The Urinary System

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The Urinary System

• BS
• Chapter 22

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The Urinary System

• Is also called the excretory system because one
  of its main functions is to remove waste products
  from the blood and then eliminate it from the
  body
• The urinary system is also responsible for
  regulation of fluid volume of the body
• It is also responsible for acid-base balance and
  electrolyte composition of body fluids

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• Just like the accessory organs that work along
  with the alimentary system to rid the body of
  waste, our body has other systems that aid in
  elimination of wastes from the body.they are as
  follows.

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Other systems involved in eliminating wastes

• Urinary system
• Digestive system
• Respiratory system
• Integumentary system

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Urinary System

• This system excretes water and waste products
  containing nitrogen and salts, these are all
  products in urine

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Digestive System

• This system eliminates water, some salts, bile
  and the waste products of digestion which are
  contained in feces
• The liver is important in eliminating the
  destroyed RBCs end products and the breaking down
  of toxins such as alcohol and certain drugs

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Respiratory System

• This system eliminates carbon dioxide and water,
  that changes into vapor
• We can see this when we breathe on a windowpane

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Integumentary System

• Excretes water, salts and small amounts of
  nitrogenous wastes, all of which appear in
  perspiration
• Evaporation of water from the skin may go on most
  of the time without even being conscious of it

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Part of the Kidney System

• We have
• 2 kidneys
• 2 ureters
• A single bladder
• A single urethra

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2 Kidneys

• These organs
• Extract wastes from the blood
• Balances body fluids
• Forms urine

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Excretion of unwanted substances

• Such as waste products from cell metabolism,
  excess salts and toxins
• Urea is filtered from amino acids (proteins)
  through the liver and then sent to the kidneys
  for elimination

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2 Ureters

• These are tubes that carry urine from the kidneys
  down to the bladder

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A single urinary bladder

• This is a reservoir that receives the urine
  brought into it by the 2 ureters

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A single urethra

• This is a tube that carries urine from the
  bladder to the outside and into the toilet for
  elimination

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Where are the kidneys?

• The 2 kidneys lie against the muscles of the back
  in the upper kidney
• The kidneys and ureters lie behind the peritoneum
  in a space called the retroperitoneal space
• The kidneys are up under the dome of the
  diaphragm and are protected by the lower ribs and
  the coastal cartilage

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Covering over the kidneys

• The kidneys are very important to our bodies
• They have a special covering made of fibrous
  connective tissue that is loosely connected to
  the kidney itself
• There is also an adipose layer (fat) around each
  kidney
• And rememberthe adrenals sit on top of each
  kidney

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Blood Supply to the Kidneys

• The kidney is supplied with blood by a short
  branch of the abdominal aorta called the renal
  artery
• The renal artery extends off into the branch that
  supplies the kidney

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• After the renal artery enters into the kidney,
  the renal artery subdivides into smaller and
  smaller branches which eventually make contact
  with the functional units of the kidney known as
  the nephron. The blood goes into the afferent
  artery
• Finally, blood leaves the kidney by efferent
  vessels that merge to form the renal vein which
  ends up carrying blood into the inferior vena
  cava for return to the heart

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Blood Vessels and Ureters
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Structure of the kidney

• The kidney is somewhat flattened
• The kidney is approximately 4 inches long x 2
  inches wide x 1 inch thick

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• The inner or medial border of the kidney
  contains a notch called a hilus. This is where
  the renal artery , the renal vein and the ureter
  connect with the kidney.
• The outer or lateral border is convex or curved
  outward giving the entire organ a bean-shaped
  appearance

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The Kidney is divided into 2 regions

• Renal cortex is the outer portion of the kidney
• Renal medulla is the innermost portion of the
  kidney that contains the tubes in which urine is
  formed and collected

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A Deeper Look Into the Renal Medulla (use your
picture book)

• In the tubes where urine is made, there are 8-10
  cone-shaped structures called the renal pyramids
• The tips of the pyramids point toward the renal
  pelvis which is a funnel-shaped basin that forms
  the upper end of the ureter
• The renal pelvis is the upper extension of the
  ureter that breaks off into all parts of the
  renal cortex and renal medulla or into the kidney
  itself

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Use your picture book

• Cuplike extensions called calyces (KA-lih-seze)
  (or one called calyx KA-liks) of the renal
  pelvis surround the tips of the pyramids and
  collect urine
• The urine that collects in the pelvis then passes
  down the ureters to the bladder

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Cross Section of Kidney
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Nephron

