NLE Renal & Urinary Nursing — UTI & Inflammatory Renal DisordersCheat Sheet

Common Values

Section Title

Urinary Tract Infection (UTI) – Lower vs Upper

Important Facts

• E. coli causes ~80% of uncomplicated UTIs; ascends from perineum via urethra.
• Risk factors: female sex (short urethra), sexual activity, pregnancy, indwelling catheter, urinary retention, diabetes, stasis.
• Older adults with UTI may present ONLY with confusion, incontinence, or falls—NOT the classic dysuria; do NOT miss this.
• Obtain urine culture BEFORE starting antibiotics; empiric therapy can mask organism.
• Clean-catch midstream or straight catheter specimen is gold standard.
• Nitrites + leukocyte esterase on urinalysis are highly suggestive of UTI.
• Phenazopyridine (urinary analgesic) turns urine ORANGE/RED—tell patient this is normal.
• Phenazopyridine treats SYMPTOMS only, NOT infection—must give antibiotics too.
• Common antibiotics: trimethoprim-sulfamethoxazole, nitrofurantoin, fosfomycin, fluoroquinolones.
• Patients must complete FULL antibiotic course even after symptoms resolve.
• Complications of untreated UTI: urosepsis, renal scarring, CKD; in pregnancy—preterm labor.

Key Definitions

Diagrams To Know

• Ascending route of infection from perineum → urethra → bladder → ureter → kidney.
• CVA (costovertebral angle) location—angle formed by 12th rib and vertebral column; tenderness = kidney involvement.

Common Values

Section Title

Pyelonephritis – Acute & Chronic

Important Facts

• Pyelonephritis = systemic illness: FEVER (often >38.5°C), chills, rigors.
• Flank/back pain (dull, constant) ± radiation; may be severe.
• CVA tenderness (kidney punch test) is key physical finding.
• Nausea, vomiting, malaise common.
• Elevated WBC count, left shift, elevated CRP/ESR.
• Urine shows WBC, bacteria, casts, possibly RBCs.
• Management: IV antibiotics if hospitalized (e.g., ceftriaxone, gentamicin, fluoroquinolones); oral if mild outpatient.
• Full course typically 10–14 days.
• Identify & correct any obstruction (ultrasound or CT).
• Avoid NSAIDs if dehydrated or acute kidney injury risk.
• Chronic pyelonephritis can progress to CKD, hypertension, and end-stage renal disease.

Key Definitions

Diagrams To Know

• Progression: lower UTI → ascending infection → pyelonephritis → sepsis/urosepsis.

Common Values

Section Title

Acute Post-Streptococcal Glomerulonephritis (APSGN)

Important Facts

• APSGN: 1–2 week latency after strep throat or pyoderma.
• Classic triad: HEMATURIA (cola/tea-colored urine), HYPERTENSION, PERIORBITAL EDEMA.
• Hematuria is hallmark—gross hematuria makes diagnosis obvious.
• Periorbital/facial edema worse in morning; usually mild.
• Proteinuria present but typically mild-to-moderate (<3 g/day).
• Oliguria common; elevated BUN/creatinine from reduced GFR.
• Lab findings: ↑ASO titer (or ↑anti-DNase B), LOW serum complement (C3), elevated BUN/Cr.
• Urinalysis: hematuria, RBC casts (diagnostic), mild proteinuria, leukocytes.
• Most children recover fully within weeks; adults have worse prognosis.
• Management: treat residual strep with antibiotics (penicillin); restrict Na/fluids during edema phase.
• Monitor BP closely—risk of hypertensive encephalopathy (headache, vision changes, seizures).
• Antihypertensives & diuretics as needed; restrict protein if BUN >40.
• Do NOT give NSAIDs—worsen renal function.
• Risk of progression to chronic GN in ~10% of adults.

Key Definitions

Diagrams To Know

• Timeline: Strep infection (throat/skin) → 1–2 week latency → immune complex formation → deposition in glomeruli → inflammation & hematuria.
• Complement cascade activation & consumption (explains low C3 on labs).

