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Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1
Diseases of the Urinary and Reproductive system
Copyright © 2005 by Elsevier Inc. All rights reserved.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 2
Orderly Function of the Urinary System
The urinary tract is responsible for:producing, storing, and excreting urine cleansing the blood of waste products regulating the water, salts, and acids in the
body fluids to ensure homeostasis
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 3
The urinary system consists of:
kidneys (2) ureters (2) urinary bladder urethra
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 4
Nephrons
About 1 million per kidney Responsible for filtration, reabsorption,
and secretion of urine Transports urine to renal pelvis and then
to ureters
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 5
Evaluation of the urinary system
Proper function is usually determined by urinalysis and blood tests.
Normal results demonstrate: proper filtration, absorption, and elimination
of metabolic wasteprecise fluid and electrolyte balance
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 6
Symptoms of Urinary Diseases
nausea loss of appetite fever headache and body
ache flank or low back pain
edema decreased urinary
output hypertension pruritus
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 7
Acute Glomerulonephritis
Description: inflammation and swelling of the
glomeruli of the kidney can be primary disease of the kidney can develop secondarily to a systemic
disease usually follows a streptococcal bacterial
infection of the throat or skin
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 8
Location of the glomerulus in the nephron
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 9
Acute Glomerulonephritis (cont’d.)
Symptoms: protein in the urine (proteinuria) edema decreased urine volume blood in urine (hematuria) hypertension (not always present)
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 10
Acute Glomerulonephritis (cont’d.)
Treatment: antibiotic therapy (if infection present) rest diuretics for edema and hypertension restricted sodium intake corticosteroids (if immune reaction is
suspected)
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 11
Chronic Glomerulonephritis
Description: a slowly progressive, noninfectious
disease that can result in irreversible renal damage and renal failureoften seen in advanced stage kidney
disorders reduces glomerular filtration, which causes
retention of uremic poisons
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 12
Chronic Glomerulonephritis (cont’d.)
Symptoms: Initially: no symptoms Midstage:
hypertension hematuria proteinuria oliguria (slight or
infrequent urination) edema
Late stage severe hypertension azotemia (an excess
amount of nitrogen-bearing wastes in blood)
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 13
Dialysis
End stage renal disease forces approximately one in every 10,000 people to use dialysis to filter wastes from their blood and urine. Without dialysis, these patients will eventually die.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 14
Hemodialysis
Fistula provides access to blood. Blood is drawn out of the body and
filtered using an artificial kidney (hemodialyzer).
Cleansed blood is returned to the body.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 16
Peritoneal Dialysis
Process uses patient’s own peritoneal membrane as a filtering device.
The dialysate solution passes into peritoneal membrane through permanent catheter.
The solution diffuses existing wastes. Contaminated fluids are drained from
body.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 17
Kidney transplantation
Approximately 10,000 people receive kidney transplants each year in the U.S.
75% are performed on patients with:diabetes adrenal failurehypertensive renal diseaseglomerulonephritis
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 18
Kidney transplantation (cont’d.)
Transplantation requires immunosuppressive agents to prevent potential rejection of the organ.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 19
Nephrotic Syndrome (Nephrosis)
affects the lower membrane of the glomerulus
secondary to a number of renal diseases and other systemic disorders
includes a group of symptoms; sometimes referred to as the protein-losing kidney
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 20
Nephrotic Syndrome (cont’d.)
Description: A condition caused by excessive loss of
protein in the urine that results in: depressed plasma protein levels increased water and sodium retention increased susceptibility to infection
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 21
Nephrotic Syndrome (cont’d.)
Symptoms: bloody urine loss of appetite pale skin puffiness around eyes swollen ankles weight gain
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 22
Nephrotic Syndrome (cont’d.)
Additional symptoms: lethargy/depression Pelvic pain Hypertension Tests can reveal high levels of albumin,
lipids in urine.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 23
Nephrotic Syndrome (cont’d.)
