15b - Urinary Flashcards
What are the main components of the urinary system?
The kidneys, ureters, bladder, and urethra
What is the primary function of the urinary system? (8)
To filter and eliminate wastes, regulate acid-base balance, maintain fluid and electrolyte balance, regulate blood volume and pressure, regulate blood glucose, activate vitamin D, and provide erythropoietin
How does the urinary system regulate blood volume and pressure?
Through the action of renin
What are 3 core considerations for kidney health?
Hydration
Moderate salt intake
Avoid high protein diets
Why is hydration essential for kidney health?
It allows efficient filtration and elimination.
Recommended intake is around 1.5–2 litres of filtered water daily, varying by constitution, climate, and physical activity.
What is the recommended daily intake of filtered water for kidney health?
Around 1.5–2 litres.
Individual requirements may vary based on constitution, climate, and level of physical activity.
What is the relationship between high salt intake and kidney health?
High salt is linked with immune cell activation and renal tissue remodelling, increasing the risk of kidney disease.
Moderate salt intake is recommended.
What effect does a high protein diet have on kidney health?
It increases nitrogenous wastes, raising kidney demand and GFR, which can damage kidney structures over time.
Animal protein increases the risk of kidney damage more than plant protein.
What are the nitrogenous wastes associated with high protein diets?
Urea, creatinine, uric acid.
These wastes increase the demand on the kidneys.
What are the potential risks associated with high protein diets?
Increased nitrogenous wastes, increased GFR, increased risk of kidney damage.
Also relates to increased acid load, phosphate, and gut microbiome disruption.
What do these urine colours indicate?
- Cloudy
- Frothy
- Red/pink
- Cloudy urine may
indicate an infection. - Frothy urine may be due to
proteinuria (and renal disease). - Red or pink urine could be due to haematuria (or eating beetroot!)
What does UTI stand for?
Urinary Tract Infection
What is the inflammation due to infection in the kidney called?
Pyelonephritis
What is the inflammation due to infection in the bladder called?
Cystitis
What is the inflammation due to infection in the urethra called?
Urethritis
What is the most common bacterial cause of UTIs?
Escherichia coli
What bacteria often cause UTIs (4)
- Escherichia coli
- Klebsiella pneumoniae
- Enterococcus faecalis
- Staphylococcus saprophyticus
What are the key signs and symptoms of Cystitis?
Dysuria, frequent/urgent urination, suprapubic pain/tenderness, foul-smelling/cloudy urine, haematuria, malaise, fever
Cystitis is an inflammation of the bladder often caused by infection.
What symptoms are associated with Urethritis?
Dysuria, urethral discharge (e.g., purulent, blood), pruritis (e.g., in men near the penile opening), change in voiding patterns
Urethritis is the inflammation of the urethra, typically due to infection.
What are the signs of Pyelonephritis?
Fever, chills, nausea, malaise, mild to extremely severe ‘loin’ discomfort, blood or pus in urine. May also have symptoms of lower urinary tract infection.
Pyelonephritis is a type of urinary tract infection that affects the kidneys.
Causes and risk factors for UTIs (9). Give explanations
- Women(8 x more prevalent) — shorter urethra ↑ the chance of bacteria ascending to the bladder.
- Menopause —low oestrogen = ↓ vaginal mucus
= ↓ monitoring of bacterial species in the area. - Pregnancy — mechanical pressure of the growing
uterus on the ureter and bladder preventing complete voiding. - Sexual activity (in weak terrain) — introduces new bacteria.
- Elderly — lowered immunity, decreased mobility, ↓ mucin (protects urinary epithelium), ↓ bacterial adherence, ↑ catheterisation.
- BPH —↑ risk; can obstruct urine flow causing bladder urinary stasis.
- Antibiotics — increases the likelihood of opportunistic bacteria proliferating and migrating into the urinary tract.
- Intestinal dysbiosis — bacteria can translocate from the perianal region and ascend to the genitourinary tract.
- ‘Gut-vagina-bladder axis’ — bacterial vaginosis (characterised by ↑ anaerobic bacteria e.g., Gardnerella vaginalis, ↓ Lactobacillus and an
alkaline vaginal pH) increases UTI risk. G. vaginalis can ascend into the urinary tract and appears to damage the bladder lining, while reactivating latent E. coli.
