Name: Jane Cairo
Address: 5 Brownfield Street
Parkdale Vic 3194
La Trobe University
School of Occupational Therapy
Subject: Occupational Health & Safety
Screening and Monitoring(OCT42OHC)
Topic: Functional Occupational Health Assessment
Kidney and Bladder Systems
Lecturer: Jean Cromie
Due Date: 15th October 2002
Date Sent:22nd October 2002(extension granted)
Approximate Word Count: 1998
Kidney/ Bladder system
The kidney and bladder systems are the main organs in the urinary system that creates
and stores urine to assist bodily excretion of wastes, and keep chemicals, electrolytes and
water in the body balanced. This ensures body tissues remain appropriately hydrated
The kidneys are kidney bean shaped organs about the size of a person’s fists, and are
near the middle of the back, just below the ribcage (NIDDK, 2002). Filtering units called
nephrons in the kidneys remove urea from the blood, and there are a million in each
kidney (NIDDK, 2001, Ross & Wilson 1983). The nephron consists of a ball formed of
small blood capillaries, called a glomerulus and a small tube called a renal tubule.
Initially waste products filter from the glomuruli to the renal tubule, forming a
glomurular filtrate that passes through the renal tubules enabling the reabsorption of
products and chemicals, such as sodium, phosphorous and potassium, for the body to still
use. Further secretions from peritubular capillaries to renal tubules combine with the
filtrate (Glen, 1994). The filtrate becomes urine that contains urea in the tubule that
travels down the ureters to the bladder.
Renal function is the actual work the kidneys perform. Two healthy kidneys equate to
100 percent renal function, where one health kidney would equate to 50 percent renal
function (NIDDK, 2001). Two unhealthy kidneys could account for 60 percent renal
function, and be steadily declining. Renal function dropping below 10 to 15 percent,
needs renal replacement therapy to maintain life, which can be dialysis or transplantation.
Apart from removing waste products the kidneys produces three important substances,
• erythropoietin (EPO) - which stimulates the bone marrow to make red
• renin - which regulates blood pressure and the levels of vital salts
• active form of Vitamin D - which helps maintain calcium for bones and
for normal chemical balance in the body.
The bladder is a hollow muscular organ shaped like a balloon that sits in the pelvis
area and is held in place by ligaments attached to other organs and the pelvic bones, and
stores urine (DHS, 1999). When full it swells in size, and if healthy can hold 500mls for
2-5 hours (NIDDK, 2002). Circular muscles called sphincters keep the urine from
leaking into the urethras until urination. As the bladder fills with urine, impulses travel
along neuronal pathways to communicate with the brain that the bladder is full and needs
emptying, so the urge to urinate intensifies.
Occupational Risks and Predisposing Factors of Kidney Disorders
Kidney disorders tend to have higher prevalence in industries where workers are
exposed to asbestos and heavy metals (DHS, 2001 and Balter et al [Toxline], 1976).
Nephrotoxic agents include lead, arsenic, cadmium, mercury, uranium, beryllium,
solvents, haloganated hydrocarbons and pesticides. The route site of entry can vary, but
once in the blood stream can damage the kidneys directly by damaging the nephron or
indirectly as a systemic, prerenal toxicity (Lilis & Landrigan, 1995, and Waldron 2001).
The dry cleaning industry has a higher incidence of renal pelvic cancer and the coke
production industry have higher incidences of kidney cancer (McCredie & Stewart 1993,
Waldron 2001). The DHS (2001), and Australian Kidney Foundation, indentifies the
following conditions can increase occupational risk to kidney cancer:-
• high cholesterol and diabetes
• phenacitin (ingredient found in painkillers)
• family history of kidney disease
• male gender.
Diabetes can later cause diabetes nephropathy, whereby unused glucose remains in
blood causing irreparable damage to the nephrons, resulting in kidney disease (NIDDK,
2002). High blood pressure also causes damage in the smaller capillaries in the kidney,
hence hindering the filtering of waste products.
Occupational Risks & Predisposing Factors of Bladder Disorders
Aromatic amines such as soot, tars, and polycyclic hydrocarbons have been shown to
cause bladder cancer, which are substances found in dyes used in textile industry, and in
mainstream and sidestream cigarette smoke (Lilis & Landrigan, 1995). Thus exposure to
cigarette smoke can exacerbate the occupational hazards of these aromatic chemicals.
Other varying health reactions to aromatic amine exposure can be due to different
inherited polymorphisms, as some people can perform N-aceytlation of 2-
naphythylamine, and other aromatic amines, whilst other people cannot (Waldron, 2001).
Employees with slow N-acetylation activity are strongly correlated to being at more risk
of bladder cancer. Occupational exposure to 4-Aminobiphenyl and benzidene are
associated with the development of employee bladder cancer. Occupations that are
recognised as presenting a carcinogenic risk for the bladder, are:-
• manufacturing and use of dyes
• manufacturing of auromine and para-Chloro-ortho-toluidine,
• manufacturing of rubber, the production of synthetic latex, tyre curing,
reclaiming and cable making
• production of aluminium.
