Urinary Disorders

contains 85% of all nephrons

Contains renal pyramids and columns; the nephrons in this area concentrate the urine

The expanded proximal end of the ureters

Drain urine into the bladder

Filters plasma at glomerulus. Reabsorbs 99% of filtered fluid. Regulates filtrate to maintain body fluid volume, electrolyte composition, and pH

tuft of capillaries where filtration occurs

branches from bowmans capsule where 2/3 of electrolytes are reabsorbed; also where all glucose and amino acids are reabsorbed

Descending and ascending loops of the renal tubule; reabsorbs Na+, K+, Cl-

Reabsorbs Na+, Cl- . Reabsorbs or secretes K+ (is hormally controlled)

tubules that receive urine from several renal tubules; eventually direct urine to the renal pelvis

nephrons filter plasma at glomerulus into bowmans space. permeable to water but not large plasma proteins. Capillary pressure, molecular size, and electrical charge affect filtration/permiability

• a specialized region where distal tubule contacts afferent and efferent arterioles of its nephron.
• specialized cells that stimulate the secretion fo the adrenal hormone aldosterone.
• synthesizes renin and plays a major role in renal autoregulation and bp

• part of the thick ascending limb of the nephron
• senses plasma sodium concentration and passes the message to renin-secreting cells

feedback between distal tubules and glomerular capillaries that help maintain homeostasis of gfr, overall blood volume, electrolyte concentration, by changing the amount of urine, or isotonic hypotonic hypertonic

increased NaCl in distal tubule decreases GFR, and decreased NaCl increase GFR. it also changes diameter of afferent and efferent arterioles.

stimulates red blood cell proliferation in bone marrow in response to kidney hypoxia, injections available

Secreted from cardiocytes in right atrium. When right atrial blood pressure increases, ANP inhibits secretion of renin, inhibits angiotensin-induced secretion of aldosterone, relaxes smooth vascular muscle, and inhibits sodium and water absorption. .. this increases urine formation, thus decreases blood volume and pressure

needed for the absorption of calcium and phosphate by the intestines which is stimulated by the kidneys.

analyzes the composition of urine

• Blood urea nitrogen/creatinine
• Cr is a by product of muscle metabolism that is filtered out by the kidneys
• BUN is the measure of levels of nitrogen in the blood in the form of urea, that is secreted by liver and removed by kidneys
• High ratios indicate decreased GFR/kidney funtion

volume of blood plasma that is cleared of creatinine per unit time; a useful measure for approximating gfr

Pictures of the KUB with radio opaque dye

• cysts develop (fluid filled spaces from accumulation with obstruction) lead to chronic renal failur
• autosomal recessive children
• autosomal dominant in adults 30-40
• s&s: flank pain, urinary tract infections, hematuria

• infection of the renal pelvis and interstitium
• acute: usually bladder infection that ascended to renal pelvis recover if treated
• Chronic: persisten infections leading to scarring and renal failure, may be due to obstructive pathologic conditions
• s&s: acute-fever chills flank pain cva tenderness dysuria .. chronic-minimal: htn, frequency dysuria flank pain
• usually require iv antibiotics

• inflammation of glomeruli
• causes drugs toxins immunologic abnormalities ischemia free radicals
• acute: strep infections hematuria proteinuria, decreased gfr, oligouriaa
• chronic: hematuria, proteinuria with progressive decline in gfr often autoimmune

• Crystallized marerial forms in renal calyces and pelvis
• cause not completely understood
• 1% of population, and recur in 30-50% of them within 5 years
• s&s: renal colic, flank/groin pain, n&v, microscopic hematuria
• management: narcotic analgesia for acute attack, lithotripsy to break up stones, prevent new ones from forming (dilute urine, dietary changes)

frequency urgency dysuria lower back pain cloudy urine hematuria ...E coli, anibiotics

inflammation of bladder (infection, irritation from stones, trauma, chemical irritants)

increased permeability of glomerular basement membrane to protein: proteinuria

• acute renal failure: generally reversible, classified by causes
• Prerenal-related to decreased renal blood flow,
• Post renal-related to outflow obstruction,
• intrarenal- nephron damage, few cells actually die but become non functional for awhile. recover 2 weeks to 12 months can become chronic
• s&s: oliguric: urine output<400cc/day, diruetic: dilute urine in normal to > amounts, recovery: renal function adequate to avoid dialysis but not normal, Cr BUN^,

• 50% ESRD 2ndary to diabetes
• s&s: decreased renal reserve, renal insufficiency: 75% nephrons damaged polyuria nocturia, ESRD

• 90% nephrons destroyed, hypervolemia, hyperkalemia, hyperphospatemia, metabolic acidosis, uremia, hypocalcemia and osteodystrophy with osteoporosis, anemia
• treatment: glucose control, diet: low protein k Na, supplement Calcium, transplant, dialysis

• hemodialysis: AV shunt ofr access blood pumped through array of semipermeable membranes surrounded by dialysate
• peritoneal dialysis: Dialysate placed into abdominal cavity (peritoneum, acts as filter) and drained out by gravity flow

surrounded by smooth muscle, sac for urine collection, parasympathetic control, external urethral spincter is under voluntary control

loss of urine preceded by a stron unexpected urge to void; involuntary bladder contractions

loss of urine with activities that result in increased intra-abdominal pressure; weak pelvic muscle floor

combo of urge and stress

involuntary loss of urine associated with a distended bladder; bladder unable to empty normally due to partial obstruction

related to other factors besides urinary tract (confusion, mobility, illness)

no sensory warning or awareness; neurological