Urinary system disorders Flashcards
Objectives:
List and describe major renal and urinary disorders.
Explain the importance of fluid and electrolyte balance in the body.
Incontinence: loss of voluntary control of the bladder
Incontinence
- involuntary urination of a child after age 4 or 5
- Usually due to developmental delay, sleep pattern or psychosocial aspects
Enuresis
Increased intra-abdominal pressure forces urine through the sphincter
Occurs with lifting, laughing, coughing
More common in women with multiparity or age
Stress incontinence
- Due to an incompetent bladder sphincter
- May have incomplete emptying in elderly (poor function of detrusor muscle), have frequency and incontinence
- Neurogenic bladder: spastic or flaccid
Overflow incontinence
- Inability to empty bladder
- May have overflow incontinence
- SCI at sacral level: retention
- Anesthesia
- May have to use pads or use a catheter
- Catheters: can be a source of infection
Retention
- Diagnostic Tests
- Urinalysis
- Blood tests
- Cystoscopy
- Ultrasound
- CT
- MRI
bladder stuff
Blood tests
BUN
- Detects urea and nitrogen
- If high:
- CHF, intestinal bleeding, systemic shock, MI, burns, dehydration
May be normal during pregnancy
Creatinine clearance (if hi kidney aren’t functioning
Can kidney remove creatinine?
If high in blood, kidney not functioning well
CHF, kidney failure
urinary system
- Use when cannot void:
- Surgery, neuro conditions, medical procedures, labor
- Types of catheters
- Indwelling/foley
- Texas catheter
- Suprapubic
- Risk of infection
Catheterization
- Cystoscope
- Look at inside of bladder and urthera
- Can take biopsy, crush stones
- Radiological Tests
- IVP: die injected that outlines urinary tract
- KUB: xray(kidney urinary bladder)
- CT
- MRI
Other testing
for urinary system disorders
- Renal Biopsy
- Needle through skin into kidney
- Urinalysis
- Helps determine infection or disease
- C&S (culture and sensitivity)done to determine what medication would be effective
Other testing
urinary disorders
- Helps eliminate water and sodium from body
- Used to treat HTN, kidney disease, CHF, pulmonary htn, liver disease
- May affect potassium levels
Diuretic Medications
- Done if pt has end stage renal failure
- Usually a close relative
- Survival rate 97%
Renal transplant
- Works as an artificial kidney
- Used in acute renal failure for acute problem or for end-stage renal failure
Continuous ambulatory peritoneal dialysis (CAPD)
filtration of wastes occurs in abdomen while asleep with a catheder at home
Peritoneal dialysis
- blood is moved from implanted shunt/catheter to machine
- Machine removes waist, fluit, electolytes
- Uses ultrafiltration: blood is returned to patients vein
- always at facility
Hemodialysis (HD)
Etiology:
- Women more susceptible because of the size and shape of the urethra
- Men can develop UTI due to retention of urine (prostatic hypertrophy)
- Pregnancy, scar tissue, renal calculi can contribute to infection
- Immunosuppression, DM can also contribute
Urinary Tract Infections
- Infection of the bladder wall and urethra only
- Signs and symptoms: pain in the lower abdomen, dysuria, urgency, frequency, nocturia, fever, cloudy urine, unusual odor of urine
Cystitis: Urinary Tract Infections
involvement of one or both of the kidneys, involves renal pelvis and medullary tissue
- Signs and symptoms: signs of cystitis +
- dull, aching pain in lower back or sides (kidney inflammation)
- Increased systemic signs (fever, N/V, malaise)
- If severe enough can obstruct urine flow to ureter
Pyelonephritis- Urinary Tract Infections
diagnosis
- Urinalysis
- Bacteria in urine
- Pyuria
- Microscopic hematuria
- If pyelonephritis will have urinary casts (from renal tubules)
Urinary Tract Infections
- treated with antibiotics
- Increase fluid intake
- Chronic cystitis: can be asymptomatic
- Must remove predisposing factors
- Cranberry juice: can be used to help prevent infections
Urinary Tract Infections
- Can develop anywhere in the urinary tract
- Form when there are excessive amounts of salts, or insufficient fluid
Urolithiasis (aka renal calculi, aka kidney stones)
Urinary Tract Obstructions:
Etiology:
-Most calculi are composed of calcium salts
-High calcium levels are a risk factor (hypercalcemia)
Urolithiasis
Signs and Symptoms:
- Often asymptomatic if small
- If large enough to obstruct a ureter: “renal colic”
- may cause UTI
Urolithiasis
Treatment:
-Small stones pass on their own.
