Alterations of Renal and Urinary

Tract Function Concept Maps

Gary L. Schofield, RN
 Potential Causes & Process of Renal Failure

Obstruction Glomerulonephritis
Renal Cancer

UTI Pylenephritis

Renal Failure

Acute Chronic End Stage Renal Disease

-Reverses
Impaired Renal Blood Flow Progressive/ Irreversible
- Abrupt renal
functions Complete Renal Failure

GFR gradually

Intra renal Transplant

Acute tubular Post renal
Pre renal Nephrons destroyed
necrosis Kidney
(Renal Ischemia)
Acute Stones
Shock
CO glomerulonephritis
Remaining Nephrons
Renal Vascular Neoplastic
Anaphylaxis Workload
Obstruction Disease
Cortical Necrosis
Allograft Rejection -Hypertrophy
Dialysis
- ability to
concentrate urine
 Tumors
Bladder =
infection

Renal Bladder

Obstruction Wilms Tumor

Bladder = Acute or Embryonal Tumor

Chronic Renal Failure Nephroblastoma
Hydroureter Sporadic and
inherited origins
Hydronephrosis Associated with
other anomalies

Lower Urinary Tract

Obstructions
Kidney Stones Neurogenic Bladder

Bladder Neck Prostate

Dyssynergia Enlargement

Interruption of nerve
supply Urethral Stricture Severe Pelvic Organ
Prolapse

Most common Gender Upper Motor Lower Motor

in pelvis of Neuron Lesion Neuron Lesion
Race
kidney
Geographic
Calcium or
Location
Phosphate 75-
80 % of the Seasonal Factors Loss of Voluntary Loss of voluntary
time control of voiding and involuntary
Fluid Intake
control of voiding
Diet
Occupation
 Congenitally abnormal
ureter
Reflux of urine from Vesicoureteral Reflux Caused By Bacteria, Fungal
bladder to kidney and Parasite
Infection, renal scarring,
pyelonephritis
UTI
Cystitis Pyleonephritis

Virulence of Uropathogens Host Defense Mechanisms

Acute
Most Common Site for
UTI
Bacterial Attaches to Periurethral Mucus
Sphincter Mechanisms
Uroepithelium Secreting Gland
Chronic
Bacteria Form
Causes: E. Coli, Klebsiella, Biofilm
Pseudomonas, Staph Body Immune System
(Bladder Wall)

Common Causes:
Infection initiates inflammatory Kidney Stones
response
Vesicoureteral Reflux
Tumors Pregnancy
Neurogenic Bladder
Instrumentation
Association: Female Sexual Trauma
Tobacco Use, Obesity, Long-term Analgesic
use

Bladder Tumors
Renal Adenoma Renal Cell Carcinoma

Primary
Associated with mutation Secondary
Most common renal of gene P53
Benign Tumors neoplasm
Proximal tubule
Located near cortex of epithelial cells
kidney Increase Risk
Result of invasion of
cancer from bordering
Workers exposed to organs
Smokers (men) chemicals, rubber, &
in textile industry
 Pyelonephritis

Acute Chronic

Common Cause: E Coli

Infection of renal pelvis Recurrent Autoimmune

and interstutium Infections

Common Causes
Kidney Stones
Vesicoureteral Reflux
Inflammation and
Pregnancy Destruction of tubules
Neurogenic Bladder scarring of kidney
Areas of atrophy/dilation/
Instrumentation Pelvis, calyces dilated
Inflammatory Process diffuse scaring
Female Sexual Trauma damages tubular cells & blunted

Impairment of function
Usually localized abscesses Urine-concentration Excretion of diluted urine
Healing occurs
Deposition of Scar tissue ability affected
Atrophy of affected tubules

