The kidneys are located in the peritoneum.

True or False?

False

kidneys are located behind the peritoneum, not really in the abdominal cavity, one on either side of the spine

What arteries feed the nephrons

directlyto form urine?

The cortical nephrons are short, with all parts located in the renal cortex.

The juxtamedullary nephrons are longer, and their tubes and blood vessels dip deeply into the medulla.

the afferent arteriole

the smallest, most distal portion of the renal arterial system.

From the afferent arteriole, blood flows

into the ________

a series of specialized capillary loops

where water and small particles are filtered from the blood to make urine.

efferent arteriole

(the first vessel in the venous system of the kidney)

increases kidney reabsorption of sodium and water, restoring blood pressure, blood volume, and blood sodium levels.

promotes potassium excretion.

The kidneys have both regulatory and hormonal functions. 

The hormonal functions control:

Where is the hormone produced and what is the action on the body?

Renin

Renin-producing granular cells

Raises blood pressure as result of angiotensin (local vasoconstriction) and aldosterone (volume expansion) secretion

Where is the hormone produced and what is the action on the body?

Prostaglandins

Renal tissues

Regulate intrarenal blood flow by vasodilation or vasoconstriction

Where is the hormone produced and what is the action on the body?

Juxtaglomerular cells of the arterioles

Increase blood flow (vasodilation) and vascular permeability

Where is the hormone produced and what is the action on the body?

Erythropoietin

Renal parenchyma

Stimulates bone marrow to make red blood cells

Where is the hormone produced and what is the action on the body?

Renal parenchyma

Promotes absorption of calcium in the Gl tract

Where is the hormone produced and what is the action on the body?

Antidiuretic hormone

Released from posterior pituitary

Makes DCT and CD permeable to water to maximize reabsorption and produce a concentrated urine

Where is the hormone produced and what is the action on the body?

Aldosterone

Released from adrenal cortex

Promotes sodium reabsorption and potassium secretion in DCT and CD; water and chloride follow sodium movement

Where is the hormone produced and what is the action on the body?

Natriuretic hormones

Cardiac atria, cardiac ventricle, brain

Cause tubular secretion of sodium

Total urine output of less than 100 mL in 24 hours

or no urine

Decreased urine output; total urine output between 

100 and 400 mL in 24 hours

about 1500 to 2000 mL/day,

or within 500 mL of the volume of fluid ingested in a day.

occurs with distention or spasm of the ureter, such as in an obstruction or the passing of a stone.

may be intermittent or continuous and may occur with pallor, diaphoresis, and hypotension.

Monitor hydration adequate fluid intake.

Caution with nephrotoxic drug

Layers of the kidney

cysts tumors and calculi.

What is cystography and

cystoscopy used to assess

The presence of bacteria in the urine

 can occur with any urologic infection

Incomplete bladder emptying = pool of urine where bacteria grow

bacteria ascend to higher structures. 

↑ multiplying the longer they remain in residual urine.

Overdistention of the bladder damages the mucosa and allows bacteria to invade the bladder wall.

Large stones can obstruct urine flow. 

stones irritates mucosal surfaces and creates a spot where bacteria can establish and grow.

Bacteria-laden urine is forced backward from the bladder up into the ureters and kidneys, where pyelonephritis can develop. 

Reflux of sterile urine can cause kidney scarring, which may promote kidney dysfunction.

Excess glucose in urine provides a rich medium for bacterial growth. 

Peripheral neuropathy affects bladder innervation and leads to a flaccid bladder and incomplete bladder emptying.

Alkalotic urine promotes bacterial growth. 

Concentrated urine promotes bacterial growth.

Women are susceptible to periurethral colonization with coliform bacteria. 

Use of diaphragms, frequency of intercourse, and a new partner within the past year are associated with UTI in women. 

Bladder displacement during pregnancy predisposes women to cystitis and the development of pyelonephritis. 

A diaphragm or pessary that is too large can obstruct urine

Urinary stasis may be caused by incomplete bladder emptying as a result of an enlarged prostate in men and cystocele and prolapse in women. 

Neuromuscular conditions that cause incomplete bladder emptying, such as Parkinson disease and strokes, affect older adults more frequently. 

The use of anticholinergic drugs in older adults contributes to delayed bladder emptying. 

Fecal incontinence contributes to poor perineal hygiene. 

Hypoestrogenism in older women adversely affects the cells of the vagina and urethra, making them more susceptible to infections.

Irritation: perineum, urethra 

Spermicides:  alter vaginal pH, ↑ pathogens. 

Inadequate lub:  urethral irritation. 

Bacteria introduced into the man's urethra: during anal intercourse or during vaginal intercourse with a woman who has a bacterial vaginitis.

What are the common manifestations

of noninfectious cystitis

Pelvic Pain and Urgency/Frequency

Patient Symptom Scale (PUF)-can identify patients with interstitial cystitis.

causes symptoms similar to urinary tract infection (UTI).

burning or difficulty with urination

sexually transmitted diseases (STDs),

gonorrhea, Chlamydia, Trichomonas vaginalis

tissue changes related to low estrogen levels.

(improvement in their urethral symptoms with the use of estrogen vaginal cream)

What are the most common causes

of Urethral strictures

complications of an STD 

trauma:  during catheterization, urologic procedures, or childbirth.

obstruction of urine flow leading to UTI.

Overflow incontinence

Strictures rarely cause pain.

surgery: dilation of the urethra (using a local anesthetic)

Stent placement

urethroplasty: best long term solution

The involuntary loss of urine during activities that increase abdominal and detrusor pressure. 

Patients cannot tighten the urethra sufficiently to overcome the increased detrusor pressure; leakage of urine results.

Weakening of bladder neck supports; associated with childbirth. 

congenital conditions: epispadias or myelomeningocele. 

Acquired anatomic damage: trauma 

What are the Clinical Manifestations

of Stress incontinence

Urine loss with physical exertion, cough, sneeze, or exercise. 

Usually only small amounts of urine are lost with each exertion.

hypermobility of the urethra or bladder neck with Valsalva maneuvers.

The involuntary loss of urine associated with a strong desire to urinate.

Patients cannot suppress the signal from the bladder to the brain

What are the Clinical Manifestations

of Urge incontinence

What is Detrusor hyperreflexia

(reflex incontinence)

What is the cause of Detrusor hyperreflexia

(reflex incontinence)

Central nervous system (CNS) lesions from stroke, multiple sclerosis, and parasacral spinal cord lesions. 

Local irritating factors such as caffeine, medications, or bladder tumor.

What are the Clinical Manifestations of Detrusor hyperreflexia

(reflex incontinence)

What are the Clinical Manifestations

of Overflow incontinence

Bladder distention, often up to the level of the umbilicus. 

Constant dribbling of urine.

Central nervous system depressants

Anticholinergic

Diuretics

an inherited disorder in which fluid-filled cysts develop in the nephrons.

cysts damage the glomerular and tubular membranes.

The kidney tissue is eventually replaced by nonfunctioning cysts, which look like clusters of grapes

Pts with Polycystic kidney disease (PKD) have 

A. Hypotention and need IV fluids

B. have hypertention caused by renin-angiotensin system

c. normal BP as blood flow to the kidneys would not affect BP

B. have hypertention caused by renin-angiotensin system

Control of hypertension is a top priority because proper treatment can disrupt the process that leads to further kidney damage. use (ACE) inhibitors.

Abdominal or flank pain

Hypertension, Nocturia

Increased abdominal girth

Constipation

Bloody or cloudy urine, Kidney stones

Chronic pyelonephritis often occurs with: