Alterations of Renal and

Urinary Tract Function

Chapter 28, 29

Structures of the Renal

System

Kidney Function
Fluid and electrolyte balance
Regulation of blood pressure
Excretion of metabolic wastes
Acid/base balance
Erythropoietin production
Vitamin D activation
4

Nephron-Functional Unit

Urinalysis

Color
Specific gravity
Protein
Glucose
Ketones
Nitrites
Casts
Crystals
pH

Hematologic Tests
GFR

mL/min

[eGFR]

125/min

Serum Creatinine 0.6-1.2 mg/dL

BUN 10-20 mg/dL

7

Bladder Disorders
Incontinence
Requires physiological and cognitive
capabilities
Need functioning nervous system, intact
bladder and urethral function

Incontinence
Define the following types of
incontinence
Stress
Urge
Mixed
Overflow
Functional
9

Enuresis
Inappropriate wetting of clothes or
bed
Primary cause is maturational delay
Diurnal vs. nocturnal

10

Urinary Tract Obstruction

Kidney Stones, Renal Calculi,

Nephrolithiasis
Etiology
Factors influencing formation

Increased concentration of solutes

Abnormal urine pH
Low urine volume
Hypercalciuria
Genetic predisposition

12

Kidney Stone
Clinical Manifestations
Vary with size and location

Abdominal pain
Flank pain
Ureteral colic
Hematuria
Dysuria

13

Entry of Pathogens
Normal Defenses
Acidic urine and urea
Unidirectional Flow
Voiding

14

Urinary Tract Infection (UTI)

Acute cystitis
Cystitis is an inflammation of the
bladder
Most common pathogen: E. coli

Cystitis
Clinical Manifestations
Small % asymptomatic
Frequency, urgency, dysuria, hematuria,
lower abdominal or suprapubic pain

Diagnostic Testing
Urinalysis
Dipstick
WBC (Pyuria) , RBC, Nitrites
Pink/Cloudy
May culture urine

16

Acute Pyelonephritis
Infection of the renal pelvis and
interstitium
Etiology
Ascending bladder infection
Indwelling urinary catheters
Post cystoscopy
Prostate enlargement
Renal Stones
Reflux
Genetic
17

Acute Pyelonephritis
Pathogenesis
Development of infection
WBC infiltration and inflammation of renal
parenchyma
Altered renal function
Recurrent infections may lead to scarring
and chronic kidney disease

18

Acute Pyelonephritis
Clinical Manifestations
Usually, sudden onset
Bacteriuria, fever, flank pain, chills,
dysuria,
WBC casts in urine

Complications
Risk of permanent decrease in kidney
function is low
Renal damage from repeated
infections/chronic
pyelonephritis
19

Chronic Pyelonephritis
Etiology
Recurrent and/or improperly treated
infections
Obstructive disorders
Vesicoureteral reflux

20

Chronic Pyelonephritis
Pathogenesis
Repeated invasion of leukocytes and
subsequent inflammation of renal
parenchyma with recurrent infection
Fibrosis and scarring of renal tubules
decreases the number of functioning
nephrons
21

Chronic Pyelonephritis
Clinical Manifestations
Similar to acute
Found during routine evaluation for other
conditions

Azotemia

22

Glomerular Abnormalities
Glomeruli are part of the nephron.
Fluid filtration from the blood to the
nephron tubules takes place
in the glomeruli.
Average GFR is 125 ml/min.

Nephron

23

Glomerular Disorders
Glomerulonephritis
Inflammation of the glomerulus

Immunologic abnormalities (most common)

Drugs or toxins
Vascular disorders
Systemic diseases
Viral causes

Most common cause of end-stage renal

failure

Glomerulonephritis
Clinical Manifestations
Hematuria
Red cell casts
Proteinuria
Signs of fluid retention due to
25

GFR

Nephrotic Syndrome
Excretion of 3.5 g or more of
protein in the urine per day
The protein excretion is caused
by glomerular injury
Findings
Hypoalbuminemia, edema,
hyperlipidemia, and lipiduria, and
vitamin D deficiency

Acute Renal Failure

Etiology
Decreased perfusion
Pyelonephritis
Drug toxicity
Autoimmune disease/glomerulonephritis
Contrast induced nephropathy

27

Acute Renal Failure

Classification
Pre-renal
Post-renal
Intra-renal

28

Acute Renal Failure

Clinical Manifestations
Sudden and near complete cessation of
renal function

Oliguria
Anuria
FVE, HTN
Elevated BUN, Creatinine
Fluid & Electrolyte imbalance
Changes in LOC
Cardiac dysrhythmias
29

Chronic Renal Failure

Defined as decrease in kidney
function or kidney damage for 3
months or longer.
Progressive loss of renal function
Tubular atrophy, glomerulosclerosis,
interstitial fibrosis
Damage to nephrons
Irreversible; terminates in ESRD
30

Chronic Renal Failure

Etiology/Risk Factors
Diabetes Mellitus
Glomerulonephritis
HTN
Cystic Kidney Disease
Other
31

Chronic Renal Failure

Stages-based on degree of nephron loss
and clinical manifestations
Decreased Renal Reserve <75%
nephron loss, no s/s
Renal Insufficiency 75-90% nephron
loss, polyuria, nocturia, slight increase in
BUN and creatinine, maybe controlled by
diet and meds

End Stage Renal Disease (ESRD) >

90% nephron loss, azotemia/uremia,
F&E problems, anemia, dialysis or
transplantation necessary
32

Chronic Renal Failure

Clinical Manifestations of ESRD
Increased BUN 180 200 mg/dL
FVE decreased GFR and activation of RAAS
Electrolyte imbalance- retention of K, Mg, Phos
Uremic Syndrome -confusion, anorexia, N/V,
pruritis,
33

Chronic Renal Failure

Alterations seen in following systems:
Musculoskeletal
Cardiovascular and pulmonary
Hematologic
Immune

Chronic Renal Failure

Neurologic
Gastrointestinal
Endocrine and reproduction
Integumentary