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Renal and Urinary Tract Disorders OutlineKidneysKidneys “filter” @ 150 Liters / dayKidneys reabsorb @ 99%Process yields @ 1.5 Liters / day of urineUrinary Tract InfectionNormally in the bodyNormal urine flow restricts bacteriaUrinary tract is normally sterile above the urethraVarious antibacterial enzymes / antibodies restrict bacteriaNormal flora in region restrict bacteriaMucus glands trap bacteriaS/S of UTIPain on urination (dysuria)Frequent UrinationSuprapubic or lower back discomfortCloudy, foul smelling urineIn the elderly:Confusion and abd discomfortUncomplicated UTIsCausesEscheriachia coli (80%)Staphylococcus saprophyticus et all (20%)It’s uncomplicated… it’s just a bug in the urinary tract somewhereComplicated UTIsAbnormalities of urinary system (anatomical problems) or compromised immune system will change a regular, uncomplicated UTI into a complicated one. Think of complicated as a bug in your system plus your anatomy being fuxed up or whateverUpper UTIsAnything above the bladder (i.e. ureters and kidneys)Lower UTIsBugs hang out in the urine and cause irritative voiding symptomsBladder Infection (Cystitis)InfoInflammation of the bladderTypesBacterial = a bug gets in thereNonbacterial = maybe an autoimmune reaction?Pyelonephritis = Pyelonephritis refers to an inflammation affecting the tubules, interstitium, and renal pelvis. It occurs in two forms. Acute pyelonephritis is caused by bacterial infection. Chronic pyelonephritis is a more complex disorder involving not only bacterial infection but other factors such as refluxAcutePathoInfection of renal pelvis, tubules, and interstitial tissue of one or both kidneysUpward spread of bacteria from bladderThe bug can get there from the pee-pee (like from a foley) or from the spread of the bug thru the bloodstreamCausesUpward spread of bacteria from bladderBug gets there by bedrest or another infection in keeping the immune response elsewhere in the bodySpecifically from:Urinary obstructionReflex of urine from the bladder squeezing (the bladder squeezes the urine back up the tubes above the bladder)Pregnancy (uterus gets large and pushes against the bladder causing pressure and squeezing urine up)Catheterization (we’re pushing catheter into bladder. If we pick up bugs on the way in the bug ends up in the bladder which could get squished up into the uretersS/S of Acute PyelonephritisEnlarged kidneys w/ abscessesSeen on kidney ultrasound usuallyFever / chillsLeukocytosis, bacteriuria, pyuria Low back pain (usually severe)Usually what makes us think of pyelonephritis Palpation of kidneys, the person will jerk back because they’re super painfulN/V, headache, malaisePainful urinationChronicPathoPersistent, recurring infectionLeads to scarring of kidney(s)Difficult to determine specific causeKidney stones increase riskVesicoureteral reflux increases riskUrinary Tract ObstructionLower urinary tract disordersEnlarged prostate (men) InfoOften benign = called Benign Prostate Hypertrophy (BPH)Can be caused by prostate CAEither leads to obstruction of urethraUrethral stricture (men or women)CausesCongenital, infection, injury, or surgical manipulationStrictures are basically scars…Any of these may cause scarring and narrowing of the lumenPelvic organ prolapse (women)InfoDownward protrusion of bladder down into the vaginaCauses bladder outlet obstruction (the bladder isn’t where it should be and gravity can’t get the pee pee out)Kidney stones (Renal Calculi)InfoMay form anywhere in the urinary tractUsually form in renal pelvis or calicesThey vary in size, shape, and number70-80% made of calcium oxalate or calcium phosphatePathoUrine becomes concentrated w/ insoluble materials→Crystals form, then consolidate→ calculi form→Calculi remain in renal pelvis (damage/destroy kidney tissue), or enter the ureter→Large caluli may cause pressure necrosisCauses / Predisposing Factors:DehydrationInfectionObstructionChanges in urine pHImmobilizationDietMetabolic factors (Ex: gout, hyperparathyroidism = more PTH increases the Ca released from the bones, hence more Ca in the circulating blood)S/SSevere pain—may move from lower back to sides to pubic regionN/VOften fever / chillsMay have hematuria May have abdominal distentionMay have oliguria Renal tumorsInfoRenal Cell Carcinoma (RCC) most commonTobacco use, obesity, and HTN appear to be associated with RCCUsually occur in one kidney and metastasize to the lungs, liver, lymph, and boneRenal Cell Adenoma (benign tumor)Encapsulated and located near renal cortexS/S of TumorsEarly stages are often silentLate signs includeHematuria, flank pain, palpable flank mass, and weight lossBladder tumorsInfoTobacco use appears to be leading risk factorArise from alteration of epithelial tissue at base of bladderOften involve ureter orifices and bladder neckUsually metastasize to lymph, liver, bones, & lungsS/SVisible, painless hematuriaPelvic or back pain may occur with metastasisUTIs are common complications which cause increase frequency, urgency, and dysuriaGlomerular DisordersGlomerulonephritis = inflammation of the glomerulusPathoInflammation of the glomerulusInfection initiates inflammatory process→Antigen-antibody processes deposited in glomeruli→Nephrosclerosis develops→(In chronic) Cortex layer shrinks→Bands of scar tissue distort remaining cortex→Branches of renal artery thicken→End-stage renal diseaseTypesAcuteglomerulonephritis is often associated w/ strep throat, or impetigo→develops 2-3 weeks post infectionChronicglomerulonephritis is often caused by IDDM or Lupus erythematosus→leads to chronic renal failureNephrotic SyndromePathoCan occur with any renal or systemic disease process that damages the glomerular capillary membrane →Large amounts of protein excreted in urine (proteinuria)Decrease of albumin in blood (hypoalbuminemia)High serum cholesterol and low – density lipoproteins (hyperlipidemia)Major S/S: Edema (pitting & ascites)NephrosclerosisInfoHypertension & Diabetes main causes→Decreased blood flow to kidneys→4191635-230505Patchy necrosis develops→Fibrosis develops; glomeruli destroyed→Leads to End-stage renal diseaseRenal FailureAcutePathoAbrupt reduction in renal function w/elevation of BUN & creatinine levelsUsually associated w/ urine output of <30 ml/hr or <400 ml/dayMost of the time condition is reversibleS/S of ARFOliguria begins within 1 day post hypotensive event & lasts 1 - 3 weeksLethargicSkin / mucus membranes dryCNS→headache, muscle twitching, seizuresMany body systems affectedRecovery depends on how long the cause lastedChronic (End-Stage Renal Disease)PathoESRD is progressive, irreversible deterioration in renal functionEnd products of protein metabolism (normally excreted in urine) accumulate in the bloodCausesDM, HTN, chronic glomerulonephritis, pyelonephritis, obstruction of urinary tractS/S of ESRDUREMIA (result of accumulation of toxins in plasma)HTN, anorexia, N/V/D, weight loss, pruritis, edema, anemia, and neurological changes ................
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