1. Chapter 7
Objectives
Name essential organs of the urinary system and describe their locations and functions
Identify common pathologic conditions affecting the urinary system
Recognize how urinalysis is used and interpreted as a diagnostic test
Define urinary system-related forms, prefixes, and suffixes
List and explain laboratory test, clinical procedures, and abbreviations that pertain to the urinary system.
Understand medical terms in their proper contexts, such as medical reports and records.

2. Urinary System
Chapter 7
Pages 215 – 255

3. Vocabulary Pages 221 – 222 arteriole glomerulus renal tubules
calciferol
hilum
renal vein
calyx or calix
kidney
renin
catheter
meatus
sodium (Na+)
cortex
medulla
trigone
creatinine
nephron
urea
electrolyte
nitrogenous waste
ureter
erythropoietin (EPO)
urethra
potassium (K+)
uric acid
filtration
reabsorption
urinary bladder
glomerular capsule
renal artery
urination (voiding)
renal pelvis
ARTERIOLE (ăr-TĔR-ē-ōl) Small artery
CALCIFEROL (căl-SĬ-fĕr-ŏl) An active form of vitamin D, necessary for the absorption of calcium from the intestine, secreted by the kidney.
calyx or calix [plural: calyces or calices] (KĀ-lĭks; KĀ-lĭ-sēz) Cup-shaped collecting region in the renal pelvis (central section of the kidney). The term comes from Greek, kalux meaning a cup or case surrounding a flower bud.
CATHETER (KĂ-thĕ-tĕr) Tube for injecting or removing fluids
CORTEX (KŎR-tĕks) Outer region of an organ; the renal cortex is the outer region of the kidney [CORTICAL (KŎR-tĭ-kăl) Pertaining to the cortex (outer region of an organ).]
CREATININE (krē-ĂT-ĭ-nēn) Nitrogen-containing waste product of muscle metabolism; excreted by the kidney in urine [CREATININE CLEARANCE (krē-ĂT-ĭ-nēn KLĒR-ăns) = a measure of the efficiency of the kidneys in removing (clearing) creatinine from the blood.]
ELECTROLYTE (ē-LĔK-trō-līt) Chemical element that carries an electrical charge when dissolved in water. Electrolytes are necessary for functioning of muscles and nerves. The kidneys maintain the proper balance of electrolytes and water in the blood. EXAMPLES: sodium (Na+), potassium (K+), and chloride (Cl-)
ERYTHROPOIETIN [EPO] (ĕ-rĭth-rō-PŌY-ĕ-tĭn [Ē-pō]) Hormone secreted by the kidney to stimulate red blood cell production by bone marrow and thus increases the amount of oxygen delivered to muscles. – This enhances athletic endurance. However, use of EPO is a form of blood doping and is prohibited by the World Anti-Doping Authority (WADA). -Poietin means a substance that forms.
FILTRATION (fĭl-TRĀ-shŭn) Process by which some substances, but not all, pass through a filter or other type of material
GLOMERULAR CAPSULE (glō-MĔR-ū-lăr KĂP-sŭl) Enclosing structure surrounding each glomerulus. Collects the material that is filtered from the blood through the walls of the glomerulus; also known as Bowman capsule
GLOMERULUS [plural: GLOMERULI] (glō-MĔR-ū-lŭs; glō-MĔR-ū-lī) Tiny ball of capillaries (microscopic blood vessels) in the cortex of the kidney; as blood flows through each glomerulus, waste materials and other substances are filtered from the bloodstream.
HILUM (HĪ-lŭm) Depression [hollow] in the surface of an organ, such as the kidney and lung; it is the area where blood vessels and nerves enter and leave the organ. Hilum comes from the Latin meaning a small thing.
KIDNEY (KĬD-nē) One of two bean-shaped organs behind the abdominal cavity on either side of the backbone in the lumbar region; it filters nitrogenous wastes from the bloodstream to form urine.
MEATUS (mē-Ā-tŭs) An opening or passageway; the urinary meatus is the opening of the urethra to the outside of the body and the auditory meatus is the opening of the ear to the outside of the body.
MEDULLA (mĕ-DŪL-ă or mĕ-DŬL-ă) Inner region of an organ – The renal medulla is the inner region of the kidney. The term comes from the Latin medulla, meaning marrow (inner part).
NEPHRON (NĔF-rŏn) Functional unit of the kidney, consisting of a glomerulus, renal tubule, and collecting tubule [where filtration, reabsorption and secretion take place]. Each capable of forming urine by itself. There are about 1 million nephrons in a kidney.
