1. URINARY SYSTEM Excretory System

2. Urinary Terminology nephr-(o) ren-(o) pyel-(o) glomerul-(o) cyst-(o) -uria ur-(o) urin-(o) ureter-(o) urethr-(o) -kidneys -renal pelvis -glomerulus -urinary bladder -urine -urine, urinary tract -urine -ureter -urethra

3. Functions of Urinary System Homeostasis – a state of equilibrium in the internal environment of the body Excretion – removing wastes, certain salts, and excess water from blood Maintain acid-base balance Secrete waste products in the form of urine Eliminate urine from bladder

4. Kidneys Bean-shaped organs Located between peritoneum and the back muscles (RETROPERITONEAL) Composed of millions of microscopic functional units called nephrons

5. The Urinary System

7. Kidney

8. Structure of the Kidney

9. Blood Supply of the Kidney

10. Nephrons Microscopic filtering units Over 1 million/kidney Contains glomerulus – Cluster of capillaries that filter waste Bowman’s capsule – Surround glomerulus picks up filtered materials and passes it to the convoluted tubule – Substances needed by the body are reabsorbed and returned to the capillaries At the end, most of the water, sugar, vitamins and salts have been reabsorbed Excess salts, water, wastes remain in the tubule and become urine Urine enters collecting ducts (tubes) in the medulla Collecting tubes empty into the renal pelvis (first section of the ureter)

11. Nephron Functional unit of the kidney Parts include: – Bowman’s capsule – Glomerulus – Proximal convoluted tubule – Loop of Henle – Distal convoluted tubule – Collecting tubule

12. Urine Formation in Nephron Filtration Reabsorption Secretion

13. Filtration First step in urine formation Blood from renal artery enters glomerulus High blood pressure in glomerulus forces fluid (FILTRATE) to filter into Bowman’s capsule Bowman’s capsule filters out 125cc of fluid/min. – 7500cc/hour As filtrate continues through nephron, 90% of water is reabsorbed

14. Reabsorption Water and useful substances are reabsorbed If blood levels of certain substances are high (glucose, amino acids, vitamins, sodium) then those substances will not be reabsorbed

15. Secretion & Urinary Output Opposite of reabsorption Electrolytes are selectively secreted to maintain body’s acid-base balance Average daily urinary output is 1500/day

16. Ureters One from each kidney Carry urine from kidneys to bladder Structure – Narrow, long tubes with expanded upper end (renal pelvis) Function – Drain urine from kidneys to bladder – Peristalsis pushes urine down ureters

17. Urinary Bladder Hollow, muscular organ capable of great expansion Made of elastic fibers and involuntary muscle Stores urine – usually about 500cc Rugae – series of folds in the lining of the bladder that disappear as the bladder fills Emptying urine (voiding) is involuntary but controlled through nervous system (voluntary)

18. Urethra Narrow tube from bladder to outside opening to allow for passage of urine from the bladder to the exterior of the body Opening of urethra to the exterior called urinary meatus

19. Urethra The urethra is different in males and females. In females- – about-1½ inches in length – opens in front of the vagina and carries only urine In males- – about- 8 inches in length – passes through the prostate gland and out through the end of the penis. – Carries both urine and semen

20. Urine About 95% water – Produce about 1500 to 2000 cc (1 ½ to 2 quarts) of urine a day Waste products included are – Urea – Uric acid – Creatinine – Mineral salts – Various pigments Could also contain RBCs, WBCs, sugar, etc but these are signs of disease

21. Urination Passage of urine from the body Also called micturation or voiding Regulated by muscle sphincters INCONTINENCE – involuntary urination

22. Catheterization

23. Other Urinary System Terms Anuria – absence of urination Polyuria – excessive urination Oliguria – below normal amounts of urination Dysuria – painful urination Enuresis – bedwetting Glycosuria – sugar in urine Nocturia – frequent urination at night Pyuria – pus in urine Hematuria – blood in the urine Incontinence – involuntary urination Retention – inability to empty the bladder

24. Disorders of the Urinary System

25. Acute Kidney Failure Caused by – Nephritis – Shock – Injury – Bleeding/hemorrhage – Sudden heart failure – Poisoning – Dehydration Symptoms – – Oliguria or anuria – Headache – Ammonia odor to breath – Edema – Cardiac arrythmia – Uremia Treatment- – Dialysis – Restricted diet – Correction of condition causing kidney failure

