urinary problems.pptx

Chapter 10
Care of the Patient with a
Urinary Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Overview of Anatomy and
Physiology
• Functions of the urinary system
 Excretion of waste products
 Regulation of water (ADH), electrolytes, and acid-
base balance (pH of blood)
• Kidneys (two)
 Nephron: Functional unit of kidneys
• Urine composition and characteristics
 95% water; remainder is nitrogenous wastes and salts
• Urine abnormalities
 Albumin; glucose; erythrocytes; ketones; leukocytes

Figure 10-2
Coronal section through right kidney.
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

Figure 10-3
The nephron unit.

Urine Formation
• 3 Phases of Urine Formation
 Filtration
• Of water and blood products occurs in glomerulus of
Bowman’s capsule
 Reabsorption
• Water, glucose, and necessary ions back into blood
(primarily done in proximal/distal convoluted tubules
and Henle’s loop)
 Secretion
• Certain ions, nitrogenous waste and drugs (primarily
distal convoluted tubule); this is the reverse of
reabsorption; substances move from blood to filtrate

Hormonal Influence
• Increased fluid loss (hemorrhage, vomiting, diarrhea,
etc.=hypotension
• Decreases amount of filtrate produced by kidneys
• Posterior pituitary releases ADH
• ADH causes nephrons to increase rate of water
reabsorption
• This causes water to return to bloodstream thus
raising BP and urine to be concentrated

Overview of Anatomy and
Physiology
• Ureters (two)
 Passageway for urine from the kidneys to the urinary
bladder
• Urinary bladder (one)
 Temporary storage pouch for urine
• Urethra (one)
 Carries urine by peristalsis from the urinary bladder
out to its external opening

Figure 10-5
The male urinary bladder, cut to show the interior.

Laboratory and Diagnostic
Examinations
• Urinalysis (most common urologic study)
 Blood urea nitrogen (BUN)
 Blood creatinine
 Creatinine clearance
 Prostate-specific antigen (PSA)
 Osmolality
 Kidney-ureter-bladder radiography (KUB)
 Intravenous pyelogram (IVP)
 Retrograde pyelography
 Voiding cystourethrography

Laboratory and Diagnostic
Examinations
• Endoscopic procedures
 Renal angiography
 Renal venogram
 Computed tomography (CT)
 Magnetic resonance imaging (MRI)
 Renal scan
 Ultrasonography
 Transrectal ultrasound
 Renal biopsy
 Urodynamic studies

Medication Considerations
• Diuretics to enhance urinary output
 Thiazide diuretics
 Loop (or high-ceiling) diuretics
 Potassium-sparing diuretics
 Osmotic diuretics
 Carbonic anhydrase inhibitor diuretics
• Medications for urinary tract infections
 Quinolone
 Nitrofurantoin
 Methenamine
 Fluoroquinolone

Maintaining Adequate Urinary
Drainage
• Types of catheters
 Coudé catheter
 Foley catheter
 Malecot, Pezzer, or mushroom catheters
 Robinson catheter
 Ureteral catheters
 Whistle-tip catheter
 Cystostomy, vesicostomy, or suprapubic catheter
 External (Texas or condom) catheter

Figure 10-6
Different types of commonly used catheters.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)

Disorders of the Urinary System
• Urinary retention
 Etiology/pathophysiology
• The inability to void despite an urge to void
 Clinical manifestations/assessment
• Distended bladder
• Discomfort in pelvic region
• Voiding frequent, small amounts

• Urinary retention (continued)
 Medical management/nursing interventions
• Warm shower or sitz bath
• Natural voiding position if possible
• Urinary catheter
• Surgical removal of obstruction
• Analgesics

• Urinary incontinence
• Involuntary loss of urine from the bladder
 Total incontinence; dribbling; stress incontinence
• Secondary
 Infection; loss of sphincter control; sudden change in
pressure in the abdomen
• Permanent or temporary

• Urinary incontinence (continued)
• Involuntary loss of urine
 Leaking with coughing, sneezing, or lifting
• Treat underlying cause
• Surgical repair of bladder
• Temporary or permanent catheter
• Bladder training
• Kegel exercises

• Neurogenic bladder
• Loss of voluntary voiding control
• Results in urinary retention or incontinence
• Lesion of the nervous system that interferes with normal
nerve conduction to the urinary bladder
• Two types
 Spastic
 Flaccid

