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(E) Alterations of Renal and Urinary Tract function
Patho 2
23
Medical
Undergraduate 2
06/04/2014

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Term
What are the functions of the urinary system?
Definition
- Conserves beneficial compounds while eliminating wastes.
- Regulates BLOOD VOLUME AND PRESSURE.
> adjusts the volume of water lost in the urine
> releases erythropoietin and renin
- Regulates plasma concentration of ions
> calcium, sodium, potassium, chloride, and other ions
- Contributes to the stabilization of * blood pH
- Assists the liver in detoxification
Term
Explain the formation of Urine
Definition
1. Blood enters the GLOMERULUS and its capillary network.
2. FILTRATION: blood pressure forces out fluids and solutes into the capsular space.
3. The filtrate enters the RENAL TUBULE OF THE NEPHRON:
> 4 regions that are different structurally and functionally
> the tubular fluid gradually changes its composition as it travels through these regions
4. Renal tubules empty into the COLLECTION SYSTEM
Term
What are the signs and symptoms of renal disease?
Definition
- Nausea/vomiting
> BUN = Blood Urea Nitrogen (Uremia = Increased BUN)
> Creatinine: Breakdown of creatine phosphate
- PU/PD
> Polyuria: Excessive Urine
> Polydipsia: Excessive thirst
Term
What are the different developmental abnormalities?
Definition
- Renal Agenesis
> Unilateral
> Bilateral
- Duplications
> Partial
> Complete
- Malpositions
> Failure to ascend
> Fusion of posterior poles
> Fusion of posterior pole to anterior pole
Term
Explain CONGENITAL POLYCYSTIC KIDNEY DISEASE
Definition
- Mendelian dominant
- Faulty development of renal tubules and collecting tubules
- Cysts gradually increase in size, causing enlargement of the kidneys
- Pressure from cysts --> necrosis of cells
- The expanding cysts compress and destroy adjacent renal tissue
- Renal failure develops
- May also develop hypertension:
> Become's obstructive, which puts pressure on renal blood vessels, decreasing blood volume to the kidneys, activating the renin-angiotensin mechanism
Term
Explain CYSTITIS
Definition
- INFLAMMATION of the urinary bladder
> Can be acute or chronic
- Normal urine in bladder is sterile, it's never sterile in the urethra
- Predisposing factors:
> conditions that impair free drainage of urine
> injury to the mucosa of the urinary tract
> introduction of a catheter or instrument
> sexual intercourse
> Neurogenic bladder
> diabetes mellitus
> poor hygiene
- Most common microorganism is: * E. COLI
- Incidence:
> Younger women: short, wide urethra -> Sexual intercourse
> Older men: prostate enlargement causes retention of urine
- Clinical signs:
> Hematuria: blood in the urine
> Stranguria/Dysuria: straining, painful urination
> Pollakiuria: Greatly Increased frequency in having to urinate (not the same as polyuria)
> Oligouria: Very small amounts of urine come out every time you have to pee
Term
Explain URETHRAL SYNDROME
Definition
- Symptoms of cystitis with a NEGATIVE URINE CULTURE
- usually in women 20-30 years of age
- Findings:
> dysfunction of the external sphincter
> vaginitis
> urethritis
> inflammation of the glands near the vagina and urethra
- Bacteria may develop up to 9 months after initial symptoms
- Treatment:
> meds that relax the external sphincter
> retraining voiding habits
Term
Explain VESICOURETERAL REFLUX
Definition
- Failure of the mechanism that prevents urine from flowing up into the ureters during urination
- Results in an incomplete emptying of the bladder.
- Predisposition to:
> cystitis: bladder infection
> pyelonephritis: kidney infection
Term
Expain ACUTE PYELONEPHRITIS
Definition
- A BACTERIAL infection of the RENAL PELVIS and MEDULLA of the KIDNEY.
> Could be UNILATERAL OR BILATERAL
- * Two different routes of infection:
> Ascending pyelonephritis (via ureters)
> Hematogenous pyelonephritis (via bloodstream)
- URINARY OBSTRUCTION and REFLUX OF URINE are the most common risk factors.
- Other risks: kidney stones, pregnancy, neurogenic bladder, instrumentation, female sexual trauma
- Pathophysiology: WBC's infiltrate into the medulla, renal edema, +/- abscesses
- Clinical signs: Acute infection, fever, lumbar pain, increased frequency of urination, dysuria, pyuria, and it's often concurrent with cystitis
- Micro: usually E. Coli, Proteus, or Pseudomonas
- Treatment: 2-3 weaks of antibiotics
- Injured areas of kidney heal with SCARRING
- Can lead to CHRONIC PYELONEPHRITIS which can lead to CHRONIC RENAL FAILURE.
Term
Explain a URINARY TRACT OBSTRUCTION
Definition
- An interference to flow of urine at any point.
- Examples: tumor, stones, trauma, edema, pregnancy, loss of peristalsis, prostatic enlargement
- Consequences depend on: location, unilateral or bilateral, partial or complete obstruction, acute or chronic onset, underlying cause
- * An acute, complete obstruction is a medical (and surgical) EMERGENCY
Term
Explain HYDROURETER/HYDRONEPHROSIS
Definition
- Progressive dilation proximal to the obstruction due to the pressure of retained urine
- Hydroureter = dilation of the URETER
- Hydronephrosis = Dilation of the renal PELVIS and CALYCES
- Distention of the calyces and pelvis in turn causes progressive, ischemic ATROPHY of the kidney
- Stagnation of urine predisposes to infection and stone formation
- Relief of acute total obstruction is followed by POST OBSTRUCTIVE DIURESIS.
