Renal and Urologic Systems Flashcards
Structures associated with excretion of urine
Upper urinary tract: kidneys and ureters
Lower urinary tract: bladder and urethra
The kidney serves as both an endocrine _______ and a target of endocrine ________, with the aim of controlling mineral and water balance.
System; Action
Kidney’s main function
Filter waste products and remove excess fluid from the blood
Functions of the renal system
- Regulation of H2O and electrolyte balance
- Regulation of systemic BP and extracellular fluid volume
- Excretion of metabolic waste and foreign substances
- Regulation of red blood cell production
- Regulation of acid-base balance
- Regulation of vitamin D production and regulation of calcium and phosphate balance
- Gluconeogenesis
Renin Angiotensin Aldosterone System
- Start: Drop in BP and blood volume
- Renin release from kidney
- Liver angiotensinogen acts with renin to form angiotensin I
- Angiotensin-converting enzyme (ACE) release from lungs acts on angiotensin I to form angiotensin II (vasoconstrictor)
- Angiot II acts on the adrenal gland to stimulate aldosterone
- Aldosterone acts on kidneys to stimulate reabsorption (retain) of salt and water
- Finish: BP increases
8.Hypothalamus signals post pituitary gland to release antiduretic hormone to reabsorb Na+ which will pull water increasing BP
What effect does aging have on the renal and urologic system?
~Aging comes with a gradual reduction of blood flow to the kidneys, coupled with a reduction in nephrons
~Kidneys become less efficient at removing waste from the blood, and the volume of urine increases somewhat with age
Urinary tract infections (UTI)
~Common, affecting men, women, and children
~Bladder and urethra usually involved
~Bacteria can spread to kidneys =more serious infection (Pyelonephritis)
~UTIs in men, pregnant women, children, and clients who are hospitalized or in a long-term care setting can be considered complicated
UTI Incidence and Prevelance
~Women and older adults comprise the majority of cases
~Those living in skilled nursing facilities, assisted living arrangements, or extended care facilities, UTI 2nd most frequent type of infection and the most common cause of hospitalization
UTI Etiologic and Risk Factors
~Most UTIs occur in adult women (shorter urethra)
~Bacteria that result in most UTIs are acquired from the large bowel (fecal flora)
~The urethral meatus is close to the fecal reservoir and rectum
~Risk factors: Hx of UTI, increased sexual activity, pregnancy, indwelling catheterization, diabetes, and more
UTI Pathogenesis
~Fecal-associated gram-negative organisms responsible for UTI
—->Escherichia coli accounting for approximately 80%
~Common UT pathogens are able to adhere to the urinary tract mucosa, colonize, and cause infection
~The most common route of entry of bacteria into the urinary tract is ascending up the urethra into the bladder
~Rare: infections may be bloodborne or acquired via the lymphatic system
UTI Clinical Manifestations
~Frequency, urgency, dysuria, nocturia, and, in children, enuresis
~Fever, chills, malaise, cloudy, bloody, or foul-smelling urine and a burning or painful sensation during urination or intercourse
~In kidney: diaphragm irritated - ipsilateral shld or LBP
~In older: malaise, anorexia, and mental status changes (especially confusion or increased confusion)
Renal Calculi
(Kidney Stones)
~3rd most common urinary tract disorder
~Crystalline and range from popcorn kernel shapes to jagged starbursts, and can cause urinary obstruction and severe pain
~4 basic types of stones are calcium (oxalate and phosphate)***, struvite, uric acid, and cystine
Renal Calculi Incidence
~Approximately 5% of adults, with men being affected more frequently than women, 6% vs. 4%, respectively
~Age span - 30-60 years for men, 20-30 for women
~Areas w/ high temp and humidity / during summer
Renal Calculi Etiologic and Risk Factors
~Disorder w/ overexcretion and hypersaturation of calcium/oxalate
—->Idiopathic hypercalciuria, renal tubular acidosis, 1ry hyperparathyroidism and hyperoxaluria
~Acidic urine, Gout
~Incidence of obesity in women
~Excess intake of calcium, sodium, sucrose, and animal protein
~Lack of sufficient calcium and potassium
Renal Calculi Pathogenesis
~Crystals are able to stay dissolved in the urine until it becomes oversaturated
~Crystals come out of solution into a solid and begin to grow around a particle, or nucleus
~Crystals then grow at a rate depending on the saturation of the urine
Renal Calculi Clinical Manifestations
~Acute “colicky” flank pain radiating to the groin or perineal areas with hematuria (blood in urine)
~Extreme back pain
~Nausea and vomiting
~Smelly urine and burning feeling when urinating
Chronic Kidney Disease (CKD)
~Kidney function decreased
~Impairment of glomerular filtration results in renal insufficiency or failure
~Risk factors: DM, HTN, CVD, and Obesity
~CKD is classified according to the severity of kidney function decline
Classification of CKD Stages 1-5
G1 Normal ≥90
G2 Mildly decreased 60-89
G3a Mildly to moderately decreased 45-59
G3b Moderately to severely decreased 30-44
G4 Severely decreased 15-29
G5 Kidney failure<15
Cardiovascular Complication of CKD
~CKD increases risk of major CV events
~Patients on dialysis - 40% have evidence of CAD and 85% have abnormal LV structure and mass
~HTN is both a cause and a consequence
~Accelerated atherosclerosis
~Heart failure is prevalent
~
Pulmonary complication of CKD
~Pulmonary edema is most serious problem***
~Fibrinous pleuritis
~Pulmonary calcification
~Treatment of ESRD (hemodialysis) associated with pulmonary complications - decrease in arterial PaO2
~Peritoneal dialysis associated w /pleural effusions and elevated diaphragm
Treatment of CKD
~Goals include retard the rate of progressive deterioration in renal function, minimize complications of CRF
~Preventive measures using medications
~Primary and secondary prevention of CVD
~Renal replacement therapy using hemodialysis or peritoneal dialysis
~Kidney transplantation