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RENAL SYSTEM               1
Organs of the Renal SystemKidneysUretersUrinary bladderUrethraNot manystructures, butvery important!                      ...
Functions of Urinary System    Regulate electrolytes (K, Na, etc)    Regulate pH in blood    Regulate blood pressure    Re...
Relationship of the Kidneys to          Vertebra and RibsThey are retroperitonealand are located in theabdominal cavity.Th...
Position of the Kidneys with inthe Posterior Abdominal Wall                            Figure 23.2a                       ...
STRUCTURES WITHIN THE         KIDNEYThe RENAL CAPSULE surrounds the kidney,made of dense fibrous connective tissue.A layer...
Vibration Platform Machine:No longer used in the USA because it          damages kidneys!                                 ...
These are still around in gyms in   other countries…beware!                                    8
Gross Anatomy of the Kidneys   Renal cortex (Most superficial layer)    Renal medulla      Renal pyramids (drain into th...
Renal fascia               Interlobar arteries               Interlobular arteriesArcuatearteries                         ...
Internal Anatomy of the Kidneys                      Interlobar artery                                          Figure 23....
Blood Supply to KidneyAORTA  RENAL ARTERY  SEGMENTAL ARTERIES   INTERLOBAR ARTERIES  ARCUATE ARTERIES (form arcs)   I...
Internal Anatomy of the Kidneys                     Interlobar artery                                         Figure 23.3b...
Microscopic Anatomy of the Kidneys Just like the functional unit of the lungs is the alveolus and the functional unit of t...
Microscopic Anatomy of the NephronGLOMERULUS WITH A CAPSULEPROXIMAL CONVOLUTED TUBULELOOP OF HENLE    DESCENDING LIMB    ...
Nephron          16
Position of Nephron in Kidney                          Figure 23.4a                                   17
Glomerulus of a Nephron                          18
Juxtaglomerular Apparatus The distal end of the  renal tubule passes  next to the  glomerulus to form  the juxtaglomerula...
Juxtaglomerular Apparatus If blood pressure is  too low, the JGA  releases  adenosine, which  causes  vasoconstriction of...
Juxtaglomerular Apparatus:             Juxtaglomerular Cells if the blood pressure is  still too low after  adenosine has...
GLOMERULUSThe glomerulus is the first part of the nephron, where thefiltration occurs.The glomeruli are located only in th...
Glomerulus   of a Nephron        23
Normally at the end of the capillary bed youhave venuoles. But this is the only part of thebody that is different: here we...
Nephron          25
Juxtaglomerularapparatus                  Efferent arteriole                  Afferent arteriole                  Bowman’s...
FUNCTION OF THE NEPHRONBlood comes in from the AFFERENT ARTERIOLES.Plasma leaks out and enters the glomerular capsule.The ...
Nephron          28
FUNCTION OF THE NEPHRONIn the distal convoluted tubule, the rest of thewater and salt are removed.The rest of the liquid g...
Figure 23.5        30
Renal Corpuscle and the  Filtration Membrane                          Figure 23.6c                                   31
Function of the Nephronhttp://www.youtube.com/watch?v=aQZaNX6 Tips for healthy urinary system:http://urology.about.com/od/...
DiureticsDiuretics are medicines that increase theamount of urine that is produced.People who have high blood pressure mig...
HISTOLOGY OF THE NEPHRONPROXIMAL AND DISTAL CONVOLUTEDTUBULES   This area absorbs nutrients, water, and salt.    Only abo...
Urine ProductionFiltration – filtrate of blood leaves kidneycapillariesReabsorption – most nutrients, water, andessential ...
Figure 23.9a         36
Collecting Duct (tubule)Receives urine from distal convolutedtubules, empties into ureter.                                ...
Ureters    These are long tubes that connect the renal    pelvis to the urinary bladder    MUCOSA     TRANSITIONAL EPITHE...
URINARY BLADDERThe histology of the urinary bladder isidentical to the ureter except the mucosallayer has folds called RUG...
