Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1
Alterations of Renal and Urinary
Tract Fun...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2
Urinary Tract Obstruction
 Urinary tract ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3
Urinary Tract Obstruction
(cont’d)
 Sever...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4
Upper Urinary Tract Obstruction
 Hydroure...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5
Urinary Tract Obstruction
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6
Upper Urinary Tract Obstruction
 Compensa...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7
Upper Urinary Tract Obstruction
(cont’d)
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8
Kidney Stone Formation
 Supersaturation o...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9
Kidney Stone Formation
(cont’d)
 Other fa...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10
Kidney Stones
 Manifestation
 Renal col...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11
Kidney Stones (cont’d)
 Treatment:
 Hig...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12
Lower Urinary Tract Obstruction
 Neuroge...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13
Tumors
 Renal tumors
 Renal adenomas
 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14
Urinary Tract Infection (UTI)
 UTI is in...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15
Urinary Tract Infection (UTI)
(cont’d)
 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16
Urinary Tract Infection (UTI)
(cont’d)
 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17
Urinary Tract Infection (UTI)
(cont’d)
 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18
Urinary Tract Infection (UTI)
(cont’d)
 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19
Chronic Pyelonephritis
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20
Glomerular Disorders
 Glomerulonephritis...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21
Glomerulonephritis
 Mechanisms of injury...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22
Glomerulonephritis (cont’d)
 Manifestati...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23
Glomerulonephritis (cont’d)
 Types:
 Me...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24
Glomerulonephritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25
Nephrotic Syndrome
 Excretion of 3.5 g o...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26
Nephrotic Syndrome (cont’d)
 Membranous ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27
Acute Kidney Injury (AKI)
 Renal insuffi...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28
Acute Kidney Injury (AKI)
(cont’d)
 Prer...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29
Acute Kidney Injury (AKI)
(cont’d)
 Intr...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30
Acute Kidney Injury (AKI)
(cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31
Acute Kidney Injury (AKI)
(cont’d)
 Init...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32
Chronic Kidney Disease (CKD)
 Progressiv...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33
Chronic Kidney Disease (CKD)
(cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34
Chronic Kidney Disease (CKD)
(cont’d)
 P...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35
Chronic Kidney Disease (CKD)
(cont’d)
 F...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36
Chronic Kidney Disease (CKD)
(cont’d)
 F...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37
Chronic Kidney Disease (CKD)
(cont’d)
 A...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38
Chronic Kidney Disease (CKD)
(cont’d)
 G...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39
Signs and Symptoms of Kidney
Failure
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Alterations and renal

  1. 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Alterations of Renal and Urinary Tract Function
  2. 2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Urinary Tract Obstruction  Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract  The obstruction can be caused by an anatomic or functional defect • Obstructive uropathy
  3. 3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Urinary Tract Obstruction (cont’d)  Severity based on:  Location  Completeness  Involvement of one or both upper urinary tracts  Duration  Cause
  4. 4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Upper Urinary Tract Obstruction  Hydroureter  Hydronephrosis
  5. 5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Urinary Tract Obstruction
  6. 6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Upper Urinary Tract Obstruction  Compensatory hypertrophy and hyperfunction  Obligatory growth  Compensatory growth  Postobstructive diuresis (nephrogenic diabetes insipidus)
  7. 7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Upper Urinary Tract Obstruction (cont’d)  Kidney stones  Calculi or urinary stones • Masses of crystals, protein, or other substances that form within and may obstruct the urinary tract  Risk factors: • Gender • Race • Geographic location • Seasonal factors • Fluid intake • Diet • Occupation  Kidney stones are classified according to the minerals that make up the stone
  8. 8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Kidney Stone Formation  Supersaturation of one or more salts  Presence of a salt in a higher concentration than the volume able to dissolve the salt  Precipitation of a salt from liquid to solid state  Temperature and pH  Growth into a stone via crystallization or aggregation
  9. 9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Kidney Stone Formation (cont’d)  Other factors affecting stone formation:  Crystal growth-inhibiting substances  Particle retention  Matrix  Stones:  Calcium oxalate or calcium phosphate  Struvite stones  Uric acid stones
  10. 10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Kidney Stones  Manifestation  Renal colic  Evaluation  History  Stone and urine analysis  Intravenous pyelogram (IVP) or kidney, ureter, bladder x-ray (KUB)  Spiral abdominal CT
  11. 11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Kidney Stones (cont’d)  Treatment:  High fluid intake  Decreasing dietary intake of stone-forming substances  Stone removal
  12. 12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Lower Urinary Tract Obstruction  Neurogenic bladder  Dyssynergia • Detrusor hyperreflexia-overactive • Detrusor areflex-underactive  Overactive bladder syndrome (OBS) • Frequency, urgency, nocturia  Obstruction • Urethal stricture, prostate enlargement, pelvic organ prolapse • Partial obstruction of bladder outlet or urethra  Low bladder wall compliance
  13. 13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Tumors  Renal tumors  Renal adenomas  Renal cell carcinoma (RCC)  Bladder tumors  Transitional cell carcinoma (most common)  Gross, painless hematuria  Most common in males older than 60 years and smokers
