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CNM NUT 2 S2 - KZ > 15b - Urinary > Flashcards

15b - Urinary Flashcards

(53 cards)

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1
Q

What are the main components of the urinary system?

A

The kidneys, ureters, bladder, and urethra

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2
Q

What is the primary function of the urinary system? (7)

A
  • To filter and eliminate wastes
  • Regulate acid-base balance
  • Maintain fluid and electrolyte balance
  • Regulate blood volume and pressure
  • Regulate blood glucose
  • Activate vitamin D
  • Provide erythropoietin
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3
Q

How does the urinary system regulate blood volume and pressure?

A

Through the action of Renin-Angiotensin-Aldosterone System (RAAS)

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4
Q

What are 3 core considerations for kidney health?

A

Hydration
Moderate salt intake
Avoid high protein diets

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5
Q

Why is hydration essential for kidney health?

A

It allows efficient filtration and elimination.

Recommended intake is around 1.5–2 litres of filtered water daily, varying by constitution, climate, and physical activity.

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6
Q

What is the recommended daily intake of filtered water for kidney health?

A

Around 1.5–2 litres.

Individual requirements may vary based on constitution, climate, and level of physical activity.

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7
Q

What is the relationship between high salt intake and kidney health? (4)

A

High salt is linked with

  • increased urinary calcium, with increased risk of kidney stones.
  • increased blood pressure, putting strain on the kidneys and damaging them over time.
  • increased fluid retention, straining the kidneys
  • immune cell activation and renal tissue remodelling, increasing the risk of kidney disease.

Moderate salt intake is recommended.

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8
Q

What effect does a high protein diet have on kidney health?

A

It increases nitrogenous wastes, raising kidney demand and GFR, which can damage kidney structures over time.

Animal protein increases the risk of kidney damage more than plant protein.

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9
Q

What are the nitrogenous wastes associated with high protein diets?

A

Urea, creatinine, uric acid.

These wastes increase the demand on the kidneys.

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10
Q

What are the potential risks associated with high protein diets?

A

Increased nitrogenous wastes, increased GFR, increased risk of kidney damage.

Also relates to increased acid load, phosphate, and gut microbiome disruption.

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11
Q

What do these urine colours indicate?
- Cloudy
- Frothy
- Red/pink

A
  • Cloudy urine may
    indicate an infection.
  • Frothy urine may be due to
    proteinuria (and renal disease).
  • Red or pink urine could be due to haematuria (or eating beetroot!)
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12
Q

What does UTI stand for?

A

Urinary Tract Infection

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13
Q

What is the inflammation due to infection in the kidney called?

A

Pyelonephritis

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14
Q

What is the inflammation due to infection in the bladder called?

A

Cystitis

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15
Q

What is the inflammation due to infection in the urethra called?

A

Urethritis

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16
Q

What is the most common bacterial cause of UTIs?

A

Escherichia coli

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17
Q

What bacteria often cause UTIs (4)

A
  • Escherichia coli
  • Klebsiella pneumoniae
  • Enterococcus faecalis
  • Staphylococcus saprophyticus
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18
Q

What are the definitions of:
- Cystitis
- Urethritis
- Pyelonephritis

A
  • Cystitis: Bladder infection
  • Urethritis: Infection of the urethra
  • Pyelonephritis: Kidney infection
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19
Q

What are the key signs and symptoms of Cystitis? (7)

A
  • Dysuria (pain / burning on peeing)
  • Frequent/urgent urination
  • Suprapubic pain/tenderness
  • Foul-smelling/cloudy urine
  • Haematuria
  • Malaise
  • Fever

Cystitis is an inflammation of the bladder often caused by infection.

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20
Q

What symptoms are associated with Urethritis? (4)

A
  • Dysuria (pain/burning on peeing)
  • Urethral discharge (e.g., purulent, blood)
  • Pruritis = itching (e.g., in men near the penile opening)
  • Change in voiding patterns

Urethritis is the inflammation of the urethra, typically due to infection.

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21
Q

What are the signs of Pyelonephritis? (7)

A
  • Fever
  • Chills
  • Nausea
  • Malaise
  • ‘loin’ discomfort
  • Blood or pus in urine
  • Symptoms of lower urinary tract infection

Pyelonephritis is a type of urinary tract infection that affects the kidneys.

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22
Q

Causes and risk factors for UTIs (9). Give explanations

Study These Flashcards
A
  • Women(8 x more prevalent) — shorter urethra ↑ the chance of bacteria ascending to the bladder.
  • Menopause —low oestrogen = ↓ vaginal mucus
    = ↓ monitoring of bacterial species in the area.
  • Pregnancy — mechanical pressure of the growing
    uterus on the ureter and bladder preventing complete voiding.
  • Sexual activity (in weak terrain) — introduces new bacteria.
  • Elderly — lowered immunity, decreased mobility, ↓ mucin (protects urinary epithelium), ↓ bacterial adherence, ↑ catheterisation.
  • BPH —↑ risk; can obstruct urine flow causing bladder urinary stasis.
  • Antibiotics — increases the likelihood of opportunistic bacteria proliferating and migrating into the urinary tract.
  • Intestinal dysbiosis — bacteria can translocate from the perianal region and ascend to the genitourinary tract.
  • ‘Gut-vagina-bladder axis’ — bacterial vaginosis (characterised by ↑ anaerobic bacteria e.g., Gardnerella vaginalis, ↓ Lactobacillus and an
    alkaline vaginal pH) increases UTI risk. G. vaginalis can ascend into the urinary tract and appears to damage the bladder lining, while reactivating latent E. coli.
23
Q

