15 Lecture Notes Urinary System Diseases and Disorders

15 Lecture Notes Urinary System Diseases and Disorders Classroom Activity to Accompany Diseases of the Human Body Fifth Edition Carol D. Tamparo Marcia A. Lewis

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Everything is funny as long as it happens to somebody else. —Will Rogers 3

Common Signs and Symptoms of Urinary System Diseases and Disorders • Urinary changes; nocturia, hematuria, dysuria, pyuria, urgency/frequency • Pain in flank or lumbar region • Fever • Nausea, vomiting, anorexia • Malaise, fatigue, lethargy 4

Cystitis and Urethritis • Description • Common UTIs • Cystitis: inflammation of bladder • Urethritis: inflammation of urethra • UTI is second most common type of bacterial infection seen by providers (URI is first) UT I = urinary tract infection; URI = upper respiratory infection. 5

Cystitis and Urethritis • Etiology • Escherichia coli (most common), Proteus, Klebsiella, Enterobacter & Serratia bacteria • Urethritis may be caused by Chlamydia trachomatis, Neisseria gonorrhoeae • Women times more susceptible than men 6

Cystitis and Urethritis • Signs and symptoms • Bacteriuria • Dysuria • Urinary frequency, urgency • Pain above pubic area • Cloudy, bloody, foul-smelling urine 7

Cystitis and Urethritis • Diagnostic procedures • History of UTIs, recent catheterization, change in sexual partners • UA with C&S • X-ray, CT scan, ultrasonography UA = urinalysis; C&S = culture and sensitivity; CT = computed tomography. 8

Cystitis and Urethritis • Treatment • Antibiotics or sulfa drugs (1 -, 3 -, or 7 -day course) • Increased fluid intake • Analgesics 9

Cystitis and Urethritis Complementary therapy • Herbal tea from goldenseal or uva-ursi • Drink pure cranberry or blueberry juice Client communication • Explain medications and complications from untreated UTIs 10

Cystitis and Urethritis • Prognosis • Without complications, good • Reinfections likely in susceptible persons • Prevention • Don’t “hold urine” • Proper feminine hygiene 11

Cystitis and Urethritis • UTIs are the second most common infection after _____ infection. 1. respiratory 2. gastrointestinal 3. pharyngeal 4. vaginal 12

Pyelonephritis (Acute) • Description • Inflammation of the kidney and renal pelvis due to infection • Infection can result in destruction or scarring of renal tissue, impairing kidney function • Most common type of kidney disease 13

Glomerulonephritis (Acute) • Description • Inflammation of glomeruli in kidney’s nephrons causes the rate of blood filtration to be reduced • Water and salt is retained; both kidneys affected 14

Glomerulonephritis (Acute) • Etiology • Often unknown • Usually from infection elsewhere in the body • Acute poststreptococcal glomerulonephritis (APSGN); other bacteria, viruses, parasites, may be causal 15

Glomerulonephritis (Acute) • Signs and symptoms • Abrupt onset • Hematuria, cola-colored urine • Proteinuria, foamy urine • Puffy eyes • Oliguria 16

Glomerulonephritis (Acute) • Diagnostic procedures • History of recent strep infection • BUN, ESR • X-ray, ultrasonography, CT scan • Renal biopsy BUN = blood urea nitrogen; ESR = erythrocyte sedimentation rate. 17

Glomerulonephritis (Acute) • Treatment • Dependent upon cause • Supportive; rest • Diuretics or ACE inhibitors • Antibiotics for underlying infection • Restrict salt, protein, fluids ACE = angiotensin-converting enzyme. 18

Glomerulonephritis (Acute) Complementary therapy • None Client communication • Refer to dietitian • National Kidney Foundation list of resources 19

Glomerulonephritis (Acute) • Prognosis • Generally good • Prevention • Prompt treatment of strep URI • Reduce hypertension 20

Renal Calculi • Description • Uroliths, kidney stones • Most common cause of urinary obstruction • Concentration of mineral salts in calyx, urinary tract • Like a grain of sand or very large 21

Renal Calculi • Etiology • Calculi form from imbalance between preventing water loss and eliminating mineral wastes • Dehydration, immobilization, excessive intake of vitamin D, calcium • Gout, Cushing syndrome, UTI, neoplasms • Genetic; more men than women affected 22

Renal Calculi • Signs and symptoms • Asymptomatic • Intense flank and back pain • Urinary urgency if lodged in ureter • Nausea and vomiting • Fever, chills, hematuria 23

Renal Calculi • Diagnostic procedures • History and physical examination; familial tendencies • UA • Noncontrast spiral CT scan • Abdominal or KUB x-ray KUB = kidney, ureter, and bladder. 24

Renal Calculi • Treatment • Clear obstruction, prevent new stone formation • Increase fluid intake • Surgical/nonsurgical intervention • Antibiotics • Analgesics 25

Renal Calculi Complementary therapy • Eight or more glasses of water/day • High-fiber, low-fat diet • Vitamin, mineral supplements • Relaxation techniques Client communication • Stress proper diet and fluid intake • Completing medication therapy 26

Renal Calculi • Prognosis • Good if urinary tract obstruction is prevented; recurrence 60% • Prevention • Adequate fluid intake • Drink pure cranberry and blueberry juice 27

Renal Calculi • Renal calculi are also known as 1. bladder stones 2. hepatic stones 3. gallbladder stones 4. kidney stones 28

Hydronephrosis • Description • Distention of the renal pelvis and calyces of a kidney due to pressure from accumulating fluid • Pressure impairs and eventually interrupts kidney function 29

