4.02 Understand the disorders of the urinary system What are some disorders of the urinary system? How are disorders of the urinary system treated? How do you relate the body’s hormone control to the urinary system?

Disorders of the urinary system

Cystitis What is cystitis cyst= medical term for ____ + itis =___ Inflammation of the mucous membrane lining of the urinary bladder Most common cause is the bacteria E. Coli, which is normally found in the rectum. Yikes!! How’d that happen?

More on Cystitis... Another cause might be from urethritis or inflammation of the urethra, which usually leads to painful urination (dysuria) and/or frequent urination (polyuria) Occurs more often in females; due to short urethra of 1.25 – 2 inches long The short urethra provides easy entry for organisms from outside the body Treatment includes antibiotics, urinary antiseptics and increased intake of fluids. Additional preventative measures require teaching the patient the proper technique for wiping after urination Also prevention includes reminding the patient to complete all the antibiotics to avoid reinfection.

Glomerulonephritis An inflammation of the glomerulus (glo mer u lus) of the nephron Two types: Acute – the inflammation is due to a bacterial infection Chronic – diminished function of the kidney due to damage to the filtration membrane

ACUTE bacteria Symptoms (albuminuria) Occurs in some children abt 1 – 3 weeks after a bacterial infection, usually a strep throat. Develops quickly. bacteria Symptoms (albuminuria) Treated with antibiotics with recovery.

Chronic glomerulonephritis The chronic form may develop silently (without symptoms) over several years. Occurs when the filtration membrane becomes permanently damaged. Early signs and symptoms of the chronic form may include: - Blood or protein in the urine (hematuria, proteinuria) - High blood pressure - Swelling of your ankles or face (edema) - Frequent nighttime urination - Very bubbly or foamy urine - Diminished functioning of the kidneys - It often leads to complete kidney failure.

Renal calculi nephrolithiasis (nephro lith iasis) aka kidney stones Also known as nephrolithiasis (nephro lith iasis) aka kidney stones Accumulation of crystals of calcium phosphate, along with uric acid and other substances that clump together Slowly grow in size Fill renal pelvis, obstruct urine flow in the ureters Symptoms include extreme pain, occurs suddenly in the area of kidney and move to groin area May have nausea/vomiting, burning, frequent urge to void, chills, fever, weakness, maybe hematuria Diagnosis by symptoms, ultrasound, x-rays Treatment includes increase of fluids to flush out, meds to dissolve the stone If not resolved a urethroscope or lithotripsy may be done

Renal calculi What will happen if the ureters are blocked? Hydronephrosis – the distention of the renal pelvis and calyces due to the accumulation of fluid

Lithotripsy aka ESWL extracorporeal shockwave lithotripsy Uses shockwaves created outside the body to travel thru skin and body tissue until it hits the stones causing them to break up They can then pass out thru the urine flow Is it a cure? No, may need to be done repeatedly.

Ureteroscopic stone removal

- Longueur : 11cm (length) - Largeur : 9cm (width) Dimension du calcul : - Longueur : 11cm (length) - Largeur : 9cm (width) - Epaisseur : 8cm (thickness) - Poids : 2Kg (weight) 1 kilogram is equal to 2.20462262185 lb Cambodia 2012

Renal failure Acute or Chronic

Renal failure Acute May be sudden onset Cause varies: nephritis, shock, injury, bleeding, sudden heart failure, or poisoning Symptoms include: oliguria, anuria and uremia Uremia symptoms: h/a, dyspnea, n/v, extreme cases – coma and death

Renal failure Chronic Gradual loss of nephron function There may not be any symptoms for a long while Can take months to years to occur It may be so slow that by the time symptoms appear and are detected less than 1/10th of kidney function is happening Final stage called End-Stage Renal Disease or ERSD

Renal failure Renal Failure Chronic kidney disease leads to a buildup of fluid and waste products in the body. How are these systems affected by renal failure?

Renal Failure – system symptoms Nervous System - drowsy, confused - issues concentrating or thinking - numbness hands, feet, other areas - muscle twitching or cramps Respiratory System - shortness of breath Digestive System - weight loss without trying - frequent hiccups - nausea - breath odor - excessive thirst - blood in stool - vomiting, typically in the morning Urinary System - build up of fluid and waste - inability to urinate - urinalysis may reveal proteinuria Integumentary System - itching (pruritus) - dry skin - abnormally dark or light skin - easy bruising - easy bleeding - edema (swelling) feet and hands

Diagnosis Urinalysis Creatinine clearance Creatinine levels BUN Changes seen in the following: - albumin - calcium - cholesterol - CBC - electrolytes - magnesium - phosphorus - potassium - sodium AND MORE….. Urinalysis Creatinine clearance Creatinine levels BUN

Renal failure Treatment option: Peritoneal dialysis Serves as a substitute kidney Uses the patient’s own peritoneal lining to filter the blood Dialysate placed in abdomen via catheter Fluid, wastes, electrolytes and chemicals pass from capillaries in the peritoneal membrane into the dialysate After several hours drained from abdomen taking waste from blood out Process takes about 30 minutes and done about 4 times a day Dialysate is a cleaning solution

Renal failure Treatment option: Hemodialysis Serves as a substitute kidney Involves passage of blood thru a device that removes harmful wastes, extra salt and water Usually done 2 to 3 times a week for 2 to 4 hours Patients are asked to eat a special diet and take prescribed meds

Renal failure Compare the treatment of acute and chronic renal failure.

How does hemodialysis mimic glomerular function?

renal transplant What is involved in this treatment option? - done in cases of prolonged chronic debilitating disease with renal failure of BOTH kidneys - typical patient has been on dialysis for a long period of time waiting for a compatible organ Two types of transplants: - donor from a living donor (a matching family member, usually) - donor of unrelated person who has died - blood and other cellular material must match from donor to recipient

Renal transplant What is the major complication of renal transplantation?

Rejection… Medication must be taken everyday to prevent rejection The maintenance agents are generally 4 classes of drugs called immunosuppressants: - Calcineurin Inhibitors: Tacrolimus and Cyclosporine - Antiproliferative agents: Mycophenolate Mofetil, Mycophenolate Sodium and Azathioprine - mTOR inhibitor: Sirolimus - Steroids: Prednisone