Urinary System Disease and Disorders

Chapter 8

Anatomy of Urinary System

Glomerulus

Urinary System Functions

Removes urea and other waste products

Maintains proper balance of water, salts and other substances by removing or reabsorbing

Excretes the waste products via urine.

Nephron – the structural & functional unit of the kidney

Diagnostic Tests

Routine UA (Urinalysis) Serum BUN & Creatinine GFR (Glomerular filtration rate) Ultrasound CT Scan Biopsy

Diagnostic Tests

Routine UAColor/Clarity – yellow and clearpH – 5.5 – 7.0Protein – negativeGlucose – negativeKetones – negativeBilirubin – negativeUrobilinogen – negativeBlood – negativeNitrite – negativeMicroscopic Evaluation: WBC – 0-5 /hpf

RBC – 0 /hpfCasts – few hyalineBacteria – none

Serum Blood Tests

Blood Urea Nitrogen (BUN) – urea is the end product of protein metabolism. Normal Values = 8 - 20mg/dL

Creatinine – the breakdown product of creatine phosphate Normal Values = 0.5 – 1.2 mg/dl

Glomerular Filtration Rate Known as Creatinine Clearance Calculation from your blood creatinine, age,

race, gender and other factors. Measures level of kidney function & indicates

stage of kidney disease5 Stages of Chronic Kidney Disease

StageDescription

Glomerular Filtration Rate GFR)

At increased risk

Risk factors for kidney disease (e.g., diabetes, high blood pressure, family history, older age, ethnic group)

More than 90 mL/min

1Kidney damage (protein in the

urine) and normal GFRMore than 90 mL/min

2Kidney damage and mild decrease

in GFR60 to 89 mL/min

3 Moderate decrease in GFR30 to 59 mL/min

4 Severe decrease in GFR15 to 29 mL/min

5Kidney failure (dialysis or kidney

transplant needed)Less than 15 mL/min

Acute Renal Failure vsChronic Renal Failure

Acute Develops suddenly

Chronic Long standing kidney disease i.e. diabetic

nephropathy Life-threatening Poorer prognosis

Polycystic Kidney Disease Description

Multiple, grapelike, fluid-filled cysts caused by a developmental defect in collecting tubules

Etiology – genetic defect Symptoms

lumbar pain Hypertension Hematura

Diagnosis – CT scans Treatment – controlling symptoms

or nephrectomy

Pyelonephritis Description

Inflammation of the kidney & renal pelvis due to an infection Etiology

Bacterial infections: E. Coli, Staph, Enterococcus, Yeast Symptoms

Pyuria – pus in urine (WBCs in routine UA) Dysuria – difficult & painful urination Nocturia – excessive urination at night Fever, chills, nausea & vomiting, Lumbar pain

Diagnosis Urinalysis

Proteinuria WBCs, Casts, bacteria

Urine Culture Treatment

Antibiotic therapy

Microscopic Urinalysis seen in Pyelonephritis

Glomerulonephritis

Description Inflammation of the glomerulus

Etiology Autoimmune reaction

Streptococcal antibodies (from Strep infection) DNA antibodies (Lupus erythematosus)

Viruses - HIV, Hepatitis Diabetes Hypertension

Glomerulonephritis, Cont’d Signs & Symptoms

Hematuria – blood in urine Oliguria – reduced urine flow Lumbar pain, edema, anorexia, malaise

Diagnosis Urinalysis

Proteinuria ↑ RBCs (Hematuria) ↑WBCs ↑Casts

↑BUN – 38 mg/dl ( 8-20) ↑Creatinine – 7.8 mg/dl (0.5-1.7mg/dl) Biopsy – Immune complexes

White Blood Cells & Red Blood Cells in Urine

WBC & RBC Casts

Glomerulonephritis Treatment

Diuretics – to control edema & hypertension Dietary restrictions

Salt Proteins Fluid intake

Antibiotics

Nephrotic Syndrome Description

Damage to the basement membrane of the glomerulus Characterized by high levels of protein in urine, low levels

of protein in blood, hyperlipemia, lipiduria

Etiology Glomerulonephritis Diabetes SLE Neoplasms Drugs

Nephrotic Syndrome, Cont’d Signs & Symptoms

Edema Shortness of breath Ascites (fluid in peritoneal cavity) Hypertension Pallor & fatigue Depression sets in Loss of appetite

Nephrotic Syndrome Diagnosis Diagnosis

Urinalysis Color red & cloudy Proteinuria ↑WBCs,RBCs & casts Findings of oval fat

bodies in urine Elevated BUN & Creatinine

Treatment Diuretics Corticosteroids

Prognosis Can progress to end-

stage renal disease.

