NURS j611 jAdvanced
jPathophysiologyjExam j#4 jStudy
jGuide
Week j 15 jRenal j and jUrologic j Systems: j Chapters j38 j& j39
Urinary jTract jObstruction: jinterference jwith jthe jflow jof jurine jat jany jsite jalong jthe jurinary jtract
* Impedes jurine jflow,
jincreases
j hydrostatic jpressure,
jand jdilates
jstructures jproximal
jtojthe jobstruction,
jincreases jrisk jfor
jinfection, jand
jcompromises j renal
jfunction
Acute jUnilateral j Renal jObstruction j& jHypertension
* Passage jof jkidney jstones jcan jbe jextremely jpainful j& jmay jproduce j“referred
jpain” jtojumbilicus jarea j(due jto jthe jsensory jinnervation jof jthe
jupper jpart jof
the jureter jarising jfrom jthe j10th jthoracic jnerve jroots)
Reduced jperfusion j(kidneys jrequirement jis jat jleast j20-25% jCO-MAP) jof jthe
jaffected j kidney j activates j the j RAAS, j which j causes j constriction j of
j peripheraljarterioles j(= jHTN)
Kidney j Stones: j masses j of j crystal, j protein, j or j other j substances j that j are j a
j commonjcause jof jurinary jtract jobstruction
* Risk jfactors jare jage, jsex, jrace, jgeographic jlocation, jseasonal jfactors, jfluid jintake,
jdiet,joccupation, jgenetics, jother jconditions jsuch jas jUTI, jHTN, jatherosclerosis,
jmetabolic jsyndrome, jobesity jand jDM jtype jII
* Classified j according j to j primary j minerals jthat make jup
jthe j stones--> j Calcium j Oxalate j most common
Pathophysiology
Complex j process; j involves j (1) j supersaturation j of j one or jmore
salts jin jurine, j(2) jprecipitation jof jsalts jfrom ja jliquid jto a
jsolidjstate, j(3) jgrowth jthrough jcrystallization jor
agglormeration, jand j(4) jeffect jof jstone jinhibitors
Clinical j Manifestations—Pain, jN/V, jGross
j orjmicroscopic jhematuria
* Renal j colic j is jmoderate jto j severe jpain
Posterior jflank j& jradiates jto jgroin Renal jpelvis jor jproximal jureter
,Lateral jflank jor jlower jabdomen Midureter
, Bothersome jUTI jsymptoms j(urgency, Lower jureter jor juterovesical jjunction
jfrequent
voiding, j urge j incontinence)
Urinary jTract jInfections j(UTI)
* Inflammation jof jthe jurinary jepithelium jusually
jcaused j by j bacteria j from j gut j flora, j occurs
j anywherejalong jthe jurinary jtract j(urethra,
jbladder, jureter, jorjkidney)
Who j jis jat j jrisk? jPremature jnewborns; jprepubertal
jchildren; jsexually jactive jand jpregnant jwomen; jwomen
jtreated jwith jantibiotics jthat jdisrupt jvaginal jflora;
jspermicide j users; j estrogen-deficient jpostmenopausal
jwomen; jindividuals jwith jindwelling jcatheters; jpersons
jwithjDM, jneurogenic jbladder, jor jurinary jtract
jobstruction
Clinical jmanifestations jof ja jUTI jin jan jolder jadult jare
jconfusion jand jpoorly jlocalized jabdominal jdiscomfort,
jveryjdifficult jdiagnose jdue jto jvague jsymptoms
Types
I. Cystitis
* Inflammation jof jthe jbladder j& jthe jmost jcommon jsite jof jUTI
jPathophysiology—most j common j infecting j microbe j is j E.coli j (80-85%), j second j is
jStaphylococcus j saprophyticus j (10%). j Bacterial j contamination j of j the j sterile j urine
j usuallyjoccurs jby jretrograde jmovement jof juropathic jgram-negative jbacilli jfrom jthe
jgut jinto j the jurethra jand jbladder jand jthen jto jthe jureter jand jkidney
Clinical j Manifestations: j related j to j the j host j inflammatory j response j & j usually
j includejfrequency, jurgency, jdysuria j(painful jurination), j& jsuprapubic jand jlow jback jpain
› Inflammatory jedema jin jthe jbladder jwall jstimulates jdischarge jof jstretch jreceptors,
jinitiating j symptoms j of j bladder j fullness j with j small j volumes j of j urine j & j producing
j urgencyjand jfrequency
› Hematuria, jflank jpain, jcloudy j& jfoul-smelling jurine
jarejmost jserious jsymptoms
Treatment--> jurosepsis j& jseptic jshock jare jmedical
jemergencies, j demand j parenteral, j broad-spectrum
j antibx jtx jand jmay jrequire jhospitalization
, II. Pyelonephritis
* Infection jof jone jor jboth jupper jurinary jtracts j(ureter, jrenal
jpelvis,jkidney jinterstitium)
Urinary jobstruction j& jreflux jof jurine jfrom jthe jbladder
(vasicoureter jreflux) jare jthe jmost jcommon junderlying jrisk jfactors
⟶ j Common j causes j are j kidney j stones, j vesicoureteral j reflux,
j pregnancy,jneurogenic j bladder, j instrumentation, j and j female j sexual
j trauma
Pathophysiology— jMicrobes jassociated jinclude jE.coli, jProteus, j&
jPseudomonas. jLatter jtwo jare jassociated jwith jinfections jafter
jsurgery.
