The Al Sham Private University Pr. Hussam Shebli

Presentation by: Joudy Alkabbani, Asmaa Aljeala, Noor Elkhechi, Abbas Mazeh, Hiba Assaf, Tarek Gherli The urinary system:

1 The kidneys

2 The ureters

3 The bladder

4 The urethra Anatomical introduction Introduction • Two reddish-brown bean-shaped organs about the • located posteriorly in the abdomen, retroperitoneally on either side of the spine at the T12–L3 level kidneys: • The right kidney is lower than the left Kidney because of the liver Histological introduction • Cortex (renal corpuscle, proximal convoluted tubule, distal convoluted tubules and collecting tubules) • Medulla (renal pyramids, minor calyces and major calyces) • Simple cuboidal epithelium

Physiological introduction • Filtration • Reabsorption • Secreting hormones (Renin and Erythropoietin) • Maintaining homeostasis The ureters Introduction • The ureters are bilateral thin (3 to 4 mm) tubular structures • They connect the kidneys to the about: (transporting from the renal pelvis into the bladder) • Transitional epithelium

The bladder • Muscular organ that stores urine • It sits on the pelvic floor • The bladder can hold between 300 and 500 ml • Transitional epithelium

The urethra • A tube that connects the urinary bladder to the urinary meatus to remove the urine from the body • Females use their urethra only for urination • But males use their urethra for urination and ejaculation • The structure of the urethra is fibrous and muscular Kidney’s hormones

Hormones that are secreted from the kidneys: Hormones that affect the kidneys:

• Erythropotien: 90% of it is secreted from the • PTH: affects the proximal tubule kidneys and the other 10% is secreted from • ADH: affects the distal tubule the liver • Aldosterone: affects the distal tubule • Natriuretic peptides: • Renin: secreted from the juxtaglomerular ANP: secreted from the atrium apparatus BNP: secreted from the ventricle It activates (Renin-angiotensin-aldosterone CNP: secreted from the vessels system) Medical history

1 Presenting complaint 3 Drug history

2 Past history 4 Family history

5 Social history Voiding symptoms

Storage Voiding phase After With symptoms symptoms micturition incontinence

Frequency Dripping Involuntary release of Urgency Incomplete Hesitancy urine  emptying Abnormalities in urine volume and composition

01 04 Hematuria (red urine)

02 05 Pneumaturia

03 06 Proteinuria Functional assessment of the lower urinary tract

Frequency/volume chart • monitor micturition patterns • Urine collection Urodynamic tests

Urine flow rate • measures the rate of urine passage Clinical examination: 5 Eyes

1 General observation 6 Lung bases

2 Hands 7 Heart

3 Arms

8 Abdomen

4 Face and neck 9 Legs Diseases related to the urinary system

Kidney cancer Renal failure Hemolytic uremic syndrome Polycystic kidney pyelonephritis Nephrolithiasis Azotemia Urinary tract inflammation Renal failure Overview

• It’s a situation that the kidneys can’t do their job well

• There are two types of renal failure: 1. Acute renal failure 2. Chronic renal failure Renal failure Types and symptoms Acute renal failure Chronic renal failure The kidneys suddenly lose the ability to The end result of progressive loss of eliminate excess fluids and waste kidney function. It may be slow that you materials from the blood. do not have symptoms until your kidneys Symptoms have almost stopped working. 1. Lack of urination Symptoms 2. Fluid retention 1. Nausea and vomiting 9. Chest pain 3. Dyspnea 2. Loss of appetite 10. Dyspnea 4. Fatigue 3. Fatigue and weakness 5. Blurring of vision 4. Insomnia 6. Nausea 5. Changes in urine volume 7. Arrhythmia 6. Reduced mental sharpness 8. Chest pain 7. Muscular spasms 9. Strokes and unconsciousness in severe cases 8. Swelling of feet and ankles Renal failure Causes

Acute renal failure Chronic renal failure 1. If the patient has a prior case that causes decreased blood flow to the 1. Patient has diabetes mellitus type kidneys. one or two. 2. If there is direct damage to the 2. High blood pressure kidneys. 3. Glomerulonephritis 3. If the ureters are blocked and toxic 4. Interstitial nephritis products are not released with the urine. 5. Polycystic kidney Disease 6. Prolonged blockage of ureters 7. Pyelonephritis (Inflammation of R enal tubule and kidney) Renal failure Diagnosis Polycystic kidney Overview

