Kidney & Bladder Diseases
Terms
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- nephrons
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-- functional renal structure
- glomerulus: surrounded by Bowman's capsule
- tubules exiting
- ~1 million nephrons in kidneys - structures affected by renal disease
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- renal pelvis
- menal pyramids (medulla): tubles system
- renal cortex: nephrons - renal disease
- -> syndrome of disorders that range from vascular to traumatic
- common outcomes of renal disease
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- renal toxicity
- osteoporosis
- acid/base imbalance
- cardiovascular disease - causes of renal disease
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- trauama, burns
- crush injury
- renal vascular disease - trauma, burns
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- circulating blood volume reduced
- renal vessels contrict -> renal ischemia
- renal damage from lack of blood deprivation = acute tubular necrosis (ATN)
- recovery: complet or only partial depending on degree of ischemia - crush injury
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- muscle damage releases myoblobin (lg. protein molecules) into circulation
- may occlude small renal vessels -> renal ischemia w/ tissue damage - renal vascular disease
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- results in decreased blood passing through the kidney to be filtered
- outcomes: systemic or renal hypertension - renal vascular disease: systemic hypertension
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- usually produced by hardening of small renal arteries (renal arterionephrosclerosis)
- juxtaglomerular apparatus (that monitors blood in kindneys) allows large renin secretions
- renin activates angiotensinogen -> angiotension I -> II
- blood vessel constriction & fluid retention
[renin-angiotensin mechanism]
s. 10 - systemic hypertension treatment
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- diuretic medicaiton: acts on kidney to reduce Na+ retention
- ACE inhibitor: affects peripheral vasoconstriction & inc. plasma volume - renal vascular disease: renal hypertension
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- from the presence of collagen vascular disease (SLE, scleroderma)
- sclerosis of renal vessesl - due to scaring & collagen replacement -> occlusion -> reduced blood flow
- renin-angiotensin mechanism activated & BP inc. - Pyelonephritis
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-> inflammation of renal pelvis & may involve renal interstitial tissue
- reflux from urinary bladder - Pyelonephritis causes
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- cystitis (urinary bladder inf)
- obstruction: urinary calculus ro enlarged prostate
- neurogenic bladder (sc injurey: residual urine collects)
- hematogenous spread from another infected area - Pyelonephritis s/s
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- high fever & chills
- hematuria
- urine contains white blood cells, bacteria
- possible physically diabling effects requiring PT
- females > males - dialysis dementia
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- pyelonephritis patient may require dialysis (due to loss of kidney function)
- may become confused, disoriented, & speech impaired - acute Glomerulonephritis (AGN)
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- Bright's Disease
-> inflammation of glomeruli
- 70% follow streptococcus pharyngitis
-- type III immune reaction -antigen-antibody complexes form
- circulate to glomerulus & get trapped
- glomeruli inflamed -> renal function impaired - acute glmerulonephritis incidence
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- >50% in children
- 2X boys > girls
- 80-90% recover w/in 4-6 weeks
- in adults: 50% recover
- subacute progeressive glomerulonephritis (SAPGN) or chronic glomerulonephritis (CGN) can develop - AGN s/s
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- renal hypertension (50%)
- edema (fluid retention from renin-angio mech)
- coke colored urine (RBCs & casts)
- proteinuria (albumen)
- hematuria
- oliguria, polyuria
- headaches, nausea, vomiting - SAPGN
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- rapidly progressive form of glomerulonephrits
- fibrin accumulation in glomerulus prevents filtration
- rapid developing renal failure & uremia
- mortality rate: 2 years - Goodpasture's syndrome
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- in some ind. w/ SAPGN
- lethal variant
- reanl failure appears rapidly due to loos of glomeruli
- develop pulmonary lesions
- hemoptysis, respiratory failure
- death comes quickly/survival poor - CGN
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- slowly progressive renal failure & uremic syndrome -> end stage renal disease (ESRD)
- progresses over several years
[uremic: toxicity due to renal failure] - diabetic nephropathy
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- diffuse or nodular diabetic glomerulosclerosis
- thickening of basement membrane of glomerulus
-loss of plasma filtering mech
- requires dialysis and/or renal transplantation
- Kimmelstiel-Wilson disease: nodular accumulations of eosinophilic material located in periphery of glomerulus - acute renal failure (ARF)
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-> abrupt, frequently reversible decline in reanl function
- recovery expect in ~6-8 weeks - ARF causes
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1. acute tubular necrosis (dec. blood flow to kindy = loose renal tubules)
2. acute obstruction (kidney stone, prostatic hypertrophy, bladder tumor)
3. nephrotoxin consumption (organic solvents, heavy metals, antibiotics, X-ray contrast media)
4. acute interstitial nephirits (inflammation of renal interstitial tissue & tubule system)
5. pigments (accumulation of hemoglobin due to disseminated intravascular coagulation; or myoglobin due to trauma) - chronic renal failure (CRF)
- -> progressive, relentless decline in nephorn population
- CRF causes
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1. chronic pyelonephritis
2. glomerulonephritis
3. chronic hypertensive vascular disease
4. collagen vascular disease (SLE)
5. polycystic kidney disease (inherited, bilater, multiple expanding cysts destroy normal renal tussue by compression)
6. renal tubular acidosis (congenital inability of rnal tubules to handle acid)
7. diabetes mellitus (damages filtration mech & causes diabetes nephropathy)
8. gout (urate kidney stones)
9. hyperparathyroidism (hypercalcemia = Ca in renal tubles -> kidney stones)
10. amyloidosis (glycoprotein amyloid deposits in renal tissue destroying function)
11. toxins (analgesics that are toxic to renal tissue)
12. obstructions - renal diagnositic procedures
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assessing renal function:
- blood urea nitrogen (BUN)
- blood creatine (produced with muscle metabolism)
- 24 hour urine volume
- intravenous pyelpgraphy (radiological method to assess kidneys - cobra head) - urinary bladder disease
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-> cystitis
- includes bladder epithelia carcinoma (can be occult & metastatic)
- may occur in urnary bladder, ureters, or urethra = bleeding & obstruction of urine flow
-- incontinence most common in older ind.
-- causes: neurogenic, red. volume capacity, or hyperactive detrusor muscle