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Patho > Renal and Urologic Systems > Flashcards

Renal and Urologic Systems Flashcards

1
Q

Structures associated with excretion of urine

A

Upper urinary tract: kidneys and ureters
Lower urinary tract: bladder and urethra

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2
Q

The kidney serves as both an endocrine _______ and a target of endocrine ________, with the aim of controlling mineral and water balance.

A

System; Action

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3
Q

Kidney’s main function

A

Filter waste products and remove excess fluid from the blood

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4
Q

Functions of the renal system

A
  1. Regulation of H2O and electrolyte balance
  2. Regulation of systemic BP and extracellular fluid volume
  3. Excretion of metabolic waste and foreign substances
  4. Regulation of red blood cell production
  5. Regulation of acid-base balance
  6. Regulation of vitamin D production and regulation of calcium and phosphate balance
  7. Gluconeogenesis
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5
Q

Renin Angiotensin Aldosterone System

A
  1. Start: Drop in BP and blood volume
  2. Renin release from kidney
  3. Liver angiotensinogen acts with renin to form angiotensin I
  4. Angiotensin-converting enzyme (ACE) release from lungs acts on angiotensin I to form angiotensin II (vasoconstrictor)
  5. Angiot II acts on the adrenal gland to stimulate aldosterone
  6. Aldosterone acts on kidneys to stimulate reabsorption (retain) of salt and water
  7. Finish: BP increases
    8.Hypothalamus signals post pituitary gland to release antiduretic hormone to reabsorb Na+ which will pull water increasing BP
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6
Q

What effect does aging have on the renal and urologic system?

A

~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

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7
Q

Urinary tract infections (UTI)

A

~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

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8
Q

UTI Incidence and Prevelance

A

~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

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9
Q

UTI Etiologic and Risk Factors

A

~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

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10
Q

UTI Pathogenesis

A

~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

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11
Q

UTI Clinical Manifestations

A

~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)

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12
Q

Renal Calculi
(Kidney Stones)

A

~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

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13
Q

Renal Calculi Incidence

A

~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

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14
Q

Renal Calculi Etiologic and Risk Factors

A

~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

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15
Q

Renal Calculi Pathogenesis

A

~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

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16
Q

Renal Calculi Clinical Manifestations

A

~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

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17
Q

Chronic Kidney Disease (CKD)

A

~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

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18
Q

Classification of CKD Stages 1-5

A

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

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19
Q

Cardiovascular Complication of CKD

A

~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
~

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20
Q

Pulmonary complication of CKD

A

~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

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21
Q

Treatment of CKD

A

~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

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22
Q

Exercise and CKD

A

~Patients with CKD have impaired exercise tolerance and reduced muscle strength/endurance
~Limiting symptom is skeletal muscle fatigue, notable skeletal muscle atrophy and weakness
~Patients with ESRD, compliance is highest when exercise sessions are performed during
dialysis
~Resistance training is recommended
~Combined aerobic exercise and resistance training augment benefits

23
Q

Clinical implications for physical therapy with CKD

A

~Patients are often debilitated and have poor tolerance for activity
~Major contributing factor is physical inactivity
~Laboratory values should be reviewed prior to each treatment, specific to Hgb, Hct, glucose, potassium,
calcium, creatinine and BUN, WBC, platelets
~Training should be a combination of aerobic and resistance training
~Additional parameter should be timing of exercise

24
Q

Glomerular Disease (GFR)

A
  1. Kidney fails - GFR decreases, increasing phosphate and calcium retention
  2. Increased parathyroid hormone (PTH) secretion, PTH mobilizes calcium from the bones (bone reabsorption) and facilitates phosphate excretion. This release of calcium and phosphate into the blood results in hypercalcemia.
  3. As kidney failure progresses, the damaged kidneys can no longer convert vitamin D to its active form and without active vitamin D, calcium absorption in the intestines is decreased and paradoxically facilitates phosphate retention.
  4. Thus the normal process of bone mineralization with calcium and phosphate is impaired
25
Q