Urinary BladderRugae:allows forexpansion-A fullbladder isroughly thesize of a softball                                   F...
URINARY BLADDERThe muscle layer around the urinarybladder is thicker than the ureters, and iscalled the DETRUSOR MUSCLE, w...
Detrusor Muscle                  42
URETER entrance to BLADDERThe URETER enters in at the base of theurinary bladder, not the top.As the bladder fills, it pre...
BLADDERThe TRIGONE is a triangular area where the ureterscome in and the urethra goes out.Between the urethra and the urin...
45
UrethraDrains the urine to the outside.Its histology is the same as the ureterFemales: 4cmMales 20 cm (varies with mood)Th...
ProblemsURETHRITIS = infection and inflammationof the urethraPYELITIS= infection of the renal calyxesCYSTITIS = infection ...
UREAUrea is a waste product of amino acidmetabolism.Remember, proteins are made of aminoacids, so when you break down prot...
COLOR OF URINEWhen you urinate, it should be clear andcolorless with almost no yellow color.The more yellow the urine is, ...
ProblemsKIDNEY STONES    Develop in the renal pelvis   Stones are made out of a variety of things:    uric acid, calcium...
KIDNEY STONESThey can block the ureter, causing the kidney toenlarge. As the kidney stretches, the capsulestretches, causi...
KidneyStones         52
5 cm Kidney Stone Surgery                            53
Kidney stones get stuck in three places: Renal pelvis In the ureter as it bends over the common iliac artery In the urinar...
Wherekidney stones   get stuckRenal pelvis  Ureter Common iliac artery    Urinary    bladder    trigone                55
56
KIDNEY STONES TREATMENTULTRASOUND LITHOTRIPSY    Put a powerful speaker on the outside of the kidney,    sends a shock wa...
ULTRASOUND LITHOTRIPSY                     58
59
Kidney Stone Prevention                          60
ReynoldsUnwrapped.com offersFANTASTIC, inexpensive daily emailsubscriptions, where you can receive aHILARIOUS new cartoon ...
Other Kidney ProblemsNephritis: inflammation of the nephrons.Hydronephritis: excess fluid in the nephron.Glucose in the ur...
Kidney ProblemsThings can happen to the kidney: infection,excess proteins, pH change, blood pressuredrops, and can lead to...
What is Renal Failure?Renal failure occurs when your kidneys stopworking.Our kidneys are very important to us becausewe us...
Causes of Renal Failure1. Medication / Poison / Infection   People with long term health problems   are most at risk to ha...
2. Sudden drop in blood flow.   - Heavy blood loss from an injury   - A serious infection (Sepsis)   - Severe Dehydration3...
Who is most likely to get Renal           Failure?Kidney or Liver DiseaseDiabetesHigh Blood PressureHeart FailureObesityBo...
SymptomsVery little or no urine during urinationIf the body is unable to excrete potassium, the rising ofpotassium levels ...
SymptomsHigh Blood PressureBecause the kidneys can not deal with the rising acidlevels in the body, breathing becomes more...
Diagnosis  Patients can be diagnosed by undergoing            blood and urine tests  Blood                       UrineBUN ...
DiagnosisPatients can also undergo an Ultrasound to see if there are any obstructions.                                    ...
Treatment   Treatments are based on the causeIssue                   Treatment- Blood Loss            - Restore blood flow...
Also, the person treating the patient willattempt to stop the buildup of waste in thebody. This may be done by dialysis.An...
PreventionRegulate Blood PressureRegulate Sugar IntakeRegulate Protein IntakeOnce the kidney fails the only options aredia...
Values                       Results         NormalAPPEARANCE                    CLEAR           CLEARBACTERIA            ...
Urinalysis: What Does It All Mean?How to perform test•Midstream catch is acceptable•Should be examined within 2 hours•Shou...
Specific Gravity• Purpose: urine osmolality and represnts  patients’ hydration status and concentrating  ability of their ...
pH• Purpose: urinary pH reflects serum pH except  in renal tubular acidosis (RTA), useful for  diagnosis/management of UTI...