• This basic unit inside of the kidney is too small
  to be seen with the naked eye
• Each kidney contains about 1 million coiled
  nephrons
• If all of the 1 million coiled nephrons were
  stretched out, they would span 75 miles

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Nephrons

• These are where the work of the kidney is
  actually done
• A nephron is a tiny coiled tube with a bulb known
  as the Bowmans capsule, at the end
• This bulb, known as Bowmans capsule, surrounds a
  cluster of capillaries called the glomerulus

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Afferent Arteriole

• This is a small blood vessel that supplies the
  glomerulus with blood
• Its diameter is bigger than in the efferent
  arteriole

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Efferent Arteriole

• This is a small vessel that carries blood from
  the glomerulus. Diameter of the vessel is
  smaller to keep the pressure going so the blood
  gets pushed on out to the rest of the nephron
• When blood leaves the glomerulus, it does not
  head immediately back towards the heart.
  Instead, it flows into a capillary network that
  surrounds the tubular portion of the nephron

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Tubular Part of the Nephron

• Has several parts to it
• The coiled part leading from Bowmans Capsule is
  called proximal convoluted tubule
• The tube then uncoils to form a hairpin-shaped
  segment called Loop of Henle
• Continuing from the loop, the tubule coils once
  again into the distal convoluted tubule
• The distal end of the tube empties into a
  collecting duct, which then continues through the
  medulla of the kidney toward the renal pelvis

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What is where????

• Renal Cortex Renal Medulla
• Glomerulus
  Loop of Henle
• Bowmans Capsule
  collecting ducts
• Distal convoluted Tubes
• Proximal convoluted Tubes

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Efferent arteriole
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Juxtaglomerular Apparatus

• There are specialized epithelial cells in this
  apparatus which are sensitive to changes in BP
• The name means near the glomerulus which
  describes the location of this apparatus

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Juxtaglomerulus Apparatus

• This is a structure forming a cuff surrounding
  the afferent arteriole that leads to the
  glomerulus
• This appartus is concerned with the production of
  renin and is involved in sodium metabolism

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Blood Pressure

• When a persons BP falls, cells in the wall of
  the afferent arteriole secrete the enzyme renin
  which raises BP by activating a protein called
  angiotensin that causes blood vessels to
  constrict, thus raising BP

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Functions of the Kidney

• Maintenance of water balance takes place in the
  kidney
• Our body can have water taken in and then it
  knows how to release the right amount to balance
  it back out in urine

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Regulation of acid-base balance

• Acids are constantly being produced from cell
  metabolism and by certain foods that cause an
  acid build up
• Our body balances acids as in bicarb that is
  released from the kidney when our body becomes
  too acidic

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Regulation of RBCs

• When the kidneys do not get enough O2, they
  produce the hormone erythropoietin
• Erythropoietin stimulates the production of RBCs
  in the red bone marrow
• Erythropoietin is now made in a lab and is given
  to pts who suffer from anemia as in a cancer pt
  who needs and increase in RBCs

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The First part of urine formation

• Begins when blood leaves the left ventricle and
  heads towards the rest of the body out of an
  artery
• Blood enters through the renal artery which leads
  into the kidney
• Blood travels through the inner part of the
  kidney (medulla) through the renal pelvis to the
  tips of the renal pyramid where the top of the
  cone is, this is where the nephrons are

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Formation of Urine

• The actual process of urine formation then begins
  with the glomerulus in Bowmans capsule
• The membranes that form the walls of the
  glomerular capillaries are sieve like and permit
  the free flow of water and soluble materials
  through them

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Glomerular Filtration

• Blood can enter the glomerulus easier through the
  afferent arteriole than it does when it leaves
  via the efferent arterioles because the afferent
  arteriole is slightly larger in diameter than the
  efferent arteriole.
• The blood entering the glomerulus is at a high
  pressure because this was left vent. Blood. When
  it leaves through the efferent arteriole (smaller
  in diameter), there is still pressure, allowing
  particles to constantly be pushed out of the
  blood into Bowmans capsule of the nephron This
  type of movement of materials under pressure is
  known as glomerular filtration
• At this time, the blood is filtered and the
  bowmans capsule is left with filtrate while the
  blood continues onward to eventually make its way
  back to the heart

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Glomerular Filtrate

• The fluid that enters Bowmans capsule is called
  glomerular filtrate and it makes its journey
  along the tubular system of the nephron
• Along with water and normal substances in the
  blood, drugs may be filtered and may become part
  of the glomerular filtrate

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Glomerular Filtrate

• Contains mostly water
• Any salt like Ca, Na, K, Cl-, Phosphorous
• Any medication we take
• Possible protein or sugar or blood
• alcohol

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• As the filtrate travels through the tubular
  system of the nephron, substances leave the
  tubule by active transport and diffusion
• It is at this time that certain substances like
  K move into urine and with movement of H ions,
  the kidneys can use the hydrogen to regulate
  acid-base balance

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How does our urine get concentrated?

