Ch 11 Urinary System

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Acute Glomerulonephritis

Back 1

Inflammation and swelling of the glomeruli. Usually follows a strep infection of the throat or skin.

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Acute Glomerulonephritis Signs and Symptoms

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Proteinuria, edema, decreased urine volume. Hematuria. Urine may be dark or coffee colored. Often in children and adolescents. 1-2 wks after strep. Hypertension, headaches, visual disturbances, malaise, low grade fever, back pain.

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Acute Glomerulonephritis Etiology

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Beta hemolytic strep

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Acute Glomerulonephritis Treatment

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Antibiotic therapy, diuretics for edema and hypertension. Restrict sodium intake. Usually resolves w/in 2 weeks.

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Chronic Glomerulonephritis

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Slow progressive non infectious, can lead to renal damage and failure

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Chronic Glomerulonephritis Signs and Symptoms

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Asymptomatic then leads to hypertension, hematuria, proteinuria, oliguria, edema. Then azotemia (kidneys fail to remove urea from blood). Body excretes through sweat glands leaves tiny crystals on skin (uremic frost).

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Chronic Glomerulonephritis Etiology

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Immune mechanisms. Antibody antigen complex lodge in glomerular capsular membrane triggering inflammatory response and glomerular injury. Systemic lupus Erythematosus could be cause.

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Chronic Glomerulonephritis Treatment

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Control edema, hypertension, prevent congestive heart failure and uremia. Patient may require dialysis or need kidney transplant.

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Chronic Glomerulonephritis Prognosis

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Will eventually lead to end stage renal disease. Dialysis will help until get kidney transplant.

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Dialysis

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Filters out unwanted elements from blood by diffusion across semi permeable membrane. 2 methods: hemodialysis and peritoneal dialysis.

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Nephrotic Syndrome (Nephrosis)

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Disease of basement membrane of glomerulus. Secondary to renal diseases. Encompasses a group of symptoms referred to protein losing kidney.

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Nephrotic Syndrome (Nephrosis) Signs and Symptoms

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Loses excessive amount of protein, mainly albumin in urine (hypoalbuminemia). Water and sodium retained, results in edema and hypertension. Plasma lipid levels elevated. Patients susceptible to infections. Lethargic, depressed, loss of appetite, pale and puffy around eyes, gains weight.

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Nephrotic Syndrome (Nephrosis) Etiology

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Increased permeability of glomerulus, indicating renal damage. Can be from diabetes, allergic rxns, infections.

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Nephrotic Syndrome (Nephrosis) Treatment

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Address underlying cause. Intake of protein is adjusted to GFR (glomerular filtration rate), diuretics for edema, ACE inhibitors for hypertension. Prognosis varies, if no responsive leads to ESRD.

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Acute Renal Failure

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Severe and sudden reduction of renal function. Nitrogenous waste begin to accumulate in blood causing uremic episode.

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Acute Renal Failure Signs and Symptoms

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Oliguria, gastrointestinal disturbances, headaches, drowsiness

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Acute Renal Failure Etiology

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Diminished blood flow to kidneys, intrarenal damage, mechanical obstruction of urine flow.

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Acute Renal Failure Treatment

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Reverse decreased renal perfusion. Evaluated for dialysis, fluid intake and output are balanced, high carb low protein diet, sodium and potassium controlled. If treated promptly recovery is rapid and complete. If untreated leads to death.

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Chronic Renal Failure

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Gradual and progressive loss of nephrons, irreversible lass of renal function and uremia.

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Chronic Renal Failure Signs and Symptoms

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Weak, tired, lethargic. Hypertension, edema. Arrhythmias, muscle weakness, dyspnea, metabolic acidosis, ulceration of gi mucosa, hair and skin changes.

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Chronic Renal Failure Etiology

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Glomerulonephritis, pyelonephritis, poly cystic kidneys, end stage chronic renal disease, chronic obstruction of urine outflow.

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Chronic Renal Failure Treatment

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Treat underlying cause. Evaluate for dialysis or kidney transplant. Erythropoietin to stimulate bone marrow helps anemia. Prognosis variable no total cure

Front 23

Pyelonephritis

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Most common type of renal disease. Inflammation of renal pelvis and connective tissue of one or both kidneys.

