Tolentino, Sabrina Cedie S.

BSN IVB Description AGN Acute GN is defined as the sudden onset of hematuria, proteinuria, and red blood cell (RBC) casts. This clinical picture is often accompanied by hypertension, edema, azotemia (ie, decreased glomerular filtration rate [GFR]), and renal salt and water retention. Acute GN can be due to a primary renal disease or to a systemic disease.

CA ASSIGNMENT

NS Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia, and edema. Nephrotic-range proteinuria is 3 grams per day or more. On a single spot urine collection, it is 2 g of protein per gram of urine creatinine.

Etiology

Infectious The most common infectious cause of acute GN is infection by Streptococcusspecies (ie, group A, betahemolytic). Two types have been described, involving different serotypes: Noninfectious Noninfectious causes of acute GN may be divided into primary renal diseases, systemic diseases, and miscellaneous conditions or agents.  Multisystem systemic diseases that can cause acute GN include the following:
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Nephrotic syndrome is usually caused by damage to the clusters of tiny blood vessels (glomeruli) of your kidneys. diseases and conditions can cause glomerular damage and lead to nephrotic syndrome, including:

Minimal change disease. Focal segmental glomerulosclerosis. Membranous nephropathy. Diabetic kidney disease. Systemic lupus erythematosus. Amyloidosis. . Blood clot in a kidney vein Heart failure. Nephrotic-range proteinuria could occur with the use of anticancer agents, such as bevacizumab, that inhibit vascular endothelial growth factor (VEGF)

Vasculitis (eg, Wegener granulomatosis) -). Collagen-vascular diseases (eg, systemic lupus  erythematosus [SLE]) –Hypersensitivity vasculitis –Cryoglobulinemia – Polyarteritis nodosa –

particularly around your eyes and in your ankles and feet Foamy urine. confusion secondary to malignant hypertension Shortness of breath or dyspnea on exertion  Possible flank pain secondary to stretching of the renal capsule Initial Blood Tests Complement Levels Urinalysis and 24-Hour Urine Study Streptozyme Test Blood and Tissue Culture Other Laboratory Tests      Swelling (edema). which may be caused by excess protein in your urine Weight gain due to excess fluid retention Diagnosis       Urine tests. Goodpasture syndrome Primary renal diseases that can cause acute GN include the following:  Membranoproliferative glomerulonephritis (MPGN) Miscellaneous noninfectious causes of acute GN include the following:  Guillain-Barré syndrome  Irradiation of Wilms tumor  Diphtheria-pertussis-tetanus (DPT) vaccine  Serum sickness  Epidermal growth factor receptor activation[6] and possibly to its inhibitor cetuximab     Signs and Symptoms  Hematuria –  Oliguria Edema (peripheral or periorbital) – Headache .   Henoch-Schönlein purpura –. Urinalysis Urine sediment examination Urinary protein measurement .This may occur secondary to  hypertension.

penicillin) are used to control local symptoms and to prevent spread of infection to close contacts. Glucocorticoids and cytotoxic agents are of no value. may decrease the inflammation that accompanies certain kidney disorders. hydralazine. nifedipine. Water pills. pulmonary edema). Vasodilator drugs (eg. Blood thinners. Bed rest is recommended until signs of glomerular     Choose lean sources of protein Reduce the amount of fat and cholesterol in your diet to . Renal ultrasonography Renal biopsy Management Antibiotics Antibiotics (eg. Sodium and fluid restriction should be advised for treatment of signs and symptoms of fluid retention (eg.   Radiography and Computed Tomography Ultrasonography and Echocardiography Renal Biopsy       Blood tests. Medications called anticoagulants help decrease your blood's ability to clot and reduce your risk of developing blood clots. Other agents  Blood pressure medications. Immune-system-suppressing medications. diazoxide) may be used if severe hypertension or encephalopathy is present. nitroprusside. Protein restriction for patients with azotemia should be advised if there is no evidence of malnutrition. such as corticosteroids. Medications to control the immune system. Cholesterol-reducing medications. Drugs called angiotensinconverting enzyme inhibitors reduce blood pressure and also reduce the amount of protein released in urine.  Loop diuretics may be required in patients who are edematous and hypertensive in order to remove excess  fluid and to correct hypertension. except in severe cases of PSGN. edema. Water pills (diuretics) help control swelling by increasing your kidneys' fluid output. such as membranous nephropathy. Medications called statins can help lower cholesterol levels. Serum albumin Serologic studies for infection and immune abnormalities Removing a sample of kidney tissue for testing.