Polycystic Kidney Disease • Description • Developmental defect of the collecting tubules • Tubules do not empty properly; swell into multiple, grapelike, fluid-filled sacs (cysts) impairing kidney function 30

Polycystic Kidney Disease • Etiology • Adults: autosomal dominant defect • Infant/childhood: autosomal recessive defect 31

Polycystic Kidney Disease • Signs and symptoms • Asymptomatic until midlife • Colic and lumbar pain • Hematuria • Headaches • UTIs 32

Polycystic Kidney Disease • Diagnostic procedures • History and physical examination • Ultrasound • CT scan • UA 33

Polycystic Kidney Disease • Treatment • Minimize symptoms • Guard against UTI; control hypertension • If renal failure occurs, dialysis or kidney transplant 34

Polycystic Kidney Disease Complementary therapy • None Client communication • Assist in maintaining supportive environment 35

Polycystic Kidney Disease • Prognosis • Varies • Kidney function progressively impaired; uremia • Prevention • None 36

End-Stage Renal Disease (ESRD) • Description • Result of chronic renal failure • Gradual, progressive kidney deterioration causes urea and creatinine to accumulate in blood to toxic levels • Affects all organs 37

End-Stage Renal Disease (ESRD) • Etiology • Diabetes mellitus (leading cause) • Hypertension • Chronic glomerulonephritis • Pyelonephritis • Obstruction of urinary tract • Congenital anomalies 38

End-Stage Renal Disease (ESRD) • Signs and symptoms • Oliguria and azotemia • Electrolyte imbalance; metabolic acidosis • Progressive weakness, lethargy • Weight loss, anorexia • Pruritus, mental confusion 39

End-Stage Renal Disease (ESRD) • Diagnostic procedures • History and physical examination • Blood tests with elevated serum creatinine, nitrogen, potassium • Hypertension • Decreased hemoglobin and hematocrit 40

End-Stage Renal Disease (ESRD) • Treatment • Dialysis (peritoneal, hemodialysis, CRRT) and kidney transplantation only treatment • Relieve symptoms, slow deterioration of renal function, guard against complications • Dietary restrictions of protein, salt, potassium CRRT = continuous renal replacement therapy. 41

End-Stage Renal Disease (ESRD) Complementary therapy • None Client communication • Educate regarding “kidney friendly diet” • Educate about dialysis and transplant • Support client, family 42

End-Stage Renal Disease (ESRD) • Prognosis • Variable yet poor • Kidney failure, uremia, and eventual death • Prevention • None known • Prompt treatment of underlying disorders, chronic kidney disease 43

End-Stage Renal Disease (ESRD) • The leading cause of ESRD is 1. diabetes mellitus 2. renal calculi 3. diabetes insipidus 4. staphylococcus 44

Neurogenic or Overactive Bladder • Description • Any loss or impairment of bladder function • Caused by CNS injury or by damage to nerves supplying the bladder • Manifests as incontinence or feeling of full bladder CNS = central nervous system. 45

Neurogenic or Overactive Bladder • Etiology • Most frequent cause is trauma to the spinal cord • May also be due to multiple sclerosis, dementia, Parkinson disease, chronic alcoholism, heavy-metal poisoning, metabolic disorders, UTIs, kidney stones, and enlarged prostate 46

Neurogenic or Overactive Bladder • Signs and symptoms • Mild to severe urinary incontinence • Inability to empty bladder completely • Difficulty in stopping or starting voiding • Bladder spasms 47

Neurogenic or Overactive Bladder • Diagnostic procedures • History and physical examination; neurological evaluation • Cystourethrography • Urine flow study • Sphincter electromyography 48

Neurogenic or Overactive Bladder • Treatment • Prevent UTI complications • Learning bladder control techniques • Credé method • Intermittent self-catheterization • Bladder relaxation medications 49

Neurogenic or Overactive Bladder Complementary therapy • Biofeedback may be useful for teaching bladder control Client communication • Educate about bladder control techniques • Emotional support for both client and family 50

Neurogenic or Overactive Bladder • Prognosis • Dependent upon extent of nerve damage • Complications are UTIs, renal calculi, hydronephrosis, or renal failure • Prevention • None known • Prompt treatment of underlying disorders 51

Renal Cell Carcinoma (Kidney Cancer) • Description • Also known as renal cell adenocarcinoma • Most common type of kidney cancer • Usually grows as a single mass 52

Renal Cell Carcinoma (Kidney Cancer) • Etiology • Cause unknown • Risk factors include obesity, hypertension, long-term dialysis, exposure to chemicals and irritants 53

Renal Cell Carcinoma (Kidney Cancer) • Signs and symptoms • Hematuria • Flank pain that does not go away • Lump or mass in abdomen • Weight loss • Fever 54

Renal Cell Carcinoma (Kidney Cancer) • Diagnostic procedures • Physical exam • BUN and creatinine • CT scan and/or IVP • Ultrasound • Biopsy IVP = intravenous pyelogram. 55

Renal Cell Carcinoma (Kidney Cancer) • Treatment • • • Dependent upon stage and spread of the cancer Partial or complete nephrectomy Arterial embolization Radiation therapy Chemotherapy Immunotherapy 56

Renal Cell Carcinoma (Kidney Cancer) Complementary therapy • Acupuncture, meditation, relaxation techniques to boost traditional treatment Client • Educate about maintaining nutritious diet 57

Renal Cell Carcinoma (Kidney Cancer) • Prognosis • Dependent upon spread of cancer • 5 -year survival is 60% to 70%; if spread to lymph and other organs, 5 -year survival is less than 5% • Prevention • Avoid risk factors 58

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