- Temperature usually constant so not usually a factor - Acidic urine pH- increase risk uric acid stone - Alkaline urine pH- increase risk of calcium phosphate stone

- Magnesium-ammonium-phosphate - Large amounts of matrix - Associated with Urinary tract infection

Urinary System Part 2 Flashcards by Katie Stapleton

Urinary Tract Obstruction

-A urinary tract obstruction is defined as a blockage of urine flow with the urinary tract
-The obstruction can be caused by an anatomic or functional defect
 Obstructive uropathy
Severity based on:
 -Location
 -Completeness
 -Involvement of one or both upper urinary tracts
 -Duration
 -Cause

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Urinary Tract Obstruction- Complete

Hydroureter-dilation of ureter proximal to site of blockage
Hydronephrosis-dilation of the renal pelvis and calyces proximal to site of blockage

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Urinary Tract Obstruction- Complete

Within 2 days:

Tubulointerstitial fibrosis- deposition of excessive amounts extracellular matrix (collagen and other proteins)
Apoptosis- excess cell destruction and death
Partial function restored within 56-69 days if obstruction removed.

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Strategies for recovery renal function after urinary tract obstruction:

-Compensatory hypertrophy of healthy tissue
- Obligatory growth-Somatostatin

-Compensatory growth- unknown hormones   -Postobstructive diuresis   -Low bladder wall compliance  -Inability to accommodate urine at low pressures due to excessive deposition of extracellular matrix in bladder wall and detrusor muscle

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Urinary tract obstruction:

-Individuals at risk for hypertension
 -RAA cascade is elevated
-Individuals at risk for Urinary tract infections
 -Incomplete bladder empty
 -Urine turbulance in the urethra

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Upper Urinary tract obstruction: 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, and occupation
-Kidney stones are classified according to the minerals comprising the stones

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Kidney Stones - 3 factors required:

1) Supersaturation of one or more salts
 -Presence of a salt in a higher concentration than the volume able to dissolve the salt
2) Precipitation of a salt from liquid to solid state
- Temperature and pH
3) Growth into a stone via crystallization or aggregation

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Temperature and pH

Temperature usually constant so not usually a factor
Acidic urine pH- increase risk uric acid stone
Alkaline urine pH- increase risk of calcium phosphate stone

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Kidney Stones

-Other endogenous factors affecting stone formation
Crystal growth-inhibiting substances
Particle retention
Matrix- organic material contained in urinary calculus

- Stones
Calcium oxalate or calcium phosphate
Struvite stones
Cystinuric stones-genetic disorder amino acid metabolism
Uric acid stones
Indinavir- Rx protease inhibitor for HIV

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Calcium Oxalate or Calcium Phosphate Stones:

-80% of stones
-Idiopathic calcium urolithiasis (ICU)
 Unknown cause, but usually one or more of the following
 -Hypercalciuria
 -Hyperoxaluria
 -Hyperuricosuria
 -Hypocitraturia
 -Mild renal tubular
acidosis
 -Crystal growth
inhibitor deficiencies

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Hypercalcinuria:

Can be associated with
 -Intestinal hyper-
      absorption of 
      dietary calcium
 -Hyperthyroidism
 - Bone 
      demineralization 
      caused by 
      prolonged
      immobilization

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Struvite Stones

Magnesium-ammonium-phosphate
Large amounts of matrix
Associated with Urinary tract infection

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Kidney Stones:

Manifestation- principle symptom
- Renal colic
Evaluation
- Stone analysis
- Intravenous 
     pyelogram
- Spiral abdominal CT Treatment
 -Stone removal

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Renal Colic

Moderate to intense pain

- If stone in lower tract could have symptoms of urgency, frequent voiding, or urge incontinence

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Lower Urinary Tract Obstruction:

Bladder neck dyssynergia
 –Smooth muscle urethrovesical junction fails to funnel during micturation and obstructs the bladder outlet
Prostate enlargement

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Lower Urinary Tract Obstruction:

-Urethral stricture
--- Scar narrowing urethral lumen
--- Infection, surgery
 
-Severe pelvic organ prolapse
 --Cystocele blocks the bladder outlet

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Lower Urinary Tract Obstruction:

-Neurogenic bladder dysfunction
-Leads to urinary incontinence or retention

Pathophysiology
-Neurogenic detrusor overactivity
– Uncontrolled or premature contractions
 –Detrusor sphincter dyssynergia
-Obstruction- detrusor sphinctor dyssynergia
- Low bladder wall compliance

Neurogenic Bladder Tumors:

-Renal tumors
 Renal adenomas
 Renal cell carcinoma
-Bladder tumors
 Papillary tumors
 Nonpapillary tumors
 Metastasis to lymph 
     nodes, liver, bone, 
     and lungs

Urinary Tract Infection:

UTI is inflammation of the urinary epithelium following invasion and colonization by some pathogen within the urinary tract
Complicated UTI- comorbid to other disorders urinary tract
Uncomplicated UTI – no other problems
Persistent UTI- ongoing despite treatment

Urinary Tract Infection:

-Most common pathogens
 Escherichia coli
 Staphylococcus 
     saprophyticus
 Enterobacter spp

