HLTH urinary system review Flashcards
transport/tubular maximum
is the limit on reabsorption in the kidneys and for glucose it is 310mg/min
where does the renal artery pass through?
the renal pelvis
obstruction in the kidneys
can be dangerous because no anastomoses exist begin vessels in the kidneys, therefore obstruction may cause necrosis and infarction may occur
3 mechanisms that control vasoconstriction in the renal vessels
local autoregulation, SNS, and RAAS
causes of incontinence
diabetes, pregnancy, childbirth, enlarged prostate, weak pelvic floor muscles, UTIs, diseases like parkinson’s and MS, injuries to the spinal cord, and severe constipation
enuresis
means involuntary urination by children after ages 4-5 when bladder control is expected
stress incontinence
occurs when abdominal pressure on the bladder causes incontinence due to coughing, laughing, lifting, or in women who have had a child
overflow incontinence
occurs often in the elderly or those with a spinal cord injury and is due to an incompetent bladder sphincter
retention
is an inability to empty the bladder and may be accompanied by overflow incontinence; can be due to a spinal cord injury that blocks the micturition reflex or following anesthesia
normal urine characteristics
clear, straw-coloured, and mild odor; pH ranges from 4.5 to 8
cloudy urine meaning
can indicate large amounts of protein, blood cells, or bacteria
dark colour urine meaning
hematuria (blood in the urine), very concentrated, or excessive bilirubin content
unpleasant odor of urine meaning
can indicate an infection
what does blood in the urine mean?
small amounts indicate infection, inflammation, or tumors; large amounts indicate blood cells can indicate a hemorrhage in the tubules or inadequate filtration
what does protein in the urine mean?
filtration is inadequate, causing albumin and other proteins to have leaked through the glomerulus
urinary casts in the urine meaning
these are microscopic molds of the tubules and can indicate inflammation of the tubules
elevated serum urea meaning
failure to excrete nitrogenous wastes and the GFR was decreased
what can anemia mean in regards to kidney function?
decreased erythropoietin secretion or bone marrow depression due to accumulated wastes
antistreptolysin O serum levels
are used to diagnose poststreptococcal glomerulonephritis
renin serum levels meaning
can indicate hypertension
what are diuretics prescribed for?
hypertension, edema, pulmonary edema, liver disease, CHF, and renal disease
most common type of diuretic
those that inhibit NaCl reabsorption, ex. hydrochlorothiazide or furosemide
side effects of diuretics
loss of electrolytes, often potassium, which may cause muscle weakness or arrhythmias; also common is frequency in the morning, orthostatic hypotension, and dry mouth
example of a potassium sparing diuretic
spironolactone
dialysis
is providing an artificial kidney that functions to sustain life, often after acute renal failure; 2 types
diet and dialysis
is very restricted, particularly protein, electrolytes, and fluid
2 types of dialysis
hemodialysis and peritoneal dialysis
hemodialysis
is provided in a hospital or from home and is taking blood from an artery and filtering it through a machine where the exchange of wastes, fluid, and electrolytes takes place, and returning it back through a vein
membrane name in hemodialysis
dialysate and this is impermeable to proteins and large molecules as the glomerulus is
what medication is given to patients on hemodialysis?
heparin to prevent clotting
how often does a patient require hemodialysis
3 times a week for about 3-4 hours
risks associated with hemodialysis
infection (HIV or hep C and B), blood clots, and damage to the shunt (causes new sites to be taken)
peritoneal dialysis
can be done in a dialysis unit or at home and the peritoneal membrane is used as the filter of wastes through inserting a catheter here, then the dialysate is drained into a container
continuous ambulatory peritoneal dialysis
refers to dialysis done at home during the night
hemodialysis vs peritoneal dialysis
peritoneal takes longer but the electrolyte changes are less noticeable for the patient
risks during peritoneal dialysis
infection to the peritoneal cavity, causing peritonitis
cortical radiate vessel textbook name
interlobular
2 infections of the lower urinary tract
cystitis or urethritis
infection of the upper urinary tract
pyelonephritis
what are most urinary tract infections?