-Stones can be broken up with high frequency sound waves and lasers
-Certain medications may be able to break up stones
-Surgery may be needed if none of the other methods are successful
-prevent recurrence
treat underlying conditions
Urolithiasis
-A complication of calculi or of other urinary tract obstructions
- Urine continues to form, but cannot be excreted, results in fluid buildup, necrosis of tissue, can lead to chronic renal failure
- may be asymptomatic
- Diagnose with US, CT, IVP
Hydronephrosis: Urolithiasis
Tumors
- Usually malignant in urinary tract
- Usually occur after age 50
- More common in males
- Smoking = predisposing factor
Urinary Tract Obstructions:
- Arises from epithelium of tubule
- Often asymptomatic in early stages
- More common in males that females (2:1) over age 40
Signs/Symptoms:
Hematuria
Dull, aching pain in area of kidney
Unexplained weight loss, anemia
Mass in abdomen
Prognosis: good if isolated to kidney
Renal cell carcinoma:
Tests
Blood tests, IVP, CT, MRI, US, biopsy
Treatment:
- Nephrectomy, chemo, radiation
- May have already metastasized to liver, lungs, bone or CNS
- 5 year survival rate = 9-23%
Renal cell carcinoma:
- Arises from epithelium lining of bladder
- Develops as multiple tumors, tends to recur
- Diagnosed with biopsy
- metastasizes to adjacent structures, pelvic lymph nodes, liver and bone
Bladder cancer:
-Early signs:
- Hematuria
- Dysuria
- Frequency
- Infection
Bladder cancer:
Etiology:
-High incidence in people working with chemicals, smokers, heavy medication intake
Treatment:
- Tumor resection
- Chemotherapy
- Radiation
- Photoradiation (drugs and laser treatment)
Bladder cancer:
Vascular changes to arterioles
- Walls thicken and harden
- Blood supply is reduced causing atrophy
- Stimulates secretion of renin
- Can lead to hypertension and chronic renal failure
Nephrosclerosis
- Autosomal dominant
- Multiple cysts develop in both kidneys
- First signs appear about 40 years of age
- Chronic renal failure requiring dialysis
Adult Polycystic Kidney
Congenital Disorders
- Multiple cysts develop
- Enlarge the kidneys then compress and destroy kidney tissue
Polycystic disease in children:
Manifest at birth
Stillborn or die
Adult Polycystic Kidney
- The failure of the kidneys to function
- Acute renal failure (ARF)
- Chronic renal failure
Renal Failure
- Sudden loss of function
- Changes electrolyte and fluid balance
- Etiology:
- Nephrotoxins
- Ischemia
- Pyelonephritis
Acute Renal Failure
Signs and Symptoms
- Blood tests reveal elevated urea in blood, and elevation of other wastes in blood
- Shows that the kidneys are not removing wastes properly
Acute Renal Failure
Treatment:
- Find and reverse primary problem ASAP
- Dialysis
Acute Renal Failure
Gradual, irreversible destruction of kidneys over a long period of time
Often due to:
Pyelonephritis (prolonged)
Congenital polycystic kidney disease
Htn, DM
Chronic Renal Failure
Chronic Renal Failure
Pathophysiology: (Three stages)
- Decreased renal reserve – loss of about 60% of nephrons
- Renal insufficiency – loss of about 75% of nephrons
- End-stage renal failure (ESRD) – more than 90% of nephrons lost
Signs and symptoms:
Decreased renal reserve – asymptomatic
Renal insufficiency – polyuria, anorexia, N/V, anemia, fatigue, exercise intolerance
End-stage renal failure (ESRD) – oliguria, dry, pruritic skin, encephalopathy (neuro signs), CHF, arrhythmias, systemic infections
GFR: 15 ml/min/1.73m2
Chronic Renal Failure
Treatment
Dialysis
Kidney transplant
Medications to treat symptoms and secondary conditions
Prognosis:
9th leading cause of death
Better outcome if receive transplant
Chronic Renal Failure
