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What are the functions of the UT?
- remove- metabolic wastes, hormones and drugs
- regulate- water, electrolyte, acid-base, BP
- Secrete- erythropoietin
- activate- vit D
What makes up the urinary system?
What is the anatomy of the kidney?
The parts of the nephrone
What controls the hydrostatic pressure in the glomerular capillaries?
- - arterioles
- - constriciton/ dialation controlled by
- - local auto-regulation
- - SNS
- - renin angiotension mechanism
What are the hormones involved in reabsorption?
- Atrial natriuertic hormone
- Antidiuretic hormone
- secreted via posterior pituitary
- reabsorption of water in distal convoluted tubules and collecting ducts
- secreted by adrenal cortex
- sodium reabsorption in exchange for potassium/ hydrogen
- hormones from the heart
- reduces sodium and fluid reabsorption
What is a urinary tract infetion?
- very common infections
- urine is an excellent growth medium
What are some examples of lower urinary tract infections?
Cystitis and urethritis
What is an example of an upper urinary tract infection?
What is the common causative organism of urinary tract infections?
What is the etiology of UTI?
- - more common in women- shortness of urethra, proximity to anus
- - older men- prostatic hypertrophy and urine retention
- - congenital abnormalities in children
- - elderly- incomplete emptying, reduced fluid intake, immobility
- - other common predisposing factors- incontinence, retention of urine- microorganisms, obsructions, direct contamination with fecal material, catheters
What is cytitis?
- - when the bladder wall and urethra are inflamed
- - irriated and hyperactve bladder
- - reduced bladder capacity
- - pain common pelvic area
- - dysuria (painful urination) , urgency, frequency and nocturia (need to urinate at night)
- - systemic signs of infection may be present- fever, malaise, nausea, leukocytosis
- - urine often cloudy with unusual odour
- - urinalysis indicates bacterium, pyuria, microscopic hematuria
What is pyelonephritis?
- - one or both kidneys involved
- - infections extends from ureter into kidney
- - purulent or chronic infection can lead to scar tissue formation over a calyx- loss of tubule funcction, hydronephrosis- obstruction, dilated area filled with urine- necrosis, eventual chronic renal failure if untreated
- - signs are simialr to those of cystitis
What are some UT inflammatory disorders?
- - glomerulonephritis
- - nephrotic syndrome (nephrosis)
What is glomerulonephritis?
- - UT inflam
- - can be acute post streptococcal glomerulonephritis (APSGN)
- - develop 2-10 days after initial infection
- -inflammatory response in the glomerulus- increase cap permeability, cell proliferation, swelling - congestion- decrease GFR and retention of waste and fluid
What is the development of APSGN?
What is nephrotic syndrome (nephrosis)?
- - UT inflam disorder
- - nonspecific disorders in which the kidneys are damaged ( abnormality in the glomerular capillaries)
- - maybe secondary to a number of renal diseases, as well as systemic disorders: systemic lupus erythematosus (SLE), exposure to nephrotoxins, drugs
- - pathophysiology is not well established but follows a sequence
What is the pathophysiology of nephrotic syndrome?
- - increased glomerular permeability- leakage of large amounts of protein from the blodd into the urine- serum hypoalbuminemia, low plasma osmotic pressure, generalised edema
- - blood pressure remains low (hypovolemia) or normal- may be elevated depending on angiotensin 2 levels
- - low blood volume increases aldosterone secretion- more severe edema, high blood cholesterol, lipoprotein in urine
What are the signs of nephrotic syndrome?
- Massive edema throughout body (anasarca)
- ascites, pleural effusion, pitting edma on legs
What is a urinary tract obstruction?
- - obstruction in the urinary tract reduces the urinary flow and impair the renal function
- - frequent effect of a partial or complete obstructionisa dilation of the renal pelvis- hydronephrosis
- - obstructions of the urinary tract are painful and need immediate treatment due to the effect on renal function- reduced GFR
What are the types and location of urinary tract obstruction?
- Calculi- in the ureter
- Cancer- ovary, cervix, uterus
- Congenital pelviuretic junction obstruction- top ureter
- Retroperitoneal fibrosis, tumours, haemorrhage- ureter
- Functional: vesicourteruc refulx and neurogenic bladder- between ureter and bladder
- Bladder cnacer
- Prostatic hypertrophy/ cancer
What are the extrinsic obstructions?