  14. 14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Urinary Tract Infection (UTI)  UTI is inflammation of the urinary epithelium caused by bacteria  Acute cystitis  Painful bladder syndrome/interstitial cystitis  Acute and chronic pyelonephritis
  15. 15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Urinary Tract Infection (UTI) (cont’d)  Most common pathogens  Escherichia coli  Virulence of uropathogens  Host defense mechanisms
  16. 16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Urinary Tract Infection (UTI) (cont’d)  Acute cystitis  Cystitis is an inflammation of the bladder  Manifestations: • Frequency • Dysuria • Urgency • Lower abdominal and/or suprapubic pain  Treatment: • Antimicrobial therapy • Increased fluid intake • Avoidance of bladder irritants • Urinary analgesics
  17. 17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Urinary Tract Infection (UTI) (cont’d)  Interstitial cystitis  Nonbacterial infectious cystitis  Manifestations: • Most common in women 20 to 30 years old • Bladder fullness, frequency, small urine volume, chronic pelvic pain  Treatment • No single treatment effective, symptom relief
  18. 18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Urinary Tract Infection (UTI) (cont’d)  Pyelonephritis  Acute pyelonephritis • Acute infection of the renal pelvis interstitium  Vesicoureteral reflux, E. coli, Proteus, Pseudomonas  Chronic pyelonephritis • Persistent or recurring episodes of acute pyelonephritis that lead to scarring • Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition
  19. 19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Chronic Pyelonephritis
  20. 20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Glomerular Disorders  Glomerulonephritis  Inflammation of the glomerulus • Immunologic abnormalities (most common) • Drugs or toxins • Vascular disorders • Systemic diseases (secondary) • Viral causes
  21. 21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Glomerulonephritis  Mechanisms of injury  Deposition of circulating soluble antigen- antibody complexes, often with complement fragments (Type III hypersensitivity)  Antibodies reacting in situ against planted antigens within the glomerulus (Type II hypersensitivity–cytotoxic)  Nonimmune (drugs, toxins, ischemia)
  22. 22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Glomerulonephritis (cont’d)  Manifestations:  Two major symptoms if severe • Hematuria with red blood cell casts • Proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein  Oliguria  Hypertension  Edema  Nephrotic sediment  Nephritic sediment
  23. 23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 Glomerulonephritis (cont’d)  Types:  Membranous nephropathy/glomerulonephritis  Rapidly progressing glomerulonephritis • Antiglomerular basement membrane disease (Goodpasture syndrome)  Chronic glomerulonephritis
  24. 24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 Glomerulonephritis (cont’d)
  25. 25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 Nephrotic Syndrome  Excretion of 3.5 g or more of protein in the urine per day  The protein excretion is caused by glomerular injury  Findings:  Hypoalbuminemia  Edema  Hyperlipidemia and lipiduria  Vitamin D deficiency
  26. 26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 Nephrotic Syndrome (cont’d)  Membranous glomerulonephritis  Focal glomerulosclerosis  Minimal change disease (lipoid nephrosis)  Nephritic syndrome  Hematuria  Mild proteinuria  Immune injury
  27. 27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 Acute Kidney Injury (AKI)  Renal insufficiency  Renal failure  End stage renal failure (ESRF)
  28. 28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 Acute Kidney Injury (AKI) (cont’d)  Prerenal  Most common cause of ARF  Caused by impaired renal blood flow  GFR declines because of the decrease in filtration pressure
  29. 29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Acute Kidney Injury (AKI) (cont’d)  Intrarenal  Acute tubular necrosis (ATN) is the most common cause of intrarenal renal failure • Postischemic or nephrotoxic • Oliguria  Postrenal  Occurs with urinary tract obstructions that affect the kidneys bilaterally
  30. 30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 Acute Kidney Injury (AKI) (cont’d)
  31. 31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 Acute Kidney Injury (AKI) (cont’d)  Initiation phase  Kidney injury is evolving  Prevention of injury is possible  Maintenance phase  Established kidney injury and dysfunction  Urine output is lowest during this phase and serum creatinine and blood urea nitrogen both increase  Recovery phase  Injury repaired and normal renal function reestablished  Diuresis common  Decline in serum creatinine and urea  Increase in creatinine clearance
  32. 32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Chronic Kidney Disease (CKD)  Progressive loss of renal function that affects nearly all organ systems  Associated with HTN, diabetes, intrinsic kidney disease  Stages:  Normal (GFR >90mL/min)  Mild (GFR 60-89mL/min)  Moderate (GFR 30-59mL/min)  Severe (GFR 15-29mL/min)  End stage (GFR less than 15)
  33. 33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Chronic Kidney Disease (CKD) (cont’d)
  34. 34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 Chronic Kidney Disease (CKD) (cont’d)  Proteinuria and uremia  Due to glomerular hyperfiltration  Damages interstitial tissue of kidney via inflammation  Creatinine and urea clearance  GFR falls  Plasma creatinine increases
  35. 35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 Chronic Kidney Disease (CKD) (cont’d)  Fluid and electrolyte balance  Sodium and water balance • Sodium excretion increases with obligatory water excretion leading to sodium deficit and volume loss • Concentration and dilution ability diminishes  Potassium balance • Tubular secretion increases early • Once oliguria sets in, potassium retained  Acid-base balance • Metabolic acidosis when GFR 30%-40%
  36. 36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36 Chronic Kidney Disease (CKD) (cont’d)  Fluid and electrolyte balance  Calcium, phosphate, bone • Reduced renal phosphate excretion, decreased renal synthesis of 1,25-(OH)2 vitamin D3, and hypocalcemia. • Fractures  Protein, carbohydrate, fat metabolism  Anemia • Lethargy, dizziness, and low hematocrit are common
  37. 37. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37 Chronic Kidney Disease (CKD) (cont’d)  Alterations seen in following systems:  Cardiovascular  Pulmonary  Hematologic  Immune  Neurologic
  38. 38. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38 Chronic Kidney Disease (CKD) (cont’d)  Gastrointestinal  Endocrine and reproduction  Integumentary
  39. 39. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39 Signs and Symptoms of Kidney Failure

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