Virulence of uropathogens-Strategies to survive
- Host defense 
      mechanisms
    -- Urine pH, urea, 
        periurethral 
        mucous-secreting 
       glands

Urinary Tract Infection:

Cystitis
- Cystitis is an 
    inflammation of the bladder
-Manifestations
     Frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain

Treatment
 -Antimicrobial therapy, increased fluid intake, avoidance of bladder irritants, and urinary analgesics

Urinary Tract Infection:

-Pyelonephritis
—Acute pyelonephritis
 -Acute infection of the ureter, renal pelvis, and/or renal parenchyma
—Chronic pyelonephritis
 -Persistent or recurring
episodes of acute
pyelonephritis
 -Risk of chronic
pyelonephritis
increases in individuals
with renal infections
and some type of
obstructive pathologic
condition

Glomerular Disorders:

-The glomerulopathies are disorders that directly affect the glomerulus
-Urinary sediment changes
- Nephrotic sediment
 (Proteinuria, lipiduria,
little or no hematuria)
 -Nephritic sediment
 (Hematuria, RBC casts,
White blood cells,
proteinuria)
 -Sediment of chronic
glomerular disease
 (Waxy casts, granular
casts, less prot. or hem).

What is cast?

“mass comprised of fibrous material, coagulated protein, or exudate that takes the shape of the region in which it has been molded, such as bronchial, renal, or intestinal structures and is usually found in urine or sputum.”
McCance Glossary

Glomerular Disorders

-Glomerular disease demonstrates a sudden or insidious onset of hypertension, edema, and an elevated blood urea nitrogen (BUN) - Decreased glomerular filtration rate  --Elevated plasma creatinine, urea, and reduced creatinine clearance -Glomerular damage causes a decreased glomerular membrane surface area, glomerular capillary blood flow, and blood hydrostatic pressure

Glomerular Disorders:

- Increased glomerular capillary permeability and loss of negative ionic charge barrier result in passage of plasma proteins into the urine -Resulting hypoalbuminemia encourages plasma fluid to move into the interstitial spaces  --Edema

Glomerular Disorders

``` -Glomerulonephritis  Inflammation of the glomerulus  -Immunologic abnormalities (most common)  -Drugs or toxins  -Vascular disorders  -Systemic diseases  - Viral causes ```

Glomerulonephritis

-Mechanisms of injury  -Deposition of circulating soluble antigen-antibody complexes, often with complement fragments  -Formation of antibodies against the glomerular basement membrane  -Streptococcal release of neuramidase

Glomerulonephritis- Types

- Acute poststreptococcal glomerulonephritis - IgA nephropathy (Berger disease) - Crescentic glomerulonephritis - Antiglomerular basement membrane disease (Goodpasture syndrome)-Chronic glomerulonephritis * cause, pathologic lesions, disease progression, clinical presentation

Nephrotic Syndrome

-Excretion of 3.5 g or more of protein in the urine per day -The protein excretion is due to glomerular injury -Findings  Hypoalbuminemia, edema, hyperlipidemia, and lipiduria

Nephrotic Syndrome

-Membranous glomerulonephritis  --Most common idiopathic nephrotic syndrome in whites; assoc. with hyperlipidemia and hyppercoaguability -Focal and segmental glomerulosclerosis  --Most common id Neur Syn in blacks.  Minimal change disease (lipoid nephrosis)  --Most common in children

Nephrotic Syndrome- Pathophysiology

-Renal Dysfunction- Classifications  Renal insufficiency  < 10% function

Renal Dysfunction: Classifications

Uremia  -Syndrome renal failure with elevated blood urea and creatinine, fatigue, nausea, vomit, pruritis, neurologic changes.  -Retention of nitrogenous toxic wastes, deficiency states, electrolyte disorders

Renal Dysfunction: Classifications

Azotemia |  -Increased serum urea levels and creatinine levels, nitrogenous wastes

Acute Renal Failure

-Acute- within hours -Prerenal acute renal failure  --Most common cause of ARF  --Caused by impaired renal blood flow  --GFR declines due to the decrease in filtration pressure

Acute Renal Failure (ARF):

- Intrarenal acute renal failure  Acute tubular necrosis (ATN) is the most common cause of intrarenal renal failure  --Postischemic  --Nephrotoxic  - Postrenal acute renal failure  Occurs with urinary tract obstructions that affect the kidneys bilaterally

Acute Renal Failure:

Oliguria: urine output less than 30ml/hr or less than 400ml/day

Acute Renal Failure:

- initiation phase - maintenance phase - Recovery phase

Chronic Renal failure:

-Chronic renal failure is the irreversible loss of renal function that affects nearly all organ systems -Progression  Reduced renal reserve  Renal insufficiency  Renal failure  End-stage renal disease

Chronic Renal Failure: | Alterations in electrolyte and acid-base balance

- Creatinine and urea clearance - Sodium and water balance - Phosphate and calcium balance - Potassium balance - Acid-base balance

Chronic Renal Failure:

- Skeletal and bone alterations - Cardiopulmonary system - Neural function - Endocrine and reproduction - Hematologic alterations

Chronic Renal Failure:

- Immunologic - Gastrointestinal - Integument - Alterations in proteins, carbohydrates, and lipids