1. Essentials of Human Diseases and Conditions 5th edition
Margaret Schell Frazier
Jeanette Wist Drzymkowski
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2. Diseases and Conditions of the Urinary System
Chapter 11
Diseases and Conditions of the Urinary System
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3. Lesson 11.1 Orderly Function of the Urinary System
1. Explain the structure and function of the normal urinary system. 2. Explain how pathologic conditions of the urinary system threaten homeostasis and result in illness. 3. Explain the diagnostic value of urinalysis.
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4. Lesson 11.1 Orderly Function of the Urinary System (Cont’d.)
4. Relate the symptoms and signs of acute glomerulonephritis.
5. Describe how immune mechanisms are suspected to be a causative factor of acute and chronic glomerulonephritis.
6. Distinguish between hemodialysis and peritoneal dialysis.
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5. Orderly Function of the Urinary System
The urinary tract is responsible for:
Producing, storing, and excreting urine
Cleansing the blood of waste products
Regulating the water, salts, and acids in the body fluids to ensure homeostasis
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6. Orderly Function of the Urinary System (Cont’d.)
The urinary system consists of:
Kidneys (2)
Ureters (2)
Urinary bladder
Urethra
What is the primary function of the kidneys?
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7. The Urinary System (Cont’d.)
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8. Orderly Function of the Urinary System (Cont’d.)
Nephrons
About 1 million per kidney
Responsible for filtration, reabsorption, and secretion of urine
Transport urine to renal pelvis and then to ureters
The nephrons are responsible for filtration, reabsorption, and secretion of urine.
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9. Orderly Function of the Urinary System (Cont’d.)
Symptoms of Urinary Disease
Nausea
Loss of appetite
Fever
Headache and body ache
Flank or low back pain
Edema
Decreased urinary output
Hypertension
Pruritus
The presence of symptoms usually indicates an accumulation of waste products in the blood and electrolyte imbalances in the body.
What types of pathology might be present with these symptoms?
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10. Orderly Function of the Urinary System (Cont’d.)
Evaluation of the Urinary System
Proper function is usually determined by urinalysis and blood tests
Normal results demonstrate
Proper filtration, absorption, and elimination of metabolic waste
Precise fluid and electrolyte balance
Other tests of urinary tract disorders include culture and sensitivity tests, radiologic tests, and biopsies of lesions.
What is each of these procedures used to detect? (Determine antibiotic therapy, visualize structural abnormalities, determine malignancy of lesions, respectively)
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11. Acute Glomerulonephritis
Description
Inflammation and swelling of the glomeruli of the kidney
Can be primary disease of the kidney
Can develop secondarily to a systemic disease
Usually follows a streptococcal bacterial infection of the throat or skin
Most cases resolve within 2 weeks.
Occurs most often in children and adolescents.
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12. Location of the Glomerulus in the Nephron
The swelling and inflammation of the glomerulus decreases the blood's filtration rate and causes the body to retain water and salts.
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13. Acute Glomerulonephritis (Cont’d.)
Symptoms
Protein in the urine (proteinuria)
Edema
Decreased urine volume
Blood in urine (hematuria)
Hypertension (not always present)
Why might hypertension result from acute glomerulonephritis?
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14. Acute Glomerulonephritis (Cont’d.)
Treatment
Antibiotic therapy (if infection present)
Rest
Diuretics for edema and hypertension
Restricted sodium intake
Corticosteroids (if immune reaction is suspected)
Why is sodium restricted in the treatment of acute glomerulonephritis?
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15. Chronic Glomerulonephritis
Description
A slowly progressive, noninfectious disease that can result in irreversible renal damage and renal failure
Often seen in advanced stage kidney disorders
Reduces glomerular filtration, which causes retention of uremic poisons
Chronic glomerulonephritis progressively destroys the glomeruli.
What is the function of the glomeruli?
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16. Chronic Glomerulonephritis (Cont’d.)
Symptoms
Initially: no symptoms
Midstage:
Hypertension
Hematuria
Proteinuria
Oliguria (slight or infrequent urination)
Edema
The patient also experiences fatigue, malaise, nausea and vomiting, severe itching (pruritus), and difficulty breathing (dyspnea).
Why would specific physiologic processes cause these symptoms?
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17. Chronic Glomerulonephritis (Cont’d.)