• ADH regulates how much water is removed from the
  urine
• ADH is a hormone released from the hypothalamus
  (which received a message from the posterior
  pituitary)

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• When filtrate passes through the Loop of Henle,
  salts like sodium are actively pumped out by the
  cells of the nephron this causes the interstitial
  fluid of the renal medulla to become more
  concentrated with the salt that was just pumped
  out
• Now the fluid of the nephron becomes dilute
  because the nephrons walls dont absorb water
  well in this part and all the salt was just
  pumped out.

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• As the fluid passes through the distal convoluted
  tubules and through to the collecting duct, water
  is drawn out by the concentrated fluids around
  the nephron and returned to the blood because Na
  is now on the outside and water follows Na back
  into the blood

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ADH

• The role of ADH is to make the walls of the
  distal convoluting tubules and the collecting
  tubule more permeable to water
• This means more water will be reabsorbed back
  into the body and less will be excreted with the
  urine
• Remember, our body uses the negative feedback
  system to help regulate things, when our body
  detects low fluids, ADH (a salt) is released to
  help keep more water in the body

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Diabetes Insipidus

• This disease HAS NOTHING TO DO WITH SUGAR.
• There is an inadequate secretion of ADH from the
  which results in elimination of large amounts of
  dilute urine to leave the body and now the pt is
  excessively thirsty

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Normal PH of urine

• Ph 6.0
• Specific gravity in general 1.005 1.030
• Urine spec. gravity 1.010-1.020
• The lower the specific gravity lt1.010 dilute
• Specific gravity gt1.020concentrated

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The Ureters

• Measure approximately 10-13 inches long
• When the bladder is completely full, the pressure
  of the bladder on the ureters makes backflow of
  urine impossible
• The muscles of the wall of the ureters are
  capable of peristalsis as in digestion
• Urine is moved to the bladder by peristalsis and
  gravity

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The Bladder

• The bladder temporarily holds urine that will be
  eliminated from the body
• The bladder has 3 layers of involuntary muscles
  that allow the bladder to stretch when full
• When the bladder is empty, the muscular wall
  becomes thick, when full, the muscle thins out

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The bladder

• When moderately full, can hold approx. 470ml
  urine
• The floor of the bladder is known as the trigone
  (TRI-gone) because of the triangular formed by
  the openings of the 2 ureters and urethra

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Urine

• Should be yellowish in color because it is 95
  water and 5 dissolved solids and gases
• The ph is 6.0
• When kidneys are diseased, they loose the ability
  to concentrate urine
• Urine can contain blood hematuria

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Concentrated Urine

• At times if a pt has liver disease, urine may be
  amber (red) colored - (tea) brown colored. This
  can be d/t bilirubin breaking down from the
  destroyed RBCs but not being able to be carried
  away

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The Urethra

• This is the tube that extends from the bladder to
  the outside and is the means by which the bladder
  is emptied
• In males, the urethra is part of both the urinary
  AND reproductive systems and is much longer than
  is the female urethra

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Male Urethra

• In the male, the urethra is 8 inches long and
  passes through the prostate gland where it is
  joined by 2 ducts carrying the male sex cells,
  and it leads to the penis and to the outside
• The male urethra serves the dual purpose of
  conveying the sex cells and draining the bladder

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Female Urethra

• In the female, the urethra is only about 1.5
  inches long
• It is located behind the pubic joint and is
  embedded in the muscle of the front wall of the
  vagina
• The external opening called the urinary meatus is
  located just in front of the vaginal opening
  between the labia minora
• The female urethra only drains urine and is
  separate from the reproductive system

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Urination

• Another name for urinating is
• Micturition (mik-tu-RISH-un)
• The process is controlled by voluntary and
  involuntary muscles of the sphincters that
  surround the urethra
• These sphincters are called internal and external
  uretheral sphincters

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• In order to void voluntarily, relaxing the
  muscles of the pelvic floor and increasing the
  pressure in the abdomen results in increased
  pressure of the bladder and the spinal reflex is
  triggered