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Pyelonephritis Signs and Symptoms

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Pus collects in renal pelvis w formation of abscesses. Rapid onset of fever, chills, nausea, vomiting, flank (lumbar) pain. UTI, foul Oder of urine, hematuria, pyuria. Enlarged kidney may be palpated.

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Pyelonephritis Etiology

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Bacteria that ascends from lower urinary tract. Less commonly caused by hematogenous or lymphatic spread. Obstruction or stasis or urine (by stones, tumor) usually E. Coli. Women more at risk. Catheterization or other procedures can introduce bacteria.

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Pyelonephritis Treatment

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Iv or oral antibiotics usually penicillin 7-14 days. Increased fluid intake and bed rest. If reoccurs test for renal abnormalities. If complications surgery for obstruction. Early detection and treatment has good prognosis. If untreated permanent kidney damage.

Front 27

Hydronephrosis

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Abnormal dilation of renal pelvis caused by pressure from urine that cannot flow past obstruction in urinary tract.

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Hydronephrosis Signs and Symptoms

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When obstruction is severe and prolonged fibrotic changes and loss of function of nephrons occurs. Usually chronic, destruction of kidney ms transpires wow pain or symptoms. Vague backache w diminished urine output. If infected may have fever, chills, hematuria, pyuria, palpable kidneys. Often accidentally detected during X-ray of abs.

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Hydronephrosis Etiology

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Caused by buildup of pressure in the kidneys by obstruction ( renal calculi, tumor, inflammation, or enlarged uterus during pregnancy).

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Hydronephrosis Treatment

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Depends on underlying cause and duration. If early detection obstruction can be removed surgically and antibiotics given for infection. If surgery not an option nephrostomy tube inserted. If condition present for long time permanent damage can occur.

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Cystoscopy

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Allows direct examination and treatment of urinary bladder. Used to obtain biopsy specimen for diagnosis and to remove tumors and stones.

Front 32

Renal Calculi

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Formed by concentration of various mineral salts.

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Renal Calculi Signs and Symptoms

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Solitary or multiple vary in size. Symptoms vary w degree of obstruction. Severe pain in flank area (renal colic), urinary urgency, nausea, vomiting, hematuria, fever chills, abdominal distention. Hydronephrosis can develop from blockage.

Front 34

Staghorn Calculi

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Large stone shape of renal pelvis

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Renal Calculi Etiology

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Often unknown. Hereditary tendency. Excessive amount of calcium or uric acid in urine. Often males 30-50.

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Renal Calculi Treatment

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Analgesic therapy and hydration so stones pass spontaneously. Large calculi can be crushed by extracorporeal shock wave lithotripsy. Uteroscope can be used to capture stone and remove. Electrohydraulic lithotripsy or laser lithotripsy. Stones in urinary bladder often pass spontaneously. If not removed during cystoscopy.

Front 37

Infectious Cystitis and Urethritis

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Inflammation of urinary bladder (cystitis) and urethra (urethritis). Both common forms of lower UTI.

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Infectious Cystitis and Urethritis Signs and Symptoms

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Urinary urgency, frequency, dysuria, incontinence, pressure in pelvis, pain in pelvic region and lower back, spasms of bladder, burning sensation during urination. Urine is dark yellow, pink or red.

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Infectious Cystitis and Urethritis Etiology

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Ascending bacterial invasion. Most common E. Coli, then Klebsiella, Enterobacter, Proteus, pseudomonas. Sexually transmitted diseases can cause both, or virus, fungus, parasites, and inflammation from chemo.

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Infectious Cystitis and Urethritis Treatment

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Organism specific antibiotics or urinary antiseptic therapy. Treatment min 3-5 days for uncomplicated and 7-10 for reoccurring infection. Antibiotics for UTIs may cause yeast infections. Prognosis: responds well to antibiotics.

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Diabetic Nephropathy

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Renal changes (glomerulosclerosis) from diabetes. Expected in all type 1 patients and many type 2.

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Diabetic Nephropathy Signs and Symptoms

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Urinary retention, hypertension, nausea, proteinuria. UTI and pyelonephritis common complications.