Symptoms
Late stage:
severe hypertension
azotemia (an excess amount of nitrogen-bearing wastes in blood)
When kidneys fail to remove urea from the blood (azotemia), the body excretes urea through sweat glands, causing tiny crystals to form on the skin.
What are these crystals called?
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18. Dialysis and Kidney Transplantation
End-stage renal disease forces approximately 1 in every 10,000 people to use dialysis to filter wastes from their blood and urine
Without dialysis, these patients will eventually die
What are the two types of dialysis used? (Hemodialysis and peritoneal dialysis)
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19. Dialysis and Kidney Transplantation (Cont’d.)
Hemodialysis
Fistula provides access to blood
Blood is drawn out of the body and filtered using an artificial kidney (hemodialyzer)
Cleansed blood is returned to the body
Hemodialysis can take place in either a patient's home or in a medical facility.
Describe how a fistula is established and used.
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20. Hemodialysis (Cont’d.)
Notice how the fistula is both the exit for the unclean blood and the entry point for the cleansed blood.
How many hours per week does the average dialysis patient undergo dialysis?
What is an alternative site for a fistula?
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21. Dialysis and Kidney Transplantation (Cont’d.)
Peritoneal Dialysis
Process uses patient's own peritoneal membrane as a filtering device
The dialysate solution passes into peritoneal membrane through permanent catheter
The solution diffuses existing wastes
Contaminated fluids are drained from body
Where is the peritoneal membrane located in the body?
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22. Peritoneal Dialysis (Cont’d.)
What are the two types of peritoneal dialysis?
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23. Dialysis and Kidney Transplantation (Cont’d.)
Two Types of Peritoneal Dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
Uses gravity to aid dialysate solution in filtering process, thereby draining waste into a bag worn around waist
Takes about 15 minutes per session; repeated 3 to 4 times per day and once at night
What kinds of adjustments would be necessary in order to maintain the dialysis schedule?
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24. Dialysis and Kidney Transplantation (Cont’d.)
Two Types of Peritoneal Dialysis
Continuous cycling peritoneal dialysis (CCPD)
Uses a machine that continuously cycles the dialysate and extracts the waste
Typically performed at night while patient sleeps
If you had to choose between hemodialysis and peritoneal dialysis, which would you choose and why?
How does each type of dialysis affect quality of life?
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25. Dialysis and Kidney Transplantation (Cont’d.)
Approximately 10,000 people receive kidney transplants each year in the United States
75% are performed on patients with:
Diabetes adrenal failure
Hypertensive renal disease
Glomerulonephritis
There are more kidney transplants each year than any other organ transplant surgery, with many on waiting lists.
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26. Dialysis and Kidney Transplantation (Cont’d.)
Kidney transplantation requires immunosuppressive agents to prevent potential rejection of the organ
Extensive screening and evaluation of both donor and recipient are performed to offer a compatible match and the best possible prognosis.
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27. Lesson 11.2 Acute and Chronic Renal Failure
7. Identify the hallmark sign of nephrosis. 8. List some nephrotoxic agents. 9. Explain why acute renal failure is considered a clinical emergency. 10. Discuss treatment measures for prolonging the life of the patient with chronic renal failure.
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28. Lesson 11.2 Acute and Chronic Renal Failure (Cont’d.)
11. Identify the etiology and diagnosis of pyelonephritis. 12. Describe hydronephrosis. 13. Describe the common symptoms of renal calculi and list possible complications.
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29. Nephrotic Syndrome (Nephrosis)
Affects the lower membrane of the glomerulus
Secondary to a number of renal diseases and other systemic disorders
Includes a group of symptoms; sometimes referred to as the protein-losing kidney
Nephrotic syndrome is caused by the excessive loss of protein.
Why does the lost protein go, and why?
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30. Nephrotic Syndrome (Nephrosis) (Cont’d.)
Description
A condition caused by excessive loss of protein in the urine that results in:
Depressed plasma protein levels
Increased water and sodium retention
Increased susceptibility to infection
Why might water and sodium be retained? (Diminished glomerular filtration)
What are the effects of increased water and sodium retention? (Hypertension and edema)
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31. Nephrotic Syndrome (Nephrosis) (Cont’d.)
Symptoms
Bloody urine
Loss of appetite
Pale skin
Puffiness around eyes
Swollen ankles
Weight gain
This condition can follow an attack of glomerulonephritis, exposure to certain toxins or drugs, pregnancy, or a kidney transplant.
