At the end of this lecture the student will be able to understand the following: Anatomy and physiology of renal & urology system Assessment of renal & urology system Introduction to renal & urology system disorders Definition of UTI Etiology/Pathophysiology of UTI Risk factors of UTI Clinical manifestation UTI Complications of UTI Diagnostic test of UTI Medical management UTI Nursing management UTI

1. Renal/Urinary Disorders #1
Prepared by:
Jamilah Saad Alqahtani
Nurse Lecturer, MSN, TOT, OR Nurse Specialist, RGN, BSN,

2. 0BJECTIVES
• At the end of this lecture the student will be able to understand the following:
• Anatomy and physiology of renal & urology system
• Assessment of renal & urology system
• Introduction to renal & urology system disorders
• Definition of UTI
• Etiology/Pathophysiology of UTI
• Risk factors of UTI
• Clinical manifestation UTI
• Complications of UTI
• Diagnostic test of UTI
• Medical management UTI
• Nursing management UTI
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3. Anatomy And Physiology Of Renal &Urinary Tract System
The Urinary System is a
group of organs in the body
concerned with filtering
out excess fluid and other
substances from the
bloodstream.
The kidneys, ureters, bladder,
and urethra are the primary
structures of the urinary system.
They filter blood and remove
waste from the body in the form
of urine.
Urine is a liquid produced
by the kidneys, collected in
the bladder and excreted
through the urethra
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7. Introduction To Renal System Disorders
• any of the diseases or disorders that affect the human urinary
system. They include benign and malignant tumors, infections and
inflammations, and obstruction by calculi.
• Diseases can have an impact on the elimination of wastes and on the
conservation of an appropriate amount and quality of body fluid.
Many of the manifestations of renal disease can be accounted for in
terms of disturbance of these two functions, and the alleviation of
symptoms in those renal diseases that cannot be cured depends on
knowledge of how these two functions are affected.
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8. Introduction To Renal System Disorders
• The eliminatory process does not, of course, end with the formation
of urine; the urine has to pass down the ureters to the bladder, be
stored there, and voided, usually under voluntary control.
• The whole mechanism can be deranged by structural changes in the
lower urinary tract, by infection, or by neurological disorders that lead
to abnormal emptying of the bladder.
• Disturbance of the lower urinary tract is an important cause of pain
and distress, notably during pregnancy and in the elderly; and it can
lead to serious and progressive damage to the kidneys, either by
interfering with the drainage of urine or by allowing bacterial
infection to have access to the kidney .
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9. Renal & Urinary Tract Disorders
Include the following:
1. Urinary tract infection UTI- (inflammation and infection
caused by bacterial growth in the renal pelvis and kidney)
2. Glomerulonephritis, inflammation of the glomerular
capillaries
3. pyelonephritis inflammation of renal pelvis ‘parenchyma’
4. Nephritis
5. nephrotic syndrome-type of renal failure with increased
glomerular permeability and massive proteinuria.
6. Renal colculi-(obstruct portions of kidneys or a ureter
kidney stones)
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12. Risk Factors For Renal/Urologic Disorder
1. Hypertension HTN
2. Diabetes mellitus DM
3. Immobilization
4. Parkinson’s disease
5. Systemic lupus erythematosus SLE
6. Gout
7. Sickle Cell Anemia SCA, multiple myeloma
8. Benign prostatic hyperplasia BPH
9. Pregnancy
10. Spinal cord injury SCI
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13. Diagnostic Evaluation
Urinalysis and urine culture
• Urine analysis provides important clinical information about kidney
function and help to diagnose other disease such as DM
• Urine culture determine the whether bacteria is present in the urine
as well as their strains and concentration.
• Urine culture and sensitivity also identify the microbilal therapy that
is best suit.
• Appropriate evaluation of any abnormality can assist in detecting
serious underlying disease
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14. Urine examination includes the
following:
• Urine color
• Urine clarity and odor
• Urine PH
• Specific Gravity normal range 1.010 to 1.025
• Tests to detect protein, glucose, and ketone bodies in urine (proteinuria,
glycosuria, ketonuria one-to-one)
• Microscopic examination of urine sediment after centrifugation to detect RBCs
hematuria, WBCs pyuria, Casts cylindruria, crystals crystalluria and bacteria
bacteriuria
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15. Renal Function Test
• Urine osmolality –indication of concentrating ability, changes seen in
early in disease processes
• Creatinine clearance- tests clearance of creatinine in one minute
reflect GFR. It Is the best indicator of overall kidney function.
• Serum creatinine- measures effectiveness of renal function in range
of 0.6 to 1.2 mg/dL. Note: serum creatinine does not increase until at
last 50% of renal function is lost.
