Urinary system disorders can cause incontinence or retention. Incontinence includes stress incontinence from increased abdominal pressure during activities like coughing or laughing. Retention is the inability to empty the bladder and may lead to overflow incontinence. Diagnostic tests of urine include urinalysis to detect abnormalities like blood, protein, bacteria, or casts indicating infections or inflammation. Blood tests check for kidney failure signs like high waste levels. Those with kidney failure may require dialysis to replace kidney function. Urinary tract infections are common and usually caused by E. coli ascending from the rectal area. Left untreated, cystitis can lead to pyelonephritis involving the kidneys. Kidney stones form from concentrated urine

1. Urinary System Disorders

2. Incontinence and Retention
• Loss of voluntary control
of bladder
• Stress incontinence
– Increase in intra-abdominal
pressure
• Forces urine through
sphincter
– Laughing
– Coughing
– Females weakened
• Spinal cord injuries, brain
damage
• Inability to empty bladder
• May accomp overflow
incontinence
• Spinal cord injury
• Inability to control
managed by pads, briefs
• Catheter
– Tube inserted in urethra
– Drains urine from bladder
to collecting bag
– Common source of UTI

3. Diagnostic Tests—Urinalysis
• Constituents, characteristics of urine vary w/
dietary intake, drugs, care of specimen
• Normally clear, straw-colored; pH 4.5-8.0
• Appearance
– Cloudy
• Presence of lg amts protein, blood cells, bacteria, pus
– Dark color
• Hematuria (blood), excessive bilirubin, high concentration of
urine
– Unpleasant, unusual odor
• infection

4. Diagnostic Tests—Urinalysis
• Abnormal constituents (high in numbers)
– Blood (hematuria)
• Small, microscopic amts
– Infection, inflammation, tumors of UT
• Lg # RBC
– Increased glomerular permeability or hemorrhage in tract
– Protein (Proteinuria)
• Leakage of albumin into filtrate
– Inflammation, increased glomerular permeability
– Bacteria (Bacteriuria) and Pus (Pyuria)
• Indicates UTI
– Urinary casts
• Microscopic mold of tubules
– Consists of one or more cells, bacteria, protein
• Inflammation of tubules
– Specific gravity
• Ability of tubules to concentrate urine
• Low is related to renal failure

5. Diagnostic Tests—Blood Tests
• High serum urea and creatinine
– Indicate failure to excrete N wastes
• Due to low GFR
• Metabolic acidosis
– Indicates low GFR, failure of tubules to control acid/base balance
• Anemia
– Indicates low erythropoietin secretion and/or bone marrow depression
• Due to accumulating wastes
• Electrolytes
• Antibody level
– Antistreptolysin O (ASO) or antistreptokinase (ASK)
• Renin levels
– Indicate cause of hypertension

6. Dialysis
• Provides “artificial kidney”
– Sustains life after kidney fails
• Acute renal failure or end-stage renal failure (those
waiting for a transplant)
• 2 forms
– Hemodialysis
– Peritoneal dialysis

9. Disorders of the Urinary System:
Urinary Tract Infections (UTI)
• Very common
• Urine is excellent medium for
microorganismal growth
– Escherichia coli
• Most are ascending
– Perineal cavity  mucosa  bladder 
ureters  kidneys

10. UTI—Etiology
• Females more anatomically vulnerable
– Short urethra
– Proximity to anus
– Frequent irritation to tissues
• Tampons, bubble bath, sexual activity
• Older males with prostatic hypertrophy
and retention of urine prone to UTI

11. UTI: Cystitis—Signs and
Symptoms
• Pain in lower abdomen
• Dysuria, frequency, urgency
– Inflammation of bladder wall irritated by urine
• Systemic signs of infection
• Cloudy urine with unusual odor
• Urinalysis indicates bacteria
(+100,000/mL), pyuria, microscopic
hematuria

12. UTI: Pyelonephritis—Signs and
Symptoms
• Signs of cystitis
• Pain
– Dull aching in lower back
– Results from renal capsule
stretching
• Urinalysis
– Similar to cystitis
– Except urinary cast
• Leukocytes or renal
epithelial cells present
– Involvement of renal
tubules

13. UTI—Treatment
• Antibiotics (Bactrim)
• Increase fluid intake
– Especially cranberry juice
• Tannin decreases ability of E. coli to adhere to
bladder mucosa
• Infection reoccurs unless predisposing
factors removed

14. Disorders of the Urinary System:
Inflammatory Disorders
• Glomerulonephritis
– Many forms
• Acute Poststreptococcal Glomerulonephritis
(APSGN)
– Follows streptococcal infection
» Originates as upper resp infection, middle ear
infection, strep throat
– Primarily affects kids 3-7 (especially boys)
– develops 2 weeks after previous infection

15. Glomerulonephritis—Signs and
Symptoms
• Back pain
– Stretching renal capsule
• Dark, cloudy urine
• Oliguria
• Facial edema, then generalized
– Low osmotic pressure of blood
– Salt, water retention
• Generalized signs of inflammation
• Increased bp

16. Glomerulonephritis—Diagnostic
Tests
• Blood tests
– High serum urea and creatinine and
decreasing GFR
– Streptococcal antibodies, ASO, ASK
– Metabolic acidosis
• Low serum bicarbonate, low pH
• Urinalysis
– Confirms presence of proteinuria, erythrocyte
casts

17. Glomerulonephritis—Treatment
• Sodium restriction
• Glucocorticoids
• Antibiotics
• Recovery w/ minimal damage
– Imp to prevent further exposure to streptococcal
infection and recurrent inflam
– Adults more difficult
• Acute renal failure in 2%
• Chronic glomerulonephritis in 10%
– Gradually destroys kidneys
• Postrecovery testing should be done

18. Urinary Tract Obstructions:
Urolithiasis
• Also called:
– Calculi
– Kidney stones
• Frequently reoccur if
not treated

19. Calculi—Pathophysiology
• Can develop anywhere in UT; lg or small
• Once any solid material or debris forms
• Tend to form when:
– excessive amts of relatively insoluble salts are in filtrate
– Insufficient fluid intake creates highly concentrated filtrate
• 75% composed of calcium salts
– Remainder: uric acid, struvite, oxalate
• Usually cause manifestations only when obstruct flow of
urine
– Infection if stasis of urine

20. Kidney Stones

21. Calculi—Signs and Symptoms
• Stones in kidney/bladder frequently
asymptomatic
• Obstruction of ureter causes attack
– “renal colic”
• Consists of intense spasms in back and groin
• Pain caused by vigorous contractions of ureter
– Effort to pass the stone

22. Calculi—Treatment
• Small stones eventually passed out
• Larger stones
– Extracorporeal shock-wave lithotripsy (ESWL)
• Decreases need for invasive surgery
– Some drugs can partially dissolve
• Need to prevent recurrences

23. Urinary Tract Obstructions:
Tumors—Renal Cell Carcinoma
• Primary, silent tumor
• Arises from tubule epithelium
• Asymptomatic in early stage
– Often metastize to liver, lungs, bones, CNS at time of diagnosis
• Common after 50
– More freq in males and smokers
• Initial sign is painless hematuria
• Other manifestations
– Dull aching flank pain, palpable mass, anemia
• Treatment is kidney removal
– 5 yr survival rate 50%