What are some other things that can lead to nephrotic syndrome? (Diabetes, certain infections, allergic reactions)
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32. Nephrotic Syndrome (Nephrosis) (Cont’d.)
Additional Symptoms
Lethargy/depression
Pelvic pain
Hypertension
Tests can reveal high levels of albumin, lipids in urine
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33. Nephrotic Syndrome (Nephrosis) (Cont’d.)
Treatment
Dietary intake of protein is adjusted to glomerular filtration rate (GFR)
Sodium is lowered and diuretics used to control edema
Urine output is monitored
Corticosteroids may help control proteinuria in some patients
Pregnant women, diabetics, and people with certain infections and allergic reactions should be monitored for kidney function.
Why should urine output be monitored?
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34. Nephrotoxic Agents Solvents (methanol, carbon tetrachloride)
Heavy metals (lead, arsenic, mercury)
Pesticides
Antibiotics (kanamycin, gentamicin)
Nonsteroidal antiinflammatory drugs (NSAIDs)
Iodinated radiographic contrast media
Antineoplastic agents
Miscellaneous compounds (acetaminophen)
Poisonous mushrooms
What other types of things qualify as nephrotoxic agents?
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35. Acute Renal Failure Description
Acute renal failure (ARF) is characterized by a sudden and severe reduction in renal function
ARF qualifies as a clinical emergency because nitrogenous waste products quickly accumulate in blood, causing an acute uremic episode
Why is an acute uremic episode dangerous?
What must a patient do if acute renal failure occurs?
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36. Acute Renal Failure (Cont’d.)
Symptoms
Slight or infrequent urination (oliguria)
Gastrointestinal disturbances
Headache
Drowsiness
What causes acute renal failure?
Is it considered an emergency?
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37. Acute Renal Failure (Cont’d.)
Etiology
Diminished blood flow to kidney
Intrarenal damage to the kidney
Mechanical obstruction of urine flow
Sudden renal failure can lead to death if not treated promptly
Intrarenal damage can be prevented by controlling exposure to nephrotoxic agents.
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38. Acute Renal Failure (Cont’d.)
Treatment
Primary goal is to reverse decreased renal function
This may be accomplished by:
Balancing fluid intake and output
Initiating a high carbohydrate/low protein diet to avoid a protein imbalance (called metabolic acidosis)
Controlling sodium and potassium intake
What happens during metabolic acidosis?
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39. Acute Renal Failure (Cont’d.)
Treatment (cont'd.)
Drug therapy may include:
Antihypertensives
Diuretics
Antiinfective agents
Prompt treatment can reverse renal failure and lead to complete recovery
Why are infections common in acute renal failure?
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40. Chronic Renal Failure Description
Results from the gradual and progressive loss of nephrons
Irreversible loss of renal function
Gradual onset of waste buildup in blood (uremia)
How does the loss of nephrons diminish kidney function?
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41. Chronic Renal Failure (Cont’d.)
Symptoms
General: weakness, fatigue, and lethargy (due to anemia)
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42. Chronic Renal Failure (Cont’d.)
Symptoms
As uremic syndrome worsens:
Hypertension
Edema
Arrhythmias
Muscle weakness
Ulceration of gastrointestinal mucosa
Hair and skin changes
Difficulty breathing (dyspnea)
Metabolic acidosis
What does the presence of hypertension and edema in chronic renal failure represent? (Retention of fluids)
What would blood in the urine (hematuria) indicate?
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43. Chronic Renal Failure (Cont’d.)
Treatment goal: to prolong and improve quality of life
Assessment for dialysis or kidney transplantation
Restricted dietary intake of protein and sodium
Drug therapy
Diuretics
Antihypertensives
Antiinfective agents
Antiemetics (to control nausea/vomiting)
Erythropoietin (a protein to help combat anemia)
Calcitriol (a form of vitamin D to strengthen bones)
What are some causes of chronic renal failure? (Primary disease or infections of the kidney such as glomerulonephritis, pyelonephritis, etc.)
Chronic renal failure is often the end stage of chronic renal disease.
Can chronic renal failure be cured?
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44. Pyelonephritis Description
An inflammation of the renal pelvis and connective tissues of one or both kidneys
The most common type of renal disease
Pyelonephritis is usually caused by an infection, pregnancy, or renal calculi (stones).
Why is this the most common type of renal disease?
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45. Pyelonephritis (Cont’d.)