- - truama
- - Tumor
- - Inflammation
- - Infection
- - Haemorrhage
- - Fibrosis
What are intrmural obstructions (in the wall of the ureter)?
- - transitional cell cancer
- - fibrosis
- - inflammation
- - infection
WHat are the intraluminal (in lumen) obstructions of the urteter?
- - calculus
- - blood clot
- - renal papilla
What is Uroithiasis (calculi)? (formation of stones)
- - can develop anywhere in urinary tract
- - stones may be small or very large
- - tend to form with excessive amounts of solutes in filtrate, insufficient fluid intake- major factor for calculi formation
- - urinary tract infection
What is the calculi of the stone composed of?
- - calcium salts
- - high urine calcium levels (hypercalcemia)
- - form readily with highly alkaline urine
What are uric acid stones?
- - type of stones
- - hyperuricemia (abnormally high levels of urine in the blood)
- - gout, high- purine diets, cancer chemotherapy
- - especially with acidic urine
Different types of stones
- - calculi
- -uric acid
- - struvite
- - cystine
- stone formation depends on predisposing factors
What is the composition of the different types of renal calculi?
What is the secondary problem is caused by calculi being located in the kidney or ureter?
- - dialation of calyces and atrophy of renal tissue
- - necrosis
What is renal colic caused by?
- obstruction of the ureter
- - intense spasm of pain in flank area- radiates intogroin,lasts until stone passes or is removed
- possible nausea and vomiting, cool moist skin, rapid pulse
- - radiologic eaxmaination confirms location of calculi
Note stones in kidney or bladder are often asymptomatic
- - frequent infections may lead to investigation
- - flank pain possinle caused by distention of renal capsule
What are the consequences of a urinary tract obstruction?
- - reduced glomerular filtration rate
- - reduced renal blood flow (after initial rise)
- - impaired renal concentrating ability
- - imapired distal tubular function
- * nephrogenic diabetes insipidus
- * renal salt wasting
- * renal tubular acidosis
- * impaired potasium concentration
= Chronic renal failure
Where do priamry renal carcinomas arise from?
- - tubule epithelium
- - more often the renal
What occurs with the progression of renal carinomas?
- - tends to symptomatic in early stages
- - oftenhas metastasized to liver, lung, bone or central nervous systemattime of diagnosis
- - occurs more frequently in males and smokers
- - treatment is kidney removal
- - immunotherapy may be used in some cases- tumor is radioresistnat and unresponsive to chemotherapy
What are the manifestations of renal cel carinomas like?
- - painless initally-either gross or microscopic
- - dull, aching flank pain
- - palpable mass
- - unexplained weight loss
- - anemia or erythrocytosis (excessive RBCS)
- - paraneoplatic synromes- crushing syndrome
Discuss bladder tumors
- - most bladder tumours are malignant and are common form transitional epithelium of the bladder
- - often develops as multiple tumours
- - tumour is invasive through wall to adj structures- metastasizes to pelvic lymph nosed, liver and bone
- - diagnosed by urine cytology and bipsy
What are the early signs of bladder cancer?
- - hematuria- blood in urine
- - dysuria- painful urination
- - infection common
what are predisposing factors for bladder cancer?
- - working with chemicals in lab/ industry- analine dyes, rubber, aluminium
- - cigarette smoking (50% of cases)
- - recurrent infections
- - heavy intake of analgesics
Blader cancer and treatment
- - surgical resection of tumour
- - chemo and radiation
- - photoradiation successful in some early cases
What is a Wilms Tumour?
- - most common tumour in children
- - defects in tumour- supressor genes on chromosome 11- may occur in conjunction with other congenital disorders
- - usually unilateral- large encapsulated mass
- - pulmonary metastases may be present at diagnosis
What is nephrosclerosis?
- - vascular disorders
- - involves vascular changes in the kidney- some occur normally with aging
- - thickening and hardening of the walls of the arterioles and small arteries
- - narrowing of the blood vessel lumen- reduction of blood supply to kidney (ischemia, atrophy), stimulation of renin (increase BP), continued ischemia (destruction of renal tissue and CHRONIC RENAL FAILURE)
How do you treat nephrosclerosis?
- -can be primary lesion (developed in kidney) or secondary to essential hypertension
- - antihypertensive agents
- - diuretics
- - beta- blockers
- - sodium intake should be reduced
Hypertension and the kidney
What are some congenital disorders?
