1. Urinary System Disorders

2. Incontinence and Retention
Loss of voluntary control of bladder
Stress incontinence
Increase in intra-abdominal pressure
Forces urine through sphincter
Laughing
Coughing
Females weakened
Spinal cord injuries, brain damage
Inability to empty bladder
May accomp overflow incontinence
Spinal cord injury
Inability to control managed by pads, briefs
Catheter
Tube inserted in urethra
Drains urine from bladder to collecting bag
Common source of UTI

3. Diagnostic Tests—Urinalysis
Constituents, characteristics of urine vary w/ dietary intake, drugs, care of specimen
Normally clear, straw-colored; pH
Appearance
Cloudy
Presence of lg amts protein, blood cells, bacteria, pus
Dark color
Hematuria (blood), excessive bilirubin, high concentration of urine
Unpleasant, unusual odor
infection

4. Diagnostic Tests—Urinalysis
Abnormal constituents (high in numbers)
Blood (hematuria)
Small, microscopic amts
Infection, inflammation, tumors of UT
Lg # RBC
Increased glomerular permeability or hemorrhage in tract
Protein (Proteinuria)
Leakage of albumin into filtrate
Inflammation, increased glomerular permeability
Bacteria (Bacteriuria) and Pus (Pyuria)
Indicates UTI
Urinary casts
Microscopic mold of tubules
Consists of one or more cells, bacteria, protein
Inflammation of tubules
Specific gravity
Ability of tubules to concentrate urine
Low is related to renal failure

5. Diagnostic Tests—Blood Tests
High serum urea and creatinine
Indicate failure to excrete N wastes
Due to low GFR
Metabolic acidosis
Indicates low GFR, failure of tubules to control acid/base balance
Anemia
Indicates low erythropoietin secretion and/or bone marrow depression
Due to accumulating wastes
Electrolytes
Antibody level
Antistreptolysin O (ASO) or antistreptokinase (ASK)
Renin levels
Indicate cause of hypertension

6. Dialysis Provides “artificial kidney” 2 forms
Sustains life after kidney fails
Acute renal failure or end-stage renal failure (those waiting for a transplant)
2 forms
Hemodialysis
Peritoneal dialysis

9. Disorders of the Urinary System: Urinary Tract Infections (UTI)
Very common
Urine is excellent medium for microorganismal growth
Escherichia coli
Most are ascending
Perineal cavity  mucosa  bladder  ureters  kidneys

10. UTI—Etiology Females more anatomically vulnerable
Short urethra
Proximity to anus
Frequent irritation to tissues
Tampons, bubble bath, sexual activity
Older males with prostatic hypertrophy and retention of urine prone to UTI

11. UTI: Cystitis—Signs and Symptoms
Pain in lower abdomen
Dysuria, frequency, urgency
Inflammation of bladder wall irritated by urine
Systemic signs of infection
Cloudy urine with unusual odor
Urinalysis indicates bacteria (+100,000/mL), pyuria, microscopic hematuria

12. UTI: Pyelonephritis—Signs and Symptoms
Signs of cystitis
Pain
Dull aching in lower back
Results from renal capsule stretching
Urinalysis
Similar to cystitis
Except urinary cast
Leukocytes or renal epithelial cells present
Involvement of renal tubules

13. UTI—Treatment Antibiotics (Bactrim) Increase fluid intake
Especially cranberry juice
Tannin decreases ability of E. coli to adhere to bladder mucosa
Infection reoccurs unless predisposing factors removed

14. Disorders of the Urinary System: Inflammatory Disorders
Glomerulonephritis
Many forms
Acute Poststreptococcal Glomerulonephritis (APSGN)
Follows streptococcal infection
Originates as upper resp infection, middle ear infection, strep throat
Primarily affects kids 3-7 (especially boys)
develops 2 weeks after previous infection

15. Glomerulonephritis—Signs and Symptoms
Back pain
Stretching renal capsule
Dark, cloudy urine
Oliguria
Facial edema, then generalized
Low osmotic pressure of blood
Salt, water retention
Generalized signs of inflammation
Increased bp

16. Glomerulonephritis—Diagnostic Tests
Blood tests
High serum urea and creatinine and decreasing GFR
Streptococcal antibodies, ASO, ASK
Metabolic acidosis
Low serum bicarbonate, low pH
Urinalysis
Confirms presence of proteinuria, erythrocyte casts

17. Glomerulonephritis—Treatment
Sodium restriction
Glucocorticoids
Antibiotics
Recovery w/ minimal damage
Imp to prevent further exposure to streptococcal infection and recurrent inflam
Adults more difficult
Acute renal failure in 2%
Chronic glomerulonephritis in 10%
Gradually destroys kidneys
Postrecovery testing should be done

18. Urinary Tract Obstructions: Urolithiasis
Also called:
Calculi
Kidney stones
Frequently reoccur if not treated

19. Calculi—Pathophysiology
Can develop anywhere in UT; lg or small
Once any solid material or debris forms
Tend to form when:
excessive amts of relatively insoluble salts are in filtrate
Insufficient fluid intake creates highly concentrated filtrate
75% composed of calcium salts
Remainder: uric acid, struvite, oxalate
Usually cause manifestations only when obstruct flow of urine
Infection if stasis of urine

20. Kidney Stones

21. Calculi—Signs and Symptoms
Stones in kidney/bladder frequently asymptomatic
Obstruction of ureter causes attack
“renal colic”
Consists of intense spasms in back and groin
Pain caused by vigorous contractions of ureter
Effort to pass the stone

22. Calculi—Treatment Small stones eventually passed out Larger stones
Extracorporeal shock-wave lithotripsy (ESWL)
Decreases need for invasive surgery
Some drugs can partially dissolve
Need to prevent recurrences

23. Urinary Tract Obstructions: Tumors—Renal Cell Carcinoma
Primary, silent tumor
Arises from tubule epithelium
Asymptomatic in early stage
Often metastize to liver, lungs, bones, CNS at time of diagnosis
Common after 50
More freq in males and smokers
Initial sign is painless hematuria
Other manifestations
Dull aching flank pain, palpable mass, anemia
Treatment is kidney removal
5 yr survival rate 50%