NITROGENOUS WASTE (nĭ-TRŎJ-ĕ-nŭs wāst) Substance containing nitrogen and excreted in urine; EXAMPLES: urea, creatinine and uric acid
POTASSIUM (pō-TĂ-sē-ŭm) [K+] Chemical element that forms salts with other minerals and when dissolved in water, it is an electrolyte whose balance is regulated by the kidney – It is essential for allowing muscle contraction and conduction of nervous impulses.
REABSORPTION (rē-ăb-SŎRP-shŭn) Process in the kidney by which the renal tubules return materials necessary to the body back into the bloodstream.
RENAL ARTERY (RĒ-năl ĂR-tĕ-rē) Blood vessel that carries blood to the kidney
RENAL PELVIS (RĒ-năl PĔL-vĭs) Central collecting chamber of the kidney
RENAL TUBULE (RĒ-năl Too-būl) Microscopic tube in the kidney where urine is formed after filtration.
RENAL VEIN (RĒ-năl vān) Blood vessel that carries blood away from the kidney and back toward the heart.
RENIN (RĒ-nĭn) A substance [enzyme and hormone] synthesized, stored and secreted by the kidney to raise blood pressure; it causes narrowing [constriction] of blood vessels.
SODIUM (SŌ-dē-ŭm) [Na+] Chemical element necessary for proper transmission of nerve impulses, heart activity, and other metabolic functions; as an electrolyte, its blood and urine levels are regulated by the kidney – A common form of sodium is sodium chloride (table salt).
TRIGONE (TRĪ-gōn) Triangular area in the urinary bladder where the ureters enter and the urethra exits.
UREA (ū-RĒ-ă) Major nitrogenous waste material in urine
URETER (ū-RĒ-tĕr or ŪR-ĕ-tĕr) One of the two tubes leading from the kidneys to the urinary bladder.
URETHRA (ū-RĒ-thră) Tube leading from the urinary bladder to the outside of the body
URIC ACID (Ū-rĭk ĂS-ĭd) Nitrogenous waste formed when proteins are used in cells; it is excreted by the kidneys in urine.
URINARY BLADDER (ŪR-ĭ-năr-ē BLĂ-dĕr) Hollow, muscular walls sac that holds and stores urine until it is discharged from the body.
urination (ūr-ĭ-NĀ-shŭn) Process of expelling urine; Also called micturition (mik-chə-ˈri-shən) or voiding (VOY-dĭng)

4. Combining Forms Pages 223 – 224 Meaning Examples
cali/o, calic/o cyst/o glomerul/o meat/o nephr/o
calyx (calix); cup-shaped
urinary bladder
glomerulus
meatus
kidney
caliectasis, caliceal
cystitis, cystectomy, cystostomy
glomerular capsule
meatal stenosis
paranephric, nephropathy, nephroptosis, nephrolithotomy, hydronephrosis, nephrostomy
THESE COMBINING FORMS ARE STRUCTURES
CALIECTASIS (kā-lē-ĔK-tă-sĭs) Dilation or widening of a calyx; this occurs when urine is backed up in the kidney as in hydronephrosis
CALICEAL (kā-lĭ-SĒ-ăl) Pertaining to a calyx (cup-shaped collecting chamber in the central portion of the kidney)
CYSTITIS (sĭs-TĪ-tĭs) Inflammation of the urinary bladder – Bacterial infections often cause acute or chronic cystitis. In acute cystitis, the bladder contains blood as a result of mucosal hemorrhage (Figure 7-7).
CYSTECTOMY (sĭs-TĔK-tō-mē) Excision (removal) of the urinary bladder.
CYSTOSTOMY (sĭs-TŎS-tō-mē) An opening is made into the urinary bladder from the outside of the body. A catheter is placed into the bladder for drainage.
GLOMERULAR CAPSULE (glō-MĔR-ū-lăr KĂP-sŭl) Enclosing structure surrounding each glomerulus. Collects the material that is filtered from the blood through the walls of the glomerulus; also known as Bowman capsule
MEATAL STENOSIS (mē-Ā-tăl stĕ-NŌ-sĭs) Narrowing of the meatus (opening) leading from the urethra to the outside of the body
PARANEPHRIC (pă-ră-NĔF-rĭk) Pertaining to beside or near a kidney
NEPHROPATHY (nĕ-FRŎ-pă-thē) Disease or abnormality of the kidney
NEPHROPTOSIS (nĕf-rŏp-TŌ-sĭs) Prolapse or Downward displacement of a kidney when its anatomic supports are weakened. TREATMENT: Nephropexy (-pexy means fixation). Also known as floating or wandering kidney
NEPHROLITHOTOMY (nĕf-rō-lĭ-THŎT-ō-mē) Incision into the kidney to remove a stone.
