Alterations of Renal and Urinary Tract Function Chapter

Alterations of Renal and Urinary Tract Function Chapter 36 1

Urinary Tract Obstruction o A urinary tract obstruction is defined as a blockage of urine flow with the urinary tract n The obstruction can be caused by an anatomic or functional defect o n Obstructive uropathy Severity based on: o o o Location Completeness Involvement of one or both upper urinary tracts Duration Cause 2 Mosby items and derived items © 2006 by Mosby, Inc.

Urinary Tract Obstruction o o Hydroureter Hydronephrosis Tubulointerstitial fibrosis Apoptosis 3 Mosby items and derived items © 2006 by Mosby, Inc.

Urinary Tract Obstruction 4 Mosby items and derived items © 2006 by Mosby, Inc.

Urinary Tract Obstruction o Compensatory hypertrophy n n o o Obligatory growth Compensatory growth Postobstructive diuresis Low bladder wall compliance 5 Mosby items and derived items © 2006 by Mosby, Inc.

Upper Urinary Tract Obstruction o Kidney stones n Calculi or urinary stones o n Risk factors o n Masses of crystals, protein, or other substances that form within and may obstruct the urinary tract Gender, race, geographic location, seasonal factors, fluid intake, diet, and occupation Kidney stones are classified according to the minerals comprising the stones 6 Mosby items and derived items © 2006 by Mosby, Inc.

Kidney Stones o Supersaturation of one or more salts n o Precipitation of a salt from liquid to solid state n o Presence of a salt in a higher concentration than the volume able to dissolve the salt Temperature and p. H Growth into a stone via crystallization or aggregation 7 Mosby items and derived items © 2006 by Mosby, Inc.

Kidney Stones o Other factors affecting stone formation n o Crystal growth-inhibiting substances Particle retention Matrix Stones n n n Calcium oxalate or calcium phosphate Struvite stones Cystinuric stones Uric acid stones Indinavir 8 Mosby items and derived items © 2006 by Mosby, Inc.

Kidney Stones o Manifestation n o Evaluation n o Renal colic Stone analysis Intravenous pyelogram Spiral abdominal CT Treatment n Stone removal 9 Mosby items and derived items © 2006 by Mosby, Inc.

Lower Urinary Tract Obstruction o o Bladder neck dyssynergia Prostate enlargement Urethral stricture Severe pelvic organ prolapse 10 Mosby items and derived items © 2006 by Mosby, Inc.

Lower Urinary Tract Obstruction o Neurogenic bladder n Neurogenic detrusor overactivity o n n Detrusor sphincter dyssynergia Obstruction Low bladder wall compliance 11 Mosby items and derived items © 2006 by Mosby, Inc.

Neurogenic Bladder 12 Mosby items and derived items © 2006 by Mosby, Inc.

Tumors o Renal tumors n n o Renal adenomas Renal cell carcinoma Bladder tumors n n n Papillary tumors Nonpapillary tumors Metastasis to lymph nodes, liver, bone, and lungs 13 Mosby items and derived items © 2006 by Mosby, Inc.

Urinary Tract Infection (UTI) o o UTI is inflammation of the urinary epithelium following invasion and colonization by some pathogen within the urinary tract Complicated UTI Uncomplicated UTI Persistent UTI 14 Mosby items and derived items © 2006 by Mosby, Inc.

Urinary Tract Infection (UTI) o Most common pathogens n n n o Escherichia coli Staphylococcus saprophyticus Enterobacter spp Virulence of uropathogens n Host defense mechanisms 15 Mosby items and derived items © 2006 by Mosby, Inc.

Urinary Tract Infection (UTI) o Cystitis n n Cystitis is an inflammation of the bladder Manifestations o n Frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain Treatment o Antimicrobial therapy, increased fluid intake, avoidance of bladder irritants, and urinary analgesics 16 Mosby items and derived items © 2006 by Mosby, Inc.