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Diabetic Nephropathy Etiology

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Kidney transplant final

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Diabetic Nephropathy Treatment

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Individualized. Control diabetes, low protein low fat recommended. Dialysis or kidney transplant for long term management. Prognosis varies no cure. Kidney transplant final option.

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Polycystic Kidney Disease

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Slowly progressive and irreversible disorder, normal renal tissue is replaced w multiple grapelike cysts. Bilateral, cysts form I’m dilated nephrons.

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Polycystic Kidney Disease Signs and Symptoms

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Kidneys become dilated, palpable. Lumbar and abdominal pain, hematuria, systemic hypertension, more prone to renal infection and calculi. Experience chronic high BP and kidney infections.

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Polycystic Kidney Disease Etiology

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Inherited. May not manifest until adolescence or adulthood. Acquired occurs bc long term dialysis. Autosomal recessive appears in infants and children.

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Polycystic Kidney Disease Treatment

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No cure. Long term dialysis and kidney transplant. Kidneys have to be surgically removed.

Front 49

Neurogenic Bladder

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Dysfunction consist of difficulty emptying bladder or urinary incontinence.

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Neurogenic Bladder Signs and Symptoms

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Vary depending on cause. Sensation of full bladder but unable to initiate stream to empty. Reflex Neurogenic Bladder normal sensation absent so void in spurts of urine bc of uncontrolled bladder contractions.

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Neurogenic Bladder Etiology

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Insult to brain, spinal cord, or nerves.

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Neurogenic Bladder Treatment

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Directed towards preventing UTIs and restore normal function. Catheterization, or drug therapy w parasympathomimetic agents. Prognosis no cure.

Front 53

Stress Incontinence

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Uncontrolled leakage

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Stress Incontinence Signs and Symptoms

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Occurs w increased abdominal pressure forced urine from sphincter.

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Stress Incontinence Etiology

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Weakening pelvic floor muscles and urethral structure. Mostly results from child birth, hormonal changes of aging, menopause, obesity, certain meds.

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Stress Incontinence Treatment

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Kegel exercises, estrogen replacement, surgical repair, collagen injections.

Front 57

Renal Cell Carcinoma

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One or more malignant tumors develop in one or both kidneys. Most common in renal cortex (Renal cell carcinoma) less common Wilms tumor.

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Renal Cell Carcinoma Signs and Symptoms

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Hematuria, abdominal mass, flank pain. Less than 10% have all 3. Many have no symptoms until advanced.

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Renal Cell Carcinoma Etiology

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Most common is component of von Hippel-Lindau (VHL) Syndrome. Smoking, hypertension, dialysis, exposure to asbestos and cadmium. More common in men.

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Renal Cell Carcinoma Treatment

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Surgical removal. Partial nephrectomy if small than 5cm.

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Renal Cell Carcinoma Prognosis

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Depends on stage of diagnosis. Early diagnosis has 90% 5 ye survival late has 10%.

Front 62

Bladder Tumors

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Usually transitional epithelium (urothelium) that lines surface of bladder. Bladder is most common site but can develop anywhere in urothelium lined urinary tract.

Front 63

Bladder Tumors Signs and Symptoms

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Gross intermittent painless hematuria. Pain in flank or suprapubic area. Voiding symptoms (dysuria, urgency and frequency). If advanced fatigue weight loss anorexia.

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Bladder Tumors Etiology

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Environmental exposure (carcinogens excreted in urine). HPV, smoking, frequent bladder infections, diesel exhaust. Usually over 60.

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Bladder Tumors Treatment

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3 goals: 1-eradicate 2-prevent reoccurrence 3- prevent development of invasive disease. Tumor resection using (TURBT) transurethral resection of bladder tumor. 80% of Tumors reoccur w/in 12 months. Follow ups required at 3-6 month intervals for 3-5 years. BCG (bacillus Calmette-Guerin) can be used (mycobacterium indices immune rxn to suppress tumor growth)

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Bladder Tumors Prognosis

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Outcome wo systemic therapy poor. Low grade more well differentiated Tumors have slower growth rate and better prognosis.

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Urinary Incontinence

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Bladder distended w urine, reflex is stimulated to initiate voluntary urination. Loss of voluntary control

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Overactive Bladder

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Urinary urgency or strong sudden uncontrollable urges.