HYDRONEPHROSIS (hī-drō-nĕ-FRŌ-sĭs) Abnormal condition of excess backup of fluid (urine) in the kidney – Obstruction of urine flow may be caused by RENAL CALCULI (RĒ-năl KĂL-kū-lī) [Kidney stones], compression of the ureter by tumor, or hyperplasia of the prostate gland at the base of the bladder in males. PICTURE – Notice the buildup of excess fluid in the kidney.
NEPHROSTOMY (nĕ-FRŎS-tō-mē) Surgical opening to the outside of the body (from the renal pelvis). This is necessary when a ureter becomes obstructed and the obstruction cannot be removed easily. The renal pelvis becomes distended with urine (hydronephrosis), making nephrostomy necessary.

5. Combining Forms (Cont’d)
Page 225
Combining Forms (Cont’d)
Meaning Examples
pyel/o ren/o trigon/o ureter/o urethr/o vesic/o
renal pelvis
kidney
trigone (region of the bladder)
ureter
urethra
urinary bladder
pyelolithotomy
renal ischemia, renal colic
trigonitis
ureteroplasty, ureteroileostomy
urethritis, urethroplasty, urethroplasty, urethral stricture
Intravesical, vesicoureteral reflux
PYELOLITHOTOMY (pī-ĕ-lō-lĭ-THŎT-ō-mē) Incision to remove a large calculus (stone) from the renal pelvis contributing to blockage of urine flow and development of infection.
RENAL ISCHEMIA (RĒ-năl ĭs-KĒ-mē-ă) Condition in which blood is held back from the kidney, often by blockage of renal arteries and arterioles
RENAL COLIC (RĒ-năl KŎL-ĭk) Severe intermittent spasms of pain caused calculi in the kidney (renal pelvis) or ureter.
TRIGONITIS (trī-gō-NĪ-tĭs) Inflammation of the trigone of the urinary bladder
URETEROPLASTY (ū-rē-tĕr-ō-PLĂS-tē) Surgical repair of a ureter
URETEROILEOSTOMY (ū-rē-tĕr-ō-ĭl-ē-ŎS-tō-mē) After cystectomy, the urologic surgeon forms a pouch from a segment of the ileum, used in place of the bladder to carry urine from ureters out of the body (Figure 7-9). It is an ileal conduit.
URETHRITIS (ū-rē-THRĪ-tĭs) Inflammation of the urethra
URETHROPLASTY (ū-rē-thrō-PLĂS-tē) Surgical repair of the urethra
URETHRAL STRICTURE (ū-RĒ-thrăl STRĬK-shŭr) Narrowing of the urethra. A STRICTURE (STRĬK-shŭr) is a narrowing of a tubular structure in the body.
INTRAVESICAL (ĭn-tră-VĔS-ĭ-kăl) Pertaining to within the bladder – Do not confuse the term vesical with the term vesicle, which is a small blister on the skin.
VESICOURETERAL REFLUX (vĕs-ĭ-kō-ū-RĒ-tĕr-ăl RĒ-flŭks) Backflow of urine from the urinary bladder to the ureters

6. Combining Forms (Cont’d)
Page 226
Combining Forms (Cont’d)
Meaning Examples
albumin/o azot/o bacteri/o dips/o kal/o ket/o, keton/o lith/o natr/o noct/o olig/o
albumin (a protein in the blood)
nitrogen
bacteria
thirst
potassium
ketone bodies
stone
sodium
night
scanty
albuminuria
azotemia
bacteriuria
polydipsia
hyperkalemia
ketosis, ketonuria
nephrolithiasis
hyponatremia
nocturia
oliguria
THESE COMBINING FORMS ARE SIGNS AND SYMPTOMS
ALBUMINURIA (ăl-bū-mĭn-Ū-rē-ă) Protein in the urine [protein leaks out of damaged glomeruli] – The suffix -uria means urine condition. Microalbuminuria is leakage of very small amounts of albumin through the glomeruli.
AZOTEMIA (ă-zō-TĒ-mē-ă) Excess of nitrogenous waste products in the blood – This toxic condition is characteristic of uremia. INDICATED BY: elevated BUN (blood urea nitrogen) test.
BACTERIURIA (băk-tē-rē-Ū-rē-ă) Bacteria in the urine – Usually a sign of urinary tract infection (UTI). INDICATED BY: positive culture and sensitivity test (C&S).
POLYDIPSIA (pŏl-ē-DĬP-sē-ā) Excessive thirst – Commonly, a sign of diabetes mellitus or diabetes insipidus. This symptom occurs when excessive urination (polyuria) signals the brain to cause thirst.