• Urea nitrogen- also indicator of renal function in range of 7 to 18
mg/dL. Measures renal excretion of urea nitrogen through product of
protein metabolism. Note: not the best indicator of renal function
because it can be effected with liver function and dehydration level.
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16. GFR
• Volume of fluid filtered from renal glomerular
capillaries into bowman’s capsule per minute.
• Normal GFR level is 125 mL/minute
Creatinine Clearance
Measure of GFR
Based on 24 hours urine collection
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17. Imaging Studies
• KUB
• U&S
• CT
• MRI
• Nuclear Scans
• IV urography- is a
radiographic study of the renal
parenchyma, pelvicalyceal
system, ureters and the
urinary bladder.
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18. Urologic endoscopic
procedures
• Cystoscopy
• Ureteral brush biopsy
• Kidney biopsy
• Urodynamic test –cystometrogram.
measures detrusor function
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19. Urinary Tract Infection Overview
• A urinary tract infection (UTI) can strike anyone — even babies.
• But adult women tend to get UTIs and the accompanying uncomfortable UTI symptoms —
like painful urination, lower abdominal cramping, and low back pain — more than anyone
else.
• In fact, women are 10 times more likely than men to get a urinary tract infection, and one in
five women will have a UTI at some point.
• Why women are more prone to UTIs isn't completely understood, but experts do know that
the way a woman's body is put together creates a perfect setup for bacteria to enter the
urinary tract.
• The urethra, which is the tube through which urine exits the body from the bladder, is
shorter in women than in men. That makes it quicker and easier for bacteria to infiltrate the
bladder.
• And a woman's urethra is closer to the anus, allowing those bacteria to reach the urethra
without going far.
• One thing that increases a woman’s risk of getting a UTI even more? Sexual activity
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20. Definition of UTIs
• Urinary tract infections UTIs are caused by pathogenic microorganism
in the urinary tract (the normal urinary tract is sterile above the
urethra)
X
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21. Etiology
• UTIs caused by pathogenic microorganism which a bacteria invaded
urinary tract.
• Inability or failure to empty the bladder completely. Stasis of urine
inside the bladder attract bacteria to inter the urinary tract.
• Instrumentation of urinary tract like catheterization, cystoscopy
procedure.
• Obstructed urine flow- abnormalities in the structure of urinary tract
could obstruct the urine flow which lead to incomplete emptying of
the bladder.
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22. Etiology
• Decrease natural host defenses-like immunosuppression patient .
• The microbial etiology of urinary infections has been regarded as well
established and reasonably consistent. Escherichia coli remains the
predominant uropathogen (80%) isolated in acute community-
acquired uncomplicated infections, followed by Staphylococcus
saprophyticus (10% to 15%). Klebsiella, Enterobacter, and Proteus
species, and enterococci infrequently cause uncomplicated cystitis
and pyelonephritis.
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23. Pathophysiology
of UTI
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24. Classification Of Urinary Tract Infections
Urinary tract infection classified by location:
• The lower urinary tract include bladder and below (cystitis ,prostatitis
,urethritis)
• Upper urinary tract includes the kidneys and ureters
• Also UTI classified as:
• Uncomplicated UTI: Community-acquired infection; common in young
women and not usually recurrent
• Complicated UTI: often nosocomial (acquired in the hospital)and related to
catheterization; occur in patients with urologic abnormalities, pregnancy,
immunosuppression, DM ,obstructions and are often recurrent.
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26. Risk Factors of UTI
• Urinary tract infections are common in women, and many women experience more
than one infection during their lifetimes. Risk factors specific to women for UTIs
include:
1. Female anatomy. A woman has a shorter urethra than a man does, which shortens
the distance that bacteria must travel to reach the bladder.
2. Sexual activity. Sexually active women tend to have more UTIs than do women who
aren't sexually active. Having a new sexual partner also increases your risk.
3. Certain types of birth control. Women who use diaphragms for birth control may be
at higher risk, as well as women who use spermicidal agents.
4. Menopause. After menopause, a decline in circulating estrogen causes changes in the
urinary tract that make you more vulnerable to infection.
5. Other risk factors for UTIs include:
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27. Risk Factors of UTI
1. Urinary tract abnormalities. Babies born with urinary tract abnormalities that don't
allow urine to leave the body normally or cause urine to back up in the urethra have
an increased risk of UTIs.
2. Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in
the bladder and increase the risk of UTIs.
3. A suppressed immune system. Diabetes and other diseases that impair the immune
system — the body's defense against germs — can increase the risk of UTIs.
4. Catheter use. People who can't urinate on their own and use a tube (catheter) to
urinate have an increased risk of UTIs. This may include people who are hospitalized,
people with neurological problems that make it difficult to control their ability to
urinate and people who are paralyzed.
