This document provides an overview of urology and nephrology topics for EMS. It begins with the anatomy and physiology of the urinary system and kidneys. It then discusses general mechanisms of nontraumatic tissue problems, pathophysiology, assessment, and management of renal and urologic emergencies. Specific conditions covered include acute renal failure, chronic renal failure, renal calculi, and urinary tract infections. For each condition, the document outlines pathophysiology, risk factors, assessment techniques, and management strategies for EMS.

1. Urology
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2. Sections
Anatomy and Physiology
General Mechanisms of Nontraumatic Tissue
Problems
General Pathophysiology, Assessment, and
Management
Renal and Urologic Emergencies
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3. Anatomy & Physiology
The Urinary
System


Female
Male
Urology &
Nephrology
The Kidneys
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4. The Kidneys
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5. Nephrons
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6. Anatomy & Physiology
Functions of the Kidneys

Forming and Eliminating Urine
Maintaining blood volume with proper balance of
water, electrolytes, and pH.
 Retaining key compounds such as glucose, while
excreting wastes such as urea.

Controlling Arterial Blood Pressure
 Regulating Erythrocyte Development

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7. Anatomy & Physiology
Formation of Urine

Glomerular Filtration


GFR
Reabsorption & Secretion
Simple diffusion and osmosis
 Facilitated diffusion


Active transport
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8. Anatomy & Physiology
Tubular Handling of Water and Electrolytes

Diuresis and Antidiuresis
Tubular Handling of Glucose and Urea

BUN and Creatnine
Control of Arterial Blood Pressure

The Renin-Angiotensin System
Control of Erythrocyte Production

Erythropoietin
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9. Dutchess Community College EMS

10. General Mechanisms of
Nontraumatic Tissue Problems
Inflammatory or Immune-Mediated Disease
Infectious Disease
Physical Obstruction
Hemorrhage
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11. General Pathophysiology, Assessment
and Management
Differentiating GI and Urologic Complaints
Pathophysiologic Basis of Pain
Causes of Pain
 Types of Pain

Visceral pain
 Referred pain

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12. Assessment and Management
Scene Size-up
Initial Assessment
Focused History






OPQRST History
Prior History of Similar Event
History of Nausea, Vomiting, and Weight Loss
Change in Bowel Habits and Stool
Last Oral Intake
Presence of Chest Pain
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13. Assessment and Management
Physical Exam

Appearance


Uncomfortable appearance.
Posture
Lying with knees drawn up.
 Relief with walking.


Level of Consciousness

Determine if changes are acute or chronic.
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14. Assessment and Management
Physical Exam



Apparent State of Health
Skin Color
Examination of the Abdomen



Inspection for distention, ecchymosis, or scarring
Pain associated with percussion of abdomen
Palpation




Normal or ectopic pregnancy
Masses
Assessment Tools
Vital Signs
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15. Assessment and Management
Management
Airway, Breathing Circulation
 Pharmacologic Interventions



IV access and analgesics.
Nonpharmacological Interventions
Nothing by mouth (NPO).
 Maintain position of comfort.
 Reassess mental status and vital signs frequently.


Transport Considerations
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16. Renal and Urologic Emergencies
Risk Factors




Older Patients
History of Diabetes
History of Hypertension
Multiple Risk Factors
Renal and Urologic Emergencies




Acute Renal Failure
Chronic Renal Failure
Renal Calculi
Urinary Tract Infection
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17. Acute Renal Failure
Pathophysiology

Prerenal Acute Renal Failure

Dysfunction before the level of kidneys


Renal Acute Renal Failure


Most common and most easily reversible
Dysfunction within the kidneys themselves
Postrenal Acute Renal Failure

Dysfunction distal to the kidneys
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18. Acute Renal Failure
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19. Acute Renal Failure
Assessment

Focused History
Change in urine output
 Swelling in face, hands, feet, or torso
 Presence of heart palpitations or irregularity
 Changes in mental function