• Neurogenic bladder (continued)
• Infrequent voiding
• Incontinence
• Diaphoresis, flushing, nausea prior to reflex
incontinence
• Antibiotics; urecholine
• Intermittent catheterization
• Bladder training

• Urinary tract infections
• Type depends on location
• Pathogens enter the urinary tract
 Nosocomial infection
 Bladder obstruction
 Insufficient bladder emptying
 Decreased bactericidal secretions of the prostate
 Perineal soiling in females
 Sexual intercourse

• Urinary tract infections (continued)
• Urgency; frequency; burning on urination
• Nocturia
• Abdominal discomfort; perineal or back pain
• Cloudy or blood-tinged urine
• Pharmacological management
 Antibiotics; urinary antiseptics/analgesics
• Encourage fluids
• Perineal care

Obstructive Disorders of the
Urinary System
• Urinary obstruction
• Strictures; kinks
• Cysts; tumors
• Calculi
• Prostatic hypertrophy
• Continuous need to void
• Voiding small amounts frequently
• Pain
• Nausea

• Urinary obstruction (continued)
• Establish urinary drainage
 Indwelling catheter
 Suprapubic cystostomy
 Ureterostomy
 Nephrostomy
 Pain relief
o Narcotics
o Anticholinergics
Urinary System

• Hydronephrosis
• Dilation of the renal pelvis and calyces
• Unilateral or bilateral
• Obstruction of the urinary tract
• Dull flank pain (slow onset)
• Severe stabbing pain (sudden onset)
• Nausea and vomiting
• Frequency, dribbling, burning, and difficulty starting
urination
Urinary System

• Hydronephrosis (continued)
 Antibiotics
 Narcotic analgesics
• Surgery to relieve obstruction
• Nephrectomy
 Severely damaged kidney
Urinary System

• Urolithiasis
• Formation of urinary calculi (stones)
• Develops from minerals
• Identified according to location
 Nephrolithiasis; ureterolithiasis; cystolithiasis
• Flank or pelvic pain
• Nausea and vomiting
• Hematuria
Urinary System

• Urolithiasis (continued)
• Antibiotics
• Encourage fluids
• Ambulate
• STRAIN ALL URINE
• Surgical procedures
 Cystoscopy; ureterolithotomy; pyelolithotomy;
nephrolithotomy
• Lithotripsy
Urinary System

Figure 10-7
Location and methods of removing renal calculi from upper urinary tract.
(From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)

Renal Tumors
• Etiology/pathophysiology
 Adenocarcinomas that develop unilaterally
 Renal cell carcinomas arise from cells of the proximal
convoluted tubules
• Clinical manifestations/assessment
 Early: Intermittent painless hematuria
 Late
• Weight loss
• Dull flank pain
• Palpable mass in flank area
• Gross hematuria

Renal Tumors
• Medical management/nursing interventions
 Radical nephrectomy
 Radiation
 Chemotherapy

Renal Cysts
 Cysts form in the kidneys
 Polycystic kidney disease
• Cysts cause pressure on the kidney structures and
compromise function
 Abdominal and flank pain
 Voiding disturbances
 Recurrent UTIs
 Hematuria
 Hypertension

Renal Cysts
 No specific treatment
 Pharmacological management
• Analgesics
• Antibiotics
• Antihypertensives
 Relieve pain
 Heat (unless bleeding)
 Dialysis
 Renal transplant

Tumors of the Urinary Bladder
 Most common site of cancer in the urinary tract
 Range from benign papillomas to invasive carcinoma
 Painless intermittent hematuria
 Changes in voiding patterns
 Localized—remove tissue by burning
 Invasive lesions—partial or total cystectomy

Conditions Affecting the Prostate
Gland
• Benign prostatic hypertrophy
• Enlargement of the prostate gland
• Common in men 50 years old and older
• Cause is unknown

Gland
• Benign prostatic hypertrophy (continued)
• Frequent urination
• Difficulty starting urination
• Dysuria
• Frequent UTIs
• Hematuria
• Oliguria
• Nocturia

