Renal and Urinary Tract Disorders Outline
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Kidneys
o Kidneys “filter” @ 150 Liters / day
o Kidneys reabsorb @ 99%
o Process yields @ 1.5 Liters / day of urine
Urinary Tract Infection
o Normally in the body
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Normal urine flow restricts bacteria
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Urinary tract is normally sterile above the urethra
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Various antibacterial enzymes / antibodies restrict bacteria
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Normal flora in region restrict bacteria
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Mucus glands trap bacteria
o S/S of UTI
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Pain on urination (dysuria)
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Frequent Urination
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Suprapubic or lower back discomfort
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Cloudy, foul smelling urine
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In the elderly:
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Confusion and abd discomfort
o Uncomplicated UTIs
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Causes
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Escheriachia coli (80%)
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Staphylococcus saprophyticus et all (20%)
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It’s uncomplicated… it’s just a bug in the urinary tract somewhere
o Complicated UTIs
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Abnormalities of urinary system (anatomical problems) or compromised immune system will change a regular,
uncomplicated UTI into a complicated one. Think of complicated as a bug in your system plus your anatomy being
fuxed up or whatever
o Upper UTIs
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Anything above the bladder (i.e. ureters and kidneys)
o Lower UTIs
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Bugs hang out in the urine and cause irritative voiding symptoms
Bladder Infection (Cystitis)
o Info
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Inflammation of the bladder
o Types
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Bacterial = a bug gets in there
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Nonbacterial = maybe an autoimmune reaction?
Pyelonephritis = Pyelonephritis refers to an inflammation affecting the tubules, interstitium, and renal pelvis. It occurs in two forms.
Acute pyelonephritis is caused by bacterial infection. Chronic pyelonephritis is a more complex disorder involving not only bacterial
infection but other factors such as reflux
o Acute
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Patho
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Infection of renal pelvis, tubules, and interstitial tissue of one or both kidneys
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Upward spread of bacteria from bladder
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The bug can get there from the pee-pee (like from a foley) or from the spread of the bug thru the
bloodstream
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Causes
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Upward spread of bacteria from bladder
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Bug gets there by bedrest or another infection in keeping the immune response elsewhere in the body
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Specifically from:
o Urinary obstruction
o Reflex of urine from the bladder squeezing (the bladder squeezes the urine back up the tubes
above the bladder)
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Pregnancy (uterus gets large and pushes against the bladder causing pressure and squeezing urine
up)
o Catheterization (we’re pushing catheter into bladder. If we pick up bugs on the way in the bug
ends up in the bladder which could get squished up into the ureters
S/S of Acute Pyelonephritis
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Enlarged kidneys w/ abscesses
o Seen on kidney ultrasound usually
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Fever / chills
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Leukocytosis, bacteriuria, pyuria
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Low back pain (usually severe)
o Usually what makes us think of pyelonephritis
o Palpation of kidneys, the person will jerk back because they’re super painful
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N/V, headache, malaise
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Painful urination
Chronic
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Patho
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Persistent, recurring infection
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Leads to scarring of kidney(s)
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Difficult to determine specific cause
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Kidney stones increase risk
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Vesicoureteral reflux increases risk
Urinary Tract Obstruction
o Lower urinary tract disorders
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Enlarged prostate (men)
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Info
o Often benign = called Benign Prostate Hypertrophy (BPH)
o Can be caused by prostate CA
o Either leads to obstruction of urethra
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Urethral stricture (men or women)
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Causes
o Congenital, infection, injury, or surgical manipulation
o Strictures are basically scars…
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Any of these may cause scarring and narrowing of the lumen
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Pelvic organ prolapse (women)
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Info
o Downward protrusion of bladder down into the vagina
o Causes bladder outlet obstruction (the bladder isn’t where it should be and gravity can’t get the
pee pee out)
o Kidney stones (Renal Calculi)
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Info
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May form anywhere in the urinary tract
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Usually form in renal pelvis or calices
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They vary in size, shape, and number
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70-80% made of calcium oxalate or calcium phosphate
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Patho
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Urine becomes concentrated w/ insoluble materials→
