Urinary Function

what does the urinary system regulate?

fluid volume, blood pressure, metabolic waste and drug excretion, vitamin d conversion, acid-base balance, hormone synthesis

normal daily urine output →

1,500 mL or 1.5 L

incontinence

loss of control over urination — very common, has physical, emotional, social, and psychological effects

process or urinating

a pressure of fluid (200-300 mL) on the sphincters and receptors sends nerve impulses to the brain, bladder contracts and the external sphincter relaxes. forcing urine out through the urethra

enuresis

involuntary urination by a child after 4-5 years of age, maybe psychological

stress incontinence

loss of urine from pressure exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy — occurs when sphincter muscle of the bladder is weakened and pelvic floor weakness

contributing factors to stress incontinence

pregnancy, childbirth, menopause, prostate removal, obesity

overactive bladder (urge incontinence)

sudden, intense urge to urinate followed by involuntary loss of urine

causes of urge incontinence

urinary tract infections, bladder irritants, stroke, injury, and nervous system damage

overflow incontinence

inability to empty bladder, urine retention, dribbling urine and a weak urine stream

causes of overflow incontinence

bladder damage, urethral blockage, nerve damage, and prostate conditions

risk factors leading to incontinence

female gender, advancing age, being overweight, smoking, other diseases

complications of incontinence

skin breakdown, recurrent urinary tract infections, negative psychological consequences, interruption of usual activities

diagnosis of incontinence

bladder diary, urinalysis, urine cultures, bladder imaging, postvoid residual measurement, and urodynamic testing

incontinence treatments

bladder training, pelvic floor muscle exercises, medications, catheter

neurogenic bladder

bladder dysfunction caused by an interruption of normal bladder nerve innervation, flaccid bladder or spastic bladder

neurogenic bladder causes

brain or spinal cord injury, nervous system tumors, dementia, parkinson’s disease, spina bifida, vaginal childbirth

manifestations of neurogenic bladder

symptoms of an overactive and under active bladder

complications of neurogenic bladder

UTI’s, renal calculo, incontinence

interstitial cystitis (IC)

chronic bladder condition, more common in women and aging individuals, caused by thinning of the lining of the bladder and pinpoint hemorrhages in the bladder wall due to inflammation

manifestations of interstitial cystitis

abdominal/pelvic pain, pain in urinary tract, frequency and nocturia, urgency, sexual dysfunction

urinary tract infections

inflammation of the bladder, bladder and urethra walls become red and swollen, can progress to pyelonephritis, kidneys become edematous and compressing renal artery and potentially developing abscesses or necrosis

UTI causes

infection and irritants, fecal matter (E. coli)

UTI manifestations

urgency, dysuria abdominal pain, pelvic pressure, infection symptoms

UTI treatments

antibiotics

UTI complications

renal failure, recurrent UTI’s, and sepsis

UTI risk factors

women, shorter urethra, perineal contamination, antibiotic use, uncircumcised penis, immobility, urine retention, decreased cognition, catheterization

UTI prevention

increase hydration, avoiding irritants, proper perineal hygiene, loose cotton clothing, not delaying urination, catheter care

nephrolithiasis

renal calculi (kidney stones), hard crystals composed of minerals that the kidneys normally excrete — in renal pelvis, ureters, or bladder

nephrolithiasis risk factors

pH changes, excessive concentration of insoluble salts in the urine, urinary stasis, family history, obesity, hypertension, and diet

manifestations of nephrolirhiasis

pain in the flank area that radiates to the lower abdomen and groin; bloody, cloudy, or foul-smelling urine; dysuria; frequency

nephrolithiasis treatment

increase fluid intake, extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, ureterpscopy, surgery, pain management

hydronephrosis

abnormal dilation of the renal pelvis and the calyces of one or both kidneys because of urinary back up

what does unilateral renal involvement indicate on hydronephrosis

indicates an obstruction in one of the ureters

what does bilateral renal involvement indicates on hydronephrosis

indicates an obstruction in the urethra

causes of hydronephrosis

urolithiasis, tumors, benign prostatic hyperplasia, strictures, stenosis, and congenital urologic defects

complications of hydronephrosis

atrophy, necrosis, and glomerular filtration cessation

renal cell carcinoma

arises from epithelium of renal tubules, most frequent occurring kidney cancer; metastasis to the liver, lungs, bone, or nervous system

manifestations of renal cell carcinoma

asymptomatic, hematuria, abnormal urine color, flank pain, urinary retention, palpable mass over the affected kidney, paraneoplastic syndromes

