PATHOPHYSIOLOGY OF URINARY SYSTEM

MED PREPJ.J. NELSON RN

URINARY SYSTEM TERMS

OLIGURIA ANURIA INCONTINENCE URINARY RETENTION ENURESIS MEATAL STENOSIS

UTI Urethritis, and Cystitis Extremely common Most infections are ascending Women are anatomically more

vulnerable Etiology: E.coli and other bacteria

UTI (cont.) S&S: Urinary urgency, frequency, dysuria,

incontinence, pelvic or low back discomfort, cloudy urine

DX: Clinical picture & UA (clean-catch) with C&S. Possible cystoscopy

TX: Antibiotics to correspond with sensitivity; increase fluid intake; teach to wipe front to back, avoid bubble bath and nylon underwear.

Animation of UTI

Health Animations - Diseases and Conditions - Urinary Tract Infection (UTI)

RENAL CALCULI (Urolithiasis) Kidney stones are formed by the

concentration of various mineral salts. (Calcium, magnesium or uric acid)

Frequently asymptomatic unless obstruction occurs

S&S with blockage or infection there is sudden severe pain in the flank area, urinary urgency, hematuria & fever. Straining urine can collect “stones”.

There are calcific densities in both kidneys that correspond to the location of the calyces. These form a cast of the right upper pole calyces.

Renal Calculi cont. Etiology: unknown, but a hereditary

tendency and past history is common DX: history, UA (+ blood and/or RBC’s)

renal ultrasound, IVP (or intravenous urogram)

TX:Pain relief during eval. Drink plenty of fluids and strain urine. Lithrotripsy or surgical removal of large stones.

Depending on the lithotripter used, the patient is submerged in warm water in a very large specially designed bathtub.   High resolution x-ray system and digital fluoroscopy assist in properly positioning the patient so the kidney stone receives the strongest impact of shock waves created by a special electrode.  These shock waves are created outside the body and then travel through the skin and tissue until they hit the dense stone.  The procedure is complete once the stone is in sandlike particles.

LITHROTRIPSY

Acute Glomerulonephritis Inflammation of glomeruli May be primary or develop

secondary to a systemic disease Etiology is usually post beta-

hemolytic strept. infection. (1-2wk) The injury to the glomeruli results in

increased capillary permeability and protein and RBC’s enter Bowmans Capsule

Acute Glomerulonephritis

Glomerulonephritis cont.

S&S: Flank pain, urine is dark and cloudy (due to proteinuria, hematuria), edema, decreased urine volume, HTN (due to increase renin secretion)DX: Clinical history,exam UA, elevated BUN, Sed Rate, KUB and/or USTX: Antibiotic, diuretics, Na restricted dietPX: Only 10% result in chronic glomerulonephritis = ESRD

PYELONEPHRITIS Inflammation of renal pelvis and

connective tissue of kidney Etiology: ascending infection (E-coli),

or calculi providing stasis of urine and resulting infection

S&S:rapid onset of fever, flank pain, N&V,H/O S&S of UTI, foul odor to urine, hematuria, pyuria.

Pyelonephritis cont. DX: Clean catch UA reveals WBC’s,

RBC’s, & protein. Urine C&S identifies the bacteria. X-Ray studies reveal kidneys that appear enlarged.

TX: IV antibiotics, increased fluids, PX: Chronic pyelonephritis causes

insidious damage with areas of obstructive scar tissue that promote continued infection and eventually renal failure.

Notice the enlargement of the right kidney

CHRONIC RENAL FAILURE CRF loss of nephrons with irreversible

loss of kidney function and uremia. Stages progress from decreased

glomeruli filtration, to insufficiency (significant retention of urea and creatinine in blood) to ESRD (uremia)

Result of infection e.g. glomerulonephritis, pyelonephritis, or polycystic kidneys

CRF Continued

S&S: All body systems will show effects.Early signs

weak, lethargicHTN & edema result from fluid retentionPolyuria and nocturia

As kidneys fail,uremic signs appear oliguria peripheral neuropathy CHF & arrhythmias At terminal stage: Uremic frost on the skin and urine odor to breath Systemic infections such as pneumonia

CRF Cont.

DX: Blood test show elevated BUN, serum creatinine

Decreased H&H.Grossly abnormal UAKUB, Renal US, kidney scans, IVP, renal

arteriogramTX: Complicated with multiple system involvement. Evaluation for kidney transplant and/or dialysis

In hemodialysis, the blood is allowed to flow, a few

ounces at a time, through a special filter that removes

wastes and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra

salt and fluids helps control the blood pressure and keep

the proper balance of chemicals like potassium

and sodium. It requires the patient to have

hemodialysis treatments three times a week for 3 to 5 or more hours each visit.

In Peritoneal Dialysis, a soft tube called a catheter is used to fill the abdomen with a dialysis solution. The peritoneum, allows waste products and extra fluid to pass from your blood into the dialysis solution. The solution contains a sugar called dextrose that will pull wastes and extra fluid into the abdominal cavity. These wastes and fluid then leave the body when the dialysis solution is drained. This treatment takes about 30 to 40 minutes. A typical schedule calls for four exchanges a day. Different types of PD have different schedules of daily exchanges.

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