Pathophysiology Chapter 18 Urinary System Disorders

Front 1

May indicate the presence of large amounts of protein, blood cells, or bacteria and pus

Back 1

Cloudy urine

Front 2

May indicate hematuria, excessive bilirubin, or concentrated urine

Back 2

Dark urine

Front 3

May indicate infection, or may result from certain dietary components or medications

Back 3

Unpleasant or unusual odor

Front 4

Blood (hematuria), protein (proteinuria, albuminuria) bacteria (bacteriuria), pus (pyuria), urinary casts, glucose and ketones

Back 4

Abnormal constituents in urine

Front 5

Hydrochlorothiazide, furosemide

Back 5

Commonly used diuretics

Front 6

Used to remove excess sodium ions and water from the body

Back 6

Diuretics

Front 7

Provided in a hospital or dialysis center

Back 7

Hemodialysis

Front 8

Administered at home or in a dialysis unit, and can be administered while patient is asleep or ambulatory

Back 8

Peritoneal dialysis

Front 9

Infected shunt or formation of blood clots, sclerosis and damage to blood vessels involved in the shunt, increased risk of infection by hepatitis virus or HIV.

Back 9

Potential complications of hemodialysis

Front 10

Prostatic hypertrophy and urinary retention in older men, congenital abnormalities in children, incomplete bladder emptying, reduced fluid intake, impaired blood supply to the bladder, immobility. Women more anatomically vulnerable because of shortness and width of urethra, proximity of urethra to anus, and frequent irritation to tissues causes by sexual activity, tampons, bubble bath, and deodorant.

Back 10

Predisposing factors to UTI

Front 11

Manifestations include lower abdominal pain, dysuria, urgency, frequency, nocturia, systemic signs of infection (fever, malaise, leukocytosis, nausea) cloudy urine with unusual odor, and urinalysis indicating bacteruria

Back 11

Manifestations of cystitis

Front 12

Manifestations include signs and symptoms of cystitis, plus pain associated with renal disease (dull aching pain in lower back), more marked systemic signs, ad urinalysis similar to that of cystitis plus the addition of urinary casts

Back 12

Manifestations of pyelonephritis

Front 13

Antistreptococcal antibodies, resulting from earlier infection, create an antibody-antigen complex that lodges in the glomerular capillaries, activating the complement to cause an inflammatory response in both kidneys. This leads to increased capillary permeability, and cell proliferation, resulting in leakage of protein and RBCs into the glomerular filtrate. When inflammation is severe, it interferes with filtration, causing decreased glomerular filtration rate (GFR) and fluid retention. Acute renal failure is possible if blood flow is sufficiently impaired. Renin secretion is likely to be triggered, leading to elevated blood pressure and edema. If the process becomes chronic, the kidneys will be scarred.

Back 13

Pathophysiology of glomerulonephritis

Front 14

Blood tests showing elevated serum urea and creatinine, elevated antistreptococcal antibodies, (ASO and ASK) and decreased complement level, metabolic acidosis with low serum pH and bicarbonate, proteinuria, gross hematuria, and erythrocyte casts.

Back 14

Tests used to diagnose glomerularnephritis

Front 15

Sodium restriction, decreased protein and fluid intake, drug treatment includes glucocorticoids to reduce inflammation, antihypertensives to reduce blood pressure

Back 15

Possible treatments for glomerularnephritis

Front 16

Abnormality in the glomerular capillaries and increased permeability resulting in proteinuria (albuminuria), hypoalbuminemia leading to generalized edema due to decreased plasma osmotic pressure low or normal blood pressure with hypovolemia or elevated depending on angiotensin levels, hypovolemia leading to aldosterone secretion and more severe edema, high levels of blood cholesterol and lipoprotein in the urine due to unknown factors, possibly liver response to protein loss in the urine

Back 16

Pathophysiology of nephrotic syndrome

Front 17

Massive edema or anasarca

Back 17

Most significant sign of nephrotic syndrome

Front 18

Weight gain, pallor, anorexia, dyspnea, decreased exercise tolerance, skin breakdown and subsequent infection

Back 18

Potential consequences of nephrotic syndrome

Front 19

Glucocorticoids, ACE inhibitors, and antihypertensives

Back 19

Medication used in treatment of nephrotic syndrome

Front 20

Excessive amounts of insoluble salts in the filtrate, e.g. hypercalcemia due to hyperparathyroidism, hyperuricemia due to gout or cancer chemotherapy

Back 20

Causative factors in development of renal calculi

Front 21

Flank pain due to distention of renal capsule, renal colic (intense spasms of pain in the flank area radiating into the groin), perhaps accompanied by nausea and vomiting, cool moist skin, and rapid pulse, confirmed by radiological examination

Back 21

Characteristic signs and symptoms of renal calculi

Front 22

Buildup of urine due to obstruction of outflow, causing a dilated area proximal to the obstruction in either ureter or kidney and resulting in tissue atrophy and necrosis

Back 22

Hydronephrosis

Front 23

Secondary complication of calculi, tumors, scar tissue in the kidney or ureter, stenosis or kinking of the ureter, and untreated prostatic development developmental defects

Back 23

Causes of hydronephrosis

Front 24

Smoking

Back 24

Major predisposing factor for development of malignant tumors in urinary system

Front 25

“Arteriosclerosis” of renal vasculature

Back 25

Nephrosclerosis

Front 26

Primary vascular changes in the kidney or secondary to essential hypertension, diabetes mellitus, or another condition

Back 26

Causes of nephrosclerosis

Front 27

Due to a defective valve in the bladder

Back 27

Vesicoureteral reflux, congenital disorders of urinary system

Front 28

Failure of one kidney to develop

Back 28

Agenesis, congenital disorders of urinary system

Front 29

Failure of kidney to develop to normal size

Back 29

Hypoplasia, congenital disorders of urinary system

Front 30

Kidney and ureters are displaces out of normal position

Back 30

Ectopic kidney, congenital disorders of urinary system

Front 31

Fusion of two kidneys during development

Back 31

”Horseshoe” kidney, Congenital disorders of urinary system

Front 32

Bilateral kidney disease, such as glomerulonephritis, severe and prolonged circulatory shock or heart failure, sepsis, nephrotoxins, ischemia, pyelonephritis, and occasionally mechanical obstructions such as calculi, blood clots, or tumors, only when affecting both kidneys

Back 32

Causes of acute renal failure

Front 33

Treatment: Reverse the primary problem quickly and provide dialysis

Back 33

Treatment of acute renal failure

Front 34

Nephrosclerosis, diabetes mellitus, nephrotoxins, chronic exposure, chronic bilateral kidney inflammation or infection, and polycystic disease

Back 34

Causes of chronic renal failure

Front 35

Second stage of chronic renal failure when about 75% of the nephrons are lost

Back 35

Renal insufficiency

Front 36

Occurs when more than 90% of nephrons are lost and GFR is negligible

Back 36

End-stage renal failure or uremia