Tolentino, Sabrina Cedie S.

BSN IVB Description AGN Acute GN is defined as the sudden onset of hematuria, proteinuria, and red blood cell (RBC) casts. This clinical picture is often accompanied by hypertension, edema, azotemia (ie, decreased glomerular filtration rate [GFR]), and renal salt and water retention. Acute GN can be due to a primary renal disease or to a systemic disease.

CA ASSIGNMENT

NS Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Nephrotic-range proteinuria is 3 grams per day or more. On a single spot urine collection, it is 2 g of protein per gram of urine creatinine.

Etiology

Infectious The most common infectious cause of acute GN is infection by Streptococcusspecies (ie, group A, betahemolytic). Two types have been described, involving different serotypes: Noninfectious Noninfectious causes of acute GN may be divided into primary renal diseases, systemic diseases, and miscellaneous conditions or agents. Multisystem systemic diseases that can cause acute GN include the following:

Nephrotic syndrome is usually caused by damage to the clusters of tiny blood vessels (glomeruli) of your kidneys. diseases and conditions can cause glomerular damage and lead to nephrotic syndrome, including:

Minimal change disease. Focal segmental glomerulosclerosis. Membranous nephropathy. Diabetic kidney disease. Systemic lupus erythematosus. Amyloidosis. . Blood clot in a kidney vein Heart failure. Nephrotic-range proteinuria could occur with the use of anticancer agents, such as bevacizumab, that inhibit vascular endothelial growth factor (VEGF)

Vasculitis (eg, Wegener granulomatosis) -). Collagen-vascular diseases (eg, systemic lupus erythematosus [SLE]) Hypersensitivity vasculitis Cryoglobulinemia Polyarteritis nodosa

Henoch-Schnlein purpura . Goodpasture syndrome

Primary renal diseases that can cause acute GN include the following:

Membranoproliferative glomerulonephritis (MPGN) Miscellaneous noninfectious causes of acute GN include the following: Guillain-Barr syndrome Irradiation of Wilms tumor Diphtheria-pertussis-tetanus (DPT) vaccine Serum sickness Epidermal growth factor receptor activation[6] and possibly to its inhibitor cetuximab

Signs and Symptoms

Hematuria Oliguria Edema (peripheral or periorbital) Headache - This may occur secondary to hypertension; confusion secondary to malignant hypertension Shortness of breath or dyspnea on exertion Possible flank pain secondary to stretching of the renal capsule Initial Blood Tests Complement Levels Urinalysis and 24-Hour Urine Study Streptozyme Test Blood and Tissue Culture Other Laboratory Tests

Swelling (edema), particularly around your eyes and in your ankles and feet Foamy urine, which may be caused by excess protein in your urine Weight gain due to excess fluid retention

Diagnosis

Urine tests. Urinalysis Urine sediment examination Urinary protein measurement

Radiography and Computed Tomography Ultrasonography and Echocardiography Renal Biopsy

Blood tests. Serum albumin Serologic studies for infection and immune abnormalities Removing a sample of kidney tissue for testing. Renal ultrasonography Renal biopsy

Management

Antibiotics Antibiotics (eg, penicillin) are used to control local symptoms and to prevent spread of infection to close contacts. Other agents

Blood pressure medications. Drugs called angiotensinconverting enzyme inhibitors reduce blood pressure and also reduce the amount of protein released in urine. Water pills. Water pills (diuretics) help control swelling by increasing your kidneys' fluid output. Cholesterol-reducing medications. Medications called statins can help lower cholesterol levels. Blood thinners. Medications called anticoagulants help decrease your blood's ability to clot and reduce your risk of developing blood clots. Immune-system-suppressing medications. Medications to control the immune system, such as corticosteroids, may decrease the inflammation that accompanies certain kidney disorders, such as membranous nephropathy.