5. A recent urinary procedure. Urinary surgery or an exam of your urinary tract that
involves medical instruments can both increase your risk of developing a urinary tract
infection.
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28. Clinical manifestation UTI
• Burning sensation
• Frequency
• Nocturia
• Suprapubic Or Pelvic Pain
• Urgency Of Urinations a sudden,
compelling urge to urinate
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29.  Types Of Urinary Tract Infection
Each type of UTI may result in more-specific signs and symptoms, depending on which part of your
urinary tract is infected
Part of urinary tract affected Signs and symptoms
Kidneys (acute pyelonephritis) •Upper back and side (flank) pain
•High fever
•Shaking and chills
•Nausea
•Vomiting
Bladder (cystitis) •Pelvic pressure
•Lower abdomen discomfort
•Frequent, painful urination
•Blood in urine
Urethra (urethritis) •Burning with urination
•Discharge
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30. Complications of UTI
When treated promptly and properly, lower urinary tract infections rarely lead to
complications. But left untreated, a urinary tract infection can have serious consequences.
• Complications of a UTI may include:
1. Recurrent infections, especially in women who experience two or more UTIs in a six-
month period or four or more within a year.
2. Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis)
due to an untreated UTI.
3. Increased risk in pregnant women of delivering low birth weight or premature infants.
4. Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with
gonococcal urethritis.
5. Sepsis, a potentially life-threatening complication of an infection, especially if the
infection works its way up your urinary tract to your kidneys.
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31. Diagnostic test of UTI
• Urine culture
• Ct scan
• Ultrasonography
• STD test STDs test performed for UTIs transmitted sexually.
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PREVENTION IS
BETTER THAN
CURE

33. Prevention
Luckily, UTI is a preventable disease mainly focusing on the hygienic practices of the
individual.
1. Avoid bath tubs-shower rather bathe in tub because bacteria in the bath water
may enter the urethra.
2. Perineal hygiene- after each bowel movement, clean the perineum and
urethral meatus from front to back to reduce concentrations of pathogens of
the urethral opening
3. Increase fluid intake-drink liberal amount of fluids daily to flush out bacteria
4. Avoid urinary tract irritants- beverages such as coffee, tea, coal, alcohol, and
other contribute to UTI.
5. Voiding habit –void at least every 2 to 3 hours during the day and completely
empty.
6. Medications- take medication exactly as prescribed.
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35. MEDICAL
MANAGEMENT
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36. Medical management UTI
Pharmacologic treatment
• Acute pharmacologic therapy-antibacterial agent that eradicate
bacteria from urinary tract with minimal effects on fecal and vagina
flora. Thereby to minimize the Incidence of yeast infections.
• Long term pharmacologic therapy- reinfection with new bacteria is
the reason for recurrence and these type of patients with recurrence
are instructed to being treatment on their own whenever symptoms
occurs, to contact their physician only when symptoms persist.
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Nursingmanagement

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39. Nursing management UTI
Nursing care of patient with UTI focuses on treating underlying infection and
prevention its recurrence.
• Nursing assessment
1. A history of signs and symptoms related to UTI is obtained from the
patient with suspected UTI.
2. Assess changes in urinary pattern such as frequency, urgency, or
hesitancy
3. Assess the patient knowledge about antimicrobials and preventive health
care measures
4. Assess the characteristics of the patient’s urine such as the color,
concentration, odor, volume and cloudiness.
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40. Nursing Diagnosis
Based on assessment data, nursing diagnosis may include the following:
1. Acute pain related to infection within the urinary tract
2. Deficient knowledge related to lack of information regarding
predisposing factors
Nursing care planning & goals
Major goals for the patient may include:
1. Relief of pain and discomfort
2. Increased knowledge of preventive measures and treatment modalities
3. Absence of complications.
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41. Nursing Interventions
• Nurses care for patients with UTI in all setting.
• Relieve pain- antispasmodic agents may relieve bladder irritability and
analgesic and application of heat help relieve pain and spasm
• Fluids- the nurse should encourage the patient to drink liberal
amount of fluids to promote renal blood flow and to flush bacteria
from the urinary tract.
• Voiding- encourage frequent voiding every 2 to 3 hours empty the
bladder completely because this can significantly lower urine
bacterial counts, reduce urinary stasis and prevent reinfection
• Irritants- avoid urinary irritants such as coffee, tea, colas, and alcohol
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42. Evaluation
Expected outcomes may include:
1. Experience relief of pain
2. Explains UTI and their treatment
3. Experiences no complication
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44. REFERNCES
• Smelter S.C.,Bare B.G.,(Brunner and suddarths Medical-surgical
Nursing ,.lippencot
• Lewis S.W., Heitkemper M.M., Dirkson S.R., Medical Surgical Nursing
Assessment And Management of clinical problems
•
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