Alterations of Renal and Urinary Tract Function Concept Maps

Gary L. Schofield, RN

Potential Causes & Process of Renal Failure

Renal Failure

Obstruction

UTI

Renal Cancer

Pylenephritis

Glomerulonephritis

Acute Chronic End Stage Renal Disease

-Reverses

- Abrupt ↓ renal functions

Impaired Renal Blood Flow

Pre renal (Renal Ischemia)Shock↓ CO Anaphylaxis

Intra renalAcute tubular necrosisAcute glomerulonephritisRenal Vascular ObstructionCortical NecrosisAllograft Rejection

Post renalKidney Stones

Neoplastic Disease

Progressive/ Irreversible

GFR gradually ↓

Nephrons destroyed

Remaining Nephrons ↑ Workload

-Hypertrophy

- ↓ability to concentrate urine

Complete Renal Failure

Transplant

Dialysis

Obstruction

Hydroureter

Hydronephrosis

↑ Bladder = infection

↓Bladder = Acute or Chronic Renal Failure

Kidney Stones Neurogenic Bladder

Interruption of nerve supply

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

Lower Urinary Tract Obstructions

Bladder Neck Dyssynergia

Prostate Enlargement

Urethral Stricture Severe Pelvic Organ Prolapse

Tumors

Renal Bladder

Wilms Tumor

Embryonal TumorNephroblastomaSporadic and inherited originsAssociated with other anomalies

UTI

Tumors

Caused By Bacteria, Fungal and Parasite

Cystitis

Virulence of Uropathogens Host Defense Mechanisms

Pyleonephritis

Most Common Site forUTI

Chronic

Acute

Periurethral MucusSecreting Gland

Sphincter MechanismsBacterial Attaches to

Uroepithelium

Bacteria FormBiofilmCauses: E. Coli, Klebsiella,

Pseudomonas, Staph

Infection initiates inflammatoryresponse

Renal Adenoma Renal Cell Carcinoma

Bladder Tumors

Body Immune System(Bladder Wall)

Common Causes:Kidney Stones

Vesicoureteral RefluxPregnancy

Neurogenic BladderInstrumentation

Female Sexual Trauma

Benign Tumors

Located near cortex of kidney

Most common renal neoplasm

Proximal tubule epithelial cells

PrimaryAssociated with mutation

of gene P53

Secondary

Association:Tobacco Use, Obesity, Long-term Analgesic

use

Increase RiskResult of invasion of cancer from bordering

organs

Smokers (men)

Workers exposed to chemicals, rubber, &

in textile industry

Vesicoureteral Reflux

Congenitally abnormalureterReflux of urine from bladder to kidneyInfection, renal scarring,pyelonephritis

Pyelonephritis

Acute Chronic

Infection of renal pelvisand interstutium

Common CausesKidney StonesVesicoureteral RefluxPregnancyNeurogenic BladderInstrumentationFemale Sexual Trauma

Inflammatory Processdamages tubular cells

Usually localized abscessesHealing occurs

Deposition of Scar tissueAtrophy of affected tubules

Affects primarily the pelvis,calyces, and medulla

Rarely causes renal failure

Excretion of diluted urineImpairment of function Urine-concentration

ability affected

Destruction of tubulesAreas of atrophy/dilation/

diffuse scaring

Inflammation and scarring of kidney

Pelvis, calyces – dilated& blunted

Recurrent AutoimmuneInfections

Renal Failure

Common Cause: E Coli

Glomerular DisordersGlomerulonephritis

Nephrotic Syndrome

Chronic Glomerulonephritis

Crescentic Glomerulonephritis(Rapidly Progressive)

IgA NephropathyBerger Disease

Acute Glomerulonephritis

Proteinuria Lipiduria

Hypocalcemia

S/SHematuriaRed Blood Cell CastsProtenuria↓ GFROliguriaEdemaHTN

Abrupt onset7-10 after infectionGroup A StrepS/S 10-21days after infections

Most individualsChildren recover with minimal loss of renal function

Most Common

Form

Unknown cause24-48 hrs after URI or GI infection

Prognosis variable 20-50% progress to Renal Fail

IdiopathicProliferative glomerular diseases

Example of CrescentGlomerulo-nephritis

Antiglomerular BasementMembrane (Good-pastureSyndrome)

Antibody FormationAffects: Pulmonary Capillary Glomerular Basement Membs

Poor Prognosis

Renal Failure

SeveralGlomerularDiseases

Focal or DiffuseSegmental fibrosisand deterioration

Poor Prognosis

Tubular dilation and atrophy

Cause: Immune response Toxin/Drugs Vasc. DisordersDamage: Biochemical Mediators of InflammationComplement activation Neutrophils/Monocytes

Disturbance in Glomerular Basement Memb(metabolic, biochemical, physiochemical) leads to increase permeability to protein

Hypoalbuminema Hyperlipidemia

Treatment:Normal, Low-fat Diet; Salt RestrictionDiuretics; Antigoagulants; Removal of toxins; Steroids; Albumin Replacements

Structural Abnormality Definition Facts

Hypospadias Congenital condition in which the urethral meatus is located on the ventral side of the penis

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

Potter syndrome (bilateral renal agenesis)

Clearly hereditary

Bilateral agenesis is usually fatal

Unilateral – males more affected

Polycystic Kidneys Autosomal dominant inherited disorder

PKD-1 and PKD-2 mutations account for the disease

The gene products regulate epithelial growth and differentiation.

ReferencesCorwin, 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.