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PATHOLOGY & PATHOPHYSIOLOGY

DISORDERS OF THE URINARY SYSTEM

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PHYSIOLOGY OF THE URINARY SYSTEM

What makes up the urinary system?

What are the functions of the kidneys?

How does it regulate blood pressure?

Learner Study Guide – Pathology & Pathophysiology, Chapter 15, pages 113-118


DISORDERS OF THE URINARY SYSTEM


URINARY

SYSTEM

DISORDERS

Inflammation &

infection Nephritis

Pyelonephritis

Uretertitis

Cystitis

Urethritis Tumours

Renal cell carcinoma

Bladder cancer

Disorders of renal

function Oedema

Electrolyte imbalances

Acid-base imbalances

Immune

disorders

Glomerulonephritis

Degenerative disorders

Incontinence Renal failure

Congenital disorders

Polycystic kidney disease


PHYSIOLOGY OF THE URINARY SYSTEM



URINARY TRACT INFECTIONS

Cystitis

Urethritis

Pyelonephritis



CYSTITIS

Definition: Inflammation of the bladder, usually due to bacterial

infection of the bladder - E. Coli

Pathophysiology: The bladder wall is inflamed – oedema,

redness and can be ulcerated. Bladder wall is irritated with

reduced bladder capacity.



CYSTITIS

Risk factors:

Female – due to short urethra, proximity to anus, irritation

Pregnancy

Sexual intercourse

Diabetes mellitus – glucose in urine favours infection

Improper toilet habits – defecation, menstruation

Catheter

Urinary retention



CYSTITIS – CLASSICAL TRIAD OF SYMPTOMS


Increased urination

Lower abdominal pain

Dysuria


CYSTITIS

Prevention:

Drink lots of water

Urinate whenever necessary

Wiping from front to back

Take showers rather than baths

Empty the bladder after sex

Avoid feminine hygiene sprays and douches



CYSTITIS

Treatment:

Drink lots of fluids

Cranberry juice (unsweetened) or tablets

A short course of antibiotics

Treat the underlying disorders, e.g. a structural problem of

the urinary tract

Include celery, parsley and watermelon in your diet as they

are natural diuretics and cleansers



CYSTITIS

Complications: Kidney infection (pyelonephritis)

Note: Recurrent cystitis may be a sign of a more serious

problem such as a deficient immune system, diabetes, an

anatomical anomaly or bladder cancer. Consult your health care

provider if symptoms persist.



PYELONEPHRITIS

Definition: Infection of the nephrons in the kidney. Usually a

bacterial infection.

Aetiology:

Infection can spread from bladder (during cystitis) to the

kidneys

Surgery, catheters and cystoscopes can also introduce

pathogens into the urinary tract

Urinary tract obstruction will increase the risk

In children there may be a vesico-ureteral reflux



PYELONEPHRITIS

Organism enters

kidneys by one of

2 routes


• Pregnancy

• Diabetes

Lower urinary tract

infection

• Bacteraemia Blood

stream


PYELONEPHRITIS

Signs and symptoms: Fever, pain in the back, fatigue, nausea,

vomiting, burning urine, frequent urination, cloudy urine

Treatment: Antibiotics

Complications: Longstanding pyelonephritis will lead to scarring

of the kidney, hypertension and kidney failure



GLOMERULONEPHRITIS

Definition: Inflammation of the glomeruli affecting the filtration

mechanism of both kidneys

Aetiology:

Immune complexes obstruct and damage the glomeruli, e.g.

pharyngitis due to streptococci infection

SLE

Bacterial endocarditis

Diabetes mellitus

Autoimmune diseases



GLOMERULONEPHRITIS


Infection Immune complex formation

Blockage of

glomerulus

Glomerular injury


GLOMERULONEPHRITIS

Signs and symptoms:

RBC’s in the urine (haematuria)

Dark/rust-coloured urine

Protein in the urine

Foamy urine

Hypertension

Oedema

Treatment: Treat the cause, control the inflammation (with

corticosteroids), control the hypertension

Complications: Can lead to kidney failure



URINARY RETENTION

Definition: The condition where the bladder is unable to expel all

its urine


Aetiology: Surgery, prostatic disorder,

bladder stones, cystitis

Treatment: Catheter


URINARY INCONTINENCE

Definition: Loss of bladder control

Risk factors and aetiology:

