1. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1 Diseases of the Urinary and Reproductive system Copyright © 2005 by Elsevier Inc. All rights reserved.

2. Slide 2 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

3. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 3 The urinary system consists of:  kidneys (2)  ureters (2)  urinary bladder  urethra

4. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 4 Nephrons  About 1 million per kidney  Responsible for filtration, reabsorption, and secretion of urine  Transports urine to renal pelvis and then to ureters

5. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 5 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

6. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 6 Symptoms of Urinary Diseases  nausea  loss of appetite  fever  headache and body ache  flank or low back pain  edema  decreased urinary output  hypertension  pruritus

7. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 7 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

8. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 8 Location of the glomerulus in the nephron

9. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 9 Acute Glomerulonephritis (cont’d.) Symptoms:  protein in the urine (proteinuria)  edema  decreased urine volume  blood in urine (hematuria)  hypertension (not always present)

10. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 10 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)

11. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 11 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

12. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 12 Chronic Glomerulonephritis (cont’d.) Symptoms:  Initially: no symptoms  Midstage:  hypertension  hematuria  proteinuria  oliguria (slight or infrequent urination)  edema  Late stage  severe hypertension  azotemia (an excess amount of nitrogen- bearing wastes in blood)

13. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 13 Dialysis  End stage renal disease forces approximately one in every 10,000 people to use dialysis to filter wastes from their blood and urine. Without dialysis, these patients will eventually die.

14. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 14 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.

15. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 15 Hemodialysis (cont’d.)

16. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 16 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.

17. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 17 Kidney transplantation  Approximately 10,000 people receive kidney transplants each year in the U.S.  75% are performed on patients with:  diabetes adrenal failure  hypertensive renal disease  glomerulonephritis

18. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 18 Kidney transplantation (cont’d.)  Transplantation requires immunosuppressive agents to prevent potential rejection of the organ.

19. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 19 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

20. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 20 Nephrotic Syndrome (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

21. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 21 Nephrotic Syndrome (cont’d.) Symptoms:  bloody urine  loss of appetite  pale skin  puffiness around eyes  swollen ankles  weight gain

22. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 22 Nephrotic Syndrome (cont’d.) Additional symptoms:  lethargy/depression  Pelvic pain  Hypertension  Tests can reveal high levels of albumin, lipids in urine.

23. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 23 Nephrotic Syndrome (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.  Corticosteriods may help control proteinuria in some patients.

24. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 24 Nephrotoxic Agents  solvents (methanol, carbon tetrachloride)  heavy metals (lead, arsenic, mercury)  pesticides  antibiotics (kanamycin, gentamicin)  nonsteroidal anti-inflammatory drugs (NSAIDs)  iodinated radiographic contrast media  antineoplastic agents  miscellaneous compounds (acetaminophen)  poisonous mushrooms

25. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 25 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.

26. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 26 Acute Renal Failure (cont’d.) Symptoms:  slight or infrequent urination (oliguria)  gastrointestinal disturbances  headache  drowsiness

27. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 27 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.

28. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 28 Acute Renal Failure (cont’d.) Treatment:  The primary goal is to reverse the 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

29. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 29 Acute Renal Failure (cont’d.) Treatment (cont’d.)  Drug therapy may include:  antihypertensives  diuretics  anti-infective agents  Prompt treatment can reverse renal failure and lead to complete recovery.

30. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 30 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)

31. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 31 Chronic Renal Failure (cont’d.)  hypertension  edema  arrhythmias  muscle weakness  ulceration of gastrointestinal mucosa  hair and skin changes  difficulty breathing (dyspnea)  metabolic acidosis Symptoms:  General—weakness, fatigue, and lethargy (due to anemia)  As uremic syndrome worsens:

32. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 32 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

33. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 33 Hydronephrosis (cont’d.)

34. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 34 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

35. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 35 Hydronephrosis (cont’d.) Treatment depends upon 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.

36. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 36 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.

37. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 37 Diabetic Nephropathy (cont’d.) Symptoms:  urinary retention  hypertension  nausea  protein in urine  Urinary tract infections and pyelonephritis are common complications.

38. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 38 Diabetic Nephropathy (cont’d.) Treatment includes:  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

39. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 39 Polycystic Kidney Disease Description:  slowly progressive, irreversible  normal renal tissue replaced with multiple grape-like cysts

40. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 40 Polycystic Kidney Disease (cont’d.)

41. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 41 Polycystic Kidney Disease (cont’d.) Symptoms:  lumbar pain  blood in urine  hypertension  prone to renal infection and kidney stones

42. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 42 Polycystic Kidney Disease (cont’d.) Diagnosis:  urinalysis shows:  blood  protein  pus  radiographic films show:  enlarged kidneys with irregular outlines  spidery appearance

43. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 43 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

44. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 44 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

45. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 45 Stress Incontinence (cont’d.) Treatment:  exercises to strengthen pelvic floor muscles  estrogen replacement (estrogen cream)  drug therapy  surgical repair  collagen injections

46. Copyright © 2005 by Elsevier Inc. All rights reserved.