UNIT 5 URINARY SYSTEM 5.1. ANATOMY AND FUNCTIONS Anatomy of the Kidney Front View of Urinary Tract LEAD IN 1 Learn the following words. bladder [‘bleedo(r)] cevosnit mixyp cortex [‘ko:teks] kopa hilum | ['harlom] popora, BuiMKa - kidney ['kadnt] HIpKa - medulla [me'dalo] plural medullae | [me'dali] (uupxu a60 HazHupHuKa) papilla [po'pilo] cocouoK parenchyma |[po'renkime] | napenximaUnit 5. URINARY SYSTEM pelvis [pelvis] | HMPKOBa Micka pyramid — ['promid] | nipamiza renal 1 | ampKopuit ureter ————( u're] cewonia urethra [jo'r:0re] | yperpa, cesonnpigunit Kanan urination [jenna] | cevosmnyckanna urinary | [juormert] | nMpKonnit fibrous. | ['faibros] | hi6posmmit tuft [taft] uyyoK tubule [tu:bju:l] rpy6ouka, Kaxanenp funnel [ fanl] BOpoHKa 2 Some facts about the urinary system. 1. On average, the kidneys filter about 180 | of blood daily, producing around 1 to 21 of urine. 2. The bladder is a muscular organ that expands to store urine. It can hold about 400-600 ml of urine in adults before the urge to urinate is felt. 3. Urine is composed of water, electrolytes, metabolic waste products, and other substances filtered by the kidneys. It can vary in color, smell, and composition based on factors such as hydration, diet, and health condi- tions. 4, The urinary system works closely with the circulatory system. 5. The urinary system plays a crucial role in removing nitrogenous waste products, such as urea and creatinine, which are byproducts of protein metabolism. 6, The average person produces about 1 to 21 of urine per day, depending on fluid intake and other factors. 7. The urinary system undergoes changes with age. As we get older, the kidneys gradually decrease in size and their filtering capacity may di- minish. 8. ‘Ihe kidneys produce a hormone called erythropoietin, which stimu- lates the production of red blood cells in the bone marrow. 5.1. ANATOMY AND FUNCTIONS Think about the anatomy of the urinary system. El Match the components of the systern with their definition. iegiadneys a. thin, muscular tubes that transport urine from the . ¥ kidneys to the bladder. 2. ureters b. the outer region of the kidney c. two bean-shaped organs responsible for filtering 3. glomerulus |” aste products and excess fluids from the blood. d. a tube that carries urine from the bladder to the outside A: urethra of the body during urination. 6 eee e. a hollow, muscular organ that stores urine until it is . ready to be eliminated from the body. 6. bladder f. the inner region of the kidney tiny ball of capillaries (microscopic blood vessels) in g 7. medulla the kidney. 4 Read the text. URINARY SYSTEM The urinary system, also known as the renal system, is responsible for the production, storage, and elimination of urine from the body. It consists of several organs that work together to maintain the body’s fluid balance and remove waste products. The kidneys, situated retroperitoneally on either side of the spine in the lumbar region, are two bean-shaped organs. They are protected by a cushion of fatty tissue and fibrous connective tissue. Each kidney is about the size of a fist. The kidneys are composed of an outer cortex region, resembling the bark of a tree, and an inner medulla region, resembling marrow. The hilum is located on the medial border of the kidney and serves as a depression through which blood vessels and nerves pass. Microscopic structure of kidneys. The nephron is the functional unit of the kidney and is responsible for urine formation. Each kidney contains millions of nephrons. A nephron consists of a renal corpuscle and a renal tubule. The renal corpuscle consists of a glomerulus, a tuft of capillaries, and a surrounding Bowman's capsule. The renal tubule is composed of several a.Unit 5. URINARY SYSTEM segments, including the proximal convoluted tubule, loop of Henle, and distal convoluted tubule. The glomerulus is a network of specialized capillaries located within the renal corpuscle. It is responsible for the initial filtration of blood. Blood is filtered across the capillary walls into the Bowman's capsule, forming a fluid called filtrate. ‘The renal tubules are tubular structures that process the filtrate and reab- sorb necessary substances back into the bloodstream while eliminating waste products. The proximal convoluted tubule is involved in reabsorption, the loop of Henle regulates water and electrolyte balance, and the distal convo- luted tubule is involved in further electrolyte reabsorption and urine concen- tration. The collecting ducts receive processed filtrate from multiple nephrons and carry it towards the renal pelvis. Macroscopic structure of kidneys. ‘The outer region of the kidney is called the cortex. It surrounds the medulla and contains renal corpuscles, proximal and distal convoluted tubules, and parts of the collecting ducts. The medulla is the inner region of the kidney, consisting of renal pyra- mids. Each pyramid contains several parallel tubules called collecting ducts. ‘The medulla is responsible for regulating water balance and concentrating urine. ‘The renal pelvis is a funnel-shaped structure at the center of the kidney. It collects urine from the collecting ducts and transports it into the ureter for elimination. ‘The kidneys have an extensive network of blood vessels that supply them with oxygenated blood for filtration. The renal artery brings oxygenated blood to the kidneys, and the renal veins carry filtered blood back to the circulatory system. ‘The ureters are muscular tubes 25-30 cm long that connect the kidneys to the urinary bladder. There are two ureters, one for each kidney. Their main function is to transport urine from the kidneys to the bladder. The ureters use peristaltic contractions to propel urine downward into the bladder. ‘The urinary bladder is a hollow, muscular sac that is located in the pelvic cavity. Its primary function is to store urine until it is ready to be eliminated from the body. The bladder expands as it fills with urine and contracts during urination to excrete the urine through the urethra. ‘The urethra is a tube that carries urine from the bladder to the outside of the body. In males, the urethra is longer and more complex than in females. On average, the male urethra is about 20-25 cm, the length of the female ure- thra is approximately 3 to 4. cm. 5.1. ANATOMY AND FUNCTIONS The urinary system performs several important functions in the body. Here are some of its key functions: filtration of waste products, toxins and their excretion, regulation of water, electrolyte, and acid-base balance, blood pressure regulation, red blood cell production, vitamin D activation, detoxifi- cation, hormone metabolism. LANGUAGE DEVELOPMENT Match the following laboratory tests and clinical procedures with their definitions. 