Chapter 11

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
Toxic necrosis
Congenital anomalies
Results of Renal Disease
Fluid & Electrolyte Imbalance
Acidosis or alkalosis
Renal calculi
Pulmonary edema
Color & clarity
Chemical nature pH
Specific Gravity (1.003-1.0300
Ketone bodies
Bile & bilirubin
Nitrogenous wastes
Fat droplets
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
Decreased Na intake
Corticosteroid therapy is immune reaction is suspected
Usually resolves in 2 weeks
Treat the symptoms
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
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
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
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
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
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