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Spinal Reflex

• As the bladder fills, stretch receptors in the
  walls of the bladder send impulses to a center in
  the lower part of the spinal cord
• Motor impulses from this center stimulate
  contraction of the bladder wall forcing urine
  outward as both the internal and external
  sphincters are made to relax

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Kidney Disorders

• These can be acute or chronic
• Acute usually occurs with infections or
  inflammation of the nephrons, these diseases
  commonly run their course for a few weeks then
  complete recovery is likely
• Chronic conditions arise slowly and often
  progress and worsen and gradual loss of kidney
  function occurs

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Reflux of the kidney

• This is referred to specifically in children
  under the age of 2 y.o.
• If the child gets recurrent UTIs, the pt is put
  through testing to see if urine is refluxing or
  getting stuck in the kidney itself and is simply
  rolling around
• A catheter is inserted into the bladder and dye
  is inserted and watched on screen to detect if
  there is a backup of dye backup of urine

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Acute Glomerulonephritis

• Is also known as acute poststreptococcal
  glomerulonephritis
• The is the most common disease of the kidneys
• Occurs in children 1-4 weeks after a strep throat
  infection occurs
• Basically antibodies formed in response to the
  strep, attach to the glomerular membrane and
  injure it

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Acute Glomerulonephritis

• This injury to the glomerulus causes large
  protein molecules and RBCs to filter into
  Bowmans capsule and then out in urine
• Usually the pt recovers without having kidney
  damage
• In adults, this condition can take long to repair
  and leaves damaged nephrons that leads to chronic
  renal failure

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Pyelonephritis

• Is an inflammation in the renal pelvis of the
  tissue of the kidney, usually from a bacterial
  infection
• This condition can be acute or chronic
• The bacteria can ascend along the lining membrane
  from an infection in the lower part of the
  urinary tract

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Acute Pyelonephritis

• Is often seen in people with partial obstruction
  of urine flow d/t stasis of urine
• Occurs in pregnant women, men with enlarged
  prostate, in pts with kidney stones that block
  the ureters
• TREATMENT antibiotics, fluids, rest, antipyretics

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Chronic Pyelonephritis

• May be caused by persistent or repeated bacterial
  infections d/t backflow of urine or stasis
• Progressive damage of the kidney tissue is seen
  when the pt has HTN, a continued loss of protein
  in the urine and urine that is dilute (d/t the
  damage of tissue, wastes are not getting out)

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Neurogenic Bladder

• A bladder dysfunction resulting from neurogenic
  lesions of the CNS, or the nerves supplying the
  bladder
• Neurogenic refers to the nervous tissue
• Pts cannot void correctly, they usually cannot
  make a direct stream and they most often need to
  be catheterized to remove all of the urine

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Hydronephrosis

• Is the distention of the renal pelvis and calyces
  with accumulated fluid caused by obstruction of
  urine flow
• The obstruction may occur at any level of the
  urinary tract
• The obstruction can be anything from a kidney
  stone, to a tumor to an enlarged prostate or scar
  tissue.
• Prompt removal of the obstruction must occur or
  there will be permanent kidney damage

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Polycystic Kidney

• Fluid containing sacs develop in the active
  tissue of the kidney and gradually, by pressure,
  destroy the functioning parts of the kidney
• This is a familial (runs in families) and
  treatment has not provided satisfactory results
  except for the use of dialysis machines and
  kidney transplants

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Tumors of the Kidney

• Usually grow rather slowly but rapidly invading
  types can occur
• Blood in the kidney and dull pain in the flank
  kidney region are warnings that should be taken
  care of at once
• Surgical removal of the kidney offers the best
  chance of cure d/t most renal cancers DO NOT
  respond to chemo

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Mets to the kidney
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Tuberculosis to the kidney
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Renal Failure

• 2 types can occur
• Acute renal failure
• Chronic renal failure

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Acute renal failure

• May result from medical or surgical emergency or
  from toxins that damage tubules
• Symptoms
• Sudden, serious decrease in kidney function
  accompanied by electrolyte and acid-base
  imbalances
• Acute renal failure occurs as a serious
  complication of other severe illnesses and may be
  fatal

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Chronic renal failure

• Results from the gradual loss of nephrons
• As more and more nephrons are destroyed, the
  kidneys gradually loose their ability to perform
  their normal functions
• As the disease continues, the accumulation of
  nitrogenous wastes get too high in the blood
  causing uremia
• Renal insufficiency occurs and urine function is
  impaired

