Alterations Alterations of Renal and and Urinary Urinary Tract Function Concept Maps Gary L. Schofield, RN
Potential Causes & Process of Renal Failure
Obstruction
Glomerulonephritis
Renal Cancer
UTI
Pylenephritis
Renal Failure
Acute -Reverses - Abrupt ↓ renal functions
Chronic
Impaired Renal Blood Flow
End Stage Renal Disease
Progressive/ Irreversible Complete Renal Failure GFR gradually ↓
Pre renal (Renal Ischemia) Shock ↓ CO Anaphylaxis
Intra renal Acute tubular necrosis Acute glomerulonephritis Renal Vascular Obstruction Cortical Necrosis Allograft Rejection
Transplant Post renal Kidney Stones Neoplastic Disease
Nephrons destroyed
Remaining Nephrons ↑ Workload -Hypertrophy - ↓ability to concentrate urine
Dialysis
Tumors
↑ Bladder = infection Renal
Obstruction
Bladder
Wilms Tumor
↓Bladder = Acute or Chronic Renal Failure
Hydroureter Hydronephrosis
Embryonal Tumor Nephroblastoma Sporadic and inherited origins Associated with other anomalies
Lower Urinary Tract Obstructions Kidney Stones
Neurogenic Bladder
Interruption of nerve supply
Most common in pelvis of kidney Calcium or Phosphate 7580 % of the time
Gender Race
Upper Motor Neuron Lesion
Lower Motor Neuron Lesion
Loss of Voluntary control of voiding
Loss of voluntary and involuntary control of voiding
Geographic Location Seasonal Factors Fluid Intake Diet Occupation
Bladder Neck Dyssynergia
Prostate Enlargement
Urethral Stricture
Severe Pelvic Organ Prolapse
Congenitally abnormal ureter Reflux of urine from bladder to kidney Infection, renal scarring, pyelonephritis
Caused By Bacteria, Fungal and Parasite
Vesicoureteral Reflux
UTI
Cystitis
Pyleonephritis
Virulence of Uropathogens
Host Defense Mechanisms
Acute
Most Common Site for UTI Bacterial Attaches to Uroepithelium
Causes: E. Coli, Klebsiella, Pseudomonas, Staph
Periurethral Mucus Secreting Gland
Sphincter Mechanisms Chronic
Bacteria Form Biofilm Body Immune System (Bladder Wall)
Common Causes: Kidney Stones Vesicoureteral Reflux Pregnancy Neurogenic Bladder Instrumentation Female Sexual Trauma
Infection initiates inflammatory response
Tumors Association: Tobacco Use, Obesity, Long-term Analgesic use
Bladder Tumors Renal Adenoma
Benign Tumors Located near cortex of kidney
Renal Cell Carcinoma
Most common renal neoplasm Proximal tubule epithelial cells
Primary Associated with mutation of gene P53
Increase Risk
Secondary
Result of invasion of cancer from bordering
Pyelonephritis
Acute
Chronic Common Cause: E Coli
Infection of renal pelvis and interstutium
Common Causes Kidney Stones Vesicoureteral Reflux Pregnancy Neurogenic Bladder Instrumentation Female Sexual Trauma
Recurrent Autoimmune Infections
Inflammatory Process damages tubular cells
Usually localized abscesses Healing occurs Deposition of Scar tissue Atrophy of affected tubules
Affects primarily the pelvis, calyces, and medulla Rarely causes renal failure
Inflammation and scarring of kidney Pelvis, calyces – dilated & blunted
Destruction of tubules Areas of atrophy/dilation/ diffuse scaring
Impairment of function Urine-concentration ability affected
Excretion of diluted urine
Renal Failure
Glomerular Disorders Glomerulonephritis Acute Glomerulonephritis S/S Hematuria Red Blood Cell Casts Protenuria ↓ GFR Oliguria Edema HTN
IgA Nephropathy Berger Disease
Crescentic Glomerulonephritis (Rapidly Progressive)
Chronic Glomerulonephritis
Idiopathic Proliferative glomerular diseases
Several Glomerular Diseases
Focal or Diffuse Segmental fibrosis and deterioration
Prognosis variable 20-50% progress to Renal Fail
Cause: Immune response Toxin/Drugs Vasc. Disorders Damage: Biochemical Mediators of Inflammation Complement activation Neutrophils/Monocytes
Antibody Formation Affects: Pulmonary Capillary Glomerular Basement Membs
Poor Prognosis
Poor Prognosis
Renal Failure
Disturbance in Glomerular Basement Memb (metabolic, biochemical, physiochemical) leads to increase permeability to protein
Most individuals Children recover with minimal loss of renal function
Hypoalbuminema
Antiglomerular Basement Membrane (Good-pasture Syndrome)
Tubular dilation and atrophy
Nephrotic Syndrome
Most Common Form
Unknown cause 24-48 hrs after URI or GI infection
Example of Crescent Glomerulonephritis
Abrupt onset 7-10 after infection Group A Strep S/S 10-21days after infections
Hyperlipidemia
Proteinuria
Lipiduria
Hypocalcemia
Treatment: Normal, Low-fat Diet; Salt Restriction Diuretics; Antigoagulants; Removal of toxins; Steroids; Albumin Replacements
Structural Abnormality Hypospadias
Definition Congenital condition in which the urethral meatus is located on the ventral side of the penis
Facts 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 Obstruction
Blockage of the tapered point where the renal pelvis transitions into the ureter
Intrinsic malformation of smooth muscle or urothelial development produces obstruction in 90% of cases. Causes kinking and scarring
Bladder Outlet Obstruction
A urethral valve is a thin membrane of tissue that occludes the urethral lumen 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 Kidneys
Ureteric duct grows into the metanephric tissue, triggering the formation of the kidneys in utero. If this growth does not occur the kidney is absent or hypoplastic (small) Renal dysplasia results from abnormal differentiation of renal tissue
Associated with a functional or organic obstruction of the collecting system Obstruction may begin prior to birth
Renal Agenesis
Absence of one or both kidneys
Clearly hereditary
Potter syndrome (bilateral renal agenesis)
Bilateral agenesis is usually fatal Unilateral – males more affected
Polycystic Kidneys
Autosomal dominant inherited disorder
The gene products regulate epithelial growth and differentiation.
PKD-1 and PKD-2 mutations account for 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.
