The Urinary System and Diseases of the Urinary System

1. The Urinary System and Diseases of the Urinary System Structure and Function Evaluation of the patient Disease states or disruption of homeostasis

2. Overview URINARY SYSTEM STRUCTURE AND FUNCTION   APPROACH TO THE PATIENT WITH URINARY SYSTEM DISEASE/RENAL DISEASE   DISEASE STATES (and what happens when homeostasis is disrupted)

3. Overview of the Urinary System Kidneys Nephrons Bowmans Capsule Proximal Tubules Loop of Henle Distal Tubules Collecting Tubes Ureters Bladder Urethra YouTube - Urinary system - The nephron

4. APPROACH TO THE PATIENT WITH RENAL DISEASE I. ELEMENTS OF RENAL FUNCTION A. URINE FORMATION B. KIDNEY AS ENDOCRINE RECEPTOR: PTH, ALDOSTERONE, ADH 1. PTH: Enhances the absorption of Ca and Mg a. Inhibits absorption of Phosphate and Bicarbonate in the proximal tubule by increasing intracellular cyclic 3’,5’ –adenosine monophosphate (cAMP) b. Stimulates renal conversion of 25-hydroxycholecalciferol, the major biologically active form of Vitamin D 2. ALDOSTERONE: a. Stimulate the rate of Na absorption in the distal nephron b. Increase the rate of net K secretion and net proton secretion by the distal nephron 3. ADH: a. Promotes formation of a hypertonic urine both by increasing the rate of salt absorption in the ascending limb of Henle b. Increases water permeability of the collecting duct system                     C.  

5. C. KIDNEY AS ENDOCRINE ORGAN 1. Prostaglandin production 2. Operation of degradation of low molecular weight proteins 3. Site for synthesis of erythropoietin and of renin a. Erythropoietin: stimulate the rate of red blood cell production by bone marrow b. Renin: secreted in response to reductions in renal perfusion pressure ? increases rate of conversion angeotensinogen ?angeotensinogen I ?Angiotensinogen I ?Angiotensinogen II ?Angeiotensinogen II is vasoconstrictor agent ?stimulate thirst ?stimulate aldosterone production ?helps volume repletion reaction II. EVALUATION OF PATIENTS WITH RENAL DISEASE (consider in context of renal syndromes) III. THE MAJOR RENAL SYNDROMES A. The underperfusion syndromes B. The renal parenchymal syndromes 1. Glomerular syndromes 2. Nephrotic syndromes C. The postrenal syndromes 1. Result from obstruction of urine flow  

6. Disorders of the Urinary/Renal System URINARY/ RENAL SYSTEM   Disorders of the Urinary/Renal System   Disorders of fluid volume, electrolyte, and acid-base balance Acute Renal Failure Chronic Renal Failure Treatment of Irreversible Renal Failure: Dialysis and Renal Transplant Glomerular Diseases Tubulointerstitial Diseases and Toxic Nephropathies Obstructive Uropathy Specific Tubular Disorders Diabetes and Hypertension and the Kidney Urinary Tract Infections and Pyelonephritis Vascular Disorders of the Kidney Hereditary Chronic Nephropathies Renal Calculi Cystic Disease of the Kidney Anomalies of the Urinary Tract Tumors of the Kidney, Ureter, and Bladder

7. URINARY SYSTEM   Disorders of the Renal System   Disorders of fluid volume, electrolyte, and acid-base balance Acute Renal Failure Chronic Renal Failure Treatment of Irreversible Renal Failure: Dialysis and Renal Transplant Glomerular Diseases Tubulointerstitial Diseases and Toxic Nephropathies Obstructive Uropathy Specific Tubular Disorders Diabetes and the Kidney Urinary Tract Infections and Pyelonephritis Vascular Disorders of the Kidney (including those associated with hypertension) Hereditary Chronic Nephropathies Renal Calculi Cystic Disease of the Kidney Anomalies of the Urinary Tract Tumors of the Kidney, Ureter, and Bladder

8. Hypertension and Diabetes are the major causes of chronic renal disease. Other causes include glomerulonephritis, cystic renal disease, other urologic diseases, and unknown etiology.

9. Diabetes and Hypertension can cause disease states that may include the following systems: cardiovascular, renal, central and peripheral nervous, and ophthalmic

10. Hypertension There is a high incidence of hypertension in CRF: 1. Na retention and volume expansion ? rise cardiac output? rise peripheral resistance YouTube - Hypertension

11. Diabetes How does diabetes cause kidney disease? ? Our bodies digest the proteins eaten ? Processes create waste products ?Kidneys filter waste products (proteins and RBCs are not able to pass through this filter) ? Blood sugar ?kidneys filter ‘too much’ blood ? hyperfiltration state / microvascular disease affecting renal glomerulus? leakage of proteins (microalbuminuria) Late: unable to filter proteins and other substances/ kidney failure ? toxin buildup YouTube - Diabetes and the Kidneys

12. Hemodialysis Renal function failure Dialysis Peritoneal Hemodialysis Renal Transplant YouTube - Hemodialysis

13. Polycystic Disease of the Kidney YouTube - Polycystic Kidney Disease(PKD)

14. Tumor of the Kidney YouTube - Kidney

15. Kidney Stone Formation Renal calculi are abnormal concretions occurring in the kidneys, consisting of crystalline components and an organic matrix. They are typically located within the calices or pelvis and may become lodged in the ureter or bladder as they are passed. Symptoms may include pain or renal colic which is the manifestation of ureteral spasm caused by the stone’s movement, dysuria, hematuria, and obstructive pathology manifested in inability to urinate.

16. Kidney stones to ureter

17. Kidney Stones YouTube - Re: Kidney Stones, Coke and Asparagus

18. Urinary Tract Infection UTI refers to both microbial colonization of the urine and tissue invasion of any structure of the urinary tract. Bacteria are most commonly responsible, although yeast, fungi, and viruses may produce urinary infection. Symptoms include frequency, dysuria, hematuria, suprapubic discomfort, flank pain or lower back pain. Most are self limited. Some may worsen to pyelonephritis. Some worsen to renal papillary necrosis, renal abscess, and perinephric abscess.

19. The Urinary/ Renal System Structure and Function Evaluation of the Patient Disease states (or disruption of homeostasis)