renal cell carcinoma risk factors

being male and smoking

bladder cancer types

transitional cell carcinoma, squamous cell carcinoma, and adenocarcinoma

bladder cancer

metastasis is common to the pelvic lymph nodes, liver, and bone

bladder cancer risk factors

advancing age, men, caucasians, working with chemicals, smoking, experiencing recurrent UTIs, long-term catheter placement, chemotherapy, and radiation

manifestations of bladder cancer

painless hematuria, abnormal urine color, frequency, dysuria, UTIs, and back or abdominal pain

benign prostatic hyperplasia

common, nonmalignant enlargement of the prostate gland that occurs as men age; declining testosterone and increasing estrogen levels are thought to cause prostatic stromal cell proliferation → enlarging the prostate and presses against urethra and obstructs urine flow

manifestations of benign prostatic hyperplasia

frequency, urgency, retention, difficulty initiating urination, weak urinary stream, dribbling urine, nocturia, bladder distension, overflow incontinence, and erectile dysfunction

polycystic kidney disease

inherited disorder characterized by numerous grape-like clusters of fluid-filled cysts in both kidneys; cysts enlarge the kidneys while compressing and eventually replacing the functional kidney tissue

autosomal dominant PKD

mutation on chromosomes 4 & 16, children and adults, symptoms don’t show til middle age

autosomal recessive PKD

less common and more serious, appears in infancy and childhood, progresses rapidly, resulting in end-stage kidney failure and generally causing death in infancy or childhood

symptoms of both forms of PKD

hematuria and nocturia

PKD symptoms in neonates

large symmetrical masses on flank, respiratory distress, uremia

PKD symptoms in adults

hypertension, abdominal girth, swelling, tenderness/lumbar pain, grossly enlarged, palpable kidneys

complications of PKD

pyelonephritis, cyst rupture, retroperitoneal bleeding, renal failure, anemia

glomerulonephritis

inflammation of glomeruli, leading cause of renal failure, typically follows and infection or chronic inflammatory conditions which impair the kidney’s ability to excrete waste and excess fluid

nephrotic syndrome (glomerulonephritis)

A cluster of findings resulting from non-inflammatory damage to the glomerular filtration barrier, allowing massive amounts of blood proteins (albumin) to leak into the urine

nephritic syndrom (glomerulonephritis)

group of kidney signs caused by inflammation of the glomeruli, which are the tiny blood-filtering units inside your kidneys. This inflammation damages the filters, letting blood and protein leak into your urine

causes of nephrotic syndrome

systemic disease, systemic lupus erythematosus (SLE), hepatitis B

cause of nephritic syndrome

inflammatory response

acute kidney injury

sudden loss of renal function, often in critically ill hospitalized patients, generally reversible

prerenal conditions of acute kidney injury

extremely low BP or blood volume, cardia dysfunction

intrarenal conditions of acute kidney injury

reduced blood supply in kidneys, hemolytic uremic syndrome, renal inflammation, toxic injury

postrenal conditions of acute kidney injury

ureter obstruction, bladder obstruction/dysfunction

phases of acute kidney injury

asymptomatic, oliguric, diuretic, recovery

oliguric phase of acute kidney injury

electrolyte disturbances, fluid volume excess, and metabolic acidosis; daily urine output <400 mL

diuretic phase of acute kidney injury

electrolyte disturbances, dehydration, and hypotension; daily urine output >5 L

recovery phase of acute kidney injury

glomerular function gradually returns to normal

CKD

gradual loss of renal function that is irreversible; affects ability to regulate fluid volume, BP, metabolic waste, drug excretion, hormone synthesis, electrolyte balance, pH balance

causes of CKD

diabetes mellitus, hypertension, urine obstruction, renal diseases, renal artery stenosis

stage 1 CKD

kidney damage present but GFR is >90

stage 2 CKD

kidney damage worsens as the GFR falls

stage 3 CKD

kidney function is significantly impaired as GFR is between 30 and 59

stage 4 CKD

kidney function is barely present with GFR dropping between 15 and 29

stage 5 CKD

kidney failure as the GFR drops to less than 15 or the patient begins dialysis

CKD process

gradual damage to nephrons, GFR progressively declines, loss of fluid volume/pH/electrolyte regulation, waste products accumulate, renal function declines

manifestations of CKD

fluid retention, hormone imbalances, electrolyte imbalances, metabolic toxins