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Renal and Urologic Systems: A Comprehensive Study Guide, Exams of Nursing

The Courtauld Institute of Art, University of LondonNursing

A detailed overview of the renal and urologic systems, covering key concepts, mechanisms, and common conditions. It includes explanations of autoregulation, the renin-angiotensin-aldosterone system, glomerular filtration, tubular reabsorption, and tubular secretion. The document also explores age-related changes in the renal system, common causes of urinary tract obstruction, and various types of urinary tract infections. Additionally, it delves into glomerulonephritis, nephrotic syndrome, uremic syndrome, and acute and chronic kidney disease. The document concludes with a discussion of common signs of chronic kidney disease, renal failure, and renal insufficiency. It also covers various conditions affecting the urinary system in children, such as wilms tumor, vesicoureteral reflux, and hypospadias.

Typology: Exams

2024/2025

Available from 03/14/2025

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WGU D115 patho-Unit 6 renal and urologic systems
1. Autoregulation of renal blood flow<Ans>prevents large changes in GFR when
there are increases/decreases in BP; regulated neural and hormonal regulation
2. renin-angiotensin-aldosterone system<Ans>-decreased blood pressure causes
the juxtaglomerular cells of kidneys to secrete renin which converts angiotensinogen
(inactive) to angiotensin I (active) which is then converted into angiotensin II by
angiotensin-converting enzyme (ACE)
-Angiotensin II stimulates the adrenal cortex to secrete aldosterone
- leads to absorption of Na and increased blood pressure
-once blood pressure is restored, there is a decreased drive to stimulate renin
release
3. glomerular filtration<Ans>the movement of fluid and dilutes across glomerular
capil- lary membrane into the Bowman space
4. tubular reabsorption<Ans>Movement of fluids and solutes from tubular lumen to
the peritubular capillary plasma
5. tubular secretion<Ans>Transfer of substances from the plasma of the
peritubular to the tubular lumen, active and passive transport
6. Excretion<Ans>Elimination of a substance in the final urine
7. Aging and Renal System<Ans>Decrease<Ans>size of kidney, renal blood flow,
GFR, number and size of nephrons
Increase<Ans>glucose in urine, urgency, frequency, nocturia
Kidneys are less able to adapt to system changes
8. Creatinine<Ans>Substance produced by muscle, is measured in plasma and urine
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WGU D115 patho-Unit 6 renal and urologic systems

  1. Autoregulation of renal blood flow prevents large changes in GFR when there are increases/decreases in BP; regulated neural and hormonal regulation
  2. renin-angiotensin-aldosterone system -decreased blood pressure causes the juxtaglomerular cells of kidneys to secrete renin which converts angiotensinogen (inactive) to angiotensin I (active) which is then converted into angiotensin II by angiotensin-converting enzyme (ACE) -Angiotensin II stimulates the adrenal cortex to secrete aldosterone
  • leads to absorption of Na and increased blood pressure -once blood pressure is restored, there is a decreased drive to stimulate renin release
  1. glomerular filtration the movement of fluid and dilutes across glomerular capil- lary membrane into the Bowman space
  2. tubular reabsorption Movement of fluids and solutes from tubular lumen to the peritubular capillary plasma
  3. tubular secretion Transfer of substances from the plasma of the peritubular to the tubular lumen, active and passive transport
  4. Excretion Elimination of a substance in the final urine
  5. Aging and Renal System Decreasesize of kidney, renal blood flow, GFR, number and size of nephrons Increaseglucose in urine, urgency, frequency, nocturia Kidneys are less able to adapt to system changes
  6. Creatinine Substance produced by muscle, is measured in plasma and urine

to calculate a commonly used clinical estimate of GFR

  1. blood urea nitrogen (BUN) blood test that measures the amount of urea in the blood. An increased BUN detects an abnormality in renal function. BUN is also an indicator of hydration status
  2. Common causes of urinary tract obstruction Stones, strictures, congenital compression, tumors, and abdominal inflammation
  3. neurogenic bladder a urinary problem caused by interference with the normal nerve pathways associated with urination
  4. obstructive uropathy anatomic changes in the urinary system caused by obstruction
  5. Types of obstructive uropathy Upper urinarykidney stones, tubulointerstitial fibrosis Lower urinary tractneurogenic bladder, overactive/underactive bladder Anatomicurethral stricture, prostate enlargement, pelvic organ prolapse, partial

