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Renal & Bladder Pathophysiology

NRS 233 Pathophysiology II
by

Katrina Dielman

on 15 May 2018

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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
(ATN)
- Ischemic, nephrotoxic
3 phases

of clinical manifestations
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
Dialysis or transplantation essential
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
Acute Tubular Necrosis
- 3 Phases
1.
2.
3.
ATN
- Pathogenesis
RIFLE
Classification of
AKI
Yikes!!
Oliguric Phase
associated with
Uremic Syndrome
=
Loss primarily of
excretory
functions +/- some
nonexcretory
functions
Symptoms of loss primarily of
excretory
renal functions +/-
nonexcretory
functions =
Uremic Syndrome
Copstead, L. & Banasik, J. (2018).
Pathophysiology
(6th ed.). St. Louis, MO: Elsevier.

Giddens, J. (2017).
Concepts for nursing practice
(2nd ed.). St. Louis, MO: Elsevier Mosby.

Bladder Structure & Innervation
Pyelonephritis
Nephrolithiasis
&
Obstructive
Disorders
Glomerulonephritis
Nephrotic Syndrome
www.uark.edu
Post-Streptococcal Glomerulonephritis
www.newhealthguide.org
KDIGO
- Kidney Disease Improving Global Outcomes
Watch: Larry Mellick YouTube: Hemolytic Uremic Syndrome - 8:15
Normal Renal Function

Excretory Function

Excrete magnesium ions
Excrete metabolic acids
Excrete nitrogenous wastes
(urea & creatinine)
Excrete phosphorus ions
Excrete potassium ions
Excrete sodium and water

Nonexcretory Function
-
Secrete erythropoietin
Convert inactive form of vitamin D
Result of Impaired Function

Loss of
excretory function
occurs with both
oliguric AKI
and
ESKD






Loss of
nonexcretory function
occurs primarily with
ESKD

Result of Impaired Function

Excretory Function
Hypermagnesemia
Metabolic acidosis
Azotemia - Elevated BUN and creatinine
Hyperphosphatemia
Hyperkalemia
ECV excess

Nonexcretory Function
Anemia
Bone mineral disorder
CKD-MBD
Full transcript