The Urinary Tract and How It Works
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Kidney, Renal Tubule – Dilation
Kidney, Renal Tubule – Dilation Figure Legend: Figure 1 Kidney, Renal tubule - Dilation in a male B6C3F1 mouse from a chronic study. Dilated tubules are noted as tracts running through the cortex and outer medulla. Figure 2 Kidney, Renal tubule - Dilation in a male F344/N rat from a chronic study. Tubule dilation is present throughout the outer stripe of the outer medulla, extending into the cortex. Figure 3 Kidney, Renal tubule - Dilation in a male B6C3F1 mouse from a chronic study. Slight tubule dilation is associated with degeneration and necrosis. Figure 4 Kidney, Renal tubule - Dilation in a male F344/N rat from a chronic study. Tubule dilation is associated with chronic progressive nephropathy. Comment: Renal tubule dilation may occur anywhere along the nephron or collecting duct system. It may occur in focal areas or as tracts running along the entire length of kidney sections (Figure 1). 1 Kidney, Renal Tubule – Dilation Renal tubule dilation may occur from xenobiotic administration, secondary mechanisms, or an unknown pathogenesis (see Kidney – Nephropathy, Obstructive (Figure 2). Dilation may result from direct toxic injury to the tubule epithelium interfering with absorption and secretion (Figure 3). It may also occur secondary to renal ischemia or from prolonged diuresis related to drug administration. Secondary mechanisms of tubule dilation may result from lower urinary tract obstruction, the deposition of tubule crystals, interstitial inflammation and/or fibrosis, and chronic progressive nephropathy (Figure 4). A few dilated tubules may be regarded as normal histologic variation. Recommendation: Renal tubule dilation should be diagnosed and given a severity grade. The location of tubule dilation should be included in the diagnosis as a site modifier. -
Urology & Incontinence
Urology & Incontinence - Glossary of Terms Anti-reflux Refers to a tube or collapsible material within a urine collection device to help prevent urine from reentering the tubing. Applicator collar Found on some Hollister male external catheters, a plastic guide with notches for the thumb and forefinger to assist proper placement against the tip of the penis. Aseptic intermittent catheterization The process of performing intermittent catheterization using sterile equipment and inserting the catheter in a sterile way. This would include a sterile ready-to-use product that can be inserted with gloves using a no-touch technique (e.g., the Advance Plus intermittent catheter or a VaPro hydrophilic catheter). Benzalkonium chloride (BZK) An antimicrobial solution used for cleansing the urethral opening prior to inserting an intermittent catheter. Does not stain skin or clothing. Bladder A collapsible balloon-like muscular organ that lies in the pelvis and functions to store and expel urine. Bladder catheterization A procedure in which a catheter is passed through the urethra or stoma into the bladder, usually for the purpose of draining urine. Bladder control The ability to control urination. Bladder diary A printed or electronic form to keep track of when one urinates or leaks urine. Catheter (urinary) A special type of hollow tube inserted through the urethra or a stoma to the bladder to withdraw urine or instill medication. Catheterization The process of inserting a tube into the bladder to drain urine. Clean intermittent catheterization The process of emptying the bladder using a clean intermittent catheter. It involves inserting and removing a catheter, typically several times a day. -
15-1040-Junu Oh-Neuronal.Key
Neuronal Control of the Bladder Seung-June Oh, MD Department of urology, Seoul National University Hospital Seoul National University College of Medicine Contents Relevant end organs and nervous system Reflex pathways Implication in the sacral neuromodulation Urinary bladder ! body: detrusor ! trigone and bladder neck Urethral sphincters B Preprostatic S Smooth M. Sphincter Passive Prostatic S Skeletal M. Sphincter P Prostatic SS P-M Striated Sphincter Membraneous SS Periurethral Striated M. Pubococcygeous Spinal cord ! S2–S4 spinal cord ! primary parasympathetic micturition center ! bladder and distal urethral sphincter ! T11-L2 spinal cord ! sympathetic outflow ! bladder and proximal urethral sphincter Peripheral innervation ! The lower urinary tract is innervated by 3 principal sets of peripheral nerves: ! parasympathetic -pelvic n. ! sympathetic-hypogastric n. ! somatic nervous systems –pudendal n. ! Parasympathetic and sympathetic nervous systems form pelvic plexus at the lateral side of the rectum before reaching bladder and sphincter Sympathetic & parasympathetic systems ! Sympathetic pathways ! originate from the T11-L2 (sympathetic nucleus; intermediolateral column of gray matter) ! inhibiting the bladder body and excite the bladder base and proximal urethral sphincter ! Parasympathetic nerves ! emerge from the S2-4 (parasympathetic nucleus; intermediolateral column of gray matter) ! exciting the bladder and relax the urethra Sacral somatic system !emerge from the S2-4 (Onuf’s nucleus; ventral horn) !form pudendal nerve, providing -