Glomerular Diseases
Implications for PT

A

manifestations of glomerulonephritis (e.g., edema, hypertension, hematuria, oliguria) is important, and their presence warrants referral of the client to a physician
~Clients with diabetes, systemic lupus erythematosus, vasculitis, and hypertension

26
Q

Side effects with diuretics

A

muscle weakness, fatigue, muscle cramps, headaches, increased frequency of urination with possibility of incontinence, and depression
~impact in PT

27
Q

Bladder Cancer

A

~Transitional cell carcinoma is the most common type of bladder cancer, accounting for 90%
~Heterogenous group -wide spectrum of aggressiveness and clinical manifestations
~Unusual- Squamous cell carcinoma accounts for 8% - results from chronic inflammation
~Adenocarcinoma, accounts for 2% of cases - arise from remnants of the embryologic urachus (ligaments)

28
Q

Bladder Cancer Etiology and Risk Factors

A

~Smoking #1 risk factor (75%)
~Occupational exposures to chemicals (20%)
~More men than woman - Age: older than 55
~White more than black
~Decreased fluid intake
~Chronic inflammation

29
Q

Bladder Cancer Pathogenesis

A

~Arise from epithelial, mesenchymal, or hematopoietic tissues - majority from the epithelium
~reversible premalignant stages followed by irreversible steps, ending in invasive cancer that can give rise to distant metastases

30
Q

Bladder Cancer Clinical Manifestations

A

~Painless hematuria (blood in urine)
~Clots may form and cause urethral blockage, with resultant bladder enlargement and painful spasms ~Intermittent pattern of bleeding can result in a delay in diagnosis
~Frequency, urgency, and dysuria
~Overactive bladder (common in women)
~Lymphedema

31
Q

Normal Bladder Function

A

~Involves a complex interplay of nerves, smooth muscle, and skeletal muscles
~Starts w/ Neural control: cortex (nerve signals)
~Parasympathetic nerves innervate the bladder wall via the pelvic nerve
~Bladder is designed to hold a pint of urine for several hours
~Coordinated detrusor smooth muscle contraction with relaxation of the smooth muscle internal urethral sphincter and skeletal muscle of the external urethral sphincter is necessary to empty effectively
~Voiding min of 2h for elderly and 3-5h for others

32
Q

Urinary Incontinence (UI)

A

~Complaint of involuntary urine loss
~8 categories; 2 more common
~Stress urinary incontinence (SUI) and Urgency Urinary incontinence (UUI)
~More than one type in incontinence - mixed UI
~Contributory factor to falls in older adults,29 pressure sores, skin breakdown, UTIs, institutionalization, depression, and isolation

33
Q

SUI

A

~complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing.
~Occurs during activities that increase intraabdominal pressure

34
Q

UUI

A

~complaint of involuntary loss of urine associated with urgency
~Urgency is the report of a sudden compelling desire to urinate that is difficult to defer
~Respond to triggers (running water, arriving home)

35
Q

UTI Prevalence and Risk Factors

A

~Prevalent more in women (aging/young) then men
~Athletes (gymnasts, athletes on trampolines, powerlifters)
~Risk factors: Obesity (high BMI), age, pregnancy, pelvic surgery, DM, race (white)

36
Q

UTI Pathogenesis and Clinical Manifestantions

A

~UUI: Irritated sensory signals from overactive PFM, bacteria of UTI, fear of leaking, other psychologic factors
~SUI: weakness or loss of tone in the PFM, internal urethral sphincter failure, hypermobility of the ureterovesical junction, or damage to the pudendal nerve

37
Q

Neurogenic Bladder Disorders

A

~Voiding dysfunction associated with neurologic pathology - Neurogenic lower urinary tract dysfunction (NLUTD)
~NO ONE ACCEPTED SCALE OR CATEGORY
~Neurogenic acontractile detrusor, neurogenic detrusor overactivity, and others
~Mixture of sensory and motor abnormalities, and symptoms may overlap

