AMBO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF ADULT HEALTH NURSING

SEMINAR PRESENTATION ON

RENAL AND URINARY TRACT PATHO GEINES FOCUSED

ON URINARY TRACT INFECION

Sumbitted to: Tesfaye H. (MD, Pathologist)

Ambo, Ethiopia

January ,2022
1
12/23/2023
 Pathophysiology of renal and urinary tract infection
Present by :Habonuf Delesa (student AHN)
ID.NO.PGR/56454/14
2
12/23/2023
 Presentation Outline
• Objective
• Introduction
• Disorder of renal and urinary tract
• Etiology
• Epidemiology
• Classification of UTI
• Pathogenesis
• Clinical presentation
• Complication
• Diagnosis ,Treatment and prevention
• References

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 Objective
At the end of this presentation, you’ll be able to:

• Explain anatomy and physiology of renal system

• Describe the renal and urinary tact disorder
• Define urinary tact infection
• List the etiologies & describe the epidemiology of UTI
• Explain the pathogenesis & describe the manifestation of UTI
• List the common complications UTI
• Describe the diagnosis of UTI
• Treat UTI with appropriate antibiotics.
• Design appropriate methods of prevention and control of UTI

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 INTRUDACTION

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 Review function of urinary system

The propose of urinary system is:.

 Eliminate waste from the body

 Regulate body volume and blood pressure

 Control level of electrolyte and metabolites

 Regulate blood PH

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 Phathophysiology of Renal and urinary tract
diorders

Renal disorders
❖Renal failure (Acute & Chronic)
❖Obstruction of urinary system
❖Urinary tract infection
❖Disease of kidney
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 Renal failure

❖ Renal failure is a systemic disease and is a final common

pathway of many different kidney and urinary tract diseases

❖ Renal failure is a severe impairment or total lack of kidney

function.

❖ Renal failure results when the kidneys cannot remove the

body’s metabolic wastes or perform their regulatory

functions.

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 Renal failure
 Classified in to ARF and CRF depending on the duration of

onset.

Acute Renal failure

➢ A rapid decline in glomerular filtration rate (GFR) over

hours to days.

➢ A rapid deterioration of renal functions resulting in the

accumulation of nitrogenous wastes.

➢ Usually reversible with medical treatment.

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 Renal failure
Causes:
1. Prerenal: sudden drop in blood volume renal or blood
flow due to severe dehydration, hemorrhage, shock or
trauma
2. Intrinsic: damage to kidney cells secondary to
sustained shock, trauma, surgery, septicemia,
nephrotoxic agents, acute glomerulonephritis
3. Post renal : (obstructive) Kidneys can form urine, but
excretion is impeded

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 Chronic Renal Failure

A slow & gradual, progressive loss of renal function (GFR)

of less than 60 ml/minute) over months to years.

Irreversible, progressive destruction of nephrons leads to

End Stage Renal Disease (ESRD) .

Presence of kidney damage, regardless of the cause, for

three or more months.

This leads to a decreased ability to remove waste products

from the body and perform homeostatic functions.
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 Chronic Renal Failure

Causes:

✓ Diabetic nephropathy: the most common cause

✓ Hypertensive nephrosclerosis

✓ Glomerulonephritis, chronic pyelonephritis

✓ Renovascular disease (ischemic nephropathy)

✓ Polycystic kidney disease

✓ Interstitial nephritis, including analgesic nephropathy

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 Pathophysiology of renal failure

 In renal failure there either glomerular or tubular dysfunction

 Glomerular dysfunction; as the main function of glomeruli is

filtration ,glomerular dysfunction leads to fail in GFR with

retention of those substance usually cleared by filtration
including water.

 Tubular dysfunction as main function of tubular is reabsorption

tubular failure results in the voiding of large volumes of dilute

in urine of low specific along, with electrolytes and nutrients
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 Obstructive Renal Disorders

• Occurs when a structural or functional defect in the urinary

tract interrupts urine flow

• Result from intrinsic or extrinsic mechanical blockade as well

as from functional defects not associated with fixed occlusion

of the urinary drainage system

• It is the common cause ARF and CRF

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 Obstructive Renal Disorders

✓ Obstruction can occur at any point along the urinary tract from

the renal tubules to the end of the urethra( unilateral/ bilateral)

Types of obstruction

✓ Mechanical blockade

-Intrinsic (due to factors within the urinary tract)

-Extrinsic (due to factors outside the urinary tract).

✓ Functional defects (neurogenic)or Congenital.

