ANATOMY OF RENAL/UROLOGICAL SYSTEM
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KIDNEYS: MAJOR ORGANS OF BOTH RENAL AND UROLOGICAL SYSTEMS; RESPONSIBLE FOR
MAINTENANCE OF THE CHEMICAL COMPOSITION OF ELECTROLYTES, FLUIDS AND TISSUES
OF THE BODY; MAJOR ROUTE TO ELIMINATE DRUGS
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LOCATED INSIDE UPPER ABDOMINAL CAVITY- RIGHT KIDNEY IS A LITTLE LOWER THAN THE
LEFT BECAUSE OF THE LOCATION OF THE LIVER
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SHAPED LIKE A KIDNEY BEAN WITH A SMALL INDENTION CALLED THE HILUS
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BLOOD ENTERS KIDNEY VIA HILUS FROM THE RENAL ARTERY; RENAL VEIN AND URETER
LEAVE THE KIDNEY VIA THE HILUS ALSO, RETURNING FILTERED BLOOD TO THE BODY
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BLADDER- HOLDING TANK FOR URINE
FUNCTION OF THE KIDNEYS
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MAIN RESPONSIBILITY= FILTER BLOOD TO REMOVE WASTE AND EXCRETION
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NORMAL URINARY OUTPUT FOR AN ADULT IS 1-2 L/DAY
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URINE CONTAINS UREA WHICH IS PRODUCED BY THE LIVER
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KIDNEYS BALANCE IONS IN THE BLOOD AND ELIMINATE EXCESS IONS
THROUGH EXCRETION IN URINE
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FILTRATE= FLUID FILTERED FROM BLOOD- COMPOSED OF H20, IONS,
GLUCOSE AND PROTEIN
NEPHRON
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THE FUNCTIONAL UNIT OF THE KIDNEY
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RESPONSIBLE FOR REGULATION OF FLUIDS, SOLUTES AND WASTES IN THE BODY
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SHAPED LIKE AN INVERTED PYRAMID AND ACTIVELY FILTER THE BLOOD 24 HRS/DAY
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RENAL ARTERY- GLOMERULUS- BOWMAN’S CAPSULE- DESCENDING (PROXIMAL
CONVOLUTED) TUBULE- LOOP OF HENLE- ASCENDING (DISTAL CONVOLUTED) TUBULE
TUBULAR REABSORPTION/SECRETION
• REABSORPTION: IMPORTANT FUNCTION OF NEPHRONS
• THE FILTRATE NOT EXCRETED AS URINE AND ARE REABSORBED BY THE NEPHRONS TO REENTER THE PLASMA FOR USE BY THE BODY; OCCURS ALONG THE PROXIMAL CONVOLUTED TUBULE, DISTAL
CONVOLUTED TUBULE AND LOOP OF HENLE
• THIS PROCESS IS CRITICAL IN REGULATION OF THE ACID-BASE CONCENTRATION; SODIUM IONS ARE
PULLED FROM THE TUBULES AND EXCHANGED FOR H+ IONS- CREATES OSMOSIS GRADIENT TO BALANCE SODIUM AND H20 CONCENTRATION
• SECRETION: OCCURS THROUGHOUT THE NEPHRON- VARIOUS IONS, TOXINS AND H20 ARE SECRETED INTO COLLECTING DUCT
• H+ IONS ENTER NEPHRON AND COMBINE WITH OTHER MOLECULES TO FORM BICARBONATES (BUFFER) WHICH IS RELEASED INTO BLOOD TO REGULATE PH AND MAINTAIN HOMEOSTASIS
ELECTROLYTES
