Question

1) An older man sees his doctor for severe pain in his lower abdominal or flank area, elevated temperature, and nausea. Exhaustive tests rule out abdominal obstructions and infections. Plain X-rays indicate a radiopaque (whitish) spot in the area of his right ureter. Diagnose his problem. Give suggested treatment and prognosis.

2) What clinical effects would low blood pressure have on the kidneys of a burn patient?

3) Eleven-year-old Harry is complaining of a severe sore throat and gets to stay home from school. His pediatrician prescribes a course of broad-spectrum antibiotics, and Harry feels much better within a few days. However, some two weeks later, Harry has a dull, bilateral pain in his lower back and his urine is a smoky brown color. On the basis of Harry's signs and symptoms, diagnose his condition and indicate the relationship (if any) between his present condition and his earlier sore throat.

4) Ellen, a 47-year-old woman who has suffered kidney disease for several years, has been diagnosed with proteinuria. Her legs and feet are so swollen that she has difficulty walking. Her hands and her left arm are also swollen. What is proteinuria, and could this condition be playing a role in her swollen limbs?

5) Rachael has been complaining of frequent and burning urination. She also reported seeing some blood in her urine. Her physician suspects cystitis. What is cystitis, and how can it cause these symptoms?

6) An 18 year old patient has a complaint of painful urination, fever, chills, and back pain. This is her second urinary tract infection (UTI) within 5 months. How can the RN instruct the patient on prevention of another UTI?

7) A 58-year-old woman complains of loss of urine when coughing and sneezing, and during exercise. She has had three children. Describe the possible causes of urinary incontinence in this patient.

8) Explain how an angiotensin converting enzyme inhibitor (ACE inhibitor) such as captopril would be effective as an antihypertensive.

Answer 1

1) Radiopaque shadow in the right ureter means that the ureter has stones which are radiopaque. Most probably these stones are Calcium oxalate stones. Other symptoms such as elevated temperature, flank pain, etc is also suggestive of stones. Diagnosis is URETERIC STONES. Treatment of stone is Surgery only. It depends on whether the stone is impacted or not. If stone is not impacted, Ureteroscopic removal (Retrograde Intrarenal Surgery) is performed. If impacted, ureterolithotomy is done. Prognosis is generally good as almost all of the cases are successfully treated by surgery.

2) In a burn patient, fluid is lost therefore the blood volume is decreased and blood pressure decreases. The low blood pressure causes increased renal blood flow which in turn causes increased GFR and increase in urine volume. To prevent this, the kidney vessels undergo vasoconstriction to reduce the renal blood flow and thereby urine volume.

3) As Harry has sore throat, the most common organism causing sore throat is group A beta hemolytic Streptococci. This organism has property of causing molecular mimicry. The antigens of these bacteria mimic body's tissue antigens. Therefore antibodies directed against the antigens of bacteria affect the the body's own tissues. Antibodies formed against streptococci damage the kidney. Immune complex formation occurs in the kidney after 1-3 weeks of infection. Smoky brown or cola coloured urine because of hemolysis. This condition is called Post streptococcal glomerulonephritis.

4) Proteinuria is excretion of proteins in the urine more than the normal amounts. Normal urine protein is 150mg/day. As the proteins are lost in the urine, the colloid osmotic pressure (oncotic pressure) exerted by the proteins become very less. Therefore hydrostatic pressure gets relatively increases inside the blood vessels. There is no much oncotic pressure to retain the fluid inside the blood vessels. This causes increased movement of fluid from the vessels into the interstitium which causes edema.