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 Obstructive Renal Disorders

cause cause
Congenital Acquired
✓ Urethral strictures
✓ Meatal stenosis. inflammatory
✓ Ureteral strictures. or traumatic.
✓ Bladder outlet obstruction
✓ Posterior urethral strictures. (BPH)
✓ Ureterovesical junction ✓ Vesical tumor.
obstruction ✓ Neuroginec bladder.
✓ Extrinsic ureteral
✓ ureteropelvic junction compression.
obstruction. ✓ Ureteral or pelvic stones,
✓ Neurologic deficits strictures and tumor.

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 Renal Calculi (kidney stone)

✓ Called nephrolithiasis (stones form in kidneys)

✓ Most commonly develop in the renal pelvis but can be

anywhere in the urinary tract.

✓ Males affected than females

✓ May stay in kidney or travel into the ureter.

✓ Can damage the urinary tract and chance of recurrence

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 Renal Calculi (kidney stone)
Cause :
✓ Prolonged immobilization, Obstruction, Urinary retention,

Medical conditions causing hypercalcuria.

✓ Excessive intake of vitamin D, milk and alkali, Medications-

antacids, laxative and high doses of aspirin.

✓ Anything which causes the urine to be alkaline.

✓ Metabolic factor:

o Hyperparathyroidism, Elevated uric acid

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 Pathophysiology
Formation of stones involve 3 conditions
✓ Slow urine flow – super saturation of urine.
✓ Damage to the lining of the urinary tract – from crystals.
✓ Decreased inhibitor substances – that would otherwise
prevent super-saturation and crystal formation.

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 Investigation

RFT,Serum electrolytes, Urinalysis

Renal ultrasound,
Doppler ultrasound of renal vessels,
CT scan (abdomen and pelvis)
Management

Treatment of the underlying causes

Dietary management

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 Urinary tract disorder

Urinary tract is the body drainage system for removing urine

which made up of waste and extra fluid

➢ The urinary tract the organ system primarily responsible for

cleaning and filtering excess fluid and waste material from the
blood

Urinary tract disorder is include :.

➢ Urinary tract infection ,glomerulonephritis, pyelonephritis ,

nephritis ,nephroticsyndrome, renal calculi

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 Urinary tract infection

UTI is an infection of any part of urinary system

➢ Presence of microorganisms in the urinary tract.

➢ Symptomatic presence of microorganisms within the urinary

tract i.e., kidney, ureters, bladder and urethra

➢ Associated with inflammation of urinary tract.

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 Urinary tract infection

Etiology

Bacteria :the most common Escherichia coli(80%)

✓ Others: Kelbsiela pneumoniae , Pseudomonas

aeruginosa Staphylococcus saprophyicus..Etc

✓ Candida species (fungus) cause in critically ill and

catheterized patient

✓ Parasite:trichomonas vaginalis,schistosomoa

haematobium
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 Epidemiology

❑ Common in females

Reasons
 Much shorter length of urethra in female than in male

 Microorganism have to travel less distance to reach the

urinary tact
 Pregnancy

-hormonal change

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 Urinary tract Infections (UTI)

➢ According to the presence of structural urinary tract

problem(patient-related condition)

Uncomplicated UTI

 No structural or functional abnormality in urinary tract

 No interference with the urine flow

 More common in female (age15-45 years)

 Male less develop uncomplicated UTI

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 Urinary tract Infections (UTI)

Complicated UTI

➢ structural or functional abnormality in urinary tract

➢ Due to stone, catheter or prostatic hypertrophy, which interfere

follow of urine

➢ May occur in both gender

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 Urinary tract Infections (UTI

Recurrent UTI-refers to multiple symptomatic UTIs with

asymptomatic periods in between.

➢ It is considered significant when there are two or more

symptomatic episodes per year or it interferes with patient‘s

quality of life.

➢ It is usually a reinfection than a relapse.

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 Pathogenesis

1.Root of enter of bacteria

2.Hoste defense mechanism

3.Bacterial virulence

4.Factor predisposing to UTI

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 Pathogenesis

Route of infection:.

The routes of bacterial entry to urinary tract.

➢ Ascending route ( urethra-kidney)

➢ Descending route

➢ Lymphatogenous route

➢ Direct extension from other organs

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 Pathogenesis

12/23/202
30
3
 Pathogenesis
Ascending route most common
 The urinary tract should be viewed as a single anatomic unit that is
united by a continuous column of urine extending from the urethra
to the kidney and bacteria gain access to the bladder via the urethra.
 Ascent of bacteria from the bladder may follow and is probably the
pathway for most renal parenchyma infections.
 Whether bladder infection ensues depends on interacting effects of
the pathogenicity of the strain, the inoculums size, and the local and
systemic host defense mechanisms.