1. blood urea nitrogen | a. X-ray examination (with contrast) of the (BUN) blood vessels of the kidney b. image of the kidney obtained after injecting a 2. creatinine clearance radioactive substance (radioisotope) into the bloodstream c. X-ray examination (without contrast) of the 3. renal angiography kidneys, ureters, and bladder d. measurement of the rate at which creatinine is 4. ultrasonography cleared from the blood by the kidney e. X-ray images obtained using computed 5. radioisotope scan tomography show multiple cross-sectional and other views of the kidney 6. cystoscopy f. measurement of urea levels in blood 7. kidneys, ureters, g. imaging of urinary tract structures using and bladder (KUB) | high-frequency sound waves h. direct visualization of the urethra and urinary 8. CT urography bladder with an endoscope 6 Complete the sentences using appropriate prepositions. 1. The kidneys are located .... the abdominal cavity. 2. A cushion of adipose tissue surrounds each kidney .... protection. 3. Blood vessels and nerves pass .... the hilum of the kidneys.Unit 5. URINARY SYSTEM ection eae 5.1, ANATOMY AND FUNCTIONS 4, The ureters carry urine .... the kidneys .... the urinary bladder. 5. The trigone is a triangular region .... the base .... the bladder. 2 Answer the following questions. x a eys consist .... an outer cortex region and an inner medulla ; 1. Where are the kidneys located in the body? is i 2 7. ‘The kidneys are located .... either side .... the spine. 2, Howare the kidneys protected®, 2 4c. : 3. What are the two main regions of the kidneys? 8. The urethra exits .... the trigone .... the bladder. ; ‘ ‘ a 7 4, What is the function of the hilum in the kidney? 9. The cortex region is located .... the outer part of the kidneys. fag . , . a . 5. What is the nephron, and what is its role? 10. The kidneys are located .... either side of the spine in the lumbar region. 6. What are the components of the renal corpuscle? Read the following pairs of words. 7. Name the segments of the renal tubule and their functions. Circle “S” if they are synonyms and circle “A” if they are antonyms. 8. What is the function of the collecting ducts? 9. What is the structure of the cortex and medulla in the kidney? 10. What is the role of the renal pelvis? 1. produce consume s A 11. What are the functions of the ureters, urinary bladder, and urethra in 2. disease health Ss A the urinary system? . . n 3. infection inflammation Ss A 12. What are the functions of the urinary system? 4. hollow full Ss A 5. contraction dilation s A ie Pes ae mnOre, Ss A 1 Complete the following outline about the kidneys. 7. major minor Ss A - ‘A: Shape: 8. critical insignificant Ss A B: Location: 9. structure organ s A C: Main Functions: 10. i approximately | exactly s A i D: Parts of the kidney: a: nephrons 8 Agree or disagree with these statements. Function: 1. The urinary system consists of the kidneys, liver, and spleen. 2. The urethra is longer in males than in females. 3. The primary function of the urinary system is to produce hormones. 4, The urinary bladder stores and eliminates urine. 5. The ureters connect the kidneys to the liver. 6, ‘The urinary system is responsible for regulating the body's water balance. 7. The urinary system plays a role in the production of red blood cells. 8. ‘The kidneys filter waste products and toxins from the blood. 9. Urine is produced in the urinary bladder. 10. The urinary system is not involved in maintaining blood pressure. b: glomerulus Function: c: renal tubule Function: d: renal pelvis Function:Unit 5. URINARY SYSTEM e: collecting ducts Function: Read the text and name the appropriate test for detecting or evaluating each of the following. . Sugar in urine . Level of bile pigment in urine . Hematuria Albumin in urine . Structuresin theshapeofrenaltubulesinurine . Chemical reaction of urine . Dilutionorconcentrationofurine. . Acetones in urine . Pus in urine weNaunAawne URINALYSIS Urinalysis is the examination of urine to identify the presence of abnormal components that may show various pathological conditions. The following are several tests that are part of a urinalysis: Color. Normal urine typically is yellow or straw-colored. A colorless or pale urine suggests a high water content, while a smoky-red or brown col- or indicates the presence of significant amounts of blood. Certain foods and medications can also cause urine to appear red. Appearance. Normally, urine is clear. Cloudy or turbid urine suggests a urinary tract infection characterized by the presence of pus (pyuria) and bac- teria (bacteriuria). pH. pH determination reveals the chemical nature of urine and indicates its acidity or alkalinity (basic) level. Normal urine has a slightly acidic pH of around 6.5. However, urine pH may become alkaline due to bacterial activity. Protein. In normal conditions, urine contains small amounts of protein, but not enough to yield a positive result in routine testing. When urinary tests for protein yield positive results, it is usually due to the presence of albumin. ro, 5.1. ANATOMY AND FUNCTIONS Albumin is the primary protein found in blood plasma. The detection of al- bumin in urine (albuminuria) may indicate a breach in the glomerular mem- brane, allowing albumin to enter the renal tubule and be excreted in the urine. Glucose. Typically, sugar is not detected in urine. However, its presence (glycosuria) often indicates diabetes mellitus. In this condition, excessive sug- ar in the bloodstream (hyperglycemia) causes sugar to ‘spill over’ into the urine as the renal tubules cannot reabsorb all the filtered sugar. Specific gravity. The specific gravity of urine is a measure of its density in comparison to water and reflects the amounts of wastes, minerals, and solids present. In patients with diabetes mellitus, the specific gravity of urine is high- er than normal due to the presence of sugar. Ketone bodies. Ketones, such as acetones, are produced when fatty acids are broken down in the liver. When the body relies on fat rather than sugar for energy, ketones accumulate in the blood and urine. Ketonuria occurs in diabetes mellitus when cells utilize fat as an