Disorder Etiology Pathogenesis Clinical Diagnostic Test Medical/Surgical Intervention Nursing Management

Manifestation
Acute An inflammation 1.Antigen - Hematuria - Electron - Treating symptoms - Give liberal amounts of
Glomerulonephritis of the glomerular 2.Antigen- antibody product - Edema microscopy - Preserving kidney function carbohydrates to provide energy
capillaries 3.Deposition of antigen-antibody - Azotemia - Immunoflorescent - Treating complication and reduce the catabolism of
complex in glomerulus Proteinuria analysis - Administer Penicillin protein
4.Increased production of epithelial cells - Kidney biopsy - Administer Corticosteroids - Monitor Intake and output
lining the glomerulus and Immunosuppresants accurately
5.Leukocyte infiltration of the glomerulus - Dietary Protein restrictions - Give fluids according to patient’s
6.Thickening of the glomerular infiltration - Sodium restriction (patients fluid losses and daily body weight
membrane with hypertension)
7.Scarring and loss of glomerular
filtration rate
Chronic May be due to 1.Repeated episodes of acute - Sudden, severe - Urinalysis - If patient has HPN, reduce - Observe for common fluid and
Glomerulonephritis repeated glomeulonephritis. nosebleed - Chest X-ray BP with sodium and water fluid electrolyte disturbances
episodes of acute 2.Can cause systemic effects - A stroke or a - ECG restriction, antihypertensive - Minimize risk for complication of
glomeulonephritis 3.Kidneys are reduced to one-fifth of seizure - CT scan agents renal complications
their original size - Feet slightly - MRI - Administer diuretics - Start dialysis before patients
4.Cortex layers shrinks to 1 to 2 mm swollen at night - Provide protein in diet develop complications
5.Bands of scar tissue distort the - Loss of weight - Provide adequate calories - Teach dietary restriction
remaining cortex and strength - Treat UTI to prevent renal - Lifestyle modifications
6.Numerous glomeruli and their tubules - Increasing damage
become scarred irritability - Initiate dialysis as early as
7. Branches of the renal artery - Nocturia possible
thickened - Headaches
8.Severe glomerular damage that can - Dizziness
result in ESRD - Digestive
disturbances
Nephrotic Caused by a 1.Damaged glomerular capillary - Edema in the - Urinalysis - Administering diuretics - Give liberal amounts of
Syndrome cluster of clinical membrane periorbital, - Protein - Administer antineoplastic carbohydrates to provide energy
findings: 2.Loss of plasma protein sacrum, ankles, electrophoresis and agents and reduce the catabolism of
- Proteinuria 3.Hypoalbuminemia/ Stimulates hands, immunoelectrophor - Repeat treatment with protein
- Hypoalbumenia synthesis of lipoproteins abdomen esis of the urine corticosteroids - Monitor Intake and output
- Edema 4.Decrease in oncotic pressure/ - Irritability - CBC - Patients who does not have accurately
- High serum Hyperlipidemia - Headache - Kidney biopsy hyperkalemia may be placed - Give fluids according to patient’s
cholesterol and 5.Generalized edema - Malaise on a low sodium diet fluid losses and daily body weight
hyperlipidemia 6.Activation of rennin-angiotensin - Dietary restriction of protein - Observe for common fluid and
system and cholesterol fluid electrolyte disturbances
7.Sodium retention - Minimize risk for complication of
8.Edema renal complications
 - Start dialysis before patients
develop complications
- Teach dietary restriction
