Week 6— The Kidney and Its Collecting System Health Problems

Urinary system, *A&P Textbook Ch.25; review at Home the PPTs

from A&P class). In-class: Urinary Tract Pathology.
Pyelonephritis. Cystitis. Urethritis. Urolithiasis (with classification
of chemical composition of kidney stones and finding/treating the
underlying causes of urolithiasis

Urinary Tract Pathology

Urinary system, *A&P Textbook Ch.25; review at

Home the PPTs from A&P class).
The urinary system, also known as the renal system
or urinary tract, consists of the kidneys, ureters,
bladder, and the urethra. The purpose of the urinary
system is to eliminate waste from the body, regulate
blood volume and blood pressure, control levels of
electrolytes and metabolites, and regulate blood pH,
hematopoiesis,vit D and renin.
[Link]
dSDIn-class: Urinary Tract Pathology.

[Link]

●​ Nephrosis – a noninflammatory disease of

kidneys.
●​ Nephrolithiasis – a kidney stone.
●​ Nephritis – inflammatory disease of kidneys.
●​ Urethritis – inflammation of the urethra, the final
pathway for urine in both sexes, and the common
 pathway for urine and semen in the male.
●​ Nocturia – frequently getting up and urinating
during the night.
●​ Enuresis – involuntary release of urine, most
often in reference to “bedwetting, or involuntary
urination, especially by children at night.
●​ Tumors – benign and malignant tumors of
kidneys

From the Syllabus:

Pyelonephritis. Cystitis. Urethritis. Urolithiasis
I.​ Pyelonephritis. [Link]
Kidney infection (pyelonephritis) is a type of urinary
tract infection (UTI) that generally begins in your
urethra or bladder and travels to one or both of your
kidneys.
[Link]
XS A kidney infection requires prompt medical
attention.

[Link]
[Link]
Inflammation of the kidney due to a bacterial
infection.
The inflammation of the kidney is due to a specific
type of urinary tract infection (UTI). The UTI usually
begins in the urethra or bladder and travels to the
kidneys.

Fever, frequent urination, and pain in the back, side,

or groin are the symptoms.
Treatment includes antibiotics and often requires
hospitalization.
What causes pyelonephritis?
The main cause of acute pyelonephritis is
gram-negative bacteria, the most common being
Escherichia coli. Other gram-negative bacteria
which cause acute pyelonephritis include Proteus,
Klebsiella, and Enterobacter. In most patients, the
infecting organism will come from their fecal flora.
Also may be because of STI/STD.
How is pyelonephritis diagnosed?
Two common laboratory tests are performed to
diagnose kidney infections (pyelonephritis). A urine
sample is examined under a microscope to
determine if white and/or red blood cells are
present. The urine is also sent to the lab to see if
bacteria grow in a urine culture.

What is the best treatment for pyelonephritis?

Outpatient oral antibiotic therapy with a
fluoroquinolone is successful in most patients with
mild uncomplicated pyelonephritis. Other effective
alternatives include extended-spectrum penicillins,
amoxicillin-clavulanate potassium, cephalosporins,
and trimethoprim-sulfamethoxazole.
Drink plenty of water!

Is pyelonephritis serious?
Acute pyelonephritis is a sudden and severe kidney
infection. It causes the kidneys to swell and may
permanently damage them. Pyelonephritis can be
life-threatening. When repeated or persistent attacks
occur, the condition is called chronic pyelonephritis.

What happens if pyelonephritis is left untreated?

Untreated infection can damage the kidneys and
lead to long term problems. In rare cases, kidney
infections can lead to kidney disease, high blood
pressure, or kidney failure. If kidney infection
spreads to the bloodstream it can cause a serious
problem called sepsis.
●​ long term problems
 ●​ kidney disease,
●​ high blood pressure,
●​ kidney failure
●​ sepsis.

II.​ Cystitis.
What is the cause of cystitis?
Cystitis is an inflammation of the bladder.
Inflammation is where part of your body becomes
irritated, red, or swollen. In most cases, the cause of
cystitis is a urinary tract infection (UTI). A UTI
happens when bacteria enter the bladder or urethra
and begin to multiply.
[Link]

What are the symptoms of cystitis?

The main symptoms of cystitis include:
●​ pain, burning or stinging when you pee.
 ●​ needing to pee more often and urgently than
normal.
●​ urine that's dark, cloudy or strong smelling.
●​ pain low down in your tummy.
●​ feeling generally unwell, achy, sick and tired.
[Link]

What does cystitis feel like?

Symptoms of cystitis in adults
a.​pain, burning or stinging when you pee.
 b.​needing to pee more often and urgently than
normal.
c.​ feeling like you need to pee again soon after
going to the toilet.
d.​urine that's dark, cloudy or strong-smelling.

