Ch. 21 Urinary Disorders
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| 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
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| Urine is formed through? | Filtration and Reabsorption
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| The transport mechanisms for reabsorption are? | Active transport, cotransport and osmosis
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| Where does most reabsorption of water occur? | Proximal convoluted tubule
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| Three hormones involved in reabsorption are? | ADH, Aldosterone and Atrial natriuetic hormone (ANP)
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| ADH | Reabsorption of water in distal convoluted tubules and collecting ducts
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| Aldosterone | Sodium reabsorption in exchange for potassium or hydrogen
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| ANP | Reduces sodium and fluid reabsorption
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| What controls the glomerular filtration rate (GFR)? | Afferent and Efferent arterioles
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| Pressure in the glomerular capillaries is controlled by? | Vasoconstriction of afferent arteriole
Dilation of afferent arteriole
Vasoconstriction of efferent arteriole
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| Vasoconstriction of the afferent arteriole causes? | Decreased glomerular pressure and decreased filtrate
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| Dilation of the afferent arteriole causes? | Increased pressure in glomerulus and increased filtrate
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| Vasoconstriction of the efferent arteriole causes? | Increased pressure in glomerulus – increased filtrate
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| What three ways control arteriolar constriction? | Autoregulation
SNS
Renin
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| Autoregulation causes? | Local adjustment in diameter of arterioles made in response to changes in blood flow in kidneys
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| SNS causes? | An increase vasoconstriction in both arterioles
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| Renin is? | Secreted by juxtaglomerular cells when blood flow to afferent arteriole is reduced and its involved in the Renin-angiotensin mechanism
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| Incontinence is? | The loss of voluntary control of the bladder
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| Enuresis is? | Involuntary urination by a child age 4+ years
Often related to developmental delay, sleep pattern, psychosocial aspect
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| Stress incontinence is? | More common in women
An increase in intra-abdominal pressure forces urine through sphincter from coughing, lifting, laughing; multiple pregnancies
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| Overflow incontinence is? | Incompetent bladder sphincter
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| Retention is? | The inability to empty the bladder
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| Retention results from? | Overflow incontinence
Anesthesia
Spinal Cord Injury
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| Diagnostic tests for urinary disorders are? | Urinalysis
Blood tests
Cultures
Clearance tests
Radiologic Tests
Cytoscopy
Biopsy
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| Urinalysis appearance | Straw colored with mild odor (Normal)
Cloudy
Dark Color
Unpleasant or unusual odor
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| Cloudy urine indicates? | The presence of large amounts of protein, blood, bacteria, and pus
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| Dark colored urine indicates? | Hematuria, excessive bilirubin, or highly concentrated urine
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| Unpleasant or Unusual odor indicates? | Infection or result from certain dietary components or medication
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| Abnormal constituents of urine | Blood
Elevated protein
Bacteria
Urinary Casts
Specific gravity
Glucose and Ketones
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| Small amounts of blood in the urine indicate? | Infection, inflammation, or tumors in urinary tract
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| Large amounts of blood in the urine indicate? | Increased glomerular permeability or hemorrhage
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| Elevated protein levels in urine indicate? | Leakage of albumin or mixed plasma proteins into filtrate
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| Bacteria in urine indicates? | Infection
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| A urinary infection is? | A heavy purulence and presence of gram negative and gram positive organisms
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| Urinary casts indicate? | Inflammation of kidney tubules
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| Specific Gravity indicates? | The ability of tubules to concentrate urine
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| Low specific gravity | Dilute urine
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| High specific gravity | Concentrated urine
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| Glucose and ketones indicate? | Poorly controlled diabetes mellitus
