The Urinary system

By

Associate Prof. Atallah Elenezi

2024
Learning Objectives

Upon completing this lecture students should be able to:-

 Discuss different disorders that affect the urinary system
such as Renal failure, pyelonephritis, renal calculi, and
bladder cancer.
 The urinary system

 The urinary system is responsible for the production

and elimination of urine when a type of waste called
urea is removed from the blood.

 Urea is produced when protein-containing foods are

broken down in the body.
 The urinary system

 It is then carried in the bloodstream to the two kidneys,

where urine is formed.

 The two ureters, the urinary bladder and the urethra are
responsible for the elimination of urine.
 Renal failure

Kidney failure, also known as end-stage renal

disease (ESRD), is a medical condition in which the
kidneys can no longer adequately filter waste products
from the blood, functioning at less than 15% of normal
levels.
 Renal failure

 End-stage renal disease (ESRD), usually the result of chronic

renal failure is the gradual, progressive deterioration of kidney
function to the point that the kidneys cannot sustain their
necessary day-to-day life activity.

 As the kidney tissue is progressively destroyed, the kidney loses

its ability to excrete the nitrogenous end products of metabolism,
such as urea and creatinine, which accumulate in the blood and
eventually reach toxic levels.
 Etiology

Causes of ESRD include diabetes mellitus (leading cause),

hypertension, chronic glomerulonephritis, pyelonephritis,
obstruction of the urinary tract, congenital anomalies such as
polycystic kidneys, vascular disorders, infections, medications, and
toxic agents.
 Signs and symptoms

 The early signs and symptoms are oliguria and

azotemia, or the presence of nitrogenous compounds in
increased amounts in the blood; electrolyte imbalance and
metabolic acidosis follow.
 Eventually, clients may complain of drowsiness and lethargy,
weight loss, easy bruising or bleeding, decreased sensation in the
hands and feet, hiccups, pruritus, and decreased urine output.
 Signs and symptoms

 The individual with ESRD also may have decreased

alertness and appear mentally confused.
 The skin may be pallid and scaly.
 The severity of signs and symptoms varies depending
on the extent of the renal damage and remaining
function, any underlying conditions, and the person’s
age.
 Diagnostic procedure

o The client may have a long history of chronic renal disease or

other predisposing disorders.

o The physical examination may reveal one or more of the

presenting signs and symptoms, along with hypertension.

o Blood testing of creatinine and BUN typically reveals elevated

serum creatinine and potassium levels, along with decreased
hemoglobin and hematocrit. Urine output decreases or stops
completely.
 Treatment

 Dialysis or kidney transplantation are the only treatments for

ESRD. The client’s physical condition and other factors
determine which one is used.
 Other treatment is generally used to assist the body in
compensating for the existing impairment and guarding against
complications; however, this treatment is unlikely to work
without dialysis or a transplant.
 Treatment

 Dietary restrictions on protein, sodium, and potassium intake

may be necessary. Blood transfusions may be needed to control
anemia.
 Prognosis

A variety of complications often cause death before

complete kidney failure occurs.

Chief among these are infections; others include a

spectrum of cardiovascular, blood, and GI abnormalities.
  Pyelonephritis, also called infective
tubulointerstitial nephritis or
kidney infection, is inflammation of
the kidney and renal pelvis due to
infection.
Pyelonephritis
 One or both kidneys may be
affected. The infection can destroy
or scar renal tissue, impairing
kidney function.
  It is the most common type of
kidney disease and is more
common in women than in men
Pyelonephritis due in part to the anatomic
difference between men and
women.
  Pyelonephritis is most commonly due to
infection by the E. coli bacteria. E. coli is
a normal intestinal bacteria that grows
rapidly and is found in fecal matter.

 Proteus, Pseudomonas, Staphylococcus,

and Enterococcus bacteria are less
Etiology frequent agents of the infection.

 The bacteria typically ascend to the

kidneys from the lower urinary tract, but
they also may enter the kidneys through
the blood or lymph.
  Women, particularly those who are
pregnant or who practice poor
genital hygiene, are at risk.
 In men, pyelonephritis may arise as
a complication of prostate
Etiology enlargement.
 Any catheterization of the urinary
tract also increases the likelihood
of infection.
 Sigs & symptoms

 The individual experiencing acute pyelonephritis may

complain of fever and lumbar, side, or groin pain.
 These symptoms may be accompanied by pyuria (pus in
the urine), dysuria (difficult or painful urination), and
nocturia (excessive urination at night).
 Clients often look quite ill and report that symptoms
appeared rapidly.
 Diagnostic procedure

 Culture and sensitivity tests are performed on a clean-

catch urine specimen, which may appear cloudy and have
a “fishy” odor.
 Urinalysis also may reveal casts, WBCs, bacteria, and
hematuria.
 An ultrasound or CT scan is frequently used to detect any
obstruction in the urinary tract.
 Treatment

 Antibiotic therapy that is appropriate to the

infecting organism is the treatment of choice.
 Antipyretics may be ordered to decrease the
fever.
 An increase in liquids is helpful.
 Treatment

 Clients must be kept hydrated and that they take

all the ordered medication.

