Chapter 13
Urinary System Diseases and
Disorders
Copyright
Copyright
© 2010
© 2010
Delmar,
Delmar,
Cengage
Cengage
Learning.
Learning.
ALLALL
RIGHTS
RIGHTS
RESERVED.
RESERVED.
Anatomy and Physiology
• Kidneys
– Remove waste products from bloodstream
• Ureters
– Tubules that run from kidney to bladder
– Transport urine
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Anatomy and Physiology
• Bladder
– Muscular organ that holds urine
• Urethra
– Carries urine to outside of body
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Anatomy and Physiology
• Urine normally:
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Clear, but slightly yellow to gold
Free from sediments
Distinct odor, but not foul-smelling
Specific gravity of 1.005 to 1.030
pH of 6
Changes in values indicate disease
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Animation
Click Here to Play Urine Formation Animation
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Common Signs and Symptoms
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Hematuria
Pyuria
Proteinuria
Dysuria
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Common Signs and Symptoms
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Nocturia
Oliguria
Anuria
Frequency/urgency
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Diagnostic Tests
• Urinalysis
• Urine culture and sensitivity
• Blood tests
– Including blood urea nitrogen (BUN) and creatinine
clearance
• Intravenous pyelogram (IVP)
• Kidney, ureter, and bladder (KUB)
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Diagnostic Tests
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Cystogram
Cystoscopy
Bladder and kidney biopsy
Catheterization
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Cystoscopy
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Urinary Tract Infections (UTIs)
• Broad diagnosis covering infections of urinary
tract
– Including urethra, bladder, and kidneys
• Most often caused by bacteria
– Can be caused by virus and fungi
– E. coli
• Most common bacteria
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UTIs
• More common in females
– Female urethra shorter and opening closer to rectum
– Some females have improper toilet habits
– Vaginal secretions may harbor bacteria while male
prostatic secretions have antibacterial effect
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UTIs
• More common in females
– Sexual intercourse may cause trauma to urethra and bladder
leading to inflammation and infection
– Pregnant females more susceptible due to pressure of
uterus on urinary tract
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UTIs
• Diagnosis by urinalysis and culture of urine
specimen
• Treatment usually antibiotics
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UTIs
• Urethritis
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Inflammation of urethra
More common in males
Commonly occurs with cystitis
Symptoms:
• Swelling of urethra
• Dysuria
• Urethral discharge
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UTIs
• Cystitis
– Inflammation of bladder
– Also known as bladder infection
– Honeymoon cystitis
• Occurs in females as they become sexually active
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UTIs
• Cystitis
– Treatment usually antibiotics
– Antispasmodic medications may decrease bladder spasms
• E.g., Pyridium
– May cause urine to turn reddish-orange
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UTIs
• Pyelitis
– Inflammation of kidney pelvis
– Result of ascending infection from bladder
– Rapid diagnosis and treatment imperative to prevent spread
of infection
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UTIs
• Pyelonephritis
– May be due to ascending or hematogenous infection
– May affect one or both kidneys
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UTIs
• Pyelonephritis
– Symptoms:
• Sudden onset of fever and chills
• Flank pain
• Hematuria
– Treated effectively with antibiotics
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Diseases of the Kidney
• Acute glomerulonephritis
– Inflammation of glomerulus or filtering unit of kidney
– Most common kidney disease
– Occurs one to four weeks after strep infection
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Diseases of the Kidney
• Acute glomerulonephritis
– Symptoms:
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Flank pain
Fever
Loss of appetite
Malaise
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Diseases of the Kidney
• Acute glomerulonephritis
– Symptoms:
• Edema of eyes and ankles
• Oliguria
• Hematuria
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Diseases of the Kidney
• Acute glomerulonephritis
– Treatment:
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Antipyretic
Diuretic
Salt restriction
Protein restriction
Fluid restriction
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Diseases of the Kidney
• Chronic glomerulonephritis
– Repeated bouts lead to chronic condition
– Symptoms include those of acute glomerulonephritis and
hypertension
– Uremia may occur during late stages
– Treatment:
• Peritoneal
• Hemodialysis
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Diseases of the Kidney
• Hydronephrosis
– Urine in renal pelvis due to obstruction leading to dilation
and distention of kidney pelvis
– Diagnosis by pyelogram
– Treatment:
• Draining of kidney pelvis by surgery
• Relief of obstruction
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Hydronephrosis
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Diseases of the Kidney
• Renal calculi
– Also known as kidney stones
– Form in kidney pelvis
– Symptoms:
• Hematuria
• Renal or urinary colic
• Extreme spasmodic flank pain
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Renal Calculi
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Diseases of the Kidney
• Renal calculi
– Diagnosis by IVP, KUB, and renal ultrasound
– Treatment:
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Pain medication
Increased fluid intake
Strain urine
Surgery
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Diseases of the Kidney
• Polycystic disease
– Inherited disease causing enlargement of kidneys due to
grape-like cysts
– Slow, progressive disease
– Symptoms:
• Lumbar pain
• Hematuria
• Recurrent UTIs
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Diseases of the Kidney
• Polycystic disease
– Treatment:
• Management of hypertension and UTIs
• Dialysis and kidney transplant
– No cure
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Diseases of the Kidney
• Renal failure
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Failure of kidneys to cleanse blood of waste products
BUN and creatinine measure kidney function
May be acute or chronic
Symptoms not significant until 75 percent of kidney
function destroyed
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Diseases of the Kidney
• Renal failure
– Treatment:
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Management of cause of failure
Limitation of sodium and protein
Measure I & O (intake and output)
Antihypertensives
Diuretics
Antibiotics
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Diseases of the Kidney
• Renal failure
– Long-term treatment:
• Dialysis
• Transplant
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Arteriovenous (AV) Shunts
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Diseases of the Kidney
• Adenocarcinoma of the kidney
– Risk factor:
• Cigarette smoking
– Frequently metastasizes to liver, brain, and bone before
symptoms appear
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Diseases of the Kidney
• Adenocarcinoma of the kidney
– Symptoms:
• Painless hematuria
• Flank pain
• Fever
– Diagnosis by KUB, IVP, CT scan, and biopsy
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Diseases of the Kidney
• Adenocarcinoma of the kidney
– Treatment:
• Nephrectomy
• Chemotherapy
• Radiation
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Diseases of the Bladder
• Urinary incontinence
– Loss of urine flow control
– Types:
• Stress
• Urge
• Overflow
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Diseases of the Bladder
• Urinary incontinence
– Treatment:
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Empty bladder
Perform Kegel exercises to strengthen pelvic muscles
Have collagen injections near external sphincter to narrow urethra
Have Marshall-Marchetti-Krantz procedure
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Diseases of the Bladder
• Transitional cell carcinoma of the bladder
– Most common neoplasm of urinary tract arising from lining
of bladder
– Diagnosis by cystoscopy and biopsy
– Treatment depends on stage of tumor, transurethral
resection (TUR), and cystectomy
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Trauma
• Straddle injuries
• Neurogenic bladder
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Rare Diseases
• Goodpasture syndrome
• Interstitial cystitis
– Nonbacterial cystitis due to inflammation of inner lining of
bladder
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Effects of Aging
• Urinary incontinence
• Prostatic hypertrophy
– Older males
– Dribbling, frequency, pain or burning, and difficulty
starting urine flow
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