End-Stage Renal Disease Description

Also known as chronic renal failure (CRF) Progressive deterioration of kidney function due to gradual

loss of nephrons Etiology

Diabetes Hypertension Chronic glomerulonephritis Pyelonephritis Polycystic kidneys Toxic agents Infections (i.e. bacterial, sexually transmitted diseases,

abscesses)

End-Stage Renal Disease, Cont’d

Symptoms Unintentional weight loss Nausea & vomiting Fatigue & Headaches Generalized itching (pruritus)

Diagnosis Elevated serum creatinine, Elevated BUN & potassium

levels Proteinuria & Broad Casts in

urine GFR – 0 – 30 mL/minute

Broad Cast

End-Stage Renal Disease, Cont’d

Treatment Dialysis

Peritoneal Hemodialysis CRRT (Continuous

Renal Replacement Therapy)

Kidney Transplantation

End-Stage Renal Disease, Cont’d

Kidney Transplant

Acute Tubular Necrosis (ATN)

Rapid destruction or death of tubular cells,

results when tubular cells do not get enough oxygen (ischemic ATN)

or when they have been

exposed to a toxic substance (nephrotoxic ATN).

Acute Tubular Necrosis, Cont’d

Etiology of Ischemic ATN: Hypotension (low blood pressure) Obstetric (birth-related) complications Obstructive jaundice (yellow-tinged skin caused

by blocked flow of bile Sepsis (infection in the blood or tissues) Surgery (e.g., open heart surgery, repair of

abdominal aortic aneurysm)

Acute Tubular Necrosis, Cont’d

Etiology of Nephrotoxic ATN Toxins

Antibiotics such as streptomycin and gentamicin Cisplatin (anticancer agent used to treat late-stage

ovarian and testicular cancers) Sovents or heavy metals Radioisotopic contrast media Crush injury & Hemolytic Blood Transfusions

Muscle enzyme creatinine phosphokinase (CPK) & myoglobin leaks into the blood.

Acute Tubular Necrosis, Cont’d

Symptoms Oliguria Anuria Hyperkalemia Weakness, mental confusion, edema

Acute Tubular Necrosis, Cont’d

Diagnosis Very difficult to diagnose History of chronic illness, trauma, surgery, toxic

exposure, transfusion, pregnancy UA showing dilute urine, RBCs & casts Elevated serum BUN & Creatinine

Treatment Supportive until kidney improves Dialysis

Renal Calculi Description

Uroliths or kidney stones Calcium uric acid, cystine,

struvite

Etiology Dehydration Immobilization Excessive intake of calcium &

vitamin D Underlying diseases

Hyperparathyroidism Gout Neoplasms Urinary tract infections

Renal Calculi, Cont’d Symptoms

Flank pain Nausea, vomiting, chills

& fever Hematuria Abdominal distention

Diagnosis CT scan Excretory urography MRI

Treatment Increased fluid intake Ureteroscopic removal Percutaneous ultrasonic

lithotripsy Extracorporeal shock

wave lithotripsy Prevention

Adequate daily fluid intake

Regulating the diet Cranberry juice

Hydronephrosis

Description Distention of the renal pelvis &

calyces of a kidney due to pressure from accumulating urine.

Etiology Urinary tract obstruction Congenital stenosis of ureter Uroliths Neoplasms Enlarged prostates in males

Hydronephrosis, Cont’d

Symptoms Flank pain Nausea & vomiting Oliguia, anuria, hematuria Difficulty in voiding

Diagnosis Changes in urinary volume UA – hematuria, increased WBCs, Excretory urogram Renal & CT scans

Treatment Remove the obstruction

Congenital Defects of the Ureter, Bladder, and Urethra

Duplicated ureter – one or both kidneys have two ureter Retrocaval ureter – right ureter passes behind the inferior

vena cava before entering the bladder. Ectopic orifice of the ureter – ureteral opening inserts into the

vagina (females) or in the prostate or vas deferens (males) Stricture/stenosis of ureter – narrowing or partially closed ureter Ureterocele – bulging of ureter into bladder Exstrophy of the bladder – malformation in which the lower

portion of the abdominal wall & the anterior wall of the bladder are missing

Congenital bladder diverticulum – out-pouching (diverticulum) of bladder wall

Cystitis & Urethritis Description

Inflammation of bladder & urethra Etiology

UTI – urinary tract infections E coli, Enterobacter, Chlamydia, Neisseria

Symptoms Dysuria Urinary urgency & frequency Pain Cloudy, bloody, foul-smelling urine

Cystitis & Urethritis, Cont’d

Diagnosis Urinalysis ↑Protein & ↑ WBCs (NO CASTS) Urine Culture (Grows out organism) Renal scans X-rays CT scans

Treatment Antibiotics

Neurogenic Bladder

Description Loss or impairment of bladder function

Etiology Bladder nerve damage Spinal cord damage

Symptoms Urinary incontinence Inability to empty the bladder completely Difficulty starting & stopping

Neurogenic Bladder, Cont’d

Diagnosis (difficult to diagnosis) Cystourethrography Urine flow study Sphincter electromyelography

Treatment Catheterization Crede’s Method – manual suprapubic pressure

Tumors

Renal Carcinoma Wilm’s tumor – an adenosarcoma

THE END