ascending, meaning then make their way up the continuous mucosa of the urinary tract
most common UTI infective agent
E coli
risk of UTIs in men
older men who have prostatic hypertrophy causing stasis of urine
risk of UTIs in the elderly
incomplete emptying, reduced fluids, immobility, and impaired blood supply to the bladder
risk factors for UTIs
retention of urine, obstruction of urine, incomplete emptying, scar tissue, pregnancy, catheters, and renal calculi
how does the bladder appear during cystitis and urethritis?
red, swollen, ulcerated, and bladder capacity is reduced
causes of cystitis
is most often bacterial but can also be due to radiation, drugs, or irritating products like feminine hygiene or a catheter
causes of urethritis
often is an STI but can also be from a catheter or chemicals
two types of urethritis
gonococcal urethritis and nongonococcal urethritis
gonococcal urethritis
is from neisseria gonorrhea and is transmitted sexuallay
nongonococcal urethritis
is from anything other than neisseria gonorrhea and often is chlamydia trachomatis
signs of cystitis and urethritis
pain in the lower abdomen, dysuria, urgency, frequency, nocturia, fever, nausea, reactive arthritis, conjunctivitis, and cloudy urine with microscopic hematuria
pyelonephritis
is an infection of the kidneys and the ureter, including the renal pelvis and medulla; purulent exudate and necrosis may be seen, and the kidney is inflamed, possibly obstructing the flow of blood
risk of recurrent pyelonephritis
scar tissue may form and obstruct the flow of blood
signs of pyelonephritis
more marked systemic signs, dysuria, dull aching pain in the lower back, and urinary casts are present in urinalysis
role of cranberry juice and UTIs
is a prophylactic measure and inhibits the E coli bacterium from adhering to the bladder mucosa
poststreptococcal glomerulonephritis
follows strep throat by an infection from a group A beta-hemolytic Streptococcus; this develops due to antibody-antigen complexes lodging in the glomeruli and initiating a new inflammatory response in both kidneys
antibodies present in poststreptococcal glomerulonephritis
IgG and C3 (complement)
complications of poststreptococcal glomerulonephritis
obstruction of filtrate forming, causing high levels of serum waste, acute renal failure, and hypertension due to renin secretion
signs of poststreptococcal glomerulonephritis
dark and cloudy urine, facial and abdomen edema that spreads, back pain, high BP, urine output decreases, and systemic inflammation signs
nephrotic syndrome
is often secondary to renal diseases and systemic disorders and is due to an abnormality in the glomerulus, causing increased permeability, resulting in hypoalbuminemia and hypovolemic shock (sometimes high BP); this leads to aldosterone secretion and hyperlipidemia
minimal change disease
is a primary nephrotic syndrome occurring in children aged 2-6
signs of nephrotic syndrome
frothy urine and massive edema that impairs respiratory function, eating, and general activity
common obstructions of the urinary system
tumors (benign prostatic hypertrophy is common in men), inflammation, scar tissue, stenosis, congenital defects, and renal calculi
renal calculi
can develop anywhere in the urinary tract and form when there is high amounts of insoluble salts and insufficient fluid intake causes concentrated urine
staghorn calculus
is a very large stone that forms in the renal pelvis and calculi and appears in the shape of a deer
nidus
is a large mass that continues to build up and forms the kidney stone; can be a calcium stone, uric acid stone, and these may also include cell debris and insoluble salts
renal calculi and infection
create high risk for infection due to obstructing urine and causing stasis of urine
hydronephrosis and renal calculi
renal calculi when in the ureters or kidney can cause this by causing dilation of calyces and atrophy or renal tissue
calcium stones
are phosphate, oxalate, or carbonate and form due to hypercalcemia, which may be due to a parathyroid tumor, vegetarian diets (high in oxalate), inadequate fluid intake, or alkaline urine
uric acid stones
are common due to gout, cancer chemo, or acidic urine
signs of renal calculi
small ones are asymptomatic but large ones will cause back/flank pain, renal colic (severe spasms from the back to the groin), nausea, pale skin, moist skin, and rapid pulse
hydronephrosis
occurs as a secondary problem often following a tumor, renal calculi, scar tissue, or prostatic enlargement; occurs when there is an obstruction causing backup pressure and dilation of the ureters and kidney, and may cause flank/back pain
renal cell carcinoma