Hematuria• Criteria: 3 or more RBC per HPF in 2 of 3 urine  samples• Testing: for peroxidase activity, will be  positive i...
ProteinuriaCriteria: >150 mg/day (10-20mg per dL)    -microalbuminuria= 30-150 mg/day (sign of early renal disease)Normal ...
Glucosuria• Normal: almost completely reabsorbed in  proximal tubule• Criteria: occurs at approximately 180-200  mg/dL• El...
Ketonuria• Normal: not present in urine• Testing: presence of acetic acid through a  chemical reaction• Causes: uncontroll...
Nitrites• Normal: Not present in urine• Testing: bacteria that reduce urinary nitrates  to nitrites• -Positive test: can b...
UTIs• -NOTE: nitrite stick sensitive to air exposure:  after one week of exposure about 1/3 of strips  give false positive...
Leukocyte Esterase• Testing: presence of neutrophils• Sterile Pyuria:• -Organisms: Chlamydia and Ureaplasma  urealyticum• ...
Bilirubin• Normal Bilirubin: no detectable amounts• -Unconjugated bili: not water soluble, doesn’t  pass through glomerulu...
Urobilinogen• Normal Urobilinogen: only small amounts• -Urobilinogen: end product of conjugated bili  after metabolized by...
88
Fun Facts• Cat urine, semen, and blood will glow under  fluorescent light.• So do most other bodily fluids.• ... anything ...
FUN URINARY TRACT     DISCUSSION QUESTIONSCan you drink your own urine?   Although urine is pretty clean, the exit tube (...
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20 renal

  1. 1. RENAL SYSTEM 1
  2. 2. Organs of the Renal SystemKidneysUretersUrinary bladderUrethraNot manystructures, butvery important! Figure 23.1a 2
  3. 3. Functions of Urinary System Regulate electrolytes (K, Na, etc) Regulate pH in blood Regulate blood pressure Regulate blood volume (removes excess fluid) Removing metabolic wastes Urea, uric acid, and creatinine This is the least important of the kidney’s functions. You can survive for a few weeks without excreting waste products in the urine, but hour by hour, the other functions are more important. 3
  4. 4. Relationship of the Kidneys to Vertebra and RibsThey are retroperitonealand are located in theabdominal cavity.They are at the level ofT12 to L3, so they are atthe costal margin, and theribs protect them a little.Even though they areprotected by thoracic ribs,they are NOT in thethoracic cavity becausethey are below thediaphragm. Figure 23.1b 4
  5. 5. Position of the Kidneys with inthe Posterior Abdominal Wall Figure 23.2a 5
  6. 6. STRUCTURES WITHIN THE KIDNEYThe RENAL CAPSULE surrounds the kidney,made of dense fibrous connective tissue.A layer of adipose tissue surrounds the capsule,called PARARENAL FAT (ADIPOSE). Itcushions and protects.Around that is a connective tissue layer calledthe RENAL FASCIA, made of loose connectivetissue. It anchors the kidney to the surroundingperitoneum and abdominal wall. It is not verystrong; jumping up and down can cause tearing. 6
  7. 7. Vibration Platform Machine:No longer used in the USA because it damages kidneys! 7
  8. 8. These are still around in gyms in other countries…beware! 8
  9. 9. Gross Anatomy of the Kidneys Renal cortex (Most superficial layer) Renal medulla Renal pyramids (drain into the calyx) Renal pelvis Calyx (drains into hylus  ureter) Ureter 9
  10. 10. Renal fascia Interlobar arteries Interlobular arteriesArcuatearteries 10
  11. 11. Internal Anatomy of the Kidneys Interlobar artery Figure 23.3b 11
  12. 12. Blood Supply to KidneyAORTA  RENAL ARTERY  SEGMENTAL ARTERIES  INTERLOBAR ARTERIES  ARCUATE ARTERIES (form arcs)  INTERLOBULAR ARTERIESINTERLOBULAR VEIN  ARCUATE VEIN  INTERLOBAR VEINS  SEGMENTAL VEINS  RENAL VEIN  INF. VENA CAVA 12
  13. 13. Internal Anatomy of the Kidneys Interlobar artery Figure 23.3b 13