A genetic disorder characterized by the development of cysts in the kidneys. These cysts are filled with fluid, and replace much of the mass of the kidneys which reduces kidney function, leading to kidney failure. Polycystic kidney Symptoms

1. High blood pressure 2. Back pain 3. Blood in the urine 4. Headache 5. Kidney stones 6. Kidney failure 7. Increasing of the abdomen size due to enlarged abdomen 8. Urinary tract infections Polycystic kidney Diagnosis

Ultrasound

MRI CT scan Nephrolithiasis Overview

• Occurs in 1 or both kidneys between ages 30 to 60 • Is an accumulation of wastes in the kidney due to deficiency in blood fluid. • They form calculus made of minerals and salts. • A small stone passes without symptoms but if a stone grows to more than 5 millimeters, it can cause blockage of the ureter. • It can lead to severe kidney pain and infections or malfunction if left untreated. Nephrolithiasis

Causes Nephrolithiasis Symptoms

A kidney stone is asymptomatic until it moves within the kidney or towards the ureters. 1. Radial Pain in the abdomen fluctuates in intensity 2. Burning sensation while urinating 3. Pink, red or brown urine (Hematuria) 4. Cloudy or foul-smelling urine 5. Persistent need to urinate 6. Nausea and vomiting 7. Pain caused by a kidney stone may change shifting to a different location as the stone moves through your urinary tract Nephrolithiasis Treatment

Treating small kidney stones • Drinking fluids (up to 3 liters/day) • Painkillers, like ibuprofen • Anti-sickness medicine • Alpha-blockers (Helps stones pass) • Avoid fizzy drinks • Do not eat too much salt Treating large kidney stones 1. Extracorporeal shock wave lithotripsy 2. Ureteroscopy • The type of procedure will depend on the size and location of your stones. Azotemia Overview • A condition that occurs when the kidneys have been damaged by a disease or injury • It is characterized by abnormally high levels of nitrogen (such as urea and creatinine) in the blood • Occurs due to insufficient or dysfunctional filtering of blood by the kidneys Pre-renal Azotemia • Occurs due to decrease in blood flow (hypoperfusion) • Follows hemorrhage, shock, volume depletion, congestive heart failure or adrenal insufficiency.

Intrinsic Azotemia Types of Azotemia: • Occurs due to infection, sepsis, or disease. • Most commonly caused by acute tubular necrosis.

Post-renal azotemia • Caused by a urinary tract obstruction. • Can occur with prerenal azotemia.

These types of azotemia have different treatments, causes, and outcomes. (They can lead to acute kidney injury and failure) Azotemia Renal azotemia symptoms

• Acute renal failure (If azotemia remains for hours or days) • Loss of energy and paleness • Not participating in usual activities • Loss of appetite • Fluid retention • Swelling and edema • Nausea and vomiting Azotemia Diagnosis and treatment Azotemia diagnosis • Usually diagnosed by urine and blood tests • These tests will check blood urea nitrogen (BUN) and creatinine levels Azotemia treatment • Dialysis (for late-stage progression and may only be temporary) • Treatment of the underlying condition • Intravenous fluids Kidney cancer Overview

• Abnormal growth • Results due to change in cells • Abnormal replication • Can spread to other locations Kidney cancer

Causes Kidney cancer Symptoms

• Symptoms maybe asymptomatic until the tumor grows Kidney cancer Diagnosis

Full body examination Biopsy Liver function tests Urine tests

Blood chemistry tests Ultrasound MRI CT scan Kidney cancer Treatment

Partial nephrectomy: only the tumor in the kidney

Complete nephrectomy: • Complete kidney • Adrenal gland • Tissues • Lymphatic nodes Hemolytic uremic syndrome Overview

HUS: a condition that occurs when the small blood vessels in the kidneys are damaged and inflamed. The damage may cause clots to form in the blood vessels. Blood clots block the filtering system in the kidneys, leading to kidney failure. Hemolytic uremic syndrome Causes