- Lifestyle modifications
Nephrosclerosis Due to prolonged 1. Prolonged hypertension and diabetes - High BP - Urinalysis - Use of aggressive - Monitor Intake and Output
hypertension and 2. Decreased blood flow in the kidneys - Uremia antihypertensive therapy accurately
diabetes, both 3. Causes patchy necrosis of renal - Atherosclerosis - assess patient for hypersensitivity
which can cause parenchyma - Hypertension to the drugs
decreased blood 4. Fibrosis occurs - Proteinuria
flow to the kidney 5. Glomeruli are destroyed - Renal
and patchy 6. Nephroscelrosis insufficiency
necrosis of renal
parenchyma
Acute Renal When kidneys 1. Blood flow to the kidney is reduced - Patients may - Urinalysis - Maintaining fluid balance - Monitor fluid and electrolyte
Failure cannot remove 2. Insufficient oxygen received by the appear critically - Ultrasonography - Avoiding fluid excess balances
the body’s kidneys ill - Renal Function - Dialysis - Reducing metabolic rate
metabolic wastes 3. Kidney impairment - Lethargic Test - IV Therapy - Promoting pulmonary function
or perform their 4. Failure of the kidney to excrete waste - Dehydration - Glomerular - Blood transfusion - Preventing infection
regulatory 5. Complete loss of kidney functions - Headaches Filtration rate - Providing skin care
functions 6. Acute renal failure - Muscle - Providing support for the patient
twitching
- Seizures
Chronic Renal Is a progressive, 1. Renal function decline - Hypertension - Glomerular - Maintaining fluid balance - Assess fluid status
Failure irreversible 2. End products of protein metabolism - Heart failure Filtration Rate - Avoiding fluid excess - Limit fluid intake to prescribed
deterioration in accumulate in the blood - Pulmonary - Urinalysis - Dialysis volume
renal function in 3. Uremia develops and adversely edema - CBC - Diet therapy (careful - Identify potential sources of fluid
which the body’s affects every system in the body - Pericarditis - Renal Function regulation of protein intake, - Explain to patient and family
ability to maintain 4. Greater build up of waste products - Severe pruritus Test sodium intake and restriction rationale for fluid restriction
metabolic and - Anorexia of some potassium) - Assist patient to cope with the
fluid and - Nausea - Pharmacologic therapy discomforts resulting from fluid
electrolyte - Vomiting (Calcium and phosphorus restriction
balance fails. - Hiccups binders, antihypertensive - Provide or encourage frequent
- Uremic fetor and cardiovascular agents, oral hygiene
- Altered level of anti seizure
consciousness agents,erythropoietin)
- Inability to
concentrate
- Muscle
twitching
- Agitation
 - Confusion
- Seizures
Renal Cancer Renal cancer has 1. Structural alteration of the small arm - Hematuria - IV Urography - Radical nephrectomy - Monitor Intake and output
many causes like of chromosome 3 - Pain - Cystoscopic - Laparoscopic nephrectomy accurately
smoking, obesity, 2. Mutation of chromosome 3 - Mass in the examination - Radiation therapy - Asses for pain and infection in
high blood 3. Formation of tumor flank - Nephrotomograms - Immunotherapy incision site
pressure, long 4. Systemic infection - Renal angiograms - Hormonal therapy - Proper positioning of patient
term dialysis, Von - Ultrasonography - Renal artery embolization - Watch out for pulmonary
Hippel Lindau - CT scan complications
syndrome,
Exposure to
asbestos and
cadmium, and
family history of
cancer.