  14. 14. Microscopic Anatomy of the Kidneys Just like the functional unit of the lungs is the alveolus and the functional unit of the liver is the lobule, the functional unit of the kidney is the NEPHRON. Each kidney has about 1 million nephrons. Each one carries out all of the various functions of the kidneys. 14
  15. 15. Microscopic Anatomy of the NephronGLOMERULUS WITH A CAPSULEPROXIMAL CONVOLUTED TUBULELOOP OF HENLE  DESCENDING LIMB Thick portion Thin portion ASCENDING LIMB Thick portion Thin portionDISTAL CONVOLUTED TUBULECOLLECTING DUCT 15
  16. 16. Nephron 16
  17. 17. Position of Nephron in Kidney Figure 23.4a 17
  18. 18. Glomerulus of a Nephron 18
  19. 19. Juxtaglomerular Apparatus The distal end of the renal tubule passes next to the glomerulus to form the juxtaglomerular apparatus (juxta means “next to”). The juxtaglomerular apparatus (JGA) consists of cells located in and around the glomerulus and the glomerular capsule. 19
  20. 20. Juxtaglomerular Apparatus If blood pressure is too low, the JGA releases adenosine, which causes vasoconstriction of the afferent arteriole. This will slow the filtration rate so less water is lost, and blood pressure increases. 20
  21. 21. Juxtaglomerular Apparatus: Juxtaglomerular Cells if the blood pressure is still too low after adenosine has caused vasoconstriction, the JGA secretes the hormone renin . Renin causes more sodium to be reabsorbed, and water follows, so blood volume increases, so blood pressure increases. 21
  22. 22. GLOMERULUSThe glomerulus is the first part of the nephron, where thefiltration occurs.The glomeruli are located only in the renal cortex.A glomerulus (“ball of yarn”) is a tuft of capillariessurrounded by a glomerular capsule (Bowman’s capsule)made of simple squamous epithelium. The glomerulusfits in the capsule like a fist punched into anunderinflated balloon.The capsule collects the plasma from the arterioles anddrains it into the convoluted tubules, which empty into acollecting duct, which exits the body.The plasma is further filtered along the way. 22
  23. 23. Glomerulus of a Nephron 23
  24. 24. Normally at the end of the capillary bed youhave venuoles. But this is the only part of thebody that is different: here we have anotherarteriole, called the EFFERENT ARTERIOLE,which takes blood away from the glomerulus.The efferent arteriole drops down straight, nextto the Loop of Henle. While it is straight, it iscalled VASA RECTA (straight capillaries).There are capillaries that come off the vasarecta which surround the loop of Henle. Here,they are called peritubular capillaries. They thenleave the area to become the interlobular vein,which leaves the kidney. 24
  25. 25. Nephron 25
  26. 26. Juxtaglomerularapparatus Efferent arteriole Afferent arteriole Bowman’s capsule 26
  27. 27. FUNCTION OF THE NEPHRONBlood comes in from the AFFERENT ARTERIOLES.Plasma leaks out and enters the glomerular capsule.The plasma contains nutrients, waste products, etc. Asthe plasma moves through the proximal convolutedtubule, all of the nutrients, and most of the water, andmost of the ions are absorbed back out of the nephronsand into the blood.In the Loop of Henle, almost all of the rest of the waterand salt are removed  blood.Everything that is not reabsorbed (the waste products)goes into the collecting duct and is excreted as urine.This is also how the water-salt balance is maintained, aswell as the acid-base balance. 27
  28. 28. Nephron 28
  29. 29. FUNCTION OF THE NEPHRONIn the distal convoluted tubule, the rest of thewater and salt are removed.The rest of the liquid goes into the collectingduct.The distal convoluted tubule and the collectingduct fine-tune the water and salt absorption andexcretion. If you are well hydrated, the water willbe allowed to leave as urine.If you are thirsty, the water will be absorbed.The purpose of the peritubular capillary bed is toabsorb these things from the nephron tubulesand put them back into the blood. 29
