Alterations of Renal and Urinary
Tract Function Concept Maps
Gary L. Schofield, RN
Potential Causes & Process of Renal Failure
Obstruction
Glomerulonephritis
Renal Cancer
UTI
Pylenephritis
Renal Failure
Acute
-Reverses
- Abrupt ↓ renal
functions
Chronic
Impaired Renal Blood Flow
End Stage Renal Disease
Progressive/ Irreversible
Complete Renal Failure
GFR gradually ↓
Pre renal
(Renal Ischemia)
Shock
↓ CO
Anaphylaxis
Intra renal
Acute tubular
necrosis
Acute
glomerulonephritis
Renal Vascular
Obstruction
Cortical Necrosis
Allograft Rejection
Transplant
Post renal
Kidney
Stones
Neoplastic
Disease
Nephrons destroyed
Remaining Nephrons
↑ Workload
-Hypertrophy
- ↓ability to
concentrate urine
Dialysis
Tumors
↑ Bladder =
infection
Renal
Obstruction
Bladder
Wilms Tumor
↓Bladder = Acute or
Chronic Renal Failure
Hydroureter
Hydronephrosis
Embryonal Tumor
Nephroblastoma
Sporadic and
inherited origins
Associated with
other anomalies
Lower Urinary Tract
Obstructions
Kidney Stones
Neurogenic Bladder
Interruption of nerve
supply
Most common
in pelvis of
kidney
Calcium or
Phosphate 7580 % of the
time
Gender
Race
Upper Motor
Neuron Lesion
Lower Motor
Neuron Lesion
Loss of Voluntary
control of voiding
Loss of voluntary
and involuntary
control of voiding
Geographic
Location
Seasonal Factors
Fluid Intake
Diet
Occupation
Bladder Neck
Dyssynergia
Prostate
Enlargement
Urethral Stricture
Severe Pelvic Organ
Prolapse
Congenitally abnormal
ureter
Reflux of urine from
bladder to kidney
Infection, renal scarring,
pyelonephritis
Caused By Bacteria, Fungal
and Parasite
Vesicoureteral Reflux
UTI
Cystitis
Pyleonephritis
Virulence of Uropathogens
Host Defense Mechanisms
Acute
Most Common Site for
UTI
Bacterial Attaches to
Uroepithelium
Causes: E. Coli, Klebsiella,
Pseudomonas, Staph
Periurethral Mucus
Secreting Gland
Sphincter Mechanisms
Chronic
Bacteria Form
Biofilm
Body Immune System
(Bladder Wall)
Common Causes:
Kidney Stones
Vesicoureteral Reflux
Pregnancy
Neurogenic Bladder
Instrumentation
Female Sexual Trauma
Infection initiates inflammatory
response
Tumors
Association:
Tobacco Use, Obesity, Long-term Analgesic
use
Bladder Tumors
Renal Adenoma
Benign Tumors
Located near cortex of
kidney
Renal Cell Carcinoma
Most common renal
neoplasm
Proximal tubule
epithelial cells
Primary
Associated with mutation
of gene P53
Increase Risk
Smokers (men)
Workers exposed to
chemicals, rubber, &
in textile industry
Secondary
Result of invasion of
cancer from bordering
organs
Pyelonephritis
Acute
Chronic
Common Cause: E Coli
Infection of renal pelvis
and interstutium
Common Causes
Kidney Stones
Vesicoureteral Reflux
Pregnancy
Neurogenic Bladder
Instrumentation
Female Sexual Trauma
Recurrent Autoimmune
Infections
Inflammatory Process
damages tubular cells
Usually localized abscesses
Healing occurs
Deposition of Scar tissue
Atrophy of affected tubules
Affects primarily the pelvis,
calyces, and medulla
Rarely causes renal failure
Inflammation and
scarring of kidney
Pelvis, calyces – dilated
& blunted
Destruction of tubules
Areas of atrophy/dilation/
diffuse scaring
Impairment of function
Urine-concentration
ability affected
Excretion of diluted urine
Renal Failure
Glomerular Disorders
Glomerulonephritis
Acute Glomerulonephritis
S/S
Hematuria
Red Blood
Cell Casts
Protenuria
↓ GFR
Oliguria
Edema
HTN
IgA Nephropathy
Berger Disease
Crescentic Glomerulonephritis
(Rapidly Progressive)
Chronic Glomerulonephritis
Idiopathic
Proliferative
glomerular
diseases
Several
Glomerular
Diseases
Focal or Diffuse
Segmental fibrosis
and deterioration
Prognosis
variable
20-50%
progress to
Renal Fail
