NLE Renal & Urinary Nursing — UTI & Inflammatory Renal DisordersConcept Map

Concept

Urinary Tract Infection (UTI)

Sub Concepts

• Lower UTI (Cystitis, Urethritis)
• Ascending pathway pathophysiology
• Escherichia coli causative organism
• Risk factors: female sex, catheterization, urinary retention, diabetes
• Manifestations: dysuria, urgency, frequency, suprapubic pain, cloudy urine
• Diagnostics: urinalysis, culture and sensitivity >10⁵ CFU/mL
• Nursing management: antibiotics, fluid intake, patient teaching
• Older adult presentation: atypical signs (confusion, falls, incontinence)

Relationship To Central

Primary infectious disorder; ascending pathophysiology from perineum to bladder/urethra

Concept

Pyelonephritis

Sub Concepts

• Renal pelvis and parenchyma inflammation
• Systemic illness markers: high fever, chills, CVA tenderness
• Flank pain and malaise
• IV antibiotics in severe cases; oral step-down therapy
• Risk of chronic progression to CKD with renal scarring
• Complication: urosepsis (fever, hypotension, tachycardia)

Relationship To Central

Upper UTI complication; ascending infection from lower UTI or obstruction-related

Concept

Acute Post-Streptococcal Glomerulonephritis (APSGN)

Sub Concepts

• Immune-complex deposition mechanism
• Timeline: 1-2 weeks post-group A streptococcal infection
• Nephritic triad: hematuria, hypertension, edema
• Hallmark sign: cola/tea-colored urine (gross hematuria)
• RBC casts in urinalysis; elevated ASO titer; low C3 complement
• Elevated BUN/creatinine from reduced GFR
• Nursing priority: BP monitoring (hypertensive encephalopathy risk)
• Sodium/fluid restriction during oliguria
• Protein restriction if BUN markedly elevated

Relationship To Central

Immune-complex inflammatory disorder of glomeruli; nephritic syndrome presentation

Concept

Nephrotic Syndrome

Sub Concepts

• Pathophysiology: increased glomerular permeability to protein
• Classic tetrad: massive proteinuria (>3.5 g/day), hypoalbuminemia, edema, hyperlipidemia
• Frothy/foamy urine indicator
• Generalized edema: periorbital, dependent, ascites, anasarca
• BP typically normal or low (contrast with GN)
• Corticosteroids (prednisone) first-line therapy
• Immunosuppressants for steroid-resistant cases
• ACE inhibitors/ARBs for proteinuria reduction
• Diuretics for edema management
• Statins for hyperlipidemia
• Infection prevention (immunoglobulin loss + steroid immunosuppression)
• Low-sodium, modest-protein diet
• Monitor daily weight, abdominal girth, I&O, urine protein

Relationship To Central

Glomerular permeability disorder; massive proteinuria and metabolic consequences

Concept

Urolithiasis (Renal Calculi/Kidney Stones)

Sub Concepts

• Calcium oxalate/phosphate stones (75-80% most common)
• Struvite stones: magnesium-ammonium-phosphate (UTI-associated, staghorn)
• Uric acid and cystine stone types
• Risk factors: dehydration, immobility, stasis, hyperparathyroidism, gout, recurrent UTI
• Renal colic: sudden severe flank pain radiating to groin/genitalia
• Restlessness during acute episode
• Hematuria, nausea, vomiting, diaphoresis
• Diagnostics: non-contrast helical CT (gold standard), KUB, ultrasound, urinalysis
• PRIORITY: pain relief (opioids + NSAIDs)
• Strain all urine to capture stone for analysis
• Increased fluid intake 2.5-3 L/day
• Ambulation to promote stone passage
• Procedures: ESWL, ureteroscopy, percutaneous nephrolithotomy
• Prevention by stone type: fluid intake (all), oxalate restriction (calcium stones), purine/allopurinol (uric acid), UTI treatment (struvite)