Symptoms
Rapid onset of:
Fever
Chills
Nausea and vomiting
Lumbar pain
Usually preceded by a urinary tract infection
Why do symptoms have a rapid onset?
What are some other symptoms? (Foul-smelling urine, which may contain blood and pus, and tender pubic region)
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46. Pyelonephritis (Cont’d.)
Etiology
Most commonly results from bacteria migrating from the lower urinary tract to the kidney
Catheterization or diagnostic procedures such as cystoscopy can introduce organisms into the urinary bladder
Women are at greater risk for developing pyelonephritis
Kidneys are prone to infection when urine is obstructed by kidney stones, tumors, or an enlarged prostate.
Why does static urine significantly increase the risk of infection?
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47. Pyelonephritis (Cont’d.)
Diagnosis is made by assessing clinical findings:
Blood culture
Radiographic studies indicating swollen or enlarged kidneys
Urinalysis of a clean-catch urine specimen that indicates:
Increased white and red blood cells
Presence of bacteria, pus, and protein
What is meant by a “clean-catch urine specimen”?
Can an accurate diagnosis be made with only a urinalysis?
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48. Pyelonephritis (Cont’d.)
Treatment
Oral antibiotics (penicillin or cephalosporin) for 7 to 10 days
Increased fluid intake to dilute urine
Bed rest
Early detection and prompt treatment usually leads to full recovery
How can women prevent pyelonephritis? (Empty bladder after intercourse, increase fluid intake, front-to-back wiping of fecal matter)
How can increased fluid intake help prevent pyelonephritis?
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49. Hydronephrosis Description
An abnormal dilation of the renal pelvis caused by pressure from urine that cannot flow past an obstruction in the urinary tract
Chronic condition that can gradually destroy kidneys
What is the renal pelvis? (A funnel-shaped outlet of the kidney into which urine is discharged before passing into the ureter)
The obstruction of urine could be caused by kidney stones, tumor, inflammation stemming from infection, etc.
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50. Hydronephrosis (Cont’d.)
Notice the blockage of urine by calculi before it enters the ureter.
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51. Hydronephrosis (Cont’d.)
Symptoms
Vague backache or diminished urine output sometimes noticeable
Often without pain or symptom
Presence of infection may bring fever, chills, blood, and/or pus in urine
Detection is often accidental
A history of kidney stones is common.
Most often the right kidney is affected by hydronephrosis, but it can be either.
Detection may occur when radiographic or ultrasonography is used on the abdominal area.
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52. Hydronephrosis (Cont’d.)
Treatment depends on the cause of the obstruction and duration of condition
Surgical intervention possible if discovered early
Insertion of nephrostomy tube if surgical intervention not possible
If condition persists for more than 2 months, kidney function usually ceases
What is a nephrostomy tube? (Tube inserted into the renal pelvis to drain urine)
Once obstruction has been removed, kidneys may return to normal function.
What lifestyle factors help prevent kidney stones? (Modifications to diet, exercise, and increased fluid intake)
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53. Renal Calculi Description
Stones in the kidney or in the urinary tract formed by the concentration of mineral salts
Stones form as a result of excessive calcium or uric acid in blood
What are common symptoms of kidney stones?
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54. Renal Calculi (Cont’d.)
Symptoms
Sudden pain in flank area (renal colic)
Nausea and vomiting
Blood in the urine (hematuria)
Fever
Chills
Abdominal distention
Hydronephrosis may result if urine is prevented from flowing past calculi
Kidney stones can occur singly or in multiples.
Small stones can go unnoticed.
Why might the stones cause bleeding?
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55. Renal Calculi (Cont’d.)
Risk Factors
Heredity
Male
Individuals between 30 and 60 years of age
Prolonged:
Dehydration
Immobilization
Infection
Urinary stasis from obstruction
Use of medication
The presence of a kidney stone is considered an emergency situation.
Risk of kidney stones is greatest in males between the ages of 30 and 60.
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56. Renal Calculi (Cont’d.)
Treatment
Removal of kidney stone and treating pain/infection are primary goals
Analgesic therapy is given for pain
Small stones (3 mm or less) may be allowed to pass naturally with increased fluid intake
Medication may be used to dissolve some stones
Location and size of the stone largely determine the type of treatment.
What causes the pain associated with kidney stones?
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57. Renal Calculi (Cont’d.)
Treatment (cont'd.)