• Benign prostatic hypertrophy (continued)
• Relieve obstruction—Foley catheter
• Prostatectomy
• Postoperative
 TURP
o Bladder irrigations
o Urine will be pink to cherry red
 Suprapubic or abdominal
o Assess dressings
Gland

• Cancer of the prostate
• Malignant tumor of the prostate gland
• Initially
 No symptoms
• Advanced stages
 Urinary obstruction
Gland

• Cancer of the prostate (continued)
• Localized: radiation and/or surgery
• Men over 70 years old: Radiation and hormone therapy
• Advanced
 Estrogen therapy
 Orchiectomy
 Radiation therapy
 Chemotherapy
Gland

Urethral Strictures
 Narrowing of the lumen of the urethra that interferes
with urine flow; congenital or acquired
 Dysuria; nocturia
 Weak urinary stream
 Pain with bladder distention
 Correction of stricture
 Analgesics

Urinary Tract Trauma
• Urinary tract trauma
 Etiology and pathophysiology
• Injury to the urinary tract may result from accidents,
surgical intervention, and fractures
 Clinical manifestations
• Hematuria
• Abdominal pain and tenderness

Immunological Disorders of the
Kidney
• Nephrotic syndrome
• Physiologic changes of the glomeruli interfere with
selective permeability
• Proteinuria; hypoalbuminemia
• Generalized edema
• Anorexia
• Fatigue
• Oliguria

Kidney
• Nephrotic syndrome (continued)
 Corticosteroids
 Diuretics
• Diet
 Low sodium
 High protein

• Nephritis (acute glomerulonephritis)
• Previous infection with β-hemolytic streptococcus
(2-3 weeks prior)
• Preexisting multisystem diseases
Kidney

• Nephritis (acute glomerulonephritis) (continued)
• Edema of the face
• Pallor
• Malaise
• Anorexia
• Dyspnea with exertion
• Hematuria
• Changes in voiding patterns
• Oliguria; dysuria
Kidney

• Nephritis (acute glomerulonephritis) (continued)
 Antibiotics
 Diuretics
 Antihypertensives
• Supportive management
• Diet
 Protein and sodium restrictions
 Increase calories
Kidney

• Nephritis (chronic glomerulonephritis)
• Slow, progressive destruction of glomeruli
• Commonly caused by other chronic illnesses
 Diabetes mellitus
 Systemic lupus erythematosus
Kidney

• Nephritis (chronic glomerulonephritis) (continued)
• Malaise; morning headaches
• Dyspnea with exertion
• Visual and digestive disturbances
• Generalized edema
• Weight loss
• Fatigue
• Hypertension
• Anemia
• Proteinuria
Kidney

• Nephritis (chronic glomerulonephritis) (continued)
• Same as acute glomerulonephritis
• Renal dialysis
• Kidney transplant
Kidney

Renal Failure
• Acute renal failure
• Kidney function altered
 Interference with ability to filter blood
 Decrease in blood flow to the kidney
• Three phases
 Oliguric phase
 Diuretic phase
 Recovery phase

Renal Failure
• Acute renal failure (continued)
• Anorexia
• Nausea
• Vomiting
• Edema
• Dry mucous membranes
• Poor skin turgor
• Urine output less than 400 mL/24 hours (oliguric phase)

Renal Failure
• Acute renal failure (continued)
 Diuretics
 Antibiotics
 Kayexalate
• Administer fluids
• Assess for and treat electrolyte imbalances
• Dialysis
• Diet: High in carbohydrates; low in protein, potassium,
and sodium

Renal Failure
• Chronic renal failure
• End-stage renal failure
• Kidneys are unable to regain normal function
• Develops slowly over an extended period of time
• Result of kidney disease or other disease process that
compromises renal blood flow

Renal Failure
• Chronic renal failure (continued)
• Headache
• Lethargy; decreased strength
• Anorexia
• Pruritus
• Anuria
• Muscle cramps or twitching
• Dusky yellow-tan or gray skin color
• Disorientation and mental lapses
• Anemia

Renal Failure
• Chronic renal failure (continued)
• Dialysis
• Renal transplant
• Medications to treat symptoms
• Diet: High in calories; restricted protein,
potassium, and sodium
• Restricted fluids
 300 to 600 mL above urine output

Care of the Patient Requiring
Dialysis
• A medical procedure for the removal of certain
elements from the blood through a semi-permeable
membrane (external or peritoneum)
• Mimics kidney function
• Two types
 Hemodialysis
 Peritoneal dialysis

Surgical Procedures for Urinary
Disorders
• Nephrectomy
• Nephrostomy
• Kidney transplantation
• Urinary diversion
 Ileal conduit
 Continent ileal urinary reservoir or Kock pouch

Figure 10-12
Renal transplantation.
(From Belcher, A.E. [1992]. Cancer nursing. St. Louis: Mosby.)