Fright, loss of consciousness, epileptic fits

Pregnancy

After childbirth

Menopause

Specific medications

Surgery to the pelvis

Injury to the brain or spinal cord

Urinary tract infections




Causes of acute incontinence: Infection

Types of chronic incontinence:

Stress incontinence

Urge incontinence

Overflow incontinence

Functional incontinence




Treatment:

Avoid alcohol, coffee, chocolate

Lose weight if overweight

Do not delay emptying the bladder

Do pelvic floor exercises



KIDNEY STONES

Renal calculi/nephrolithiasis

Crystals formed from minerals/urinary constituents that can be

found anywhere in the urinary tract

Four types of stones:

Calcium stones (calcium oxalate or calcium phosphate) –

80% of stones

Magnesium ammonium phosphate stones

Uric acid stones

Cystine stones



KIDNEY STONES

Aetiology:

Excessive calcium in the blood

Reduced urine volume (low fluid intake/excessive sweating)


Frequent infections of the

urinary tract

Urinary tract obstruction

Abnormal pH of urine

Inherited metabolic

disturbances


KIDNEY STONES

Signs and symptoms:

85% of kidney stones pass through the urinary tract without

causing symptoms

Blood in the urine

Excruciating pain that radiates to the flank and groin, the

pain has a sudden onset and comes and goes in waves

Nausea and vomiting

Strangury – This is the painful and frequent desire to

urinate, although only a few drops can be passed



KIDNEY STONES

Complications: Kidney infections and failure

Prevention: (if you are prone to kidney stones)

Drink lots of fluid

Decrease the consumption of animal protein

Avoid foods that contain oxalic acid, e.g. asparagus, beets,

celery, eggs, grapes, parsley, rhubarb, spinach, chocolate,

cocoa, peanuts and pecans



RENAL FAILURE

Definition: The kidneys cannot meet the demands of the body.

They cannot perform their function efficiently anymore.

ACUTE RENAL FAILURE

Sudden failure of both kidneys, reversible if cause is corrected

Due to glomerulonephritis, shock or heart failure, toxicity of

kidneys due to drugs (e.g. NSAIDs, aspirin, penicillin), chemicals

or toxins



RENAL FAILURE

CHRONIC RENAL FAILURE

Gradual, irreversible destruction of the kidneys over a long

period of time. Leading to retention of body wastes.

Due to bilateral chronic pyelonephtitis, polycystic kidneys,

hypertension, diabetes mellitus, long term exposure of toxins,

chronic kidney disease



RENAL FAILURE

Signs and symptoms:

Malaise

Decreased urine output

Systemic oedema (especially around the eyes and ankles)

Hypertension

Arrhythmia

Anaemia

Osteomalacia

Rashes and skin discolouration

Fatigue

Headaches

Tremors

Seizures

Muscle cramps

Nausea and vomiting

Pruritis

Acidosis



Treatment:

Control the symptoms,

especially the hypertension

Haemodialysis or peritoneal

dialysis

Kidney transplant


RENAL FAILURE



RENAL FAILURE

Characteristics ACUTE RENAL FAILURE

CHRONIC RENAL FAILURE

Causes Severe shock DM

Onset Sudden, acute Slow, insidious

Early signs Oliguria Polyuria, anemia, fatigue, HT

Progressive signs Recovery, if prolonged failure - uremia

Oliguria, uremia, acidosis


BLADDER CANCER

Relatively common, the 4th leading cancer in men and 8th leading

cancer in women

Usually a disease of older people, the average age at diagnosis

is 68 years

Aetiology: Smoking, pelvic radiation, chronic bladder infection,

bladder stones, catheter use, schistosoma haematobium

infection

Signs and symptoms: Haematuria, in the beginning stages there

is no pain

Treatment: As for other cancers (surgery, chemo, radiation)

Prognosis: Good. The 5 year survival rate for bladder cancer can

be as good as 76%.



STAGING OF BLADDER CANCER



QUESTIONS

PATHOLOGY & PATHOPHYSIOLOGYforum.dougans-international.com/files/files/DISORDERS OF THE URIN… · Pathophysiology: The bladder wall is inflamed – oedema, redness and can be ulcerated.

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