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Renal & Bladder Pathophysiology

NRS 233 Pathophysiology II
by

Katrina Dielman

on 8 May 2016

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Transcript of Renal & Bladder Pathophysiology

Disorders of the Bladder
Control:
Continence vs. Incontinence
Undeveloped elimination mechanisms, malfunctions of mechanisms , or alterations in cognition
Injury/disease impacts neuromuscular integrity of sphicters and muscles
Changes in cognition result in inability to control elimination
Acute Kidney Injury - AKI
1. Prerenal
Absolute decrease in circulating volume
Relative decrease in circulating volume
Primary renal hemodynamic abnormality

2. Intrarenal
Acute
Tubular
Necrosis - Ischemic, nephrogenic
3 phases
Glomerular
- Acute glomerulonephritis
Interstitial
- Acute pyelonephritis
Vascular
- Vasculitis, emboli

3. Postrenal
Benign prostatic hyperplasia
Kinked/obstructed catheters
Intraabdominal tumors
Strictures
Calculi
Chronic Kidney Disease - CKD
1. Decreased Renal Reserve
<75% nephron destruction
Normal BUN - no azotemia
Undiagnosed
No signs/symptoms

2. Renal Insufficiency
75-90% nephron destruction
Mild azotemia
HTN
Increased UOP/polyuria/nocturia due to decreased ability to concentrate urine
Manage with diet & medication

3. End-Stage Kidney Disease
>90% nephron destruction
Azotemia
Decreased GFR
Uremic Syndrome
Intrarenal Disorders
1. Pyelonephritis
2. Nephrolithiasis & Obstructive Disorders
3. Glomerulonephritis
4. Nephrotic Syndrome
Disorders of the Kidneys
Disorders of the Bladder
The Takeaway -
Monitor Urine Output!!

Renal & Bladder Pathophysiology
References
NRS 233 Pathophysiology II
Ensure
Hydration
Increases volume
Reduces bladder irritation
Helps eliminate toxins from the body
30 mL/hr minimum
Acute Kidney Injury - AKI

Acute Tubular Necrosis
will occur if
prerenal
or
postrenal
kidney injury is not corrected
within a few hours
Check for
Obstruction, Retention
, or
Infection
Retention:
Bladder Distention
Obstructions, inflammation, or ineffective neuromuscular activation within the bladder
Infection:
Cystitis
Pain is often associated with urinary tract infection
Uremic Syndrome
Loss of
Nonexcretory
Renal Function
ESKD
Loss of
Excretory
Renal Function
Oliguric
phase of
AKI
ESKD
Acute Tubular Necrosis
- 3 Phases
1.
2.
3.
ATN - Pathogenesis
RIFLE
Classification of
AKI
www.renalmed.co.uk
Yikes!!
Oliguric Phase
associated with
Uremic Syndrome
-
Loss of
excretory
functions
Symptoms of loss of
excretory
renal function =
Uremic Syndrome
Black, J.M., & Hawks, J.H. (2008).
Medical-Surgical nursing: Clinical management for positive outcomes
(8th ed.). St. Louis, MO: Elsevier.

Copstead, L. & Banasik, J. (2013).
Pathophysiology
(5th ed.). St. Louis, MO: Elsevier.

Felver, L. (2013). Online Materials:
PROP- Pathophysiology online.
Retrieved from https://evolve.elsevier.com/

Giddens, J. (2013).
Concepts for nursing practice
(1st ed.). St. Louis, MO: Elsevier Mosby.

YouTube videos embedded on some slides.
Bladder Structure & Innervation
Pyelonephritis
Nephrolithiasis
& Obstructive Disorders
Glomerulonephritis
Nephrotic Syndrome
www.uark.edu
Post-Streptococcal Glomerulonephritis
www.newhealthguide.org
The Basement Membrane!
Full transcript