Figure 10-13
Ileal conduit or ileal loop.

Kock pouch.
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. (13th ed.). St. Louis: Mosby.)
Figure 10-14

• Nursing diagnoses
 Urinary elimination, impaired
 Tissue perfusion: renal, ineffective
 Pain, acute and chronic
 Infection, risk for
 Fluid volume excess
 Sexuality patterns, ineffective
 Knowledge, deficient
Nursing Process

Chapter 15
Cardiovascular and Renal Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 61

Chapter 15
Lesson 15.1
62
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Learning Objectives
 Identify the approved way to give different
forms of antianginal therapy
 Discuss the uses and general actions of
cardiac drugs used to treat dysrhythmias
 Describe the common treatment for various
types of lipoprotein disorders
63

Urinary System
64

Chapter 15
Lesson 15.2
65

Learning Objectives
 List the general uses and actions of
cardiotonic drugs
 Explain the actions of different categories of
drugs used to treat hypertension
 Identify indications for electrolyte replacement
66

Antihypertensives, Diuretics, and Other
Drugs Affecting the Urinary Tract
Diuretics
 Indirectly reduce blood pressure by producing
sodium and water loss and lowering the tone
or rigidity of the arteries
 Types
 Thiazide and sulfonamide diuretics
 Loop diuretics
 Potassium-sparing diuretics
67

Drugs Affecting the Urinary Tract (cont.)
Adrenergic Inhibitors
 Beta-adrenergic blockers
 Nonselective; block beta1 and beta2 sites
 Selective; block beta1 sites
 Central adrenergic inhibitors
 Cause vascular relaxation and lower blood
pressure
 Peripheral adrenergic antagonists
 Limit norepinephrine release, prevent
vasoconstriction
68

Drugs Affecting the Urinary Tract (cont.)
 Alpha1-adrenergic inhibitors
 Lower peripheral resistance and blood pressure
 Combined alpha- and beta-adrenergic blockers
Angiotensin-Related Agents
 Angiotensin-converting enzyme inhibitors
 Angiotensin II receptor antagonists
Vasodilators
Calcium Channel Blocking Agents
69

High Blood Pressure
 Stage I: Lifestyle Changes
 Stage II: Drug Therapy
 Adverse Reactions
 Drug specific
 Drug Interactions
70

Drugs Useful in Treating Urinary
Problems
 Urinary incontinence
 Treatment: anticholinergics/antispasmodics, alpha-
adrenergic agonists, estrogens, cholinergic agonists,
and alpha-adrenergic antagonists
 Benign prostatic hyperplasia
 Treatment: alpha1-adrenergic receptor blockers
 Analgesia
 Treatment: phenazopyridine
71

Williams' Basic Nutrition & Diet
Therapy
Chapter 21
Kidney Disease
Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 72
14th Edition

Lesson 21.1: Kidney Anatomy,
Physiology, and Disease
 Kidney disease interferes with the normal capacity of
nephrons to filter waste products of metabolism.
 Short-term kidney disease requires basic nutrition
support for healing rather than dietary restriction.
73
Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Introduction (p. 425)
 100,000 Americans diagnosed with end-stage renal
disease each year
 84,000 die per year
 Reduced kidney function often undiagnosed
 Requires extensive medical nutrition therapy
 Dialysis extends lives but carries high costs
74

Basic Structure and Function of
the Kidneys (p. 425)
 Kidneys filter about 1.2 L of fluid per minute
 Structures
 Nephron
• Glomurulus: cluster of capillaries filters the blood
• Tubules: carries filtered fluid to kidney medulla
75

Basic Structure and Function of
the Kidneys (cont’d) (p. 427)
76

Tubules (p. 426)
 Proximal tubule: reabsorbs needed nutrients and
returns them to blood
 Loop of Henle: exchanges sodium, chloride, water
 Distal tubule: secretes hydrogen ions as needed
 Collecting tubule: produces concentrated urine
77

