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Ch. 21 Patho

Ch. 21 Urinary Disorders

Functions of the Urinary System are? Remove metabolic wastes, hormones, drugs and foreign materials Regulate water, electrolyte, acid-base balance Secrete erythropoietin Activate vitamin D Regulate blood pressure through the renin-angiotensin-aldosterone system
Urine is formed through? Filtration and Reabsorption
The transport mechanisms for reabsorption are? Active transport, cotransport and osmosis
Where does most reabsorption of water occur? Proximal convoluted tubule
Three hormones involved in reabsorption are? ADH, Aldosterone and Atrial natriuetic hormone (ANP)
ADH Reabsorption of water in distal convoluted tubules and collecting ducts
Aldosterone Sodium reabsorption in exchange for potassium or hydrogen
ANP Reduces sodium and fluid reabsorption
What controls the glomerular filtration rate (GFR)? Afferent and Efferent arterioles
Pressure in the glomerular capillaries is controlled by? Vasoconstriction of afferent arteriole Dilation of afferent arteriole Vasoconstriction of efferent arteriole
Vasoconstriction of the afferent arteriole causes? Decreased glomerular pressure and decreased filtrate
Dilation of the afferent arteriole causes? Increased pressure in glomerulus and increased filtrate
Vasoconstriction of the efferent arteriole causes? Increased pressure in glomerulus – increased filtrate
What three ways control arteriolar constriction? Autoregulation SNS Renin
Autoregulation causes? Local adjustment in diameter of arterioles made in response to changes in blood flow in kidneys
SNS causes? An increase vasoconstriction in both arterioles
Renin is? Secreted by juxtaglomerular cells when blood flow to afferent arteriole is reduced and its involved in the Renin-angiotensin mechanism
Incontinence is? The loss of voluntary control of the bladder
Enuresis is? Involuntary urination by a child age 4+ years Often related to developmental delay, sleep pattern, psychosocial aspect
Stress incontinence is? More common in women An increase in intra-abdominal pressure forces urine through sphincter from coughing, lifting, laughing; multiple pregnancies
Overflow incontinence is? Incompetent bladder sphincter
Retention is? The inability to empty the bladder
Retention results from? Overflow incontinence Anesthesia Spinal Cord Injury
Diagnostic tests for urinary disorders are? Urinalysis Blood tests Cultures Clearance tests Radiologic Tests Cytoscopy Biopsy
Urinalysis appearance Straw colored with mild odor (Normal) Cloudy Dark Color Unpleasant or unusual odor
Cloudy urine indicates? The presence of large amounts of protein, blood, bacteria, and pus
Dark colored urine indicates? Hematuria, excessive bilirubin, or highly concentrated urine
Unpleasant or Unusual odor indicates? Infection or result from certain dietary components or medication
Abnormal constituents of urine Blood Elevated protein Bacteria Urinary Casts Specific gravity Glucose and Ketones
Small amounts of blood in the urine indicate? Infection, inflammation, or tumors in urinary tract
Large amounts of blood in the urine indicate? Increased glomerular permeability or hemorrhage
Elevated protein levels in urine indicate? Leakage of albumin or mixed plasma proteins into filtrate
Bacteria in urine indicates? Infection
A urinary infection is? A heavy purulence and presence of gram negative and gram positive organisms
Urinary casts indicate? Inflammation of kidney tubules
Specific Gravity indicates? The ability of tubules to concentrate urine
Low specific gravity Dilute urine
High specific gravity Concentrated urine
Glucose and ketones indicate? Poorly controlled diabetes mellitus
Blood tests show? Elevated urea and creatinine Metabolic Acidosis Anemia Electrolytes Antibody levels Renin levels
Elevated urea and creatinine indicate? The failure to excrete nitrogenous wastes due to decreased GFR
Metabolic Acidosis indicates? Decreased GFR and failure of the tubules to control acid base balance
Anemia indicates? Decreased erythropoietin secretion and/or bone marrow depression due to accumulated wastes
Elevated Renin levels indicate? A cause of hypertension
Culture tests Identify causative organism of infection and select appropriate drug treatment
Radiologic tests Are used to visualize structures and possible abnormalities, flow patterns, and filtration rates
Clearance tests Used to assess GFR
Cystoscopy Visualizes the lower urinary tract which helps with the removal of kidney stones
Diuretic drugs Are used to remove excess sodium ions and water from the body
Effects of diuretic drugs Increase the excretion of water though the kidneys and reduce the fluid volume in tissues and blood
Diuretics are used for? Renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
Hydrocholorothiazide (Hydro DIURIL) Inhibits reabsorption of sodium and water in the distal convoluted tubule
Effects of Hydrocholorothiazide (Hydro DIURIL) Increased excretion of fluid in hypertension, CHF and edema
Spironolactone (Aldactone) Aldosterone antagonist, blocks reabsorption of sodium and potassium in DCT
Effects of Spironolactone (Aldactone) Decreases sodium and water in the body but conserves potassium in CHF hypertension and liver disease
Furosemide (Lasix) Decreases reabsorption of sodium and water in the PCT, DCT and loop of henle
Effects of Furosemide (Lasix) Reduced body fluids in hypertension, CHF, edema, renal disease and liver disease
Acetazolamide (Diamox) Carbonic anhydrase inhibitor that blocks reabsorption of sodium and secretion of hydrogen
Effects of Acetazolamide (Diamox) Reduce fluids in CHF and glaucoma
Mannitol (intravenous) Increases osmotic pressure and water in the filtrate, and reduces sodium absorption
Effects of Mannitol (intravenous) Cerebral edema and galucoma
Dialysis Used to treat a patient with acute renal failure or end stage renal failure
What are the two forms of dialysis? Hemodialysis and Periotneal dialysis
Hemodialysis Provided in a hospital, dialysis center or at home. The patients blood moves from an implanted shunt or catheter in an artery, through a tube to a machine where the exchange of wastes, fluids, and electrolytes takes place
Potential complications for hemodialysis Shunt may become infected. Blood clots may form. Blood vessels involved in shunt become sclerosed or damaged. Patient has an increased risk of infections with hepatitis B or C or HIV if standard precautions are not followed.