HYPERKALEMIA (hī-pĕr-kă-LĒ-mē-ă) High levels of potassium in the blood – Because potassium normally is excreted by the kidneys, it accumulates in blood when the kidneys fail.
KETOSIS (kē-TŌ-sĭs) Accumulation of large quantities of ketone bodies [acetone (ĂS-ĕ-tōn)] in the blood; Also known as ketoacidosis – Acids accumulate in the blood and tissues. The breath of a patient with ketosis has a sweet or “fruity” odor.
KETONURIA (kē-tōn-Ū-rē-ă) Presence of ketones in the urine; common in uncontrolled diabetes mellitus, but can occur in anytime the body begins to break down fatty tissue to provide energy, as in starvation 
NEPHROLITHIASIS (nĕf-rō-lĭ-THĪ-ă-sĭs) Abnormal condition of kidney stones
HYPONATREMIA (hī-pō-nă-TRĒ-mē-ă) Low levels of sodium in the blood – This condition can occur when water intake is excessive—primary polydipsia, or when athletes drink too much water in high-endurance events.
NOCTURIA (nŏk-TŪ-rē-ă) Frequent, excessive urination at night.
OLIGURIA (ŏl-ĭ-GŪ-rē-ă) Scanty urination 

7. Combining Form / Suffix
Page 226
Combining Form / Suffix
Meaning Examples
-poietin py/o -tripsy ur/o urin/o -uria
substance that forms
pus
to crush
urine (urea)
urine
urination; urine condition
erythropoietin
pyuria
lithotripsy
uremia, enuresis, diuresis, antidiuretic hormone
urinary incontinence, urinary retention
dysuria, anuria, hematuria, glycosuria, polyuria
ERYTHROPOIETIN [EPO] (ĕ-rĭth-rō-PŌY-ĕ-tĭn [Ē-pō]) Hormone secreted by the kidney to stimulate red blood cell production by bone marrow and thus increases the amount of oxygen delivered to muscles. – This enhances athletic endurance. However, use of EPO is a form of blood doping and is prohibited by the World Anti-Doping Authority (WADA). -Poietin means a substance that forms.
PYURIA (pī-Ū-rē-ă) Pus in the urine; sign of urinary tract infection (UTI)
LITHOTRIPSY (LĬTH-ō-trĭp-sē) Process of using high-energy sound waves to crush a stone within the kidney or ureter
UREMIA (ū-RĒ-mē-ă) Excessive amount of urea and other nitrogenous wastes in the blood – This toxic state results when nitrogenous waste accumulates abnormally in the blood.
ENURESIS (ĕn-ū-RĒ-sĭs) Bedwetting – Literally, a condition (-esis) of being “in urine”. 
DIURESIS (dī-ūr-RĒ-sĭs) Increased excretion of urine by the kidneys; a diuretic is an agent that increases diuresis, such as tea, coffee or alcohol – Di- (from dia-) means complete.
ANTIDIURETIC HORMONE (ăn-tĭ-dī-ū-RĔ-tĭk HŎR-mōn) [ADH] Pituitary gland hormone that normally stimulates the kidney to decrease production of urine, preventing excess loss of water; Also known as vasopressin.
URINARY INCONTINENCE (ŪR-ĭ-năr-ē ĭn-KŎN-tĭ-nĕns) Involuntary passage of urine – It literally means not (in-) able to hold (tin) together (con-). EXAMPLE: Stress incontinence occurs with strain on the bladder opening during coughing or sneezing. Urgency incontinence occurs with the inability to hold back urination when feeling the urge to void.
URINARY RETENTION (ŪR-ĭ-năr-ē rē-TĔN-shŭn) Inability to pass urine, which is held back in the urinary bladder – This symptom results when the outflow of urine from the bladder is blocked.
DYSURIA (dĭs-Ū-rē-ă) Painful urination
ANURIA (ăn-Ū-rē-ă) Suppression of urine formation by the kidney – Commonly caused by renal failure or urinary tract obstruction.
HEMATURIA (hēm-ă-TŪ-rē-ă) Blood in the urine – Microhematuria is hematuria that is visible only under a microscope, as opposed to gross hematuria, which can be seen with the naked eye.
GLYCOSURIA (glī-kōs-Ū-rē-ă) Sugar in the urine – A sign of diabetes mellitus.
POLYURIA (pŏl-ē-Ū-rē-ă) Excessive urination – A symptom of both diabetes insipidus and diabetes mellitus.