a metabolite of testosterone. but do not necessarily directly cause the condition. primarily in the kidney (nephrolithiasis) or ureter (ureterolithiasis). Prostatic enlargement. help control your blood cholesterol levels  Eat a low-salt diet to help control the swelling (edema) you experience Description BPH Benign prostatic hyperplasia (BPH). This means that androgens have to be present for BPH to occur.these conditions can also lead to the "hyper triad": hyperparathyroidism. elevation of the bladder neck. On the other hand. Dihydrotestosterone (DHT). This enzyme is localized principally in the stromal cells. hence. Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention.  Urolithiasis: Decreased urine volume     Increased excretion of stone-forming components Inadequate urine drainage. Cystolithiais: Bladder outlet obstruction remains the most common cause of bladder calculi in adults. This is supported by the fact that castrated boys do not develop BPH when they age. type 2. gross hematuria. is a histologic diagnosis characterized by proliferation of the cellular elements of the prostate. also known as benign prostatic hypertrophy. 2005). recurrent urinary tract infections. which may lead to stasis Decrease in urinary citrate levels leading to deposition of calcium Deficiency of vitamins A or C . administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms. and high . Etiology Most experts consider androgens (testosterone and related hormones) to play a permissive role. is a critical mediator of prostatic growth.inflammation and circulatory congestion subside. hypercalcaemia. and may also form in or migrate into the lower urinary system (bladder or urethra) (Bernier. UROLITHIASIS The term nephrolithiasis (kidney calculi or stones) refers to the entire clinical picture of the formation and passage of crystal agglomerates called calculi or stones in the urinary tract (Wolf. Prolonged inactivity is of no benefit in the patient recovery process. renal insufficiency. and bladder calculi. those cells are the main site for Cystolithiasis :Bladder (vesical) calculi are stones or calcified materials that are present in the bladder (or in a bladder substitute that functions as a urinary reservoir). and hyperuricosuria. 2004). Urolithiasis (urinary calculi or stones) refers to calcifications that form in the urinary system. DHT is synthesized in the prostate from circulating testosterone by the action of the enzyme 5α-reductase.

Pain can be localized at the costovertebral angle.The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully evacuate the bladder Decreased force of stream . weak stream Incomplete bladder emptying .The subjective loss of force of the urinary stream over time Dribbling . pain or discomfort in the penis Painful urination Frequent urination Difficulty urinating or interruption of urine flow Blood in your urine Cloudy or abnormally dark-colored urine Signs and Symptoms        Urinary frequency Urinary urgency Hesitancy . which is an acute. Hematuria may be present. In addition. which leads to crystal nucleation and accretion. patients who have static urine and develop urinary tract infections are more likely to form bladder calculi. postvoid residual urine volume cause stasis.The loss of small amounts of urine due to a poor urinary stream Kidney Stone Symptoms  Stones in the kidneys can become lodged at the junction of the kidney and ureter (ureteropelvic junction). spasmlike pain located in the flank. regardless of the frequency of urination Straining .        Cystolithiasis Lower abdominal pain In men. This ultimately results in overt calculi.the synthesis of DHT. Stones moving down  .Difficulty initiating the urinary stream. Hematuria   Ureteral Stone Symptoms  Stones that can pass into the ureter may produce ureteral colic. interrupted.The feeling of persistent residual urine. resulting in acute ureteral obstruction with severe intermittent colicky flank pain. sharp.

perform a rectal exam to determine whether your prostate is enlarged. can help your doctor detect bladder stones. This is a brief evaluation of your  mental functioning and nervous system. A sample of your urine may be collected and examined for microscopic amounts of blood. diaphoresis. the pain remains sharp but with a waxing and waning quality. bacteria and crystallized minerals. Analyzing a sample of your urine in the laboratory can help rule out an infection or other conditions that can cause similar symptoms. Your doctor  will want to know about other health problems you may have. in some cases.   Diagnosis  Detailed questions about your symptoms. An X-ray of your kidneys. Neurological exam. Nausea. Analysis of your urine (urinalysis). An ultrasound. Ultrasound. Spiral computerized tomography (CT) scan.the ureter to the pelvic brim and iliac vessels will produce spasms with intermittent.  As a stone passes through the distal ureter. testicles. pain may intensify and radiate to the groin. or labia. vomiting. Urine test (urinalysis). what medications you're taking and whether there's a history of prostate problems in your family. ureters and bladder helps your doctor determine whether stones are present    . A conventional CT scan combines multiple X-rays with computer technology to create cross-sectional images of your body. and tachypnea may be present and patients are typically uncomfortable. which bounces sound waves off organs and structures in your body to create pictures. colicky pain radiating to the lateral flank and around the umbilical region. Digital rectal exam. X-ray. This exam can allow your doctor to  check your prostate by inserting a finger into your rectum. near the bladder. sharp. Your doctor will likely feel your lower abdomen to see if your bladder is enlarged (distended) and. tachycardia.  Your doctor may use additional tests to rule out other problems and help confirm enlarged prostate is causing  A physical exam.

