urinary tract disorders,powerpoint.ppt

8/9/2019 Urinary tract disorders,powerpoint.ppt

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Urinary System Disorders

Dahler Bahrun,Sp A(K


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Overview

Incontinence andRetention

Dianostic !ests" Urinalysis

" Blood tests" Other tests

Diuretic Drus Dialysis Disorders o# the Urinary

System" Urinary !ract In#ections" In#lammatory Disorders

$lomerulonephritis

Urinary !ractO%structions" Urolithiasis" !umors

Renal &ailure" Acute" 'hronic


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Incontinence and Retention

oss o# voluntary control

o# %ladder

Stress incontinence

" Increase in intra)a%dominal

pressure

&orces urine throuh

sphincter

" auhin

" 'ouhin

" &emales wea*ened

Spinal cord in+uries, %rain

damae

Ina%ility to empty %ladder

ay accomp over#low

incontinence

Spinal cord in+ury Ina%ility to control

manaed %y pads, %rie#s

'atheter

" !u%e inserted in urethra" Drains urine #rom %ladder

to collectin %a

" 'ommon source o# U!I


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'atheter


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Dianostic !ests-Urinalysis

'onstituents, characteristics o# urine vary w.dietary inta*e, drus, care o# specimen

/ormally clear, straw)colored0 p1 234)536

Appearance" 'loudy

7resence o# l amts protein, %lood cells, %acteria, pus

" Dar* color

1ematuria (%lood8, e9cessive %iliru%in, hih concentration o#urine

" Unpleasant, unusual odor in#ection


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Dianostic !ests-Urinalysis

A%normal constituents (hih in num%ers8" Blood (hematuria8

Small, microscopic amts" In#ection, in#lammation, tumors o# U!

: RB'" Increased lomerular permea%ility or hemorrhae in tract

" 7rotein (7roteinuria8 ea*ae o# al%umin into #iltrate

" In#lammation, increased lomerular permea%ility

" Bacteria (Bacteriuria8 and 7us (7yuria8 Indicates U!I

" Urinary casts

icroscopic mold o# tu%ules" 'onsists o# one or more cells, %acteria, protein In#lammation o# tu%ules

" Speci#ic ravity A%ility o# tu%ules to concentrate urine ow is related to renal #ailure


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RB' 'ast


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Dianostic !ests-Blood !ests

1ih serum urea and creatinine" Indicate #ailure to e9crete / wastes

Due to low $&R

eta%olic acidosis" Indicates low $&R, #ailure o# tu%ules to control acid.%ase %alance

Anemia" Indicates low erythropoietin secretion and.or %one marrow depression

Due to accumulatin wastes

;lectrolytes Anti%ody level

" Antistreptolysin O (ASO8 or antistrepto*inase (ASK8

Renin levels" Indicate cause o# hypertension


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Dianostic !ests-Other !ests

'ulture and sensitivity tests" Urine specimens

ID oranism and select dru treatment

'learance tests" 'reatinine, insulin clearance" Used to asses $&R

Radioloic tests" Intravenous pyeloraphy (I


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I


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Anioraphy, Ultrasound


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'!


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'!, RI


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Diuretic Drus

Removes e9cess /a ion and water #rom %ody" Increase e9cretion o# water thru *idneys and urinary vol

!a*e in mornin

7rescri%ed #or many disorders" Renal disease, hypertension, edema, '1&, pulmonary edema

ost commonly used dru roup inhi%its /a'lrea%sorption

a+or side e##ect is e9cess loss o# electrolytes

" any cause e9cessive loss o# potassium" 'ause muscle wea*ness or cardiac arrhythmias


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Dialysis

7rovides ?arti#icial *idney@

" Sustains li#e a#ter *idney #ails

Acute renal #ailure or end)stae renal #ailure (those

waitin #or a transplant8

#orms

" 1emodialysis

" 7eritoneal dialysis


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1emodialysis

1ospital, dialysis center

7ts %lood moves #rom implanted shunt in armarterytu%emachinee9chane o#

wastes, #luids, electrolytes" Semipermea%le mem%rane separates pts %lood #rom

dialysis #luid 'onstituents move %etween the compartments

" ;9C wastes in %looddialysate

%icar%onate in dialysate%loodBlood cells, proteins remain in %lood

ovement %y ultra#iltration, di##usion, osmosis

Blood to pt vein


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1emodialysis

1eparin (anticoaulant8

Re>uired Es.wee* #or )2 hrs

7otential complications" Shunt %ecomes in#ected

" Blood clot #orms

" Blood vessels %ecome damaed ust move to new site

" Increased ris* o# hepatitis, 1I


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7eritoneal Dialysis


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Disorders o# the Urinary SystemC

Urinary !ract In#ections (U!I8


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U!I-;tioloy

&emales more anatomically vulnera%le

" Short urethra

" 7ro9imity to anus

" &re>uent irritation to tissues

!ampons, %u%%le %ath, se9ual activity

Older males with prostatic hypertrophy

and retention o# urine prone to U!I


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U!I-;tioloy

Incontinence Bladder retention o# urine O%struction o# urine #low

'onenital a%normality 7renancy, scar tissue, *idney stones,

vesicourethral re#le9" Urine does not #low #reely

Decreased host resistance (immunosuppression8 Impaired %lood supply to %ladder (ain8 Dia%etes mellitus


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U!IC 'ystitis-7athophysioloy

Bladder wall and urethra in#lamed, red, swollen

" Decreased %ladder capacity


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U!IC 7yelonephritis-

7athophysioloy

G or %oth *idneys involved In#ection #rom ureterrenal pelvismedullary

tissue (tu%ules and interstitial8 7urulent e9udate #ills *idney pelvis and calyces A%scess and necrosis seen in medulla

" ay e9tend thru corte9 to capsule" Severe may compress renal artery and vein and

o%struct urine #low to ureter

Bilateral o%struction results in acute renal #ailure Recurrent chronic in#ection

" 'an lead to #i%rous tissue over caly9 oss o# tu%ule #unction


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U!IC 7yelonephritis-Sins and

Symptoms Sins o# cystitis

7ain

" Dull achin in lower %ac*

" Results #rom renal capsule

stretchin

Urinalysis

" Similar to cystitis

" ;9cept urinary cast

eu*ocytes or renalepithelial cells present

" Involvement o# renal

tu%ules


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U!I-!reatment

Anti%iotics (Bactrim8

Increase #luid inta*e

" ;specially cran%erry +uice

!annin decreases a%ility o# E. colito adhere to

%ladder mucosa

In#ection reoccurs unless predisposin

#actors removed


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Disorders o# the Urinary SystemC

In#lammatory Disorders

$lomerulonephritis

" any #orms

Acute 7oststreptococcal $lomerulonephritis

(A7S$/8" &ollows streptococcal in#ection

H Oriinates as upper resp in#ection, middle ear

in#ection, strep throat

"7rimarily a##ects *ids ) (especially %oys8

" develops wee*s a#ter previous in#ection

In#lammatory DiseasesC


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In#lammatory DiseasesC

$lomerulonephritis-

7athophysioloy Antistreptococcal anti%odies create antien)anti%odycomple9" !ype III hypersensitivity r9n

" ode in lomerular capillaries

'ause in#lammation in %oth *idneys" Increase cap perm and cell proli#eration

H ea*ae o# proteins and erythrocytes into #iltrate

Severe in#lammation" 'onestion and proli#eration inter#ere w. #iltration in *idney

Decrease $&R and retention o# #luid and wastes" I# %lood #low impaired, acute renal #ailure

ow %lood #lowincrease reninincrease %p and edema

" Scar tissue on *idney


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$lomerulonephritis-Sins and

Symptoms

Bac* pain

" Stretchin renal capsule

Dar*, cloudy urine

Oliuria

&acial edema, then enerali=ed

" ow osmotic pressure o# %lood

" Salt, water retention $enerali=ed sins o# in#lammation

Increased %p


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$lomerulonephritis-Dianostic

!ests

Blood tests

" 1ih serum urea and creatinine and

decreasin $&R

" Streptococcal anti%odies, ASO, ASK

" eta%olic acidosis

ow serum %icar%onate, low p1

Urinalysis" 'on#irms presence o# proteinuria, erythrocyte

casts


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$lomerulonephritis-!reatment

Sodium restriction

$lucocorticoids

Anti%iotics

Recovery w. minimal damae" Imp to prevent #urther e9posure to streptococcal

in#ection and recurrent in#lam

"Adults more di##icult

Acute renal #ailure in J 'hronic lomerulonephritis in G6J

" $radually destroys *idneys

7ostrecovery testin should %e done


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Urinary !ract O%structionsC

Urolithiasis

Also calledC

" 'alculi

" Kidney stones

&re>uently reoccur i#not treated


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'alculi-7athophysioloy

'an develop anywhere in U!0 l or small

Once any solid material or de%ris #orms

!end to #orm whenC" e9cessive amts o# relatively insolu%le salts are in #iltrate

" Insu##icient #luid inta*e creates hihly concentrated #iltrate

4J composed o# calcium salts" RemainderC uric acid, struvite, o9alate

Usually cause mani#estations only when o%struct #low o#

urine" In#ection i# stasis o# urine


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Kidney Stones-7athophysioloyC

!ypes o# Stones 'alcium stones

" &orm when calcium levels hih in urine 1ypercalcemia

i9ed inoranic salts" In#ection

De%ris #rom in#ection %ein deposition o# crystals

" Urine p1 al*aline

Uric acid stones" Develop w. hyperuricemia

Due to out, cancer chemo

'alcium o9alate" 'ertain veetarian diets" 1ih levels o# o9alate in urine


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Kidney Stones


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'alculi-Sins and Symptoms

Stones in *idney.%ladder #re>uently

asymptomatic

O%struction o# ureter causes attac*

" ?renal colic@

'onsists o# intense spasms in %ac* and roin

7ain caused %y viorous contractions o# ureter

" ;##ort to pass the stone


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'alculi-!reatment

Small stones eventually passed out

arer stones

" ;9tracorporeal shoc*)wave lithotripsy (;S8

Decreases need #or invasive surery

" Some drus can partially dissolve

/eed to prevent recurrences


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;S

U i ! t O% t ti !


