Urinary Disorders

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Urinary Disorders
2010-10-21 13:59:36

Structure and function of renal and urologic systems, Alterations of renal and urinary tract function
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  1. Renal Cortex
    contains 85% of all nephrons
  2. Renal Medulla
    Contains renal pyramids and columns; the nephrons in this area concentrate the urine
  3. Renal Pelvis
    The expanded proximal end of the ureters
  4. Ureters
    Drain urine into the bladder
  5. Renal Function
    Filters plasma at glomerulus. Reabsorbs 99% of filtered fluid. Regulates filtrate to maintain body fluid volume, electrolyte composition, and pH
  6. Glomerulus
    tuft of capillaries where filtration occurs
  7. Proximal tubule
    branches from bowmans capsule where 2/3 of electrolytes are reabsorbed; also where all glucose and amino acids are reabsorbed
  8. Loop of Henle
    Descending and ascending loops of the renal tubule; reabsorbs Na+, K+, Cl-
  9. Distal convoluted tubule
    Reabsorbs Na+, Cl- . Reabsorbs or secretes K+ (is hormally controlled)
  10. Collecting Duct
    tubules that receive urine from several renal tubules; eventually direct urine to the renal pelvis
  11. glomerular filtration
    nephrons filter plasma at glomerulus into bowmans space. permeable to water but not large plasma proteins. Capillary pressure, molecular size, and electrical charge affect filtration/permiability
  12. juxtaglomerular apparatus
    • a specialized region where distal tubule contacts afferent and efferent arterioles of its nephron.
    • specialized cells that stimulate the secretion fo the adrenal hormone aldosterone.
    • synthesizes renin and plays a major role in renal autoregulation and bp
  13. macula densa
    • part of the thick ascending limb of the nephron
    • senses plasma sodium concentration and passes the message to renin-secreting cells
  14. glomerulotubular balance
    feedback between distal tubules and glomerular capillaries that help maintain homeostasis of gfr, overall blood volume, electrolyte concentration, by changing the amount of urine, or isotonic hypotonic hypertonic
  15. NaCl
    increased NaCl in distal tubule decreases GFR, and decreased NaCl increase GFR. it also changes diameter of afferent and efferent arterioles.
  16. erythroproietin
    stimulates red blood cell proliferation in bone marrow in response to kidney hypoxia, injections available
  17. atrial NAtriuretic peptide
    Secreted from cardiocytes in right atrium. When right atrial blood pressure increases, ANP inhibits secretion of renin, inhibits angiotensin-induced secretion of aldosterone, relaxes smooth vascular muscle, and inhibits sodium and water absorption. .. this increases urine formation, thus decreases blood volume and pressure
  18. Vitamin D
    needed for the absorption of calcium and phosphate by the intestines which is stimulated by the kidneys.
  19. urinalysis
    analyzes the composition of urine
  20. BUN/Cr Ratio
    • Blood urea nitrogen/creatinine
    • Cr is a by product of muscle metabolism that is filtered out by the kidneys
    • BUN is the measure of levels of nitrogen in the blood in the form of urea, that is secreted by liver and removed by kidneys
    • High ratios indicate decreased GFR/kidney funtion
  21. creatinine clearance
    volume of blood plasma that is cleared of creatinine per unit time; a useful measure for approximating gfr
  22. IVP Introvenous Pyelograms
    Pictures of the KUB with radio opaque dye
  23. polycystic kidney disease
    • cysts develop (fluid filled spaces from accumulation with obstruction) lead to chronic renal failur
    • autosomal recessive children
    • autosomal dominant in adults 30-40
    • s&s: flank pain, urinary tract infections, hematuria
  24. Pyelonephritis
    • infection of the renal pelvis and interstitium
    • acute: usually bladder infection that ascended to renal pelvis recover if treated
    • Chronic: persisten infections leading to scarring and renal failure, may be due to obstructive pathologic conditions
    • s&s: acute-fever chills flank pain cva tenderness dysuria .. chronic-minimal: htn, frequency dysuria flank pain
    • usually require iv antibiotics
  25. glomerulonephritis
    • inflammation of glomeruli
    • causes drugs toxins immunologic abnormalities ischemia free radicals
    • acute: strep infections hematuria proteinuria, decreased gfr, oligouriaa
    • chronic: hematuria, proteinuria with progressive decline in gfr often autoimmune
  26. Kidney Stones
    • Crystallized marerial forms in renal calyces and pelvis
    • cause not completely understood
    • 1% of population, and recur in 30-50% of them within 5 years
    • s&s: renal colic, flank/groin pain, n&v, microscopic hematuria
    • management: narcotic analgesia for acute attack, lithotripsy to break up stones, prevent new ones from forming (dilute urine, dietary changes)
  27. UTI
    frequency urgency dysuria lower back pain cloudy urine hematuria ...E coli, anibiotics
  28. cystitis
    inflammation of bladder (infection, irritation from stones, trauma, chemical irritants)
  29. nephrotic syndrome
    increased permeability of glomerular basement membrane to protein: proteinuria
  30. Acute Renal Failure
    • acute renal failure: generally reversible, classified by causes
    • Prerenal-related to decreased renal blood flow,
    • Post renal-related to outflow obstruction,
    • intrarenal- nephron damage, few cells actually die but become non functional for awhile. recover 2 weeks to 12 months can become chronic
    • s&s: oliguric: urine output<400cc/day, diruetic: dilute urine in normal to > amounts, recovery: renal function adequate to avoid dialysis but not normal, Cr BUN^,
  31. Chronic Renal Failure
    • 50% ESRD 2ndary to diabetes
    • s&s: decreased renal reserve, renal insufficiency: 75% nephrons damaged polyuria nocturia, ESRD
  32. ESRD
    • 90% nephrons destroyed, hypervolemia, hyperkalemia, hyperphospatemia, metabolic acidosis, uremia, hypocalcemia and osteodystrophy with osteoporosis, anemia
    • treatment: glucose control, diet: low protein k Na, supplement Calcium, transplant, dialysis
  33. types of dialysis
    • hemodialysis: AV shunt ofr access blood pumped through array of semipermeable membranes surrounded by dialysate
    • peritoneal dialysis: Dialysate placed into abdominal cavity (peritoneum, acts as filter) and drained out by gravity flow
  34. bladder
    surrounded by smooth muscle, sac for urine collection, parasympathetic control, external urethral spincter is under voluntary control
  35. urge
    loss of urine preceded by a stron unexpected urge to void; involuntary bladder contractions
  36. stress
    loss of urine with activities that result in increased intra-abdominal pressure; weak pelvic muscle floor
  37. mixed:
    combo of urge and stress
  38. overflow
    involuntary loss of urine associated with a distended bladder; bladder unable to empty normally due to partial obstruction
  39. functional
    related to other factors besides urinary tract (confusion, mobility, illness)
  40. reflex incontinence
    no sensory warning or awareness; neurological