Anatomy, Physiology & Disease Chapter 16 The Urinary System: Filtration and Fluid Balance.

Anatomy, Physiology & DiseaseAnatomy, Physiology & Disease

Chapter 16Chapter 16The The UrinaryUrinary System: System:

Filtration and Fluid BalanceFiltration and Fluid Balance

IntroductionIntroduction

Kidneys act as Kidneys act as purification plantpurification plant, cleaning blood , cleaning blood of waste materials.of waste materials.

Kidneys controlKidneys control electrolyte electrolyte (Na, K, Cl, Co2)(Na, K, Cl, Co2) & fluid balances& fluid balances for body. for body. Kidneys filter bloodKidneys filter blood, , reabsorbreabsorb & & secrete ionssecrete ions, & , &

produce urineproduce urine.. Without this important functionWithout this important function you would you would

survive only a survive only a few daysfew days..

Urinary System OverviewUrinary System Overview

Two kidneysTwo kidneys, , bean shapedbean shaped organs organs located in located in superior dorsal superior dorsal abdominal abdominal cavity that cavity that filter bloodfilter blood & & make urinemake urine, , & accessory structures.& accessory structures.

UreterUreter a tube that carries urine from a tube that carries urine from each kidney to a each kidney to a single urinary single urinary bladderbladder, located in , located in inferior ventral inferior ventral pelvic cavity.pelvic cavity.

BladderBladder: expandable sac that holds : expandable sac that holds urine.urine.

Urinary System Overview con’tUrinary System Overview con’t

UrethraUrethra: a tube that : a tube that transportstransports urine urine from bladder to the Meatus.from bladder to the Meatus.

Function of urinary systemFunction of urinary system is to is to make urinemake urine, thus controlling body’s , thus controlling body’s fluid fluid && electrolyte balance electrolyte balance & & eliminating eliminating waste productswaste products..

To make urineTo make urine, , 33 processes are processes are necessary:necessary: FiltrationFiltration purificationpurification ReabsorptionReabsorption of waterof water SecretionSecretion of excess waterof excess water

The Urinary SystemThe Urinary System

MeatusMeatus

Upper Upper PolePole

Lower Pole

External Anatomy of the KidneyExternal Anatomy of the Kidney Renal CapsuleRenal Capsule: Kidney : Kidney

covered by fibrous layer of covered by fibrous layer of connective tissueconnective tissue..

Renal HilumRenal Hilum: Gives kidney : Gives kidney its its shapeshape..

@ Hilum@ Hilum renal arteriesrenal arteries bring blood to kidneys to be bring blood to kidneys to be filtered and filtered and renal veinsrenal veins take take filtered blood away from filtered blood away from kidney.kidney.

Ureter Ureter also attached at also attached at hilum to transport urine hilum to transport urine from kidney to bladderfrom kidney to bladder

Internal AnatomyInternal Anatomyof the Kidneyof the Kidney

Kidney divided into 3 layersKidney divided into 3 layers:: Renal cortexRenal cortex: : outer layerouter layer, ,

grainy in appearance, has little grainy in appearance, has little obvious structure to naked eye; obvious structure to naked eye; where blood filtration occurswhere blood filtration occurs..

Renal medullaRenal medulla: : middle layermiddle layer: : Transports urineTransports urine to the renal to the renal pelvis via “pelvis via “pyramidspyramids.” .”

Renal pelvisRenal pelvis: : inner layerinner layer. . Collects urineCollects urine..

Path of Urine ProductionPath of Urine Production

1.1. Renal CortexRenal Cortex

2.2. Renal MedullaRenal Medulla

3.3. Renal PelvisRenal Pelvis

Renal CortexRenal Cortex

Outer layerOuter layer: grainy in appearance, has little : grainy in appearance, has little obvious structure to naked eye; where blood obvious structure to naked eye; where blood filtrationfiltration occurs. occurs.

Renal MedullaRenal Medulla middle layermiddle layer: : Transports urineTransports urine to the renal pelvis to the renal pelvis

via via 7-187-18 “ “pyramidspyramids,” or collecting tubes.,” or collecting tubes. pyramids composedpyramids composed ofof collecting tubules for urine collecting tubules for urine

that is formed in kidney.that is formed in kidney.

