MEDSURG | GU

Renal/urologic disorders involve infection, inflammation, obstruction, and immune-mediated damage to the urinary system. UTIs (cystitis, urethritis, pyelonephritis) occur when bacteria—mainly E. coli—enter the urinary tract. Risk factors include female anatomy, obstruction (BPH, stones), retention, catheter use, pregnancy, diabetes, and immunosuppression. Symptoms include dysuria, frequency, urgency, suprapubic pain, foul/cloudy urine, and hematuria. Older adults may only show confusion 🧠. Diagnosis uses UA + culture; treatment uses antibiotics like TMP-SMX, nitrofurantoin, fosfomycin. Teaching: hydration, wipe front-to-back, void after sex, complete antibiotics 🌊.

Pyelonephritis is infection of the renal parenchyma. Acute cases present with fever, chills, CVA tenderness, N/V, systemic toxicity 🤒. Labs show WBCs, bacteria, possible casts. Treat with broad-spectrum IV or PO antibiotics and hydration. Chronic pyelonephritis leads to fibrosis, CKD, and renal scarring.

Urethritis often arises from bacterial or STI causes, presenting with dysuria and discharge. Treat based on organism.

Interstitial cystitis/painful bladder syndrome causes chronic pelvic pain, urinary frequency, and urgency without infection. No cure—management includes diet changes (avoid citrus, caffeine, alcohol), stress reduction, and bladder analgesics.

🧬 Glomerular Disorders

Glomerulonephritis (GN) results from immunologic inflammation of the glomeruli. Triggers include infections (post-strep GN), autoimmune diseases (SLE), hypertension, diabetes, drugs, and toxins. S/S: hematuria (tea-colored urine), proteinuria, edema, hypertension, flank pain. APSGN follows strep infection; treat with rest, sodium/fluid restriction, antihypertensives, and sometimes diuretics or antibiotics 🎯.

Nephrotic syndrome results from massive protein loss (≥3.5 g/day). Causes: diabetes, SLE, infections, drugs. Symptoms: severe edema, ascites, foamy urine, hyperlipidemia, hypoalbuminemia. Treatment: ACEIs/ARBs, corticosteroids, statins, diuretics, low-sodium diet. Risk for DVT/PE due to hypercoagulability ⚠️.

🪨 Urinary Tract Calculi

Stones form when solutes supersaturate urine. Types: • Calcium oxalate 🧊 • Calcium phosphate • Uric acid • Struvite (infection) • Cystine (genetic)

Risk factors: dehydration, high sodium, high animal protein, hyperparathyroidism, immobility, UTIs. Symptoms: sudden severe flank pain radiating to groin, N/V, hematuria, restlessness. Diagnosis: CT, ultrasound. Management: fluids, tamsulosin, pain control, strain urine. Procedures: lithotripsy, ureteroscopy, stent placement.

🚑 Renal Trauma & Vascular Disorders

Renal trauma occurs from blunt injuries (MVCs, falls). Assess flank bruising, hematuria. Management ranges from observation to surgery.

Vascular conditions include nephrosclerosis, renal artery stenosis, and thromboembolism—may require antihypertensives or revascularization.

🧬 Polycystic Kidney Disease (PKD)

Autosomal dominant disorder → multiple renal cysts → enlarged kidneys, flank pain, hematuria, HTN, progressive renal failure. No cure; manage BP, treat infections, prepare for dialysis/transplant. Tolvaptan may slow progression. Counseling is essential due to hereditary risk. 🧬