Urinary

• Urinary System


  • Removes metabolic wastes, hormones, drugs and other foreign material from the body
  • Regulates water, electrolyte, acid-base balance
  • Secretes erythropoietin
  • Activates vitamin D
  • Regulates blood pressure through the renin-angiotensin-aldosterone system
• Urinary System organs in order


  1. Kidneys

  2. Ureters

  3. Urinary bladder

  4. Urethra
• Kidney

  • Nephrons are the functional units
  • Each kidney has over a million nephrons
• Nephron in order


  1. Renal corpuscles

  2. Glomerulus

  3. Bowman capsule

  4. Renal tubules

  5. Proximal convoluted tubules

  6. Loop of Henle

  7. Distal convoluted tubules

  8. Collecting duct
• Antidiuretic hormone (ADH)


  Secreted by the posterior pituitary, reabsorbs water in distal convoluted tubules and collecting ducts
• Aldosterone


  Secreted by adrenal cortex, reabsorbs sodium in exchange for potassium or hydrogen
• Atrial natriuretic hormone


  Hormone from the heart, reduces sodium and fluid reabsorption
• Glomerular Filtration Rate (GFR) control

  1. Autoregulation

  2. Sympathetic nervous system

  3. Renin-angiotensin mechanism
• Incontinence


  Loss of voluntary control of the bladder
• Enuresis


  Involuntary urination by child age older than 4 years
• Stress incontinence


  Happens when physical movement or activity puts pressure on the bladder, causing urine leakage
• Overflow incontinence


  You have the urge to urinate but can release only a small amount
• Incompetent bladder sphincter


  The muscles and tissues that control the release of urine from the bladder are weakened or damaged, leading to involuntary urine leakage
• Retention


  Inability to empty bladder, may be accompanied by overflow incontinence
• Urinalysis: Appearance of Urine

  • Straw colored with mild odor is normal
  • Cloudy may indicate presence of large amounts of protein, blood, bacteria, and pus
  • Dark color may indicate hematuria, excessive bilirubin, or highly concentrated urine
  • Unpleasant or unusual odor may indicate infection or result from certain dietary components or medication
• Urinalysis: Urinary Infection


  Heavy purulence and presence of gram-negative and gram-positive organisms
• Abnormal Constituents of Urine

  • Blood (hematuria)
  • Elevated protein level (proteinuria, albuminuria)
  • Bacteria (bacteriuria)
  • Urinary casts
• Urinary casts are tiny tube-shaped particles that can be found when urine is examined under the microscope during a urinalysis. Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat. The content of a cast can help tell your health care provider whether your kidney is healthy or abnormal.
• Elevated serum urea and serum creatinine levels

  Indicate failure to excrete nitrogen wastes, caused by decreased GFR
• Metabolic acidosis


  Indicates decreased GFR and failure of tubules to control acid-base balance
• Anemia


  Indicates decreased erythropoietin secretion and/or bone marrow depression
• Elevated renin levels


  Indicate kidney as a cause of hypertension
• Clearance tests


  Examples: creatinine or inulin clearance, used to assess GFR
• Cystoscopy


  Visualizes lower urinary tract, may be used to perform biopsy or remove kidney stones
• Diuretic drugs


  Used to remove excess sodium ions and water from the body, increase excretion of water through the kidneys, reduce fluid volume in tissues and blood
• Dialysis


  1. Hemodialysis

  2. Peritoneal dialysis
• Hemodialysis


  Exchange of wastes, fluids, and electrolytes, blood cells and proteins remain in blood, blood returned to patient's vein
• Peritoneal Dialysis


  Takes more time than hemodialysis, major complication is infection resulting in peritonitis
• Disorders of the Urinary System

  • Urinary Tract Infections
  • Cystitis and Urethritis
  • Pyelonephritis
  • Glomerulonephritis
  • Nephrotic Syndrome
• Urinary Tract Infections (UTIs)

  Very common infections, urine is an excellent growth medium
• Lower urinary tract infections

  • Cystitis (inflammation of the bladder)
  • Urethritis (urethra becomes swollen and sore)
• Cystitis and Urethritis


  Bladder wall (cystitis) and urethra (urethritis) are inflamed, causes pain, dysuria, urgency, frequency, and nocturia
• Pyelonephritis


  One or both kidneys involved, purulent exudate fills pelvis and calyces, recurrent or chronic infection can lead to scar tissue formation and eventual chronic renal failure if untreated
• Glomerulonephritis


  A group of diseases that injure the glomeruli, presence of antistreptococcal (ASO) antibodies, causes inflammatory response in glomeruli
• Glomerulonephritis symptoms


  Urine becomes dark and cloudy, facial and periorbital edema, elevated blood pressure, flank or back pain, decreased urine output
• Blood tests in glomerulonephritis show elevated serum urea and creatinine levels, and metabolic acidosis. Urinalysis shows proteinuria, hematuria, and erythrocyte casts.
• Hyperactive bladder and reduced capacity

  Pain is common in pelvic area
• Dysuria


  Painful Urination, urgency, frequency, and nocturia
• Systemic signs


  • Fever, malaise, nausea, leukocytosis
• Pyuria


  A condition in which you have pus in your pee