Treatment: Dietary intake of protein is adjusted to
glomerular filtration rate (GFR). Sodium is lowered and diuretics used to
control edema. Urine output is monitored. Corticosteriods may help control
proteinuria in some patients.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 24
Nephrotoxic Agents
solvents (methanol, carbon tetrachloride) heavy metals (lead, arsenic, mercury) pesticides antibiotics (kanamycin, gentamicin) nonsteroidal anti-inflammatory drugs (NSAIDs) iodinated radiographic contrast media antineoplastic agents miscellaneous compounds (acetaminophen) poisonous mushrooms
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 25
Acute Renal Failure
Description: Acute renal failure (ARF) is
characterized by a sudden and severe reduction in renal function.
ARF qualifies as a clinical emergency because nitrogenous waste products quickly accumulate in blood causing an acute uremic episode.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 26
Acute Renal Failure (cont’d.)
Symptoms:slight or infrequent urination (oliguria)gastrointestinal disturbancesheadachedrowsiness
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 27
Acute Renal Failure (cont’d.)
Etiology:diminished blood flow to kidney intrarenal damage to the kidneymechanical obstruction of urine flowSudden renal failure can lead to death if not
treated promptly.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 28
Acute Renal Failure (cont’d.)
Treatment: The primary goal is to reverse the
decreased renal function. This may be accomplished by:balancing fluid intake and output initiating a high carbohydrate/low protein
diet to avoid a protein imbalance (called metabolic acidosis)
controlling sodium and potassium intake
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 29
Acute Renal Failure (cont’d.)
Treatment (cont’d.)
Drug therapy may include:antihypertensivesdiureticsanti-infective agentsPrompt treatment can reverse renal failure
and lead to complete recovery.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 30
Chronic Renal Failure
Description: results from the gradual and progressive
loss of nephrons irreversible loss of renal functiongradual onset of waste buildup in blood
(uremia)
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 31
Chronic Renal Failure (cont’d.)
hypertension edema arrhythmias muscle
weakness
ulceration of gastrointestinal mucosa
hair and skin changes difficulty breathing
(dyspnea) metabolic acidosis
Symptoms:General—weakness, fatigue, and lethargy (due to anemia)As uremic syndrome worsens:
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 32
Hydronephrosis
Description:an abnormal dilation of the renal pelvis
caused by pressure from urine that cannot flow past an obstruction in the urinary tract
chronic condition that can gradually destroy kidneys
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 34
Hydronephrosis (cont’d.)
Symptoms:vague backache or diminished urine output
sometimes noticeableoften without pain or symptompresence of infection may bring fever, chills,
blood and/or pus in urine detection is often accidental
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 35
Hydronephrosis (cont’d.)
Treatment depends upon the cause of the obstruction and duration of condition.surgical intervention possible if discovered
early insertion of nephrostomy tube if surgical
intervention not possible If condition persists for more than 2 months,
kidney function usually ceases.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 36
Diabetic Nephropathy
Description: various renal changes (called
glomerulosclerosis) that result from diabetes
All patients with type 1 diabetes (and many with type 2 diabetes) will eventually develop renal changes.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 37
Diabetic Nephropathy (cont’d.)
Symptoms: urinary retention hypertension nausea protein in urine Urinary tract infections and
pyelonephritis are common complications.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 38
Diabetic Nephropathy (cont’d.)
Treatment includes: glucose management controlling blood pressure infection control balance fluid intake and output customizing for patient needs possible dialysis or kidney transplant as
part of long-term treatment
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 39
Polycystic Kidney Disease
Description: slowly progressive, irreversible normal renal tissue replaced with
multiple grape-like cysts
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 41
Polycystic Kidney Disease(cont’d.)
Symptoms: lumbar painblood in urine hypertensionprone to renal infection and kidney stones
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 42
Polycystic Kidney Disease(cont’d.)
Diagnosis:urinalysis shows:
blood protein pus
radiographic films show:enlarged kidneys with irregular outlinesspidery appearance
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 43
Stress Incontinence
Description: uncontrollable leakage of small amounts
of urine from the bladder during physical exertion or actions that stress the pelvic muscles such as: laughing lifting stretching running
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 44
Stress Incontinence (cont’d.)
Etiology: weakening of the pelvic floor muscles
and urethral structure, often attributed to: trauma from childbirthpressure from an existing pregnancyhormonal changes associated with
aging/menopausecertain medicationsobesity
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 45
Stress Incontinence (cont’d.)
Treatment:exercises to strengthen pelvic floor musclesestrogen replacement (estrogen cream)drug therapysurgical repaircollagen injections