Renal PelvisRenal Pelvis

Inner layerInner layer: : CollectsCollects, then , then emptiesempties urine into urine into proximal Ureterproximal Ureter on way to bladder. on way to bladder.

Vasculature of the KidneyVasculature of the KidneyHealthy blood supply to kidney is essentialHealthy blood supply to kidney is essential

Arterial SystemArterial System Renal Renal Segmental Segmental Lobar Lobar InterlobularInterlobular Arcuate Arcuate InterlobularInterlobular Afferent arterioles Afferent arterioles Glomerulus Glomerulus Efferent arteriolesEfferent arterioles

Venous SystemVenous System RenalRenal LobarLobar InterlobularInterlobular ArcuateArcuate InterlobularInterlobular Peritubular Peritubular

capillariescapillaries

The NephronThe Nephron

The NephronThe Nephron

Functional unit of kidneyFunctional unit of kidney: consisting of millions of : consisting of millions of microscopicmicroscopic funnels and tubules. funnels and tubules.

Divided into 2 partsDivided into 2 parts::

a. a. Renal CorpuscleRenal Corpuscle: a filter: a filter

b. b. Renal TubuleRenal Tubule: where : where reabsorptionreabsorption & & secretionsecretion

take place.take place.

The Nephron con’tThe Nephron con’t

Blood entersBlood enters renal renal corpuscle via corpuscle via glomerulusglomerulus, ball of , ball of capillaries.capillaries.

Surrounding Surrounding glomerulusglomerulus is double- is double-layered membrane layered membrane called called Bowman’s Bowman’s capsulecapsule, the , the filterfilter..

The Nephron con’tThe Nephron con’t Blood flowsBlood flows into into glomerulusglomerulus & &

everything everything BUT BUT blood cells & few blood cells & few large molecules, mainly protein, large molecules, mainly protein, pushed from capillaries across filter pushed from capillaries across filter & into glomerular (& into glomerular (Bowman’sBowman’s) ) capsule. Fluid now called “capsule. Fluid now called “filtratefiltrate.”.”

Protein ureaProtein urea: protein in UA (filtrate): protein in UA (filtrate)

oror

HematuriaHematuria: blood in UA indicates : blood in UA indicates renal problems!renal problems!

The Nephron con’tThe Nephron con’t

Renal TubulesRenal Tubules

Proximal loopProximal loop Loop of HenleLoop of Henle Distal loopDistal loop

Path of Path of Urine ProductionUrine Production

How How UrineUrine is Formed is Formed

3 processes 3 processes must occur in Nephron:must occur in Nephron:11. Glomerular Filtration. Glomerular Filtration: fluid & molecules pass from : fluid & molecules pass from

glomerular capillaries glomerular capillaries intointo glomerular ( glomerular (Bowman’sBowman’s) capsule. ) capsule.

FiltrateFiltrate flows into renal tubule flows into renal tubule..


3 processes 3 processes must occur in Nephron:must occur in Nephron:1.1. Glomerular Filtration Glomerular Filtration: fluid & molecules pass from : fluid & molecules pass from

glomerular capillaries glomerular capillaries intointo glomerular ( glomerular (Bowman’sBowman’s) capsule. ) capsule.

FiltrateFiltrate flows into renal tubule flows into renal tubule..2.2. Tubular Reabsorption Tubular Reabsorption: substances reabsorbed pass from : substances reabsorbed pass from

renal tubule renal tubule intointo peritubular capillaries & peritubular capillaries & returnreturn to blood to blood stream.stream.


3 processes3 processes must occur in Nephron: must occur in Nephron:

1.1. Glomerular Filtration Glomerular Filtration: fluid & molecules : fluid & molecules pass from glomerular capillaries pass from glomerular capillaries intointo glomerular (glomerular (Bowman’sBowman’s) capsule. ) capsule. FiltrateFiltrate flows into renal tubule.flows into renal tubule.