 Generally, a follow-up culture is done 2 weeks

after the person has finished the antibiotic
therapy to ensure that the infection is gone.
 Prevention

The best prevention is avoidance of any infection and the

use of proper genital hygiene.

Remind clients to drink plenty of fluids, especially water,

and empty their bladder after intercourse.
 Renal calculi

o Renal calculi are the most common cause of urinary

obstruction.
o A renal calculus is a concentration of various mineral
salts in the renal pelvis or the cuplike extension of the
renal pelvis called the calyx.
o They can be small like a grain of sand or very large.
o Most stones develop in the kidney and are formed from
calcium salts, uric acid, cystine, and struvite, in
descending order of frequency.
 Etiology

1. Many factors, such as prolonged dehydration or

immobilization, can upset this balance.

2. The balance also may be upset by underlying diseases,

such as gout, hyperparathyroidism (the disease caused
by oversecretion of the parathyroid glands), Cushing
syndrome, or urinary tract infections and neoplasms.
 Signs & symptoms

 Classic ureteral colicky pain is manifested by acute,

intermittent, and excruciating pain in the flank and upper
outer quadrant of the abdomen on the affected side.
 If calculi are in the renal pelvis and calyces, the pain is duller
and more constant.
 Back pain and severe abdominal pain may occur.
 Other presenting symptoms include nausea, vomiting, chills
and fever, hematuria, and abdominal distention.
 Diagnostic procedure

 A urinalysis may be ordered to detect elevated levels of

RBCs or WBCs in the urine or to check for the presence of
protein, pus, and bacteria.

 CT scan and abdominal x-ray (or kidneys, ureter, bladder

[KUB]) may be ordered to determine the locations of
calculus formation.
 Treatment

 Ureteroscopic removal with fluoroscopic guidance may

be used to dilate the ureter to grasp and remove the stone.

 Techniques such as ultrasonic percutaneous lithotripsy

and extracorporeal shock wave lithotripsy pulverize
stones in place, allowing them to be passed in the urine or
removed by suction.
 Treatment

 Lithotripsy via ureteroscope can also be used to remove

urethral stones.

 Antibiotics may be prescribed if it is determined that the

calculus buildup is due to bacterial infection.

 Analgesics may be necessary for the relief of intense

pain.
 Prognosis

 The prognosis is good if urinary tract obstruction is

prevented and underlying disorders are promptly treated.

 However, about 60% of people who have a calcium stone

have further stone formation later.
 Prevention

 An adequate daily fluid intake is the best way to

minimize the chance of stone formation, especially
among individuals at risk.

 Fruit juices, especially unsweetened cranberry and

blueberry juice help acidify urine and may help prevent
the formation of renal calculi.
 Bladder cancer

 Tumors of the bladder arise from the epithelial cell

membrane lining the bladder interior.
 These neoplasms are almost always malignant, and they
metastasize readily.
 Bladder tumors are staged according to their depth of
penetration.
 Transitional cell carcinoma is the most common type of
bladder cancer in the United States.
 Etiology

Predisposing factors may include exposure to certain types

of industrial chemicals and/or radiation.
Individuals with chronic cystitis also seem prone to
developing bladder tumors.
The disease affects men three times more frequently than
women and generally occurs between ages 50 and 70.
Bladder cancer is the fourth most common cancer in men.
 Signs and symptoms

 Many persons are asymptomatic until advanced stages of

the disease.
 For those presenting with symptoms, however, painless,
gross hematuria is the most common indicator.
 Less frequently, the individual may complain of dysuria,
urinary frequency, and urgency, or nocturia. UTIs are a
common complication.
 Diagnostic procedure

o Microscopic urinalysis may reveal cancer cells.

o Cystoscopy and biopsy of the suspected lesions are
usually required to reach a definite diagnosis.
o A bone scan, CT scan, and MRI will help determine
possible metastases and staging of the cancer.
 Treatment

 The choice of treatment is based on the extent of

the disease.
 If the disease is superficial, an endoscopic
resection may be all that is necessary.
 If it is invasive, further surgery is required.
 Treatment

 The tumor may be surgically removed through fulguration (electrical

destruction) or transurethral resection, a surgical procedure in
which cancerous tissue is removed from the bladder using an
instrument passed through the urethra.

 For advanced cases, removal of the urinary bladder, or radical

cystectomy may be required, followed by radiation, immunotherapy,
or chemotherapy treatment.
 Prognosis

When the tumor penetrates the bladder more deeply

or has metastasized, the prognosis is poor, with a
low 5-year survival rate.