- - vesicoureteral reflux
- - agenesis
- - hypoplasia
- - ectopic kidney
- - horseshoe kidney
What is vesicoureteral reflux?
- defective valve in the bladder
What is agenesis?
- failure of one kidney to develop
What is hypoplasia?
- - congenital disorder
- - failure to develop to normal size
What is ectopic kidney?
- - kidney and ureter displaced out of normal position
- - congenital disorder
Whta is horseshoe kidney?
- - congenital disorders
- - fusion of the two kidneys
What is adult polycystic kidney?
- - autosonal dominant gene on chromosome 16
- - no indications in child and young adults
- - first manifestations usually around age 40
- - multiple cysts develop in both kidneys: enlargement of kidneys, compression and destruction of kdney tissue, CHRONIC RENAL FAILURE
- - diagnosis by CT
What is acute renal failure due to?
- - acute bilateral kidney diseases
- - severe, prolonged circulatrory shock or heart failure
- - nephrotoxins- drugs, chemicals, or toxins
- - mechanical obstruction- calculi, blood clots, tumors- block urine flow beyond kidneys
What is the pathophysiology of acute renal failure?
- - sudden onset
- - greatly reduced GFR
- - sharp fall in urine output- oliguria (decrease) or anuria (complete loss)
What is Azotemia?
- - accumulation of nitrogenour waste products in blood BUN
- often asymptomatic (no symptoms)
What findings would there be in the blood urine tests for acute renal failure?
- - elevated seru urean nitrogen (BUN) and creatinine
- - metabolic acidosis and hyperkalemia (high levels of potassium)
How do you treat acute renal failure?
- - identify and remove or treat primary problem - to minimize the risk of necrosis and permanent kidney damage
- - dialysis- to normalize body fluids and maintain homeostasis
Chronic renal failure
- - gradual irreversible destrucion of kidneys over a long period of time
- - asymptomatic in early stages
What can chronic renal be a result from?
- - chronic kidney disease
- - congenital polycystic kidney disease
- - systemic disorders
- - LL exposure to nephrotoxins over sustained period of time
What are the stages of chronic renal failure?
- - decreased renal reserve
- - renal insufficiency
- - end- stage renal failure
What occurs in the decrease renal reserve stage of renal failure?
- - decrease in GFR
- - higher than normal serum creatinine levels
- - no apparent clinical symptoms
What occurs in the renal insufficiency stage of chronic renal failure?
- - decrease GFR to about 20% of normal
- - significant retention of nitrogen wastes
- - excretion of large volumes of dilute urine
- - decreased erythropoiesis
- - elevated blood pressure
What is the end- stage renal failure of chronic renal failure?
- - negligible GFR
- - fluid, electrolytes, and wastes retained in body
- - azotemia, anemia and acidosis (3As)
- - all body systems affected
- - arked oliguria or anuria
- - regular dialysis or kidney transplant- to maintain pts life
- Number of nephrons
What are the early signs of chronic renal failure?
- - increase urinary output- polyuria
- - general signs- anorexia, nausea, anemia, fatigue, unintended wieght loss, exercise intolerance
- - bone marrow depression and impaired cell function- caused by increased wastes and altered blood chemistry
- - elevated BP
What occurs with complete failure of chronic renal failure?
- - dry, pruritic, hyperpigmented skin, easy bruising
- - peripheral neuropathy
- - impotence in men, mentrual irregularities in women
- - encephalopathy
- - congestive heart failure, dysrhythmias
- - failure to activate vitamin D- osteodystrophy
- - possible uremic frost on the skin
- - systemic infections
What is uremia?
- - usually 2/3 of nephrons destroyed
- - decrease GFR, Increase BUN
- -acid- base and electrolyte disturbances
- - altered regulatory functions
- - increased nitrogen on body
What are the acid base and electrolyte disturbances of Uremia?
- - increase K, creatinine, phosphate and a dcrease in Ca
- - hyperkalemia- cardiac and skeletal mm fatigue
- - fluid retention, edema, pulmonary congestion
What are the altered regulatory functions of uremia?
- - hypertension if oliguria is prolonged
- - anemia
- - osteodystrophy
Wat are the effects of increased nitrogen on body of uremia?
- -fatigue, anorexia, nausea, vom, pruitis, apathy
- - peripheral neuropathy, uremic encphalopathy
Chronic renal failure overview
Management of Chronic and acute renal failure?