These jspecific jmicrobes jsplit jurea jin
to jammonia, jmaking jalkaline jurine jthat jincreases jthe jrisk jof jstone
jformation. jIn jsevere jinfections, jlocalized jabscesses jmay jform jin jthe
jmedulla jand jextend jto jthe jcortex.
Clinical jManifestations: jacute, jwith jfever, jchills, jand jflank jor jgroin jpain. jOlder jadults
jmayjexperience jlow-grade jfever jand jmalaise.
** jDifferentiating jsymptoms jof jcystitis jfrom jthose jof jpyelonephritis jby
jclinicaljassessment jalone jis jdifficult.
The jspecific jdiagnosis jis jestablished jby jurine jculture, jUA, jand jclinical jsigns
j&jsymptoms.
WBC jcasts jindicate jpylenephritis**
Painful jBladder jSyndrome/Interstitial jCystitis j(PBS/IC): junpleasant jsensation j(pain,
jpressure, jdiscomfort) jperceived jto jbe jrelated jto jthe jurinary jbladder jassociated jwith
jlower jurinary jtractjsymptoms jof jmore jthan j6 jweeks’ jduration jin jthe j jabsence j jof j
jinfection j jor j jother jidentifiable j causes
jPathophysiologyjExam j#4 jStudy
jGuide
Week j 15 jRenal j and jUrologic j Systems: j Chapters j38 j& j39
Urinary jTract jObstruction: jinterference jwith jthe jflow jof jurine jat jany jsite jalong jthe jurinary jtract
* Impedes jurine jflow,
jincreases
j hydrostatic jpressure,
jand jdilates
jstructures jproximal
jtojthe jobstruction,
jincreases jrisk jfor
jinfection, jand
jcompromises j renal
jfunction
Acute jUnilateral j Renal jObstruction j& jHypertension
* Passage jof jkidney jstones jcan jbe jextremely jpainful j& jmay jproduce j“referred
jpain” jtojumbilicus jarea j(due jto jthe jsensory jinnervation jof jthe
jupper jpart jof
the jureter jarising jfrom jthe j10th jthoracic jnerve jroots)
Reduced jperfusion j(kidneys jrequirement jis jat jleast j20-25% jCO-MAP) jof jthe
jaffected j kidney j activates j the j RAAS, j which j causes j constriction j of
j peripheraljarterioles j(= jHTN)
Kidney j Stones: j masses j of j crystal, j protein, j or j other j substances j that j are j a
j commonjcause jof jurinary jtract jobstruction
* Risk jfactors jare jage, jsex, jrace, jgeographic jlocation, jseasonal jfactors, jfluid jintake,
jdiet,joccupation, jgenetics, jother jconditions jsuch jas jUTI, jHTN, jatherosclerosis,
jmetabolic jsyndrome, jobesity jand jDM jtype jII
* Classified j according j to j primary j minerals jthat make jup
jthe j stones--> j Calcium j Oxalate j most common
Pathophysiology
Complex j process; j involves j (1) j supersaturation j of j one or jmore
salts jin jurine, j(2) jprecipitation jof jsalts jfrom ja jliquid jto a
jsolidjstate, j(3) jgrowth jthrough jcrystallization jor
agglormeration, jand j(4) jeffect jof jstone jinhibitors
Clinical j Manifestations—Pain, jN/V, jGross
j orjmicroscopic jhematuria
* Renal j colic j is jmoderate jto j severe jpain
Posterior jflank j& jradiates jto jgroin Renal jpelvis jor jproximal jureter
,Lateral jflank jor jlower jabdomen Midureter
, Bothersome jUTI jsymptoms j(urgency, Lower jureter jor juterovesical jjunction
jfrequent
voiding, j urge j incontinence)
Urinary jTract jInfections j(UTI)
* Inflammation jof jthe jurinary jepithelium jusually
jcaused j by j bacteria j from j gut j flora, j occurs
j anywherejalong jthe jurinary jtract j(urethra,