• SALTS WHICH ARE DISSOLVED IN BODY FLUIDS AND ARE NECESSARY IN PROPER CONCENTRATION
TO MAINTAIN NORMAL BODY FUNCTIONS
• BALANCE OF ELECTROLYTES IN THE BODY HELPS TO MAINTAIN HOMEOSTASIS
• CATIONS: CALCIUM (CARDIAC, NERVE, MUSCLE CONTRACTION), POTASSIUM (GLYCOGEN IN LIVER AND SKELETAL MUSCLES), MAGNESIUM (CARDIAC AND SKELETAL MUSCLE EXCITABILITY), SODIUM (WATER BALANCE, ACID-BASE, NERVE IMPULSE)
• ANIONS: CHLORIDE (TRANSPORT OF SODIUM, HYDROGEN AND POTASSIUM), BICARBONATE
(BUFFER, ACID-BASE BALANCE), PHOSPHATE (ACID-BASE BALANCE, NEUROMUSCULAR ACTION AND CARBOHYDRATE METABOLISM)
• CAN BE USED AS A REPLACEMENT FOR DEPLETED SALTS; AMMONIUM, BICARBONATE, CALCIUM,
RENAL DISEASES
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CHRONIC KIDNEY DISEASE: PROGRESSIVE LOSS OF KIDNEY FUNCTION MOST COMMONLY
CAUSED BY DIABETES AND UNCONTROLLED HYPERTENSION
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CATEGORIZED INTO 5 STAGES BASED ON GLOMERULAR FILTRATION RATE (GFR)= MEASURE
OF HOW WELL THE KIDNEYS ARE FILTERING; AS THIS PROGRESSES ALL PARTS OF BODY
ARE AFFECTED DUE TO A BUILD UP OF WASTE PRODUCTS AND IMBALANCE OF FLUIDS
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SYMPTOMS: FATIGUE, HEADACHE, SOB, SUDDEN WEIGHT CHANGES AND EDEMA; ANEMIA
IN MORE ADVANCED CKD BECAUSE OF DECREASED PRODUCTION OF ERTHYROPOIETIN
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TREATMENT: DIETARY MANAGEMENT (LIMIT PHOSPHATE AND DAIRY), DIALYSIS
EDEMA
• BUILDUP OF FLUID IN TISSUES OF THE BODY; CAN OCCUR IN EXTREMITIES (PERIPHERAL) OR
LUNGS (PULMONARY)- FLUID NORMALLY STORED IN THE INTERSTITIAL SPACES AROUND THE CELLS
• PERIPHERAL EDEMA CAN CAUSE PITTING (LEAVES AN INDENTION) OR NONPITTING (NO
INDENTION AND GENERALLY HARDER TO TREAT) EDEMA
• CAUSES: TEMPORARY EDEMA CAUSED BY HIGH ALTITUDE, EXERCISE OR MEDICATION; CHRONIC
CAUSES CAN BE FROM VENOUS INSUFFICIENCY, CIRRHOSIS, HEART FAILURE, HIGH SALT INTAKE, KIDNEY DISEASE THROMBOPHLEBITIS
• TREATMENT: ELEVATE LEGS, SUPPORT STOCKINGS
• DRUGS: DIURETICS (THIAZIDES, LOOP, POTASSIUM SPARING, ALDOSTERONE ANTAGONISTS,
EDEMA MEDICATIONS
• DIURETICS: USED FOR CONGESTIVE HEART FAILURE, HTN, AND FLUID RETENTION; ALTERS
BODY’S ELECTROLYTE PATTERN BY PROHIBITING OR ENHANCING EXCRETION OF ELECTROLYTES
• THIAZIDES: INDUCES AN EQUAL INCREASE IN THE URINARY EXCRETION OF THE IONS SODIUM
AND CHLORIDE BY INHIBITING NORMAL PROCESS OF REABSORPTION IN DISTAL CONVOLUTED TUBULE; KIDNEYS SECRETE MORE, DECREASES WATER RETENTION AND DECREASED BP; MAY REQUIRE A POTASSIUM SUPPLEMENT; USED TO TREAT HTN AND PREVENT KIDNEY STONES
• SIDE EFFECTS: INCREASED URINATION, WEAKNESS, MUSCLE CRAMPS, STOMACH UPSET,
DIZZINESS
• DRUGS: HYDROCHLORTHIAZIDE (HCTZ) (HYDRODIURIL, MICROZIDE), CHLOROTHIAZIDE (DIURIL,
EDEMA MEDICATIONS
• LOOP DIURETICS: USED TO TREAT CHF; INHIBIT REABSORPTION OF SODIUM AND CHLORIDE IN