8. Urinalysis Page 228 Tests included in a urinalysis: Color
Specific gravity
Appearance
Ketone bodies pH
Sediment
Protein
Phenylketonuria
Glucose
Bilirubin
URINALYSIS (ū-rĭn-ĂL-ĭ-sĭs) Series of tests to evaluate the composition of urine; it includes tests to determine:
1. Color—Normal urine color is yellow (amber) or straw-colored.
A colorless, pale urine indicates a large amount of water in the urine, whereas a smoky-red or brown color of urine indicates the presence of large amounts of blood.
Foods such as beets and certain drugs also can produce a red coloration of urine.
2. Appearance—Normally, urine should be clear.
Cloudy or turbid urine indicates a urinary tract infection with pus (pyuria) and bacteria (bacteriuria).
3. pH—Determination of pH reveals the chemical nature of urine.
It indicates to what degree a solution is acid or alkaline (basic).
Normal urine is slightly acidic pH of 6.5.
However, in some infections of the bladder, the urine pH may be alkaline, owing to the actions of bacteria in the urine that break down urea and release ammonia (an alkaline substance).
4. Protein—Small amounts of protein are normally found in the urine but not in sufficient quantity to produce a positive result by ordinary methods of testing.
When urinary tests for protein become positive, albumin is usually responsible.
Albumin is the major protein in blood plasma. If it is detected in urine (albuminuria), it may indicate a leak in the glomerular membrane, which allows albumin to enter the renal tubule and pass into the urine. Through more sensitive testing, smaller abnormal amounts of albumin may be detected, revealing microalbuminuria, when ordinary tests are negative.
Microalbuminuria is recognized as the earliest sign of renal involvement in diabetes mellitus.
5. Glucose—Sugar is not normally found in the urine. In most cases, when it does appear (glycosuria), it indicates diabetes mellitus. 
In diabetes mellitus, there is excess sugar in the bloodstream (hyperglycemia), which leads to the “spilling over” of sugar into the urine.
The renal tubules cannot reabsorb all the sugar that filters out through the glomerular membrane.
6. Specific gravity—The specific gravity of urine reflects the amounts of wastes, minerals, and solids in the urine.
It is a comparison of the density of urine with that of water. The urine of patients with diabetes mellitus has a higher-than-normal specific gravity because of the presence of sugar.
7. Ketone bodies—Ketones (or acetones, a type of ketone body) are formed when fatty acids are broken down in the liver.
Ketones accumulate in blood and urine when the body breaks down fat, instead of sugar, for fuel. 
Ketonuria occurs in diabetes mellitus when cells deprived of sugar must use up their available fat for energy.
In starvation, when sugar is not available, ketonuria and ketosis (ketones in the blood) occur as fat is catabolized abnormally. Ketones in the blood are dangerous because they increase the acidity of the blood (ketoacidosis). 
If severe, this may lead to coma (unconsciousness) and death.
8. Sediment and casts—The presence of abnormal particles in the urine is a sign of a pathologic condition.
Such particles, which may settle to the bottom of a urine sample as sediment, may include cells (epithelial, white, or red blood cells), bacteria, crystals, and casts(cylindrical structures of protein often containing cellular elements).
9. PHENYLKETONURIA (fē-nĭl-kē-tōn-ŪR-ē-ă) [PKU] This is a rare condition in which a baby is born unable to break down an amino acid, phenylalanine.
Resulting high blood levels of phenylalanine (phenylketones are detected in urine) can lead to mental retardation.
Although the PKU test originally was performed on urine specimens, now it is done by pricking the newborn's heel to obtain a small blood sample.
If phenylalanine is detected, the infant is fed a diet excluding phenylalanine.
Affected children remain on this diet until adulthood.
10. Bilirubin—This pigment substance, which results from hemoglobin breakdown, may be present in the urine (bilirubinuria) of patients with liver disease.
Urobilinogen, a breakdown product of bilirubin, also may be found in the urine.
It is an inexpensive, noninvasive test that provides valuable information not only about the contents of urine, but about diseases affecting the body as a whole.

9. Pathology: Kidney Pages 229 – 231 Glomerulonephritis Pyelonephritis
Interstitial nephritis
Renal cell carcinoma (Hypernephroma)
Nephrolithiasis
Renal failure
Nephrotic syndrome (nephrosis)
Renal hypertension
Polycystic kidney disease (PKD)
Wilms tumor
GLOMERULONEPHRITIS (glō-mĕr-ū-lō-nĕ-FRĪ-tĭs) Inflammation of glomeruli in the kidney.
This condition can follow a streptococcal infection. SYMPTOMS: leaky glomeruli, hematuria, red blood cell casts, albuminuria, & when severe renal failure, and uremia. TREATMENT: Drugs to control inflammation, and dialysis or renal transplantation may be necessary if uremia occurs. Can lead to hypertension and renal failure if untreated.