Term
Explain CALCULI NEPHROLITHIASIS
Definition
- Stones can form anywhere in the urinary tract.
- Types:
> Calcium oxalate/phosphate
> Struvite (magnesium, ammonium, phosphate)
> Uric acid
> Cystine stones
- Contributing factors
> urine pH
> diet
> diseases
> drugs
- Stone begins to form around a NIDUS
- urine pH affects the solubility of many crystals
- * Many are < 5mm in diameter
- STAGHORN CALCULI (big calculi that completely fills renal pelvis and shaped like antler horns)
- Clinical Manifestations:
> pain
> hematuria
> X-ray: radiopaque or radiolucent
> IVP: contrast study
Term
Explain NEUROGENIC BLADDER
Definition
- FUNCTIONAL urinary tract obstruction caused by an interruption of nerve supply to the bladder
- Leads to bladder distention, urine retention, and incontinence (dribble's)
- Causes: multiple sclerosis, spinal cord tumor or injury, herniated disc, abdominal surgery
Term
Explain the different types of renal tumors
Definition
- RENAL ADENOMA
> uncommon and small
> encapsulated and near cortex
> can become maligant, but can be removed
- RENAL CELL CARCINOMA
> 5 year survival rate < 50%
> Usually unilateral and moves via lymph to the lungs, liver, LN, and bone
> asymptomatic or hematuria, lumbar pain, wt. loss
> Men 2x more likely to get it than women
> most common in the 50-60 age range
Term
Explain BLADDER TUMORS
Definition
- TRANSITIONAL CELL CARCINOMA'S
- Risk: Smokers, rubber, chemical, textile workers
- mets to LN, bone, lungs, liver
- Secondary bladder cancer:
> develops from invasion of nearby carcinomas (usually cervical or prostate cancer)
- asymptomatic OR hematuria
Term
Explain GLOMERULONEPHRITIS
Definition
- An INFLAMMATION of the glomeruli, which can be caused by a variety of factors:
> an immunologic abnormality (type II or III)
> ischemia or vascular disease
> free radicals, drugs, or toxins
> systemic diseases
- ** Glomerular disease is THE most common cause of renal failure.
- In all types, the PODOCYTES are disturbed, which changes the membrane permeability
Term
Explain IMMUNE-COMPLEX GLOMERULONEPHRITIS
Definition
- * Type III
- Acute glomerulonephritis
> starts as acute --> chronic
- Usually following a beta streptococcal infection
- Large immune complexes become trapped in the filtration slits of the glomeruli
- Activates complement and attracts WBC's
Term
Explain ANTIGLOMERULAR BASEMENT MEMBRANE GLOMERULONEPHRITIS
Definition
- * Type II
- Formation of auto-antibodies against the basement membrane (podocytes) of the glomerulus
- May also attack the basement membrane of the pulmonary capillaries (Goodpasture syndrome)
- --> Chronic glomerulonephritis
Term
Explain the clinical manifestations of GLOMERULONEPHRITIS
Definition
- HEMATURIA
> RBC casts
> brown, smoky tinged urine with no blood clots
> Acidic urine converts hemoglobin into METHEMOGLOBIN
- PROTEINURIA: especially albumin
- Decreased GFR (glomerular filtration rate) --> Fluid retention (oliguria) --> Increased BP
- Eventually renal insufficiency develops, and then nephrotic syndrome, and then finally end-stage RENAL FAILURE (polyuria)
Term
Explain NEPHROTIC SYNDROME
Definition
- Excretion of > 3.5 grams (gm) protein per day
> (up to 10 gm in 24 hours)
- Usually due to a glomerular injury
- LIVER is unable to produce enough proteins to compensate for the loss
- Other findings:
> Hypoalbuminemia --> Edema (oncotic pressure)
> Hyperlipidemia/Lipiduria: due to low protein levels
> Decreased vitamin D: due to loss of serum transport proteins and decreased vit. D activation by the kidneys
> Loss of immunoglobulins --> INCREASED SUSCEPTIBILITY TO INFECTIONS
Term
Explain RENAL DYSFUNCTION terms
Definition
- Renal Insufficiency: Renal function is down to 25% of normal
- Renal Failure: Less than 10% of total renal function remains
- Uremia: A SYNDROME/SYMPTOMS of renal failure that INCLUDES increased BUN and CREATININE.
> Accompanied by nausea, fatigue, anorexia, vomiting, pruritus, and neurologic changes
> Retention of toxic wastes, deficiency states, and electrolyte disorders
- Azotemia: Increased serum urea, BUN, and Creatinine on a lab report
> If you have uremia you also have azotemia, and vice versa
>> You can use azotemia to confirm uremia
Term
Explain ACUTE RENAL FAILURE (ARF)
Definition
- AKA Kidney Shutdown
- Usually, but not always associated with OLIGOURIA
- REVERSIBLE if treated early
> Phases: 1. Oligouria 2. Diuresis 3. Recovery
- Classified as:
> Pre-renal: Impaired renal blood flow
> Renal: Acute tubular necrosis
> Post-renal: Bilateral urinary tract obstruction
Term
Exlpain CHRONIC RENAL FAILURE (CRF)
Definition
- Progressive and IRREVERSIBLE loss of nephrons
- Kidneys can compensate for a long period of time and signs (uremia) do not begin until 25% of kidney function remains.
- Causes:
> 50% of cases are due to * GLOMERULONEPHRITIS
> 50% due to pyelonephritis, polycystic kidney disease, nephrosclerosis, diabetic nephropathy
- Other signs:
> PU/PD, nausea/vomiting, weakness, and lethargy, electrolyte and acid/base balance disturbances
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