III.​ Urethritis. [Link]

Urethritis is inflammation of the urethra. That's the
tube that carries urine from the bladder to outside
the body. Pain with urination is the main symptom of
urethritis. Urethritis is commonly due to infection by
bacteria. It can typically be cured with antibiotics.
[Link]

Urethritis is a bacterial or viral infection that causes

swelling and irritation of the urethra. It's commonly
caused by a sexually transmitted infection.
Symptoms include painful, burning, or frequent
urination, or a discharge from the urethra.
Treatment involves antibiotics.
Major Pathogens involved?
 a.​gonococcal infection (GU): Neisseria
gonorrhoeae
b.​non-gonococcal infection (NGU): Chlamydia
trachomatis

What is the most common cause of urethritis?

Chlamydia trachomatis is the most common
nongonococcal cause of urethritis and is also
transmittable through sexual intercourse. Chlamydia
trachomatis is a small gram-negative obligate
intracellular parasitic bacteria.

[Link]
What happens if urethritis goes untreated?
Gonococcal urethritis that is not treated correctly or
not treated at all can lead to advanced pelvic
inflammatory disease in women, which can result in
scarring that can lead to infertility. Antibiotic
treatment of chlamydia will cure this disease and
can prevent complications.
 ●​ pelvic inflammatory disease (PID) in women,
●​ scarring that can lead to infertility.
●​ Antibiotic cure and prevent this disease

IV.​ Urolithiasis

Urolithiasis or else called Urinary Calculosis is the

formation of stones (calculi) anywhere in the urinary
tract (in the renal pyelocalyceal system, ureters,
bladder, urethra). It is the third most common urinary
tract disease in humans, following urinary tract
infections and prostatic diseases.
[Link]
What is the kidney stone?
a.​A small, hard deposit that forms in the kidneys
and is often painful when passed.
b.​Kidney stones are hard deposits of minerals and
acid salts that stick together in concentrated
urine.
c.​ They can be painful when passing through the
urinary tract, but usually don't cause permanent
damage.
d.​The most common symptom is severe pain,
usually in the side of the abdomen, that's often
associated with nausea.
Treatment includes pain relievers and drinking lots
of water to help pass the stone. Medical procedures
may be needed to remove or break up larger
stones.

What causes urolithiasis?

Kidney stones (also called renal calculi,
nephrolithiasis or urolithiasis) are hard deposits
made of minerals and salts that form inside your
kidneys. Diet, excess body weight, some medical
conditions, and certain supplements and
medications are among the many causes of kidney
stones.

What is the difference between nephrolithiasis and

urolithiasis?
Urolithiasis refers to stones originating anywhere in
the urinary system, including the kidneys and
bladder. Nephrolithiasis refers to the presence of
such stones in the kidneys.
●​ Stones in the kidney
●​ Stones in the ureters
●​ Stones in the bladder
●​ Stones in the urethra
V.​ Classification of kidney stones
[Link]
Kidney stones are broadly categorized into
calcareous (calcium containing) stones, which are
radio-opaque, and non-calcareous stones.
●​ calcareous (calcium containing) stones
●​ non-calcareous stones
What are the types of kidney stones?
Types of Kidney Stones
a.​Calcium Oxalate Stones. The most common
type of kidney stone is a calcium oxalate stones
b.​Calcium Phosphate Stones. Calcium phosphate
kidney stones are caused by abnormalities in the
way the urinary system functions. …
c.​ Struvite Stones. …
d.​Uric Acid Stones. …
e.​Cystine Stones.
How do you know what type of kidney stone you
have?
Medical tests include:
a.​X-ray examination, stones with calcium
b.​blood tests for calcium, phosphorus, uric acid,
and electrolytes.
c.​ blood urea nitrogen (BUN) and creatinine to
assess kidney functioning.
d.​urinalysis to check for crystals, bacteria, blood,
and white cells.
 e.​examination of passed stones to determine their
type.

What is considered a small kidney stone?

Small kidney stones are defined as being less than
5mm in size. These stones are normally able to
pass through the urinary tract on their own.
Depending on the circumstances, it is generally safe
to wait as long as four to six weeks for a small
kidney stone to pass out of the body.
VI.​ Treatment of kidney stones
Treatment consists of fluids and urinary retention
medications

Treatment includes pain relievers and drinking lots

of water to help pass the stone. Medical procedures
may be needed to remove or break up larger
stones.
[Link]

What is the best treatment for kidney stones?

Treatment?
a.​Drinking water. Drinking as much as 2 to 3
quarts (1.8 to 3.6 liters) a day will keep your urine
dilute and may prevent stones from forming. …
b.​Pain relievers. Passing a small stone can cause
some discomfort. …
c.​ Medical therapy. Your doctor may give you a
medication to help pass your kidney stone.