INTERSTITIAL NEPHRITIS (ĭn-tĕr-STĬ-shŭl nĕ-FRĪ-tĭs) Inflammation of the connective tissue in the kidney that lies between the renal tubules. Acute interstitial nephritis, an increasingly common disorder, may develop after use of NSAIDs (non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen) and other drugs. SYMPTOMS: fever, skin rash, and eosinophils in the blood and urine
NEPHROLITHIASIS (nĕf-rō-lĭ-THĪ-ă-sĭs) Kidney stones (renal calculi). Stones often lodge in the ureter or bladder, as well as in the renal pelvis, & may require removal by lithotripsy or surgery.
NEPHROTIC SYNDROME (nĕ-FRŎT-ĭk SĬN-drōm) Group of symptoms that occur due to loss of protein in the urine. SYMPTOMS: edema (ĕ-DĒ-mă) [Abnormal accumulation of fluid in tissue spaces], hypoalbuminemia [loss of protein from the blood], heavy proteinuria, and infection; – Also known as nephrosis
POLYCYSTIC KIDNEY DISEASE (pŏl-ē-SĬS-tĭk KĬD-nē dĭ-ZĒZ) [PKD] Hereditary condition characterized by a progressive growth of cysts (fluid filled sacs) on and within the kidney that prevent normal function. EXAMPLE: One type usually is asymptomatic until middle age and then age is marked by hematuria, urinary tract infections, nephrolithiasis, & renal failure. The other type of PKD occurs in infants or children and results in renal failure. PICTURE -  A, Polycystic kidney disease. Typically, polycystic kidneys weigh 20 times more than their usual weight.
PYELONEPHRITIS (pī-ĕ-lō-nĕf-RĪ-tĭs) Inflammation of the lining of the renal pelvis and kidney; caused by bacterial infection. SYMPTOMS: pyuria. TREATMENT: antibiotics and surgical correction of any obstruction to urine flow.
RENAL CELL CARCINOMA (RĒ-năl sĕl kăr-sĭ-NŌ-mă) Malignant tumor of the kidney in an adult. Also known as hypernephroma. SYMPTOMS: Hematuria and the tumor often metastasizes to bones and lungs. TREATMENT: Nephrectomy or partial nephrectomy PICTURE - renal cell carcinoma
RENAL FAILURE (RĒ-năl FĀL-ūr) Failure of the kidneys to produce and excrete urine. A large number of conditions, including high blood pressure, infection, & diabetes, can lead to renal failure, which may be acute (ARF) or chronic (CRF), reversible or progressive, mild or severe.
RENAL HYPERTENTION (RĒ-năl hī-pĕr-TĔN-shŭn) High blood pressure resulting from kidney disease
This is SECONDARY HYPERTENSION (SĔ-kŏn-dă-rē hī-pĕr-TĔN-shŭn) High blood pressure caused by kidney disease or by other disorders [i.e. glomerulonephritis, etc.]. The most common type of high blood pressure is ESSENTIAL HYPERTENSION (ē-SĔN-shŭl hī-pĕr-TĔN-shŭn) High blood pressure due to no apparent cause; also known as primary hypertension. Can result in stroke, myocardial infraction (heart attack), heart failure, or renal failure.
WILMS TUMOR (wĭlmz TŌŌ-mŭr) Malignant tumor of the kidney that occurs in childhood. TREATMENT: surgery, radiation therapy, and chemotherapy.

10. Pathologic Conditions
Pages 231
Pathologic Conditions
Urinary bladder
Bladder cancer
Associated conditions
Diabetes insipidus (DI)
Diabetes mellitus (DM)
BLADDER CANCER (bladər kansər) – Malignant tumor of the urinary bladder. Occurs more frequently in men (often smokers) & in persons older than 50 years of age, especially industrial workers exposed to dyes & leather-tanning agents. SYMPTOMS: gross (visible to the naked eye) or microscopic hematuria and dysuria. DIGNOSIS: Cystoscopy with biopsy. TREATMENT: Superficial tumors are removed by electro-cauterization (burning). Cystectomy, chemotherapy, and radiation therapy.
DIABETES INSIPIDUS (dī-ă-BĒ-tēz ĭn-SĬP-ĭ-dŭs) [DI] Abnormal condition of inadequate secretion of antidiuretic hormone (ADH) from the pituitary gland or there is a resistance of the kidney to ADH; SYMPTOMS: polyuria (excessive urination) and polydipsia (excessive thirst)
DIABETES MELLITUS (dī-ă-BĒ-tēz MĔL-ĭ-tŭs) [DM] Abnormal condition of no insulin or inadequate insulin secretion from the pancreas or tissues are resistant to its effects; SYMPTOMS: glycosuria (sugar in the urine), hyperglycemia (high blood sugar), polyuria (excessive urination), & polydipsia (excessive thirst) – The term diabetes, when used alone, refers to diabetes mellitus

11. Laboratory Tests Page 232 blood urea nitrogen (BUN)
creatinine clearance
BLOOD UREA NITROGEN (BUN) – Measurement of urea levels in blood; Normally, the blood urea level is low because urea is excreted in the urine continuously. However, when the kidney is diseased or fails, urea accumulates in the blood (uremia), leading to unconsciousness & death.