  30. 30. Figure 23.5 30
  31. 31. Renal Corpuscle and the Filtration Membrane Figure 23.6c 31
  32. 32. Function of the Nephronhttp://www.youtube.com/watch?v=aQZaNX6 Tips for healthy urinary system:http://urology.about.com/od/infections/tp/5tipsf 32
  33. 33. DiureticsDiuretics are medicines that increase theamount of urine that is produced.People who have high blood pressure might beprescribed diuretics to decrease the bloodvolume.Alcohol is a diuretic and this is whatcontributes to the symptoms of a hangover.The best way to prevent a hangover afterdrinking is to consume a lot of water beforeyou go to bed.Caffeine is also a diuretic, so coffee andregular Coca-cola are diuretics. 33
  34. 34. HISTOLOGY OF THE NEPHRONPROXIMAL AND DISTAL CONVOLUTEDTUBULES This area absorbs nutrients, water, and salt. Only about 1% of the fluid filtered by the kidney actually becomes urine.LOOP OF HENLE This is where water is reabsorbed. It is located in the renal medulla. 34
  35. 35. Urine ProductionFiltration – filtrate of blood leaves kidneycapillariesReabsorption – most nutrients, water, andessential ions reclaimedSecretion – active process of removingundesirable molecules 35
  36. 36. Figure 23.9a 36
  37. 37. Collecting Duct (tubule)Receives urine from distal convolutedtubules, empties into ureter. Figure 23.4a 37
  38. 38. Ureters These are long tubes that connect the renal pelvis to the urinary bladder MUCOSA TRANSITIONAL EPITHELIUM (for expansion) LAMINA PROPRIA (has elastic tissue to recoil) MUSCULAR LAYER (smooth muscle) INNER CIRCULAR OUTER LONGITUDINAL ADVENTITIA Provides protection, strength for organs, and attaches ureters to surrounding structures 38
  39. 39. URINARY BLADDERThe histology of the urinary bladder isidentical to the ureter except the mucosallayer has folds called RUGAE, which allowfor expansion.The rugae have the same basic functionas transitional epithelium—accommodating stretch as the bladderfills.You can hold up to one liter of urine,although at 500 ml, you’ll be dancing. 39
  40. 40. Urinary BladderRugae:allows forexpansion-A fullbladder isroughly thesize of a softball Figure 23.14 40
  41. 41. URINARY BLADDERThe muscle layer around the urinarybladder is thicker than the ureters, and iscalled the DETRUSOR MUSCLE, whichcontracts to allow emptying of the urinarybladder.The function of the urinary bladder is justto store urine. 41
  42. 42. Detrusor Muscle 42
  43. 43. URETER entrance to BLADDERThe URETER enters in at the base of theurinary bladder, not the top.As the bladder fills, it presses down on theureters to prevent urine from backing upinto the kidneys. 43
  44. 44. BLADDERThe TRIGONE is a triangular area where the ureterscome in and the urethra goes out.Between the urethra and the urinary bladder are twosphincters:INTERNAL URETHRAL SPHINCTER: smooth muscleEXTERNAL URETHRAL SPHINCTER: skeletal muscle.Although it is primarily under voluntary control, it willcontract if the urine volume is too much.If the patient is in a coma or under anesthesia for a longtime, the internal sphincter will be closed, like when youare asleep, so a catheter is needed to open it to drainthe urine out. 44
  45. 45. 45
  46. 46. UrethraDrains the urine to the outside.Its histology is the same as the ureterFemales: 4cmMales 20 cm (varies with mood)Therefore, women (esp. little girls) aremore susceptible to UTI. 46
  47. 47. ProblemsURETHRITIS = infection and inflammationof the urethraPYELITIS= infection of the renal calyxesCYSTITIS = infection of the urinarybladder.CHOLEOCYTITIS = infection of the gallbladder 47