energy source due to sugar depri- vation. In cases of starvation, ketonuria and ketosis (elevated ketone levels in the blood) occur as abnormal fat breakdown takes place. Sediment and casts. The presence of abnormal particles in urine indicates an underlying pathological condition. These particles may settle at the bottom of a urine sample as sediment and can include epithelial cells, white blood cells, red blood cells, bacteria, crystals, and casts (cylindrical structures con- taining protein and cellular elements). Bilirubin. Bilirubin is a pigment that forms when hemoglobin breaks down, and it can be detected in the urine of individuals with liver disease (bilirubinuria). Another substance called urobilinogen, which is derived from the breakdown of bilirubin, may also be observed in the urine.UNIT 5 URINARY SYSTEM LEAD IN 5.2. NEPHRITIS 1 Learn the following words. bilateral ,bar'letaral] BOCTOpOHHiit dysuria dis jveria] qusypia, posmag | ceyvopumyckaHHa “interstitial “ntor’strfal] _ BHYTpilHbOTKaHMAHMit glomerulonephritis | [,glomarju:loonr fraitis] | rmomepynonedpur nephritis ni'fraitis] a Hepur pyuria — | [par juoria] | niypia, rit Bcegi pyelonephritis | [.paroloonr'frartrs] | nienoueppur urinalysis , Juare'neelisis] | anamis cei | oedema 1 di:mo] HaOpak oliguria Dlr gjuaria) onirypia, SMeHIIeHHA BYDieHHA Cedi permeability —_ | | p3:rmie'bilotr] | mpoumenicts _ nocturia. [nok (juoria] | Hixtypia, uiuna noniypia failure SS fealjo(@)] HeqoctatHict haematuria hypotensive "hema'tju(a)r1a] | [ haipov'tensiv] reMarypia, Kpos B ceui rinoTeHsuBHuii, 31 SHIDKEHMM KpOB’AHMM | THcKom 2 5.2. NEPHRITIS Write their meanings in the spaces provided. 1. nocturia 2. dysuria 3. oliguria 4. polyuria 5. anuria 6. pyuria 7. albuminuria 8. hematuria 9. glycosuria 10. ketonuria 11, bacteriuria Get familiar with some of the facts about nephritis and search for more information to present to the group. 1. Nephritis can affect people of all ages, but certain conditions such as diabetes, high blood pressure, and autoimmune diseases increase the risk. 2. If left untreated or poorly managed, nephritis can lead to kidney dam- age and chronic kidney disease, which may require dialysis or kidney transplantation. 3. The diagnosis of nephritis typically involves a combination of medi- cal history assessment, physical examination, laboratory tests (such as urine analysis and blood tests), and imaging studies. 4, Glomerulonephritis is a specific type of nephritis that affects the glom- eruli, the filtering units of the kidneys. It is often associated with im- mune system disorders. 5. The two main types of nephritis are acute nephritis and chronic nephri- tis. Acute nephritis develops suddenly and is often caused by infections, while chronic nephritis is a long-term condition that can lead to kidney damage and failure. 6. Nephritis can be caused by various factors, including infections, auto- immune disorders, certain medications, and exposure to toxins. 7. The most common type of nephritis in children is acute poststreptococ- cal glomerulonephritis, which typically follows a strep throat infection. 8. Children with nephritis may also experience symptoms such as ab- dominal pain, joint pain, and skin rashes.Unit 5. URINARY SYSTEM 4 Read the text. NEPHRITIS Nephritis is an inflammation of the nephrons, which are part of the kid- neys. There are several different types of nephritis, including glomerulone- phritis, pyelonephritis, and interstitial nephritis. Glomerulonephritis (GN). Glomerulonephritis is a type of kidney disease that involves inflammation of the glomeruli, which are the tiny filtering units in the kidneys. It is characterized by damage to the glomeruli, leading to im- paired kidney function and various symptoms. Glomerulonephritis can oc- cur suddenly (acute) or develop gradually over time (chronic). Glomerulonephritis can have various underlying causes, including infec- tions (e.g. strep throat or skin infections), autoimmune disorders (e.g. lupus), immunoglobulin A (IgA) nephropathy, vasculitis. ‘The signs and symptoms of glomerulonephritis can vary depending on the type and severity of the condition. Common symptoms include: hematuria, proteinuria, edema, hypertension, decreased urine output, fever, fatigue, nau- sea, vomiting, loss of appetite, flank pain. Diagnosis of glomerulonephritis typically involves a combination of med- ical history assessment, physical examination, laboratory tests (urinalysis, blood tests), and kidney biopsy to examine the kidney tissue. Treatment for glomerulonephritis aims to control symptoms, slow the progression of kidney damage, and address the underlying cause. Depend- ing on the type and severity of glomerulonephritis, treatment may include immunosuppressive drugs, such as corticosteroids and immunosuppressants, to reduce inflammation and suppress the immune response; medications to control blood pressure, such as angiotensin-converting enzyme (ACE) inhibi- tors or angiotensin receptor blockers (ARBs), to protect the kidneys and man- age hypertension; reducing salt and protein intake to alleviate the workload on the kidneys and manage fluid retention; dialysis or kidney transplantation. Pyelonephritis (PN). Pyelonephritis is a type of urinary tract infection (UTI) that specifically affects the kidneys. It is characterized by inflamma- tion and infection of the renal pelvis and the kidney tissue. Pyelonephritis is usually caused by bacteria, most commonly Escherichia coli (E. coli), which enter the kidneys from the lower urinary tract. It can occur in individuals of all ages, but it is more common in women and individuals with underlying urinary tract abnormalities. Ihe symptoms of pyelonephritis can vary in severity and may include: high fever, flank pain, abdominal pain, frequent urination, urgency to uri- —_ 5.2. NEPHRITIS nate, pain or a burning sensation during urination (dysuria), cloudy urine, blood in urine, fatigue, general malaise, nausea, vomiting. Diagnosis of pyelonephritis includes urine culture, urinalysis, imaging studies such as ultrasound, CT scan, or MRI. ‘The primary treatment for pyelonephritis is antibiotics to eradicate the bacterial infection. The choice of antibiotics depends on the severity of the infection, local antibiotic resistance patterns, and the results of the urine cul- ture. Commonly used antibiotics include fluoroquinolones, cephalosporins, or penicillins. Adequate hydration is essential to flush out the bacteria from