2.2. Tubular Reabsorption Tubular Reabsorption: substances : substances reabsorbed pass from renal tubule reabsorbed pass from renal tubule intointo peritubular capillaries & peritubular capillaries & returnreturn to blood to blood stream.stream.

3.3. Tubular Secretion Tubular Secretion: substances that are : substances that are secreted pass through peritubular secreted pass through peritubular capillaries capillaries into into renal tubule & eventually renal tubule & eventually leave body as leave body as urineurine, , no longer filtrateno longer filtrate……

How How UrineUrine is Formed is Formed SummarySummary

Reabsorbed Reabsorbed vs vs

SecretionSecretion

Pathology Connection:Pathology Connection:Kidney Stones Kidney Stones ((Renal CalculiRenal Calculi))

EtiologyEtiology::

Calcium, phosphorus, & uric acid Calcium, phosphorus, & uric acid

crystals, & nephritis.crystals, & nephritis. S/SS/S: :

Hematuria, flank/abd/pelvic pain. Urgency, fever, N/V. Hematuria, flank/abd/pelvic pain. Urgency, fever, N/V. Mild to extreme pain 10/10!Mild to extreme pain 10/10!

D/XD/X;;

History/Exam, UA, Ultrasound or CT, KUB, IVPHistory/Exam, UA, Ultrasound or CT, KUB, IVP

Normal KUB & IVPNormal KUB & IVP

KUBKUB IVPIVP

Abnormal IVPAbnormal IVP

NFRKNFRK


RRCRRC RUPJCRUPJC


L

Normal IVPNormal IVP

Pathology Conncection:Pathology Conncection:RX for RX for Kidney Stones Kidney Stones ((Renal CalculiRenal Calculi) con’t) con’t

Depends on size & location of stoneDepends on size & location of stone Pain/Nausea medicationsPain/Nausea medications, fluids, strain UA, fluids, strain UA Extracoporal LithotripsyExtracoporal Lithotripsy: shock waves to break up : shock waves to break up

stone into smaller stones.stone into smaller stones. UreteroscopyUreteroscopy: fiberoptic endoscope threaded up : fiberoptic endoscope threaded up

urethra, through bladder, & into ureter; attached urethra, through bladder, & into ureter; attached instrument shatters stone & captures pieces.instrument shatters stone & captures pieces.

Percutaneous Nephro/ureterolithotomyPercutaneous Nephro/ureterolithotomy: Surgical : Surgical removal of stoneremoval of stone

Extracoporal Lithotripsy Extracoporal Lithotripsy

Common Disorders of the Urinary SystemCommon Disorders of the Urinary System

Urinary Tract (Bladder) Infection (UTI) Urinary Tract (Bladder) Infection (UTI) EtiologyEtiology: fecal bacteria into urinary tract: fecal bacteria into urinary tract S/SS/S: freq, dysuria, hematuria, turbid urine, & urine : freq, dysuria, hematuria, turbid urine, & urine

with unusual odor, fever, hypogastric or LBP. with unusual odor, fever, hypogastric or LBP. DxDx: UA, C&S, Pt. History: UA, C&S, Pt. History RxRx: Antibiotics, increase fluids: Antibiotics, increase fluids Prognosis: ExcellentPrognosis: Excellent Pts. Most @ Risk: Women, elderly, hospitalized with Pts. Most @ Risk: Women, elderly, hospitalized with

or without catheters, men with BPH.or without catheters, men with BPH.

Common Disorders of the Urinary SystemCommon Disorders of the Urinary System Polycystic Kidney DiseasePolycystic Kidney Disease EtiologyEtiology: Genetic : Genetic S/SS/S: enlarged, cystic kidneys, hypertension, UTI, : enlarged, cystic kidneys, hypertension, UTI,

dilute urine, liver cysts, pain, hematuria, aneurysmdilute urine, liver cysts, pain, hematuria, aneurysm DxDx: CT, MRI, Genetic tests: CT, MRI, Genetic tests RxRx: various meds and or Renal Transplant: various meds and or Renal Transplant PrognosisPrognosis: No cure without transplant: No cure without transplant


Ischemic NephropathyIschemic Nephropathy EtiologyEtiology: decrease blood flow to kidneys: decrease blood flow to kidneys S/SS/S: kidney failure, uremia, hypertension or : kidney failure, uremia, hypertension or

hypotension, oliguria, increase serum creatinine & hypotension, oliguria, increase serum creatinine & urea.urea.