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 Pathogenesis

Descending route
 Descending spread less frequent than ascending infection

 Occurs most often time in debilitated patients who are either

chronically ill or receiving immunosuppressive therapy.
 Metastatic staphylococcal or candidal infections of the
kidney may follow bacteremia or fungemia, spreading from
distant foci of infection in the bone, skin, vasculature, or
elsewhere

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 Pathogenesis

Lymphatogenous route:

 Men- through rectal and colonic lymphatic vessels to

prostate and bladder.

 Women- through periuterine lymphatics to urinary tract.

Direct extension from other organs:

 Pelvic inflammatory diseases

 Genitor-urinary tract fistulas

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 Pathogenesis

2.Host defense mechanisms

• Normally urinary tract generally is resistant to invasion

by bacteria and efficient in rapidly eliminate

microorganism that reach the bladder

➢ Reasons:. -Low ph(acid) of urine

- high urea concentration ,

-very high osmolality

• So, loss of these protective mechanism predispose to UTI

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3
 Pathogenesis

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 Pathogenesis

3.Bacterial virulence 3.Bacterial virulence

• Virulence i.e. capacity to

induced disease
• Bacteria that attach to urinary
epithelium are virulent
• E.coli has fimbriae hair like
structure to help in attachment
• so, if E,coli attach urinary
tubules it can retention to
produce UTI
36 12/23/2023
 Pathogenesis

4.Factor predisposing to UTI

 Structural abnormalities UT that obstruct or slow urine

flow/increase the adherence of bacteria to mucosal surface

Disease:. Prostatic hypertrophy, Stroke, Long standing diabetes

,Spinal cord injury

Others :. urinary catheters ,Bladder tumors, Calculi/stones in

the ureters or kidneys, Pregnancy(anatomical and hormonal
change) ,Vesicoureteral reflux(common in children)

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 Pathogenesis
 An important virulence factor of bacteria is their to adhere to

urinary epithelial cell by fimbriae,resultin in colonization of

urinary tract, bladder infection, and pyelonephritis.

 Other virulence factors include hemolysin,a cytotoxin protein

produced by bacteria that lyses wide range of cell including

erythrocyte,polymoronuclear leakocytes,and monocytes,and
aerobactin,which facilitates the binding and uptake of iron by
E.coli

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39 12/23/2023
 Pathologies of UTI

➢ as infections involving the upper or lower urinary tract

1. Lower UTI
✓ urethritis /urethra
✓ Prostatitis /prostate
✓ Cystitis/ bladder

2.Upper UTI
✓ Pyelonephritis
✓ Ureteritis

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12/23/2023
 Lower UTI

Urethritis - is an inflammation of the urethral mucosa usually

an ascending route

➢ infection involves the tissues around the urethra

Clinical manifestation

➢ Urgency

➢ frequency and dysuria

➢ burning sensation, Hematuria… etc

41 12/23/2023
 Lower UTI

cystitis: is an acute or chronic inflammation of the urinary

bladder that is most often by ascending infection from urethra.

 Infection result when the bacteria ascends to the urinary

bladder

 Cause: Ascending bacteria infection from the urethra

 Urethrovesicular reflux;

-flowing back of urine from the urethra in the bladder

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 Lower UTI

The cystitis clinical manifestation

➢ Usually report dysuria,

➢ Frequency

➢ Urgency,

➢ suprapubic pain.

➢ Purulent urethral discharge present.

43 12/23/2023
 Lower UTI

Prostatitis:.is inflammation of prostate gland.

➢ Caused by infections: Bacteria, Fungi and Urethral stricture

& hyperplasia of prostate

Clinical Manifestation : Perineal pain and discomfort,

Urgency , frequency and dysuria.Prostatodynia (pain in
the prostate) on voiding and Sudden onset or fever &
chills

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 Upper UTI

Ureteritis : is infection of the ureter

✓Primary disorder of the ureters occurs less frequently than

disease of the other part of the urinary system.

✓This may lead to a back flow of urine from ureter to kidney

✓Ureteritis occurs with pyelonephritis

✓Calculus may become lodged within a ureter causing an

obstruction of the flow of urine as well as severe pain.

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 Upper UTI

 Pyelonephritis: is bacterial infection of the renal pelvis,

tubules, and interstitial tissue of one or both kidneys.