the urinary system. Over-the-counter pain relievers, such as nonsteroidal an- ti-inflammatory drugs (NSAIDs) like ibuprofen, can help alleviate pain and reduce inflammation. In some cases, hospitalization may be required, espe- cially if the infection is severe, there are complications, or the individual is un- able to tolerate oral fluids or medications. Intravenous fluids and antibiotics can be administered in the hospital. If left untreated, pyelonephritis can lead to serious complications, such as kidney abscesses or sepsis. Interstitial nephritis (IN). Interstitial nephritis is a condition characterized by inflammation and swelling in the interstitial tissue of the kidneys. The in- terstitial tissue is the space between the kidney tubules where the blood ves sels and supporting structures are located. Interstitial nephritis can be acute or chronic and can occur due to various causes, including medications, infec- tions, autoimmune diseases, and systemic disorders. The symptoms of interstitial nephritis can vary depending on the underlying cause and whether it is acute or chronic. Common symptoms may include: fatigue and general malaise, fever, swelling (edema) of the legs, ankles, or face, decreased urine output, blood in the urine (hematuria), foamy urine, frequent urination, especially at night, high blood pressure (hypertension), back or flank pain. Diagnosis of interstitial nephritis include urine and blood tests to reveal the presence of white blood cells, red blood cells, protein, and other markers of kidney damage, to measure creatinine and blood urea nitrogen (BUN) lev- els; imaging tests, such as ultrasound or CT scan, to evaluate the size, shape, and structure of the kidneys and detect any abnormalities. In some cases, a kidney biopsy may be necessary to obtain a small sample of kidney tissue for examination under a microscope. This helps confirm the diagnosis and deter- mine the specific cause of interstitial nephritis. The treatment of interstitial nephritis aims to address the underlying cause and manage symptoms. Depending on the cause and severity of the condi tion, treatment may include corticosteroids or immunosuppressive drugs, maintaining adequate hydration and managing blood pressure levels, treat ment of underlying infections or systemic disorders. -Unit 5. URINARY SYSTEM LANGUAGE DEVELOPMENT 5 Match the following terms with their definitions. fea a. abnormal particles present in the urine-cells, . albuminuria 7 bacteria, casts, and crystals . : i f | bilirubinuria b. smoky-red color of urine caused by the presence ot blood c. turbid (cloudy) urine caused by the presence of . glycosuria polymorphonuclear leukocytes and pus : d. urine test that reflects the acidity or alkalinity of . hematuria " the urine ; e. sugar in the urine; a sign of diabetes mellitus and a . ketonuria ; result of hyperglycemia H f. high levels of acids and acetones accumulate in the .P urine as a result of abnormal fat breakdown ri g. dark pigment that accumulates in urine as a result + Pyuria of liver or gallbladder disease - h. urine test that reflects the concentration of the . sediment . urine i. leaky glomeruli can produce accumulation of . specific gravity ‘ protein in the urine Complete the sentences with the words and word-combinations from the box. hypertension _acterial infection urinary obstruction pyelonephritis dysuria pyuria antibacterial therapy complaints 1. The most common form of glomerulonephritis is caused by 2, is an important treatment approach for bacterial-related glomerulonephritis. 3. Patients with glomerulonephritis may have specific related to kidney dysfunction. 4. The most common symptoms of acute are fever, flank pain, and chills. 5.2. NEPHRITIS is a condition that results in the blockage of urine flow, leading to potential kidney damage. . The presence of in the urine is a common sign of glo- merulonephritis, indicating the presence of pus. . Treatment for glomerulonephritis aims to manage symptoms and un- derlying causes, such as controlling to prevent further kidney damage. . Glomerulonephritiscan cause varioussymptoms suchas. . which is painful or difficult urination. Complete the following multiple-choice test. Discuss your answers in the group. . Nephritis is a condition that primarily affects which organ? a) Liver b) Kidney c) Heart d) Lungs . What is the main cause of acute nephritis? a) Bacterial infection b) Viral infection c) Autoimmune disease d) Genetic predisposition . Which of the following is a common symptom of nephritis? a) Chest pain b) Joint pain c) Abdominal pain d) Flank pain . Which diagnostic test is commonly used to confirm the presence of nephritis? a) Blood test b) Urine test c) X-ray d) Electrocardiogram . Glomerulonephritis is characterized by inflammation of which struc ture in the kidney? a) Renal cortex b) Renal medulla c) Renal pelvis d) GlomeruliN Unit 5. URINARY SYSTEM. . Nephritis is characterized by inflammation of which organ? a) Liver b) Spleen c) Kidney d) Pancreas . Glomerulonephritis can lead to which of the following complications? a) Hypertension b) Kidney failure c) Urinary tract infection d) Gallbladder stones - What is the primary treatment approach for nephritis? a) Antibiotics b) Corticosteroids c) Anticoagulants d) Antidepressants Agree or disagree with the following statements. Comment on your answer. . Glomerulonephritis is a condition characterized by inflammation of the renal tubules. . Glomerulonephritis can be caused by viral or bacterial infections. . Glomerulonephritis primarily affects the renal medulla. . The treatment of glomerulonephritis may involve immunosuppressive medications. . Regular exercise and a healthy diet can help prevent diseases of the uri- nary tract. . Nephritis is a condition characterized by inflammation of the liver. . Nephritis can lead to kidney failure and the need for dialysis. . Autoimmune diseases such as lupus can contribute to the development of nephritis. 5.2. NEPHRITIS Complete the following sentences by filling in the blanks with the appropriate words from the box. imaging kidneys toxic hematuria blood tests _genetic immunosuppressive medical personal + edema _ tissue renal failure bacterial . Nephritis is an inflammation of the . The most common cause of nephritis is infection. . The primary symptom of nephritis is . Nephritis can result in fi . The diagnosis of nephritis is confirmed through and tests. . The treatment of nephritis often involves duce inflammation. 