DxDx: UA, BUN & Creatinine: UA, BUN & Creatinine RxRx: treat underlying cause & symptoms, possible : treat underlying cause & symptoms, possible

renal transplantation. renal transplantation. PrognosisPrognosis: Poor without treating cause or : Poor without treating cause or

transplantation.transplantation.

Common Disorders of the Urinary System Common Disorders of the Urinary System Diabetic Nephropathy Diabetic Nephropathy EtiologyEtiology: Diabetes Mellitus (type I or II): Diabetes Mellitus (type I or II) S/SS/S: : early stagesearly stages: increased glomerular filtration, : increased glomerular filtration,

protein in urine, protein in urine, laterlater: uremia, HTN.: uremia, HTN. DxDx: BUN, Creatinine, UA, 24 hour UA: BUN, Creatinine, UA, 24 hour UA RxRx: tight glycemic control, blood anti-HTN Meds, lipid : tight glycemic control, blood anti-HTN Meds, lipid

control, diet, kidney replacementcontrol, diet, kidney replacement PrognosisPrognosis: Poor without RX & Pt. life-style changes: Poor without RX & Pt. life-style changes

Diabetic Nephropathy Diabetic Nephropathy


Drug Drug Induced Nephropathy Induced Nephropathy EtiologyEtiology: drugs toxic to kidney tissue, especially : drugs toxic to kidney tissue, especially

contrast dye & NSAIDs.contrast dye & NSAIDs. S/SS/S: : early stagesearly stages: increased glomerular filtration, : increased glomerular filtration,

protein in urine, protein in urine, laterlater: uremia, hypertension: uremia, hypertension DxDx: BUN, Creatinine, UA, 24 hour UA: BUN, Creatinine, UA, 24 hour UA RxRx: : stop drugs, no contrast dyes for patients with : : stop drugs, no contrast dyes for patients with

known risk factors, keep patients well hydrated known risk factors, keep patients well hydrated before contrast dye use.before contrast dye use.

PrognosisPrognosis: Poor without treating cause or : Poor without treating cause or transplantation.transplantation.


GlomerulonephritisGlomerulonephritis EtiologyEtiology: : inflammation & scarring of glomerulus: : inflammation & scarring of glomerulus S/SS/S: : early stagesearly stages: increased glomerular filtration, : increased glomerular filtration,

protein in urine, protein in urine, laterlater: uremia, hypertension: uremia, hypertension DxDx: BUN, Creatinine, UA, 24 hour UA: BUN, Creatinine, UA, 24 hour UA RxRx: treating underlying cause : treating underlying cause maymay decrease decrease

progression.progression. PrognosisPrognosis: Poor if cause not found, transplantation: Poor if cause not found, transplantation


Uremia Uremia EtiologyEtiology: build up of organic waste products in blood : build up of organic waste products in blood

due to renal insufficiency.due to renal insufficiency. S/SS/S: elevated BUN & Creatinine, fatigue, : elevated BUN & Creatinine, fatigue,

neuropathy, seizures, lack of appetite, decreased neuropathy, seizures, lack of appetite, decreased smell & taste, mental confusion, insulin resistance, smell & taste, mental confusion, insulin resistance, itching, inflammation, clotting problems.itching, inflammation, clotting problems.