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Results of Chronic Renal Failure

• Dehydration
• Edema
• Electrolyte imbalance
• HTN
• Anemia
• Uremia

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Dehydration

• Excessive loss of body fluid may occur early in
  renal failure when the kidneys cannot concentrate
  the urine and large amounts of water are
  eliminated

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Edema

• Accumulation of fluid in the tissue spaces may
  occur late in chronic renal disease when the
  kidneys cannot eliminate water in adequate amounts

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Electrolyte Imbalance

• Na and K are off balance d/t poor or impaired
  urinary function

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HTN

• May occur as a result of fluid overload and the
  increased production of renin

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Anemia

• Occurs when the kidneys cannot produce the
  hormone erythropoietin to activate RBC production
  in bone marrow

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Uremia

• Occurs when levels of nitrogenous waste products
  in the blood are very high
• Urea can be changed into ammonia in the stomach
  and cause ulcerations and bleeding

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Kidney Stones

• Also called calculi
• Are made of substances such as Ca salts or uric
  acid that precipitate out of the urine instead of
  remaining in solution
• Calculi usually form in the renal pelvis and in
  the bladder at times

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Causes of kidney stone formation

• Sometimes stones are caused by dehydration
• Stagnation of urine
• Infection of the urinary tract
• Blockage of the ureter r/t kidney stone that is
  lodged inside of the ureter
• Stones vary in size

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Kidney stones

• Can be tiny sand-like to large masses that look
  like the stones in a driveway
• There is no way to dissolve the stones because
  substances that could do so would also destroy
  the kidney

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Lithotriptor

• Literally means stone cracker
• This actually gives external shock waves to
  shatter the stones
• This procedure is called lithotripsy
• Many times this works well, other times, surgery
  is required to remove the stones

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Lithotripsy
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(ESWL) extracorporeal shock wave lithotripsy

• This is a procedure that is performed while the
  pts lower body is submerged in a tank of water
  or surrounded by a fluid-filled bag.
• Ultrasound, not radiation or a laser beam, is the
  mechanism used to pulverize the stones
• Pts are sedated and premedicated with analgesics
  to reduce the discomfort that is commonly
  described as a blow to the body
• It is common for bruises to appear as a
  consequence of the ultrasonic energy

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The Passing of Kidney Stones

• IS EXTREMLY PAINFUL
• Pts usually present to the E.R. in horrific pain
• Lots of narcotics are given once it has been
  determined that the pt has stones, ultra sound is
  the test used most often

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Renal Dialysis

• Is used in pts who have no renal function to rid
  the body of the natural wastes it makes
• There is an accumulation of nitrogenous wastes
• 2 types of dialysis can be performed
• Peritoneal dialysis
• hemodialysis

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Peritoneal Dialysis

• The use of the peritoneal membrane as a filter is
  the process
• A fluid called dialysate is delivered into the
  peritoneum and it sits there collecting waste,
  this is called dwell-time, the machine then
  pumps the waste filled dialysate fluid out into
  the toilet and the nitrogenous waste is removed

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Hemodialysis

• A shunt is placed in the pts forearm (usually)
  and there is a cellophane type membrane inside of
  the shunt that filters the waste products
• A needle is inserted into this shunt
• NEVER TAKE BP IN THE SHUNT ARM, you can ruin the
  shunt

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Assessment of the pts shunt

• The nurse assesses the shunt along with VS
• The nurse should hear a bruit (bru-wee, brew-ee)
  which is the adventitious sound of the blood
  moving through the shunt heard upon auscultation,
  having venous or arterial origin
• The nurse places her fingers gently over the
  shunt and she should also feel a thrill,
  movement of the blood
• WHAT DO YOU DO IF YOU DONT FEEL A THRILL OR
  BRUIT?
• CALL DR. STAT, CIRCULATION CAN BE IMPAIRED OR
  CLOT CAN BE THERE-SERIOUS MATTER

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Dialysis

• Usually done in a free-standing clinic
• Usually pts go to dialysis for 2-3 hours, 3xs a
  week

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Diet of the patient with impaired kidneys

• Low sodium lt2 gms/day
• Low protein diet
• Sometimes, low K diets d/t K being held in

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Kidney Transplant

• Is performed when kidney failure arises
• Many hoops to jump through before transplant can
  be done
• Many meds to be on post transplant
• What is major concern with any transplant?
• What is the med used for transplant pts?