jbladder, jureter, jorjkidney)
Who j jis jat j jrisk? jPremature jnewborns; jprepubertal
jchildren; jsexually jactive jand jpregnant jwomen; jwomen
jtreated jwith jantibiotics jthat jdisrupt jvaginal jflora;
jspermicide j users; j estrogen-deficient jpostmenopausal
jwomen; jindividuals jwith jindwelling jcatheters; jpersons
jwithjDM, jneurogenic jbladder, jor jurinary jtract
jobstruction
Clinical jmanifestations jof ja jUTI jin jan jolder jadult jare
jconfusion jand jpoorly jlocalized jabdominal jdiscomfort,
jveryjdifficult jdiagnose jdue jto jvague jsymptoms
Types
I. Cystitis
* Inflammation jof jthe jbladder j& jthe jmost jcommon jsite jof jUTI
jPathophysiology—most j common j infecting j microbe j is j E.coli j (80-85%), j second j is
jStaphylococcus j saprophyticus j (10%). j Bacterial j contamination j of j the j sterile j urine
j usuallyjoccurs jby jretrograde jmovement jof juropathic jgram-negative jbacilli jfrom jthe
jgut jinto j the jurethra jand jbladder jand jthen jto jthe jureter jand jkidney
Clinical j Manifestations: j related j to j the j host j inflammatory j response j & j usually
j includejfrequency, jurgency, jdysuria j(painful jurination), j& jsuprapubic jand jlow jback jpain
› Inflammatory jedema jin jthe jbladder jwall jstimulates jdischarge jof jstretch jreceptors,
jinitiating j symptoms j of j bladder j fullness j with j small j volumes j of j urine j & j producing
j urgencyjand jfrequency
› Hematuria, jflank jpain, jcloudy j& jfoul-smelling jurine
jarejmost jserious jsymptoms
Treatment--> jurosepsis j& jseptic jshock jare jmedical
jemergencies, j demand j parenteral, j broad-spectrum
j antibx jtx jand jmay jrequire jhospitalization
, II. Pyelonephritis
* Infection jof jone jor jboth jupper jurinary jtracts j(ureter, jrenal
jpelvis,jkidney jinterstitium)
Urinary jobstruction j& jreflux jof jurine jfrom jthe jbladder
(vasicoureter jreflux) jare jthe jmost jcommon junderlying jrisk jfactors
⟶ j Common j causes j are j kidney j stones, j vesicoureteral j reflux,
j pregnancy,jneurogenic j bladder, j instrumentation, j and j female j sexual
j trauma
Pathophysiology— jMicrobes jassociated jinclude jE.coli, jProteus, j&
jPseudomonas. jLatter jtwo jare jassociated jwith jinfections jafter
jsurgery.
These jspecific jmicrobes jsplit jurea jin
to jammonia, jmaking jalkaline jurine jthat jincreases jthe jrisk jof jstone
jformation. jIn jsevere jinfections, jlocalized jabscesses jmay jform jin jthe
jmedulla jand jextend jto jthe jcortex.
Clinical jManifestations: jacute, jwith jfever, jchills, jand jflank jor jgroin jpain. jOlder jadults
jmayjexperience jlow-grade jfever jand jmalaise.
** jDifferentiating jsymptoms jof jcystitis jfrom jthose jof jpyelonephritis jby
jclinicaljassessment jalone jis jdifficult.
The jspecific jdiagnosis jis jestablished jby jurine jculture, jUA, jand jclinical jsigns
j&jsymptoms.
WBC jcasts jindicate jpylenephritis**
Painful jBladder jSyndrome/Interstitial jCystitis j(PBS/IC): junpleasant jsensation j(pain,
jpressure, jdiscomfort) jperceived jto jbe jrelated jto jthe jurinary jbladder jassociated jwith
jlower jurinary jtractjsymptoms jof jmore jthan j6 jweeks’ jduration jin jthe j jabsence j jof j
jinfection j jor j jother jidentifiable j causes