7. Individuals with nephritis may experience and fatigue. 8. Risk factors for nephritis include predisposition and cer- tain conditions. 9. Nephritis can be prevented by maintaining ing substances. 10.Chronic nephritis can lead to function. VReONe a therapy to re- hygiene and avoid- damage and impaired kidney 10 Answer the following questions. . What is nephritis and what part of the kidneys does it affect? . What are the different types of nephritis? . What is glomerulonephritis and what are its underlying causes? . What are the common symptoms of glomerulonephritis? . How is glomerulonephritis diagnosed? . What are the treatment options for glomerulonephritis? . What is pyelonephritis and what is its main cause? . What are the symptoms of pyelonephritis? . What are the potential complications of untreated pyelonephritis? 10. What is interstitial nephritis and what are its causes? 11. What are the symptoms of interstitial nephritis? 12. How is interstitial nephritis treated? 13. What role do medications play in the treatment of nephritis? 14. Are there any lifestyle modifications or preventive measures to reduce the risk of nephritis? wereNuauneawneUnit 5. URINARY SYSTEM TALKING POINTS 1 Read and discuss the following case histories. Establish the diagnosis. 1. Patient Information: Name: Emily Johnson Age: 32 Gender: Female Presenting Complaints: edema in the face, hands, and feet, decreased urine output, blood in urine, fatigue, high blood pressure, shortness of breath. Medical History: the patient has a history of streptococcal throat infection three weeks ago, which was left untreated. She has no known allergies or sig- nificant medical conditions. Clinical Findings: Blood pressure is significantly elevated (170/100 mmHg). Laboratory tests show elevated levels of blood urea nitrogen (BUN) and creatinine. Urinalysis reveals the presence of red blood cells (hematuria), proteinuria, and the presence of red cell casts. 2. Patient Information: Name: Michael Thompson Age: 45 Gender: Male Presenting Complaints: high fever, flank pain on the right side, burning sensation during urination, frequent urge to urinate, general malaise and fa- tigue. Medical History: the patient has a history of recurrent urinary tract in- fections (UTIs) in the past. He does not have any known drug allergies or significant medical conditions. Clinical Findings: Elevated body temperature (39.2 °C) upon examination. Palpation reveals tenderness in the right flank region. Laboratory tests show elevated white blood cell count and C-reactive pro- tein levels. Urinalysis reveals the presence of white blood cells (pyuria) and bacteria in the urine. GRAMMAR. Modal verbs: ability and probability 3. Patient Information: Name: Emily Johnson Age: 32 Gender: Female Presenting Complaints: fatigue and weakness, swelling in the legs and an- Kles, decreased urine output, flank pain on both sides, fever and chills. Medical History: The patient has a history of taking nonsteroidal anti-in- flammatory drugs (NSAIDs) regularly for chronic knee pain. She has no known drug allergies and has not experienced any significant medical con- ditions in the past. Clinical Findings: Examination reveals edema (swelling) in the lower extremities. Blood pressure is elevated (160/100 mmHg). Laboratory tests show elevated serum creatinine and blood urea nitrogen (BUN) levels. Urinalysis reveals the presence of red blood cells, white blood cells, and proteinuria (excess protein in the urine). MORE READING 1 Read the text and be ready to answer the following questions. 1. What are urinary tract infections (UTIs) and who do they commonly affect? 2. How do bacteria enter the urinary tract in children? . What are the symptoms of UTIs in infants and younger children? How do they differ in older children? . What factors increase the risk of UTIs in children? . How are UTIs diagnosed in children? . What is the usual treatment for UTIs in children? . What preventive measures can be taken to reduce the risk of UTIs in children? . What are the potential complications of untreated UTIs in children? . How are kidney infections (pyelonephritis) related to UTIs and what are their symptoms? 10. How can UTIs in children be managed to prevent complications and recurrent infections? NAUR Bw wooUnit 5. URINARY SYSTEM URINARY TRACT INFECTIONS IN CHILDREN Urinary tract infections (UTIs) are common bacterial infections that can affect children of all ages. UTIs occur when bacteria enter the urinary tract, which includes the kidneys, bladder, ureters, and urethra. In children, UTIs can cause discomfort and may lead to complications if left untreated. UTIs in children are usually caused by bacteria, most commonly Esche- richia coli (E. coli). The bacteria can enter the urinary tract through the ure- thra and travel upward into the bladder and other parts of the urinary system. ‘The symptoms of UTIs in children can vary depending on their age. In infants and younger children, common signs include fever, irritability, poor feeding, vomiting, and foul-smelling urine. Older children may experience frequent urination, pain or burning during urination (dysuria), urgency to urinate, abdominal pain, and cloudy or bloody urine. Certain factors increase the risk of UTIs in children, including being fe- male (girls are more prone to U'TIs than boys), infancy, having structural abnormalities in the urinary tract, constipation, poor hygiene practices, and urinary tract blockages or obstructions. To diagnose a UTI, a urine sample is collected for analysis. This may in- volve a clean-catch method or, in some cases, a catheterization or suprapubic aspiration. The urine sample is examined for the presence of bacteria, white blood cells, and other signs of infection. UTIs in children are typically treated with antibiotics to eliminate the bacterial infection. The choice of antibiotics depends on the specific bacteria causing the infection and may require a urine culture to guide the selection. It is important to complete the full course of antibiotics. Preventive measures can help reduce the risk of UTIs in children. Encour- aging good hygiene practices, such as regular handwashing and wiping from front to back after using the toilet, can help prevent the spread of bacteria. Ad- equate hydration and regular emptying of the bladder can also be beneficial. Some children may experience recurrent UTIs, which are defined as hav- ing two or more infections within a