1. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  The urinary tract is responsible for:  producing, storing, and excreting urine  cleansing the blood of waste products  regulating the water, salts, and acids in the body fluids to ensure homeostasis Orderly Function of the Urinary System

2. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  kidneys (2)  ureters (2)  urinary bladder  urethra The Urinary System Consists of:

3. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Proper function is usually determined by urinalysis and blood tests.  Normal results demonstrate:  proper filtration, absorption, and elimination of metabolic waste  precise fluid and electrolyte balance Evaluation of the urinary system

4. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  nausea  loss of appetite  fever  headache and body ache  flank or low back pain  edema  decreased urinary output  hypertension  pruritus Symptoms of Urinary Diseases

5. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Glomerulonephritis Description:  inflammation and swelling of the glomeruli of the kidney  can be primary disease of the kidney  can develop secondarily to a systemic disease  usually follows a streptococcal bacterial infection of the throat or skin

6. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Glomerulonephritis (cont’d.) Symptoms:  protein in the urine (proteinuria)  edema  decreased urine volume  blood in urine (hematuria)  hypertension (not always present)

7. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Glomerulonephritis (cont’d.) Treatment:  antibiotic therapy (if infection present)  rest  diuretics for edema and hypertension  restricted sodium intake  corticosteroids (if immune reaction is suspected)

8. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Dialysis  End stage renal disease forces approximately one in every 10,000 people to use dialysis to filter wastes from their blood and urine. Without dialysis, these patients will eventually die.

9. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemodialysis  Fistula provides access to blood.  Blood is drawn out of the body and filtered using an artificial kidney (hemodialyzer).  Cleansed blood is returned to the body.

10. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hemodialysis (cont’d.)

11. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Peritoneal Dialysis  Process uses patient’s own peritoneal membrane as a filtering device.  The dialysate solution passes into peritoneal membrane through permanent catheter.  The solution diffuses existing wastes.  Contaminated fluids are drained from body.

12. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Peritoneal Dialysis (cont’d.)

13. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Kidney transplantation  Approximately 10,000 people receive kidney transplants each year in the U.S.  75% are performed on patients with:  diabetes adrenal failure  hypertensive renal disease  glomerulonephritis

14. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Kidney transplantation (cont’d.)  Transplantation requires immunosuppressive agents to prevent potential rejection of the organ.

15. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Renal Failure Description:  Acute renal failure (ARF) is characterized by a sudden and severe reduction in renal function.  ARF qualifies as a clinical emergency because nitrogenous waste products quickly accumulate in blood causing an acute uremic episode.

16. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Renal Failure (cont’d.) Symptoms:  slight or infrequent urination (oliguria)  gastrointestinal disturbances  headache  drowsiness

17. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Renal Failure (cont’d.) Etiology:  diminished blood flow to kidney  intrarenal damage to the kidney  mechanical obstruction of urine flow  Sudden renal failure can lead to death if not treated promptly.

18. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Renal Failure (cont’d.) Treatment:  The primary goal is to reverse the decreased renal function. This may be accomplished by:  balancing fluid intake and output  initiating a high carbohydrate/low protein diet to avoid a protein imbalance (called metabolic acidosis)  controlling sodium and potassium intake

19. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Acute Renal Failure (cont’d.) Treatment (cont’d.)  Drug therapy may include:  antihypertensives  diuretics  anti-infective agents  Prompt treatment can reverse renal failure and lead to complete recovery.

20. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Chronic Renal Failure Description:  results from the gradual and progressive loss of nephrons  irreversible loss of renal function  gradual onset of waste buildup in blood (uremia)

21. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  hypertension  edema  arrhythmias  muscle weakness  ulceration of gastrointestinal mucosa  hair and skin changes  difficulty breathing (dyspnea)  metabolic acidosis Symptoms:  General—weakness, fatigue, and lethargy (due to anemia)  As uremic syndrome worsens: Chronic Renal Failure (cont’d.)

22. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Chronic Renal Failure (cont’d.) Treatment goal: to prolong and improve quality of life  assessment for dialysis or kidney transplantation  restricted dietary intake of protein and sodium  drug therapy  diuretics  antihypertensives  anti-infective agents  antiemetics (to control nausea/vomiting)  erythropoietin (a protein to help combat anemia)  calcitriol (a form of vitamin D to strengthen bones)

23. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pyelonephritis Description:  an inflammation of the renal pelvis and connective tissues of one or both kidneys  the most common type of renal disease

24. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pyelonephritis (cont’d.) Symptoms:  rapid onset of:  fever  chills  nausea and vomiting  lumbar pain  usually preceded by a urinary tract infection

25. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pyelonephritis (cont’d.) Etiology:  most commonly results from bacteria migrating from the lower urinary tract to the kidney  Catheterization or diagnostic procedures such as cystoscopy can introduce organisms into the urinary bladder.  Women are at greater risk for developing pyelonephritis.

26. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pyelonephritis (cont’d.) Diagnosis is made by assessing clinical findings:  blood culture  radiographic studies indicating swollen or enlarged kidneys  urinalysis of a clean-catch urine specimen that indicates:  increased white and red blood cells  presence of bacteria, pus and protein

27. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Pyelonephritis (cont’d.) Treatment:  oral antibiotics (penicillin or cephalosporin) for 7 to 10 days  increased fluid intake to dilute urine  bed rest  Early detection and prompt treatment usually leads to full recovery.

28. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Renal Calculi Description:  stones in the kidney or in the urinary tract formed by the concentration of mineral salts  Stones form as a result of excessive calcium or uric acid in blood.

29. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Renal Calculi (cont’d.) Symptoms:  sudden pain in flank area (renal colic)  nausea and vomiting  blood in the urine (hematuria)  fever  chills  abdominal distention  Hydronephrosis may result if urine is prevented from flowing past calculi.

30. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Renal Calculi (cont’d.) Risk factors:  heredity  male  individuals between 30 and 60 years of age  prolonged: dehydration dehydration immobilization immobilization infection infection urinary stasis from obstruction urinary stasis from obstruction use of medication use of medication

31. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Renal Calculi (cont’d.) Treatment:  Removal of kidney stone and treating pain/infection are primary goals.  Analgesic therapy is given for pain.  Small stones (3mm or less) may be allowed to pass naturally with increased fluid intake.  Medication may be used to dissolve some stones.

32. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Renal Calculi (cont’d.) Treatment (cont’d.):  Surgical procedures for removal:  Crush stones into smaller pieces using conventional or laser lithotripsy  Capture and remove stone using a ureteroscope or cystoscope

33. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Renal Calculi (cont’d.) Possible complications:  If procedures mentioned previously fail to remove calculi, surgical incision into kidney may be necessary to remove stone before permanent damage occurs.

34. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Renal Calculi (cont’d.) Prevention:  Drink at least eight glasses of water a day.  Exercise regularly.  Avoid foods high in:  oxalates  purine  phosphorus

35. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Description:  Infectious cystitis: inflammation of the urinary bladder  Urethritis: inflammation of the urethra  Both are common forms of urinary tract infections. Infectious Cystitis and Urethritis

36. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Symptoms:  frequent urination with burning sensation and discoloration (dark yellow, pink, or red)  pain in the pelvic region and low back  spasm of the bladder  fever  chills Infectious Cystitis and Urethritis (cont’d.)

37. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Etiology:  bacteria:  E. coli (most common)  Klebsiella  Enterobacter  Proteus  Pseudomonas  sexually transmitted diseases  viruses  fungi  parasites  inflammation caused by chemotherapy or radiation Infectious Cystitis and Urethritis (cont’d.)

38. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Treatment:  antibiotic therapy (penicillin derivatives are used to treat complex cystitis) for 3 to 5 days for uncomplicated cases and 7 to 10 days for recurring infections  increased fluid intake  regular emptying of bladder Infectious Cystitis and Urethritis (cont’d.)

39. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Diabetic Nephropathy Description:  various renal changes (called glomerulosclerosis) that result from diabetes  All patients with type 1 diabetes (and many with type 2 diabetes) will eventually develop renal changes.

40. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Diabetic Nephropathy (cont’d.) Symptoms:  urinary retention  hypertension  nausea  protein in urine  Urinary tract infections and pyelonephritis are common complications.

41. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Diabetic Nephropathy (cont’d.) Treatment includes:  glucose management  controlling blood pressure  infection control  balance fluid intake and output  customizing for patient needs  possible dialysis or kidney transplant as part of long-term treatment

42. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Stress Incontinence Description:  uncontrollable leakage of small amounts of urine from the bladder during physical exertion or actions that stress the pelvic muscles such as:  laughing  lifting  stretching  running

43. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Stress Incontinence (cont’d.) Etiology:  weakening of the pelvic floor muscles and urethral structure, often attributed to:  trauma from childbirth  pressure from an existing pregnancy  hormonal changes associated with aging/menopause  certain medications  obesity

44. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Stress Incontinence (cont’d.) Treatment:  exercises to strengthen pelvic floor muscles  estrogen replacement (estrogen cream)  drug therapy  surgical repair  collagen injections