Cause: Immune response
Toxin/Drugs
Vasc. Disorders
Damage: Biochemical
Mediators of Inflammation
Complement activation
Neutrophils/Monocytes
Antibody Formation
Affects:
Pulmonary Capillary
Glomerular Basement Membs
Poor Prognosis
Poor Prognosis
Renal Failure
Disturbance in Glomerular Basement Memb
(metabolic, biochemical, physiochemical) leads
to increase permeability to protein
Most individuals
Children recover
with minimal
loss of renal
function
Hypoalbuminema
Antiglomerular Basement
Membrane (Good-pasture
Syndrome)
Tubular dilation and atrophy
Nephrotic Syndrome
Most
Common
Form
Unknown
cause
24-48 hrs
after URI or
GI infection
Example of
Crescent
Glomerulonephritis
Abrupt onset
7-10 after
infection
Group A Strep
S/S 10-21days
after infections
Hyperlipidemia
Proteinuria
Lipiduria
Hypocalcemia
Treatment:
Normal, Low-fat Diet; Salt Restriction
Diuretics; Antigoagulants; Removal of
toxins; Steroids; Albumin
Replacements
Structural Abnormality
Definition
Facts
Hypospadias
Congenital condition in which the
urethral meatus is located on the ventral
side of the penis
Related to disruption in male hormones
Accompanied by Chordee or penile
torsion
Corrective Surgery
Epispadias
Exstrophy of the bladder- Urethral
opening on the dorsal surface of penis.
Urethral opening small and situated
behind the glans with fissure extending
the length of penis
Constant dribbling of urine
Exstrophy of Bladder
Extensive congenital anomaly in which
the lower urinary tract is exposed
directly to the surface of the body
Caused by intrauterine failure of the
abdominal wall and the mesoderm of the
anterior bladder to fuse
Reconstructive surgery girls – teens
Boys – 2-3 yrs of age
Ureteropelvic Junction
Obstruction
Blockage of the tapered point where the
renal pelvis transitions into the ureter
Intrinsic malformation of smooth muscle
or urothelial development produces
obstruction in 90% of cases. Causes
kinking and scarring
Bladder Outlet
Obstruction
A urethral valve is a thin membrane of
tissue that occludes the urethral lumen
and obstructs urinary outflow in males.
Polyps rarely arise form the prostatic
urethra – often cause sever obstruction
and impair renal embrogenesis leading
to UTI, Vesicoureteric reflux, and renal
failure. Resection as soon as possible
Hypoplastic(Dysplastic
Kidneys
Ureteric duct grows into the metanephric
tissue, triggering the formation of the
kidneys in utero. If this growth does not
occur the kidney is absent or hypoplastic
(small) Renal dysplasia results from
abnormal differentiation of renal tissue
Associated with a functional or organic
obstruction of the collecting system
Obstruction may begin prior to birth
Renal Agenesis
Absence of one or both kidneys
Potter syndrome (bilateral renal
agenesis)
Clearly hereditary
Bilateral agenesis is usually fatal
Unilateral – males more affected
Polycystic Kidneys
Autosomal dominant inherited disorder
PKD-1 and PKD-2 mutations account for
the disease
The gene products regulate epithelial
growth and differentiation.
References
Corwin, E. J. (2000). Handbook of Pathophysiology (2nd ed.). Philadelphia, PA:
Lippincott.
Gray, M., Huether, S., & Forshee, B. (2006). Alterations of renal and urinary
tract function. In K. L. McCance & S. Huether (Eds.), Pathophysiology: The
Biologic Basis for Disease in Adults & Children (pp.1301- 1336). St Louis,
MO: ElSevier Mosby.
Huether, S. (2006) Alteration of renal and urinary tract functions in children. In K.
L. McCance & S. Huether (Eds.), Pathophysiology: The Biologic Basis for
Disease in Adults & Children (pp.1337- 1351). St Louis, MO: ElSevier Mosby.