Preface viii
Acknowledgements x
1 Anatomy and Physiology: The Renal System 1
Renal System 1
Kidneys (External) 1
Kidneys (Internal) 2
Nephrons 3
The Functions of the Kidney 7
Kidney Blood Supply 8
Urine Formation 9
Hormonal Control of Tubular Reabsorption and Secretion 10
Composition of Urine 12
Ureters 13
Urinary Bladder 14
Urethra 15
Male Urethra 15
Female Urethra 17
Micturition 17
Conclusion 17
Glossary of Terms 18
Multiple Choice Questions 19
References 20
2 Renal System Assessment 21
Assessing Needs 21
History Taking 22
Effective Communication 22
The Health History 24
Application of the Patient History to Renal System Conditions 26
Introduction and Establishing Rapport 26
Chief Complaint and Presenting Symptoms 26
History of Present Illness 26
Pain Assessment 26
Past Medical History 27
Medication History 27
Allergy History 27
Family History 28
Dietary Habits, Including Salt and Fluid Intake 28
Social History 28
Occupational History 28
Review of Systems 28
Urinary Habits 29
Fluid Intake and Output 29
Weight 29
Fluid Balance Charts 30
Psychosocial History 30
Patient Concerns and
Expectations 30
Patient Education Needs 30
The Physical Examination 30
Specific Gravity 32
Additional Factors 33
Conclusion 35
Glossary of Terms 36
Multiple Choice Questions 37
References 38
3 Pyelonephritis 39
Pathophysiological Changes Associated with Pyelonephritis 39
Epidemiology 42
Risk Factors 43
Clinical Presentation 44
Clinical Investigations and Diagnosis 46
Clinical Investigations 48
Management 50
Health Teaching 52
Conclusion 53
Glossary of Terms 53
Multiple Choice Questions 54
References 55
4 Acute Kidney Injury 57
Pathophysiological Changes Associated with Acute Kidney Injury 57
Categorisation of Acute Kidney Injury 58
Epidemiology 58
Risk Factors 61
Clinical Presentation 64
Clinical Investigations and Diagnosis 67
The History 67
Physical Examination 68
Investigation and Tests 70
Laboratory Tests 70
Urinalysis 70
Electrolyte and Acid-Base Balance 70
Full Blood Count 70
Inflammatory Markers 71
Imaging Studies 71
Renal Biopsy 71
Management 71
Health Teaching 73
Conclusion 73
Glossary of Terms 74
Multiple Choice Questions 74
References 76
5 Chronic Kidney Disease 77
Acute Kidney Injury 77
Pathophysiological Changes Associated with Chronic Kidney Disease 78
Epidemiology 80
Risk Factors 80
Clinical Presentation 80
Clinical Investigations and Diagnosis 82
Categorisation of Chronic Kidney Disease 82
Medical History and Physical Examination 83
Investigations and Tests 86
Management 87
Health Teaching 88
Conclusion 89
Glossary of Terms 89
Multiple Choice Questions 90
References 91
6 Renal Calculi 93
Pathophysiological Changes Associated with Renal Calculi 94
Typical Sites of Stone Impaction in the Urinary Tract 96
Epidemiology 98
Risk Factors 98
Clinical Presentation 99
Clinical Investigations and Diagnosis 101
Physical Examination 103
Clinical Investigations 104
Management 106
Health Teaching 108
Conclusion 108
Glossary of Terms 108
Multiple Choice Questions 109
References 111
7 Bladder Cancer 112
Pathophysiological Changes Associated with Bladder Cancer 114
Epidemiology 115
Risk Factors 116
Clinical Presentation 116
Clinical Investigations and Diagnosis 117
History Taking 118
Physical Examination 118
Staging of Bladder Cancer 119
Bladder Cancer Grading 121
Management 122
Treating Non-muscle-invasive Bladder Cancer 123
Treating Muscle-invasive
Bladder Cancer 123
Health Teaching 123
Conclusion 124
Glossary of Terms 125
Multiple Choice Questions 125
References 127
8 Urinary Tract Infection 128
Pathophysiological Changes Associated with Urinary Tract Infection 129
Epidemiology 130
Risk Factors 130
Clinical Presentation 132
Clinical Investigations and Diagnosis 132
Obtaining a Midstream Specimen of Urine 136
Management 137
Recurrent Urinary Tract Infection 139
Health Teaching 140
Conclusion 141
Glossary of Terms 142
Multiple Choice Questions 142
References 144
MCQ Answers 145
Index 146