Periotneal dialysis Administered in a dialysis unit or at home. A catheter is placed in the perioneal cavity and dialyzing fluid is instilled through the catheter allowing the exchange of wastes, electrolytes to occur by diffusion and osmosis
Major complication of periotneal dialysis Infection resulting in peritonitis
Urinary Tract Infections (UTI's) Caused by E.Coli attaching to the mucosa of the bladder interfering with the ability to eliminate when the bladder empties
Two types of UTI's are? Cystitis and Pyelonephritis
Cystitis Lower urinary tract infection where bladder wall and urethra are inflammed
Signs and Symptoms for Cystitis are? Dysuria, urgency, frequency, and nocturia Systemic signs may be present. Cloudy urine Urinalysis indicates bacteriuria and pyuria
Pyelonephritis Upper urniary tract infection involving one or both of the kidneys and extends from the ureter into the kidney. Purulent exudate fills kidney and causes imflammation of the medulla
Signs and Symptoms for Pyelonephritis are? Dull, aching pain in lower back or flank area Systemic signs include high temperature Urinalysis shows signs of urinary casts
Treatmentfor Pyelonephritis requires? Antibacterials
Inflammatory Disorders include? Glomerulonephritis, Nephrotic Syndrome (Nephrosis)
Glomerulonephritis Usually originates with strep throat and is the presence of anti-streptococcal (ASO) antibodies
Glomerulonephritis is caused by? Formation of an antigen-antibody complex that activates the complement system to cause an immune response.
Glomerulonephritis leads to? Increased capillary permability and cell proliferation resulting in the leakage of protein and large amounts of erythrocytes into the filtrate
Signs and symptoms for Glomerulonephritis are? Dark and cloudy urine Facial and preorbital edema Elevated blood pressure Flank or back pain Signs of imflammation Decreased urine output
Tests used to diagnos glomerulonephritis are? Blood tests, Metabolic Acidosis, Urinalysis
Blood tests for glomerulonephritis show? Elevated serum urea and creatinine Elevation of anti-DNase B, streptococcal antibodies Decreased complement levels
What treatment is required for glomerulonephritis? Sodium restriction possible Protein and fluid intake decreased in severe cases Glucocorticoids to reduce inflammation Antihypertensives
Nephrotic Syndrome Is secondary to numerous renal disease and is a primary disease in young children from ages 2-6
Nephrotic Syndrome occurs from? An abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate
Nephrotic Syndrom leads to? Hypoalbuminemia with decreased plasma osmotic pressure Low blood pressure Increased aldosterone High blood cholesterol
Signs and Symptoms for Nephrotic Syndrome are? Proteinuria, lipiduria, cast Massive edema Sudden increase in girth
What treatment is required for Nephrotic Syndrome? Glucocorticoids to reduce inflammation ACE inhibitors may reduce protein loss in urine Antihypertensives Restriction of sodium intake
Urolithiasis (Kidney Stones) form from? Excessive amounts of solutes in filtrate Insufficient fluid intake – major factor for calculi formation Urinary tract infection
Kidney Stones may lead to? Infection, Hydronephrosis and atrophy of renal tissue
When do calculi form? When calcium levels in the urine are high from hypercalcemia and when the urine is highly alkaline
What causes calculi formation? Inadequate fluid intake
When do uric acid stones form? When urine is acidic and from hyperuricemia caused by gout, high purine diets and chemotherapy
Signs and symptoms for Kidney stones are? Usually asymptomatic Flank pain Infection Renal colic
Renal colic Intense spasms of pain in the flank area radiating into the groin that last until the stone is passed or has been removed
What causes renal colic? Obstruction of the ureter
What treatment is required for Kidney stones? Small stones will be passed eventually. Extracorporeal shock-wave lithotripsy (ESWL) Laser lithotripsy Drugs may be used to partially dissolve stones. Surgery
What are some preventative factors for kidney stones? Treatment of underlying condition Adjustment of urine pH through dietary modifications Consistent increased fluid intake
Hydronephrosis Secondary problem due to Complication of calculi Tumors, scar tissue in kidney or ureter Untreated prostatic enlargement Developmental abnormalities restricting urine flow
Renal Cell Carcinoma Primary tumor arising from the tubule epithelium occuring more frequently in men and smokers