six-month period or three or more in- lections within a year. In such cases, further evaluation may be necessary to identify underlying causes or predisposing factors. UTIs, if left untreated, can lead to more serious complications in children, including kidney infections (pyelonephritis), which may cause high fever, back or abdominal pain, and potentially kidney damage. Long-term compli- cations, such as urinary scarring or kidney dysfunction, are rare but can occur in severe or recurrent cases. GRAMMAR Modal verbs: ability and probability To talk about ability, permission, and probability we use can/can‘t, could/ couldn’t and may/might. He can walk after operation. (ability) He may walk after operation. (permission) He could walk after operation yesterday. (ability in the past) Can/Could/May/Might we be present during operation? (asking permission) Can/Could you help me with urinalysis? (request) The patient has cloudy urine and fever. It can/could/may/might be pyelonephritis. (possibility) Fill in the modal verbs: can, could, may, might. Sometimes more than one answer is correct. . Patients with nephritis .... experience fatigue and loss of appetite. The inflammation in the kidneys .... cause pain and discomfort. . Treatment for nephritis .... include medications and lifestyle changes. . In severe cases, hospitalization .... be necessary. . The doctor .... order blood and urine tests to diagnose nephritis. . Dietary modifications .... help reduce symptoms and manage the con- dition. . Nephritis .... lead to complications if left untreated. . Patients .... need to limit their intake of salt and fluids. 9. Regular follow-up appointments .... be required to monitor the prog- ress of treatment. 10. Individuals with nephritis .... be at an increased risk of developing kidney stones. ANRWNE won Fill in the gaps with may or may not and one of the verbs from the list. go have be buy experience provide be —_ develop have prescribe3} Unit 5. URINARY SYSTEM 1.... to school tomorrow. I don't feel very well. . I feel bad. 1.... a fever. . Where is the doctor? ~ I don't know. He .... in the surgical department. .... these vitamins. I haven’t got enough money. She .... some discomfort after the procedure. . The results of the biopsy .... a definitive diagnosis. It .... advisable to consume alcohol while taking the prescribed medication. 8. Ifyou follow a healthy diet and exercise regularly, you .... certain health conditions. NAVAN 9. With proper care and maintenance, the electronic device .... a longer lifespan. 10. The doctor .... certain medications if there are known interactions with other drugs. Make up sentences expressing request and permission. .. examine your medical records? .. you please provide me with your medical history? I request a second opinion from another healthcare professional? sign this consent form before proceeding with the procedure? .. you grant me permission to discuss your case with other specialists? .. [kindly request that you fill out this patient questionnaire? .. Share your test results with your primary care physician? .. you allow me to take your blood pressure for monitoring purposes? .. lask you to provide a urine sample for further analysis? 10. .... I request that you follow the prescribed medication regimen for optimal recovery? PRPNAV EP PP UNITS URINARY SYSTEM LEAD IN 1 Learn the following words. cloudy | ['Klavdr] 3. KIDNEY STONES kanamyTanii struvite | [‘stru:vart] ctpyBiTHnit “diuretic |[, dayju retik] Hiypetuunuit, cesorinnuit nephrolithotomy | [,nefra'li@vtemr]) Hedporirotomis, sujanenust KaMeHW 3 HUPKK potassium [po'testom] Kamit cystine | ['sisti:n ] WMCTHHOBMIL cystinuria ——[,sisti'njusrio) =~ [uncramypin “obstruction | [ob'strakjn] 3akymopka, HempoxiguicTb lithotripsy [19 'tripst ] nivoTpuucia, 1po6ienHA KameHiB B HMpKax outflow [avtfloo] Bigrik, BuTiKxaHna sodium ['soudiom] Hatpiit dehydration [.dithar'dreyin] | sHesoquenua 7Unit 5. URINARY SYSTEM 2. Match the English word combinations with Ukrainian equivalent. 1. uric acid a. Kpos’ AHMit THCK 2. urinary obstruction b. niyperuxu 3. fever and chills C, CHOKMBaHHA HaTpito Ta Kaztii0 4. urine and blood test d. cewopa kucnota 5. water pills ¢, HenpoxigHicr cevoBux UULAXiB . shock wave lithotripsy f. pMicr WMTpaTHoi KucHOTH. 7. percutaneous nephrolithotomy —_| g. 1xomanka Ta 0306 8. blood pressure h. niquixipna Hepporitomia 9. citrate content i. anamis ceyi Ta KpoBi 10. intake of sodium and potassium | j. yaapHo-xsumbosa Nitorpuncia Get familiar with some of the facts about kidney stones and search for more information to present to the group. 1. The most common type of kidney stone is calcium oxalate, which forms when calcium combines with oxalate in the urine. 2. The size of kidney stones can vary from tiny grains to large stones that can fill the entire kidney. 3. Drinking an adequate amount of water and staying hydrated is crucial for preventing kidney stone formation. 4, Kidney stones can be recurrent. The prevalence of kidney stones is increasing worldwide, with a higher incidence in developed countries, affecting approximately 1 in 10 people. Certain dietary factors, such as a high intake of oxalate-rich foods (spinach, chocolate, nuts) or sodium, can increase the risk of kidney stone formation. 6. 7. Men are more likely to develop kidney stones than women, with the risk peaking between the ages of 30 and 50. 8. Recurrence of kidney stones is common, with approximately 50% of people who have had a kidney stone experiencing another episode within 5 to 10 years. 