1. Copyright © 2015 Cengage Learning ®. Chapter 13 Urinary System Diseases and Disorders

2. Copyright © 2015 Cengage Learning ®. Anatomy and Physiology Kidneys – Remove waste products from bloodstream Ureters – Tubules that run from kidney to bladder to transport urine Bladder – Muscular organ that holds urine Urethra – Carries urine to outside of body

3. Copyright © 2015 Cengage Learning ®. Anatomy and Physiology Urine normally: – Clear, but slightly yellow to gold – Free from sediments – Distinct odor, but not foul-smelling – Specific gravity of 1.005 to 1.030 – pH of 6 – Changes in values indicate disease

4. Copyright © 2015 Cengage Learning ®. Common Signs and Symptoms Hematuria—blood in urine Pyuria—puss in urine Proteinuria—protein in urine Dysuria—painful or difficult urination Nocturia– night time urination Oliguria—scant urine Anuria—no urine polyuria—increased urine Frequency/urgency—urinating often with urgency

5. Copyright © 2015 Cengage Learning ®. Diagnostic Tests Urinalysis-- checks for pH, nitrate, specific gravity, ketones, glucose, bilirubin and blood Urine culture and sensitivity—must be catherized or clean catch specimen Blood tests –Including blood urea nitrogen (BUN) and creatinine clearance Kidney, ureter, and bladder– X-ray(KUB)

6. Copyright © 2015 Cengage Learning ®. Diagnostic Tests Intravenous pyelogram (IVP) Cystogram Cystoscopy Bladder and kidney biopsy Catheterization

7. Copyright © 2015 Cengage Learning ®. Cystoscopy

8. Copyright © 2015 Cengage Learning ®. Urinary Tract Infections (UTIs) Broad diagnosis covering infections of urinary tract that includes urethra, bladder, and kidneys Most often caused by bacteria – Can be caused by viruses and fungi – E. coli is the most common bacteria found in UTIs— 80%

9. Copyright © 2015 Cengage Learning ®. UTIs More common in females because: – Female urethra shorter and opening closer to rectum – Some females have improper toilet habits – Vaginal secretions may harbor bacteria, while male prostatic secretions have antibacterial effect – Sexual intercourse may cause trauma to urethra and bladder leading to inflammation and infection – Pregnant females are more susceptible due to pressure of uterus on urinary tract

10. Copyright © 2015 Cengage Learning ®. UTIs Diagnosis by urinalysis and culture of urine specimen Treatment usually antibiotics

11. Copyright © 2015 Cengage Learning ®. UTIs Urethritis – Inflammation of urethra – More common in males – Commonly occurs with cystitis – Symptoms: Swelling of urethra Dysuria Urethral discharge

12. Copyright © 2015 Cengage Learning ®. UTIs Cystitis –Inflammation of bladder –Also known as bladder infection –Honeymoon cystitis Occurs in females as they become sexually active –Treatment usually antibiotics –Antispasmodic medications may decrease bladder spasms E.g., Pyridium –May cause urine to turn reddish-orange and stain clothing –After treatment, urine C&S to determine elimination of bacteria

13. Copyright © 2015 Cengage Learning ®. UTIs Pyelitis – Inflammation of kidney pelvis – Result of ascending infection from bladder – Rapid diagnosis and treatment imperative to prevent spread of infection

14. Copyright © 2015 Cengage Learning ®. UTIs Pyelonephritis – May be due to ascending or hematogenous infection – May affect one or both kidneys – Symptoms: Sudden onset of fever and chills Flank pain Hematuria – Treated effectively with antibiotics

15. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Acute glomerulonephritis – Inflammation of glomerulus or filtering unit of kidney – Most common kidney disease that occurs 1 to 4 weeks after strep infection – Not suppurative, inflammation is a result of tissue destruction caused by immune system (antigen– antibody reaction)

16. Copyright © 2015 Cengage Learning ®. site of action of loop...

17. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Acute glomerulonephritis – Symptoms: Flank pain Fever Loss of appetite Malaise Edema of eyes and ankles Oliguria Hematuria

18. Copyright © 2015 Cengage Learning ®.

19. Diseases of the Kidney Acute glomerulonephritis –Treatment: Antipyretic Diuretic Salt restriction Protein restriction Fluid restriction –Prevention Prompt and proper antibiotic treatment for streptococcal infections

20. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Chronic glomerulonephritis – Repeated bouts of acute glomerulonephritis lead to chronic condition – include those of acute glomerulonephritis plus hypertension – Uremia may occur during late stages – Treatment: Control hypertension Dietary restrictions End stage may require hemodialysis or kidney transplant

21. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Hydronephrosis – Urine in renal pelvis due to obstruction leading to dilation and distention of kidney pelvis – Diagnosis by pyelogram – Treatment: Draining of kidney pelvis by surgery Relief of obstruction

22. Copyright © 2015 Cengage Learning ®. Hydronephrosis

23. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Renal calculi – Also known as kidney stones – Form in kidney pelvis – Symptoms: Hematuria Renal or urinary colic – Extreme spasmodic flank pain – “Worst pain in life”

24. Copyright © 2015 Cengage Learning ®. The most common kidney problems include infection and stones

25. Copyright © 2015 Cengage Learning ®. Renal Calculi

26. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Renal calculi – Diagnosis by IVP, KUB, and renal ultrasound – Treatment: Pain medication Increased fluid intake Strain urine Lithotripsy—or hydrolithotripsy Surgery

27. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Polycystic disease – Inherited disease causing enlargement of kidneys due to grape-like cysts – Slow, progressive disease – Symptoms: Lumbar pain Hematuria Recurrent UTIs – Treatment: Management of hypertension and UTIs Dialysis and kidney transplant

28. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Renal failure – Failure of kidneys to cleanse blood of waste products – May be acute or chronic – Symptoms Not significant until 75% of kidney function destroyed Acute symptoms plus – Infertility / impotence – Bone weakness / fractures – Diagnosis Creatinine and BUN

29. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Renal failure – Treatment: Management of cause of failure Limitation of sodium and protein Measure I & O (intake and output) Antihypertensives Diuretics Antibiotics – Long-term treatment: Dialysis Transplant

30. Copyright © 2015 Cengage Learning ®. Arteriovenous (AV) Shunts

31. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Adenocarcinoma of the kidney – Risk factor: Cigarette smoking – Frequently metastasizes to liver, brain, and bone before symptoms appear – Symptoms: Painless hematuria Flank pain Fever – Diagnosis by KUB, IVP, CT scan, and biopsy

32. Copyright © 2015 Cengage Learning ®. Diseases of the Kidney Adenocarcinoma of the kidney – Treatment: Nephrectomy Chemotherapy Radiation – Prevention – may not be preventable Might be helpful to control risk factors such as: – Not smoking – Increase intake of fruits and vegetables – Stay active; maintain normal body weight – Control blood pressure

33. Copyright © 2015 Cengage Learning ®. Diseases of the Bladder Urinary incontinence – Loss of urine flow control – Common in females age 60 and older – Types: Stress Urge Overflow

34. Copyright © 2015 Cengage Learning ®. Diseases of the Bladder Urinary incontinence – Diagnosis Urinalysis CBC Urodynamic testing Postvoid residual volumes – Treatment: Kegel exercises to strengthen pelvic muscles Collagen injections near external sphincter to narrow urethra Marshall-Marchetti-Krantz procedure

35. Copyright © 2015 Cengage Learning ®. Diseases of the Bladder Transitional cell carcinoma of the bladder – Most common neoplasm of urinary tract – Arises from lining of bladder – Usually occurs in males after age 60 – Risk factor is cigarette smoking – Diagnosis by cystoscopy and biopsy – Treatment Depends on stage of tumor Transurethral resection (TUR) Radical cystectomy

36. Copyright © 2015 Cengage Learning ®. Trauma Straddle injuries – Commonly cause injury to the urethra – More common in males – Accidents include walking a fence or beam, riding a horse or motorcycle Neurogenic bladder – Dysfunction of the bladder related to nervous system injury – Spinal cord injury – MVA – Other causes – stroke, herniated lumbar disks, diabetes

37. Copyright © 2015 Cengage Learning ®. Rare Diseases Goodpasture’s syndrome – An autoimmune disorder characterized by glomerulonephritis and pulmonary hemorrhage Interstitial cystitis – Nonbacterial cystitis due to inflammation of inner lining of bladder

38. Copyright © 2015 Cengage Learning ®. Effects of Aging Urinary incontinence –The most common problem Prostatic hypertrophy –Older males –Dribbling, frequency, pain or burning, and difficulty starting urine flow