PROXIMAL CONVOLUTED TUBULE, DISTAL CONVOLUTED TUBULE AND LOOP OF HENLE; MAY NEED A POTASSIUM SUPPLEMENT
• SIDE EFFECTS: INCREASED URINATION, WEAKNESS, MUSCLE CRAMPS, STOMACH UPSET, DIZZINESS
• DRUGS: FUROSEMIDE (LASIX), BUMETANIDE (BUMEX), ETHACRYNIC ACID (EDECRIN), TORSEMIDE (DEMADEX)
• POTASSIUM SPARING DIURETIC: FUNCTION MAINLY IN DISTAL, CONSUMING A LOT OF POTASSIUM RICH FOODS; TREATS CHF AND IS CONSIDERED A “WEAK” DIURETIC
• SIDE EFFECTS: INCREASED URINATION, WEAKNESS, MUSCLE CRAMPS, STOMACH UPSET, DIZZINESS
EDEMA MEDICATIONS
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COMBINATION DIURETICS: AMILORIDE + HCTZ (MODURETIC), TRIAMTERENE
+ HCTZ (MAXZIDE, DYAZIDE)
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OSMOTIC DIURETICS: INHIBIT TUBULAR REABSORPTION OF WATER BY
INCREASING OSMOLARITY OF THE GLOMERULAR FILTRATE- PULLS WATER OUT
OF THE BODY AND INTO THE KIDNEYS; USED FOR PROPHYLAXIS OF ACUTE
RENAL FAILURE AND TO PRODUCE INTENSE DIURESIS IN A HOSPITAL SETTING
RENAL DISORDER
• URINARY TRACT INFECTION (UTI): BACTERIAL OR FUNGAL INFECTION IN ANY PART OF THE
URINARY TRACT (KIDNEYS, BLADDER, URETERS, URETHRA); MOST COMMON CAUSE IS E.COLI; CAN ALSO BE CAUSED FROM STD’S OR IMMUNOCOMPROMISED SYSTEMS
• URETHRITIS- INFECTION IS FOCUSED IN THE URETHRA
• CYSTITIS- INFECTION OR INFLAMMATION OF THE BLADDER
• PYELONEPHRITIS- INFECTION OR INFLAMMATION OF THE KIDNEY
• SYMPTOMS: PAINFUL, BURNING URINATION, FEVER, LACK OF URINE OUTPUT, CLOUDY OR BLOODY
URINE, N&V, AND CONFUSION
• DRUGS: ANTIMICROBIAL AGENTS SUCH AS NITROFURANTOIN (MACROBID, MACRODANTIN),
KIDNEY STONES
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SMALL AGGREGATIONS OF MATERIAL (CALCIUM, MAGNESIUM OR URIC ACID
SALTS) THAT FORM IN THE KIDNEY AND/OR URINARY TRACT
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ALSO KNOWN AS UROLITHIASIS’
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SYMPTOMS: PAIN DURING URINATION, BLOOD IN URINE; CAN SOMETIMES
COMPLETELY BLOCK THE URINARY TRACT (FEVER, VOMITING, EXTREME BACK
PAIN, BLOOD IN URINE)
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TREATMENT: NATURALLY PASS THE STONE, LITHOTRIPSY
RENAL DISORDERS
• URINARY INCONTINENCE: COMMON CONDITION WHERE THERE IS A LOSS OF CONTROL OF URINATION (OVERACTIVE
BLADDER) OR DEFACATION; CAN BE CAUSED BY STRESS INCONTINENCE (COUGH, SNEEZE), WEIGHT GAIN, OR URGE INCONTINENCE (INVOLUNTARY URINATION RESULTING FROM A SUDDEN, UNCONTROLLABLE IMPULSE TO URINATE)
• TREATMENT: KEGEL EXERCISES
• DRUGS: ANTICHOLINERGIC MEDICATIONS SUCH AS OXYBUTYNIN (DITROPAN, OXYTROL, GELNIQUE), TOLTERODINE
(DETROL), DARIFENACIN (ENABLEX), TROSPIUM (SANCTURA)
• GOUT: OVERPRODUCTION OR INSUFFICIENT ELIMINATION OF URIC ACID THAT WILL CRYSTALLIZE IN THE JOINTS
CAUSING PAIN AND INFLAMMATION