  48. 48. UREAUrea is a waste product of amino acidmetabolism.Remember, proteins are made of aminoacids, so when you break down proteins,you break them down into amino acids,and the waste product left over is urea.This is the main waste product in urine.Excessive proteins can cause kidneydamage, since they are acidic. 48
  49. 49. COLOR OF URINEWhen you urinate, it should be clear andcolorless with almost no yellow color.The more yellow the urine is, the moredehydrated you are.If the urine is very dark yellow, you areburning too much protein (as in fooddeprivation). This is often seen indiabetes. 49
  50. 50. ProblemsKIDNEY STONES Develop in the renal pelvis Stones are made out of a variety of things: uric acid, calcium, cystine (an amino acid), or cholesterol. They keep growing. 50
  51. 51. KIDNEY STONESThey can block the ureter, causing the kidney toenlarge. As the kidney stretches, the capsulestretches, causing excruciating pain in cycles ofhours. As pressure builds up around the stone,urine can pass, and the kidney stone movesdown the urethra slowly.Symptomatic kidney stones may be pea sized orlarger (up to 1 ½ inches).They get stuck in three places: Renal pelvis In the ureter as it bends over the common iliac artery In the urinary bladder at the trigone. 51
  52. 52. KidneyStones 52
  53. 53. 5 cm Kidney Stone Surgery 53
  54. 54. Kidney stones get stuck in three places: Renal pelvis In the ureter as it bends over the common iliac artery In the urinary bladder at the trigone. 54
  55. 55. Wherekidney stones get stuckRenal pelvis Ureter Common iliac artery Urinary bladder trigone 55
  56. 56. 56
  57. 57. KIDNEY STONES TREATMENTULTRASOUND LITHOTRIPSY Put a powerful speaker on the outside of the kidney, sends a shock wave which the tissues absorb, but the stones shatter so the pieces can pass easier.STENT (1 ½ foot long tube) in to keep the ureter open along its entire length. Insert under general anesthetic, remove without.To help prevent kidney stones, drink enoughfluid so your urine stays clear and light colored. 57
  58. 58. ULTRASOUND LITHOTRIPSY 58
  59. 59. 59
  60. 60. Kidney Stone Prevention 60
  61. 61. ReynoldsUnwrapped.com offersFANTASTIC, inexpensive daily emailsubscriptions, where you can receive aHILARIOUS new cartoon every day, and it isa MARVELOUS idea for a UNIQUE gift foryour family and friends as well. That is how Ilearned about this...one of my fellow teachersgave me a subscription as a birthday present.He also has FUNNY greeting cards andBEAUTIFUL paintings for sale as well.You can also get reprints suitable for framing,or originals. Here is more info about his workand a YOUTUBE video.https://nccnews.expressions.syr.edu/?p=11515 61
  62. 62. Other Kidney ProblemsNephritis: inflammation of the nephrons.Hydronephritis: excess fluid in the nephron.Glucose in the urine: indicates diabetes. 62
  63. 63. Kidney ProblemsThings can happen to the kidney: infection,excess proteins, pH change, blood pressuredrops, and can lead to kidney failure.Treatment for kidney failure is DIALYSIS, whichremoves blood, send it through a filter, andreturn it without the wastes. It is done threetimes a week, six hours a day. Ideally, theyneed a kidney transplant because the kidneyhas other functions as well.The brain, heart, and kidney are the only threeorgans in the body that have to get oxygen tosustain life. 63
  64. 64. What is Renal Failure?Renal failure occurs when your kidneys stopworking.Our kidneys are very important to us becausewe use them to remove waste from our bodiesAnd our kidneys keep the balance of water andsalt in our body.If we are unable to regulate the water andmineral balance in our body, Renal Failure canbe life threatening. 64
  65. 65. Causes of Renal Failure1. Medication / Poison / Infection People with long term health problems are most at risk to have kidney problems from medication. - Antibiotics - Pain Medication - Blood Pressure Medicine - Dyes used in X-rays 65