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Crystals form, then consolidate→ calculi form→
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Calculi remain in renal pelvis (damage/destroy kidney tissue), or enter the ureter→
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Large caluli may cause pressure necrosis
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Causes / Predisposing Factors:
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Dehydration
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Infection
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Obstruction
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Changes in urine pH
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Immobilization
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Diet
Metabolic factors (Ex: gout, hyperparathyroidism = more PTH increases the Ca released from the bones,
hence more Ca in the circulating blood)
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Severe pain—may move from lower back to sides to pubic region
N/V
Often fever / chills
May have hematuria
May have abdominal distention
May have oliguria
S/S
Renal tumors
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Info
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Renal Cell Carcinoma (RCC) most common
o Tobacco use, obesity, and HTN appear to be associated with RCC
o Usually occur in one kidney and metastasize to the lungs, liver, lymph, and bone
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Renal Cell Adenoma (benign tumor)
o Encapsulated and located near renal cortex
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S/S of Tumors
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Early stages are often silent
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Late signs include
o Hematuria, flank pain, palpable flank mass, and weight loss
o Bladder tumors
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Info
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Tobacco use appears to be leading risk factor
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Arise from alteration of epithelial tissue at base of bladder
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Often involve ureter orifices and bladder neck
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Usually metastasize to lymph, liver, bones, & lungs
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S/S
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Visible, painless hematuria
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Pelvic or back pain may occur with metastasis
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UTIs are common complications which cause increase frequency, urgency, and dysuria
Glomerular Disorders
o Glomerulonephritis = inflammation of the glomerulus
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Patho
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Inflammation of the glomerulus
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Infection initiates inflammatory process→
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Antigen-antibody processes deposited in glomeruli→
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Nephrosclerosis develops→
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(In chronic) Cortex layer shrinks→
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Bands of scar tissue distort remaining cortex→
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Branches of renal artery thicken→
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End-stage renal disease
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Types
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Acute
o glomerulonephritis is often associated w/ strep throat, or impetigo→develops 2-3 weeks post
infection
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Chronic
o glomerulonephritis is often caused by IDDM or Lupus erythematosus→leads to chronic renal
failure
o Nephrotic Syndrome
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Patho
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Can occur with any renal or systemic disease process that damages the glomerular capillary membrane →
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Large amounts of protein excreted in urine (proteinuria)
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Decrease of albumin in blood (hypoalbuminemia)
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High serum cholesterol and low – density lipoproteins (hyperlipidemia)
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Nephrosclerosis
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Info
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Renal Failure
o Acute
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Patho
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Major S/S: Edema (pitting & ascites)
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Hypertension & Diabetes main causes→
Decreased blood flow to kidneys→
Patchy necrosis develops→
Fibrosis develops; glomeruli destroyed→
Leads to End-stage renal disease
Abrupt reduction in renal function w/elevation
of BUN & creatinine levels
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Usually associated w/ urine output of
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<30 ml/hr or <400 ml/day
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Most of the time condition is reversible
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S/S of ARF
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Oliguria begins within 1 day post hypotensive event & lasts 1 - 3 weeks
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Lethargic
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Skin / mucus membranes dry
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CNS→headache, muscle twitching, seizures
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Many body systems affected
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Recovery depends on how long the cause lasted
Chronic (End-Stage Renal Disease)
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Patho
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ESRD is progressive, irreversible deterioration in renal function
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End products of protein metabolism (normally excreted in urine) accumulate in the blood
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Causes
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DM, HTN, chronic glomerulonephritis, pyelonephritis, obstruction of urinary tract
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S/S of ESRD
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UREMIA (result of accumulation of toxins in plasma)
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HTN, anorexia, N/V/D, weight loss, pruritis, edema, anemia, and neurological changes