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Disorders of the ureters

• Strictures
• Can be caused by abnormal pressure from tumors or
  other masses outside the tube
• May be d/t stones lodged in ureters
• May be caused by kinking of the tube
• Ureteral stents can be placed inside the ureter
  to keep the ureter open

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IVP

• Intravenous pyelogram is a dye study to see how
  the kidneys are functioning

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The patient is injected with radiopaque dye and
X-rays are taken as the dye travels through the
urinary tract. This procedure is performed to
confirm the presence of kidney stones, although
some somes may be too small to see. Lots of
fluid must be given post-IVP
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Disorders involving the bladder

• If a pt has a full bladder, it is not very
  protected once it is stretched
• If a blow to the abdominal area occurs, the
  bladder may rupture and surgery would be needed
  to repair the bladder

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Cystitis

• Inflammation of the bladder
• Can be caused by bacteria from the colon,
  especially in women d/t their short length of the
  urethra
• Symptoms include
• Pain
• Urgency to urinate
• Frequency to urinate
• TREATMENT antibiotics

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Tumors of the bladder

• Are seen mostly in men over 50 y.o.
• 90 of bladder tumors arise from the epithelial
  lining
• Exams with a cystoscope can determine problems
• Causes smoking, continued stones,
• Removal of the tumor before it affects the wall
  of the bladder have the best outcomes
• Many tumors in the actual kidney are cancerous
  and NOT treatabledeath

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Congenital Disorders of the Urethra

• The opening of the urethra to the outside may be
  too small causing a back pressure of urine and
  then stasis frequent infections
• Kids often have a reimplant of their ureters d/t
  many chronic problems, this is referred to as a
  ureteral reimplant
• Pt goes home with foley cath for weeks while are
  inside is healing
• Urine on these pts is cherry colored, pts also
  have a suprapubic catheter inserted to empty urine

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Hypospadius

• The uretheral opening is on the underside of the
  penis instead of at the end
• Surgical repair of this is done early in the child

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Urethritis

• Characterized by inflammation of the mucous
  membrane and the glands of the urethra
• More common in males than in females
• Often d/t gonorrhea or Chlamydia although other
  bacteria may be the cause also
• Straddle injuries also cause this problem in men

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Rupture of the urethra

• Again, occurs in straddling accidents and in
  fractures of the pelvis bone
• Fracturing the pelvis bone can cause rupture of
  the urethra because the fractured pieces of the
  pelvic bone and tear through the urethra

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Effects of aging

• Aging in itself causes the kidneys to lose some
  of their ability to concentrate urine
• With aging, more water is needed to excrete the
  same amount of waste
• Older people find it necessary to drink more
  water than younger people and then they urinate
  more (polyuria), especially during the night
  (nocturia)

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Aging

• Starting at age 40, there is a decrease in the
  number and size of nephrons
• More than ½ of a persons nephrons are lost by
  age 80
• There may be an increase of blood urea nitrogen
  (BUN) without serious symptoms
• Women who have had babies, loose muscular control
  of the pelvic floor causing uncontrolled urinary
  incontinence at times

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Aging

• Prostate a gland in males that secretes a
  slightly alkaline fluid that forms part of the
  seminal fluid
• Enlarged prostate in older men occurs frequently
  causing obstruction and problems. If left
  untreated, can cause too many backups of urine
• Meds such as Flomax are used to decrease edema in
  prostate

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Abnormal constituents in urine

• Glucose - sugar
• Albumin - protein
• Blood many problems called hematuria
• Ketones burning of fat for many reasons
• WBCs infection, pus in urine is pyuria
• Casts these are molds formed in the microscopic
  kidney tubules that usually indicate disease of
  nephrons

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Important Lab values r/t urine

• BUN (blood, urea, nitrogen) tells us how much
  urea or waste is in the blood and how much didnt
  go out of the kidneys, tells us if the kidneys
  arent working
• Creatinine its a normal alkaline constituent
  of urine and blood that comes from muscles, Dr.
  must tell you he wants either a blood creat. Or
  urine creatinine
• RFI renal function index
• Specific gravity used to detect dehydration
• Urine ph, ketones, sugar, protein
• Bilirubin/uroglobin detects liver disease
• GFR - Glomerular function or filtration rate,
  tells us of the glomerulus are working

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Why we care about lab values r/t urine

• These values can determine if one is
• dehydrated
• Has protein in the urine
• Has blood in the urine
• Has diseased kidneys
• Has kidney failure

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The End