Pathology Ch. 19

Front 1

Collecting System

Back 1

Includes a little of both:

1). Renal pelvis

2). Ureter

3). Bladder

Front 2

Upper urinary tract

Back 2

•Right kidney

•Right renal pelvis

Front 3

Lower urinary tract

Back 3

•Right ureter

•Urinary bladder

•Urethra

Front 4

Kidney Functions

Back 4

•Eliminate waste

•Regulate plasma osmolality

•Regulate blood acid-base balance

Front 5

Kidney Functions

Back 5

•Adjust blood-volume & pressure via renin

•Stimulate red blood cell production (Erythropoietin)

Front 6

The Normal Glomerulus

Back 6

•Fluid and soluble small molecules passing from blood into Bowman space must cross three layers of tissue:

-Vascular Endothelium

-Basement membrane

-Visceral epithelial cells

Front 7

The Normal Glomerulus

Back 7

•180 liters of glomerular filtrate formed/day

(50 gallons, large garbage bag full)

•178-179 liters are reabsorbed (99%) by renal tubules

Front 8

The Normal Glomerulus

Back 8

•Hence 1-2 liters (1% of filtrate) is formed as urine/day

-30 min. to filter entire blood volume

-Plasma is cleansed 50x/day

-Renal Functional Measurements:

Glomerular Filtration Rate (GFR)

•Insulin Clearance Test

Front 9

Tubular Processing of the Glomerular

Filtrate

Back 9

•The tubule completely reabsorbs glucose and amino acids and regulates plasma acid-base balance and osmolality by reabsorbing variable amounts of water, electrolytes, and acid.

•Toxins, creatinine, and urea pass unaltered into urine. Filtration, Reabsorption, Secretion, Excretion.

Front 10

Tubular Processing of the Glomerulus

Back 10

•Glycosuria if blood (glucose) 180-200 mg% (renal threshold)

•Aminoaciduria - occurs if (protein) above renal threshold

•Primary waste products in urine (urea & creatinine) products of protein metabolism

Front 11

Tubular Processing of the Glomerulus

Back 11

•Typical Lab Measurements to access renal function

-BUN

-Creatinine - best indicator of glomerular function

•Doubling of blood (creatinine) = 50% decline in glomerular function

Front 12

Clinical Side of Renal Failure

Hemodialysis

Back 12

•Purfied blood is pumped from the dialyzer into the arteriovenous fistula

•Blood is pumped from the arteriovenous fistula into a dialyzer

•In the dialyzer, waste products filter from the blood through an artificial membrane into a fluid called the dialysate

Front 13

Clinical Side of Renal Failure

Peritoneal Dialysis

Back 13

•Fluid drains or is pumped into the peritoneal space

•Fluid and waste products are drained from the peritoneal space

Front 14

Diseases of the Urinary System

Major Determinants of Disease

Back 14

•Disease of one renal structure usually affects others

•The urinary tract is especially susceptible to bacterial Infection

•Most primary glomerular disease is caused by autoimmune reactions

Front 15

Diseases of the Urinary SystemMajor Determinants of Disease

Back 15

•High blood pressure is a common cause of kidney disease.

•The kidney collects, concentrates, and excretes toxins, some of which may cause neoplasms or damage to the kidney or urinary tract.

•Renal tubules are metabolically very active and therefore especially susceptible to oxygen deprivation or toxic damage.

Front 16

Normal Urine and Urinalysis

Back 16

•Urnalysis:

-Fresh or refrigerated urine tested by dipstick method. Microscopic examination of urinary sediment is a separate task

Front 17

The Language of Renal Disease

Back 17

•Renal Failure: Loss of Kidney ability to excrete waste, concentrate urine & conserve electrolytes

Front 18

The Language of Renal Disease

Back 18

•Description of Illness (S&SX) caused by renal disease associated with renal failure include:

-Diuresis: Increased urine output

-Dysuria: Painful Urination

-Pyuria: WBC (pus) in urine

-Hematuria: RBC in urine

Front 19

The Language of Renal Disease

Back 19

•Description of Illness (S&SX) caused by renal disease associated with renal failure include:

-Nocturia: Night time urination (2x = abnorm)

-Oliguria: Less than normal urination

-Proteinuria: Protein in urine (not norm.)

