Renal and Urologic Problems | Chapter 50 - Lewis’s Medical-Surgical Nursing (12th Edition)

Chapter 50 of Lewis’s Medical-Surgical Nursing (12th Edition) addresses renal and urologic problems across the upper tract (kidneys, ureters) and lower tract (bladder, urethra), with a strong focus on pathophysiology, diagnostics, interprofessional treatment, and nursing management. The chapter begins with infectious and inflammatory disorders—notably urinary tract infection (UTI) as the most common outpatient infection (typically due to E. coli), along with cystitis, urethritis, and pyelonephritis—emphasizing risk factors, clinical manifestations (dysuria, frequency, urgency, flank pain, fever), urinalysis and culture, and evidence-based care (antibiotics, hydration, analgesics, avoidance of bladder irritants, and adherence to full therapy). It details glomerulonephritis (immunologic injury of the glomeruli) and nephrotic syndrome (massive proteinuria, hypoalbuminemia, edema) with associated complications, dietary and fluid strategies, blood pressure control, and careful monitoring for infection and thrombosis. Vascular and structural conditions include nephrosclerosis and renal artery stenosis, which can progress to renal insufficiency and require BP optimization, endovascular or surgical options, and renal function surveillance. The section on renal calculi (kidney stones/nephrolithiasis) explains supersaturation and crystal formation, hallmark renal colic, hematuria, imaging choices, pain control, hydration, stone analysis, alpha-blockers to facilitate passage, and lithotripsy or endoscopic/surgical removal when indicated; nurses strain urine, track I and O, and provide prevention teaching (fluids, diet modification). Interstitial cystitis (painful bladder syndrome) and neurogenic bladder are covered with symptom-based management, bladder training, pelvic floor strategies, medications, and long-term support. Lower-tract functional problems—urinary incontinence (stress, urge, overflow, functional, mixed) and urinary retention (including BPH-related)—are addressed through assessment, bladder scanning, timed voiding, catheterization when needed, pharmacologic therapy, and skin integrity protection. Renal and urologic cancers (including renal cell carcinoma and bladder cancer) are summarized with hematuria-focused recognition, cystoscopy/biopsy and imaging, intravesical therapy, partial or radical surgery, systemic therapy, and comprehensive nursing care (post-op monitoring, stoma and skin care when urinary diversions such as an ileal conduit are created, hydration, infection prevention, and psychosocial support). Perioperative topics such as nephrectomy and reconstructive procedures are integrated throughout. Across conditions, the chapter stresses health promotion, early recognition, diagnostic accuracy, complication prevention, and patient-centered education to protect renal function and quality of life.



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