 Secondary to ureterovesical reflux in which incompetent

ureterovesical valve allows the urine to back up into the

ureters.

 Cause: Ascending infection , urethra ,bladder, ureter , kidney

 Due to hematologic spread it can be acute or chronic

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 Upper UTI

Acute pyelonephritis

Active infection manifested by:-fever, chills, CVA tenderness

,nausea, vomiting, tachycardia, and symptoms of lower UTI
such as dysuria and frequency.

Chronic Pyelonephritis:May be due to repeated attack of

acute pyelonephritis.

➢ Noticeable signs include:. fatigue, poor appetite headache,

polyuria, excessive thirst, and weight loss.

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 pathopysiology
Resulting fibroses
Microbial invasion • Decreased tubular
reabsorbation and
renal pelvis secretion

• Inflammatory response

Impaired renal
function

48 12/23/2023
 clinical manifestation

Upper UTI Lower UTI

 Flank pain  Pain and burning sensation

 Lumber tenderness  Frequency

 Frequency  dysuria

 Dysuria  Nocturia

 Fever ,chills  Hematutria

 Nausea and vomiting  Fever, chills ,malaise

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 Complication of urinary tract infection

• In pregnancy
- Abortion, premature delivery, low birth weight
• Recurrent infection
• Permanent kidney damage
• Urethral narrowing
• End stage renal disease
• Sepsis
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 Diagnosis

1. Urinalysis:
• Urinary sediment : Leukocytes are found in the urine : > 5
WBCs/ high power field in centrifuged urine or > 10 WBCs/
higher power field in unspun urine suggests UTI
• Microscopic bacteruria: single microorganism per oil
immersion field of unspun urineis indicative of a colony
growth on culture of more than 105 colonies /ml.
• Gram stain of urethral discharge may be help full in patients
suspected of having STI associated urethritis
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 Diagnosis

2. Culture of the urine: is a definitive means for diagnosis

• A clean catch , mid stream urine specimen should be collected

• The growth of more than 105 colonies /ml in the presence of

symptoms signifies infection that needs treatment

3. Blood: increased WBCs in the blood

4. Radiologic urologic evaluation: may be help full in

identification of some predisposing conditions such as
urolithiasis, BPH, vesicoureteral reflux
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 Managements

Goals of therapy:
✓ Elimination of infection

✓ Relief of acute
symptoms,
✓ Prevention of recurrence
and long term
complications
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 Management

Antibiotic therapy

1. Acute Uncomplicated lower UTI

✓ Trimethoprim ,Sulfamethoxazol , Norfloxacin

2. Acute uncomplicated pyelonephritis

✓ Norfloxacin /Ciprofloxacin (BID for 7-14 days )

Single dose of Ceftriaxon 1gm or Gentamicin 80 mg IV

followed by Trimethoprim ,Sulfamethoxazol (PO BID for 14
days
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 Management

3.Complicated UTI

✓ Norfloxacin or Ciprofloxacin (PO BID for 10-14 days

4. Severe illness or possibleurosepsis: hospitalization is

required.

✓ Ceftriaxone ,Gentamicine,Ampicillin Asymptomatic

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 Nursing management
• Encourage patient to drink fluid

• Administered antibiotics as order

• Encourage patient to void frequently

• Patient education

56 12/23/2023
 prevention
 Urinate after and after
sexual activity
 Good hygiene
 Drink plenty of water
 don’t hold urine in for
long period of time
 Wipe front to back after
urinate or defecating
 Avoiding potentially
irritant feminine product

57 12/23/2023
 References:
• Kasper L., Braunwald E., Harrison’s principles of Internal medicine, 16th
Edition,Urinary tract infection and pyelonephritis , pages 1715-1721.
• Myers R. Allen, National Medical Series for independent Study (NMS)
3rd edition Medicine, Urinary tract infection, Pages 284-285.
• Smelter s.c.,Bare B.G.,(Brunner and suddarths medical surgical
nursing,.lippencot
• Pathophysiology of disease introduction to clinical medicine seven
edition, renal disease, page 466.
• https://youtu.be/udoh0j6adGI /http://youtu.be/KY8oeT9-RGg
• standard treatment guideline for general hospitals in Ethiopia 4th edition
,page 442-447

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 Acknowledgement

I would like to forward my deepest gratitude

to my instructor : Dr. Tesfaye H. (MD,
pathologist) for providing us this opportunity
of presentation and gave us the chance to
deal with renal and urinary tract pathologies
focusing on UTI

59 12/23/2023
THANK
YOU!!