Exam 4 Renal System

Total Incontinence.

Total Incontinence.

Inability to store urine

Overflow Incontinence

Frequent dribbling that relieves a constantly full bladder

Urge Incontinence***

Sudden and uncontrollable need to void that cannot be suppressed

Stress Incontinence***

Uncontrollable voiding that occurs with weakness of the pelvic floor muscles

Urinary frequency

need to urinate excessively, but voiding normal or less than normal amounts

Urinary urgency

sudden urge to urinate

Urinary hesitancy

difficulty starting or maintaining urinary stream

Nocturia

excessive urination at night

Oliguria

decreased urine output (<30 ml/hr or <400 ml/day)

Polyuria

excessive urine output

Anuria

little to no urine output (<100 ml/day)

Dysuria

difficult, painful urination

Pyuria

pus in urine

Urinalysis

lab test to evaluate the urine chemistry- looks at WBCs, RBCs, protein, color, ketones

Obstructive uropathy

a structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction

Urolithiasis

formation of urinary calculi (stones) in the urinary tract. Generally asymptomatic until they pass into the lower urinary tract

What are the different types of stones?

• Calcium oxalate (75-85%)

• Struvite (15%)

• Uric Acid (7%)

Where do stones usually form?

· Stones usually grow on the papillae or in the renal tubules, calyces, or renal pelvis

· Can also occur in the ureter or bladder

What are risk factors for stone formation?

· Gender (more common in males)

· Frequent UTI

· Dehydration

· Tubular defects

· Diet (high protein & tea)

· Alterations in urine pH (high or low)

What are the symptoms of stones?

Pain (depend on location- generally renal colic, flank pain; can be painless unless actively being passed)

Obstruction: can cause obstruction at upper or lower urinary tract

• Urinary urgency, frequency

• Hematuria- blood in urine

• Nausea and/or vomiting

• Hydronephrosis: kidneys are backed up and swell> Renal failure

Hydronephrosis

Occurs when a kidney has an excess of fluid (swelling) due to a backup of urine, often caused by an obstruction in the upper part of the urinary tract

How does hydronephrosis occur with urolithiasis?

When a stone causes a blockage, it can cause backup of urine (hydronephrosis)

Benign Prostatic Hypertrophy (BPH)

• Non-malignant enlargement of the prostate

• Occurs in 50% of men > 50 yo and 90% of men past 80 years old

• Pushes on the urethra

and results in bladder

outflow obstruction

What is the concern with BPH?

• can lead to UTIs and create obstructions

• Also post renal kidney injury/failure

What are the manifestations of BPH?

· Nocturia

· Urinary frequency

· Urinary hesitancy

· Hematuria

· Interruption in urinary flow

· Large smooth prostate

· Increased serum PSA

What are the most common risk factors for UTIs?

· Female: TEACH GIRLS TO WIPE FRONT TO BACK

· Sexually active (multiple partners increases risk; STIs like gonorrhea & chlamydia increase risk)

· Use of diaphragm with spermicide, bubble baths

· Diabetics

· Recent catheterization

· Obstructive uropathy

Most common cause of UTIs

E. coli (80% of cases)

What are the classic manifestations of lower UTIs?

WBC and/or nitrites in urine

Hematuria

Urinary frequency and urgency

Dysuria

Foul smelling urine

Cloudy urine (pyuria- pus in urine)

What are the classic manifestations of upper UTIs?

Same symptoms of lower UTI

Fever

Chills

Nausea

Vomiting

Malaise

Low back "flank" pain

How do elderly usually present with a UTI?

May have new onset of confusion along smelly urine

Nephritis

• Infection and inflammation in kidney- affects the renal pelvis, calyces, medulla

• Usually caused by E.coli, Proteus, or Pseudomonas

• Typically starts in lower tract and infection ascends from bladder

Systemic Manifestations of Infection- could lead to sepsis, if not taken care of

• Filtration, reabsorption, and secretion can be impaired (can decrease renal function)

• Repeated attacks can cause scarring and renal damage

Glomerulonephritis

damage to kidneys as a result of immune response; type 3 hypersensitivity-immune complex hypersensitivity

Pyelonephritis

• inflammation of the kidney and renal pelvis

• CVA (costovertebral angle) tenderness and fever

Hallmark manifestation of Glomerulonephritis

Tea colored urine

Key difference between pyelonephritis and glomerulonephritis

pyelonephritis is the inflammation of the kidney due to the urinary tract infections that reach the renal pelvis of the kidney, while glomerulonephritis is the inflammation of tiny blood vessels of the kidney known as glomeruli due to inflammation and thickening of the glomerular basement membrane that becomes leaky

Acute Glomerulonephritis (AGN) causes

• streptococcal infection

• bacterial endocarditis

• viral infections

Chronic Glomerulonephritis (CGN) causes

• immune diseases

• HTN

• DM

How does protein effect the kidneys?

i. Normally, kidneys are relatively non-permeable to proteins

ii. When kidneys are damaged, they can allow protein to leak, resulting in proteinuria

iii. When patients have proteinuria, can develop low albumin levels in blood; kidneys become permeable to protein and start leaking protein

iv. In people with kidney conditions, high-protein diets can be nephrotoxic; when people have existing kidney conditions and losing protein in the urine, albumin will drop in blood. Protein cannot simply be replaced- will cause further kidney damage; protein shouldn't get too low but cannot have too much

Proteinuria

the presence of an abnormal amount of protein in the urine

Hypoproteinemia

low protein in blood

Hypoalbuminemia

decreased albumin levels in blood

Hyperlipidemia

-excessive amounts of lipids in the blood

-because liver is conserving cholesterol due to low protein/albumin

Manifestations of nephrotic syndrome and why these occur****

· Proteinuria

· Hypoproteinemia

· Hypoalbuminemia

· Edema