Kidneys 2017
adrenal gland
Label & color
prostate
Label & color
Glomerulus (singular)
Glomeruli (plural)
adrenal gland
Label & color
prostate
-20 WE pts if I see a phone
The
Urinary
System
•2 kidneys
•2 ureters
•1 bladder
•1 urethra
Have 2
Can live c only 1
Vital!!!
Very vascular
In postero of laparo postero hepato & gastro
The urinary tract is supposed to be a STERILE PLACE!!!
Nephrology
• A&P of kidneys
• Kidney disorders
• Ex. Kidney failure
• NO surgery
Urology
• Deals with ‘plumbing’
• Males, females, all ages
• Ex. UTI’s, kidney stones
• Also, male reproduction (ex. ED,
prostate)
• Also a surgeon
Basic
Steps
• Fresh O2 blood, lungs > heart
• Heart beats, blood to aorta > arteries > organs
• Aorta > renal arteries > kidneys
• Nephrons in kidneys filter blood, removing ‘junk’
• Clean blood > renal veins > heart & lungs, repeat
• Junk + H2O + pigment (UROCHROME) = urine
• Urine drips down kidney pelvis > ureter > bladder > urethra > out
So the kidneys clean our blood & make urine…is that
all they do?
Water
Balance
• K’s maintain basic water balance by urinating & recycling
• Too much H2O in blood = more pee
• Too little H2O in blood = less pee
• Gauge by the color of urine
• Homeostasis
Electrolyte
Balance
• K’s constantly monitor/regulate blood’s levels of electrolytes
• Na, Cl, Ca, K
• Needed for muscles / nerves
• oligo electrolytes = death
• Homeostasis
Rid wastes
from
blood
• Urea (proteins)
• Nephrons clean blood & eliminates wastes
• BUN = Blood Urea Nitrogen
Regulate
BP
• K’s make hormone RENIN
• Renin regulates Na in blood
• Too much Na in blood = BP
• Ever heard of pt c HBP to cut down on Na foods?
• Na > edema > excess blood volume > HBP
Build
RBC’s
• K’s make hormone ERYTHROPOIETIN
• Which stimulates bone marrow to make RBC’s
Blood’s
pH • Blood pH = 7.35 – 7.45
• VERY narrow window of ‘normal’
• Ex: Uncontrolled diabetes > acidic blood
• > multiple organ death
Look
closely at
kidneys
Look
closely at
kidneys
• Basic cells of K’s
• ≈ 1 million/kidney
• Fragile, delicate, tiny but mighty
• Glomeruli + tubules do all the kidney’s work
Look
closely at
kidneys
When nephrons make urine, it …
• Constantly drips from kidney pelvis into ureter
• Collects in bladder
• Exits thru urethra
What is
a
urinalysis?
U/A
• Mash-up of 2 words: urine + analysis
• “pee in a cup”
• Indicates general health, not only of K’s
What is
a
urinalysis?
• Albumin = protein
• Healthy kidneys do not ‘spill’ protein into urine
• So, PRO in urine is serious!
What is
a
urinalysis?
• Glucose = Blood Sugar
• Glucose in urine = diabetes
What is
a
urinalysis?
• WBC’s in urine = infection
• WBC’s indicate urine no longer sterile
• UTI = urinary tract infection
What is
a
urinalysis?
• RBC’s = bleeding
• Could be stones, UTI, tumors, trauma, etc.
• HEMATURIA
What is
a
urinalysis?
• pH of urine
• Slightly acidic in AM (6.5 – 7.0)
• More alkaline as we eat/drink (7.5 – 8.0)
Ureters
• Pair of tubes
• Kidney pelvis to bladder
• Peristalsis
Bladder
• “Balloon” that expands
• Hollow & muscular
• Lined with mucous membrane
Bladder
• Voluntary ; Sphincter
• M&F: In front of rectum
• F: In front of vagina & below uterus
• M = larger. Why???