An intravenous pyelogram is a test that uses a contrast material to highlight organs in your urinary tract. Special imaging of your urinary tract (intravenous pyelogram). Urinary flow test. These medications relax bladder neck muscles and muscle fibers in the prostate itself and Generally. recent tests. PSA levels can also be elevated due to prostate cancer. If the stone is small. bladder stones should be removed. surgery or infection (prostatitis).your urinary symptoms. Also called urethrocystoscopy. When you have an enlarged prostate. This test measures the strength and amount of your urine flow. With these procedures. PSA levels increase. a catheter is threaded through your urethra into your bladder Cystoscopy. this procedure allows your doctor to see inside your urethra and bladder Intravenous pyelogram or CT urogram. a transrectal ultrasound guides needles used to take tissue samples of the prostate Urodynamic studies and pressure flow studies. your doctor may recommend that you drink a lot    Management  . An ultrasound test provides measurements of your prostate and also reveals the particular anatomy of your prostate.  Prostate-specific antigen (PSA) blood test. These tests can help detect urinary tract stones. This test measures whether you can empty your bladder completely Transrectal ultrasound. Alpha blockers. which helps liquefy semen. These can include:  in your urinary system. tumors or blockages above the bladder. Postvoid residual volume test. However. It's normal for your prostate gland to produce PSA. With this procedure.     Prostate biopsy.

Like TURP. bladder stones that are large or too hard to break up are removed through open surgery. Surgical removal Surgery .make it easier to urinate. treatment for prostate enlargement.   Tadalafil (Cialis). TUIP involves special instruments that are inserted through the urethra. of water each day to help the stone pass. because bladder stones are often caused by the inability to empty the bladder completely. However. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself. This medication. Transurethral resection of the prostate (TURP) TURP has been a common procedure for enlarged prostate for many years. spontaneous passage of the stones is unlikely.  Combination drug therapy.. especially if you have health problems that make other surgeries too risky. bladder damage or other complicating factors. It also can be used as a called a cystolitholapaxy (sis-toe-lih-THOL-uh-pak-see). Minimally invasive surgery Laser surgery . such as bladder stones. Standard surgeries: Occasionally. is often used to treat Bladder stones are often removed during a procedure impotence (erectile dysfunction). Almost all cases require removal of the stones. and it is the surgery with which other treatments are compared Transurethral incision of the prostate (TUIP or TIP) This surgery is an option if you have a moderately enlarged or small prostate gland. Open prostatectomy This type of surgery is generally done if you have a very large prostate. from a class of drugs Breaking stones apart called phosphodiesterase inhibitors.

Reference: http://www. Enucleative procedures are similar to open prostatectomy. These procedures generally remove all the prostate tissue blocking urine flow and prevent regrowth of tissue Types of laser surgery include:      Holmium laser ablation of the prostate (HoLAP) Visual laser ablation of the prostate (VLAP) Holmium laser enucleation of the prostate (HoLEP) Photoselective vaporization of the prostate (PVP) Transurethral microwave thermotherapy (TUMT) With this procedure.com http://www.Laser surgeries (also called laser therapies) use highenergy lasers to destroy or remove overgrown prostate tissue Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away. Transurethral needle ablation (TUNA) With this outpatient procedure.medicine. your doctor inserts a special electrode through your urethra into your prostate area.mayoclinic.com/viewarticle/521366_3 http://www. Prostatic stents A prostatic stent is a tiny metal or plastic device that's inserted into your urethra to keep it open. a lighted scope (cystoscope) is passed into your urethra.medscape. but with fewer risks.net . easing urine flow.