Week 14- Genitourinary System 1 Flashcards
Function of the kidneys
-Filter waste products and remove excess fluid from the blood
-Serve as both an endocrine organ and a target of endocrine action to control mineral and water balance
Why do kidney and bladder have higher risk of cancer?
The filtration and storage functions associated with excretion expose the kidney and bladder to carcinogens for extended periods, increasing the risk of cancer’s developing in these organs compared with the other urinary tract structures.
Why do females have higher incidence of UTI?
The urethra of females lies close to the vaginal and rectal openings, allowing for relative ease of bacterial transport and increased risk of infection. The shorter urethra in females also contributes to the increased incidence of urinary tract infections (UTIs) in females.
Effects of aging on the renal/urologic systems
-Gradual reduction of blood flow to the kidneys and nephrons
-Responses to vasoconstrictor stimuli are enhanced; vasodilatory responses are impaired
-Produce more urine at night
-Pelvic floor muscle dysfunction
True or false: Kidneys become more efficient at removing waste from the blood, and the volume of urine decreases somewhat with age
False
(less efficient, urine increases)
The most common bacterial infections acquired in the community and in hospitals
Urinary tract infections (UTI)
___________ and ___________ are usually involved in UTI
Bladder, urethra
True or false: UTIs can be uncomplicated, complicated, relapsed, or recurrent
True
Pathogenesis of UTIs
Fecal-associated gram-negative organisms, with E. coli accounting for ~80% of pathogens
The pathogenesis of UTI commonly ascend up the _____________ into the ____________
-Urethra
-Bladder
UTI clinical manifestations
-Fever, nausea or vomiting
-Cloudy, bloody, or foul-smelling urine
-Burning or painful sensation during urination
-Pain in the suprapubic, lower abdominal, groin, or flank areas
-The diaphragm may become irritated, resulting in ipsilateral shoulder or lumbar back pain (if kidney is involved)
-Malaise, anorexia, and mental status changes (especially confusion or increased confusion or delirium) in elderly adults
Appropriate catheter care
-Maintaining unobstructed urine flow
-Keeping the catheter and collecting tube free from kinking
-Having the collecting bag below the level of the bladder at all times
-Do not rest the bag on the floor
Bacterial infection causing inflammation of the kidneys
Pyelonephritis
Pyelo-
Renal pelvis
True or false: Pyelonephritis can be acute or chronic
True
Pyelonephritis occur more in men than women
False
(more in women than men)
Acute pyelonephritis
-Ascending UTIs; caused most commonly by E. coli
-From bloodborne pathogens associated with infection elsewhere
-Immunocompromised people are at risk for bacterial and fungal seeding of the kidney
Chronic pyelonephritis
-Vesicoureteral reflux (the most common cause), urinary obstruction, analgesic nephropathy, or bacterial infection superimposed on a structural/functional abnormality
Clinical manifestations of acute pyelonephritis
-Usually abrupt
-Fever, chills, malaise, headache, and flank pain
-Tenderness over the costovertebral angle (Murphy sign)
-Bladder irritation including dysuria, urinary frequency, and urgency
Clinical manifestation of chronic pyelonephritis
-Symptoms vary depending upon the causative process or may not be present
Accounting for 90-95% of all renal tumors
Renal cell carcinoma (RCC)
Male: female ratio for RCC
2:1
True or false: RCC is often resistant to radiation and traditional chemotherapy, making surgery the predominant treatment intervention
True
Five major subtypes of RCC
-Conventional or clear cell (ccRCC); -75%
-Papillary RCCs; 15-20%
-Chromophobe RCCs; ~5%
-Collecting duct RCCs; < 1%
-Unclassified; ~2%
Risk factors of RCCs
-Age
-Gender
-Race: African Americans
-Blood pressure: elevated
-Smoking tobacco: doubles
-Obesity
-Overuse of certain medications: long-term use of diuretics and analgesic pain medications (aspirin, acetaminophen, and ibuprofen)
-Occupational exposure: exposure to asbestos and/or cadmium
PT implications of RCC
-Be aware of the symptoms and signs
-Extensive abdominal and thoracic surgical sites may produce scarring
-Side effects of cancer treatment
-Prevent deconditioning and fall
-Be aware of the presence of bone metastasis
-Watchful surveillance
Renal calculi is also known as…
Urinary stone disease (nephrolithiasis)
Majority of kidney stones develop in the ___________
Kidneys
Renal calculi can cause…
Urinary obstruction and severe pain
Four basic types of renal calculi
-Calcium stone
-Uric acid stone
-Stuvite stone
-Cysteine stone
Regarding renal calculi, there is a higher incidence in _____________ countries and areas noted for ___________ temperatures and humidity
-Industrialized
-High
Risk factors associated with renal calculi
-Acidic urine pH
-gout
-Chronic dehydration
-Dietary (excess intake of supplemental calcium, sodium, sucrose, and animal protein)
Refers to the presence of solutes in solution at higher concentrations than that of their own solubility, and is a prerequisite for stone formation (step 1).
Supersaturation
Solutes combine into clusters resulting in the formation of microscopic particles
Nucleation
After the crystal nucleus has reached a critical size, it grows as a result of continuous exposure to saturated urine. This is known as the…
Metastable zone
Preformed crystals conglomerate to form larger particles that are usually embedded in a matrix of organic macromolecules (for example, proteins, carbohydrates, glycosaminoglycans, and lipids) termed the stone matrix.
Aggregation
Clinical manifestations of renal calculi
-Acute and severe “colicky” flank pain radiating to the groin or perineal areas (including the scrotum in males and labia in females) with hematuria (>90% of cases)
-The area of radiating pain may be related to the location of stone
-Symptoms consistent with a UTI (urinary urgency and frequency and dysuria) are often present
Indicator of chronic kidney disease (CKD)
Decreased kidney function shown by estimated glomerular filtration rate (eGFR) of < 60 mL/min per 1.73 m2, or markers of kidney damage, or both, for a duration of at least 3 months, regardless of the underlying cause
Etiologic and risk factors of CKD
-Diabetes, accounting for 30-50% of all CKD
-Hypertension, accounting for > 25% of all CKD
-Analgesic nephropathy- excessive nonprescription analgesic drug use
-Other disorders: polycystic kidney disease (PKD), urinary tract obstruction, repeated infection, hereditary defects of the kidneys, toxicities, and systemic lupus erythematosus
CKD pathogenesis
-Hyper glycemia
-Release of angiotensin II
SLIDE 31
Assesses how much blood passes through these filters each minute
Glomerular filtration rate (GFR)
SLIDE 33-34
Systemic manifestations of kidney failure
-Urinary system
-Cardiopulmonary
-Gastrointestinal Tract
-Nervous system (CNS & PNS)
-Integumentary (Skin)
-Eyes
-Endocrine
-Hematopoietic: anemia, platelet dysfunction
-Skeletal
Types of renal replacement therapy
-Dialysis (hemodialysis, peritoneal dialysis)
-Kidney transplantation
Types of peritoneal dialysis
-Continuous ambulatory peritoneal dialysis [CAPD]
-Continuous cycling peritoneal dialysis [CCPD]
SLIDE 37