  66. 66. 2. Sudden drop in blood flow. - Heavy blood loss from an injury - A serious infection (Sepsis) - Severe Dehydration3. Blockage of fluid out of the Kidney - Kidney Stones - Tumor(s) - Enlarged Prostate Gland 66
  67. 67. Who is most likely to get Renal Failure?Kidney or Liver DiseaseDiabetesHigh Blood PressureHeart FailureObesityBone Marrow TransplantHeart or Belly Surgery 67
  68. 68. SymptomsVery little or no urine during urinationIf the body is unable to excrete potassium, the rising ofpotassium levels is associated with ventriculartachycardia and ventricular fibrillation. Lethal injectionsare excess potassium.Loss of appetiteAs waste accumulates, lethargy and fatigue becomeapparent to the point where mental function candecrease to coma.Body WeaknessBecause of low levels of erythropoietin produced byfailing kidneys they do not stimulate the bone marrowwhich leads to a decrease in red blood cells. This leadsto less oxygen throughout the body which leaves thebody unable to do work. 68
  69. 69. SymptomsHigh Blood PressureBecause the kidneys can not deal with the rising acidlevels in the body, breathing becomes more rapid as thelungs attempt to blow off carbon dioxide to buffer theacid levels. In doing so, fluid can be deposited in thelungs possibly causing congestive heart failure.Swelling of the legs and feetNausea and or VomitingBack pain below the rib cage, (Flank Pain)Some people may not have any symptoms(asymptomatic) 69
  70. 70. Diagnosis Patients can be diagnosed by undergoing blood and urine tests Blood UrineBUN Protein-Blood Urea Nitrogen Abnormal presence ofCreatinine White and Red blood-Waste product levels cellsGFR Electrolytes-Glomerular Filtration Rate 70
  71. 71. DiagnosisPatients can also undergo an Ultrasound to see if there are any obstructions. 71
  72. 72. Treatment Treatments are based on the causeIssue Treatment- Blood Loss - Restore blood flow- Medication / Poison - Stop taking the medication or poison- Blockage - Remove or bypass blockage 72
  73. 73. Also, the person treating the patient willattempt to stop the buildup of waste in thebody. This may be done by dialysis.And the person treating the patient mayalso administer other medication toprevent the retention of excess fluid andminerals and prevent any further renaldamage.-lowering Phophorus levels-increase production of Red Blood Cells-regulate blood pressure with medication 73
  74. 74. PreventionRegulate Blood PressureRegulate Sugar IntakeRegulate Protein IntakeOnce the kidney fails the only options aredialysis and transplantation. 74
  75. 75. Values Results NormalAPPEARANCE CLEAR CLEARBACTERIA MODERATE NEGBILIRUBIN NEGATIVE NEGCOLOR AMBER StrawEPITHELIAL CELLS FEW FEWERYTHROCYTES 3-5/HPF (High) 0-2GLUCOSE NEGATIVE NEGHEMOGLOBIN NEGATIVE NEGHYALINE CASTS 0-4/LPF 0-4KETONES 1+ NEGLEUKOCYTE ESTERASE 1+ NEGLEUKOCYTES 6-10/HPF (High) 0-2NITRITE NEGATIVE NEGPH 6.5 4.5-8.5PROTEIN TRACE NEGSPECIFIC GRAVITY 1.029 1.003-1.035UROBILINOGEN 0.2 <1.0HPF = high power fieldLPF = low power field 75
  76. 76. Urinalysis: What Does It All Mean?How to perform test•Midstream catch is acceptable•Should be examined within 2 hours•Should be refrigerated if not read immediately 76
  77. 77. Specific Gravity• Purpose: urine osmolality and represnts patients’ hydration status and concentrating ability of their kidneys• Normal: 1.003-1.030• Increased USG: glycosuria, SIADH• Decreased USG: diuretic use, DI, adrenal insufficiency, aldosteronism, impaired renal fx 77
  78. 78. pH• Purpose: urinary pH reflects serum pH except in renal tubular acidosis (RTA), useful for diagnosis/management of UTIs and calculi• Normal: 4.5-8.0, slightly acidic usually (5.5- 6.5)• Alkaline urine: suggest urea-splitting organism• Acidic urine: uric acid calculi 78