What are the dietary (not supplement) treatments for UTIs give reasons. (7)

Study These Flashcards
A

CNM Naturopathic Diet with a focus on:
* 2l water daily: flush bacteria through the urinary tract (incl. herbal teas).
- Phytonutrients: antimicrobial, antioxidant and
anti-inflammatory.
* Probiotic foods: optimise microbiome.
- High fibre / prebiotics: modulate microbiome, decrease intestinal pH, prevent growth of E.coli.
- Avoid sugar and refined carbohydrates:
cause dysbiosis, inflammation and compromise immunity.
- Avoid caffeine, sweeteners and alcohol: urinary irritants.
* Avoid red meat, pork and poultry — source of E. coli. Promote inflammation.
* Cranberry: 15–30 ml unsweetened juice daily or 500 mg powder 3x day. Proanthocyanins decrease bacterial adhesion to the bladder epithelium.

24
Q

What nutritional supplements can be used to support a client with a UTI? (6) - give doses

Study These Flashcards
A
  • D-mannose (500mg every
    2 hours for 3 - 5 days)
  • Vitamin A (5000 iu/ day)
  • Vitamin C (500–5000 mg /
    day in divided doses.)
  • Vitamin D ( Optimise levels)
  • Zinc (15 mg: Preventative.
    Up to 60 mg during
    an acute infection.)
  • Probiotic (Lactobacillus spp.
    As per label dose.
    Probiotic powder can
    be smeared directly
    inside vaginal wall.)
25
What is the trilogy of supplements to support mucus membranes anywhere in the body?
Zinc, Vit C, Vit A
26
How does D-mannose help in the treatment of UTIs (2)
- Binds type 1 fimbriae of uropathogenic E.coli, forming a physical ‘coating’ that prevents their binding to the urothelium. * Shows benefit in treatment and prevention of recurrent UTIs.
27
What role does Vitamin A play in urinary tract health? (3)
- Maintains integrity and supports repair of the urinary tract mucous membrane. - Supports lymphatic tissues and immune cells. - Enhances T-cell proliferation
28
What role does Vitamin C play in urinary tract health? (3)
* Has immunostimulatory effects. * Regulates lymphocytes, phagocytes and natural killer cells. * Helps maintain integrity of the uroepithelial lining of the urinary tract
29
What is the role of Vitamin D in the urinary system in response to pathogen exposure? (3)
* Promotes production of anti-microbial substances in the urinary epithelium. * Strengthens innate mucosal immunity - Deters pathogenic bacterial attachment to the uroepithelium
30
What effects does Zinc have on UTIs and immune cells? (2)
* Increases phagocyte, natural killer cell, T-and B-cell activity. * Low levels are associated with increased risk of recurrent UTI
31
What probiotic species is recommended for UTI support?
Lactobacillus spp. ## Footnote Probiotic powder can be smeared directly inside the vaginal wall to suppress pathogenic colonisation.
32
How does the probiotic Lactobacillus spp. help in UTI prevention? (3)
- Suppresses pathogenic colonisation - Modulates the immune system. - Maintains epithelial barrier integrity. ## Footnote Includes production of antibacterial agents such as lactic acid and hydrogen peroxide.
33
What herbs help to treat UTIs (3). What is their mechanism? How would you prepare them?
* Crataeva (Crataeva nurvala) — helps flush the urinary tract, decreases urinary tract inflammation. * Bearberry (uva-ursi) — anti-inflammatory and a urinary antiseptic. * Cornsilk (Zea mays) — a mild diuretic and urinary demulcent. 5g herb infused in 500ml boiled water. Take 1/2 - 1 cup every 2-4 hours.
34
What is interstitial cystitis (IC)?
A chronic inflammatory condition of the bladder characterised by pain and a sense of pressure. ## Footnote IC is not associated with infection and does not respond to antibiotic treatment.
35
Is interstitial cystitis associated with infection?
No, it is not always associated with infection. ## Footnote IC does not respond to antibiotic treatment.
36
In which gender is interstitial cystitis significantly more common?
Women. ## Footnote It is thought that many men diagnosed with non-bacterial prostatitis may actually have IC.
37
What are some signs and symptoms of interstitial cystitis? (3)
- Pressure/pain in bladder and pelvic area - Urinary urgency and frequency - Dyspareunia (painful intercourse) ## Footnote Petechial (pinpoint) haemorrhages are often visible on cystoscopy.
38
What type of haemorrhages are often visible on cystoscopy in interstitial cystitis?
Petechial (pinpoint) haemorrhages.
39
What are possible causes of intersticial cystitis? Explain the mechanisms. (4)
