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URINARY DISORDERS CHEMICAL CONTROL OF URINARY SYSTEM Reabsorption of H2O in distal convoluted tubule controlled by ADH (antidiuretic hormone) – hormone makes collecting tubules more permeable to water ADH known as the “waterretaining hormone” Secretion and regulation of ADH is controlled by the pituitary gland in the hypothalamus ALDOSTERONE – secreted by the adrenal cortex, promotes excretion of potassium and hydrogen ions and reaborption of sodium, chlorine ions and H20 ADRENAL GLANDS CHEMICAL CONTROL OF THE URINARY SYSTEM RENIN –hormone released by kidneys, stimulates release of aldosterone from adrenal cortex DIURETICS inhibit reabsorption of H2O Lasix –well known diurectic that acts on the Loop of Henle to block reabsorption NERVOUS CONTROL OF THE URINARY SYSTEM Direct control through nerve impulses on the kidney blood vessels Indirect control through stimulation of endocrine glands ACUTE KIDNEY FAILURE Rapid decline in kidney function Caused by a variety of factors that alter blood pressure or affect glomerular filtration such as nephritis, shock, injury, bleeding, sudden heart failure or poisoning Symptoms – OLIGURIA OR ANURIA ACUTE RENAL FAILURE Suppression of urine formation can lead to UREMIA – toxic condition when blood retains urinary waste products Concentration of nitrogenous waste is assessed by the Blood Urea Nitrogen (BUN) Urea is produced by the breakdown of protein already in the body and protein in your diet Normal BUN is 7 – 20 mg/dL in adults and 5 – 18 mg/dL in children A high BUN usually means the kidney function is less than normal CHRONIC RENAL FAILURE Gradual loss of function of nephrons Stage I – Some nephrons are lost but others compensate by enlarging and taking over (BUN is normal) Stage II – called renal insuffiency – remaining nephrons can’t handle urea load and BUN climbs – also have polyruria and dehydration Stage III – called uremia – very high BUN due to loss of kidney function – fluids retained by the body so get hypertension and edema – need kidney transplant GLOMERULONEPHRITIS Inflammation of the glomerulus Filtration process affected Plasma proteins are filtered through and found in urine, RBCs too (HEMATURIA) Can be acute or chronic Acute is caused by a delayed immune response (1 – 6 weeks) to a streptococcal infection – most common form of kidney disease Chronic – there is permanent damage PYELONEPHRITIS Literally “pelvis nephritis” and refers to inflammation of the renal pelvis and connective tissue of the kidney Usually caused by infection from ureters or bladder Symptoms – fever, chills, pain in the sides, nausea and an urge to urinate frequently Another symptom is PYURIA (pus in urine) – yellow streaks seen in the medulla indicate tubules filled with pus Rx - antibiotics HYDRONEPHROSIS Urine backs up because of blockage in ureter and renal pelvis and calcyes become distended Can be due to kidney stone Can also be caused by pregnancy and enlarge prostrate Rx – Remove the cause RENAL CALCULI (Kidney Stone) Develop in the renal pelvis or calcyes (under reanl pyamids) Made of crystals of calcium phosphate and uric acid Gradually they grow larger until they block the ureter – small ones may pass through First symptom – severe pain Other symptoms – nausea and vomiting, urine frequency, chills, fever, and hematuria RENAL CALCULI (KIDNEY STONES Diagnosis – by symptoms, utlrasound, or x-ray (IVP – intravenous polygram or KUB) Rx – increase fluids to flush out stones, medications, and if needed - LITHOTRIPSY LITHROTRIPSY Surgical procedure to remove kidney stones Shock waves hit dense stones and break them up Done on outpatient basis Cystitis Inflammation of the mucous membrane lining of the urinary bladder Most common cause – E.Coli Symps = DYSURIA (painful urination) and frequency Usually in females (shorter urethra) Rx - antibiotics Incontinence Involuntary urination Dialysis Used for kidney failure Involves the passage of blood through a device with semipermeable membrane Dialysis serves as a substitute kidney Hemodialysis Blood from patient flows through machine and its filtered Usually a FISTULA is created (opening between vein and artery) for inserting needles Can be done at home or in clinic Takes 2-4 hours, 2-3 times a week Peritoneal Dialysis Uses the peritoneal lining to filter blood Dialysate (cleaning solution) flows in and out via a catheter tube Kidney Transplant Done as a last resort Involves donor organ from someone with a similar immune system Main complication rejection Urinary Conditions ENURESIS - bedwetting NOCTURIA – frequent urination at night GLYCOSURIA – sugar in urine Hematuria – blood in urine