5.3. KIDNEY STONES: 4 Read the text. KIDNEY STONES Kidney stones, also known as renal calculi, are hard deposits that form in the kidneys. They are made up of various substances that can crystallize and accumulate over time. Kidney stones can vary in size, from as small as a grain of sand to as large as a golf ball. They can occur in one or both kidneys and can cause significant pain and discomfort. The formation of kidney stones is a complex process influenced by several factors, including the concentration of certain substances in the urine, inad- equate fluid intake, and underlying medical conditions. Kidney stones can affect individuals of all age groups, but they are most commonly observed in adults between the ages of 30 and 60. The most common types of kidney stones include calcium stones, uric acid stones, struvite stones, and cystine stones. Calcium stones are the most common type of kidney stones and are made up of calcium oxalate or calcium phosphate. High levels of calcium and oxa- late in the urine can contribute to the formation of these stones. Calcium ox- alate stones have a high tendency to recur in individuals who have previously experienced them. Struvite stones are typically formed as a result of urinary tract infections caused by certain bacteria. These stones can grow rapidly and become quite large. Uric acid stones are formed when there is an excess of uric acid in the urine. This can occur due to certain medical conditions, such as gout, or a diet high in purines. Cystine stones are rare and are formed due to a genetic disorder called cys- tinuria. People with cystinuria have a defect in the way their kidneys reabsorb certain amino acids, leading to the formation of cystine stones. Symptoms of kidney stones often manifest when the stones move within the urinary tract or obstruct the flow of urine. The most common symptom is severe pain, known as renal colic, which is usually felt in the back or side below the ribs. The pain can radiate to the lower abdomen and groin area. Other symptoms may include fever and chills, nausea, vomiting, blood in the urine (hematuria), frequent urination, urgency to urinate, cloudy urine, and a persistent need to urinate.Unit 5. URINARY SYSTEM Diagnosis of kidney stones is typically done through a combination of medical history, physical examination, and imaging tests such as ultrasound, CT scan, or X-ray. Urine and blood tests may also be conducted to determine the composition of the kidney stones and identify any underlying conditions contributing to their formation. ‘Treatment for kidney stones depends on the size, location, and composi- tion of the stones, as well as the severity of symptoms. Small stones may pass through the urinary tract with increased fluid intake and pain management. ‘The average size of a kidney stone that can be passed naturally without med- ical intervention is generally considered to be around 4 mm. However, larger stones or those causing severe symptoms may require medical intervention. Certain medications can help dissolve or prevent the formation of specific types of kidney stones. These may include medications to reduce calcium or uric acid levels, or to control underlying conditions like urinary tract infec- tions. Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive proce- dure which uses shock waves to break up kidney stones into smaller frag- ments that can be passed out through urine. By ureteroscopy a thin tube with a camera is inserted into the urinary tract to locate and remove or break up stones using laser energy. In more complex cases, a surgical procedure may be required to remove larger stones through a small incision in the back. This procedure is called percutaneous nephrolithotomy (PCNL). Prevention of kidney stones involves lifestyle modifications and dietary changes. Drinking an adequate amount of water to maintain proper hydration is crucial. Additionally, reducing the intake of substances that can contribute to stone formation, such as sodium, oxalate-rich foods (spinach, chocolate, nuts), and animal proteins, can be helpful. LANGUAGE DEVELOPMENT Complete the following multiple-choice test. Discuss your answers in the group 1, Which of the following is not a type of kidney stone? a) Calcium stones b) Struvite stones c) Uric acid stones d) Hemoglobin stones @ 5.3. KIDNEY STONES . Which type of kidney stone is commonly associated with excessive in- take of oxalate-rich foods? a) Calcium stones b) Struvite stones c) Uric acid stones d) Cystine stones . What is the primary symptom of a kidney stone? a) Fever b) Hematuria (blood in urine) c) Abdominal pain d) Fatigue . Which imaging technique is commonly used to diagnose kidney stones? a) Magnetic resonance imaging (MRI) b) Computed tomography (CT) scan c) X-ray d) Ultrasound . Which lifestyle factor increases the risk of developing kidney stones? a) Regular exercise b) Adequate hydration c) Low-sodium diet d) Sedentary lifestyle . Which type of kidney stone is most likely to recur after treatment? a) Calcium stones b) Struvite stones c) Uric acid stones d) Cystine stones . Which age group is most commonly affected by kidney stones? a) Children b) Teenagers c) Young adults d) Elderly adults . What is the primary treatment approach for small kidney stones that can be passed naturally? a) Surgery b) Medication c) Shock wave lithotripsy d) Fluid intake and pain managementUnit 5. URINARY SYSTEM 9. Which medical condition increases the risk of developing calcium oxa- late stones? a) Hypertension b) Diabetes c) Osteoporosis d) Asthma 10. What is the average size of a kidney stone that can be passed naturally without medical intervention? a) Less than 1 mm. b) 2-4 mm c) 5-7 mm. d) More than 10 mm Complete the following sentences by filling in the blanks with the appropriate words from the box. obstruction calcium —hydration ~— fluid — calcium surgery mineral struvite _lithotripsy nephrolithiasis abdominal 1. Kidney stones are hard, substances that form in the kidneys. 2. The most common type of kidney stone is composed of 3. The medical term for the presence of kidney stones is 4, Kidney stones can cause severe pain. 5. The formation of kidney stones is influenced by factors such as intake and urinary levels. 6. A kidney stone that obstructs the urinary tract can cause 7. Treatment options for kidney stones include , medication, and lifestyle changes. 8. stones are commonly associated with urinary tract infections. 9. The process of breaking down kidney stones using shock waves is called 10. Kidney stones can be prevented by maintaining proper and following a healthy diet. 5.3. KIDNEY STONES & Agree or disagree with these statements. 1. Kidney stones are always painful. 2. Drinking plenty of water can help prevent the formation of kidney stones. wR stones. rpona . Men are more prone to kidney stones than women. . Kidney stones can be caused by certain medications. . High intake of dietary calcium increases the risk of developing kidney ._ Kidney stones can be hereditary. . Kidney stones can be dissolved with medication. . The primary symptom of a kidney stone is frequent urination. . Kidney stones can cause blood in the urine. 0. Kidney stones can lead to kidney damage if left untreated. 8 Match the terms with their definitions. 