Alterations of Renal and Urinary

Tract Function Concept Maps
Gary L. Schofield, RN
!otential Causes & !rocess of Renal Failure
Renal Failure
Obstruction
UTÌ
Renal Cancer
!ylenephritis
Glomerulonephritis
Acute Chronic End Stage Renal Disease
-Reverses
- Abrupt | renal
functions
Ìmpaired Renal Blood Flow
Pre renaI
(Renal Ìschemia)
Shock
| CO
Anaphylaxis
Intra renaI
Acute tubular
necrosis
Acute
glomerulonephritis
Renal Vascular
Obstruction
Cortical Necrosis
Allograft Rejection
Post renaI
Kidney
Stones
Neoplastic
Disease
!rogressive/ Ìrreversible
GFR gradually |
Nephrons destroyed
Remaining Nephrons
| Workload
-Hypertrophy
- |ability to
concentrate urine
Complete Renal Failure
Transplant
Dialysis
-struction
Hydroureter
Hydronephrosis
| Bladder =
infection
|Bladder = Acute or
Chronic Renal Failure
Kidney Stones Neurogenic Bladder
Ìnterruption of nerve
supply
Most common
in pelvis of
kidney
Calcium or
!hosphate 75-
80 % of the
time
Gender
Race
Geographic
Location
Seasonal Factors
Fluid Ìntake
Diet
Occupation
Upper Motor
Neuron Lesion
Lower Motor
Neuron Lesion
Loss of Voluntary
control of voiding
Loss of voluntary
and involuntary
control of voiding
Lower Urinary Tract
Obstructions
Bladder Neck
Dyssynergia
!rostate
Enlargement
Urethral Stricture Severe !elvic Organ
!rolapse
Tumors
Renal Bladder
Wilms Tumor
Embryonal Tumor
Nephroblastoma
Sporadic and
inherited origins
Associated with
other anomalies
UTÌ
Tumors
Caused By Bacteria, Fungal
and !arasite
Cystitis
Virulence of Uropathogens Host Defense Mechanisms
!yleonephritis
Most Common Site for
UTÌ
Chronic
Acute
!eriurethral Mucus
Secreting Gland
Sphincter Mechanisms
Bacterial Attaches to
Uroepithelium
Bacteria Form
Biofilm
Causes: E. Coli, Klebsiella,
!seudomonas, Staph
Ìnfection initiates inflammatory
response
Renal Adenoma Renal Cell Carcinoma
Bladder Tumors
Body Ìmmune System
(Bladder Wall)
ommon auses:
Kidney Stones
Vesicoureteral Reflux
Pregnancy
Neurogenic Bladder
Instrumentation
Female Sexual Trauma
Benign Tumors
Located near cortex of
kidney
Most common renal
neoplasm
!roximal tubule
epithelial cells
!rimary
Associated with mutation
of gene P53
Secondary
Association:
Tobacco Use, Obesity, Long-term Analgesic
use
Ìncrease Risk
Result of invasion of
cancer from bordering
organs
Smokers (men)
Workers exposed to
chemicals, rubber, &
in textile industry
Vesicoureteral Reflux
Congenitally abnormal
ureter
Reflux of urine from
bladder to kidney
Ìnfection, renal scarring,
pyelonephritis
PyeIonephritis
Acute
hronic
Ìnfection of renal pelvis
and interstutium
ommon auses
Kidney Stones
Vesicoureteral Reflux
Pregnancy
Neurogenic Bladder
Instrumentation
Female Sexual Trauma
Ìnflammatory !rocess
damages tubular cells
Usually localized abscesses
Healing occurs
Deposition of Scar tissue
Atrophy of affected tubules
Affects primarily the pelvis,
calyces, and medulla
Rarely causes renal failure
Excretion of diluted urine
Ìmpairment of function
Urine-concentration
ability affected
Destruction of tubules
Areas of atrophy/dilation/
diffuse scaring
Ìnflammation and
scarring of kidney
!elvis, calyces ÷ dilated
& blunted
Recurrent Autoimmune
Ìnfections
Renal Failure
Common Cause: E Coli
Glomerular Disorders
Glomerulonephritis
Nephrotic Syndrome
Chronic Glomerulonephritis
Crescentic Glomerulonephritis
(Rapidly !rogressive)
ÌgA Nephropathy
Berger Disease
Acute Glomerulonephritis
!roteinuria Lipiduria
Hypocalcemia
S/S
Hematuria
Red Blood
Cell Casts
!rotenuria
| GFR
Oliguria
Edema
HTN
Abrupt onset
7-10 after
infection
Group A Strep
S/S 10-21days
after infections
Most individuals
Children recover
with minimal
loss of renal
function
Most
