Chapter 11

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Diseases & Conditions of the Urinary System

Major Purposes

Filter to remove nitrogenous waste
Maintain correct hydration
Regulate electrolytes
Maintain acid\base balance
Regulate BP
Assist RBC production
Activates vitamin D

Organs of the Renal System

2 kidneys
2 ureters
1 urinary bladder
1 urethra
Nephron - functioning unit of the kidney

Types of Disturbances which may cause renal disease

Infection
Scarring
Toxic necrosis
Trauma
Congenital anomalies
Obstructions

Results of Renal Disease

Fluid & Electrolyte Imbalance
Acidosis or alkalosis
Renal calculi
Hypertension
Anemia
Pulmonary edema

Urinalysis

Color & clarity
Odor
Chemical nature pH
Specific Gravity (1.003-1.0300
Crystals
Protein
Glucose
Ketone bodies
Bile & bilirubin
Nitrogenous wastes
Fat droplets

CYSTITIS

Inflammation of urinary bladder
S & S; Urinary urgency, frequency, & burning, pain in pelvic region, fever & chills, bladder spasms, cloudy dark urine
Etiology: ascending bacterial infection
Antibiotics, urinary antiseptic therapy, Pyridium for dysuria, force fluids

Acute Glomerulonephritis

Inflammation & swelling of glomeruli.
Follows Strep infection of throat or skin
Etiology is idiopathic or result of immune reaction causing antigen-antibody complexes to become trapped within the network of capillaries of a glomerulus

Chronic Glomerulonephritis

Slow progressive noninfectious disease with irreversible renal damage
S & S: proteinuria, edema, decreased urinary output, hematuria, hypertension, headaches, visual disturbances, low grade fever, flank or back pain
Chronic azotemia, oliguria, uremic frost, pruritus, electrolyte imbalance

Treatment of Glomerulonephritis

Antibiotic if infections occur
Diuretics
Decreased Na intake
Corticosteroid therapy is immune reaction is suspected
Usually resolves in 2 weeks
Treat the symptoms

Nephrosis

Known as the "protein losing kidney"
Increased permeability of glomeruli
Loses albumin in urine (proteinuria)
Develops hypoalbuminemia
Filtration diminishes and water & Na are retained

Symptoms of Nephrosis

Hypertension
Hematuria
Slough fat bodies in urine
Very susceptible to infections
Lethargic & Depressed
Pale & Puffy eyes, Weight gain

Treatment of Nephrosis

Correct the cause if possible
Increase protein intake
Restrict Na intake
Diuretic therapy
Corticosteroid therapy

Dialysis

Purposes are to
Restore fluid balance
Maintain correct pH
Remove waste products from blood
Establish desired electrolyte balance
Hemodialysis; Blood is filtered through a machine outside the body
Peritoneal Dialysis; the peritoneum is the semi-permeable membrane for osmosis

RENAL FAILURE

Indicates the kidneys are no longer able to filter the blood and remove toxins in an efficient manner.
Chronic renal failure: gradual & progressive destruction of nephrons. Over 75% function lost when diagnosed. May result from any major chronic kidney disease.

Chronic Renal Failure

Weak, tired, lethargic, hypertensive, edema, cardiac arrhythmias, metabolic acidosis, hair & skin changes, infertility, impotence, bone weakness
Dialysis, diet (limit protein & Na intake) Limit fluid intake
Drug therapy
Erythropoietin to help form new RB

Acute Renal Failure

Sudden severe diminished blood flow to kidneys
Intrarenal damage (disease, nephrotoxic agents)
Mechanical obstruction of urine flow
Treat immediately! Usually reversible

Renal Calculi

Formed from concentration of mineral salts
Singular or multiple
Large or tiny
Symptoms vary with degree of obstruction
Renal colic, urinary urgency, hematuria, fever & chills, N & V, Abdominal distention

Risk factors for renal calculi

Prolonged and severe dehydration
Extended bedrest
Infection
Urinary stasis from obstruction
Long-term ingestion of certain Rx
Metabolic diseases ie gout

Treatment of Renal Calculi

Relieve obstruction
Eliminate pain
Cure infection
Resolve problem to prevent further formation of stones
Flush with large amounts of fluid
Extracorporeal shock wave lithotripsy
Surgical intervention
Analgesics, antibiotics, sulfonamides
Diet

PYELONEPHRITIS

Most common type of renal disease
Inflammation of renal pelvis & connective tissue
Rapid onset, fever, chills, N & V, foul urinary odor, hematuria, pyuria, pain
Medication (Cipro, Penicillin, Levaquin)

Renal Cell Carcinoma

Most common type of kidney neoplasm-adult
Wilm's Tumor is congenital renal tumor of childhood
Smoking, obesity, dialysisfor cystic kidney, prolonged exposure to chemicals like asbestos & cadmium
Men 50-70 years
Treatment: Nephrectomy

Bladder Tumors

Involve urothelium (Lining)
May reoccur anywhere in urinary tract lining
Gross painless, intemittent hematuria, dysuria, urgency, increased frequency
TURB, Cystectomy, chemoradiotherapy, Close follow-up post-op

Neurogenic Bladder

Inability to retain urine due to neurogenic problem, structural abnormality, sphincter impairment
Leaks but does not empty
TX: Empty frequently, train with indwelling catheter, medications

Stress Incontinence

Leak urine with increased abdominal pressure
Weak pelvic floor muscles & urethral structure
TX: Drugs, Kegel exercises, Estrogen cream inserted vaginally, Surgical Repair, Collagen injections

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