1. Urinary System Pathologies
To pee or not to pee

2. Organs of the urinary system
2 kidneys
2 ureters
1 urinary bladder
1 urethra

3. Responsibilities Producing Storing Excreting urine
Cleansing waste product left from metabolism from the blood
Regulation water, salts and acids to insure homeostasis of acid-base balance
Part of regulating BP, ADH/vasopressin

4. Normal Function of the System
The Nephron: working unit responsible for filtration, reabsorption and secretion of urine.
Each Kidney is made up of 1 million nephrons.

5. Other functions of the kidneys
Secretes the hormone renin that raises BP
Produces erythropoietin that stimulates production of rbcs.
Plays a role in activation of Vitamin D

6. Trauma, Toxins, and Scarring
Can all result in damage to renal function that may allow urea (nitrogenous waste of metabolism) or extracellular fluid and electrolytes to accumulate in the blood.

7. All can cause the system to be compromised
Other disorders:
Obstructions: tumors, structural defects that may be acquired or congenital.
Immunologic disorders
Circulatory problems
Cystic disease
Metabolic disorders
All can cause the system to be compromised

8. Common abnormal symptoms
Loss of appetite
Fever
Nausea
HA/body aches
Flank pain
Low back pain
Hematuria
Edema
pruritus
Decrease in urine output
Increase in BP

9. Usually symptoms reflect an accumulation of waste products in the blood causing electrolyte imbalances in the body.
Often the first diagnostic test to be done is the urinalysis: physical, chemical and microscopic examination of the urine
What is meant by physical, chemical and micro exam of urine: describe.

10. Urinalysis:
Demonstrates the filtration, absorption and elimination of metabolic waste and precise fluid and electrolyte balance
Other tests may include C & S, radiologic tests and view structural problems and cystoscopy or even biopsy of lesions.
SEE PAGE 504 OF TEXT: ROUTINE URINALYSIS

11. See page 505: renal diagnostic tests

12. Urine Terminology
Incontinence: loss of voluntary control or the bladder
Retention: inability to empty the bladder, may be accompanied by overflow incontinence.
Micturation (urination or voiding) reflex is stimulated by increased pressure within the urinary bladder as it distends (fills) the reflex is sent to
Parasympathetic nerves and they send impulse to the sphincters of the bladder and the pelvic diaphragm (muscles) to relax and the bladder muscles contract emptying the bladder

13. Causes of Incontinence
Increased intra-abdominal pressure: laughing/coughing
Multiple pregnancyies with vaginal delivery
Age
Spinal cord injuries
Or brain damage in control areas

14. Common blood tests
BUN: blood, urea, nitrogen and serum creatinine: indicate failure to excrete nitrous waste from protein metabolism. GFR
Metabolic acidosis (decreased serum pH and decreased serum bicarbonate: indicated decrease GFR, and failure of the tubules to control acid-base balance

15. Common blood tests: cont.
Anemia: low hbg level: indicated decreased erythropoietin secretion and/or bone marrow depression, due to accumulation of wastes.
Electrolytes: depend on related fluid balance: specific to retention of fluid if GFR is decreased may result in a dilution effect, and lab values are not a true reflection of renal status. However may still require monitoring and treatment.

16. Common blood tests: cont.
Antibody level: antistreptolysis O (ASO) or antitreptokinase (ASK) titers are used for diagnosis of post-streptococcal glomerulonephritis.
Renin levels: indicate possible cause of hypertension.
C & S: used to ID causative organism of infection if present and best antibiotic

17. Common blood tests: cont.
24-hour urines like creatinine or insulin clearance or radioisotope studies are used to access GFR.
Radiologic tests: IVP, angiography, ultrasound, Ct, MRI, radionuclide imagine all may be used to visualize structures and any abnormalities of the Urinary system
Cystoscopy: visualized the Lower UT and may be used in performing a biopsy or removing kidney stones.

18. What is the normal pH of blood and urine?
6.0 is this acid or base
Acidic
Blood:
is this acid or base
Slightly basic

19. See text bos 11-1 pg 511
Nephrotoxic agents:

20. MORE TERMINOLOGY Ren/o Olig/o Nephr/o Pyel/o Hydr/o Calculi Lith/o
Cyst/o
Nocturia
Polyuria
Azotemia
KUB
IVP
Cystourethrography
Voiding (VCUG)