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20. Acute Renal Failure

Physical Assessment





Altered mental status
Hypertension
Tachycardia
ECG indicative of hyperkalemia
Pale, cool, moist skin
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21. Acute Renal Failure
Physical Assessment


Edema of face, hands, or feet
Abdominal findings
dependent on the cause of
ARF
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22. Acute Renal Failure
Management
Airway, Breathing, Circulation
 IV Access



Protect fluid volume.
Positioning and Transport
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23. Chronic Renal Failure
Chronic Renal Failure
Permanent Loss of Nephrons
 End-Stage Renal Failure (ESRF)

Pathophysiology

Similar to Renal ARF
Microangiopathy, glomerular injury
 Tubular cell injury
 Insterstitial injury

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24. Chronic Renal Failure
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25. Chronic Renal Failure

Impairment of Kidney Functions

Maintenance of blood volume with proper balance
of water, electrolytes, and pH


Retention of key compounds such as glucose with
excretion of wastes such as urea


Loss of glucose and buildup of urea within the blood
Control of arterial blood pressure


Increased sodium, water, and potassium retention
Disruption of the renin-angiotensin loop resulting in HTN
Regulation of erythrocyte development

Development of chronic anemia
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26. Chronic Renal Failure
Assessment
Differentiate chronic and acute problems.
 Focused history and physical exam.

Gastrointestinal complaints
 Changes in mental status
 Marked abnormalities during physical exam
 Uremic frost

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27. Dutchess Community College EMS

28. Dutchess Community College EMS

29. Chronic Renal Failure
Immediate Management
Monitor and support ABCs.
 Establish IV access.


Regulate fluid volume.
Monitor vital signs and cardiac rhythm.
 Expedite transport to an appropriate facility.

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30. Chronic Renal Failure
Long-Term Management

Renal Dialysis
Hemodialysis
 Common complications

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31. Hemodialysis
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32. Chronic Renal Failure
Long-Term Management
 Renal
Dialysis
 Peritoneal
dialysis
 Common complications
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33. Peritoneal
Dialysis
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34. Renal Calculi
Pathophysiology
Results when “too much insoluble stuff”
accumulates in the kidneys.
 Stone types

Calcium salts
 Struvite stones
 Uric acid
 Cystine

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35. Renal Calculi
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36. Renal Calculi
Assessment

Focused History
Severe pain in one flank that increases in intensity
and migrates from the flank to the groin
 Painful, frequent urination with visible hematuria
 Prior history of calculi


Physical Exam
Difficult due to patient discomfort
 Tachycardia with pale, cool, and moist skin

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37. Renal Calculi
Management
Maintain ABCs.
 Maintain position of comfort.
 Establish IV access.



Fluid bolus may promote stone movement and urine
formation.
Consider medication administration.

Parenteral narcotic analgesics may be indicated.
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38. Urinary Tract Infection
Pathophysiology

Risk Factors
Increased risk in female or catheterized patients
 Sexual activity


Lower and Upper UTIs
Urethritis
 Cystitis
 Prostatitis
 Pyelonephritis
 Community-acquired vs. nosocomial infections

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39. Urinary Tract Infection
Assessment
 Focused
History
 Abdominal
pain
 Frequent, painful urination
 A “burning sensation” associated with
urination
 Difficulty beginning and continuing to void
 Strong or foul-smelling urine
 Similar past episodes
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40. Urinary Tract Infection

Physical Exam
Restless, uncomfortable appearance.
 Presence of a fever.
 Vital signs vary with degree of pain.

Management
Maintain ABCs.
 Establish IV access.
 Consider analgesics.
 Transport to appropriate facility.

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41. Urology and Nephrology Review
Anatomy and Physiology
General Mechanisms of Nontraumatic
Tissue Problems
General Pathophysiology, Assessment, and
Management
Renal and Urologic Emergencies
Dutchess Community College EMS