Relationship To Central

Mechanical disorder from urinary solute precipitation; acute pain emergency

To

Pyelonephritis

From

Urinary Tract Infection

Strength

strong

Relationship

Lower UTI can ascend to become upper UTI if untreated or if obstruction present

To

Urosepsis

From

Pyelonephritis

Strength

strong

Relationship

Severe complication when upper UTI with obstruction leads to bacteremia and systemic inflammatory response

To

Post-Streptococcal Glomerulonephritis

From

Group A Streptococcal Infection

Strength

strong

Relationship

Immune-complex delayed reaction 1-2 weeks after throat or skin streptococcal infection triggers glomerular inflammation

To

Nephrotic Syndrome

From

Glomerulonephritis

Strength

moderate

Relationship

Both are glomerular inflammatory disorders but with distinct presentations; GN shows hematuria + HTN, nephrotic shows massive proteinuria + edema

To

Infection Risk

From

Nephrotic Syndrome

Strength

strong

Relationship

Massive immunoglobulin loss in urine combined with steroid immunosuppression creates high infection susceptibility

To

Struvite Stones

From

Urolithiasis

Strength

strong

Relationship

Recurrent UTI is a major risk factor for struvite (magnesium-ammonium-phosphate) stone formation

To

Renal Colic

From

Urolithiasis

Strength

strong

Relationship

Stone passage through ureter causes sudden severe flank pain radiating to groin—defining symptom of acute stone episode

To

Pain Management Priority

From

Renal Colic

Strength

strong

Relationship

Renal colic is a genuine emergency of comfort; opioids + NSAIDs are first-line interventions before diagnostics or other procedures

To

Obstruction with Infection

From

Urolithiasis

Strength

strong

Relationship

Stone causing obstruction + concurrent UTI creates a urologic emergency requiring immediate drainage intervention

To

Dietary Prevention

From

Calcium Oxalate Stones

Strength

moderate

Relationship

Restriction of oxalate-rich foods (spinach, beets, chocolate, tea, nuts) reduces calcium oxalate stone recurrence

To

Purine Restriction

From

Uric Acid Stones

Strength

moderate

Relationship

Low-purine diet and alkalinization of urine (plus allopurinol) prevent uric acid stone formation

To

Reduced GFR

From

Glomerulonephritis

Strength

strong

Relationship

Immune-mediated glomerular damage decreases filtration rate, causing azotemia (elevated BUN/creatinine) and oliguria

To

Hypoalbuminemia

From

Nephrotic Syndrome

Strength

strong

Relationship

Massive proteinuria losses deplete serum albumin, reducing plasma oncotic pressure and driving generalized edema formation

To

Thromboembolism Risk

From

Nephrotic Syndrome

Strength

moderate

Relationship

Loss of anticoagulant proteins (antithrombin III, protein C) in massive proteinuria increases venous thrombosis and pulmonary embolism risk

To

Atypical UTI Presentation

From

Older Adults

Strength

strong

Relationship

Elderly patients may present with confusion, incontinence, falls, or functional decline rather than classic dysuria/urgency signs

To

Asymptomatic Bacteriuria Management

From

Pregnancy

Strength

strong

Relationship

Asymptomatic bacteriuria must be treated in pregnancy because it readily progresses to pyelonephritis and increases preterm labor risk

To

Hypertension Management

From

Glomerulonephritis

Strength

strong

Relationship

Sodium and fluid restriction during the edematous/oliguric phase are critical to prevent hypertensive encephalopathy and heart failure

To

Corticosteroid Therapy

From

Nephrotic Syndrome

Strength

strong

Relationship

Prednisone is first-line, especially in children with minimal-change disease which has >90% remission rate with steroids

To

Kidney Stone Management

From

ESWL Procedure

Strength

moderate

Relationship

Extracorporeal shock wave lithotripsy breaks stones non-invasively using sound waves; expect post-procedure hematuria and bruising

To

UTI Diagnosis

From

Urinalysis Findings

Strength

strong

Relationship

Positive leukocyte esterase, nitrites, WBCs (pyuria), and bacteria on urinalysis are diagnostic; culture confirms organism and guides antibiotic selection