CREATININE CLEARANCE (krē-ĂT-ĭ-nēn KLĒR-ăns) Measures the rate at which creatinine is cleared from the blood by the kidney; This test assess the functioning of the kidney. Glomerular filtration rate (GFR) normal is 90 to 120 mL/minute.

12. Clinical Procedures Pages 232 – 233 CT urography
Kidneys, ureters, and bladder (KUB)
Renal angiography
Retrograde pyelogram (RP)
Voiding cystourethrogram (VCUG)
Ultrasonography
Radioisotope scan
MRI urography
X-RAY STUDIES
CT UROGRAPHY (CT ū-RŎG-ră-fē) X-ray images using computed tomography show multiple cross-sectional and other views of the kidney; used to detect kidney stones and to evaluate patients with hematuria. PICTURE – A, CT urography with contrast (axial view) shows a benign cyst on the kidney. It does not take up the contrast and is smooth and round. 
KIDNEYS, URETERS, AND BLADDER (KUB) – X-ray examination (without contrast) of the kidneys, ureters, & bladder; looks at the size and location of the kidneys in relation to other organs in the abdominopelvic region.
RENAL ANGIOGRAPHY (RĒ-năl ăn-jē-ŎG-ră-fē) X-ray record of blood vessels of the kidney after injecting contrast material; Helps diagnosis obstruction or construction of blood vessels leading to the kidney. The same changes can be seen on CT & MRI urography
RETROGRADE PYELOGRAM (RĔ-trō-grād PĪ-ĕ-lō-grăm) [RP] X-ray image of the renal pelvis & ureters after injection of contrast through a urinary catheter into the ureters from the bladder. Useful in locating urinary stones and obstructions
VOIDING CYSTOURETHROGRAM (VOY-dĭng sĭs-tō-ū-RĒ-thrō-grăm) [VCUG] X-ray record of the urinary bladder and urethra taken while a patient is urinating and after contrast material is injected through the urethra. Reflux of contrast into the ureters is abnormal & may occur with recurrent urinary tract infections. PICTURE – B, Voiding cystourethrogram showing a normal female urethra.
ULTRASOUND EXAMINATIONS
ULTRASONOGRAPHY (ul″trah-sŏ-nog´rah-fe) Imaging of urinary tract structures using high-frequency sound waves; Kidney size, tumors, hydronephrosis, polycystic kidney disease, & ureteral & bladder obstruction can be diagnosed using ultrasound techniques.
RADIOACTIVE STUDY
RADIOISOTOPE SCAN (rā'dē-ō-ī'sō-tōp) – Image of the kidney obtained after injecting a radioactive substance (radioisotope) into the bloodstream; Pictures show the size & shape of the kidney (renal scan) & its functioning (renogram). These studies can indicate narrowing of blood vessels, diagnose obstruction, & determine the individual functioning of each kidney
MAGNETIC RESONANCE IMAGING
MRI UROGRAPHY (MRI ū-RŎG-ră-fē) Process of taking MRI images of the urinary tract after injecting contrast. This test is useful in visualizing tumor invasion of blood vessels, lymph nodes, & adjacent tissues.

