Alterations of Renal and Urinary Tract Function Concept Maps

1. Alterations of Renal and Urinary Tract Function Concept Maps Gary L. Schofield, RN

2. Potential Causes & Process of Renal Failure Obstruction Glomerulonephritis Renal Cancer UTI Pylenephritis Renal Failure Acute Chronic End Stage Renal Disease • Reverses • Abrupt ↓ renal functions Impaired Renal Blood Flow Progressive/ Irreversible Complete Renal Failure GFR gradually ↓ Transplant Pre renal (Renal Ischemia) Shock ↓ CO Anaphylaxis Intra renal Acute tubular necrosis Acute glomerulonephritis Renal Vascular Obstruction Cortical Necrosis Allograft Rejection Post renal Kidney Stones Neoplastic Disease Nephrons destroyed Remaining Nephrons ↑ Workload • Hypertrophy • ↓ability to concentrate urine Dialysis

3. Tumors ↑ Bladder = infection Renal Bladder Obstruction Wilms Tumor Embryonal Tumor Nephroblastoma Sporadic and inherited origins Associated with other anomalies ↓Bladder = Acute or Chronic Renal Failure Hydroureter Hydronephrosis Lower Urinary Tract Obstructions Kidney Stones Neurogenic Bladder Bladder Neck Dyssynergia Prostate Enlargement Interruption of nerve supply Urethral Stricture Severe Pelvic Organ Prolapse Most common in pelvis of kidney Calcium or Phosphate 75-80 % of the time Gender Race Geographic Location Seasonal Factors Fluid Intake Diet Occupation Upper Motor Neuron Lesion Lower Motor Neuron Lesion Loss of Voluntary control of voiding Loss of voluntary and involuntary control of voiding

4. Congenitally abnormal ureter Reflux of urine from bladder to kidney Infection, renal scarring, pyelonephritis Vesicoureteral Reflux Caused By Bacteria, Fungal and Parasite UTI Cystitis Pyleonephritis Most Common Site for UTI Virulence of Uropathogens Host Defense Mechanisms Acute Bacterial Attaches to Uroepithelium Periurethral Mucus Secreting Gland Sphincter Mechanisms Chronic Bacteria Form Biofilm Causes: E. Coli, Klebsiella, Pseudomonas, Staph 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 Renal Cell Carcinoma Secondary Primary Associated with mutation of gene P53 Most common renal neoplasm Proximal tubule epithelial cells Benign Tumors Located near cortex of kidney Increase Risk Result of invasion of cancer from bordering organs Workers exposed to chemicals, rubber, & in textile industry Smokers (men)

5. Pyelonephritis Acute Chronic Common Cause: E Coli Infection of renal pelvis and interstutium Recurrent Autoimmune Infections Common Causes Kidney Stones Vesicoureteral Reflux Pregnancy Neurogenic Bladder Instrumentation Female Sexual Trauma Inflammation and scarring of kidney Pelvis, calyces – dilated & blunted Destruction of tubules Areas of atrophy/dilation/ diffuse scaring Inflammatory Process damages tubular cells Impairment of function Urine-concentration ability affected Excretion of diluted urine Usually localized abscesses Healing occurs Deposition of Scar tissue Atrophy of affected tubules Affects primarily the pelvis, calyces, and medulla Rarely causes renal failure Renal Failure

6. Glomerular Disorders Glomerulonephritis Acute Glomerulonephritis S/S Hematuria Red Blood Cell Casts Protenuria ↓ GFR Oliguria Edema HTN Abrupt onset 7-10 after infection Group A Strep S/S 10-21days after infections Nephrotic Syndrome IgA Nephropathy Berger Disease Crescentic Glomerulonephritis (Rapidly Progressive) Most Common Form Disturbance in Glomerular Basement Memb (metabolic, biochemical, physiochemical) leads to increase permeability to protein Most individuals Children recover with minimal loss of renal function Chronic Glomerulonephritis Idiopathic Proliferative glomerular diseases Unknown cause 24-48 hrs after URI or GI infection Several Glomerular Diseases Hypoalbuminema Hyperlipidemia Antiglomerular Basement Membrane (Good-pasture Syndrome) Focal or Diffuse Segmental fibrosis and deterioration Prognosis variable 20-50% progress to Renal Fail Proteinuria Lipiduria Example of Crescent Glomerulo- nephritis Hypocalcemia Tubular dilation and atrophy Cause: Immune response Toxin/Drugs Vasc. Disorders Damage: Biochemical Mediators of Inflammation Complement activation Neutrophils/Monocytes Antibody Formation Affects: Pulmonary Capillary Glomerular Basement Membs Treatment: Normal, Low-fat Diet; Salt Restriction Diuretics; Antigoagulants; Removal of toxins; Steroids; Albumin Replacements Poor Prognosis Poor Prognosis Renal Failure

8. 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.