Here are the detailed notes for Chapter 50: Renal and Urologic Problems from Lewis’s
Medical-Surgical Nursing (12th Ed.), covering the requested pages.
I. Obstructive Uropathies (pp. 1213-1214)
Urinary obstruction is any condition that blocks or impedes the flow of urine. It can be
congenital or acquired, and its severity depends on location, duration, and pressure.
● Pathophysiology:
○ Bladder Outlet Obstruction: Pressure increases during bladder filling. This can lead
to reflux (backward movement of urine).
○ Hydroureter: Ureteral dilation and distention.
○ Hydronephrosis: Dilation or enlargement of the renal pelvis and calyces. If left
untreated, this leads to renal atrophy and irreversible kidney damage.
● Clinical Significance: If only one kidney is obstructed, the patient may be asymptomatic
as the other kidney compensates. Progressive bilateral obstruction leads to renal failure.
● Treatment: Focuses on finding and relieving the blockage (e.g., insertion of a urethral or
ureteral tube, surgical correction, or urinary diversion).
II. Immunologic Kidney Problems (pp. 1218-1219)
1. Acute Poststreptococcal Glomerulonephritis (APSGN)
APSGN is an inflammation of the glomeruli that develops 1–6 weeks after a streptococcal
infection of the tonsils, pharynx, or skin (e.g., impetigo).
● Manifestations: Generalized edema (starting as periorbital edema), hypertension,
oliguria, and hematuria (smoky or rust-colored urine).
● Nursing Management:
○ Prevention: Early diagnosis and full antibiotic treatment of sore throats/skin lesions.
○ Acute Care: Rest, sodium and fluid restriction, and diuretics to reduce edema.
Restrict protein if BUN is elevated.
2. Chronic Glomerulonephritis
A syndrome of permanent and progressive renal fibrosis. It often progresses insidiously
toward End-Stage Renal Disease (ESRD) over many years. It is characterized by proteinuria,
hematuria, and slow development of uremia.
3. Anti-Glomerular Basement Membrane (GBM) Disease
Formerly called Goodpasture syndrome, this is an autoimmune disease where antibodies
attack both glomerular and alveolar basement membranes.
● Symptoms: Cough, shortness of breath, hemoptysis (lung involvement), and
hematuria/anemia (renal involvement).
● Treatment: Corticosteroids, immunosuppressants, and plasmapheresis to remove
Medical-Surgical Nursing (12th Ed.), covering the requested pages.
I. Obstructive Uropathies (pp. 1213-1214)
Urinary obstruction is any condition that blocks or impedes the flow of urine. It can be
congenital or acquired, and its severity depends on location, duration, and pressure.
● Pathophysiology:
○ Bladder Outlet Obstruction: Pressure increases during bladder filling. This can lead
to reflux (backward movement of urine).
○ Hydroureter: Ureteral dilation and distention.
○ Hydronephrosis: Dilation or enlargement of the renal pelvis and calyces. If left
untreated, this leads to renal atrophy and irreversible kidney damage.
● Clinical Significance: If only one kidney is obstructed, the patient may be asymptomatic
as the other kidney compensates. Progressive bilateral obstruction leads to renal failure.
● Treatment: Focuses on finding and relieving the blockage (e.g., insertion of a urethral or
ureteral tube, surgical correction, or urinary diversion).
II. Immunologic Kidney Problems (pp. 1218-1219)
1. Acute Poststreptococcal Glomerulonephritis (APSGN)
APSGN is an inflammation of the glomeruli that develops 1–6 weeks after a streptococcal
infection of the tonsils, pharynx, or skin (e.g., impetigo).
● Manifestations: Generalized edema (starting as periorbital edema), hypertension,
oliguria, and hematuria (smoky or rust-colored urine).
● Nursing Management:
○ Prevention: Early diagnosis and full antibiotic treatment of sore throats/skin lesions.
○ Acute Care: Rest, sodium and fluid restriction, and diuretics to reduce edema.
Restrict protein if BUN is elevated.
2. Chronic Glomerulonephritis
A syndrome of permanent and progressive renal fibrosis. It often progresses insidiously
toward End-Stage Renal Disease (ESRD) over many years. It is characterized by proteinuria,
hematuria, and slow development of uremia.
3. Anti-Glomerular Basement Membrane (GBM) Disease
Formerly called Goodpasture syndrome, this is an autoimmune disease where antibodies
attack both glomerular and alveolar basement membranes.
● Symptoms: Cough, shortness of breath, hemoptysis (lung involvement), and
hematuria/anemia (renal involvement).
● Treatment: Corticosteroids, immunosuppressants, and plasmapheresis to remove
