Renal and Urinary Tract Disorders

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Renal and Urinary Tract Disorders

• BCE 542--Physical Disabilities Rehabilitation and
  Employment
• Dr. Dunn
• October 1, 2002

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The Urinary Tract

• Kidneys
• Filter wastes from blood, creating urine.
• Ureters
• Tubes draining urine from kidneys to bladder.
• Urinary Bladder
• Fills with urine from the kidneys
• Urethra and Urinary Meatus
• Tube and opening leading from bladder to allow
  urine to be eliminated.

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Disorders of the Urinary Tract

• Infections/Autoimmune Dysfunctions
• Blockages
• Genetic Disorders
• Failure of Kidneys to Filter Wastes from Blood
  due to various causes.

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Kidney Stones

• Hard, rock-like structures that may form anywhere
  in the urinary tract.
• Most are passed through the system without need
  for medical attention.
• Stones that block the flow of urine in the
  urinary tract can cause infection and eventual
  kidney damage.
• Stones too large to be passed, and those which
  block the flow of urine, must be removed through
  surgery or ultrasound treatment.

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Chronic Cystitis

• Recurring inflammation of the bladder (bladder
  infection)
• Caused by inadequate bladder drainage
• Must be treated before infection reaches the
  kidneys, which is more serious
• Treatment involves removing the cause of the
  blockage antibiotics to remove infection.

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Pyelonephritis

• Inflammation of the kidneys (kidney infection).
• Disease can be chronic or acute chronic
  pyelonephritis can lead to kidney damage and
  kidney failure.
• Usually caused by a blockage in lower urinary
  tract or in the body of the kidney itself.
• Treatment involves removing obstructions,
  administering antibiotics

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Hydronephrosis

• Distention of the pelvis of the kidney due to
  pooling of urine brought about by blockage.
• Treatment involves surgical removal of blockages
  and draining of the kidney pelvis

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Glomerulonephritis

• Inflammation of the glomeruli (structures in the
  kidney that make urine) as a result of an
  autoimmune reaction
• Often develops as a result of some other
  infection in the body.
• Can become chronic chronic glomerulonephritis is
  a major cause of kidney failure.
• Treatment involves removing infection before it
  can cause serious damage to the kidneys.

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Nephrosis

• Damage to the kidneys from causes other than
  infection or blockages (e.g., diabetes,
  hypertension).
• Kidneys do not function normally, and eventually
  allow wastes to build in the blood (uremia).
• Usually diagnosed through high levels of protein
  in the urine loss of protein in this manner can
  become serious.

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Genetic Disorders of the Kidneys and Urinary Tract
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Genetic Anomolies

• Absence of kidneys at birth (lethal)
• Incomplete kidneys (may be lethal).
• Unusual number of kidneys (usually one or three
  usually only a curiosity).
• Horseshoe Kidney (two kidneys fused into one)
  usually only a curiosity.
• Ectopic Kidneys--Kidneys are not where they
  should be usually only a curiosity.
• Exastrophy of Bladder--Inside Out Bladder
  often fatal can be treated by diverting urine to
  colon or to body surface.
• Congenital Blockages (narrowing of kidney pelvis
  narrowed or absent ureters, bladder). Treated by
  surgical widening/enlargement of structure
  involved or by diversion of urine to colon or
  body surface.

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Polycystic Kidney Disease

• Genetic disorder involving the appearance of
  cysts in the kidney, affecting kidney function.
• Often slow progressing may not be diagnosed
  until kidneys begin to fail.
• Treatment involves kidney transplant however,
  because the disease tends to run in families many
  of the best donors may have the disease
  themselves.

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End Stage Renal Failure
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Description and Symptoms

• Kidney can no longer filter body wastes.
• Person develops uremia (build up of body
  wastes--urea--in the bloodstream).
• Physical symptoms include bleeding in mouth,
  stomach and rectum, nausea, vomiting,
  osteoporosis, anemia, sexual dysfunction,
  peripheral neuropathy.
• Person becomes confused, forgetful often,
  competency in work is questioned if kidney
  failure is not diagnosed.
• Untreated kidney failure will eventually be fatal.

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Treatment

• Treatment aims to filter wastes from the
  bloodstream that kidney does not remove.
• Three modalities
• Hemodialysis
• Peritoneal Dialysis
• Kidney Transplant

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Hemodialysis

• Kidney machine (artificial kidney) filters wastes
  from the blood as blood is passed through it.
• Blood is brought out of body through a fistula
  (union of blood vessels into which a needle is
  inserted) or a shunt (a plastic tube inserted
  into the skin). Shunts in particular require
  meticulous care.
• Hemodialysis may have serious complications but
  is necessary to prolong life.
• Can take several hours a number of times each
  week.

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Peritoneal Dialysis

• Dialysis performed by placing fluid (dialysate)
  into the abdominal cavity through an implanted
  tube, allowing abdominal capillaries to filter
  wastes from the body, and then removing the
  dialysate.
• Person is ambulatory, does not require the
  dedicated time that hemodialysis required.
• Requires much room for storage of materials.

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Kidney Transplant

• Implantation of donor kidney (from living donor
  or cadaver) usually implanted in the groin area.
• Body may try to reject kidney as a foreign
  object person will have to take antirejection
  medication for the rest of their life.
• Medication can suppress immune system, increase
  likelihood of infection.

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Rehabilitation Considerations

• Psychological Implications The individual with
  failing kidneys may have feelings of uselessness,
  out of control of their lives, heavy depression.
• Functional restrictions may vary greatly
• The cleaner the blood, the fewer the limitations.
• Sedentary and light work, occasional medium work
  usually most appropriate.
• Climbing, balancing, grip strength can be
  affected.
• Anemia may occur, causing problems with fatigue.
• Avoid hot environments due to perspiration
  problems

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Rehabilitation Considerations, cont.

• With hemodialysis, person may need to spend a
  great deal of time hooked to machine this can
  interfere with work activities. (Home dialysis
  machine preferable)
• Shunts must be cared for--cannot be immersed in
  water arm in which shunt is implanted can only
  be used for very light activities.
• With kidney transplant, individual will have very
  few restrictions--must avoid groin injuries.
• Person awaiting kidney transplant must be
  counseled on chance of failure/rejection this
  can be emotionally devastating.