What are the dietary (not supplement) treatments for UTIs (7)
- Avoid simple sugars and refined carbohydrates:
negatively impact the microbiome, increase
inflammation and compromise immunity. - Avoid substances that irritate the urinary tract epithelium, in particular caffeine, diet soft drinks and alcohol (Caffeine and artificial sweeteners — shown
to increase detrusor muscle contraction contributing to urinary urgency and frequency) - Avoid red meat, pork and poultry — can act as reservoir for uropathogenic E. coli. Can also promote inflammation (arachidonic acid)
- CNM Naturopathic Diet: Plant-based diets are associated with ↓ incidence of UTIs: phytonutrients are antimicrobial, antioxidant and
anti-inflammatory. High fibre content may modulate microbiota, ↓ intestinal pH and prevent growth of E.coli and Enterobacteriaceae. - Prebiotic and probiotic foods — to optimise microbiota colonisation.
- Ensure optimal water intake to flush bacteria through the urinary tract (incl. herbal teas).
- Cranberry 15–30 ml unsweetened 100%
(undiluted) juice daily or 500 mg powder 3x day. Its proanthocyanins ↓ bacterial adhesion to the bladder epithelium
What nutritional supplements can be used to support a client with a UTI? (6) - give doses
- D-mannose (500mg every
2 hours for 3 - 5 days) - Vitamin A (5000 iu/ day)
- Vitamin C (500–5000 mg /
day in divided doses.) - Vitamin D ( Optimise levels)
- Zinc (15 mg: Preventative.
Up to 60 mg during
an acute infection.) - Probiotic (Lactobacillus spp.
As per label dose.
Probiotic powder can
be smeared directly
inside vaginal wall.)
How does D-mannose help in the treatment of UTIs
Binds type 1 fimbriae of uropathogenic E.coli, forming a physical ‘coating’ that prevents their binding to the urothelium.
* Shows benefit in treatment and prevention of recurrent UTIs.
What role does Vitamin A play in urinary tract health?
Maintains integrity and supports repair of the urinary tract mucous membrane. Supports lymphatic tissues and immune cells.
Enhances T-cell proliferation
What role does Vitamin C play in urinary tract health?
- Has immunostimulatory effects.
- Regulates lymphocytes,
phagocytes and natural killer cells. - Helps maintain integrity of the uroepithelial lining of the urinary tract
What is the role of Vitamin D in response to pathogen exposure?
- Promotes production of anti-microbial substances in the urinary epithelium.
- Strengthens innate mucosal immunity and deters pathogenic bacterial attachment to the uroepithelium
What effects does Zinc have on immune cells?
- Increases phagocyte, natural killer cell, T-and B-cell activity.
- Low levels are associated with increased risk of recurrent UTI
What probiotic is recommended for UTI support?
Lactobacillus spp.
Probiotic powder can be smeared directly inside the vaginal wall to suppress pathogenic colonisation.
How does the probiotic Lactobacillus spp. help in UTI prevention?
Suppresses pathogenic colonisation and modulates the immune system.
Maintains epithelial barrier integrity.
Includes production of antibacterial agents such as lactic acid and hydrogen peroxide.
What herbs help to treat UTIs (3). What is their mechanism?
How would you prepare them?
- Crataeva (Crataeva nurvala) — a bladder tonic — helps flush the urinary tract, reducing residual urine in which bacteria can flourish. ↓ UT inflammation. Especially indicated for recurrent UTIs.
- Bearberry (uva-ursi) — anti-inflammatory and a
urinary antiseptic (attributed to the urinary metabolite hydroquinone). - Cornsilk (Zea mays) — a mild diuretic and urinary demulcent
(soothes mucous membranes of the urinary tract).
5g herb infused in 500ml boiled water. Take 1/2 - 1 cup every 2-4 hours.
What is interstitial cystitis (IC)?
A chronic inflammatory condition of the bladder characterised by pain and a sense of pressure.
IC is not associated with infection and does not respond to antibiotic treatment.
Is interstitial cystitis associated with infection?
No, it is not associated with infection.
IC does not respond to antibiotic treatment.
In which gender is interstitial cystitis significantly more common?
Women.
It is thought that many men diagnosed with non-bacterial prostatitis may actually have IC.
What are some signs and symptoms of interstitial cystitis?
Mild to intense pressure/pain in bladder and pelvic area, urinary urgency and frequency, dyspareunia.
Petechial (pinpoint) haemorrhages are often visible on cystoscopy.
What type of haemorrhages are often visible on cystoscopy in interstitial cystitis?
Petechial (pinpoint) haemorrhages.
What are possible causes of intersticial cystitis?
- Injury to the protective glycosaminoglycan layer of the
bladder wall. Increases permeability, allowing potassium and chemical irritants in urine to damage underlying tissues. - Allergic — elevated IgE levels are observed in some cases of IC. Activation of mast cells ↑ histamine and cytokine release = pain.