Function (p. 427)
 Excretory and regulatory functions
 Filtration: removes most particles from blood
except proteins and RBCs
 Reabsorption: substances body needs are
reabsorbed and returned to blood
 Secretion: additional hydrogen ions secreted as
needed to maintain acid-base balance
 Excretion: waste materials excreted in
concentrated urine
78

Endocrine Functions (p. 428)
 Renin secretion: maintains hormonal control of body
water balance
 Erythropoietin secretion: stimulate RBC production
within bone marrow
 Vitamin D activation: converts inactive form to final
active vitamin D
79

Disease Process and Dietary
Considerations (p. 428)
 General causes of kidney disease
 Infection and obstruction: bladder infections,
kidney stones
 Damage from other diseases: diabetes mellitus,
hypertension
 Toxins: environmental agents, animal venom,
certain plants, heavy metals, drugs
 Genetic or congenital defects: cystic diseases,
congenital abnormalities
80

General Causes of Kidney
Disease (p. 428)
 Risk factors
 Diabetes, hypertension, CVD
 Older than 60, smoke, obese
 Family history of kidney disease
81

Case Study
 Mrs. Hendricks is a 65-year-old female who has poor
glycemic control with her Type 2 diabetes of 32
years, hypertension, and smokes 1 pack of cigarettes
per day. Her most recent glomerular filtration rate is
22 mL/min.
82

Case Study (cont’d)
 What are Mrs. Hendrick’s risk factors for chronic
kidney disease (CKD)?
83

 What clinical assessment parameters would be
useful to find out from Mrs. Hendricks?
84

Medical Nutrition Therapy in
Kidney Disease (p. 429)
 Based on the nature of the disease process
and individual responses
 Length of disease: acute or chronic
• Long term: more specific nutrient modifications
 Degree of impaired renal function
• Extensive: extensive nutrition therapy required
 Individual clinical symptoms
85

Nephron Diseases (p. 429)
 Acute glomerulonephritis or nephritic
syndrome
 Disease process: affects glomeruli
 Clinical symptoms: hematuria, proteinuria,
possible edema, mild hypertension
 Medical nutrition therapy: diet modifications
usually not crucial
86

Nephrotic Syndrome (Nephrosis)
(p. 430)
 Disease process: nephron tissue damage allows
protein to pass into tubule
 Clinical symptoms: hypoalbuminemia, edema,
ascites, distended abdomen, reduced plasma protein
level
87

Nephrotic Syndrome (Nephrosis)
(cont’d) (p. 430)
 Medical nutrition therapy:
 Protein: moderate
 Energy: adequate to support nutrition status
 Sodium, potassium: restricted and monitored
 Calcium, phosphorus: 1 to 1.5 g/day calcium,
maximum 12 mg/day phosphorus
 Fluid: restricted according to output and losses
88

Lesson 21.2: Treatment of
Kidney Disease
 The progressive degeneration of chronic kidney
disease requires dialysis treatment and nutrient
modification according to individual disease status.
 Current therapy for kidney stones depends more on
basic nutrition and health support for medical
treatment than on major food and nutrient
restrictions.
89

Kidney Failure (p. 431)
 Acute kidney injury
 Disease process
• Prerenal: inadequate blood flow to kidneys and
subsequent reduced GFR
• Intrinsic: damage to a part of the kidney
• Postrenal obstruction: obstruction of urine flow
90

Acute Kidney Injury (p. 431)
 Clinical symptoms: RIFLE classification
system assesses severity of:
 Risk
 Injury
 Failure
 Loss
 End-stage kidney disease
91

Acute Kidney Injury (cont’d)
(p. 431)
 Medical nutrition therapy
 Basic objective: improve or maintain nutrition
status
 Principle: prevent protein catabolism, electrolyte
and hydration disturbance, acidosis, uremic
toxicity
92

Chronic Kidney Disease (CKD)
(p. 432)
 Disease process:
 Progressive breakdown of kidney tissue
 Most often results from
• Primary glomerular disease
• Metabolic diseases with kidney involvement
• Inherited diseases
• Other causes: immune diseases, obstruction, infection,
hypertension
93