Loop diuretics may be required in patients who are edematous and hypertensive in order to remove excess fluid and to correct hypertension. Vasodilator drugs (eg, nitroprusside, nifedipine, hydralazine, diazoxide) may be used if severe hypertension or encephalopathy is present. Glucocorticoids and cytotoxic agents are of no value, except in severe cases of PSGN. Sodium and fluid restriction should be advised for treatment of signs and symptoms of fluid retention (eg, edema, pulmonary edema). Protein restriction for patients with azotemia should be advised if there is no evidence of malnutrition. Bed rest is recommended until signs of glomerular

Choose lean sources of protein Reduce the amount of fat and cholesterol in your diet to

inflammation and circulatory congestion subside. Prolonged inactivity is of no benefit in the patient recovery process.

help control your blood cholesterol levels

Eat a low-salt diet to help control the swelling (edema) you experience

Description

BPH Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate. Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention, renal insufficiency, recurrent urinary tract infections, gross hematuria, and bladder calculi.

UROLITHIASIS
The term nephrolithiasis (kidney calculi or stones) refers to the entire clinical picture of the formation and passage of crystal agglomerates called calculi or stones in the urinary tract (Wolf, 2004). Urolithiasis (urinary calculi or stones) refers to calcifications that form in the urinary system, primarily in the kidney (nephrolithiasis) or ureter (ureterolithiasis), and may also form in or migrate into the lower urinary system (bladder or urethra) (Bernier, 2005).

Etiology

Most experts consider androgens (testosterone and related hormones) to play a permissive role. This means that androgens have to be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by the fact that castrated boys do not develop BPH when they age. On the other hand, administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms. Dihydrotestosterone (DHT), a metabolite of testosterone, is a critical mediator of prostatic growth. DHT is synthesized in the prostate from circulating testosterone by the action of the enzyme 5-reductase, type 2. This enzyme is localized principally in the stromal cells; hence, those cells are the main site for

Cystolithiasis :Bladder (vesical) calculi are stones or calcified materials that are present in the bladder (or in a bladder substitute that functions as a urinary reservoir). Urolithiasis: Decreased urine volume
Increased excretion of stone-forming components Inadequate urine drainage, which may lead to stasis Decrease in urinary citrate levels leading to deposition of calcium Deficiency of vitamins A or C - these conditions can also lead to the "hyper triad": hyperparathyroidism, hypercalcaemia, and hyperuricosuria.

Cystolithiais: Bladder outlet obstruction remains the most common cause of bladder calculi in adults. Prostatic enlargement, elevation of the bladder neck, and high

the synthesis of DHT.

postvoid residual urine volume cause stasis, which leads to crystal nucleation and accretion. This ultimately results in overt calculi. In addition, patients who have static urine and develop urinary tract infections are more likely to form bladder calculi. Cystolithiasis Lower abdominal pain In men, pain or discomfort in the penis Painful urination Frequent urination Difficulty urinating or interruption of urine flow Blood in your urine Cloudy or abnormally dark-colored urine

Signs and Symptoms

Urinary frequency Urinary urgency Hesitancy - Difficulty initiating the urinary stream; interrupted, weak stream Incomplete bladder emptying - The feeling of persistent residual urine, regardless of the frequency of urination Straining - The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder Decreased force of stream - The subjective loss of force of the urinary stream over time Dribbling - The loss of small amounts of urine due to a poor urinary stream

Kidney Stone Symptoms Stones in the kidneys can become lodged at the junction of the kidney and ureter (ureteropelvic junction), resulting in acute ureteral obstruction with severe intermittent colicky flank pain. Pain can be localized at the costovertebral angle. Hematuria

Ureteral Stone Symptoms Stones that can pass into the ureter may produce ureteral colic, which is an acute, sharp, spasmlike pain located in the flank. Hematuria may be present. Stones moving down

the ureter to the pelvic brim and iliac vessels will produce spasms with intermittent, sharp, colicky pain radiating to the lateral flank and around the umbilical region. As a stone passes through the distal ureter, near the bladder, the pain remains sharp but with a waxing and waning quality. pain may intensify and radiate to the groin, testicles, or labia. Nausea, vomiting, diaphoresis, tachycardia, and tachypnea may be present and patients are typically uncomfortable.