Claudins in the Renal Collecting Duct
International Journal of Molecular Sciences Review Claudins in the Renal Collecting Duct Janna Leiz 1,2 and Kai M. Schmidt-Ott 1,2,3,* 1 Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, 12203 Berlin, Germany; [email protected] 2 Molecular and Translational Kidney Research, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany 3 Berlin Institute of Health (BIH), 10178 Berlin, Germany * Correspondence: [email protected]; Tel.: +49-(0)30-450614671 Received: 22 October 2019; Accepted: 20 December 2019; Published: 28 December 2019 Abstract: The renal collecting duct fine-tunes urinary composition, and thereby, coordinates key physiological processes, such as volume/blood pressure regulation, electrolyte-free water reabsorption, and acid-base homeostasis. The collecting duct epithelium is comprised of a tight epithelial barrier resulting in a strict separation of intraluminal urine and the interstitium. Tight junctions are key players in enforcing this barrier and in regulating paracellular transport of solutes across the epithelium. The features of tight junctions across different epithelia are strongly determined by their molecular composition. Claudins are particularly important structural components of tight junctions because they confer barrier and transport properties. In the collecting duct, a specific set of claudins (Cldn-3, Cldn-4, Cldn-7, Cldn-8) is expressed, and each of these claudins has been implicated in mediating aspects of the specific properties of its tight junction. The functional disruption of individual claudins or of the overall barrier function results in defects of blood pressure and water homeostasis. In this concise review, we provide an overview of the current knowledge on the role of the collecting duct epithelial barrier and of claudins in collecting duct function and pathophysiology. -
Nerve Disease and Bladder Control
Nerve Disease and Bladder Control National Kidney and Urologic Diseases Information Clearinghouse For the urinary system to do its job, muscles and nerves must work together to hold Brain urine in the bladder and then release it at the right time. Nerves carry messages from NATIONAL the bladder to the brain to let it know when INSTITUTES the bladder is full. They also carry messages OF HEALTH Central nervous from the brain to the bladder, telling muscles system (brain either to tighten or release. A nerve prob and spinal cord) lem might affect your bladder control if the nerves that are supposed to carry messages Spinal cord between the brain and the bladder do not work properly. Nerve signals U.S. Department to bladder of Health and Bladder and sphincter Human Services What bladder control muscles problems does nerve damage cause? Nerves that work poorly can lead to three Urethra different kinds of bladder control problems. Overactive bladder. Damaged nerves may Sphincter muscles send signals to the bladder at the wrong time, causing its muscles to squeeze with Nerves carry signals from the brain to the bladder out warning. The symptoms of overactive and sphincter. bladder include • urinary frequency—defined as urination eight or more times a day or two or nerves to the sphincter muscles are dam more times at night aged, the muscles may become loose and allow leakage or stay tight when you are • urinary urgency—the sudden, strong trying to release urine. need to urinate immediately Urine retention. For some people, nerve • urge incontinence—leakage of urine damage means their bladder muscles do that follows a sudden, strong urge to not get the message that it is time to release urinate urine or are too weak to completely empty Poor control of sphincter muscles. -
Laboratory 8 - Urinary and Reproductive Systems
Laboratory 8 - Urinary and Reproductive Systems Urinary System Please read before starting: It is easy to damage the structures of the reproductive system as you expose structures associated with excretion, so exercise caution as you do this. Please also note that we will have drawings available as well to help you find and identify the structures described below. The major blood vessels serving the kidneys are the Renal renal artery and the renal pyramid vein., which are located deep in the parietal peritoneum. The renal artery is a branch of the dorsal aorta that comes off Renal further caudal than the cranial pelvis mesenteric artery. Dissect the left kidney in situ, dividing it into dorsal and ventral portions by making a frontal section along the outer periphery. Observe the renal cortex renal medulla (next layer in) renal pyramids renal pelvis ureter (see above diagram) The kidneys include a variety of structures including an arterial supply, a venous return, extensive capillary networks around each nephron and then, of course, the filtration and reabsorption apparatus. These structures are primarily composed of nephrons (the basic functional unit of the kidney) and the ducts which carry urine away from the nephron (the collecting ducts and larger ducts eventually draining these into the ureters from each kidney. The renal pyramids contain the extensions of the nephrons into the renal medulla (the Loops of Henle) and the collecting ducts. Urine is eventually emptied into the renal pelvis before leaving the kidneys in the ureters. The ureters leaves the kidneys medially at approximately the midpoint of the organs and then run caudal to the urinary bladder. -