is a malignant tumor (adenocarcinoma) arising from the tubule epithelium, often in the cortex; it tends to metastasize before it is diagnosed
common metastasis spots for renal cell carcinoma
lungs, liver, bone, or CNS
signs of renal cell carcinoma
painless hematuria, back/flank pain, a mass, weight loss, anemia, and possibly paraneoplastic syndrome or cushing syndrome
bladder cancer
is a malignant tumor often arising from the transitional epithelium, and often penetrates through the wall to metastasize
common metastasis spots for bladder cancer
pelvic lymph nodes, liver, and bone
signs of bladder cancer
hematuria, dysuria, and frequency
risk factors for developing bladder cancer
working with chemicals like dyes, aluminum, or rubber, as well as cigarette smoking
nephrosclerosis
involves vascular changes similar to atherosclerosis in the kidneys (thickening and hardening of walls) that reduces blood flow to the kidneys; this leads to ischemia, atrophy, and increased secretion of renin
causes of nephrosclerosis
diabetes, essential hypertension, or another disorder
vesicoureteral reflux
is a congenital disorder causing a defective valve in the bladder
agenesis
is a congenital disorder where one kidney never develops
hypoplasia
is a congenital disorder and is failure of the kidney to develop to normal size, usually unilateral
ectopic kidney
is a congenital disorder occurring when a kidney and its ureter out of position, common in the abdominal or pelvic cavity
fusion of the kidneys
is a congenital disorder when the 2 kidneys fuse to form a single, horseshoe shaped kidney where function remains normal
adult polycystic kidney gene
is an autosomal dominant gene located on chromosome 16
polycystic disease
is transferred as an autosomal recessive gene and manifests at birth, often causing a stillborn or death as an infant
adult polycystic kidney
is a genetic condition that often doesn’t manifest until about age 40 with chronic renal failure; occurs when multiple cysts develop on both kidneys and grow throughout the years, causing the kidneys first to enlarge, then compressing kidney tissue; may occur on liver as well
wilms tumor another name
nephroblastoma
wilms tumor
common in children and is due to defects in tumor suppressing genes on chromosome 11; usually is a unilateral mass that manifests as a mass on the abdomen and high BP
where does wilms tumor often spread to?
the lungs
characteristics of renal failure
inflammation and necrosis can cause back pressure and obstruction, leading to decreased GFR and no or little urine output
causes of acute renal failure
glomerulonephritis, severe and prolonged shock (burns and sepsis), nephrotoxins, and obstructions
how may burns cause acute renal failure?
damaged RBCs break down into the circulation and can cause obstruction in the tubules; hemoglobin is also toxic to tubules, causing further inflammation (myoglobin has a similar effect)
nephrotoxins
are those that cause tubule necrosis and obstruction and some are penicillin, sulfa drugs, phenacetin, NSAIDS, acetaminophen and aspirin
blood levels during acute renal failure
high levels of urea, creatinine, potassium, and metabolic acidosis
sign of recovery from acute renal failure
increased urine output
chronic renal failure
is the gradual, irreversible (due to scar tissue) destruction of the kidneys that occurs over a long period of time due to decreased nephrons; 3 stages are decreased reserve, renal insufficiency, and end stage renal failure
causes of chronic renal failure
bilateral pyelonephritis, polycystic disease, nephrotoxins, or systemic disorders like hypertension or diabetes
decreased reserve stage
GFR is decreased, serum nitrogenous wastes are high, and kidneys continue to adapt to the increase their capacity; no clinical signs
renal insufficiency stage
about 75% of nephrons are lost at this point and GFR is decreased to about 20%; nitrogenous wastes in the blood rise, BP rises, urine is less concentrated (large volumes of urine), and pH changes by the kidneys are impaired
end-stage renal failure
GFR is negligible (>90% of nephrons are lost), very high levels of waste in the blood, and marked oliguria (low urine output) or anuria develop
treatment for chronic renal failure
dialysis or a kidney transplant
early signs of chronic renal failure
polyuria, general signs like anemia, fatigue, nausea, etc., bone marrow depression, and high BP
late signs of chronic renal failure
oliguria or anuria, dry, itching, pigmented skin, decreased lipido, amenorrhea, encephalopathy, CHF, arrhythmias, failure to activate vitamin D, urine breath, and common infections
3 As of chronic renal failure
acidosis, azotemia, and anemia
azotemia
refers to high levels of uric acid or other nitrogenous wastes in the blood
