
• Benign prostatic hyperplasia


  A noncancerous enlargement of the prostate gland that occurs commonly in men over age 40 years
• Diagnosis of benign prostatic hyperplasia


  1. Digital rectal examination

  2. Physician inserts index finger into rectum and palpates the prostate for size, shape, and consistency
• Surgical procedures to treat prostatic hypertrophy


  • Transurethral resection of the prostate
  • Suprapubic prostatectomy
  • Perineal resection
  • Retropubic resection
• Prostate cancer is best treated when detected early
• Prostate cancer is most common in men over age 50 years, with 75% of diagnoses in men over age 75 years
• Treatment for prostate cancer depends on the extent of the malignancy and the patient's age and general health status
• Testicular cancer accounts for only about 1% of all malignancies, but the metastatic and mortality rates are high
• Testicular cancer is most often seen in men ages 15 to 34 years
• Hydrocele


  A collection of fluid in the scrotum and around the testes
• Cryptorchidism


  One or both undescended testes
• If an undescended testis is not surgically corrected, it results in sterility of the undescended organ and may increase the risk of testicular malignancy later in life
• Inguinal hernia


  Protrusion of the intestines through a weakened area at the anterior base of the abdominal wall
• Orchitis may also result in hydrocele, which should be treated if it becomes a severe complication
• Microorganisms responsible for causing infections in the male reproductive system include staphylococci, streptococci, Escherichia coli, chlamydia, and Neisseria gonorrhoeae