DxDx: BUN, Creatinine, UA, 24 hour UA: BUN, Creatinine, UA, 24 hour UA RxRx: dialysis or renal transplantation : dialysis or renal transplantation PrognosisPrognosis: poor without dialysis or transplantation: poor without dialysis or transplantation


Diabetes Insipidus Diabetes Insipidus (Dull-lacking flavor)(Dull-lacking flavor) EtiologyEtiology: ADH deficiency : ADH deficiency

1. 1. Central Central (Brain) 2. (Brain) 2. NephrogenicNephrogenic (Kidneys) (Kidneys) S/SS/S: polyuria, dilute urine, thirst, dehydration, low : polyuria, dilute urine, thirst, dehydration, low

K+, lethargy, muscle pain, irritability. K+, lethargy, muscle pain, irritability. DxDx: UA, 24 UA, BUN, Creatinine, CT head & : UA, 24 UA, BUN, Creatinine, CT head &

abdomenabdomen RxRx: Thiazide or Amiloride “: Thiazide or Amiloride “LoopLoop” Diuretics or” Diuretics or

surgery.surgery. PrognosisPrognosis: Varies: Varies

Common Disorders of the Urinary SystemCommon Disorders of the Urinary System Renal Failure Renal Failure EtiologyEtiology: acute or chronic decrease in glomerular : acute or chronic decrease in glomerular

filtration rate.filtration rate. S/SS/S: decrease urine output, uremia, edema, loss of : decrease urine output, uremia, edema, loss of

appetite, fatigue, hiccups, nausea, mentalappetite, fatigue, hiccups, nausea, mental

confusion, clotting disorder, seizures, coma.confusion, clotting disorder, seizures, coma. DxDx: UA, BUN & Creatinine, CT, IVP. : UA, BUN & Creatinine, CT, IVP. RxRx: BP meds, glucose & protein control, treatment : BP meds, glucose & protein control, treatment

of underlying condition, prevention CVD, peritoneal of underlying condition, prevention CVD, peritoneal or hemodialysis, transplantation.or hemodialysis, transplantation.

PrognosisPrognosis: Good with transplantion: Good with transplantion


Overactive Bladder (Overactive Bladder (IncontinenceIncontinence) ) EtiologyEtiology: Unkn. : Unkn. Possible life-style choices S/SS/S: urgency, inability to control urine flow: urgency, inability to control urine flow DxDx: Pt. Hx, UA, bladder studies: Pt. Hx, UA, bladder studies RxRx: Bladder training, sympathetic drugs: Bladder training, sympathetic drugs PrognosisPrognosis: Good : Good


Bladder Cancer Bladder Cancer EtiologyEtiology: Malignant tumor fm tobacco, radiation: Malignant tumor fm tobacco, radiation S/SS/S: Hematuria, UTI’s, dysuria: Hematuria, UTI’s, dysuria DxDx: UA, cytology, cystoscopy, CT: UA, cytology, cystoscopy, CT RxRx: 1.Transurethral Resection BT (: 1.Transurethral Resection BT (TUR-BTTUR-BT))

2. Chemotherapy 3. Radiation2. Chemotherapy 3. Radiation PrognosisPrognosis: Very good if Dx early, poor if stage 3-4.: Very good if Dx early, poor if stage 3-4.

Bladder CancerBladder Cancer

Staging CancerStaging Cancer

The TNM System T: describes the size & whether it has invaded

nearby tissues. N: describes regional lymph nodes involved M: describes distant metastasis

Staging CancerStaging Cancer

0: no cancer found 1: In-situ (Latin “in the place”) in the layer

of cells in which they developed. 2: Localized: Cancer limited to the organ in which

they developed. 3: Regional: Cancer spread to nearby lymph nodes

or organs. 4: Distant: Cancer spread to distant lymph nodes or

organs.

Hemolytic Uremic SyndromeHemolytic Uremic Syndrome EtiologyEtiology: bacterial infection with certain strains of : bacterial infection with certain strains of

E. coli, toxins damage kidneysE. coli, toxins damage kidneys

S/SS/S: fever, abdominal pain, pallor, fatigue, : fever, abdominal pain, pallor, fatigue, bruising, decreased urination, swellingbruising, decreased urination, swelling

DxDx: blood tests, history: blood tests, history

TxTx: blood transfusion, kidney dialysis: blood transfusion, kidney dialysis

Anatomy, Physiology & Disease Chapter 16 The Urinary System: Filtration and Fluid Balance.

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Transcript of Anatomy, Physiology & Disease Chapter 16 The Urinary System: Filtration and Fluid Balance.