Common Values

Section Title

Nephrotic Syndrome – The Protein-Losing Disease

Important Facts

• Nephrotic syndrome tetrad: (1) MASSIVE proteinuria (≥3.5 g/day), (2) hypoalbuminemia, (3) generalized edema, (4) hyperlipidemia.
• In children: minimal-change disease (~90% of cases); highly steroid-responsive.
• In adults: membranoproliferative GN, membranous nephropathy, focal segmental glomerulosclerosis (FSGS).
• Pathophysiology: massive protein loss → ↓plasma oncotic pressure → fluid shifts to interstitium → edema; liver compensates with ↑lipid synthesis.
• Edema: periorbital (worse on waking), dependent (ankles/sacrum), ascites, anasarca (total body swelling).
• Weight gain (from fluid accumulation); frothy urine.
• Blood pressure is typically NORMAL or LOW (contrast with GN hypertension).
• Hyperlipidemia: ↑cholesterol, ↑triglycerides (from hepatic overproduction).
• Loss of anticoagulant proteins (protein C, S, antithrombin) → hypercoagulability → VTE/PE risk.
• Loss of immunoglobulins → immunodeficiency + steroids → HIGH infection risk.
• Labs: severe proteinuria, low albumin, low total protein, elevated lipids, normal/low complement (if MPGN), elevated BUN/Cr.
• First-line: PREDNISONE (steroid-responsive cases, esp. minimal change).
• Immunosuppressants (cyclophosphamide, mycophenolate) for steroid-resistant cases.
• ACE inhibitors/ARBs reduce proteinuria & slow progression; also used for hypertension if present.
• Diuretics for edema; low-sodium diet (very high protein NOT recommended anymore).
• Anticoagulation if high thrombosis risk or documented VTE.
• Statins for dyslipidemia.
• Meticulous skin care for edematous tissue (high infection risk).
• Monitor daily weight, abdominal girth, I&O, urine protein.
• Infection is a leading cause of death in nephrotic syndrome—prevent with vaccination, handwashing, avoid crowds.

Key Definitions

Diagrams To Know

• Tetrad cycle: massive proteinuria → loss of albumin → ↓plasma oncotic pressure → edema; separately, loss of anticoagulants → thrombosis.
• Immune mechanism: normal glomerular barrier → loss of charge/size selectivity → proteinuria.

Common Values

Section Title

Urolithiasis (Kidney Stones) – The Acute Emergency

Important Facts

• Stone composition: calcium oxalate/phosphate (~75–80%), struvite (~10–15%), uric acid (~5–10%), cystine (~1–2%).
• Risk factors: dehydration/low fluid intake, immobility, urinary stasis, hyperparathyroidism (hypercalcemia), gout (uric acid), recurrent UTI (struvite).
• Pathophysiology: solute supersaturation → precipitation & crystal aggregation → stone formation.
• Renal colic: classic presentation—sudden severe flank pain radiating to groin/genitalia, patient cannot lie still.
• Associated: hematuria (from mucosal trauma), nausea/vomiting, urinary frequency/urgency, diaphoresis.
• Fever + worsening pain + decreased one-sided urine output = OBSTRUCTION WITH INFECTION = urologic EMERGENCY.
• Diagnostics: non-contrast helical CT (gold standard), KUB, ultrasound, urinalysis (hematuria, crystals).
• MUST strain ALL urine to catch the stone; send for chemical analysis to guide prevention.
• Management priorities: (1) PAIN RELIEF, (2) hydration, (3) strain urine, (4) monitor for obstruction/infection.
• Pain control: opioids (morphine, meperidine) + NSAIDs (ketorolac)—NSAIDs also reduce ureteral spasm.
• Antiemetics for nausea/vomiting.
• Increase fluid intake to 2.5–3 L/day to promote passage & prevent new stones.
• Ambulation & movement encourage stone passage.
• Procedures: ESWL (extracorporeal shock-wave lithotripsy—breaks stones with sound waves; expect hematuria/bruising), ureteroscopy (basket/laser retrieval), percutaneous nephrolithotomy (for large/staghorn stones).
• Complications: obstruction → hydronephrosis & permanent renal damage, obstruction + infection → sepsis.

Key Definitions

Diagrams To Know

• Stone passage pathway: renal pelvis → ureter (narrow sites: pelvureteric junction, pelvic brim, ureterovesical junction) → bladder → urethra.
• Pain radiation: flank → groin/genitalia (follows course of stone down ureter).

Common Values

Section Title

Prevention & Dietary Management by Stone Type

Important Facts

• ALL STONE FORMERS: high fluid intake is #1 preventive measure—target 2.5–3 L urine/day.
• Calcium oxalate prevention: (1) normal-to-adequate dietary calcium (do NOT restrict), (2) limit oxalate-rich foods, (3) high fluids, (4) citrate supplementation if low urinary citrate.
• Avoid excess vitamin C (metabolized to oxalate).
• Struvite stone prevention: treat & prevent UTI (target organisms: Proteus, Klebsiella); urine acidification (methionine, cranberry).
• Uric acid stone prevention: low-purine diet, alkaline urine (sodium bicarbonate, potassium citrate to keep pH >6.5), allopurinol 300 mg daily.
• Cystine stones: high fluids (3–4 L/day), urine alkalinization, tiopronin or D-penicillamine (bind cystine), limit sodium & protein.
• Patient teaching: maintain fluid diary, recognize symptoms of recurrence, comply with diet/medications.

Key Definitions

Diagrams To Know

• Stone-type-specific prevention pathway: identify stone → analyze composition → tailor diet & pharmacotherapy → prevent recurrence.