Renal Trauma Caused by blunt 1. Traumatic injury to the flank - Pain - Urinalysis - Anti-microbial medications - Asses patient frequently to detect
or penetrating 2. Kidneys could be thrust against the - Renal colic - CBC - Bed rest flank and abdominal pain
injuries to the lower ribs - Hematuria - IV Urography - Fluid resuscitation - If patient undergone surgery,
kidneys causing 3. Resulting to contusion and rupture - Mass in the - Ultrasonography - Nephrectomy monitor for infection and drainage
renal contusion 4. Renal trauma flank - Note the incision site
and lacerations. - Ecchymoses - Use aseptic technique for caring
- Lacerations or of the incision site
wound of the - Monitor urine
lateral
abdomen
Lower Urinary tract Several 1. Bacteria gain access to the bladder - Dysuria - Urinalysis - Acute Pharmacologic - Relieving pain
Infection mechanisms 2. Attach to the epithelium of the bladder - Burning - Urine cultures Therapy - Monitoring and managing potential
maintain the 3. Colonize and multiply in the sensation while - Cellular studies - Long-term Pharmacologic complications
sterility of the epithelium urinating - CT scan Therapy - Promoting home and community-
bladder. 4. Invades host defense mechanism - Frequency - Ultrasonography based care
Abnormalities or 5. Initiate inflammation - Urgency
dysfunctions of - Nocturia
these - Incontinence
mechanisms are - Suprapubic or
contributing risk pelvic pain
factors for lower - Hematuria
UTIs. - Back pain
Acute Bacterial infection 1. Obstruction occurring in the urinary - Acutely ill with - Ultrasonography - 2 week course of antibiotic - Monitor Intake and Output
Pyelonephritis of the renal tract chills - CT Scan - Rehydration of oral or accurately
pelvis, tubules, 2. Causes static urine - Fever - IV pyelogram parenteral fluids - Asses temperature every 4 hours
 and interstitial 3. Bacteria grows on the static urine - Leukocytosis - Radionuclide - Put patient on bed rest
tissue of one or 4. Infection spreads in the kidneys - Bacteriuria imaging - Prevention for further infection
both kidneys. 5. Enlargement of the kidneys with - Pyuria - WBC count
interstitial infiltrations of inflammatory - Low back pain - Urine culture and
cells - Flank pain sensitivity test
- Nausea and
vomiting
- Headache
- Malaise
- Painful
urination
Chronic Repeated bouts 1. Obstruction occurring in the urinary - Fatigue - IV urogram - Long term use of - Monitor Intake and Output
Pyelonephritis of acute tract - Headache - Measurements of prophylactic antimicrobial accurately
Pyelonephritis 2. Causes static urine - Poor appetite creatinine therapy - Asses temperature every 4 hours
3. Bacteria grows on the static urine - Polyuria clearance, blood - Put patient on bed rest
4. Infection spreads in the kidneys - Excessive thirst urea nitrogen, and - Prevention for further infection
5. Enlargement of the kidneys with - Weight loss creatinine levels
interstitial infiltrations of inflammatory
cells
Urinary Involuntary loss 1. With aging, bladder capacity - Urine leakage - Urination diary - Behavioral therapy - Provide support and
Incontinence of urine from the decreases - Bedwetting - Stress test - Administering anticholinergic encouragement to patients
bladder 2. Ability to inhibit urination declines (children) - Urinalysis agents undergoing behavioral therapy
3. Involuntary bladder contractions occur - Blood test - Administering tricyclic - Teach the patient about urination
more often - Ultrasound of the antidepressant medications diary
4. Bladder contractility is impaired kidneys and urinary - Puriurethral bulking - Monitor urine output hourly
5. Voiding becomes more difficult to system - Placement of artificial urinary
postpone and tends to be incomplete - Cystoscopy sphincter
- Urodynamics - Transurethral resection
Urinary Retention Is the inability to 1. Increased urethral resistance - Urine retention - Series of - Urinary catheterization - Monitor urine output accurately
empty the 2. Low bladder pressure - Reduce urine Urodynamic studies - Prostatic stent - Encourage normal voiding pattern
bladder 3. Interruption of sensory or motor - Total inability to - Urination diary - Suprapubic cystostomy - Ensuring an environment and a
completely during innervations of the bladder urinate - Ultrasound of the - Administering alpha blockers position conducive to voiding
attempts to 4. Central failure of coordination of - Distended bladder - Transurethral resection of - Assist the patient when using the
urinate. Can be bladder contraction with external bladder prostate bathroom
caused by aging sphincter relaxation - Prostatectomy - Applying warm compress to relax
or postoperatively the sphincters
in surgery - Giving the patient hot tea
affecting the - Offer encouragement and
perineal or anal reassurance
regions.