Urethra
• Narrow tube
• Drains urine from bladder
• MUCH shorter in F
• MUCH longer in M
Prostate
• Male repro structure
• At base of bladder
• Surrounds urethra
• In older men, hypertrophies
• CA vs. Benign
What
is
urinary
incontinence?
• Lack of voluntary bladder control
• Babies: sphincters immature so bladder empties when
it’s full
• As we grow, our urinary sphincters mature so we can
control when we pee
• Older adults may lose this control
• Smokers have this x2
Aging
urinary
system
• Kidneys – shrink, decreased blood flow, filter less
• Kidney diseases more common
• Sensation of thirst decreases > dehydration
• UTI’s more common
• Incontinence more common
Do you recall these items of medical equipment?
• Catheter & Foley bag?
• Specimen cup?
• Bedside commode?
• Endoscope? Esp. cystoscope?
• Urine strainer?
• Briefs? (NOT diapers)
• Urine dipstick
One type of
________
CYSTOSCOPY
CYSTOSCOPY
CYSTOSCOPY
• https://www.youtube.com/watch?v=d9Vx3Lgz4sw
Kidney Stones aka NEPHROLITHIASIS
• https://www.youtube.com/watch?v=LngbrHJkXoE
Kidney Stones aka NEPHROLITHIASIS
1. Common or rare? Circle one
2. More common in this sex: _____________________________
3. The K’s are 2 B____-shaped organs located near the M______ of the back.
4. They work as F________ removing W_______ P__________ & E___________
F__________ from the blood & return C______________ B___________ to the body.
The waste products & excess fluid become U___________.
5. Urine travels from the kidneys thru 2 narrow tubes called U____________, to the
B___________ and leaves the body thru the U_________________.
6. If there is a chemical imbalance in the composition of the urine, C____________ can
form which can build up into stone-like lumps
7. ID 3 causes of kidney stones: 1.D__________________________ 2. A diet high in
P__________________ and 3 Other medical conditions such as 8.____________
_____________ ____________.
Kidney Stones aka NEPHROLITHIASIS
9. If stones are small, how do they usually leave the body? __________________________
10. Larger stones can get ‘stuck’ in the kidneys.
11. Kidney stones are often tx’d with IV F______________ and P_________
K____________. However, in the case of infection or obstruction, other interventions can
become necessary.
12. Describe shock way therapy (AKA ESWL, or extra-corporeal shock wave lithotripsy)
13. Describe percutaneous nephrolithotomy.
14. Describe ureteroscopy.
Kidneys & NSAID’s
• Recall: Non-Steroidal Anti-Inflammatory Drugs
• Ex: ASA, Motrin (Ibuprofen), Aleve (naproxen) -- (NOT
Tylenol!)
• NSAID’s reduce blood flow thru kidneys
• Thus, NSAID’s can damage the kidneys
• Pts w/ impaired renal fxn should avoid NSAID’s
• NSAID overdose can lead to acute renal failure
UTI, or Urinary Tract Infections, or bladder
infections, or cystitis
• If you unable to ID the 4 parts of the urinary tract, list them here
• Most common: bladder & urethra
• F>M why?
• Antibiotics to kill E.Coli
• Cranberry juice
https://www.youtube.com/watch?v=u11DfF6fuCM
UTI Cause(s)
• Bacteria climb up urethra (E.Coli)
• STI
• Prostate issues
• Incontinence
• Catheter use
UTI S/S
• Urgency
• Frequency
• Dysuria
• Smelly pee
• Cloudy or pink urine
BPH & Prostate CA
• Men >50
• Hypertrophied prostate
• Benign vs. malignant
• PSA
• Digital rectal exam
https://www.youtube.com/watch?v=aLPqzYMg42Y
https://www.baptistjax.com/health-library/symptoms/urinary-incontinence
BPH &
Prostate
CA
• https://www.youtube.com/watch?v=flHXrnSWxCU
• Robotic prostatectomy
• https://www.youtube.com/watch?v=2XKnkB7p_l8