* Alterations to the urinary microbiome — ↓ Lactobacillus species, ↓ microbial diversity and ↑ pro-inflammatory cytokines observed. * Injury to the protective glycosaminoglycan layer of the bladder wall. Increases permeability, allowing potassium and chemical irritants in urine to damage underlying tissues. * Allergic — elevated IgE levels are observed in some cases of intersticial cystitis. Activation of mast cells ↑ histamine and cytokine release = pain. * Neurogenic pain — excitation of sensory nerves triggers inflammation through release of neuropeptides. Triggers include Mast cell activation, stress, autoimmune events (e.g., SLE, IBD).
40
What is a food based (not supplement) approach to supporting patients with intersticial cystitis?
* Remove urinary irritants, reduce inflammation and promote microbial balance and diversity. * Assess for food or environmental allergy / intolerance. * Follow the CNM Naturopathic Diet emphasising antioxidant-rich vegetables alongside anti-inflammatory foods and herbs e.g., oily fish (EPA); turmeric, fresh ginger. * Include aloe vera juice (inner leaf gel) — inhibits COX and hence PG2; appears to increase production of glycosaminoglycans.
41
What nutritional supplements can be used to support clients with intersticial cystitis? (4) give dose.
* Quercetin ( 500 mg twice daily) * Glucosamine sulphate (500 mg 3 x daily). * Chondroitin (200–400 mg 3 x daily) * Probiotics (dose per label)
42
How does Quercetin support clients with intersticial cystitis? (3)
* Anti-allergic; inhibits histamine release from mast cells. * Anti-inflammatory; downregulates NF-κB and inhibits LOX and COX. * Shown to provide significant improvement in IC symptoms
43
How do N-acetyl glucosamine and Chondroitin support clients with intersticial cystitis? (2)
* Increase glycosaminoglycan synthesis in the bladder improving mucous membrane integrity. * Reduces inflammation by inhibiting inflammatory cytokine formation.
44
What herbs can be used to support clients with intersticial cystitis? (give dose & mechanisms) (2)
* Marshmallow root - demulcent, helping to soothe irritation in the urinary tract and relieve pain. Infuse 1 teaspoon in 150 ml boiled water, 3 x daily. * Gotu kola — improves integrity of connective tissue and heals bladder ulcerations. 500 mg, 2 x daily.
45
What are urinary calculi?
Formation of crystalline salts and organic matter in the kidney and bladder (gravel).
46
What symptoms may urinary calculi cause? (5)
- May be asymptomatic - Debilitating pain (renal colic) if a stone lodges in a ureter - Nausea - Vomiting - Fever.
47
What is the most common type of urinary stone?
Calcium oxalate.
48
List the main types of urinary stones.
* Calcium oxalate * Calcium phosphate * Uric acid * Struvite stones
49
What causes struvite stones?
Most often caused by chronic bacterial infection, which increases alkalinity of urine
50
What are the key causes & risk factors of urinary calculi and how do they cause stones? (5)
* Dehydration — urine becomes too concentrated allowing minerals and other compounds to precipitate out of solution, forming crystals. * Dietary acid load (animal protein, dairy, soft drinks i.e., phosphoric acid) - increase urinary calcium, decrease citric acid and increase uric acid * High table salt intake — increases urinary calcium * A diet low in fibre, high in refined carbohydrates and alcohol. * Excessive calcium supplementation with low vitamin K2 status (not storing calcium in bones)
51
What is the food (not supplement) approach to urinary calculi? (9)
* Increase fluid intake (at least 8 glasses daily.) * Alkalise with a plant-based diet high in chlorophyll. Regular green juices / smoothies. * Reduce animal proteins and high purine foods. * Reduce salt intake (i.e., table salt), * Avoid alcohol (↑ uric acid). * Increase potassium-rich foods (fruit and vegetables) to reduce urinary calcium. * Avoid oxalate-rich foods such as spinach, rhubarb, strawberries, beetroot, almonds and cashews. * Stinging nettle leaf (Urtica dioica) has diuretic properties and is alkalising. Use as a tea: 1 tsp per cup, 3 cups per day. Combine with demulcent herbs to lubricate the urinary tract (e.g., marshmallow root) * Lemon juice 1 teaspoon every ½ hour for two days can help to soften stones. The citric acid component binds to calcium to promote excretion.
52
What nutritional supplements can be used for urinary calculi? (3)
* Magnesium (600 mg / day) as citrate — ↑ the solubility of calcium oxalate * Pyridoxine (B6) (25 mg / day) — reduces endogenous production and urinary excretion of oxalates. * Folate (B9) (5 mg / day) — for uric acid stones. ↑ purine scavenging and xanthine oxidase inhibition, resulting in ↓ uric acid production.
53
What can be applied topically for all urinary conditions to give relief?
Castor oil packs can be applied to reduce inflammation and decrease pain

CNM NUT 2 S2 - KZ (12 decks)

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