URINARY SYSTEM

Major functions of the Renal System

● Renal Clearance
○ Renal clearance refers to the ability of the kidneys to clear solutes from the plasma.
● Regulation of RBC Production
○ When the kidneys detect a decrease in the oxygen tension in renal blood flow, because of
anemia, arterial hypoxia, or inadequate blood flow, they release erythropoietin.
● Excretion of Waste Products
○ The kidneys eliminate the body’s metabolic waste products.
○ The major waste product of protein metabolism is urea, of which about 25 to 30 g are produced
and excreted daily.
○ Other waste products of metabolism that must be excreted are creatinine, phosphates, and
sulfates.
○ Uric acid, formed as a waste product of purine metabolism, is also eliminated in the urine.
○ The kidneys serve as the primary mechanism for excreting drug metabolites.

Diagnostics Test
Diagnostic Procedure Purpose Nursing Interventions

Bladder Ultrasonography - Is a non- invasive method - Before bladder

of measuring urine volume
in the bladder.
- Indicated for urinary
frequency, inability to void
after catheter removal,
measurement of post-
voiding residual urine
volume and inability to void
post-operatively.
ultrasonography, explain
the procedure to the
patient and ensure their
bladder is adequately filled
if required.
- During the test, assist with
positioning for optimal
imaging, maintain patient
comfort, and observe for
any signs of discomfort.
- After the ultrasound,
document findings, and
provide post-procedure
care instructions as
needed, ensuring the
patient's well-being and
understanding of the
results.

Intravenous Urography / - Visualizes the kidneys, - Before intravenous

Pyelography ureter and bladder via
x-ray imaging as the dye
moves through the upper
and lower urinary system.
- Initiate urologic conditions
such lesions in the kidneys
and ureters.
urography, verify patient
consent, assess for
allergies, and ensure they
are well-hydrated.
- During the procedure,
monitor vital signs, ensure
the IV contrast injection is
well-tolerated, and provide
emotional support to
alleviate anxiety.
- After the procedure,
observe for any adverse

Cystography - Aids in evaluating the
vesicoureteral reflux
meaning the backflow of
urine from the bladder into
one or both of the ureter
and assessing for bladder
injury.
Renal Angiogram - Provides an image of the
renal arteries.
- Evaluates the renal blood
flow in renal trauma, to
differentiate renal cyst from
renal tumors and to
evaluate hypertension
Risk Factors for UTI
● Female anatomy. A woman has a shorter urethra than a man does, which shortens the distance that
bacteria must travel to reach the bladder.
reactions, encourage
increased fluid intake to
flush out the contrast
medium, and educate the
patient on post-procedure
care.
- Pre-cystography, educate
the patient, check for
allergies to iodine or cm,
secure informed consent,
and ensure they fast
appropriately.
- During the procedure,
assist with positioning,
continuously monitor vital
signs, and provide
emotional support.
- After cystography, monitor
for adverse reactions,
encourage hydration,
manage pain, and offer
post-procedure care
instructions.
Before the Procedure
- Administer laxative to clear
the colon
- Injection site must be
shaved (groin for femoral
and axilla for axillary)
- Mark the peripheral sites
(radial, femoral) for easy
access during the
procedure.
After the Procedure
- Monitor VS on the opposite
arm of the insertion site
- Examine the injection site
for hematoma and
swelling.
- Monitor for color,
temperature and pulse of
the affected extremity and
compare to the non
affected side.
- Apply cold compress to the
injection site to decrease
edema and pain.
 ● Sexual activity. Sexually active women tend to have more UTIs than do women who aren't sexually
active. Having a new sexual partner also increases your risk.
● Certain types of birth control. Women who use diaphragms for birth control may be at higher risk, as
well as women who use spermicidal agents.
● Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract that
make you more vulnerable to infection.
● Urinary tract abnormalities. Babies born with urinary tract abnormalities that don't allow urine to leave
the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
● Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder and
increase the risk of UTIs.
● A suppressed immune system. Diabetes and other diseases that impair the immune system — the
body's defense against germs — can increase the risk of UTIs.
● Catheter use. People who can't urinate on their own and use a tube (catheter) to urinate have an
increased risk of UTIs. This may include people who are hospitalized, people with neurological
problems that make it difficult to control their ability to urinate and people who are paralyzed.
● A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical
instruments can both increase your risk of developing a urinary tract infection.

Causative Agent for UTI

● Escherichia coli remains the predominant uropathogen (80%) isolated in acute community- acquired
uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%). Klebsiella,
Enterobacter, and Proteus species, and enterococci infrequently cause uncomplicated cystitis and
pyelonephritis.

Health Teachings for UTI

● Advocate for adequate fluid intake, particularly water, to help flush bacteria out of the urinary tract and
maintain proper hydration.
● Encourage good personal hygiene practices, such as wiping from front to back after using the toilet and
regular bathing, to minimize the risk of introducing bacteria into the urethra.
● Promote the importance of emptying the bladder regularly, as holding in urine can create a breeding
ground for bacteria, and consider avoiding irritants like excessive caffeine and alcohol which can irritate
the bladder.

