CHAPTER 9 Genitourinary System^389
- Weight loss due to chronic disease
- Abdominal bruit with ischemic nephropathy
- Peripheral edema with third spacing of fluids
- Decreased urinary output
- Uremic pruritis—see excoriations from scratching
- Anemia in chronic disease—kidneys produce erythropoetin
INTERPRETING TEST RESULTS
- BUN elevated.
- Creatinine elevated.
- BUN/creatinine ratio elevated.
- Urinalysis may show casts (hyaline or granular in acute prerenal; RBC, WBC
in renal), proteinuria. - Glomerular filtration rate decreases in chronic disease.
- Creatinine clearance decreases.
- Renal ultrasound shows decrease in renal size in chronic renal failure; dila-
tion and fluid build up in post-renal failure.
TREATMENT
Treatment needs to address the underlying disease process. What will correct one
cause may make another cause worse.
- Administer intravenous fluids to correct hypovolemia.
- Administer inotropic agents for patients with CHF to enhance cardiac output.
- Administer antibiotics for pyelonephritis.
- Stent placement or catheter (urethral, suprapubic, nephrostomy) to allow for
drainage of urine if blockage present. - Dialysis.
- Administer erythropoetin to treat anemia.
- Restrict potassium, phosphate, sodium, and protein in diet.
- Administer phosphate binders to reduce phosphate levels.
- Administer sodium polystyrene sulfonate to reduce potassium levels.
- Monitor electrolyte levels.