Urinary Tract Disorders, Powerpoint
Urinary Tract Disorders, Powerpoint
Urinary Tract Disorders, Powerpoint
Overview
Incontinence and
Retention
Diagnostic Tests
Urinalysis
Blood tests
Other tests
Diuretic Drugs
Dialysis
Disorders of the Urinary
System
Urinary Tract Infections
Inflammatory Disorders
Glomerulonephritis
Urinary Tract
Obstructions
Urolithiasis
Tumors
Renal Failure
Acute
Chronic
Catheter
Diagnostic TestsUrinalysis
Constituents, characteristics of urine vary w/
dietary intake, drugs, care of specimen
Normally clear, straw-colored; pH 4.5-8.0
Appearance
Cloudy
Presence of lg amts protein, blood cells, bacteria, pus
Dark color
Hematuria (blood), excessive bilirubin, high concentration of
urine
Diagnostic TestsUrinalysis
Lg # RBC
Increased glomerular permeability or hemorrhage in tract
Protein (Proteinuria)
Leakage of albumin into filtrate
Inflammation, increased glomerular permeability
Urinary casts
Microscopic mold of tubules
Consists of one or more cells, bacteria, protein
Inflammation of tubules
Specific gravity
Ability of tubules to concentrate urine
Low is related to renal failure
RBC Cast
Metabolic acidosis
Indicates low GFR, failure of tubules to control acid/base balance
Anemia
Indicates low erythropoietin secretion and/or bone marrow depression
Due to accumulating wastes
Electrolytes
Antibody level
Antistreptolysin O (ASO) or antistreptokinase (ASK)
Renin levels
Indicate cause of hypertension
Clearance tests
Creatinine, insulin clearance
Used to asses GFR
Radiologic tests
Cytoscopy
Visualize lower UT
Can be used to perform biopsy or remove kidney stones
Biopsy
Acquire tissue specimen for microscopic analysis
Angiography, Ultrasound
CT
CT, MRI
Diuretic Drugs
Removes excess Na ion and water from body
Increase excretion of water thru kidneys and urinary vol
Take in morning
Prescribed for many disorders
Renal disease, hypertension, edema, CHF, pulmonary edema
Dialysis
Provides artificial kidney
Sustains life after kidney fails
Acute renal failure or end-stage renal failure (those
waiting for a transplant)
2 forms
Hemodialysis
Peritoneal dialysis
Hemodialysis
Hospital, dialysis center
Pts blood moves from implanted shunt in arm
artery tube machine exchange of
wastes, fluids, electrolytes
Semipermeable membrane separates pts blood from
dialysis fluid
Constituents move between the 2 compartments
Ex: wastes in blood dialysate
bicarbonate in dialysate blood
Blood cells, proteins remain in blood
Movement by ultrafiltration, diffusion, osmosis
Blood to pt vein
Hemodialysis
Heparin (anticoagulant)
Required 3Xs/week for 3-4 hrs
Potential complications
Shunt becomes infected
Blood clot forms
Blood vessels become damaged
Must move to new site
Peritoneal Dialysis
Peritoneal Dialysis
UTIEtiology
Females more anatomically vulnerable
Short urethra
Proximity to anus
Frequent irritation to tissues
Tampons, bubble bath, sexual activity
UTIEtiology
Incontinence
Bladder retention of urine
Obstruction of urine flow
Congenital abnormality
Pregnancy, scar tissue, kidney stones,
vesicourethral reflex
Urine does not flow freely
UTI: CystitisPathophysiology
Bladder wall and urethra inflamed, red, swollen
Decreased bladder capacity
UTI: Pyelonephritis
Pathophysiology
1 or both kidneys involved
Infection from ureter renal pelvis medullary
tissue (tubules and interstitial)
Purulent exudate fills kidney pelvis and calyces
Abscess and necrosis seen in medulla
May extend thru cortex to capsule
Severe may compress renal artery and vein and
obstruct urine flow to ureter
Bilateral obstruction results in acute renal failure
Urinalysis
Similar to cystitis
Except urinary cast
Leukocytes or renal
epithelial cells present
Involvement of renal
tubules
UTITreatment
Antibiotics (Bactrim)
Increase fluid intake
Especially cranberry juice
Tannin decreases ability of E. coli to adhere to
bladder mucosa
Inflammatory Diseases:
Glomerulonephritis
Pathophysiology
Severe inflammation
Congestion and proliferation interfere w/ filtration in kidney
Decrease GFR and retention of fluid and wastes
GlomerulonephritisSigns and
Symptoms
Back pain
Stretching renal capsule
GlomerulonephritisDiagnostic
Tests
Blood tests
High serum urea and creatinine and
decreasing GFR
Streptococcal antibodies, ASO, ASK
Metabolic acidosis
Low serum bicarbonate, low pH
Urinalysis
Confirms presence of proteinuria, erythrocyte
casts
GlomerulonephritisTreatment
Sodium restriction
Glucocorticoids
Antibiotics
Recovery w/ minimal damage
Imp to prevent further exposure to streptococcal
infection and recurrent inflam
Adults more difficult
Acute renal failure in 2%
Chronic glomerulonephritis in 10%
Gradually destroys kidneys
Frequently reoccur if
not treated
CalculiPathophysiology
Can develop anywhere in UT; lg or small
Once any solid material or debris forms
Tend to form when:
excessive amts of relatively insoluble salts are in filtrate
Insufficient fluid intake creates highly concentrated filtrate
Kidney StonesPathophysiology:
Types of Stones
Calcium stones
Form when calcium levels high in urine
Hypercalcemia
Urine pH alkaline
Calcium oxalate
Certain vegetarian diets
High levels of oxalate in urine
Kidney Stones
CalculiTreatment
Small stones eventually passed out
Larger stones
Extracorporeal shock-wave lithotripsy (ESWL)
Decreases need for invasive surgery
ESWL
Common after 50
More freq in males and smokers
Nephrotoxins
Drugs, chemicals, toxins
Aspirin, NSAIDs, penicillin
Mechanical obstruction
Calculi, blood clots, tumors
Block urine from leaving kidney
Systemic disorders
Hypertension
Diabetes
Stages
Renal Insufficiency
Stages
Uremia (End-stage renal failure)
+90% nephron loss
negligible GFR
Fluid, electrolytes, wastes retained in body
All systems affected
Oliguria or anuria
Regular dialysis or transplant needed to
sustain life
Early signs
Increase urine output (polyuria)
General signs
Increase wastes and altered blood chemistry
Bone marrow depression, impaired cell function
Increase bp
Uremic signs
Oliguria
Dry, hyperpigmented skin
Peripheral neuropathy (abnorm sensations in lower limbs)
Males impotence, decrease libido; females irreg menstrual cycle
Encephalopathy (lethargy, memory lapses, seizures, tremors)
CHF, arrhythmias
Failure of kidneys to activate vitamin D
Leads to hypocalcemia, osteodystrophy, osteoporosis, tetany
Azotemia
Presence of N wastes in blood
Severe anemia
Varying electrolyte levels
Depends on amt water retained