Diagnosis

Detailed questions about your symptoms. Your doctor will want to know about other health problems you may have, what medications you're taking and whether there's a history of prostate problems in your family. Digital rectal exam. This exam can allow your doctor to check your prostate by inserting a finger into your rectum. Neurological exam. This is a brief evaluation of your mental functioning and nervous system. Urine test (urinalysis). Analyzing a sample of your urine in the laboratory can help rule out an infection or other conditions that can cause similar symptoms. Your doctor may use additional tests to rule out other problems and help confirm enlarged prostate is causing

A physical exam. Your doctor will likely feel your lower abdomen to see if your bladder is enlarged (distended) and, in some cases, perform a rectal exam to determine whether your prostate is enlarged. Analysis of your urine (urinalysis). A sample of your urine may be collected and examined for microscopic amounts of blood, bacteria and crystallized minerals. Spiral computerized tomography (CT) scan. A conventional CT scan combines multiple X-rays with computer technology to create cross-sectional images of your body. Ultrasound. An ultrasound, which bounces sound waves off organs and structures in your body to create pictures, can help your doctor detect bladder stones. X-ray. An X-ray of your kidneys, ureters and bladder helps your doctor determine whether stones are present

your urinary symptoms. These can include:

in your urinary system.

Prostate-specific antigen (PSA) blood test. It's normal for your prostate gland to produce PSA, which helps liquefy semen. When you have an enlarged prostate, PSA levels increase. However, PSA levels can also be elevated due to prostate cancer, recent tests, surgery or infection (prostatitis). Urinary flow test. This test measures the strength and amount of your urine flow. Postvoid residual volume test. This test measures whether you can empty your bladder completely Transrectal ultrasound. An ultrasound test provides measurements of your prostate and also reveals the particular anatomy of your prostate.

Special imaging of your urinary tract (intravenous pyelogram).An intravenous pyelogram is a test that uses a contrast material to highlight organs in your urinary tract.

Prostate biopsy. With this procedure, a transrectal ultrasound guides needles used to take tissue samples of the prostate Urodynamic studies and pressure flow studies. With these procedures, a catheter is threaded through your urethra into your bladder Cystoscopy. Also called urethrocystoscopy, this procedure allows your doctor to see inside your urethra and bladder Intravenous pyelogram or CT urogram. These tests can help detect urinary tract stones, tumors or blockages above the bladder. Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and Generally, bladder stones should be removed. If the stone is small, your doctor may recommend that you drink a lot

Management

make it easier to urinate.

Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.

of water each day to help the stone pass. However, because bladder stones are often caused by the inability to empty the bladder completely, spontaneous passage of the stones is unlikely. Almost all cases require removal of the stones.

Tadalafil (Cialis). This medication, from a class of drugs Breaking stones apart called phosphodiesterase inhibitors, is often used to treat Bladder stones are often removed during a procedure impotence (erectile dysfunction). It also can be used as a called a cystolitholapaxy (sis-toe-lih-THOL-uh-pak-see). treatment for prostate enlargement. Surgical removal Surgery .. Standard surgeries: Occasionally, bladder stones that are large or too hard to break up are removed through open surgery. Transurethral resection of the prostate (TURP) TURP has been a common procedure for enlarged prostate for many years, and it is the surgery with which other treatments are compared Transurethral incision of the prostate (TUIP or TIP) This surgery is an option if you have a moderately enlarged or small prostate gland, especially if you have health problems that make other surgeries too risky. Like TURP, TUIP involves special instruments that are inserted through the urethra. Open prostatectomy This type of surgery is generally done if you have a very large prostate, bladder damage or other complicating factors, such as bladder stones. Minimally invasive surgery Laser surgery

Laser surgeries (also called laser therapies) use highenergy lasers to destroy or remove overgrown prostate tissue Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away, easing urine flow. Enucleative procedures are similar to open prostatectomy, but with fewer risks. These procedures generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue Types of laser surgery include:

Holmium laser ablation of the prostate (HoLAP) Visual laser ablation of the prostate (VLAP) Holmium laser enucleation of the prostate (HoLEP) Photoselective vaporization of the prostate (PVP) Transurethral microwave thermotherapy (TUMT) With this procedure, your doctor inserts a special electrode through your urethra into your prostate area. Transurethral needle ablation (TUNA) With this outpatient procedure, a lighted scope (cystoscope) is passed into your urethra. Prostatic stents A prostatic stent is a tiny metal or plastic device that's inserted into your urethra to keep it open.

Reference:
http://www.medscape.com/viewarticle/521366_3 http://www.mayoclinic.com http://www.medicine.net