Urinary System Diseases and Disorders Study Notes

Chapter 13: Urinary System Diseases and Disorders

Chapter Objectives

  • Goal: By the end of this chapter, you should be able to:
    • 13.1 Define the terminology common to the urinary system and its disorders.
    • 13.2 Discuss the basic anatomy and physiology of the urinary system.
    • 13.3 Identify important signs and symptoms associated with common urinary system disorders.
    • 13.4 Describe common diagnostics used to determine the type and cause of urinary system disorders.
    • 13.5 Identify common disorders of the urinary system.
    • 13.6 Describe the typical course and management of common urinary system disorders.
    • 13.7 Describe the effects of aging on the urinary system and associated disorders.

Anatomy and Physiology (1 of 2)

  • Kidneys:
    • Function: Remove waste products from the bloodstream.
    • Location: Located on either side of the vertebral column.
  • Ureters:
    • Definition: Tubes that transport urine from the kidneys to the bladder.
  • Bladder:
    • Definition: Muscular organ that stores urine before excretion.
    • Capacity: Can hold around 400-600 mL of urine.
  • Urethra:
    • Function: Carries urine from the bladder to the outside of the body.

Anatomy and Physiology (2 of 2)

  • Urine Characteristics:
    • Normally clear but can appear slightly yellow to gold.
    • Should be free from sediments.
    • Characteristic odor: distinct but not foul-smelling.
    • Specific gravity: Ranges from 1.0051.005 to 1.0301.030.
    • pH: Usually around 66.
    • Clinical significance: Changes in these values may indicate disease.

Common Signs and Symptoms

  • Hematuria: Blood in urine.
  • Pyuria: Presence of pus in urine.
  • Proteinuria: Abnormal levels of protein in the urine.
  • Dysuria: Painful urination.
  • Nocturia: Increased frequency of urination at night.
  • Oliguria: Reduced urine output.
  • Anuria: Absence of urine output.
  • Frequency/Urgency: Increased need to urinate, often urgently.

Diagnostic Tests (1 of 2)

  • Urinalysis: Complete analysis of urine.
  • Urine culture and sensitivity: Determines the presence of bacteria and their susceptibilities to antibiotics.
  • Blood tests: Identify levels of blood urea nitrogen (BUN) and creatinine clearance to assess kidney function.
  • Kidney, ureter, and bladder (KUB): Radiological examination of the urinary tract.

Diagnostic Tests (2 of 2)

  • Intravenous pyelogram (IVP): Imaging test to view the urinary tract using injected dye.
  • Cystogram: Imaging study of the bladder.
  • Cystoscopy: A procedure to look inside the bladder using a thin tube with a camera.
  • Bladder and kidney biopsy: Tissue sampling for pathological examination.
  • Catheterization: Insertion of a catheter to drain urine or measure output.

Urinary Tract Infections (UTIs)

  • Definition: Broad diagnosis encompassing infections of the urinary tract, including urethra, bladder, and kidneys.
  • Causes: Most often caused by bacteria; can also be caused by viruses and fungi. The most common bacterium is E. coli.
UTIs (1 of 5)
  • Gender Differences:
    • More common in females due to:
    • Shorter female urethra and its proximity to the rectum.
    • Improper toilet habits may increase risk.
    • Female vaginal secretions may harbor bacteria; male prostatic secretions often have antibacterial properties.
    • Sexual intercourse can cause trauma to the urethra and bladder, increasing susceptibility.
    • Pregnant women are more prone due to pressure from the uterus on the urinary tract.
UTIs (2 of 5)
  • Diagnosis: Confirmed through urinalysis and culture of urine specimens.
  • Treatment: Typically involves antibiotics.
  • Urethritis:
    • Definition: Inflammation of the urethra.
    • Commonly occurs with cystitis.
    • More prevalent in males.
UTIs (3 of 5)
  • Cystitis:
    • Definition: Inflammation of the bladder (bladder infection).
    • Often referred to as honeymoon cystitis in sexually active females.
    • Treatment: Usually antibiotics and may include antispasmodic medications like Pyridium, which can turn urine reddish-orange.
    • Post-treatment urine culture is necessary to confirm bacterial elimination.
UTIs (4 of 5)
  • Pyelitis:
    • Definition: Inflammation of the kidney pelvis, typically due to ascending infection from the bladder.
    • Importance: Rapid diagnosis and treatment are imperative to prevent the spread of infection.
UTIs (5 of 5)
  • Pyelonephritis:
    • Definition: Infection that can be due to ascending infection or hematogenous spread.
    • Key symptoms:
    • Sudden onset of fever and chills.
    • Flank pain.
    • Hematuria.
    • Generally treated with antibiotics.

Diseases of the Kidney (1 of 9)

  • Glomerulonephritis (acute):
    • Definition: Inflammation of the glomerulus, the filtering unit of the kidney.
    • Occurs 1 to 4 weeks post strep infection. Not suppurative; inflammation arises due to tissue destruction via antigen-antibody reaction.

Diseases of the Kidney (2 of 9)

  • Symptoms of Glomerulonephritis:
    • Flank pain.
    • Fever.
    • Loss of appetite.
    • Malaise.
    • Edema of eyes and ankles.
    • Oliguria.
    • Hematuria.

Diseases of the Kidney (3 of 9)

  • Hydronephrosis:
    • Definition: Presence of urine in the renal pelvis due to obstruction leading to dilation and distention of the kidney pelvis.
    • Diagnosis: Determined through pyelograms.
    • Treatment: Draining the kidney pelvis via surgery and relieving the obstruction.