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| Blood tests show? | Elevated urea and creatinine
Metabolic Acidosis
Anemia
Electrolytes
Antibody levels
Renin levels
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| Elevated urea and creatinine indicate? | The failure to excrete nitrogenous wastes due to decreased GFR
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| Metabolic Acidosis indicates? | Decreased GFR and failure of the tubules to control acid base balance
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| Anemia indicates? | Decreased erythropoietin secretion and/or bone marrow depression due to accumulated wastes
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| Elevated Renin levels indicate? | A cause of hypertension
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| Culture tests | Identify causative organism of infection and select appropriate drug treatment
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| Radiologic tests | Are used to visualize structures and possible abnormalities, flow patterns, and filtration rates
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| Clearance tests | Used to assess GFR
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| Cystoscopy | Visualizes the lower urinary tract which helps with the removal of kidney stones
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| Diuretic drugs | Are used to remove excess sodium ions and water from the body
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| Effects of diuretic drugs | Increase the excretion of water though the kidneys and reduce the fluid volume in tissues and blood
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| Diuretics are used for? | Renal disease, hypertension, edema, congestive heart failure, liver disease, pulmonary edema
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| Hydrocholorothiazide (Hydro DIURIL) | Inhibits reabsorption of sodium and water in the distal convoluted tubule
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| Effects of Hydrocholorothiazide (Hydro DIURIL) | Increased excretion of fluid in hypertension, CHF and edema
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| Spironolactone (Aldactone) | Aldosterone antagonist, blocks reabsorption of sodium and potassium in DCT
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| Effects of Spironolactone (Aldactone) | Decreases sodium and water in the body but conserves potassium in CHF hypertension and liver disease
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| Furosemide (Lasix) | Decreases reabsorption of sodium and water in the PCT, DCT and loop of henle
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| Effects of Furosemide (Lasix) | Reduced body fluids in hypertension, CHF, edema, renal disease and liver disease
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| Acetazolamide (Diamox) | Carbonic anhydrase inhibitor that blocks reabsorption of sodium and secretion of hydrogen
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| Effects of Acetazolamide (Diamox) | Reduce fluids in CHF and glaucoma
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| Mannitol (intravenous) | Increases osmotic pressure and water in the filtrate, and reduces sodium absorption
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| Effects of Mannitol (intravenous) | Cerebral edema and galucoma
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| Dialysis | Used to treat a patient with acute renal failure or end stage renal failure
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| What are the two forms of dialysis? | Hemodialysis and Periotneal dialysis
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| 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
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| 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.
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| 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
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| Major complication of periotneal dialysis | Infection resulting in peritonitis
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| 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
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| Two types of UTI's are? | Cystitis and Pyelonephritis
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| Cystitis | Lower urinary tract infection where bladder wall and urethra are inflammed
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| Signs and Symptoms for Cystitis are? | Dysuria, urgency, frequency, and nocturia Systemic signs may be present. Cloudy urine Urinalysis indicates bacteriuria and pyuria
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| 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
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| 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
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| Treatmentfor Pyelonephritis requires? | Antibacterials
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| Inflammatory Disorders include? | Glomerulonephritis, Nephrotic Syndrome (Nephrosis)
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| Glomerulonephritis | Usually originates with strep throat and is the presence of anti-streptococcal (ASO) antibodies
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| Glomerulonephritis is caused by? | Formation of an antigen-antibody complex that activates the complement system to cause an immune response.