Affects primarily the pelvis,

calyces, and medulla

Rarely causes renal failure

Renal Failure
 Glomerular Disorders
Glomerulonephritis
Acute Glomerulonephritis
S/S
Hematuria
Red Blood Abrupt onset
Cell Casts 7-10 after
Protenuria IgA Nephropathy infection
GFR Berger Disease Group A Strep Nephrotic Syndrome
Oliguria S/S 10-21days
Edema after infections
HTN
Crescentic Glomerulonephritis
(Rapidly Progressive) Most
Common
Form
Most individuals Disturbance in Glomerular Basement Memb
Chronic Glomerulonephritis Children recover (metabolic, biochemical, physiochemical) leads
Idiopathic
Proliferative with minimal to increase permeability to protein
Unknown
glomerular loss of renal
cause
Several diseases function
24-48 hrs
Glomerular after URI or
Diseases GI infection
Hypoalbuminema Hyperlipidemia
Antiglomerular Basement
Membrane (Good-pasture
Syndrome)
Focal or Diffuse Proteinuria Lipiduria
Prognosis
Segmental fibrosis
variable
and deterioration
Example of 20-50%
Crescent progress to Hypocalcemia
Glomerulo- Renal Fail
Tubular dilation and atrophy nephritis

Cause: Immune response

Toxin/Drugs
Antibody Formation
Vasc. Disorders
Affects:
Damage: Biochemical
Pulmonary Capillary
Mediators of Inflammation
Glomerular Basement Membs
Complement activation Treatment:
Neutrophils/Monocytes
Normal, Low-fat Diet; Salt Restriction
Poor Prognosis Poor Prognosis Diuretics; Antigoagulants; Removal of
toxins; Steroids; Albumin
Replacements

Renal Failure
Structural Abnormality Definition Facts

Hypospadias Congenital condition in which the

urethral meatus is located on the ventral
side of the penis
Related to disruption in male hormones
Accompanied by Chordee or penile
torsion
Corrective Surgery

Epispadias Exstrophy of the bladder- Urethral

opening on the dorsal surface of penis.
Urethral opening small and situated
behind the glans with fissure extending
the length of penis
Constant dribbling of urine

Exstrophy of Bladder Extensive congenital anomaly in which

the lower urinary tract is exposed directly
to the surface of the body
Caused by intrauterine failure of the
abdominal wall and the mesoderm of the
anterior bladder to fuse
Reconstructive surgery girls teens
Boys 2-3 yrs of age

Ureteropelvic Junction Blockage of the tapered point where the

renal pelvis transitions into the ureter
Intrinsic malformation of smooth muscle
or urothelial development produces
Obstruction obstruction in 90% of cases. Causes
kinking and scarring

Bladder Outlet A urethral valve is a thin membrane of

tissue that occludes the urethral lumen
Obstruction and obstructs urinary outflow in males.
Polyps rarely arise form the prostatic
urethra often cause sever obstruction
and impair renal embrogenesis leading
to UTI, Vesicoureteric reflux, and renal
failure. Resection as soon as possible

Hypoplastic(Dysplastic Ureteric duct grows into the metanephric

tissue, triggering the formation of the
Associated with a functional or organic
obstruction of the collecting system
Kidneys kidneys in utero. If this growth does not
occur the kidney is absent or hypoplastic
Obstruction may begin prior to birth

(small) Renal dysplasia results from

abnormal differentiation of renal tissue

Renal Agenesis Absence of one or both kidneys

Potter syndrome (bilateral renal
Clearly hereditary
Bilateral agenesis is usually fatal
agenesis) Unilateral males more affected

Polycystic Kidneys Autosomal dominant inherited disorder

PKD-1 and PKD-2 mutations account for
The gene products regulate epithelial
growth and differentiation.
the disease
 References
Corwin, E. J. (2000). Handbook of Pathophysiology (2nd ed.). Philadelphia, PA:
Lippincott.

Gray, M., Huether, S., & Forshee, B. (2006). Alterations of renal and urinary
tract function. In K. L. McCance & S. Huether (Eds.), Pathophysiology: The
Biologic Basis for Disease in Adults & Children (pp.1301- 1336). St Louis,
MO: ElSevier Mosby.

Huether, S. (2006) Alteration of renal and urinary tract functions in children. In K.

L. McCance & S. Huether (Eds.), Pathophysiology: The Biologic Basis for
Disease in Adults & Children (pp.1337- 1351). St Louis, MO: ElSevier Mosby.