- Neurogenic pain — excitation of sensory nerves triggers
inflammation through release of neuropeptides. Triggers include mast cell activation, stress, autoimmune events (e.g., SLE, IBD). - Alterations to the urinary microbiome — ↓ Lactobacillus species, ↓ microbial diversity and ↑ pro-inflammatory cytokines observed.
What is a food based (not supplement) approach to supporting patients with intersticial cystitis?
- Remove urinary irritants, reduce inflammation and promote microbial balance and diversity.
- Assess for food or environmental allergy / intolerance.
- Follow the CNM Naturopathic Diet emphasising
antioxidant-rich vegetables alongside anti-inflammatory
foods and herbs e.g., oily fish (EPA); turmeric, fresh ginger. - Include aloe vera juice (inner leaf gel) — inhibits COX and hence PG2; appears to increase production of glycosaminoglycans.
What nutritional supplements can be used to support clients with intersticial cystitis? (4) give dose.
- Quercetin ( 500 mg twice daily)
- N-acetyl glucosamine (1500–2000 mg 3 x daily).
- Chondroitin (200–400 mg 3 x daily)
- Probiotics (dose per label)
How does Quercetin support clients with intersticial cystitis?
- Anti-allergic; inhibits histamine release from mast cells.
- Anti-inflammatory; downregulates NF-κB
and inhibits LOX and COX. - Shown to provide significant improvement in IC symptoms
How do N-acetyl
glucosamine and
Chondroitin support clients with intersticial cystitis?
- Increase glycosaminoglycan synthesis in the bladder
improving mucous membrane integrity. - Reduces inflammation by inhibiting inflammatory cytokine formation.
What herbs can be used to support clients with intersticial cystitis? (give dose & mechanisms) (2)
- Marshmallow root - demulcent, helping to soothe irritation in the urinary tract and relieve pain. Infuse 1 teaspoon in 150 ml boiled water, 3 x daily.
- Gotu kola — improves integrity of connective
tissue and heals bladder ulcerations. 500 mg, 2 x daily.
What are urinary calculi?
Formation of crystalline salts and organic matter in the kidney and bladder (gravel).
What symptoms may urinary calculi cause?
May be asymptomatic or cause debilitating pain (renal colic) if a stone lodges in a ureter. Other symptoms include nausea, vomiting, fever.
What is the most common type of urinary stone?
Calcium oxalate.
List the main types of urinary stones.
- Calcium oxalate
- Calcium phosphate
- Uric acid
- Struvite stones
What causes struvite stones?
Most often caused by chronic bacterial infection, which increases alkalinity of urine
What are the key causes & risk factors of urinary calculi and how do they cause stones? (5)
- Dehydration — urine becomes too concentrated allowing minerals and other compounds to precipitate out of solution, forming crystals.
- Dietary acid load (animal protein, dairy, soft drinks i.e., phosphoric acid) - increase urinary calcium, decrease citric acid and increase uric acid
- High table salt intake — increases urinary calcium
- A diet low in fibre, high in refined carbohydrates and alcohol.
- Excessive calcium supplementation with low vitamin K2 status
(not storing calcium in bones)
What is the food (not supplement) approach to urinary calculi? (7)
- Increase fluid intake (at least
8 glasses daily.) - Alkalise with a plant-based diet high in chlorophyll. Regular green juices / smoothies.
- Reduce animal proteins and high purine foods.
- Reduce salt intake (i.e., table salt),
- Avoid alcohol (↑ uric acid).
- Increase potassium-rich foods (fruit and vegetables) to reduce urinary calcium.
- Avoid oxalate-rich foods such as spinach, rhubarb, strawberries, beetroot, almonds and cashews.
- Stinging nettle leaf (Urtica dioica) has diuretic properties and is alkalising. Use
as a tea: 1 tsp per cup, 3 cups per day. Combine with demulcent herbs to lubricate the urinary tract (e.g., marshmallow root) - Lemon juice 1 teaspoon every ½ hour for two days can help to soften stones. The citric acid component binds to calcium to promote excretion.
What nutritional supplements can be used for urinary calculi?
- Magnesium (600 mg / day) as citrate — ↑ the solubility of calcium oxalate
- Pyridoxine (B6) (25 mg / day) — reduces endogenous production and urinary excretion of oxalates.
- Folate (B9) (5 mg / day) — for uric acid stones. ↑ purine scavenging and
xanthine oxidase inhibition, resulting in ↓ uric acid production.
What can be applied topically for all urinary conditions to give relief?
Castor oil packs can be applied to reduce inflammation and decrease pain