Urinary Tract Infection (UTI) o Pyelonephritis n Acute pyelonephritis o n Acute infection of the ureter, renal pelvis, and/or renal parenchyma Chronic pyelonephritis o o Persistent or recurring episodes of acute pyelonephritis Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition 17 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerular Disorders o o The glomerulopathies are disorders that directly affect the glomerulus Urinary sediment changes n n n Nephrotic sediment Nephritic sediment Sediment of chronic glomerular disease 18 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerular Disorders o o Glomerular disease demonstrates a sudden or insidious onset of hypertension, edema, and an elevated blood urea nitrogen (BUN) Decreased glomerular filtration rate n o Elevated plasma creatinine, urea, and reduced creatinine clearance Glomerular damage causes a decreased glomerular membrane surface area, glomerular capillary blood flow, and blood hydrostatic pressure 19 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerular Disorders o o Increased glomerular capillary permeability and loss of negative ionic charge barrier result in passage of plasma proteins into the urine Resulting hypoalbuminemia encourages plasma fluid to move into the interstitial spaces n Edema 20 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerular Disorders o Glomerulonephritis n Inflammation of the glomerulus o o o Immunologic abnormalities (most common) Drugs or toxins Vascular disorders Systemic diseases Viral causes 21 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerulonephritis o Mechanisms of injury n n n Deposition of circulating soluble antigen-antibody complexes, often with complement fragments Formation of antibodies against the glomerular basement membrane Streptococcal release of neuramidase 22 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerulonephritis 23 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerulonephritis o o o Acute poststreptococcal glomerulonephritis Ig. A nephropathy (Berger disease) Crescentic glomerulonephritis Antiglomerular basement membrane disease (Goodpasture syndrome) Chronic glomerulonephritis 24 Mosby items and derived items © 2006 by Mosby, Inc.

Glomerulonephritis 25 Mosby items and derived items © 2006 by Mosby, Inc.

Nephrotic Syndrome o o o Excretion of 3. 5 g or more of protein in the urine per day The protein excretion is due to glomerular injury Findings n Hypoalbuminemia, edema, hyperlipidemia, and lipiduria 26 Mosby items and derived items © 2006 by Mosby, Inc.

Nephrotic Syndrome o o o Membranous glomerulonephritis Focal and segmental glomerulosclerosis Minimal change disease (lipoid nephrosis) 27 Mosby items and derived items © 2006 by Mosby, Inc.

Nephrotic Syndrome 28 Mosby items and derived items © 2006 by Mosby, Inc.

Renal Dysfunction o o o Renal insufficiency Renal failure End-stage real failure Uremia Azotemia 29 Mosby items and derived items © 2006 by Mosby, Inc.

Acute Renal Failure (ARF) o Prerenal acute renal failure n n n Most common cause of ARF Caused by impaired renal blood flow GFR declines due to the decrease in filtration pressure 30 Mosby items and derived items © 2006 by Mosby, Inc.

Acute Renal Failure (ARF) o Intrarenal acute renal failure n Acute tubular necrosis (ATN) is the most common cause of intrarenal failure o o o Postischemic Nephrotoxic Postrenal acute renal failure n Occurs with urinary tract obstructions that affect the kidneys bilaterally 31 Mosby items and derived items © 2006 by Mosby, Inc.

Acute Renal Failure (ARF) 32 Mosby items and derived items © 2006 by Mosby, Inc.

Acute Renal Failure (ARF) 33 Mosby items and derived items © 2006 by Mosby, Inc.

Acute Renal Failure (ARF) o o o Initiation phase Maintenance phase Recovery phase 34 Mosby items and derived items © 2006 by Mosby, Inc.

Chronic Renal Failure o o Chronic renal failure is the irreversible loss of renal function that affects nearly all organ systems Progression n n Reduced renal reserve Renal insufficiency Renal failure End-stage renal disease 35 Mosby items and derived items © 2006 by Mosby, Inc.

Chronic Renal Failure o o o Creatinine and urea clearance Sodium and water balance Phosphate and calcium balance Potassium balance Acid-base balance 36 Mosby items and derived items © 2006 by Mosby, Inc.

Chronic Renal Failure o o o Skeletal and bone alterations Cardiopulmonary system Neural function Endocrine and reproduction Hematologic alterations 37 Mosby items and derived items © 2006 by Mosby, Inc.

Chronic Renal Failure o o Immunologic Gastrointestinal Integument Alterations in proteins, carbohydrates, and lipids 38 Mosby items and derived items © 2006 by Mosby, Inc.