Common
Form
Unknown
cause
24-48 hrs
after URÌ or
GÌ infection
!rognosis
variable
20-50%
progress to
Renal Fail
Ìdiopathic
!roliferative
glomerular
diseases
Example of
Crescent
Glomerulo-
nephritis
Antiglomerular Basement
Membrane (Good-pasture
Syndrome)
Antibody Formation
Affects:
!ulmonary Capillary
Glomerular Basement Membs
!oor !rognosis
Renal Failure
Several
Glomerular
Diseases
Focal or Diffuse
Segmental fibrosis
and deterioration
!oor !rognosis
Tubular dilation and atrophy
Cause: Ìmmune response
Toxin/Drugs
Vasc. Disorders
Damage: Biochemical
Mediators of Ìnflammation
Complement activation
Neutrophils/Monocytes
Disturbance in Glomerular Basement Memb
(metabolic, biochemical, physiochemical) leads
to increase permeability to protein
Hypoalbuminema Hyperlipidemia
Treatment:
Normal, Low-fat Diet; Salt Restriction
Diuretics; Antigoagulants; Removal of
toxins; Steroids; Albumin
Replacements
Structural Abnormality
Definition Facts
Hypospadias
Congenital condition in which the
urethral meatus is located on the ventral
side of the penis
Related to disruption in male hormones
Accompanied by Chordee or penile
torsion
Corrective Surgery
Epispadias
Exstrophy of the bladder- Urethral
opening on the dorsal surface of penis.
Urethral opening small and situated
behind the glans with fissure extending
the length of penis
Constant dribbling of urine
Exstrophy of Bladder
Extensive congenital anomaly in which
the lower urinary tract is exposed
directly to the surface of the body
Caused by intrauterine failure of the
abdominal wall and the mesoderm of the
anterior bladder to fuse
Reconstructive surgery girls ÷ teens
Boys ÷ 2-3 yrs of age
Ureteropelvic Junction
Obstruction
Blockage of the tapered point where the
renal pelvis transitions into the ureter
Ìntrinsic malformation of smooth muscle
or urothelial development produces
obstruction in 90% of cases. Causes
kinking and scarring
Bladder Outlet
Obstruction
A urethral valve is a thin membrane of
tissue that occludes the urethral lumen
and obstructs urinary outflow in males.
!olyps rarely arise form the prostatic
urethra ÷ often cause sever obstruction
and impair renal embrogenesis leading
to UTÌ, Vesicoureteric reflux, and renal
failure. Resection as soon as possible
Hypoplastic(Dysplastic
Kidneys
Ureteric duct grows into the metanephric
tissue, triggering the formation of the
kidneys in utero. Ìf this growth does not
occur the kidney is absent or hypoplastic
(small) Renal dysplasia results from
abnormal differentiation of renal tissue
Associated with a functional or organic
obstruction of the collecting system
Obstruction may begin prior to birth
Renal Agenesis
Absence of one or both kidneys
!otter syndrome (bilateral renal
agenesis)
Clearly hereditary
Bilateral agenesis is usually fatal
Unilateral ÷ males more affected
!olycystic Kidneys
Autosomal dominant inherited disorder
!KD-1 and !KD-2 mutations account for
the disease
The gene products regulate epithelial
growth and differentiation.
References
Corwin, E. J. (2000). Handbook of !athophysiology (2nd ed.). !hiladelphia, !A:
Lippincott.
Gray, M., Huether, S., & Forshee, B. (2006). Alterations of renal and urinary
tract function. Ìn K. L. McCance & S. Huether (Eds.), Pathophysiology: The
Biologic Basis for Disease in Adults & Children (pp.1301- 1336). St Louis,
MO: ElSevier Mosby.
Huether, S. (2006) Alteration of renal and urinary tract functions in children. Ìn K.
L. McCance & S. Huether (Eds.), Pathophysiology: The Biologic Basis for
Disease in Adults & Children (pp.1337- 1351). St Louis, MO: ElSevier Mosby.

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