Surgical procedures for removal:
Crush stones into smaller pieces using conventional or laser lithotripsy
Capture and remove stone using a ureteroscope or cystoscope
Describe how a ureteroscope and cystoscope work.
Both lithotripsy and laser lithotripsy break the stone into smaller pieces that can pass naturally.
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58. Renal Calculi (Cont’d.)
Possible Complications
If procedures mentioned previously fail to remove calculi, surgical incision into kidney may be necessary to remove stone before permanent damage occurs
Surgical removal of the stone is rare.
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59. Renal Calculi (Cont’d.)
Prevention
Drink at least eight glasses of water a day
Exercise regularly
Avoid foods high in:
Oxalates
Purine
Phosphorus
Prognosis for recovery is good after stone passes or is removed, but return of stone formation is possible.
What specific foods should one avoid?
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60. Renal Calculi (Cont’d.)
How would you advise a person with kidney stones who consumes a number of these foods on a regular basis?
Some dieticians also recommend limiting calcium in the diet.
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61. Lesson 11.3 Other Diseases and Conditions of the Urinary System
14. List causes of infectious cystitis and urethritis. 15. Describe diabetic nephropathy. 16. Contrast neurogenic bladder with stress incontinence. 17. Describe the polycystic kidney and discuss the treatment options.
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62. Lesson 11.3 Other Diseases and Conditions of the Urinary System (Cont’d.)
18. Identify those most at risk for renal cell carcinoma and bladder tumors. 19. List and describe symptoms of renal cell and bladder carcinoma.
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63. Infectious Cystitis and Urethritis
Description
Infectious cystitis: inflammation of the urinary bladder
Urethritis: inflammation of the urethra
Both are common forms of urinary tract infections
Patient often experiences a strong urge to urinate frequently due to the inflammation and infection.
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64. Infectious Cystitis and Urethritis (Cont’d.)
Symptoms
Frequent urination with burning sensation and discoloration (dark yellow, pink, or red)
Pain in the pelvic region and low back
Spasm of the bladder
Fever
Chills
These symptoms require prompt attention.
What causes the burning sensation during urination?
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65. Infectious Cystitis and Urethritis (Cont’d.)
Etiology
Bacteria
E. coli (most common)
Klebsiella
Enterobacter
Proteus
Pseudomonas
What might increase a person's susceptibility to these forms of bacteria?
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66. Infectious Cystitis and Urethritis (Cont’d.)
Etiology
Sexually transmitted diseases
Viruses
Fungi
Parasites
Inflammation caused by chemotherapy or radiation
It is important for women to void after sexual intercourse and wipe from front to back after eliminating.
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67. Infectious Cystitis and Urethritis (Cont’d.)
Treatment
Antibiotic therapy (penicillin derivatives are used to treat complex cystitis) for 3 to 5 days for uncomplicated cases and 7 to 10 days for recurring infections
Increased fluid intake
Regular emptying of bladder
Infectious cystitis and urethritis respond well to antiinfective drug therapy.
Why would increased fluid intake be part of the treatment?
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68. Diabetic Nephropathy Description
Various renal changes (called glomerulosclerosis) that result from diabetes
All patients with type 1 diabetes (and many with type 2 diabetes) will eventually develop renal changes
What is diabetes?
What is the difference between type 1 and type 2 diabetes?
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69. Diabetic Nephropathy (Cont’d.)
Symptoms
Urinary retention
Hypertension
Nausea
Protein in urine
Urinary tract infections and pyelonephritis are common complications
All patients with diabetes who have elevated glucose levels and high blood pressure are at risk.
Diabetic nephropathy is irreversible.
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70. Diabetic Nephropathy (Cont’d.)
Treatment
Glucose management
Controlling blood pressure
Infection control
Balance fluid intake and output
Customizing for patient needs
Possible dialysis or kidney transplant as part of long-term treatment
A low-protein and low-fat diet may also be recommended.
Why would a balanced fluid intake and output be important for this condition?
What does diabetic nephropathy often lead to? (End-stage renal disease)
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71. Polycystic Kidney Disease
Description
Slowly progressive, irreversible
Normal renal tissue replaced with multiple grapelike cysts
Cysts develop on both sides of the kidney and significantly increase its size.
How do the cysts lead to renal failure? (They compress the kidney and impair renal function.)
Compare autosomal recessive polycystic kidney disease and the autosomal dominant form of the disease.