Clinical Symptoms (p. 433)
 Water balance: large amounts of dilute urine
 Electrolyte balance: metabolic acidosis
 Nitrogen retention
 Anemia
 Hypertension
 Azotemia
94

General Signs and Symptoms
(p. 433)
 Progressive weakness
 Shortness of breath
 General lethargy
 Fatigue
 Possible thirst, anorexia, weight loss, diarrhea,
vomiting
95

Medical Nutrition Therapy
(p. 433)
 Basic objectives: monitor at regular intervals
 Principles
 Protein: generally limited to .0 to 0.8 g/kg body weight
 Energy: 35 kcal/day for those under 60 with GFR less than
25 ml/min
 Sodium/potassium: may be restricted
 Phosphorus/calcium: phosphorus may be restricted, calcium
1.0 to 1.5 g/day
 Vitamins/minerals: help patients meet needs for B-complex
vitamins and vitamin C
 Fluid: intake balanced with output
96

 Mrs. Hendricks is in what stage of chronic kidney
disease?
97

 Outline appropriate medical nutrition therapy plan of
care for Mrs. Hendricks.
98

End-Stage Renal Disease
(p. 434)
 Disease process
 Patient, family, physician face life-support
decisions
 Irreversible damage to majority of nephrons
 Options are long-term dialysis for kidney
transplant
99

Hemodialysis (p. 434)
 Artificial kidney machine removes toxins and
restores metabolites and nutrients
 Three to six treatments per week
 Protein: major concern of patients on dialysis
 Energy: 35 kcal/day for patients <60 years
 Sodium/potassium: may be restricted
 Phosphorus/calcium: monitored and limited
 Vitamins/minerals: achieve the DRI
100

Peritoneal Dialysis (p. 437)
 About 6% of patients
 Exchange of fluids occurs within the body,
allows mobility
 Protein: increased slightly
 Energy: maintain lean body weight
 Sodium/potassium: intake slightly more liberal
 Phosphorus/calcium, vitamins/minerals: same as
for hemodialysis
101

Peritoneal Dialysis (cont’d)
(p. 437)
102

Transplantation (p. 438)
 Improves quality of life and survival
 More cost effective than maintenance dialysis
 Waiting lists can be long
 Donor matches difficult to find
103

Transplantation (cont’d) (p. 439)
 Transplantation
 Complications: bone disorders, malnutrition,
anemia, hormonal and blood pressure
imbalances, depression, reduced quality of life
 Nutrition support: enteral or parenteral feedings
customized to dialysis
104

Transplantation (cont’d) (p. 439)
 Osteodystrophy
 Bone disease and disorders common with CKD
 Decreased activation of vitamin D has cascade
effect
 Neuropathy
 Central and peripheral disturbances common at
initiation of dialysis
 Patients should be periodically assessed
105

Kidney Stone Disease (p. 442)
 Basic cause is unknown
 Factors relating to urine or urinary tract
environment contribute to formation
 Present in 5% of U.S. women and 12% of
U.S. men
 Major stones are formed from one of three
substances:
 Calcium
 Struvite
 Uric acid
106

Calcium Stones (p. 442)
 Most common type: 80% of cases
 High levels of urinary oxalate
 Long-term megadosing of vitamin C
 Dietary calcium intake inversely related to stones
107

Struvite Stones (p. 442)
 10% of all stones
 Caused primarily by urinary tract infection
 No diet therapy
 Usually surgically removed
108

Uric Acid Stones (p. 443)
 Caused by impairment of purine metabolism
with some diseases
 Account for 9% of stones
 Other stones
 Due to inherited disorders or complications of
medications
109

Clinical Symptoms and Medical
Nutrition Therapy (p. 443)
 Clinical symptoms
 Severe pain
 Urinary symptoms
 Weakness, fever
 Protein: no more than DRI
 Calcium: normal calcium intake
 Sodium: no more than 2300 to 3450 mg/day
 Oxalates: avoid
 Vitamins/minerals: limit to DRI
 Fluid: high intake
110

Objectives Specific to Type of
Stone (p. 444)
 Calcium stones: reduce dietary intake of stone
constituents, consider fiber intake
 Uric acid stones: raise urinary pH, maintain healthy
weight, limit animal protein
 Cystine stones: reduce intake of cystine and dilute
urine
111

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