26. Chronic Kidney Failure Results from the progressive loss of function of kidney Caused by – Chronic glomerulonephritis – Hypertension – Toxins – Endocrine disease Symptoms – Nausea, vomiting, diarrhea – Decreases mental ability – Convulsions – Muscle irritability – Ammonia odor to the breath and perspiration – Coma and death Treatment – Dialysis – Diet modifications – Careful mouth and skin care – A kidney transplant is the only cure

27. Dialysis Used for kidney failure Dialysis serves as substitute kidney 2 types – Peritoneal dialysis – Hemodialysis

28. Peritoneal Dialysis Uses the patient’s own peritoneal lining to filter the blood Cleansing solution travels through a catheter implanted into the abdomen Wastes pass from tiny blood vessels into the solution through diffusion

29. Hemodialysis Involves the passage of blood through device with semi permeable membrane Wastes in the blood pass through the membrane The patient is connected to the machine by means of needles and tubing.

30. Kidney Transplant As a last resort Involves donor organ from someone with a similar immune system Main complication – rejection

31. Renal Calculi (Kidney Stones) Made of crystals of calcium phosphate and uric acid Gradually they get larger until they block ureters First symptom – – Sudden, severe pain Other symptoms – – Nausea and vomiting – Frequency – Urinary retention – Chills, fever – Hematuria Treatment – Increase fluids to flush out stone – Medications – LITHOTRIPSY

32. Lithotripsy Surgical procedure to remove kidney stones from the ureters or renal pelvis Shock waves hit dense stones and break them up Done on outpatient basis

33. Cystitis Inflammation of the mucous membrane lining of the bladder Caused by pathogens entering the urinary meatus – Most common – E. Coli Usually in females (shorter urethra) Symptoms – – Dysuria – Frequent urination – Burning sensation during urination – Hematuria – Bladder spasm – Fever Treatment – – Antibiotics – Increased fluid intake

34. Urinalysis Diagnostic test used to examine the urine – Most common noninvasive test done Detects presence of: – Blood cells – Bacteria – Acidity level (pH) – Specific gravity (weight) – Physical characteristics such as color, clarity, and odor

35. Urinalysis

36. Pyelonephritis Inflammation of the kidney tissues and renal pelvis Usually caused by pus- forming bacteria Symptoms – Chills, fever – Back pain – Dysuria – Hematuria – Pyuria Treatment – Antibiotics – Increased fluid intake

37. Glomerulonephritis/Nephritis Inflammation of the glomerulus of the kidney Usually follows a streptococcal infection – Strep throat, scarlet fever, or rheumatic fever Repeated attacks can cause a chronic condition Symptoms – Chills,fever – Fatigue – Edema – Oliguria – Hematuria – Protein in the urine – Hypertension Treatment – Restriction of salt – Maintenance of fluid and electrolyte balance – IV Antibiotics

38. Chronic Glomerulonephritis Chronic glomerulonephritis is a progressive disease that causes scarring of the glomerulus Early symptoms – Hematuria – Protein in the urine – Hypertension Symptoms as the disease progresses – Edema, fatigue, anemia – Hypertension – Congestive heart failure Treatment – Treatment of the symptoms – Low sodium diet – Antihypertensive drugs – Dialysis When both kidneys are severely damaged, a kidney transplant can be performed

39. Related Occupations Urologist – Education- HS, 4 years college, 4 years med school, 5 years residency – Duties- Surgical management of diseases of the kidney Nephrologist – Education- HS, 4 years college, 4 years med school, 5 years residency – Duties- Medical management of diseases of the kidney Organ Procurement Team – Education- Additional training after nurse or physician’s assistant training – Duties-Coordinates the harvesting, preservation, and transportation of donated kidneys, and maintenance of a system to locate prospective organ recipients Renal Transplant Coordinator – Education- PA or nurse with a background knowledge of dialysys, renal disease, and transplantation – Duties- Coordinates the transplantation Tissue Typing Technician – Education- Background in medical technology, blood banking, immunology, or histology – Duties- Performs lab tests to determine compatability between a potential donor and a potential recipient