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Urology &
Nephrology
Sections
 Anatomy and Physiology
 General Mechanisms of
Nontraumatic Tissue Problems
 General Pathophysiology,
Assessment, and Management
 Renal and Urologic Emergencies
Anatomy & Physiology
 The Urinary
System
 Female
 Male
 Urology &
Nephrology
 The
Kidneys
Anatomy & Physiology
 The
Kidneys
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Hilum
Medulla
Pyramids
Papilla
Renal Pelvis
Anatomy & Physiology
 Nephrons
 Glomerulus
 Bowman’s
capsule
 Proximal Tubule
 Loop of Henle
 Distal Tubule
 Collecting Duct
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
Anatomy & Physiology
 Formation of Urine
 Glomerular Filtration
 GFR
 Reabsorption & Secretion
 Simple diffusion and osmosis
 Facilitated diffusion
• Active transport
Anatomy & Physiology
 Tubular Handling of Water and
Electrolytes
 Diuresis and Antidiuresis
 Tubular Handling of Glucose and
Urea
 BUN and Creatinine
 Control of Arterial Blood Pressure
 The Renin-Angiotensin System
 Control of Erythrocyte Production
 Erythropoietin
Anatomy & Physiology
 Ureters
 Urinary
Bladder
 Urethra
 Testes
 Epididymus
and Vas
Deferens
 Prostate Gland
 Penis
General Mechanisms of
Nontraumatic Tissue Problems
 Inflammatory or Immune-Mediated
Disease
 Infectious Disease
 Physical Obstruction
 Hemorrhage
General Pathophysiology,
Assessment and Management
 Differentiating GI and Urologic
Complaints
 Pathophysiologic Basis of Pain
 Causes of Pain
 Types of Pain
 Visceral pain
 Referred pain
Assessment and
Management
 Scene Size-up
 Initial Assessment
 Focused History
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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
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.
Assessment and
Management
 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
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
Renal and Urologic
Emergencies
 Risk Factors
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Older Patients
History of Diabetes
History of Hypertension
Multiple Risk Factors
 Renal and Urologic Emergencies
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Acute Renal Failure
Chronic Renal Failure
Renal Calculi
Urinary Tract Infection
Acute Renal Failure
 Pathophysiology
 Prerenal Acute Renal Failure
 Dysfunction before the level of kidneys
• Most common and most easily reversible
 Renal Acute Renal Failure
 Dysfunction within the kidneys themselves
 Postrenal Acute Renal Failure
 Dysfunction distal to the kidneys
Acute Renal Failure
Acute Renal Failure
 Assessment
 Focused History
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Change in urine output
Swelling in face, hands, feet, or torso
Presence of heart palpitations or irregularity
Changes in mental function
Acute Renal Failure
 Physical Assessment
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Altered mental status
Hypertension
Tachycardia
ECG indicative of hyperkalemia
Pale, cool, moist skin
Acute Renal Failure
 Physical
Assessment
 Edema of face,
hands, or feet
 Abdominal
findings
dependent on
the cause of
ARF
Acute Renal Failure
 Management
 Airway, Breathing, Circulation
 IV Access
 Protect fluid volume.
 Positioning and Transport
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
Chronic Renal Failure
Chronic Renal Failure
 Impairment of Kidney Functions
 Maintenance of blood volume with proper balance
of water, electrolytes, and pH
• Increased sodium, water, and potassium retention
 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
• Disruption of the renin-angiotensin loop resulting in HTN
 Regulation of erythrocyte development
• Development of chronic anemia
Chronic Renal Failure
 Assessment
 Differentiate chronic and acute problems.
 Focused history and physical exam.
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Gastrointestinal complaints
Changes in mental status
Marked abnormalities during physical exam
Uremic frost
Chronic Renal Failure
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.
Chronic Renal Failure
 Long-Term
Management
 Renal Dialysis
 Hemodialysis
 Common
complications
Chronic Renal Failure
 Long-Term
Management
 Renal Dialysis
 Peritoneal
dialysis
 Common
complications
Renal Calculi
 Pathophysiology
 Results when “too
much insoluble stuff”
accumulates in the
kidneys.
 Stone types
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Calcium salts
Struvite stones
Uric acid
Cystine
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
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.
Urinary Tract Infection
 Pathophysiology
 Risk Factors
 Increased risk in female or catheterized patients
 Sexual activity
 Lower and Upper UTIs
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Urethritis
Cystitis
Prostatitis
Pyelonephritis
Community-acquired vs. nosocomial infections
Urinary Tract Infection
 Assessment
 Focused History
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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
Urinary Tract Infection
 Physical Exam
 Restless, uncomfortable appearance.
 Presence of a fever.
 Vital signs vary with degree of pain.
 Management
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Maintain ABCs.
Establish IV access.
Consider analgesics.
Transport to appropriate facility.
Urology and Nephrology
 Anatomy and Physiology
 General Mechanisms of
Nontraumatic Tissue Problems
 General Pathophysiology,
Assessment, and Management
 Renal and Urologic Emergencies