Congenital Anomalies of Kidney and Ureter
ogy: iol Cu ys r h re P n t & R y e s Anatomy & Physiology: Current m e o a t Mittal et al., Anat Physiol 2016, 6:1 r a c n h A Research DOI: 10.4172/2161-0940.1000190 ISSN: 2161-0940 Review Article Open Access Congenital Anomalies of Kidney and Ureter Mittal MK1, Sureka B1, Mittal A2, Sinha M1, Thukral BB1 and Mehta V3* 1Department of Radiodiagnosis, Safdarjung Hospital, India 2Department of Paediatrics, Safdarjung Hospital, India 3Department of Anatomy, Safdarjung Hospital, India Abstract The kidney is a common site for congenital anomalies which may be responsible for considerable morbidity among young patients. Radiological investigations play a central role in diagnosing these anomalies with the screening ultrasonography being commonly used as a preliminary diagnostic study. Intravenous urography can be used to specifically identify an area of obstruction and to determine the presence of duplex collecting systems and a ureterocele. Computed tomography and magnetic resonance (MR) imaging are unsuitable for general screening but provide superb anatomic detail and added diagnostic specificity. A sound knowledge of the anatomical details and familiarity with these anomalies is essential for correct diagnosis and appropriate management so as to avoid the high rate of morbidity associated with these malformations. Keywords: Kidney; Ureter; Intravenous urography; Duplex a separate ureter is seen then the supernumerary kidney is located cranially in relation to the normal kidney. In such a case the ureter Introduction enters the bladder ectopically and according to the Weigert-R Meyer Congenital anomalies of the kidney and ureter are a significant cause rule the ureter may insert medially and inferiorly into the bladder [2]. -
How Well Are Your Kidneys Working?
How well are your kidneys working? Explaining Your Kidney Test Results Kidney Your GFR result on was . Kidney Disease Date 35 40 0 45 3 6 5 5 50 0 A GFR of 60 or higher is in the normal range. 1 2 5 0 5 2 Kidney A GFR below 60 may mean kidney disease. Failure Normal 0 120 A GFR of 15 or lower may mean kidney failure. GFR What is GFR? GFR stands for glomerular filtration rate. GFR is a measure of how well your kidneys filter blood. Your urine albumin result on was . Date A urine albumin result below 30 is normal. A urine albumin result above 30 may mean kidney disease. What is urine albumin? Albumin is a protein found in the blood. A healthy kidney does not let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better. Inside a healthy kidney Inside a damaged kidney blood blood filter filter urine urine albumin Your blood pressure result on was . Date Controlling your blood pressure may help to protect your kidneys. 1 What your kidneys do You have two kidneys. Their main job is to filter wastes and extra water out of your blood to make urine. kidneys How your kidneys are checked Two tests are used to check for kidney disease. • A blood test checks your GFR, which tells how well your kidneys are filtering. • A urine test checks for albumin in your urine, a sign of kidney damage. Why your kidneys are being checked You need to have your kidneys checked because you can’t feel kidney disease. -
Hydronephrosis
Patient and Family Education Hydronephrosis What is Hydronephrosis? Hydronephrosis is a dilation of the kidney, specifically in the renal pelvis or the place in the kidney where urine is stored after its production. It occurs in 1-2% of all pregnancies. This extra fluid can be the result of some type of abnormality in or below the kidney or it may be a variant of normal. Hydronephrosis can be caused by many factors. Some of the most common reasons include obstruction or urinary reflux. Obstruction of the kidneys can occur at the level of the kidney (uretero-pelvic junction obstruction or UPJ) or at the level of the bladder (uretero-vesical junction or UVJ). It can also include a megaureter. Urinary reflux is the abnormal back flow of urine from the bladder back towards the kidneys. Obstruction: Reflux: How is hydronephrosis diagnosed? Hydronephrosis is usually diagnosed in one of two ways. 1. A prenatal ultrasound (ultrasound during pregnancy). This may reveal that the unborn baby has dilated or enlarged kidneys. This occurs in about 1 out of 100 pregnancies. 2. An ultrasound done after the baby is born. This sometimes is found after a routine evaluation for another medical problem or concern such as urinary tract infection or incontinence. Once hydronephrosis is noted, additional tests may be needed in order to find out why there is extra fluid in the kidneys. Early diagnosis and treatment of such an abnormality can prevent future urinary tract infections and permanent kidney damage or scarring. How is hydronephrosis graded and why it this important? Hydronephrosis is graded on a scale ranging from 1-4, with one being the mildest form and four being the most severe. -