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72. Polycystic Kidney Disease (Cont’d.)
The cysts develop from dilated nephrons and collecting ducts.
It is not fully understood why the cysts form.
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73. Polycystic Kidney Disease (Cont’d.)
Symptoms
Lumbar pain
Blood in urine
Hypertension
Prone to renal infection and kidney stones
Polycystic kidney disease is often inherited but may not be diagnosed until adolescence or adulthood.
Why might it take so long to diagnose this condition?
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74. Polycystic Kidney Disease (Cont’d.)
Diagnosis
Urinalysis shows:
Blood
Protein
Pus
Radiographic films show:
Enlarged kidneys with irregular outlines
Spidery appearance
There is a form of acquired (noninherited) polycystic kidney disease, but it is more rare.
How might a person with a family history of this condition prepare for its development?
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75. Neurogenic Bladder Description
Dysfunction of the urinary bladder that causes difficulty emptying the bladder or urinary incontinence
What does the term neurogenic mean?
How might difficulty in emptying a bladder cause incontinence?
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76. Neurogenic Bladder (Cont’d.)
Symptoms vary by cause
Sensory-related problems
Hesitancy and decreased volume of urine stream
Urinary retention due to absence of stimuli to void
Motor paralysis
Full bladder sensation but unable to empty
Uninhibited neurogenic bladder
Persistent incontinence of small amounts of urine
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77. Neurogenic Bladder (Cont’d.)
Symptoms (cont'd.)
Reflex neurogenic bladder
Normal sensation to void is absent—replaced by bladder contractions that cause spontaneous spurts of urine
Autonomous neurogenic bladder
All sensations and contractions to void are absent, so pressure must be applied to pubic area to initiate voiding
The inability to empty the bladder as well as incontinence are stressful for patients and those closest to them.
How do you think most people respond to incontinence?
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78. Neurogenic Bladder (Cont’d.)
Etiology
An injury to the brain, spinal cord, or nerves connecting the lower urinary tract may result in an inability to empty bladder or maintain continence
What are some examples of causes of neurogenic bladder? (Tumors, cerebrovascular accident, spinal cord trauma, neuropathies, herniated lumbar discs)
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79. Neurogenic Bladder (Cont’d.)
Treatment
Main goal—intervention to prevent urinary tract infections and restore some normal function
Other means:
Catheterization (intermittent or continuous) to
improve quality of life
Drug therapy
External collection devices
Surgery
Usually there is no cure.
Management of the condition is emphasized.
Drug therapy may be helpful to some individuals.
How would quality of life be affected with a neurogenic bladder?
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80. Stress Incontinence Description
Uncontrollable leakage of small amounts of urine from the bladder during physical exertion or actions that stress the pelvic muscles such as:
Laughing
Lifting
Stretching
Running
Stress incontinence occurs when increased abdominal pressure forces urine though the bladder sphincter.
Many common tasks or responses in daily life increase abdominal pressure and may cause leakage of urine in those with stress incontinence.
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81. Stress Incontinence (Cont’d.)
Etiology
Weakening of the pelvic floor muscles and urethral structure, often attributed to:
Trauma from childbirth
Pressure from an existing pregnancy
Hormonal changes associated with aging/menopause
Certain medications
Obesity
Stress incontinence is more common in older women.
How might an older adult deal with episodes of stress incontinence?
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82. Stress Incontinence (Cont’d.)
Treatment
Exercises to strengthen pelvic floor muscles
Estrogen replacement (estrogen cream)
Drug therapy
Surgical repair
Collagen injections
How might collagen injections help stress incontinence?
Medications are helpful for some individuals.
What are some exercises and how are they performed?
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83. Stress Incontinence (Cont’d.)
Neurogenic Bladder
Difficulty emptying bladder, or incontinence
Caused by damaged nerves to lower urinary tract
No cure, but quality of life can be improved
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84. Stress Incontinence (Cont’d.)
Uncontrolled leaking of urine during common activities
Caused by weakened pelvic floor muscles
Condition can be improved and possibly cured
What are the common factors?
How might the average person confuse the two conditions?
What feature distinguishes them?
Discuss overactive bladder.
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85. Renal Cell Carcinoma Description The most common form of renal cancer
One or more malignant tumors develops in one or both kidneys
Other Types
Wilms’ tumor: congenital tumor seen in children
Cancer of the renal pelvis
Renal cell carcinoma is more common in men between the ages of 50 and 70.
