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Chronic kidney disease

• Progressive, irreversible decrease in renal function

• Metabolic, fluid, and

• electrolyte imbalances

• Uremia and nitrogenous waste products build-up in the blood

• Effects in every body

system (see illustration)

Chronic kidney disease (continued)

• Signs and symptoms

• Polyuria and oliguria

• Edema of the extremities, sacral area, and abdomen

• Hypertension

• Weakness and fatigue

• Nausea and vomiting

• In later stages, yellowish pale skin that causes itching due to urea crystals on the skin

Chronic kidney disease (continued)

• Treatment

• Dietary restrictions (protein, salt, potassium)

• Control or blood glucose levels and blood pressure

• Smoking cessation

• Prevention of further damage and end-stage renal disease (ESRD)

1. Mr. L. was diagnosed last year with chronic kidney disease and hypertension. Now he
complains of weakness, fatigue, nausea, vomiting, and skin that is yellowish and itching.
The physician is concerned that excessive waste products are building up in his blood
and prescribes (antibiotics, antifungals, dialysis).
2. Mr. R. has chronic kidney disease. His blood tests show elevated nitrogenous products.
The physician charts this result as (anuria, azotemia, hematuria).

End-stage renal disease

• Inability of kidneys to sustain daily activity

• Usually the result of chronic renal failure

• Toxic build-up of urea and creatinine in the blood

• Effects all systems, with dialysis or renal transplantation needed for survival
End-stage renal disease (continued)

• Signs and symptoms

• Progressive, with varied severity depending on the extent of renal damage and
remaining function

• Weakness

• Anorexia

• Diarrhea

• Pruritus

• Polyuria

End-stage renal disease (continued)

• Treatment

• Dietary restriction of protein,

sodium, and potassium

• Antiemetics for nausea

• Control of hypertension

• Dialysis

• Renal transplantation

• Patient's kidneys usually left in place

• Donor kidney usually placed inferior

to diseased kidneys

1. Mr. J. requires renal transplantation because his kidneys are no longer functioning. His
disease is charted as ESRD, or .
2. A patient scheduled for prostate CA surgery is currently continent, but is worried that,
after surgery, he may not be able to control his bladder, a condition known as urinary

3. Mrs. S. arrives at the clinic complaining of painful urination. The nurse notes a history of
cystitis and documents her painful urination as .

4. Ms. T. is a 38-year-old female admitted with pyonephrosis. A key finding of this

inflammatory condition is accumulation of
in the kidneys.

Renal calculi

• Concentration of mineral salts in the renal pelvis or calyx (see illustration)

• Most common cause of urinary obstruction

Renal calculi (continued)

• Signs and symptoms

• Possibly asymptomatic for long periods

• Intense pain and urinary urgency if the calculus fragment lodges in a ureter

• Dull, constant pain if calculus is in the renal pelvis and calyx

• Back pain and severe abdominal pain

• Other signs and symptoms, including nausea, vomiting, chills and fever, hematuria,
and abdominal distention

Renal calculi (continued)

• Treatment

• Passage of small calculi without treatment

• Surgical excision (lithotomy) for larger calculi

• Extracorporeal shock-wave lithotripsy (ESWL) — powerful sound waves used to

break up calculi (using ultrasound to locate and monitor calculi destruction)

Renal calculi (continued)

• Treatment (continued)

• Prevention of new calculus formation and enhanced elimination of calculi with

increased fluid intake

• Antibiotics if build-up is due to bacterial infection

• Analgesics for relief of intense pain

1. Mrs. K. develops kidney stones, although she underwent various treatments to avoid
them. She must now undergo a surgical excision to remove the stone called .
2. Mr. M. is diagnosed with renal calculi. He arrives at the physician's office complaining of
pain in the kidney area. The medical term for this symptom is .

3. Mrs. H. has a history of nephrolithiasis. Now she complains of hematuria, pain, and
nausea. The physician detects calculi using high-frequency sound waves, in a procedure
called (MRI, ultrasonography, CT scan).