1. calcium oxalate a. genetic disorder causing cystine stone formation 2. uric acid b. common substance found in kidney stones 3. struvite c. excess of this substance can lead to uric acid stone formation 4, cystinuria d. kidney stone formed due to urinary tract infection 5. calcium phosphate e. most common type of kidney stone 6. purines f. kidney stone made up of calcium oxalate or calcium phosphate 7. renal colic g. drinking an adequate amount of water to prevent stone formation 8. hematuria h. non-invasive procedure using shock waves to break up kidney stones 9. lithotripsy 10. hydration i. blood in the urine j. severe pain caused by kidney st stone movementUnit 5. URINARY SYSTEM Answer the following questions. . What are kidney stones and what are they made of? . What is the typical size range of kidney stones? . Which age group is most commonly affected by kidney stones? . What are the most common types of kidney stones? . What are struvite stones and how are they formed? . What causes the formation of uric acid stones? . How are cystine stones formed and what is the underlying genetic dis- order associated with them? 8. What are the common symptoms of kidney stones? 9. How are kidney stones diagnosed and what tests are commonly used? 10. What are the treatment options for kidney stones, and when is medical intervention necessary? NaAuURYUNS TALKING POINTS Read and discuss the following tips that help reduce the risk of contracting the disease: ° stay hydrated; «limit sodium intake; * moderate animal protein consumption; « reduce oxalate-rich foods; * eat calcium-rich foods; + maintain a healthy weight; «limit caffeine and soda intake; + avoid vitamin C supplements; + regular medical check-ups MORE READING Read the text and be ready to answer the following questions. 1. What is cystitis? 2. What is the main cause of cystitis? . Why is cystitis more commonly observed in women? 5.3. KIDNEY STONES . What are the common symptoms of cystitis? . How is cystitis diagnosed? . What is the treatment for cystitis? . What are some commonly prescribed antibiotics for cystitis? . What are some non-pharmacological measures to alleviate the symp- toms of cystitis? 9. What preventive measures can help reduce the risk of cystitis? 10. What are the potential complications of untreated or spreading cystitis? SONYA CYSTITIS Cystitis is a common urinary tract infection (UTI) that specifically affects the bladder. It is characterized by inflammation of the bladder lining, usually caused by bacterial infection. Cystitis can occur in individuals of all ages, but it is more commonly observed in women due to their shorter urethra, which allows bacteria to reach the bladder more easily. The most common cause of cystitis is the bacterium Escherichia coli (E. coli), which is normally present in the intestines. However, other bacteria, such as Staphylococcus saprophyticus and Klebsiella pneumoniae, can also cause bladder infections. Risk factors for cystitis include sexual activity, uri- nary catheterization, menopause, diabetes, and urinary tract abnormalities. The symptoms of cystitis can vary in severity and may include frequent urination, a strong and persistent urge to urinate (urgency), pain or discom- fort in the lower abdomen or pelvic area, a burning sensation during urina- tion (dysuria), cloudy or bloody urine, and a strong smell of the urine. In some cases, individuals may experience low-grade fever and general malaise. Diagnosis of cystitis is typically based on the symptoms reported by the individual and a urine analysis. The presence of bacteria, white blood cells, and red blood cells in the urine, along with the individual's symptoms, helps confirm the diagnosis. In some cases, a urine culture may be performed to determine the specific bacteria causing the infection. Treatment for cystitis involves antibiotics to eliminate the bacterial infec- tion. The choice of antibiotics depends on the severity of the infection and the results of the urine culture. Commonly prescribed antibiotics include nitro- furantoin, trimethoprim-sulfamethoxazole, and fosfomycin. It is important to complete the full course of antibiotics to ensure the infection is completely cleared. In addition to antibiotics, other measures can help alleviate the symptoms of cystitis and promote healing. Drinking plenty of water and fluids can helpflush out the bacteria from the bladder. Avoiding irritants such as caffeine, alcohol, and spicy foods may also provide relief. Over-the-counter pain re- lievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help al- leviate pain and reduce inflammation. Preventive measures can help reduce the risk of cystitis. These include maintaining good hygiene practices, drinking an adequate amount of water and avoiding excessive use of irritants. While cystitis is generally a mild and self-limiting condition, complica- tions can occur if left untreated or if the infection spreads to the kidneys. In such cases, a more severe infection called pyelonephritis may develop, which can cause kidney damage and lead to more serious health complications. GRAMMAR Modal verbs: permission, obligation, possibility, and advice To talk about permission we use may, can, could. e.g. He may walk after operation. (permission) May L use your computer? (asking for permission) Can/could I call my doctor? (asking for permission) To talk about obligation we use must, mustn’t, have to, don’t/doesn’t have to. e.g. A surgeon must start operation immediately. (obligation) Ihave to attend the hospital this afternoon. (obligation) To talk about possibility we use could, might. e.g. The patient has a fever. It might/could be glomerulonephritis. (possibility) He has nausea and vomiting again. He might/could have forgotten to take his pills. (possibility in the past) To give advice we use should, ought to. e.g. You should/ought to consult a specialist for a second opinion on your condition. (advice) Fill in the gaps with the appropriate modal verb. Sometimes more than one answer is correct. 1 Ihave a glass of water before the procedure? 2. Visitors sanitize their hands before entering the hospital room. 3. The doctor said I get enough rest to recover from the illness. 4. I continue taking my current medication while starting the new prescription? 5, You get a flu shot to protect yourself during the flu season. 6. Teat or drink anything before the surgery? 7. Patients follow a balanced diet for overall health and well-being. 8. T use over-the-counter painkillers for my headache? 9. I remove my contact lenses before the eye examination?