Treatment for renal cell carcinoma requires? Removal of the kidney and possible immunotherapy. Tumor is radioresistant
Signs and symptoms for Renal cell carcinoma are? Painless hematuria Dull, aching flank pain Palpable mass Unexplained weight loss Anemia or erythrocytosis Cushings Syndrome Hypercalcemia
Bladder cancer Most bladder tumors are malignant and commonly arise from transitional epithelium of the bladder. Can develop as multiple tumors and metastisizes to pelvic lymph nodes, liver and bone
Early signs of bladder cancer are? Hematuria, dysuria, and infection
What are the predisposing factors for bladder cancer? Cigarette smoking Recurrent infections Heavy intake of analgesics Working with chemicals such as dyes rubber and aluminum
What treatment is required for bladder cancer? Surgical resection of tumor Chemotherapy and radiation Photoradiation successful in some early cases
Nephrosclerosis occurs when? Involves vascular changes in the kidney that cause thickening and hardening of the walls of the arterioles and small arteries.
Nephrosclerosis results in? Narrowing of the blood vessel lumen Reduction of blood supply to kidney Stimulation of renin which increases blood pressure Ischemia leading to chronic renal failure
Treatment for nephrosclerosis includes? Antihypertensive agents Diuretics Beta-blockers Sodium intake should be reduced
Congenital disorders include? Vesicoureteral reflux Agensis Hypoplasia Ectopic Kidney Fusion
Agensis Failure of one kidney to develop
Hypoplasia Failure to develop to normal size
Ectopic Kidney Kidney and ureter displaced out of normal position
Fusion (Horseshoe Kidney) Fusion of the two kidneys
Adult Polycystic Kidney Genetic disease that is autosomal dominant gene on chromosome 16. Usually develop around age 40
Adult Polycystic Kidney occurs when? Multiple cysts develop in both kidneys. Enlargement of kidneys Compression and destruction of kidney tissue Chronic renal failure
Wilms Tumor Most common tumor occuring in children. Defects in tumor suppressor genes on chromosome 11. Large encapulated mass and is unilateral
What are the causes for acute renal failure? Acute bilateral kidney diseases Severe, prolonged circulatory shock or heart failure Nephrotoxins such as Drugs, chemicals, or toxins Mechanical obstruction from Calculi, blood clots, tumors Block urine flow beyond kidneys
Blood tests for acute renal failure show? Elevated serum urea nitrogen and creatinine Metabolic acidosis and hyperkalemia
Treatment for acute renal failure requires? Dialysis to normalize fluids and the ability to identify and remove primary problem to reduce the chance of necrosis
Chronic renal failure Gradual irreversible destruction of the kidneys over a long period of time
Chronic renal failure causes include? Chronic kidney disease Congenital polycystic kidney disease Systemic disorders Low-level exposure to nephrotoxins over sustained period of time
What are the three stages of chronic renal failure? Decreased renal reserve, renal insufficiency, and end stage renal failure
Decreased renal reserve Decrease in GFR Higher than normal serum creatinine levels No apparent clinical symptoms
Renal Insufficiency Decreased GFR to about 20% of normal Significant retention of nitrogen wastes Excretion of large volumes of dilute urine Decreased erythropoiesis Elevated blood pressure
End Stage Renal Failure Negligible GFR Fluid, electrolytes, and wastes retained in body Azotemia, anemia, and acidosis (3 As) All body systems affected Marked oliguria or anuria Regular dialysis or kidney transplant
Early signs of chronic renal failure include? Increased urinary output Anorexia, nausea, anemia, fatigue, unintended weight loss, exercise intolerance Bone marrow depression and impaired cell function caused by increased wastes and altered blood chemistry Elevated blood pressure
Signs for complete failure of the kidneys include? Oliguira Dry, pruritic, hyperpigmented skin, easy bruising Peripheral neurophathy Impotence in men, menstrual irregularities in women Encephalopathy Congestive heart failure, dysrhythmias Failure to activate vitamin D Systemic infections
What are the key indicators for chronic renal failure? Anemia, acidosis, and azotemia
The required treatment for chronic renal failure includes? Difficult to maintain homeostasis of fluids, electrolytes, and acid-base balance Drugs to stimulate erythropoiesis Drugs to treat cardiovascular problems Intake of fluid, electrolytes, protein must be restricted Dialysis or transplant
Created by: cdanella