Colonization
● pathogen colonizes urethra and ascends towards the bladder
● inflammation of e. coli to the urethra – inflammatory cytokines — activation of inflammatory can lead to
UTI — urethritis

Ascension
● bacteria ascends towards the kidneys through the ureters
● swelling of prostate gland – compression of the ureter – dec. urine outflow – backflow of urine from
ureter to urinary bladder – UTI
Adult Voiding Dysfunctions

Urinary Incontinence
● Defined as involuntary or uncontrolled loss of urine from the bladder

Stress Incontinence - is the involuntary loss of urine through an intact urethra as a result of sneezing,
coughing, or changing position. Due to increased abdominal pressure.

Urge Incontinence - is the involuntary loss of urine associated with a strong urge to void that cannot be
suppressed.

Functional Incontinence - Condition such as cognitive impairment leads to urinary incontinence.

Iatrogenic Incontinence - refers to the involuntary loss of urine due to extrinsic medical factors, predominantly
medications.

Causes of Urinary Incontinence

Urinary Retention

1. Enlarged prostate gland

a. Common to male
b. Age 50 below
c. Inflammation of prostate gland: Prostatis
d. May lead to Benign Prostate Hyperplasia – prostate cancer
2. Urethral structure or narrowing
3. Stone formation in the bladder or urethra
a. Common causes: renal calculi = stone formation in the renal tract (ureters, bladder, urethra) 4.
b. Tumor growth
4. Narrowing of the urethral sphincter (external and internal)
Renal Calculi

5 Types of Renal Stones

1. Calcium oxalate stone (Is the most common 80%)
2. Calcium phosphate stone
3. Struvite stone (Triple stone)
4. Uric acid stone
 5. Cystic stone

Ureterolithotomy - refers to the open or laparoscopic surgical removal of a stone from the ureter.

Pyelolithotomy - is a surgical procedure used in cases involving a stone in the renal pelvis.

Partial Nephrectomy - is the removal of part of the kidney, usually because of a tumor, while sparing the
remainder from damage or removal.

BPH

Testosterone Production
● Testosterone is primarily produced in the testes in men and the ovaries and adrenal glands in women.
The process begins with the hypothalamus releasing gonadotropin-releasing hormone (GnRH), which
stimulates the anterior pituitary gland to release luteinizing hormone (LH) and follicle-stimulating
hormone (FSH). LH then acts on the Leydig cells in the testes to stimulate testosterone production,
which plays a vital role in male sexual development and functions.

Dihydroxytestosterone - this is the hormone that when elevated could be an indication of BPH

7-8. 5 Alpha reductase inhibitors and alpha adrenergic receptor blockers

9. intermittent catheterization
10. Trans Urethral Resection of Prostate (TURP)
11. Trans urethral electroraporization of prostate (TUVP)
12. Trans urethral needle ablation (TUNA)
13. laser prostectomy
14. intraprostatic urethral stents
15. Trans urethral microwave thermotherapy - Uses trans uretheral probe to deliver the heat

Hematuria
● In acute glomerulonephritis, the inflammation and damage to the glomeruli, which are the filtering units
of the kidneys, can result in the leakage of red blood cells into the urine, leading to hematuria. This
occurs due to increased permeability of the damaged glomerular filtration membrane, allowing red
blood cells to pass into the urinary space and be excreted in the urine.

Edema
● Edema in acute glomerulonephritis is primarily a result of the impaired kidney function. The damaged
glomeruli are less effective at filtering waste products and excess fluid from the bloodstream, causing
fluid retention in the body and leading to the development of edema, typically in the ankles, legs, and
sometimes the face.

Azotemia
● Azotemia in acute glomerulonephritis arises due to the decreased ability of the inflamed glomeruli to
effectively filter waste products and excess nitrogenous compounds from the bloodstream. As a result,
elevated levels of nitrogenous waste products like urea and creatinine accumulate in the blood, leading
to azotemia, which is characterized by elevated blood urea nitrogen (BUN) and serum creatinine levels.
Hypertension
● In acute glomerulonephritis, the inflammation of the glomeruli can disrupt the regulation of blood
pressure by the kidneys. This dysfunction can lead to increased retention of salt and water, contributing
to an expansion in blood volume and subsequently causing hypertension.

Hypoalbuminemia
● The inflammation and damage to the glomeruli in the kidneys can result in increased permeability of the
glomerular filtration membrane, allowing albumin (a blood protein) to leak into the urine. This loss of
albumin from the bloodstream leads to a decrease in serum albumin levels, contributing to
hypoalbuminemia.

Hyperlipidemia
● characterized by elevated levels of lipids (cholesterol and triglycerides) in the blood, can occur in acute
glomerulonephritis due to disturbances in lipid metabolism often associated with kidney inflammation
and dysfunction.

Elevated creatinine
● indicative of impaired kidney function, as the inflammation and damage to the glomeruli can hinder the
effective filtration of waste products, leading to a buildup of creatinine in the blood.

Hypertensive encephalopathy
● can develop in acute glomerulonephritis due to severe, uncontrolled hypertension, leading to cerebral
edema and neurological symptoms, including confusion, seizures, and altered consciousness.

Heart failure
● can occur in acute glomerulonephritis when the increased fluid volume, elevated blood pressure, and
salt and water retention, associated with impaired kidney function, lead to strain on the heart, potentially
resulting in congestive heart failure.

Pulmonary Congestion
● Pulmonary congestion can develop in acute glomerulonephritis due to fluid overload, which can lead to
the accumulation of excess fluid in the lungs, resulting in symptoms such as shortness of breath and
cough.