Term
| What are the functions of the urinary system? |
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Definition
- Conserves beneficial compounds while eliminating wastes.
- Regulates BLOOD VOLUME AND PRESSURE.
> adjusts the volume of water lost in the urine
> releases erythropoietin and renin
- Regulates plasma concentration of ions
> calcium, sodium, potassium, chloride, and other ions
- Contributes to the stabilization of * blood pH
- Assists the liver in detoxification |
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Term
| Explain the formation of Urine |
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Definition
1. Blood enters the GLOMERULUS and its capillary network.
2. FILTRATION: blood pressure forces out fluids and solutes into the capsular space.
3. The filtrate enters the RENAL TUBULE OF THE NEPHRON:
> 4 regions that are different structurally and functionally
> the tubular fluid gradually changes its composition as it travels through these regions
4. Renal tubules empty into the COLLECTION SYSTEM |
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Term
| What are the signs and symptoms of renal disease? |
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Definition
- Nausea/vomiting
> BUN = Blood Urea Nitrogen (Uremia = Increased BUN)
> Creatinine: Breakdown of creatine phosphate
- PU/PD
> Polyuria: Excessive Urine
> Polydipsia: Excessive thirst |
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Term
| What are the different developmental abnormalities? |
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Definition
- Renal Agenesis
> Unilateral
> Bilateral
- Duplications
> Partial
> Complete
- Malpositions
> Failure to ascend
> Fusion of posterior poles
> Fusion of posterior pole to anterior pole |
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Term
| Explain CONGENITAL POLYCYSTIC KIDNEY DISEASE |
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Definition
- Mendelian dominant
- Faulty development of renal tubules and collecting tubules
- Cysts gradually increase in size, causing enlargement of the kidneys
- Pressure from cysts --> necrosis of cells
- The expanding cysts compress and destroy adjacent renal tissue
- Renal failure develops
- May also develop hypertension:
> Become's obstructive, which puts pressure on renal blood vessels, decreasing blood volume to the kidneys, activating the renin-angiotensin mechanism |
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Term
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Definition
- INFLAMMATION of the urinary bladder
> Can be acute or chronic
- Normal urine in bladder is sterile, it's never sterile in the urethra
- Predisposing factors:
> conditions that impair free drainage of urine
> injury to the mucosa of the urinary tract
> introduction of a catheter or instrument
> sexual intercourse
> Neurogenic bladder
> diabetes mellitus
> poor hygiene
- Most common microorganism is: * E. COLI
- Incidence:
> Younger women: short, wide urethra -> Sexual intercourse
> Older men: prostate enlargement causes retention of urine
- Clinical signs:
> Hematuria: blood in the urine
> Stranguria/Dysuria: straining, painful urination
> Pollakiuria: Greatly Increased frequency in having to urinate (not the same as polyuria)
> Oligouria: Very small amounts of urine come out every time you have to pee |
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Term
| Explain URETHRAL SYNDROME |
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Definition
- Symptoms of cystitis with a NEGATIVE URINE CULTURE
- usually in women 20-30 years of age
- Findings:
> dysfunction of the external sphincter
> vaginitis
> urethritis
> inflammation of the glands near the vagina and urethra
- Bacteria may develop up to 9 months after initial symptoms
- Treatment:
> meds that relax the external sphincter
> retraining voiding habits |
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Term
| Explain VESICOURETERAL REFLUX |
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Definition
- Failure of the mechanism that prevents urine from flowing up into the ureters during urination
- Results in an incomplete emptying of the bladder.
- Predisposition to:
> cystitis: bladder infection
> pyelonephritis: kidney infection |
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Term
| Expain ACUTE PYELONEPHRITIS |
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Definition
- A BACTERIAL infection of the RENAL PELVIS and MEDULLA of the KIDNEY.
> Could be UNILATERAL OR BILATERAL
- * Two different routes of infection:
> Ascending pyelonephritis (via ureters)
> Hematogenous pyelonephritis (via bloodstream)
- URINARY OBSTRUCTION and REFLUX OF URINE are the most common risk factors.
- Other risks: kidney stones, pregnancy, neurogenic bladder, instrumentation, female sexual trauma
- Pathophysiology: WBC's infiltrate into the medulla, renal edema, +/- abscesses
- Clinical signs: Acute infection, fever, lumbar pain, increased frequency of urination, dysuria, pyuria, and it's often concurrent with cystitis
- Micro: usually E. Coli, Proteus, or Pseudomonas
- Treatment: 2-3 weaks of antibiotics
- Injured areas of kidney heal with SCARRING
- Can lead to CHRONIC PYELONEPHRITIS which can lead to CHRONIC RENAL FAILURE. |
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Term
| Explain a URINARY TRACT OBSTRUCTION |
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Definition
- An interference to flow of urine at any point.
- Examples: tumor, stones, trauma, edema, pregnancy, loss of peristalsis, prostatic enlargement
- Consequences depend on: location, unilateral or bilateral, partial or complete obstruction, acute or chronic onset, underlying cause
- * An acute, complete obstruction is a medical (and surgical) EMERGENCY |
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Term
| Explain HYDROURETER/HYDRONEPHROSIS |
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Definition
- Progressive dilation proximal to the obstruction due to the pressure of retained urine
- Hydroureter = dilation of the URETER
- Hydronephrosis = Dilation of the renal PELVIS and CALYCES
- Distention of the calyces and pelvis in turn causes progressive, ischemic ATROPHY of the kidney
- Stagnation of urine predisposes to infection and stone formation
- Relief of acute total obstruction is followed by POST OBSTRUCTIVE DIURESIS. |
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Term
| Explain CALCULI NEPHROLITHIASIS |
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Definition
- Stones can form anywhere in the urinary tract.
