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Ch. 21 Patho
Ch. 21 Urinary Disorders
| Question | Answer |
|---|---|
| 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
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