URINARY DISORDERSURINARY DISORDERS

CHEMICAL CONTROL OF URINARY SYSTEMCHEMICAL CONTROL OF URINARY SYSTEM

Reabsorption of H2O in distal convoluted tubule controlled by ADH (antidiuretic hormone) – hormone makes collecting tubules more permeable to water

ADH known as the “water-retaining hormone”

Secretion and regulation of ADH is controlled by the pituitary gland in the hypothalamus

ALDOSTERONE – secreted by the adrenal cortex, promotes excretion of potassium and hydrogen ions and reaborption of sodium, chlorine ions and H20

ADRENAL GLANDS

CHEMICAL CONTROL OF CHEMICAL CONTROL OF THE URINARY SYSTEMTHE URINARY SYSTEM

RENIN –hormone released by kidneys, stimulates release of aldosterone from adrenal cortex

DIURETICS inhibit reabsorption of H2O

Lasix –well known diurectic that acts on the Loop of Henle to block reabsorption

NERVOUS CONTROL OF NERVOUS CONTROL OF THE URINARY SYSTEMTHE URINARY SYSTEM

Direct control through nerve impulses on the kidney blood vessels

Indirect control through stimulation of endocrine glands

ACUTE KIDNEY FAILUREACUTE KIDNEY FAILURE

Rapid decline in kidney function Caused by a variety of factors that

alter blood pressure or affect glomerular filtration such as nephritis, shock, injury, bleeding, sudden heart failure or poisoning

Symptoms – OLIGURIA OR ANURIA

ACUTE RENAL FAILUREACUTE RENAL FAILURE Suppression of urine formation can lead

to UREMIA – toxic condition when blood retains urinary waste products

Concentration of nitrogenous waste is assessed by the Blood Urea Nitrogen (BUN)

Urea is produced by the breakdown of protein already in the body and protein in your diet

Normal BUN is 7 – 20 mg/dL in adults and 5 – 18 mg/dL in children

A high BUN usually means the kidney function is less than normal

CHRONIC RENAL FAILURECHRONIC RENAL FAILURE

Gradual loss of function of nephrons

Stage I – Some nephrons are lost but others compensate by enlarging and taking over (BUN is normal)

Stage II – called renal insuffiency – remaining nephrons can’t handle urea load and BUN climbs – also have polyruria and dehydration

Stage III – called uremia – very high BUN due to loss of kidney function – fluids retained by the body so get hypertension and edema – need kidney transplant

GLOMERULONEPHRITISGLOMERULONEPHRITIS Inflammation of the glomerulus Filtration process affected Plasma proteins are filtered

through and found in urine, RBCs too (HEMATURIA)

Can be acute or chronic Acute is caused by a delayed

immune response (1 – 6 weeks) to a streptococcal infection – most common form of kidney disease

Chronic – there is permanent damage

PYELONEPHRITISPYELONEPHRITIS

Literally “pelvis nephritis” and refers to inflammation of the renal pelvis and connective tissue of the kidney

Usually caused by infection from ureters or bladder

Symptoms – fever, chills, pain in the sides, nausea and an urge to urinate frequently

Another symptom is PYURIA (pus in urine) – yellow streaks seen in the medulla indicate tubules filled with pus

Rx - antibiotics

HYDRONEPHROSISHYDRONEPHROSIS Urine backs up because of

blockage in ureter and renal pelvis and calcyes become distended

Can be due to kidney stone Can also be caused by

pregnancy and enlarge prostrate

Rx – Remove the cause

RENAL CALCULI (Kidney Stone)RENAL CALCULI (Kidney Stone) Develop in the renal pelvis or

calcyes (under reanl pyamids) Made of crystals of calcium

phosphate and uric acid Gradually they grow larger

until they block the ureter – small ones may pass through

First symptom – severe pain Other symptoms – nausea and

vomiting, urine frequency, chills, fever, and hematuria

RENAL CALCULI RENAL CALCULI (KIDNEY STONES(KIDNEY STONES

Diagnosis – by symptoms, utlrasound, or x-ray (IVP – intravenous polygram or KUB)

Rx – increase fluids to flush out stones, medications, and if needed - LITHOTRIPSY

LITHROTRIPSYLITHROTRIPSYSurgical procedure to remove kidney stonesShock waves hit dense stones and break

them up Done on outpatient basis

                         

                           

CystitisCystitis Inflammation of the mucous membrane lining of the urinary bladder

Most common cause – E.Coli

Symps = DYSURIA (painful urination) and frequency

Usually in females (shorter urethra)

Rx - antibiotics

IncontinenceIncontinence

Involuntary urination

DialysisDialysis Used for kidney failure Involves the passage of

blood through a device with semipermeable membrane

Dialysis serves as a substitute kidney

HemodialysisHemodialysis Blood from patient flows

through machine and its filtered

Usually a FISTULA is created (opening between vein and artery) for inserting needles

Can be done at home or in clinic

Takes 2-4 hours, 2-3 times a week

Peritoneal DialysisPeritoneal Dialysis

Uses the peritoneal lining to filter blood

Dialysate (cleaning solution) flows in and out via a catheter tube

Kidney TransplantKidney Transplant Done as a last resort Involves donor organ

from someone with a similar immune system

Main complication - rejection

Urinary ConditionsUrinary Conditions

ENURESIS - bedwetting GLYCOSURIA – sugar in urine

NOCTURIA – frequent urination at night Hematuria – blood in urine