What size of kidney stone requires surgery?

a.​The larger a stone is, the less likely that it will
pass without surgery.
b.​Surgical treatment is usually recommended for
stones 0.5 centimeters in size and larger,
c.​ patients who fail conservative management.
d.​The procedures used today to remove stones
are minimally invasive and highly effective.
e.​For certain kidney stones — depending on size
and location — your doctor may recommend a
procedure called extracorporeal shock wave
lithotripsy (ESWL).
ESWL uses sound waves to create strong
vibrations (shock waves) that break the stones
into tiny pieces that can be passed in your urine.
[Link]
Week 18— (11/30/2020) — Urinary system, *A&P Textbook Ch.25; review at Home the
PPTs from A&P class). In-class: Urinary Tract Pathology. Pyelonephritis. Cystitis.
Urethritis. Urolithiasis (with classification of chemical composition of kidney stones and
finding/treating the underlying causes of urolithiasis

MCQ

1. Which of the following symptoms do you expect to see in a patient diagnosed with acute
pyelonephritis?

a.​Jaundice and flank pain

b.​Costovertebral angle tenderness and chills
c.​Burning sensation on urination
d.​Polyuria and nocturia

2. You have a patient that might have a urinary tract infection (UTI). Which statement by the
patient suggests that a UTI is likely?
 a.​“I pee a lot.”
b.​“It burns when I pee.”
c.​ “I go hours without the urge to pee.”
d.​ “My pee smells sweet.”

3. Which instructions do you include in the teaching care plan for a patient with cystitis
receiving phenazopyridine (Pyridium).

a.​If the urine turns orange-red, call the doctor.

b.​Take phenazopyridine just before urination to relieve pain.
c.​Once painful urination is relieved, discontinue prescribed antibiotics.
d.​After painful urination is relieved, stop taking phenazopyridine.

4. Which intervention do you plan to include with a surgical patient who has renal calculi?

a.​Maintain bed rest

 b.​Increase dietary purines
c.​Restrict fluids
d.​Strain all urine

5. Which of the following causes the majority of UTI’s in hospitalized patients?

a.​Lack of fluid intake

b.​Inadequate perineal care
c.​Invasive procedures
d.​Immunosuppression

6. The most common early sign of kidney disease is:

a.​Sodium retention
b.​Elevated BUN (Blood Urea Nitrogen) level
c.​Development of metabolic acidosis
 d.​Inability to dilute or concentrate urine

7. A 22 y.o. patient with diabetic nephropathy says, “I have two kidneys and I’m still young. If I
stick to my insulin schedule, I don’t have to worry about kidney damage, right?” Which of the
following statements is the best response?

a.​“You have little to worry about as long as your kidneys keep making urine.”
b.​“You should talk to your doctor because statistics show that you’re being unrealistic.”
c.​“You would be correct if your diabetes could be managed with insulin.”
d.​“Even with insulin, kidney damage is still a concern.”

8. A patient diagnosed with sepsis from a UTI is being discharged. What do you plan to include
in her discharge teaching?

a.​Take cool baths

b.​Avoid tampon use
c.​Avoid sexual activity
d.​Drink 8 to 10 eight-oz glasses of water daily
9. Which finding leads you to suspect acute glomerulonephritis in your 32 y.o. patient?

a.​Dysuria, frequency, and urgency

b.​Back pain, nausea, and vomiting
c.​Hypertension, oliguria, and fatigue
d.​Fever, chills, and right upper quadrant pain radiating to the back
a.​Pain

10. You have a paraplegic patient with renal calculi. Which factor contributes to the
development of calculi?

a.​Increased calcium loss from the bones

b.​Decreased kidney function
c.​Decreased calcium intake
d.​High fluid intake
11. Your patient has complaints of severe right-sided flank pain, nausea, vomiting and
restlessness. He appears slightly pale and is diaphoretic. Vital signs are BP 140/90 mmHg, Pulse
118 beats/min., respirations 33 breaths/minute, and temperature, 98.0F. Which subjective data
supports a diagnosis of renal calculi?

a.​Pain radiating to the right upper quadrant

b.​History of mild flu symptoms last week
c.​Dark-colored coffee-ground emesis
d.​Dark, scanty urine output

12. What is the best indicator of prognosis for a melanoma?

a.​Asymmetry
b.​Colour
c.​Diameter
d.​Invasion of the dermis
HOMEWORKS
1.​What is Pyelonephritis?
2.​What is Urolithiasis? What is the chemical
composition of commonly found kidney stones?
3.​What is glomerulonephritis?