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| Glomerulonephritis leads to? | Increased capillary permability and cell proliferation resulting in the leakage of protein and large amounts of erythrocytes into the filtrate
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| 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
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| Tests used to diagnos glomerulonephritis are? | Blood tests, Metabolic Acidosis, Urinalysis
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| Blood tests for glomerulonephritis show? | Elevated serum urea and creatinine Elevation of anti-DNase B, streptococcal antibodies Decreased complement levels
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| What treatment is required for glomerulonephritis? | Sodium restriction possible Protein and fluid intake decreased in severe cases Glucocorticoids to reduce inflammation Antihypertensives
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| Nephrotic Syndrome | Is secondary to numerous renal disease and is a primary disease in young children from ages 2-6
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| Nephrotic Syndrome occurs from? | An abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate
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| Nephrotic Syndrom leads to? | Hypoalbuminemia with decreased plasma osmotic pressure Low blood pressure Increased aldosterone High blood cholesterol
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| Signs and Symptoms for Nephrotic Syndrome are? | Proteinuria, lipiduria, cast Massive edema Sudden increase in girth
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| What treatment is required for Nephrotic Syndrome? | Glucocorticoids to reduce inflammation ACE inhibitors may reduce protein loss in urine Antihypertensives Restriction of sodium intake
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| Urolithiasis (Kidney Stones) form from? | Excessive amounts of solutes in filtrate Insufficient fluid intake – major factor for calculi formation Urinary tract infection
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| Kidney Stones may lead to? | Infection, Hydronephrosis and atrophy of renal tissue
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| When do calculi form? | When calcium levels in the urine are high from hypercalcemia and when the urine is highly alkaline
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| What causes calculi formation? | Inadequate fluid intake
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| When do uric acid stones form? | When urine is acidic and from hyperuricemia caused by gout, high purine diets and chemotherapy
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| Signs and symptoms for Kidney stones are? | Usually asymptomatic Flank pain Infection Renal colic
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| 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
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| What causes renal colic? | Obstruction of the ureter
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| 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
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| What are some preventative factors for kidney stones? | Treatment of underlying condition Adjustment of urine pH through dietary modifications Consistent increased fluid intake
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| Hydronephrosis | Secondary problem due to Complication of calculi Tumors, scar tissue in kidney or ureter Untreated prostatic enlargement Developmental abnormalities restricting urine flow
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| Renal Cell Carcinoma | Primary tumor arising from the tubule epithelium occuring more frequently in men and smokers
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| Treatment for renal cell carcinoma requires? | Removal of the kidney and possible immunotherapy. Tumor is radioresistant
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| 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
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| 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
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| Early signs of bladder cancer are? | Hematuria, dysuria, and infection
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| 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
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| What treatment is required for bladder cancer? | Surgical resection of tumor Chemotherapy and radiation Photoradiation successful in some early cases
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| Nephrosclerosis occurs when? | Involves vascular changes in the kidney that cause thickening and hardening of the walls of the arterioles and small arteries.
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| 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
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| Treatment for nephrosclerosis includes? | Antihypertensive agents Diuretics Beta-blockers Sodium intake should be reduced
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| Congenital disorders include? | Vesicoureteral reflux Agensis Hypoplasia Ectopic Kidney Fusion
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| Agensis | Failure of one kidney to develop
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| Hypoplasia | Failure to develop to normal size
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| Ectopic Kidney | Kidney and ureter displaced out of normal position
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| Fusion (Horseshoe Kidney) | Fusion of the two kidneys
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| Adult Polycystic Kidney | Genetic disease that is autosomal dominant gene on chromosome 16. Usually develop around age 40
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| Adult Polycystic Kidney occurs when? | Multiple cysts develop in both kidneys. Enlargement of kidneys Compression and destruction of kidney tissue Chronic renal failure
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| Wilms Tumor | Most common tumor occuring in children. Defects in tumor suppressor genes on chromosome 11. Large encapulated mass and is unilateral
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| 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
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| Blood tests for acute renal failure show? | Elevated serum urea nitrogen and creatinine Metabolic acidosis and hyperkalemia
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| 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
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| Chronic renal failure | Gradual irreversible destruction of the kidneys over a long period of time
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| Chronic renal failure causes include? | Chronic kidney disease Congenital polycystic kidney disease Systemic disorders Low-level exposure to nephrotoxins over sustained period of time
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| What are the three stages of chronic renal failure? | Decreased renal reserve, renal insufficiency, and end stage renal failure
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| Decreased renal reserve | Decrease in GFR Higher than normal serum creatinine levels No apparent clinical symptoms
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| 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
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| 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
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| 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
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| 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
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| What are the key indicators for chronic renal failure? | Anemia, acidosis, and azotemia
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| 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
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