Alert If the patient is pregnant, antibiotics must be prescribed cautiously.
Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 10 to 14 days. Follow-up treatment may include reculturing urine 1 week after drug therapy stops, then periodically for the next year to detect residual or recurring infection. Most patients with uncomplicated infections respond well to therapy and don’t suffer reinfection.
In infection from obstruction or vesicoureteral reflux, antibiotics may be less effective; treatment may then necessitate surgery to relieve the obstruction or correct the anomaly. Patients at high risk of recurring urinary tract and kidney infections, such as those with prolonged use of an indwelling catheter or maintenance antibiotic therapy, require long-term follow-up. Recurrent episodes of acute pyelonephritis can eventually result in chronic pyelonephritis. (See Chronic pyelonephritis.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Kidney cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Radical nephrectomy, with or without regional lymph node dissection, offers the only chance of cure. Because the disease is radiation resistant, radiation is used only if the cancer spreads to the perinephric region or the lymph nodes or if the primary tumor or metastatic sites can't be fully excised. In these cases, high radiation doses are used.
Chemotherapy has been only erratically effective against kidney cancer. Fluorouracil, cyclophosphamide, vinblastine, vincristine, cisplatin, tamoxifen, teniposide, interferons, and hormones such as medroxyprogesterone and testosterone have been used, usually with poor results. Biotherapy (interferon and interleukins), commonly used in advanced disease, has produced few durable remissions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Medullary sponge kidney:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment focuses on preventing or treating complications caused by stones and infection. Specific measures include increasing fluid intake and monitoring renal function and urine. New symptoms necessitate immediate evaluation.
Because medullary sponge kidney is a benign condition, surgery is seldom necessary, except to remove stones during acute obstruction. Only serious, uncontrollable infection or hemorrhage requires nephrectomy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Polycystic kidney disease:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Polycystic kidney disease can’t be cured. The primary goal of treatment is preserving renal parenchyma and preventing infectious complications. Management of secondary hypertension will also help prevent rapid deterioration in function. Progressive renal failure requires treatment similar to that for other types of renal disease, including dialysis or, rarely, kidney transplantation.
When adult polycystic kidney disease is discovered in the asymptomatic stage, careful monitoring is required, including urine cultures and creatinine clearance tests every 6 months. Prompt and vigorous antibiotic treatment is needed when a urine culture reveals infection — even when the patient is asymptomatic. As renal impairment progresses, selected patients may undergo dialysis, transplantation, or both. Cystic abscess or retroperitoneal bleeding may require surgical drainage; intractable pain (a rare symptom) may also require surgery. However, because this disease affects both kidneys, nephrectomy usually isn’t recommended because it increases the risk of infection in the remaining kidney.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hematuria:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Pyelonephritis, acute:
Treatment
(Handbook of Diseases)
Effective treatment centers on antibiotic therapy appropriate to the specific infecting organism after identification by urine culture and sensitivity studies.
Antibiotic therapy
I.V. antibiotics are used initially to control bacterial infection. Chronic pyelonephritis may require long-term antibiotic therapy. Commonly used antibiotics include sulfa drugs, amoxicillin, cephalosporins, levofloxacin, and ciprofloxacin. If the patient is pregnant, antibiotics must be prescribed cautiously. Urinary analgesics such as phenazopyridine are also appropriate.
Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 10 to 14 days.
Follow-up treatment
Follow-up treatment includes reculturing urine after drug therapy stops. Most patients with uncomplicated infections respond well to therapy and don’t suffer reinfection.
CLINICAL TIP: In infection from obstruction or vesicoureteral reflux, antibiotics may be less effective; treatment may then necessitate surgery to relieve the obstruction or correct the anomaly. Patients at high risk for recurring urinary tract and kidney infections — such as those with prolonged use of an indwelling urinary catheter or maintenance antibiotic therapy — require long-term follow-up.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Kidney cancer:
Treatment
(Handbook of Diseases)
Radical nephrectomy, with or without regional lymph node dissection, offers the only chance of cure. Because the disease is radiation-resistant, radiation is used only if the cancer spreads to the perinephric region or the lymph nodes or if the primary tumor or metastatic sites can’t be fully excised. In such cases, high doses of radiation are used.
Chemotherapy has been only erratically effective against kidney cancer and includes various drugs. Interferons and hormones, such as medroxyprogesterone and testosterone, have also been used. Biotherapy (lymphokine-activated killer cells with recombinant interleukin-2) shows promise, but causes adverse reactions. Interferon is somewhat effective in advanced disease. Hormone therapy may be tried in advanced cases.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Polycystic kidney disease:
Treatment
(Handbook of Diseases)
Polycystic kidney disease can’t be cured. The primary goal of treatment is to preserve renal parenchyma and prevent infectious complications. Management of secondary hypertension will also help prevent rapid deterioration in function. Progressive renal failure requires treatment similar to that for other types of renal disease, including dialysis or, rarely, a kidney transplant.
Asymptomatic stage
When adult polycystic kidney disease is discovered in the asymptomatic stage, careful monitoring is required, including urine cultures and creatinine clearance tests every 6 months. When a urine culture detects infection, prompt and vigorous antibiotic treatment is needed (even when the patient is asymptomatic).
Progressive renal impairment
As renal impairment progresses, selected patients may undergo dialysis, transplantation, or both. Cystic abscess or retroperitoneal bleeding may require surgical drainage; intractable pain (a rare symptom) may also require surgery. Anemia is treated with iron and other supplements, erythropoietin, or blood transfusions. However, because this disease affects both kidneys, nephrectomy usually isn’t recommended because it increases the risk of infection in the remaining kidney.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hematuria:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient how to collect serial urine specimens using the three-glass technique. This technique helps determine whether hematuria marks the beginning, end, or entire course of urination. Encourage the patient to drink plenty of fluids, unless contraindicated.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hematuria:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Check vital signs frequently.
▪ Monitor intake and output, including the amount and pattern of hematuria.
▪ If the patient has an indwelling urinary catheter in place, ensure its patency and irrigate it if necessary to remove clots and tissue that may impede urine drainage.
▪ Administer prescribed analgesics, and enforce bed rest as indicated.
▪ Prepare the patient for diagnostic tests, such as blood and urine studies, cystoscopy, and renal X-rays or biopsy.
▪ Monitor hemoglobin level and hematocrit; administer blood products as ordered.
Patient teaching
▪ Show the patient how to collect urine specimens.
▪ Emphasize the need to increase fluid intake.
▪ Explain the underlying cause of hematuria and its treatment.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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