-Glycosuria: Glucose in urine (not norm); BS > 180mg/dl)

Front 20

The language of Renal Disease

Clinical Syndromes (Collection of clinical signs & symptoms) of renal disease (1)

Back 20

•Azotemia: Renal failure detectable only by lab tests (excess) bun), no s or sx

•Uremia: Excess BUN (Lab tests) + Renal Failure with clinical S & Sx (literally urine in the blood)

•Acute nephritic syndrome: Renal failure, autoimmune, high BP, hematuria. Often after Strep Infection.

Front 21

The language of Renal Disease

Clinical Syndromes (Collection of clinical signs & symptoms) of renal disease (1)

Back 21

•Nephrotic syndrome: Renal failure with marked proteinuria and edema. Evolves from many glomerular disease

•Occult hematuria: Microscopic (Not Visible) blood in urine, may be early sign of glomerular disease

•Nephrolithiasis: Kidney stones (various types)

Front 22

The Language of Renal Disease

Clinical Syndromes of Renal Disease 2

Back 22

•Acute renal failure: Immediate, oliguria, anuria, azotemia, common cause = acute tubular necrosis

•Chronic renal failure: Over time, oliguria, uremia, progresses to end-stage renal disease

•Urinary tract infection: bacteriuria, pyruia, cystitis

Front 23

The Language of Renal Disease

Clinical Syndromes of Renal Disease 2

Back 23

•Urinary tract obstruction: acute=prostatitis, chronic = tumor, scar, stones

•Occult proteinuria: protein in urine, no S & Sx, fever, UTI, exercise, may precede glomerular disease or renal damage HTN

Front 24

The Language of Renal Disease

Clinical Syndromes of Renal Disease 2

Back 24

•Understand that each syndrome can be caused by a number of different diseases, which in turn include multiple, descriptions (S&Sx, oliguria, dysuria...) And some renal syndromes are related to other renal syndromes.

Front 25

Normal Urine and Urinalysis

Back 25

•Protein Cast

•White cell cast

•Red cell cast

•Red blood cells

Front 26

Normal Urine and Urinalysis

Back 26

•White blood cells

•Bacteria

•Calcium oxalate crystals

•Urothelial epithelial cells

(Transitional cells)

Front 27

Don't Shoot the "Messenger"

Back 27

•Ok, so Acute Nephritic syndrome is associated with Azotemia (another clinical syndrome), both which are considered a type of renal failure, (but separate from acute and chronic renal failure), which can be caused by many diseases (glomerulnephritis, renovascular, obstruction) yet if it runs it's course may end in Tubular interstitial disease.

Front 28

Clinical Syndromes of Renal Disease

Back 28

•Acute Nephritic Syndrome (Resulting from acute glomerulnephritis "Disease") -Always Autoimmune glomerular disease often following strep throat.

-Hematuria, HTN, Azotemia, Oliguria, Edema

Front 29

Clinical Syndromes of Renal Disease

Back 29

•Autoimmune Glomerular Inflammation

•Reactive Glomerular Hyperplasia

•Impairs Glomerular Blood-Flow & cannot reach Juxtaglomerular apparatus

Front 30

Clinical Syndromes of Renal Disease part 2

Back 30

•Increases Renin

•Hyoertension

•Hematuria (RBC's Leak into filtrate) & Oliguria (Decreased blood flow and GFR)

Front 31

Clinical Syndromes of Renal Disease

Nephrotic Syndrome

Back 31

•Proteinuria, Protein Casts Hypoalbuminemia (blood), Edema, Hyperlipidemia & lipiduria

•Urinary (Bowman) space, normally filled with clear Glomerular filtrate, contains a large amount of protein-rich fluid, which takes a smooth, red stain.

Front 32

Clinical Syndromes of Renal Disease

Nephrotic Syndrome

Back 32

•Tubles contain dense deposits of similar, denser red material - protein that has condensed into casts, which will be flushed out as a diagnostic clue in the urine sediment.