1. The most common reason: an infection with the E.Coli bacteria. 2. An infection with pneumococcal bacteria. 3. Viruses like: HIV or influenza. 4. Using specific kinds of drugs. 5. In rare cases: it may occur as complications of pregnancy, autoimmune diseases and cancer. Hemolytic uremic syndrome Symptoms

Primary symptoms: But when your blood vessels are destroyed these symptoms will show:

1. Pale coloring 2. Fatigue 3. Dyspnea 4. Bruises 5. Nose bleeding 6. Edema 7. Decreased urination 8. Seizures or stroke 9. High blood pressure Hemolytic uremic syndrome Complications

1. Kidney failure 2. Coma 3. Clotting problems 4. Heart problems 5. Digestive tract problems Hemolytic uremic syndrome Treatment

Kidney dialysis Steroids Plasma exchange Kidney transplant Pyelonephritis Overview

Also called Kidney infection It is a type of that generally begins in your urethra or bladder and travels to one or both of your kidneys. Pyelonephritis Causes

1. The most common cause: Bacteria (ex: E.coli). 2. Frequent bladder infections in the urinary tract. 3. Bacteria from an infection elsewhere (ex: An artificial joint or an infected heart valve). Pyelonephritis Symptoms

Fever Nausea and vomiting Chills

Abdominal pain Back, side or groin pain Bad smelled urine

Frequent urination Burning sensation Hematuria Pyelonephritis Risk factors

1. Being female

2. Having a urinary tract blockage

3. Having a weakened immune system

4. Having damage to nerves around the bladder

5. Using a urinary catheter for a time

6. Having a condition that causes urine to flow the wrong way Urinary incontinence Overview

The loss of bladder control • It is common and often an embarrassing problem • The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time. Urinary incontinence Types

Stress Urinary Incontinence Is the leaking of small amounts of urine during activities that increase abdominal pressure. It is one of the most common types of Sudden, intense urge to urinate followed by an involuntary loss of urine

Overflow incontinence Is the inability to empty the bladder completely Urinary incontinence Types

Functional incontinence A physical or mental impairment keeps you from making it to the toilet in time

Nocturnal enuresis A condition that can cause substantial psychological distress in children, is defined as nighttime bedwetting in children five years of age or older

Mixed incontinence You experience more than one type of urinary incontinence Urinary incontinence Causes

Temporary urinary incontinence

Certain drinks, foods and medications may act as diuretics, they stimulate your bladd er and increase your volume of urine. Such as: 1. Alcohol 2. Caffeine 3. Carbonated drinks and sparkling water 4. Artificial sweeteners 5. Chocolate 6. Chili peppers 7. Foods that are high in spice, sugar or acid, especially citrus fruits 8. Heart and blood pressure medications, sedatives, and muscle relaxants 9. Large doses of vitamin C Urinary incontinence Causes

Persistent urinary incontinence 1. Pregnancy 2. Childbirth 3. Changes with age 4. Menopause 5. Hysterectomy 6. Enlarged prostate 7. Prostate cancer 8. Obstruction 9. Neurological disorders Urinary incontinence Diagnosis Urinalysis A sample of your urine is checked for signs of infection, traces of blood or other abnormalities

Bladder diary For several days you record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes

Post-void residual measurement Urinate (void) into a container that measures urine output. Then checking out the amount of leftover urine in your bladder using a catheter or ultrasound test A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles Medical story Urinary tract infection Overview A urinary tract infection (UTI) is an infection that affects any part of the urinary system (the kidneys, ureters, bladder and urethra)

Most infections involve the lower urinary tract (the bladder and the urethra)

Women are more likely to develop UTI than men

The infection in the bladder can be painful and upsetting However, severe consequences can occur if the infection moves to the kidneys Urinary tract infection Causes

• The most common cause is E.Coli bacteria

• The short urethral tract in female

• STD - Sexually transmitted diseases:  Herpes simplex  Gonorrhea  Chlamydiosis Urinary tract infection Symptoms Urinary tract infection Diagnosis

Using a scope to see inside Analyzing a urine sample your bladder

Further tests: Growing urinary tract Ultrasound bacteria in a lab CT scan References

Macleod’s clinical Wikipedia examination

Medscape Mayo clinic

Very well health WebMD Thanks for listening