Diseases of the Kidney (4 of 9)

  • Renal Calculi:
    • Also known as kidney stones.
    • Forms in the kidney pelvis.
    • Symptoms:
    • Hematuria.
    • Renal or urinary colic (severe pain).
    • Described as "the worst pain in life".

Diseases of the Kidney (5 of 9)

  • Diagnosis of Renal Calculi:
    • Techniques: IVP, KUB, and renal ultrasound.
    • Treatment:
    • Pain medications.
    • Increased fluid intake.
    • Straining urine for stones.
    • Lithotripsy (shock wave therapy to break stones).
    • Surgery if needed.

Diseases of the Kidney (6 of 9)

  • Polycystic Disease:
    • Inherited condition resulting in kidney enlargement due to grape-like cysts.
    • Slow, progressive disease.
    • Symptoms:
    • Lumbar pain.
    • Hematuria.
    • Recurrent UTIs.
    • Treatment: Management of hypertension and UTIs, dialysis, and potential kidney transplant.

Diseases of the Kidney (7 of 9)

  • Renal Failure:
    • Definition: Inability of kidneys to cleanse blood of waste products.
    • Types: Can be acute or chronic.
    • Symptoms: Not significant until 75% of kidney function is destroyed. Symptoms include:
    • Acute symptoms plus infertility/impotence and bone weakness/fractures.
    • Diagnosis: Through measuring creatinine and BUN levels.

Diseases of the Kidney (8 of 9)

  • Adenocarcinoma of the Kidney:
    • Risk factor: Cigarette smoking.
    • Character: Frequently metastasizes to liver, brain, and bone before symptoms develop.
    • Symptoms:
    • Painless hematuria.
    • Flank pain.
    • Fever.
    • Diagnosis: Via KUB, IVP, CT scan, and biopsy.

Diseases of the Kidney (9 of 9)

  • Treatment of Adenocarcinoma:
    • Options include nephrectomy (removal of the kidney), chemotherapy, and radiation therapy.
    • Prevention: May not be preventable, but controlling risk factors is beneficial; such as:
    • Not smoking.
    • Increasing intake of fruits and vegetables.
    • Staying active to maintain a normal body weight.
    • Controlling blood pressure.

Diseases of the Bladder (1 of 3)

  • Urinary Incontinence:
    • Definition: Loss of urine flow control.
    • Demographics: Common in females and individuals aged 65 and older.
    • Types of incontinence:
    • Stress Incontinence: Leakage upon exertion.
    • Urge Incontinence: Involuntary leakage due to strong urge to urinate.
    • Overflow Incontinence: Inability to fully empty the bladder.

Diseases of the Bladder (2 of 3)

  • Diagnosis of Urinary Incontinence:
    • Urinalysis.
    • CBC (Complete Blood Count).
    • Urodynamic testing to measure bladder pressure and capacity.
    • Assessment of postvoid residual volumes.
  • Treatment: Depends on the type of incontinence and may include:
    • Behavioral techniques (like bladder training).
    • Medications (anticholinergics, etc.).
    • Medical devices (pessaries, etc.).
    • Therapeutic interventions or surgeries if necessary.

Diseases of the Bladder (3 of 3)

  • Transitional Cell Carcinoma of the Bladder:
    • Definition: Most common neoplasm of the urinary tract, originating from the body's bladder lining.
    • Demographics: More common in males over age 60.
    • Risk factor: Cigarette smoking increases the risk of development.
    • Diagnosis: Confirmed via cystoscopy and biopsy.
    • Treatment: Varies based on the stage of the tumor, may include:
    • Transurethral resection (TUR).
    • Radical cystectomy.

Trauma

  • Straddle Injuries:
    • Commonly cause urethral injuries, more prevalent in males.
    • Accidents may occur from:
    • Walking a fence or beam.
    • Riding horses or motorcycles.
  • Neurogenic Bladder:
    • Definition: Bladder dysfunction resulting from nervous system injury.
    • Causes:
    • Spinal cord injuries (e.g., from motor vehicle accidents).
    • Other causes include strokes, herniated lumbar disks, and diabetes.

Rare Diseases

  • Goodpasture’s Syndrome:
    • An autoimmune disorder characterized by glomerulonephritis and pulmonary hemorrhage.
  • Interstitial Cystitis:
    • Nonbacterial cystitis associated with inflammation of the bladder's inner lining.

Effects of Aging

  • Urinary Incontinence:
    • The most common issue among the elderly population.
  • Prostatic Hypertrophy:
    • Common in older males, may present with:
    • Dribbling of urine.
    • Increased frequency of urination.
    • Pain or burning sensation during urination.
    • Difficulty starting urine flow.

Knowledge Check Activity 13-1

  • Question: Which of the following would be a treatment for adenocarcinoma of the kidney?
    • Biopsy of the kidney
    • Removal of the kidney
    • Medication
    • There is no treatment
  • Correct Answer: Removal of the kidney is a treatment for adenocarcinoma.

Knowledge Check Activity 13-2

  • Question: Which of the following would be a symptom of polycystic kidney disease?
    • Constipation
    • Low back pain
    • Nocturia
    • Hematuria
  • Correct Answer: Low back pain is a symptom of polycystic kidney disease.

Self Assessment

  • Scenario: Imagine someone close to you is diagnosed with bladder cancer. Consider how this condition can impact daily life and activities, as well as discuss its prognosis.

Summary

  • Review the objectives for this chapter by accessing the provided link.
  • Focus on understanding the anatomy, physiology, common diseases, diagnostics, and treatments related to the urinary system.