  79. 79. Hematuria• Criteria: 3 or more RBC per HPF in 2 of 3 urine samples• Testing: for peroxidase activity, will be positive in hematuria, myoglobinuria, hemoglobinuria• -if positive: must look at micro to confirm presence of RBCs• Types: glomerular, renal, urologic 79
  80. 80. ProteinuriaCriteria: >150 mg/day (10-20mg per dL) -microalbuminuria= 30-150 mg/day (sign of early renal disease)Normal urinary proteins: albumin, serum globulins, proteins secreted by the nephron-Dipstick results: 1+ = 30 mg/dL 2+ = 100 mg/dL 3+ = 300 mg/dL 4+ = 1,000 mg/dLTypes: transient and persistent -Transient: temporary change, benign, self-limited (ex: orthostatic proteinuria that results from prolonged standing, but negative U/A after recumbency). -Positive test: Repeat U/A -Persistent has 3 types: glomerular, tubular, overflow -Glomerular: albumin primary urinary protein -Tubular: malfunctioning tubule cells - Overflow: Low MW Proteins overwhelm ability of tubules to reabsorb -Positive test: Perform 24-hour urinary protein excretion or spot urinary protein-creatinine ratio 80
  81. 81. Glucosuria• Normal: almost completely reabsorbed in proximal tubule• Criteria: occurs at approximately 180-200 mg/dL• Elevated: DM, Cushing’s syndrome, liver and pancreatic disease, Fanconi’s syndrome 81
  82. 82. Ketonuria• Normal: not present in urine• Testing: presence of acetic acid through a chemical reaction• Causes: uncontrolled diabetes, pregnancy, carbohydrate-free diets, starvation 82
  83. 83. Nitrites• Normal: Not present in urine• Testing: bacteria that reduce urinary nitrates to nitrites• -Positive test: can be gram negatives or gram positive organism (neg > pos)• (>10,000/mL)Indicates significant number -Negative test: Can’t R/O UTI because non- nitrate reducing organism can cause it 83
  84. 84. UTIs• -NOTE: nitrite stick sensitive to air exposure: after one week of exposure about 1/3 of strips give false positive 84
  85. 85. Leukocyte Esterase• Testing: presence of neutrophils• Sterile Pyuria:• -Organisms: Chlamydia and Ureaplasma urealyticum• -Other causes: balantis (inflammed head of penis), urethritis, TB, bladder tumors, viral infx, nephrolithiasis (kidney stones), foreign body, exercise, glomerulonephritis, corticosteroid use 85
  86. 86. Bilirubin• Normal Bilirubin: no detectable amounts• -Unconjugated bili: not water soluble, doesn’t pass through glomerulus• -Conjugated bili: water soluble, indicates possible liver dysfunction or biliary obstruction 86
  87. 87. Urobilinogen• Normal Urobilinogen: only small amounts• -Urobilinogen: end product of conjugated bili after metabolized by intestine, small amount reabsorbed into portal circulation and filtered by glomerulus• Increased urobilinogen: hemolysis, haptocellular disease• Decreased urobilinogen: antibiotic use, bile duct obstruction 87
  88. 88. 88
  89. 89. Fun Facts• Cat urine, semen, and blood will glow under fluorescent light.• So do most other bodily fluids.• ... anything with phosphorus in it will glow under a black light. 89
  90. 90. FUN URINARY TRACT DISCUSSION QUESTIONSCan you drink your own urine? Although urine is pretty clean, the exit tube (urethra) is not, so as it comes out, it gets contaminated like a garden hose with mud on the tip.Is it more sanitary to be spit on or peed on?If you are stranded on a desert island, should you drinkseawater or your own urine?Why do I have to go to the bathroom immediately after acup of coffee?Why do you have to pee when you hear water dripping?Does cranberry juice cure urinary tract infections? Yes, by deforming the disease-causing bacteria 90

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