Occupational Related Disorders of the Kidney/Bladder Systems
Kidney Cancer – initial signs and symptoms may be blood in urine, a pain or ache in
lower back, a lump in abdomen, tiredness, unexplained or sudden weight loss or fever
(DHS, 2001 & Australian Kidney Foundation). Different types of kidney cancer
• renal cell carcinoma – starts in the lining of one or both kidneys. This
type accounts for 80 percent of cases.
• renal sarcoma – a rare type of kidney cancer.
• transitional cell carcinoma – this cancer starts in the join between the
kidney and the adjoining ureter.
Renal Failure – factors that influence the speed of kidney failure are still not completely
understood, but current research is focused on how protein in diet and cholesterol in
blood affect kidney function. Signs and symptoms indicative of kidney disease are
needing to urinate more or less, loss of appetite, nausea and vomiting, swelling of hands
or feet may occur, feeling drowsy, inability to concentrate, skin darkening, swelling of
extremities or puffy eyelids and muscle cramps (Australian Kidney Foundation, NIDDK
2002). Three types of renal failure are:-
• acute renal failure (ARF) – happens quickly, such as an accident that
injures the kidneys like suddenly losing a lot of blood or sudden damage
caused by some drugs or poisons. Kidney function suddenly drops.
• chronic kidney disease (CKD) – happens gradually, and is often called
silent kidney disease for years before realisation that damage to renal
function and kidneys has occurred.
• end-stage renal disease (ESRD) – is total or near total renal failure, and
people with this condition have to undergo dialysis or transplantation to
Bladder Cancer – in 80 percent of cases, bladder cancers are superficial, where small
mushroom like growths occur (DHS, 2001). They are removed using a cystoscope to
snip the tumor off, and then cauterised to prevent bleeding. Often growths reoccur so
follow up cystoscopies are required. Other bladder cancers require treatment such as
surgical removal of part of the bladder, chemotherapy and radiotherapy. Early symptoms
of bladder cancer are blood in the urine, frequent urge to urinate and/or painful sensations
whilst urinating (DHD, 2001 & NIDDK 2002).
Urine Test/Urinalysis – involves urinating into a special container so urine can be
assessed for appearance, specific gravity, protein, albumin, creatinine, ketone bodies or
blood (Glen, 1994, NIDDK 2002). Testing urine can measure the creatinine clearance,
which is a measure of the rate of removal of creatinine from the blood by the kidneys
renal function. The normal rate in men is 97 to137 ml/min, and in women is 88 to 128
mL/min (NIDDK, 2001).
Urodynamic Tests – evaluates urine storage in the bladder and how urine flows from the
bladder through to the urethra (NIDDK, 2002). A small tube called a catheter is inserted
through the urethra to the bladder to fill with either water or gas. Another small tube is
inserted into the rectum to measure the pressure placed on the bladder, when straining of
coughing. Other bladder tests use x-ray dye instead of water, so x-ray pictures can be
taken when the bladder fills and empties, to assist detection of abnormalities in the shape
or function of the bladder.
Physical Examination – physical well being such as blood pressure, pulse, temperature,
respirations, physical appearance, outstanding symptomology, appearance and subjective
feelings of well being are assessed, as well as palpitation of the kidneys and bladder
(Australian Kidney Foundation and Kozier & Erb, 1983). Palpitation checks the kidney
for contour, size and tenderness. Tenderness can indicate inflammation. If unable to
palpate, which could be due to obesity or very firm abdominal muscles, kidney
tenderness may be detected by jarring the costoverbal angle.
Cystoscopy – a slender tube is inserted to the bladder via the urethra allowing
visualization of any signs of bleeding (DHS, 2001)
Blood Tests – Samples of blood are tested for presence of substances that should be
absent (NIDDK, 2001). Some of these substances are:-
* Creatinine - instead of being put in urine by kidneys to leave the body,
sometimes it can stay in blood and build up to unhealthy levels if kidneys have problems.
A normal creatinine range is 0.6 to 1.2 mg/dL, but variations can occur due to diet,
genetic make up and sex (NIDDK,2001).
* Blood Urea Nitrogen (BUN) – is urea, a compound containing nitrogen that is
found in the blood. Urea is waste product that is produced after cells use protein from the
blood. Urea should be present in the urine but if kidneys are inefficient then urea stays
in the blood. If BUN is more than 20 mgm/dL the kidneys are not working optimally and
this could be due to gradual renal failure, dehydration or heart failure.
Computerised Tomography (CT Scan) – a special x-ray that gives a three dimensional
picture of your internal organs (NIDDK, 2002, DHS, 2001).
Magnetic Resonance Imaging (MRI Scan) – similar to the CT scan, but radio waves
and a strong magnetic field are used to give a three dimensional picture.
Ultrasound Scan – sound waves create a picture of the inside of the body.
Intravenous Pylogram – an injected dye that makes kidneys more visible during an
x-ray (DHS, 2001).