38
Q

Neurogenic Bladder Disorders
Prevalence

A

~ Older adult in long-term care
Cerebral palsy, 36%
*Dementia, 30% to 100%
*Parkinson disease, 37% to 70%
Multiple systems atrophy, 73%
Multiple sclerosis, 37% to 72%
Spinal stenosis, 61% to 62%
Spinal surgery, 38% to 60%
Disc disease, 28% to 87%
Diabetes mellitus, 25% to 87%
Radical hysterectomy, 8% to 57%
Guillain-Barré, 25%

39
Q

Neurogenic overactive bladder

A

urgency, with or without urgency urinary incontinence, usually with increased daytime frequency and nocturia in the setting of a clinically relevant neurologic disorder with at least partially preserved sensation

40
Q

Neurogenic acontractile detrusor

A

one that cannot be demonstrated to contract during urodynamic studies in the setting of a clinically relevant neurologic lesion

~urinary retention which usually manifests as overflow leakage because the bladder is so full a small increase in intraabdominal pressure will cause urine leakage.

41
Q

Nonrelaxing urethral sphincter

A

a nonrelaxing, obstructing urethral sphincter resulting in reduced urine flow

42
Q

Detrusor-sphincter dyssynergia (DSD)

A

describes a detrusor contraction concurrent with an involuntary contraction of the urethral and/or periurethral striated muscle. Occasionally flow may be prevented altogether

43
Q

Neurogenic Bladder Disorders
Etiologic Factors

A

~cerebrovascular accident, dementia, Parkinson disease, multiple sclerosis, and brain tumors
~2ndary to spinal cord lesions

44
Q

Neurogenic Bladder Disorders

A

Suprapontine lesions
Lesions in the spinal cord
Sacral spinal cord lesions
Diabetic cystopathy

45
Q

Suprapontine lesions

A

loss of voluntary inhibition of voiding and a neurogenic overactive bladder, but coordinated sphincter function is retained

46
Q

Lesions in the spinal cord

A

~Detrusor sphincter dyssynergia (DSD) - sphincter remains closed while the bladder contracts resulting in urinary retention and incomplete voiding
~High bladder pressure and ureteral reflux can lead to kidney damage.
~ loss of sympathetic inhibition

47
Q

Diseases that can result in DSD

A

ischemia, multiple sclerosis, myelodysplasia, and trauma

48
Q

Sacral spinal cord lesions

A

~Neurogenic acontractile detrusor
~Underactivity in PFM dysfunction
~Both the bladder and PFM are weak

49
Q

Diabetic cystopathy

A

~50% of people with diabetes
~includes impaired bladder sensation, increased postvoid residuals, increased bladder capacity, and decreased bladder contractility

50
Q

Neurogenic Bladder Disorders
Clinical Manifestations

A

~Complications: UTIs, kidney stones, deterioration in renal function
~Symptoms: partial or complete urinary retention, incontinence, urgency, suprapubic pain, or frequent urination

51
Q

Interstitial Cystitis (IC)/Painful Bladder Syndrome (PBS)
Overview and Incidence

A

~PBS - Persistent or recurrent chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as an urgent need to void or urinary frequency
—>Subgroup - IC (needs specific diagnosis)
~Incidence of PBS/IC are unavailable because of a lack of uniform definitions and inconsistent terminology

52
Q

IC / BPS Etiologic and Risk Factors

A

~Not identified
~Coexistent: gastritis, child abuse, fibromyalgia, anxiety disorder, headache, esophageal reflux, unspecified back disorder, depression, allergic reactions, vulvodynia, and irritable bowel syndrome

53
Q

IC / BPS Pathogenesis

A

~Unclear, related to several factors:
—>Altered permeability of the bladder wall, overactivity of the PFM and visceromuscular reflex, and hypersensitivity and neurologic irritation

54
Q

IC / BPS Clinical Manifestation

A

~Symptoms may increase with physical/emotional stress, acid foods, travel, or intercourse.
~urinary urgency and frequency

Patho (13 decks)

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