- Types:
> Calcium oxalate/phosphate
> Struvite (magnesium, ammonium, phosphate)
> Uric acid
> Cystine stones
- Contributing factors
> urine pH
> diet
> diseases
> drugs
- Stone begins to form around a NIDUS
- urine pH affects the solubility of many crystals
- * Many are < 5mm in diameter
- STAGHORN CALCULI (big calculi that completely fills renal pelvis and shaped like antler horns)
- Clinical Manifestations:
> pain
> hematuria
> X-ray: radiopaque or radiolucent
> IVP: contrast study |
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Term
| Explain NEUROGENIC BLADDER |
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Definition
- FUNCTIONAL urinary tract obstruction caused by an interruption of nerve supply to the bladder
- Leads to bladder distention, urine retention, and incontinence (dribble's)
- Causes: multiple sclerosis, spinal cord tumor or injury, herniated disc, abdominal surgery |
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Term
| Explain the different types of renal tumors |
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Definition
- RENAL ADENOMA
> uncommon and small
> encapsulated and near cortex
> can become maligant, but can be removed
- RENAL CELL CARCINOMA
> 5 year survival rate < 50%
> Usually unilateral and moves via lymph to the lungs, liver, LN, and bone
> asymptomatic or hematuria, lumbar pain, wt. loss
> Men 2x more likely to get it than women
> most common in the 50-60 age range |
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Term
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Definition
- TRANSITIONAL CELL CARCINOMA'S
- Risk: Smokers, rubber, chemical, textile workers
- mets to LN, bone, lungs, liver
- Secondary bladder cancer:
> develops from invasion of nearby carcinomas (usually cervical or prostate cancer)
- asymptomatic OR hematuria |
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Term
| Explain GLOMERULONEPHRITIS |
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Definition
- An INFLAMMATION of the glomeruli, which can be caused by a variety of factors:
> an immunologic abnormality (type II or III)
> ischemia or vascular disease
> free radicals, drugs, or toxins
> systemic diseases
- ** Glomerular disease is THE most common cause of renal failure.
- In all types, the PODOCYTES are disturbed, which changes the membrane permeability |
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Term
| Explain IMMUNE-COMPLEX GLOMERULONEPHRITIS |
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Definition
- * Type III
- Acute glomerulonephritis
> starts as acute --> chronic
- Usually following a beta streptococcal infection
- Large immune complexes become trapped in the filtration slits of the glomeruli
- Activates complement and attracts WBC's |
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Term
| Explain ANTIGLOMERULAR BASEMENT MEMBRANE GLOMERULONEPHRITIS |
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Definition
- * Type II
- Formation of auto-antibodies against the basement membrane (podocytes) of the glomerulus
- May also attack the basement membrane of the pulmonary capillaries (Goodpasture syndrome)
- --> Chronic glomerulonephritis |
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Term
| Explain the clinical manifestations of GLOMERULONEPHRITIS |
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Definition
- HEMATURIA
> RBC casts
> brown, smoky tinged urine with no blood clots
> Acidic urine converts hemoglobin into METHEMOGLOBIN
- PROTEINURIA: especially albumin
- Decreased GFR (glomerular filtration rate) --> Fluid retention (oliguria) --> Increased BP
- Eventually renal insufficiency develops, and then nephrotic syndrome, and then finally end-stage RENAL FAILURE (polyuria) |
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Term
| Explain NEPHROTIC SYNDROME |
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Definition
- Excretion of > 3.5 grams (gm) protein per day
> (up to 10 gm in 24 hours)
- Usually due to a glomerular injury
- LIVER is unable to produce enough proteins to compensate for the loss
- Other findings:
> Hypoalbuminemia --> Edema (oncotic pressure)
> Hyperlipidemia/Lipiduria: due to low protein levels
> Decreased vitamin D: due to loss of serum transport proteins and decreased vit. D activation by the kidneys
> Loss of immunoglobulins --> INCREASED SUSCEPTIBILITY TO INFECTIONS |
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Term
| Explain RENAL DYSFUNCTION terms |
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Definition
- Renal Insufficiency: Renal function is down to 25% of normal
- Renal Failure: Less than 10% of total renal function remains
- Uremia: A SYNDROME/SYMPTOMS of renal failure that INCLUDES increased BUN and CREATININE.
> Accompanied by nausea, fatigue, anorexia, vomiting, pruritus, and neurologic changes
> Retention of toxic wastes, deficiency states, and electrolyte disorders
- Azotemia: Increased serum urea, BUN, and Creatinine on a lab report
> If you have uremia you also have azotemia, and vice versa
>> You can use azotemia to confirm uremia |
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Term
| Explain ACUTE RENAL FAILURE (ARF) |
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Definition
- AKA Kidney Shutdown
- Usually, but not always associated with OLIGOURIA
- REVERSIBLE if treated early
> Phases: 1. Oligouria 2. Diuresis 3. Recovery
- Classified as:
> Pre-renal: Impaired renal blood flow
> Renal: Acute tubular necrosis
> Post-renal: Bilateral urinary tract obstruction |
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Term
| Exlpain CHRONIC RENAL FAILURE (CRF) |
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Definition
- Progressive and IRREVERSIBLE loss of nephrons
- Kidneys can compensate for a long period of time and signs (uremia) do not begin until 25% of kidney function remains.
- Causes:
> 50% of cases are due to * GLOMERULONEPHRITIS
> 50% due to pyelonephritis, polycystic kidney disease, nephrosclerosis, diabetic nephropathy
- Other signs:
> PU/PD, nausea/vomiting, weakness, and lethargy, electrolyte and acid/base balance disturbances |
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