• Distention of the renal pelvis and calyces due to pressure from accumulating urine

• Leading to impairment and, possibly, total interruption of kidney function

• Possibly affecting one or both kidneys (see illustration)

Hydronephrosis (continued)

• Signs and symptoms

• Possibly asymptomatic for a long period if only one kidney is affected

• Intense pain, possibly including back and abdominal pain

• Nausea

• Vomiting

• Oliguria

• Anuria

• Hematuria

Hydronephrosis (continued)

• Treatment

• Placement of stents and a nephrostomy tube (see illustration)

• Stent placement inside the ureters to hold them open (A)

• Nephrostomy tube inserted into renal pelvis to drain urine, with the
catheter exiting through an incision in the flank (B)

Hydronephrosis (continued)

• Treatment (continued)

• Removal of obstruction, prevention of complications, and treatment of underlying


• Catheterization for immediate relief of urinary pressure

• Analgesics if needed

• Antibiotics if infection occurs

• Surgery if needed to dilate a ureteral stricture

1. The physician diagnoses Mrs. S. with ureterolithiasis and explains that it may cause a
reflux of urine into the kidney, a serious disorder known as (hydrosis, nephropathy,
2. Mrs. B. is concerned because she only urinated once in the past 24 hours. The medical
term for this symptom is
3. Mrs. C. arrives at the clinic complaining of blood in her urine. The physician documents
this finding as .
4. Ms. T. is diagnosed with nephrosis and has swelling in her ankles and feet. The medical
term for swelling is .
5. Radiographic studies of Mr. D.'s kidneys reveal enlargement of the right kidney. The
radiologist documents this finding as .
6. Mr. J. undergoes surgical repair of the renal pelvis. Before obtaining informed consent,
the physician charts this surgical procedure as .
1. catheterization:

2. electrolytes:

3. Enuresis/incontinence

4. filtrate:

5. fistula:

6. percutaneous:

• Catheterization

• Insertion of a slender tube into the bladder (see illustration)

• Used to withdraw urine for diagnostic purposes

• Used to introduce liquids

• Hemodialysis

• Diversion of the patient's blood into a machine for filtering

• Return of filtered blood to the body

• Peritoneal dialysis

• Dialysis using the patient's peritoneum (see illustration)

• Infusion of dialysis solution into the peritoneum (A)

• Removal of fluid containing waste products (B)

• Extracorporeal shock-wave lithotripsy (ESWL)

• Use of powerful sound-wave vibrations to pulverize calculi in the kidney (See


• Renal transplantation

• Diseased kidneys replaced by transplanted kidney (See illustration.)

1. Mrs. F. is unable to urinate after surgery, so the nurse inserts a catheter into her bladder
to remove urine. This therapeutic procedure is known as .
2. Mr. H. is diagnosed with nephrolithiasis. The physician explains that she must crush the
kidney stones into smaller pieces so he can expell them in urine. Crushing of stones is a
surgical procedure called .

3. Mr. R. is diagnosed with multiple renal calculi. The doctor explains that the treatment of
choice is to use powerful sound-wave vibrations to break up the kidney stones. The
abbreviation for this procedure is .

4. Mrs. A. has a history of bladder carcinoma and undergoes endoscopy of the urinary
bladder. Visual examination of the bladder is a medical procedure called
• Bladder scan

• Use of sound waves to estimate the amount of urine in the bladder (See illustration.)

• Painless and noninvasive

• No patient preparation required

• Cystoscopy

• Insertion of a cystoscope through the urethra and into the urinary bladder (see

• Used for various purposes

• Examining the bladder

• Obtaining biopsies of tumors or other growths

• Removing polyps

• Blood urea nitrogen

• Measurement of the amount of urea, the major waste product

• Used to evaluate renal function

• Indication of impaired renal function (with high values)

• Pyelography

• Radiographic procedure that evaluates the kidneys, renal pelvis, ureters, and

• Also called intravenous pyelography (IVP) when performed after intravenous

administration of a radiopaque dye

• Urinalysis

• Voiding cystourography (VCUG)

1. visual examination of the bladder:

2. process of recording (radiography) the bladder and urethra:
3. process of recording (radiography) the renal pelvis:
4. instrument to examine the urethra:
5. visual examination of the kidney(s):

• Antibiotics

• Antispasmodics

• Diuretics
1. A chest x-ray reveals fluid accumulation in Mr. K.'s lungs. The physician prescribes a drug
to stimulate the production and flow of urine, called a(n) (antispasmodic, antidiuretic,
2. Mr. Q. was catheterized for surgery and now experiences spasms in the urethra and
bladder. To decrease spasms and enable normal emptying, the physician prescribes a(n)
(antispasmodic, antidiuretic, diuretic).
3. Mrs. T. is diagnosed with a urinary tract infection. To treat the bacterial infection, the
physician prescribes a(n) (antibiotic, antiviral, diuretic).
4. Mr. Y. suffers from nephralgia. To relieve this condition, the physician prescribes a(n)
(analgesic, antibiotic, thrombolytic).