called chronic nephritis, May take 10-20 yrs, associated with diabetes and lupus

  1. nephrotic syndrome characterized by massive proteinuria caused by glomeru- lar damage. corticosteroids are the mainstay. Pt more susceptible to infection
  2. uremic syndrome Syndrome of renal failure, elevated blood urea and creati- nine, fatigue, anorexia, N/V, pruritis, neurological changes, retention of toxic wastes, electrolyte disorders, proinflammatory state
  3. azotemia Increased serum urea and often increased creatinine, renal insuffi- ciency or failure, accumulation of nitrogenous waste products in blood related to decreasing kidney function
  4. acute kidney injury -rapid loss of kidney function demonstrated by rise in serum creatinine &/or reduction in urine output -small increase in serum creatinine or reduction in urine output to the development of azotemia (accumulation of nitrogenous waste products) -develops over hours to days ’ progressive elevations of BUN, creatinine, potassium -50% mortality rate
  1. Chronic Kidney Disease (CKD) progressive, irreversible loss of kidney func- tion due to systemic disease
  2. Stages of CKD • Stage 1 = kidney damage GFR >
  • Stage 2 = kidney damage GFR 60- 89
  • Stage 3= moderate GFR 30- 59
  • Stage 4 = severe GFR 15- 29
  • Stage 5 = end-stage GFR <
  1. Factors of Progression of CKD Proteinuria-contributes to tubulointerstitial injury by promoting inflammation and progressive fibrosis Angiotensin II-promotes glomerular HTN, participates in tubulointerstitial fibrosis and scarring Other factorsglomerular HTN, hyperfiltration, tubulointerstitial injury, fibrosis
  2. uremia Proinflammatory state with systemic effects, associated with the accu- mulation of urea and other nitrogenous compounds and toxins
  3. Common signs of chronic Kidney Disease Lethargy, seizures, coma, frost, red eye, anorexia, N/V, HTN, pericarditis, heart failure, pleurisy, dyspnea on ex- ercise, nail changes, bone pain, edema, peripheral neuropathy, myopathy(muscle weakness), amenorrhea, impotence, infertility, bruising, pruritic excoriations, sallow pigmentation, epitaxis
  4. renal failure loss of kidney function resulting in its inability to remove waste products from the body and maintain electrolyte balance
  5. renal insufficiency decline in renal function to about 25% of normal
  6. urinalysis (UA) Evaluation of color, turbidity, protein, pH, specific gravity, sedi- ment, supernatant
  7. Policystic kidney disease Inherited disorder causing defects in the
  1. Henoch-Schonlein Purpura (HSP) Immune mediated IgA vasculitis cause inflammation and damage to glomerular blood vessels Sxpalpable purpura, arthritis, abdominal pain
  2. Hemolytic Uremic Syndrome a condition in which hemolytic anemia and thrombocytopenia cause acute renal failure and possibly death in children
  3. Nephrotic syndrome (kids) Term used to describe a symptom complex of proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Most common types in childrenminimal change nephropathy, focal segmental glomerulosclerosis, congen- ital (Finnish type)
  4. Hypospadius congenital defect, open of urinary meatus on under side of the penis
  5. epispadias a congenital abnormality in males in which the urethra is on the upper surface of the penis and in females a cleft along ventral urethra which usually extends to bladder neck
  6. Exstrophy of the bladder A congenital deformity resulting from failure of the pelvic structures to fuse so that the bladder opens on the surface of the lower abdomen.
  7. UTI's in children Infants Correct AnswerOften causes fever, vomiting , diarrhea, jaundice Childrenincontinence in previously dry child
  8. Wilms tumor (nephroblastoma) - kidney tumor usually occurs in children age <5
  • usually discovered when caregivers note an unusual bulging/swelling on one side of abdomen -"two hit " hypotheses
  1. vesicoureteral reflux (VUR) disorder caused by the failure of urine to

pass through the ureters to the bladder, usually due to impairment of the valve between the ureter and bladder or obstruction in the ureter

  1. Struvite stones More common in women, they grow large and branch into a staghorn configuration in the renal pelvis and calyces, closely associated with UTI's
  2. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) oversecretion of ADH from the neurohypophysis leading to severe hyponatremia and the inability to excrete diluted urine *over secretion of ADH by posterior pituitary gland common in prostate or renal cancers
  3. post obstructive diuresis Rapid excretion of large volumes of water, sodium, or other electrolytes, resulting in urine output >10L/day Causes dehydration, often related to passing kidney stone which unblocked urethra or ureter