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Urinary Tract Obstruction
- Obstruction can occur anywhere in the urinary tract, and it may be anatomic or functional, including renal stones, an enlarged prostate gland, or urethral strictures. The most serious complications are hydronephrosis, hydroureter, ureterohydronephrosis, and infection caused by the accumulation of urine behind the obstruction.
- Hypertrophy of the opposite kidney compensates for loss of function of the kidney with obstructive disease.
- Relief of obstruction is usually followed by postobstructive dieresis and may cause fluid and electrolyte imbalance.
- Persistent obstruction of the bladder outlet leads to residual urine volumes, low bladder wall compliance, and risk for vesicoureteral reflux and infection.
- Kidney stones are caused by supersaturation of the urine with precipitation of stone-forming substances, changes in urine pH, or urinary tract infection.
- The most common kidney stone is formed from calcium oxylate and most often causes obstruction by lodging in the ureter.
- Obstruction of the bladder are a consequence of neurogenic or anatomic alteration bladder or both.
- A neurogenic bladder is caused by a neural lesion that interrupts innervation of the bladder.
- Upper motor neuron lesions result in overactive or hyperreflexive bladder function and dyssynergia (lack of coordinated neuromuscular contraction).
- Lower motor neuron lesions result in underactive, hypotonic, or atonic bladder function.
- Overactive bladder (OAB) syndrome is an uncontrollable or premature contraction of the bladder that results in urgency with or without incontinence, frequency, and nocturia.
- Underactive bladder (UAB) is a condition in which the duration or strength of contraction is inadequate to empty the bladder resulting in distention and overflow incontinence.
- Detrusor sphincter dyssynergia is failure of the urethra-vesicle junction smooth muscle to release urine during micturition and causes a functional obstruction.
- Other causes of lower urinary tract obstruction include prostatic enlargement, urethral stricture, and pelvic organ prolapse in women.
- Partial obstruction of the bladder can result in overactive bladder contractions with urgency. There is deposition of collagen in the bladder wall over time, resulting in decreased bladder wall compliance and ineffective detrusor muscle contraction.
- Renal cell carcinoma is the most common renal neoplasm. The larger neoplasms tend to metastasize to the lung, liver, and bone.
- Bladder tumors are commonly composed of transitional cells with a papillary appearance and a high rate of recurrence.
Urinary Tract Infection
- Urinary tract infections (UTIs) are commonly cause by the retrograde movement of bacteria into the urethra and bladder. UTIs are uncomplicated when the urinary system is normal or complicated when the urinary system is normal or complicated when there is an abnormality.
- Cystitis is an inflammation of the bladder commonly caused by bacteria and may be acute or chronic.
- Painful bladder syndrome/interstitial cystitis include nonbacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal), noninfectious cystitis (i.e., radiation injury), and interstitial cystitis, which is related to autoimmune injury.
- Pyelonephritis is an acute or chronic inflammation of the renal pelvis often related to obstructive uropathies and may cause abscess formation and scarring with an alteration in renal function.
- Glomerular disorders are a group of related diseases of the glomerulus that can be caused by immune responses, toxins or drugs, vascular disorders, and other systemic diseases.
- Acute glomerulonephritis commonly results from inflammatory damage to the glomerulus as a consequence of immune reactions after a streptococcal infection.
- The urine sediment may contain large amounts of protein (nephrotic sediment) or have red and white blood cells and protein (nephritic sediment).
- Rapidly progressive glomerulonephritis (RPGN) is associated with injury that results in the proliferation of glomerular capillary endothelial cells and a rapid loss of renal function.
- Chronic glomerulonephritis is related to a variety of diseases that cause deterioration of the glomerulus and a progressive loss of renal function.
- Immune mechanisms in glomerulonephritis are the deposition of antigen-antibody complexes often with complement components and the formation of antibodies specific for the glomerular basement membrane.
- Nephrotic syndrome is the excretion of at least 3.5 g protein (primarily albumin) in the urine per day because of glomerular injury with increased capillary permeability and loss of membrane negative charge. Its principal signs are hypoproteinuria, hyperlipidemia, and edema. The liver cannot produce enough protein to adequately compensate for urinary loss.
- Acute renal failure is classified as prerenal, intrarenal, or postrenal and is usually accompanied by oliguria with an elevated plasma BUN and plasma creatinine levels.
- Prerenal acute renal failure is caused by decreased renal perfusion with a decreased GFR, ischemia, and tubular necrosis.
- Intrarenal acute renal failure is associated with several systemic diseases but is commonly related to acute tubular necrosis (ATN).
- Postrenal failure is associated with diseases that obstruct the flow of urine from the kidneys.
- Chronic renal failure represents a progressive loss of renal function. Plasma creatinine levels gradually become elevated as GFR declines; sodium is lost in the urine; potassium is retained; acidosis develops; calcium metabolism and phosphate metabolism are altered and erythropoietin production is diminished. All organs systems are affected by CRF.
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