The highest rates of renal cell carcinoma are found in the United States and Scandinavia.
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86. Renal Cell Carcinoma (Cont’d.)
Classic Symptoms
Blood in urine
Abdominal mass
Flank pain
Less Common Symptoms
Weight loss
Anemia
Fever
Abnormally high concentration of calcium in blood
Fewer than 10% of patients exhibit all three symptoms at once.
Some patients have no symptoms until the disease is advanced.
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87. Renal Cell Carcinoma (Cont’d.)
Risk Factors
Heredity
Smoking
Obesity
Dialysis patients with cystic kidney disease
Prolonged exposure to chemicals such as asbestos and cadmium
The hereditary factor is associated with a condition called Lindau's disease.
Patients are prone to developing cysts and carcinomas in the kidneys and other areas of the body.
How might knowledge of these risk factors affect the average person?
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88. Renal Cell Carcinoma (Cont’d.)
Diagnosis
Abdominal CT scans
Abdominal ultrasound
X-ray of kidney using radiographic agent
A biopsy is usually not required.
How does imaging using radiographic agents work?
How does it work specifically with imaging the kidney?
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89. Renal Cell Carcinoma (Cont’d.)
Treatment
Surgical removal of diseased kidney (nephrectomy) is preferred intervention
Individuals with small tumors or only one functional kidney may undergo a partial nephrectomy
Immunotherapy may be helpful for some
Metastatic renal cell carcinoma is usually resistant to surgical cure and to chemotherapy.
The single most important consideration for prognosis is stage at diagnosis.
The overall 5-year survival rate is 40% but jumps to 74% to 94% if diagnosed in the early stage.
The survival rate dramatically drops to less than 5% if diagnosed once tumors have metastasized.
What kind of support would a patient need if renal cell carcinoma is diagnosed in the advanced stage?
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90. Renal Cell Carcinoma (Cont’d.)
Prevention
Periodic urinalysis and abdominal ultrasound indicated for people with:
Family history of renal cell carcinoma
Lindau's disease
Previous exposure to kidney radiation
End-stage renal disease with 3 to 5 years or more of dialysis
Cessation of smoking is also highly recommended as a preventive measure.
Why might previous exposure to kidney radiation increase the risk of developing renal cell carcinoma?
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91. Bladder Tumors Description
Bladder growths (tumors) are usually found in the bladder, but may appear anywhere along the urothelium
What is the urothelium? (Lines the surface of the bladder and the entire urinary tract)
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92. Bladder Tumors (Cont’d.)
Symptoms
Blood in urine (intermittent, painless) is most common
Pain in flank or pubic area as carcinoma becomes advanced or metastatic, along with:
Fatigue
Weight loss
Anorexia
Voiding symptoms such as pain during urination, an urgency to void, and increased frequency may also be present.
Which conditions are characterized by blood in the urine? How can a clinician make an accurate diagnosis?
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93. Bladder Tumors (Cont’d.)
Etiology
Environmental exposure to carcinogens is thought to account for most cases
Risk factors:
Occupational exposure to aniline dyes or diesel exhaust
Cigarette smoking
History of prior bladder cancer
The lining of the bladder is exposed to potential carcinogens that are excreted in the urine.
Over 80% of cases are diagnosed in patients over age 60.
White males are most often affected.
What types of occupations are at highest risk for exposure to environmental carcinogens?
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94. Bladder Tumors (Cont’d.)
Diagnosis
The presence of otherwise unexplained blood in the urine in a person over age 40 indicates cancer in the urinary tract until proven otherwise
A full urological evaluation is indicated
Once a diagnosis is made, ultrasonography or a CT scan may be used to evaluate for metastatic disease.
Name some of the components of a full urological evaluation.
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95. Bladder Tumors (Cont’d.)
Treatment
Standard initial treatment is surgical removal of bladder lesions
80% of tumors recur within 12 months
Recurrent tumors are treated similarly
Frequent recurrences may require removal of part or all of the urinary bladder
For patients with metastatic carcinoma, multidrug chemotherapy may help shrink tumor and increase survival time, but this is not a cure
Stage is the most important indicator of treatment outcome.
Once carcinoma appears outside the bladder, an optimistic prognosis becomes increasingly unlikely.
Lower grade and well-differentiated tumors have a slower growth rate and better prognosis.
How might a person reduce susceptibility to bladder tumors?
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