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Urinary !ract O%structionsC !umors

-Renal 'ell 'arcinoma 7rimary, silent tumor

Arises #rom tu%ule epithelium

Asymptomatic in early stae" O#ten metasti=e to liver, luns, %ones, '/S at time o# dianosis

'ommon a#ter 46" ore #re> in males and smo*ers

Initial sin is painless hematuria

Other mani#estations

" Dull achin #lan* pain, palpa%le mass, anemia !reatment is *idney removal

" 4 yr survival rate 46J


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R l & il A t R l & il


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Renal &ailureC Acute Renal &ailure

-7athophysioloy ay #ail suddenly #or di##erent reasons

&ailure reversi%le i# primary pro%lem success#ully treated

Dialysis re>uired

Develops rapidly

;itherC" Directly decreases %lood #low to *idney

" In#lammation and necrosis o# tu%ules cause o%struction and%ac* pressure

$reatly decreases $&R and oliuria

Blood tests show hih / (*idneys not removin wastes8

I# cause not promptly treated, chronic


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Acute Renal &ailure-;tioloy

Acute %ilateral *idney disease" $lomerulonephritis

ow $&R

Severe proloned circulatory shoc* or heart #ailure" Results in tissue necrosis" BurnsC 1% accum in tu%ules L o%struction

/ephroto9ins" Drus, chemicals, to9ins

Aspirin, /SAIDs, penicillin

" 'ause tu%ule necrosis and o%struction o# %lood #low

echanical o%struction" 'alculi, %lood clots, tumors" Bloc* urine #rom leavin *idney


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Acute Renal &ailure-!reatment

Important to reverse primary pro%lem

>uic*ly

Dialysis

Recovery evidenced %y increased urine

output

" ay ta*e couple months %e#ore renal tu%ules

#ully recover

'h i R l & il


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'hronic Renal &ailure-

7athophysioloy $radual, irreversi%le destruction o# *idney nephrons

ay result #romC" 'hronic *idney disease

Bilateral pyelonephritis

" Systemic disorders 1ypertension

Dia%etes

" on term e9posure to nephroto9ins

Asymptomatic until well advanced

" Due to reserve #unction o# nephrons" 'ant %e stopped once in advanced

Scar tissue and loss o# #unctional orani=ation" &urther deenerative chanes

'h i R l & il


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'hronic Renal &ailure-

7athophysioloyC Staes

Decreased reserve

" M6J nephron loss

" ow $&R, hih creatinine levels

Both still in normal rane

" /ormal urea levels

" /o apparent clinical sins

" Remainin nephrons adapt Increase capacity #or #iltration


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Staes

Renal Insu##iciency" 4J nephron loss

" 'hanes in %lood chemistry and mani#estations

" $&R decrease to 6J o# normal

" Sini#icant retention o# / wastes in %lood

" Decrease tu%ule #unction &ailure to concentrate urine and control secretion #or

e9chane o# acids and electrolytes

" ;9cretion o# l vol o# dilute urine" 1ih %p

" 'ardiovascular system compensates


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Staes

Uremia (;nd)stae renal #ailure8

" FN6J nephron loss

" nelii%le $&R

" &luid, electrolytes, wastes retained in %ody

All systems a##ected

" Oliuria or anuria

" Reular dialysis or transplant needed tosustain li#e


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'hronic Renal &ailure Sins and


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'hronic Renal &ailure-Sins and

Symptoms ;arly sins

" Increase urine output (polyuria8" $eneral sins" Increase wastes and altered %lood chemistry

Bone marrow depression, impaired cell #unction

" Increase %p

Uremic sins" Oliuria" Dry, hyperpimented s*in" 7eripheral neuropathy (a%norm sensations in lower lim%s8" alesimpotence, decrease li%ido0 #emalesirre menstrual cycle" ;ncephalopathy (lethary, memory lapses, sei=ures, tremors8" '1&, arrhythmias

" &ailure o# *idneys to activate vitamin D eads to hypocalcemia, osteodystrophy, osteoporosis, tetany

" Uremic #rost on s*in, urine)li*e %reath" Systemic in#ection

pneumonia


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'hronic Renal &ailure Dianostic


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'hronic Renal &ailure-Dianostic

!ests

eta%olic acidosis %ecomes decompensated

" Serum p1 %elow 34

" ow $&R

" !u%ule #unction lost A=otemia

" 7resence o# / wastes in %lood

Severe anemia


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'hronic Renal &ailure

A##ects all %ody systems Di##icult to maintain control o# %lood chemistry

and %ody #luid levels Drus to treatC

" 1ypertension, arrhythmias, heart #ailure" Dosaes ad+usted %.c decreased a%ility to e9crete

them

Su%+ect to many complications

"A##ect uremia" In#ection increases wastes in %ody0 compromises all

%ody systems

urinary tract disorders,powerpoint.ppt

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