13. Other Procedures Pages 233 – 236 Cystoscopy Dialysis Hemodialysis (HD)
Continuous ambulatory peritoneal dialysis (CAPD)
Lithotripsy
Renal angioplasty
Renal biopsy
Renal transplantation
Urinary catheterization
CYSTOSCOPY (sĭs-TŎS-kō-pē) Visual (endoscopic) examination of the urinary bladder and the urethra. Preformed in two ways:
Flexible cystoscopy: a thin fiber optic cystoscope – Used for diagnosis and check-ups of the urinary bladder
Rigid cystoscopy: a hollow metal tube – Used to take biopsy samples, remove polyps, or perform laser treatments
DIALYSIS (dī-ĂL-ĭ-sĭs) Process of separating nitrogenous waste materials from the blood. Used to treat acute or chronic renal failure and some cases of drug use. There are two methods:
1) HEMODIALYSIS (hē-mō-dī-ĂL-ĭ-sĭs) [HD] Removal of waste materials (urea, creatinine, and uric acid) from the blood in patients whose kidneys have stopped functioning; blood leaves the body and circulates through a machine that removes wastes before sending the blood back into the body through a vein
2) PERITONEAL DIALYSIS (pĕr-ĭ-tō-NĒ-ăl dī-ĂL-ĭ-sĭs) [PD] Separation of nitrogenous wastes from the bloodstream by introducing fluid into the peritoneal cavity; wastes then leave the bloodstream and enter the fluid, which is drained through an abdominal catheter
When used to treat patients with chronic kidney disease, PD may be performed continuously by the patient without mechanical support (CAPD - continuous ambulatory PD) or with the aid of a mechanical apparatus used at night during sleep
LITHOTRIPSY (LĬTH-ō-trĭp-sē) Process of using high-energy sound waves to crush a stone within the kidney or ureter; also known as extracorporeal shock wave lithotripsy [ESWL]
RENAL ANGIOPLASTY (RĒ-năl ĂN-jē-ō-plăs-tē) Surgical repair of blood vessels in the kidney; narrowed areas of renal arteries are dilated using an inflatable balloon attached to a catheter. Afterward, stents (metal-mesh tubes) may be inserted to keep the vessel open. This procedure is used to treat renal hypertension & to preserve renal function
RENAL BIOPSY (RĒ-năl bī-äpsē) - Removal of kidney tissue for microscopic examination; may be performed at the time of surgery (open) or through the skin (percutaneous, or closed). When the latter technique is used, the patient lies in the prone position; then, after administration of local anesthesia to the overlying skin & muscles of the back, the physician inserts a biopsy needle down into the kidney. Several specimens are obtained for examination by a pathologist
RENAL TRANSPLANTATION (RĒ-năl trăns-plăn-TĀ-shŭn) Surgical transfer of a complete kidney from a donor to a recipient. Patients with renal failure may receive a kidney from a living donor, such as an identical twin (isograft) or other person (allograft), or from a patient at the time of death (cadaver transplant). Best result occur when the donor is closely related to the recipient - 98% of transplanted kidneys survive for 1 year on longer
URETERONEOCYSTOSTOMY (ū-rē-tĕr-ō-nē-ō-sĭs-TŎS-tō-mē) Surgical transplantation of a ureter to a new site in the urinary bladder; this occurs with a kidney transplant
URINARY CATHETERIZATION (ŪR-ĭ-năr-ē kă-thĕ-tĕr-ĭ-ZĀ-shŭn) Passage of a catheter into the urinary bladder for temporary or permanent drainage of urine

14. Abbreviations Page 237 ADH C&S PD ARF Cysto pH AKI eGFR PKD BILI ESRD
PKU
BUN
ESWL
PUL
CAPD
HCO3- RP
Cath HD
sp gr
CCPD IC UA
CKD
IVP
UTI
CL- K+
VCUG
CrCl
KUB
CRF
Na+
ADH = Antidiuretic hormone—vasopressin
ARF = Acute kidney (renal) failure
AKI = Acute kidney (renal) injury
BILI = Bilirubin
BUN = Blood urea nitrogen
CAPD = Continuous ambulatory peritoneal dialysis
Cath = Catheter; catheterization
CCPD = Continuous cycling peritoneal dialysis
CKD = Chronic kidney disease—a condition during which serum creatinine and BUN levels rise, which may result in impairment of all body systems
CL- = Chloride, —an electrolyte excreted by the kidney
CrCl = Creatinine clearance
CRF = Chronic renal failure—progressive loss of kidney function
C&S = Culture and sensitivity testing—to determine antibiotic effectiveness against bacteria grown from a patient's urine specimen
Cysto = Cystoscopic examination
eGFR = Estimated glomerular filtration rate
ESRD = End-stage renal disease
ESWL = Extracorporeal shockwave lithrotripsy
HCO3- = Bicarbonate, an electrolyte conserved by the kidney
HD = Hemodialysis
IC = Interstitial cystitis—chronic inflammation of the bladder wall; not caused by bacterial infection and not responsive to conventional antibiotic therapy
IVP = Intravenous pyelogram
K+ = Potassium—an electrolyte
KUB = Kidney ureter and bladder
Na+ = Sodium, an electrolyte—an electrolyte
PD = Peritoneal dialysis
pH = Potential hydrogen; scale to indicate degree of acidity or alkalinity
PKD = polycystic kidney disease
PKU = Phenylketonuria
PUL = percutaneous ultrasound lithotripsy
RP = retrograde pyelography
sp gr = Specific gravity
UA = Urinalysis
UTI = Urinary tract infection
VCUG = Voiding cystourethrogram