HAVING a URETERIC STENT What to Expect and How to Manage
You have been sent home with HAVING A URETERIC STENT What to expect and how to manage 1 INTRODUCTION In patients who have, or might have an obstruction (blockage) of the kidney, an internal drainage tube called a “stent” is commonly placed in the ureter, the tube between the kidney and the bladder. This is placed there in order to prevent of temporarily relieve the obstruction. This information sheet has been given to you to help answer some of the questions you may have about having a ureteric stent inserted. If you have any questions or concerns, please, do not hesitate to speak to a doctor or a nurse caring for you. 2 THE URINARY SYSTEM AND URETERIC STENT THE URINARY SYSTEM AND THE URETER The kidneys produce urine. Normally there are two kidneys situated in the upper part of the abdomen, towards the back. The urine formed in the kidney is carried to the bladder by a fine muscular tube called a ureter. The urinary bladder acts as a reservoir for the urine and when it is full it is emptied via the urethra. Figure 1: The urinary system HOW DOES A KIDNEY BECOME OBSTRUCTED ? Common causes of obstruction of the kidneys and ureter are: -A kidney stone or its fragments moving into the ureter, either spontaneously, or occasionally following such treatment as shock wave therapy. -Narrrowing (stricture) of the ureter anywhere along its path. This can be due. scaring of wall of the ureter, narrowing of the area where the ureter leaves from the kidney (pelvi-ueteric junction) 3 -Temporarily, following an operation or after an instrument has been inserted into the ureter and kidneys. -
Incomplete Bladder Emptying and Tips to Help
A guide for patients about incomplete bladder emptying and tips to help What is incomplete bladder emptying? When the bladder doesn't empty properly this may cause numerous problems. One of the problems is known as overflow incontinence. This is when the bladder doesn’t empty and urine leaks out. You may not get the message to go to the toilet either. The bladder never empties completely so some residue is normal. You may find it difficult to start to pass water and that even when you have started; the flow is weak and slow. You might find that you dribble after you have finished passing water. Perhaps you dribble urine all the time, even without noticing. What causes incomplete bladder emptying? Incomplete bladder emptying occurs when the muscles of the bladder are not able to squeeze properly to empty the bladder. This can happen in cases where there may have been nerve or muscle damage, perhaps caused by injury, surgery, or disease such as Parkinson's disease, Multiple Sclerosis and Spina Bifida. Medication can also cause problems with bladder emptying. In some cases, it can be due to an obstruction which is making it more difficult for you to empty your bladder. This obstruction can be caused by an enlarged prostate in men, a kidney stone blocking the urethra, constipation, or stricture of the urethra in either men or women, which makes it difficult for urine to flow out of the bladder outlet. If you are not able to empty completely, your bladder and its muscles may become floppy over time. -
Choosing a Treatment for Kidney Failure
CHOOSING A TREATMENT FOR KIDNEY FAILURE www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF-KDOQI™) offers guidelines and commentaries that help your doctor and healthcare team make important decisions about your medical treatment? The information in this booklet is based on those recommended guidelines. What is your stage of kidney disease? There are 5 stages of kidney disease. They are shown in the table below. Your doctor determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate (GFR), which is a measure of your level of kidney function. Your treatment is based on your stage of kidney disease. Speak to your doctor if you have any questions about your stage of kidney disease or your treatment. STAGES OF KIDNEY DISEASE Stage Description Glomerular Filtration Rate (GFR)* Kidney damage (e.g., protein 1 90 or above in the urine) with normal GFR Kidney damage with mild 2 60 to 89 decrease in GFR 3 Moderate decrease in GFR 30 to 59 4 Severe reduction in GFR 15 to 29 5 Kidney failure Less than 15 *Your GFR number tells your doctor how much kidney function you have. As chronic kidney disease progresses, your GFR number decreases. TABLE OF CONTENTS Kidney Failure ............................... 5 Hemodialysis ............................... 8 Peritoneal Dialysis ...........................14 Kidney Transplant ...........................16 Living with Your Treatment Choice .............17 For More Information. 24 If your doctor said you may need dialysis or a kidney transplant soon, you are probably wondering how to decide on the best choice for you.