Arteriogram – an injected dye into an artery to show up any tumors in arteries and veins
around the kidneys.
Occupational Health and Safety Assessment, Responsibilities,
Identification of occupational hazards of chemical agents that workers are exposed to
in the workplace, and have a risk of causing disorders or disease of the bladder and
kidneys. The establishment and reviewing of material safety data sheets(MSDS), to
ensure they current on all substances, and being informed on present, past and relevant
epidemiological studies on workers in similar industries. Risk Assessment completion
would allow a baseline to evaluate work practices. A safety programme then to be
• Prescreening all employees before being employed in industry to obtain
information about current and state of health, lifestyle factors and
genetic history. Smoking, diabetes and family history of renal disease
would place future employees in high risk groups before exposure to
• Ongoing monitoring of workplace environment to ensure any hazardous
exposure levels are not exceeded and ensure protective devices are
working efficiently to maintain safety. Occupational hygienists can
monitor workplaces regularly, and advise of further precautions.
• Eliminate risks of chemicals/hazards by not using chemical hazard
where possible, if not then maximising on use of, Personal Protection
Equipment(PPE), safe design/layout of workplace and equipment that
removes hazards such as extractor that rids laboratory of airborne toxic
• Monitoring employee’s health regularly, such as weekly urine tests to
measure creatinine levels, with 3-6 monthly physical check ups.
• Documentation and actual education for workers of risks involved in
working in industry, how to effectively utilise PPE, work safely with
chemical/hazards, and maintain a healthy lifestyle to assist avoidance of
diabetes, high cholesterol and smoking.
• To recognise kidney and bladder disorders occurring due to exposures
in the workplace. Diagnosed disorders to be detailed in workplace
register, and treatment to be organised with further preventative
measures such as job rotation, or tasks that involve not working with
• Cost analysis of most economically effective way to maintain
programme, as it may be more cost effective to do urine testing within
company, and physical check ups and ultrasounds externally.
Australian Kidney Foundation (AKF). Kidney Health - Fact Sheet.
[.Accessed 11th October 2002]
Balter, P., Muehrcke, R.C., Morris, A.M., Moles, J.B., & Lawrence, A. G. (Toxline-
Abstract). (1976). Chronic Toxic Nephrapathies Diagnosis and Management. (Source:
Annals of Clinical and Laboratory Science, Vol 6, No. 4. pages 306-311.) Item 8 of 105.
Department of Human Services, Victorian Government (DHS). (2000).Bladder
Cancer. Better Health Channel.[online] 23rd October 2000. Available:
[Accessed 9th October 2002].
Department of Human Services, Victorian Government. (DHS). (2001). Kidney
Cancer. Better Health Channel. [online] April 2001. Available:
[Accessed 9th October 2002].
Department of Human Services, Victorian Government. (DHS). (1999). Urinary
system. Better Health Channel. [online]. 13th October 1999. Available:
[Accessed 16th October 2002].
Glen, S. B. (1994). The Urinary System – An Illustrated Review of the the Urinary
System. Harper Collins.
HealthInsite. (2002). Diseases Which Affect the Kidneys. Commonwealth
Government of Australia Initiative. [online]. Available:
[Accessed 11th October 2002].
Kozier, B., & Erb, G. (1983). Fundamentals of Nursing – Concepts and Procedures.
2nd Ed. California, United States of America: Addison-Wesley Publishing Company.
Chapter 28. pp 704-736.
Lilis,R., & Landrigan, P. J.(Abstract –Toxline). (1995). Renal and Urinary Tract
Disorders -Occupational Health. Recognising and Preventing Work Related Disease
(Abstract). Toxline. [online].
15th October 2002. Available: http://toxnet.nlm.nih.gov/cgi-bin/sis/download.txt.
>[Accessed 16th October 2002].
McCredie, M., & Stewart, J. H. (1993). Risk Factors for kidney cancer in New South
Wales. IV. Occupation (Abstract from article published in British Journal of Industrial
Medicine). [online]. Available:
[Accessed: 16th October 2002].
Miller, B., & Keane,C., (1987). Encyclopedia and Dictionary of Medicine, Nursing,
and Allied Health. 4th ed. Philadelphia, United States of America: Saunders.
National Kidney and Urologic Diseases Information Clearinghouse (NIDDK)., U.S.
Department of Health and Human Services. (2002a). Your Kidneys and How They
Work. [online]. February. Available:
http://www.niddk.nih.gov/health/kidney/pubs/yourkids/index.htm>[Accessed 11 October
National Kidney and Urologic Diseases Information Clearinghouse (NIDDK)., U.S.
Department of Health and Human Services. (2002b). Your Urinary System and How it
Works. [online]. March
National Occupational Health & Safety Commission (NOSHC).(2002). Kidney-
>[Accessed 16th October 2002].
Ross, K., & Wilson, J. (1981). Foundations of Anatomy and Physiology. 5th ed.
New York, United States of America: Churchill Livingstone.
Waldron, H. & Edling.C.(Eds). 2001. Occupational Health Practice (4th ed). Oxford,