Neurogenic Is a dysfunction Spastic bladder - Distended - Measurement of - Administer - Assess the patient and the system
Bladder that results from 1. Lesion on the spinal cord above the bladder fluid intake, urine parasympathomimetic - Monitor urine output accurately
a lesion of the voiding reflex arc - Urine retention output, and residual medications - Monitor for infection if the patient
nervous system 2. Loss of conscious sensation and the - Reduce urine urine volume - Urinary diversion procedure has a catheter
and leads to cerebral motor control - Inability to - Urinalysis - Catheterization - Minimize truma
urinary 3. Bladder empties on reflex, with urinate at will - Assessment of
incontinence. minimal or no controlling influence to sensory awareness
regulate its activity of bladder fullness
Flaccid bladder and degree of
1. Lower motor neuron lesion from motor control
trauma - Comprehensive
2. Bladder continues to fill and become urodynamic studies
distended
3. Overflow incontinence occurs
4. Bladder muscle does not contract
forcefully at any time
Urolithiasis and Are stones in the 1. Formation of stones from - Intense, deep - X-ray of the - Increase fluid intake - Relieving pain
Nephrolithiasis urinary tract and urinary concentrations of substances ache in the Ureters, Kidney, - Restrict calcium intake if - Monitor and managing potential
kidney. such as calcium oxalate, calcium costovertebral and bladder patient has calcium stones complications
phosphate, and uric acid increase region - Ultrasonography - Put patient in a low purine - Promoting home and community-
2. Stones form in the kidneys - Hematuria - IV urography diet for uric acid stones based care
3. Stones travel down the ureter and - Pyuria - Retrograde - Low-protein diet for patients - Teaching patient about self care
obstruct the flow of the urine - Pain originating pyelography with cystine stones - Monitoring diet
4. Pain during urination from the renal - Blood chemistry - Ureteroscopy - Encourage more fluid intake
area - Extracorporeal shockwave - Monitor urine output accurately
- Nausea lithotripsy (ESWL)
- Vomiting - Endourologic stone removal
- Pain during - Nephrolithotomy
urination - Nephrectomy
- Pyelolithotomy
- Ureterolithotomy
- Cystotomy
- Cystolitholapaxy
Genitourinary Various types of 1. Blunt or penetrating trauma to the - Blood in the - IV urography - Surgical repair and - Asses frequently for the first few
Trauma injuries of the flank, back or upper abdomen urinary meatus - Exploratory surgery placement of stent days after the injury
flank, back, or 2. Contusions - Inability to void - Insertion of suprapubic - Instruct the patient about the care
upper abdomen 3. Ecchymosis - Distended catheter for the incision site
may result in 4. Rupture of the bladder bladder - Urethrography - Encourage increase fluid intake
trauma to the 5. Complications such as hemorrhage, - Monitor BP
ureters, bladder, shock, sepsis, and extravasation of - Note for any bleeding
 or urethra. blood into the tissues
Cancer of the Bladder cancer 1. Mutation of a gene - Visible, - Cystoscopy - Transurethral resection or - Monitor Intake and output
Bladder has many causes 2. Formation of tumor painless - Excretory fulguration accurately
like smoking, 3. Blockage of the passageway of urine hematuria urography - Simple or radical cystectomy - Asses for pain and infection in
bladder 4. Less urine output - Infection of the - CT scan - Chemotherapy incision site
stones, 5. Distended bladder urinary tract - Ultrasonography - Radiation therapy - Proper positioning of patient
Exposure to - Frequency - Bimanual - Photodynamic techniques in - Watch out for pulmonary
environmental - Urgency examination treating superficial bladder complications
carcinogens, high - Dysuria - Biopsy of tumor cancer
urinary ph, high - Pelvic or back -
cholesterol pain
intake, pelvic
radiation therapy,
and family history
of cancer.