URINARY DISORDERS

1
URINARY DISORDERS

2
CHEMICAL CONTROL OF URINARY SYSTEM

• Reabsorption of H2O in distal convoluted tubule
  controlled by ADH (antidiuretic hormone)
  hormone makes collecting tubules more permeable
  to water
• ADH known as the water-retaining hormone
• Secretion and regulation of ADH is controlled by
  the pituitary gland in the hypothalamus
• ALDOSTERONE secreted by the adrenal cortex,
  promotes excretion of potassium and hydrogen ions
  and reaborption of sodium, chlorine ions and H20

ADRENAL GLANDS
3
CHEMICAL CONTROL OF THE URINARY SYSTEM

• RENIN hormone released by kidneys, stimulates
  release of aldosterone from adrenal cortex
• DIURETICS inhibit reabsorption of H2O
• Lasix well known diurectic that acts on the Loop
  of Henle to block reabsorption

4
NERVOUS CONTROL OF THE URINARY SYSTEM

• Direct control through nerve impulses on the
  kidney blood vessels
• Indirect control through stimulation of endocrine
  glands

5
ACUTE KIDNEY FAILURE

• Rapid decline in kidney function
• Caused by a variety of factors that alter blood
  pressure or affect glomerular filtration such as
  nephritis, shock, injury, bleeding, sudden heart
  failure or poisoning
• Symptoms OLIGURIA OR ANURIA

6
ACUTE RENAL FAILURE

• Suppression of urine formation can lead to UREMIA
  toxic condition when blood retains urinary
  waste products
• Concentration of nitrogenous waste is assessed
  by the Blood Urea Nitrogen (BUN)
• Urea is produced by the breakdown of protein
  already in the body and protein in your diet
• Normal BUN is 7 20 mg/dL in adults and 5 18
  mg/dL in children
• A high BUN usually means the kidney function is
  less than normal

7
CHRONIC RENAL FAILURE

• Gradual loss of function of nephrons
• Stage I Some nephrons are lost but others
  compensate by enlarging and taking over (BUN is
  normal)
• Stage II called renal insuffiency remaining
  nephrons cant handle urea load and BUN climbs
  also have polyruria and dehydration
• Stage III called uremia very high BUN due to
  loss of kidney function fluids retained by the
  body so get hypertension and edema need kidney
  transplant

8
GLOMERULONEPHRITIS

• Inflammation of the glomerulus
• Filtration process affected
• Plasma proteins are filtered through and found in
  urine, RBCs too (HEMATURIA)
• Can be acute or chronic
• Acute is caused by a delayed immune response (1
  6 weeks) to a streptococcal infection most
  common form of kidney disease
• Chronic there is permanent damage

9
PYELONEPHRITIS

• Literally pelvis nephritis and refers to
  inflammation of the renal pelvis and connective
  tissue of the kidney
• Usually caused by infection from ureters or
  bladder
• Symptoms fever, chills, pain in the sides,
  nausea and an urge to urinate frequently
• Another symptom is PYURIA (pus in urine) yellow
  streaks seen in the medulla indicate tubules
  filled with pus
• Rx - antibiotics

10
HYDRONEPHROSIS

• Urine backs up because of blockage in ureter and
  renal pelvis and calcyes become distended
• Can be due to kidney stone
• Can also be caused by pregnancy and enlarge
  prostrate
• Rx Remove the cause

11
RENAL CALCULI (Kidney Stone)

• Develop in the renal pelvis or calcyes (under
  reanl pyamids)
• Made of crystals of calcium phosphate and uric
  acid
• Gradually they grow larger until they block the
  ureter small ones may pass through
• First symptom severe pain
• Other symptoms nausea and vomiting, urine
  frequency, chills, fever, and hematuria

12
RENAL CALCULI (KIDNEY STONES

• Diagnosis by symptoms, utlrasound, or x-ray
  (IVP intravenous polygram or KUB)
• Rx increase fluids to flush out stones,
  medications, and if needed - LITHOTRIPSY

13
LITHROTRIPSY

• Surgical procedure to remove kidney stones
• Shock waves hit dense stones and break them up
• Done on outpatient basis

14
Cystitis

• Inflammation of the mucous membrane lining of the
  urinary bladder
• Most common cause E.Coli
• Symps DYSURIA (painful urination) and frequency
• Usually in females (shorter urethra)
• Rx - antibiotics

15
Incontinence

• Involuntary urination

16
Dialysis

• Used for kidney failure
• Involves the passage of blood through a device
  with semipermeable membrane
• Dialysis serves as a substitute kidney

17
Hemodialysis

• Blood from patient flows through machine and its
  filtered
• Usually a FISTULA is created (opening between
  vein and artery) for inserting needles
• Can be done at home or in clinic
• Takes 2-4 hours, 2-3 times a week

18
Peritoneal Dialysis

• Uses the peritoneal lining to filter blood
• Dialysate (cleaning solution) flows in and out
  via a catheter tube

19
Kidney Transplant

• Done as a last resort
• Involves donor organ from someone with a similar
  immune system
• Main complication - rejection

20
Urinary Conditions
ENURESIS - bedwetting
GLYCOSURIA sugar in urine
NOCTURIA frequent urination at night
Hematuria blood in urine
21