Item

PHENAZOPYRIDINE TURNS URINE ORANGE/RED — this is normal and harmless; it is a URINARY ANALGESIC, NOT an antibiotic; patient still needs antibiotics to treat the actual infection.

Rank

1

Item

OLDER ADULTS WITH UTI often present ATYPICALLY with CONFUSION, FALLS, INCONTINENCE, or FUNCTIONAL DECLINE—NOT dysuria; do not attribute confusion to dementia without ruling out UTI first.

Rank

2

Item

OBTAIN URINE CULTURE BEFORE STARTING ANTIBIOTICS — once you start empiric therapy, the culture may be contaminated or organism overgrown by commensal flora.

Rank

3

Item

POST-STREPTOCOCCAL GLOMERULONEPHRITIS: 1–2 WEEK LATENCY after strep throat/skin infection; look for COLA-COLORED URINE (gross hematuria), HYPERTENSION, PERIORBITAL EDEMA, and RBC CASTS on UA; labs show ↑ASO titer, LOW C3.

Rank

4

Item

NEPHRITIC vs. NEPHROTIC: Nephritic (GN) = HEMATURIA + HYPERTENSION + mild proteinuria; Nephrotic = MASSIVE PROTEINURIA + severe EDEMA + hyperlipidemia + normal/low BP. They are opposite presentations.

Rank

5

Item

NEPHROTIC SYNDROME TETRAD: (1) massive proteinuria ≥3.5 g/day, (2) hypoalbuminemia, (3) generalized edema (periorbital, dependent, ascites, anasarca), (4) hyperlipidemia (elevated cholesterol/triglycerides).

Rank

6

Item

RENAL COLIC PRIORITY = PAIN RELIEF: give opioids (morphine) + NSAIDs (ketorolac)—NSAIDs reduce ureteral spasm; this is a genuine comfort emergency, not just 'manage pain gently'; push fluids 2.5–3 L/day; STRAIN ALL URINE.

Rank

7

Item

FEVER + WORSENING PAIN + DECREASED ONE-SIDED URINE OUTPUT = OBSTRUCTION WITH INFECTION—a urologic EMERGENCY; requires urgent decompression (stent/catheter) + antibiotics to prevent sepsis and permanent renal damage.

Rank

8

Item

CALCIUM OXALATE STONES (~75% of cases): paradoxically, do NOT restrict dietary calcium; instead, limit OXALATE-rich foods (spinach, rhubarb, chocolate, nuts, tea); high fluids are the foundation of all stone prevention.

Rank

9

Item

ASYMPTOMATIC BACTERIURIA MUST BE TREATED ONLY IN PREGNANT WOMEN (to prevent pyelonephritis & preterm labor) and before urologic procedures; in non-pregnant non-surgical patients, do NOT treat—it increases antibiotic resistance without benefit.

Rank

10

Tip

When you see 'dysuria + urgency + frequency + NO fever' → think LOWER UTI (cystitis); when you add FEVER + FLANK PAIN + CVA TENDERNESS → it's PYELONEPHRITIS (upper UTI). The presence of fever and CVA tenderness is your gateway to 'upper' classification.

Tip

If a question mentions 'cola-colored urine' or 'tea-colored urine' after a recent sore throat → immediately think POST-STREPTOCOCCAL GLOMERULONEPHRITIS with hematuria; this is almost diagnostic and must appear in the differential.

Tip

For nephrotic syndrome, remember: 'loss of albumin → loss of plasma oncotic pressure → fluid shifts INTO tissues → edema; separately, loss of anticoagulant proteins → thromboembolism risk.' These two mechanisms explain why nephrotic patients get both edema AND blood clots.

Tip

Renal colic questions often have a 'trap' answer about hydration: ALWAYS advocate for high fluid intake (2.5–3 L/day) unless there is acute hyperkalemia or severe volume overload; high fluids promote stone passage and prevent recurrence, so 'avoid dehydration' is almost always correct.

Tip

Significant bacteriuria on exam questions is almost ALWAYS stated as >100,000 CFU/mL or 10⁵; if you see 10,000 or 50,000 CFU/mL, that's NOT significant bacteriuria—do not confuse the threshold; culture must be ≥10⁵ to diagnose UTI in asymptomatic patients.

Rows

Columns

• Feature
• Nephritic (GN)
• Nephrotic Syndrome

Table Title

Nephritic (Glomerulonephritis) vs. Nephrotic Syndrome – Key Differences

Rows

Columns

• Feature
• Lower UTI (Cystitis/Urethritis)
• Upper UTI (Pyelonephritis)

Table Title

Lower UTI vs. Upper UTI (Pyelonephritis) – Clinical Features

Rows

Columns

• Stone Type
• % of Cases
• Key Risk Factors
• Urine Finding
• Prevention Strategy

Table Title

Stone Types – Composition, Risk Factors, & Prevention