Urinary System Diseases

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Urinary System Diseases

• Chapter 5

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Review of Function

• Production and elimination of urine
• Regulation of water, electrolyte and acid-base
  content of the blood
• Filtration of waste byproducts of metabolism
• Regulation of blood pressure
• Filtration, reabsorption secretion

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Factoid

• Only 1 of the fluid passing thru a nephron is
  actually urine!

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Routine Dx. And Screening Tests

• Urinalysis
• Ph
• Hematuria
• Casts
• Crystals

• Specific Gravity
• Proteinuria
• Ketonuria
• Creatinine
• Bacteria

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Specific Gravity

• The weight of a drop of urine as compared to
  distilled water.
• Normal 1.005 - 1.030
• May vary based on the lab you use.

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Polycystic Kidney Disease

• Collecting tubules in the cortex fail to empty
  properly.
• They slowly begin to swell into fluid-filled sacs
  (grape-like clusters)
• The pressure causes damage to surrounding tissue

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Polycystic Kidneys.

• Kidney function is impaired
• Usually impacts BOTH kidneys

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What causes it?

• (2) forms
• (1) forms in adulthood and is autosomal dominant
• (2) forms in childhood and is autosomal recessive

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What to look for?

• Usually asymptomatic and then.
• Lumbar pain
• Hematuria
• Renal calculi
• Insidious

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Diagnostic Procedures

• May be familial so a history is in order
• Enlarged, palpable kidneys
• HTN
• CT
• Ultrasounds
• UA for function and abnormal findings

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Treatment

• Progressive disease
• Manage symptoms
• Prevent infection
• Renal dialysis
• Transplantation

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Prognosis

• Poor
• Renal failure
• Death usually within 10 years

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Pyelonephritis

• Inflammation of the kidney and renal pelvis due
  to infection.
• More common in men than women.
• Destruction of tissue and impairment of renal
  function

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Causes

• Good old E Coli
• Staph Strep (although less common)
• Usually starts as a bladder infection and then
  ascends

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What to look for?

• NV
• Chills
• Fever
• Diarrhea
• Pyuria
• Dysuria
• Lumbar pain

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Diagnostic Procedures

• Physical exam-flank tenderness
• CS
• fishy odor
• UA-casts, WBCs, bacteria, hematuria
• KUB

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Treatment

• Antibiotic therapy
• Antipyretics
• Increased fluid intake

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Prognosis

• Pretty good unless the patient continues to
  become infectedin which case
• Renal failure

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Prevention

• Proper hygiene
• Rememberfront to back, not back to front

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Glomerulonephritis

• Inflammation of the glomeruli
• Interestingly follows URI with strep

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Cause

• Circulating antibody-antigen complexes become
  trapped in the capillaries of the glomeruli
  decreases the ability of the kidneys to filter

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Signs Symptoms

• Secondary HTN
• Edema
• Pain in lumbar area
• Oliguria
• Malaise

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Diagnostic Procedures

• Medical history
• Recent URI strep infection
• Elevated BUN
• Creatinine
• Elevated ESR
• Urine color-changed
• KUB-Bilateral kidney enlargement

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Treatment

• Supportive
• Diuretics
• Bed rest
• Low salt, low protein
• Possibly antibiotics

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Chronic Renal Failure

• Progressive deterioration of kidney function
• Inability to excrete nitrogenous waste

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Etiology

• Diabetes mellitus
• HTN renal disease
• Chronic glomerulonephritis

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Signs/Symptoms

• Weakness, lethargy, weight loss, anorexia,
  pruritis, polyuria.

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Diagnostic Procedures

• History and physical
• Blood testingelevated serum creatinine, BUN, and
  K.
• Proteinuria
• Decreased Hgb and Hct.

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Treatment

• Relieve symptoms
• Guard against complications
• Restrict protein, sodium and potassium

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Prognosis

• Poor
• Complete kidney failure

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Renal Calculi

• Concentration of various mineral salts in the
  renal pelvis
• Calcium salts, uric acid, cystine, struvite.

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Etiology

• Disruption in homeostasis
• Preventing water loss while getting rid of
  water-soluble wastes.
• Prolonged dehydration, immobilization.
• Gout, hyperparathyroidism, Cushings, UTIs,
  neoplasms.
• Excessive intake of Vitamin D or calcium

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Signs and Symptoms

• May be asymptomatic
• Intense flank pain
• Back pain
• Nausea
• Vomiting
• Chills
• Hematuria

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Treatment

• Clear stone
• Increase fluid intake
• Lithotripsy
• Antibiotics
• Analgesics

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Lower Urinary Tract Diseases
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Cystitis and Urethritis

• Bladder inflammation
• Urethral inflammation

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Etiology

• E Colitypically
• STDs

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Who

• Women more often affected than men
• Short urethra

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Signs and Symptoms

• So commonyou tell me.