NR 507 Discussion: Alterations in Renal and Urinary Function

NR 507 Discussion: Alterations in Renal and Urinary Function

NR 507 Discussion: Alterations in Renal and Urinary Function

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Week 4: Open Forum Discussion

This open forum is required but not graded. Please feel free to post questions related to content or assignments.

In our lesson this week, we covered the renal system and it’s functions. We learned about the various issues that can arise like an obstruction, calculi, an infection like a UTI, cystitis, and pyelonephritis, or an infection in the kidney. We then looked at common diseases and disorders that can occur in this system like cancer and nephrotic syndrome. Most of my time this week, however, is going toward studying for the midterm. Looking over the study guide, I found that I should probably take some extra time to look at epigenetics as it is a concept that I can sometimes struggle with. For some reason, DNA and genes and all the accompanying topics are definitely not my favorite part of biology, so I know I need to study those just a bit harder. Good luck on the exam everyone!

NR 507 Discussion: Alterations in Renal and Urinary Function
NR 507 Discussion: Alterations in Renal and Urinary Function

according to NR 507 Discussion: Alterations in Renal and Urinary Function, the renal and urinary function can be affected by a variety of disorders. The most common type of urinary dysfunction is infection. Stones, tumors, or inflammation also can obstruct the urinary tract. Renal function can be impaired by disorders of the kidney itself or by many other systemic diseases and ultimately may result in acute kidney injury or chronic kidney disease. Because the kidney filters the blood, it is directly linked to every other organ system. Renal failure, whether acute or chronic, is life-threatening.

Urinary Tract Obstruction

Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract (Figure 38-1). An obstruction may be anatomic or functional. It impedes flow proximal to the obstruction, dilates structures distal to the obstruction, increases risk for infection, and compromises renal function. Anatomic changes in the urinary system caused by obstruction are referred to as obstructive uropathy. The severity of an obstructive uropathy is determined by: (1) the location of the obstructive lesion, (2) the involvement of one or both upper urinary tracts (ureters and renal pelvis), (3) the completeness of the obstruction, (4) the duration of the obstruction, and (5) the nature of the obstructive lesion.1,2 Obstructions may be relieved or partially alleviated by correction of the obstruction, although permanent impairments occur if a complete or partial obstruction persists over weeks to months or longer.

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Upper Urinary Tract Obstruction

Common causes of upper urinary tract obstruction include stricture or congenital compression of a calyx or the ureteropelvic or ureterovesical junction (e.g., stones [calculi]); ureteral compression from an aberrant vessel, tumor, or abdominal inflammation and scarring (retroperitoneal fibrosis); or ureteral blockage from stones or a malignancy of the renal pelvis or ureter.

Obstruction of the upper urinary tract causes dilation of the ureter, renal pelvis, calyces, and renal parenchyma proximal to the site of urinary blockage.NR 507 Discussion: Alterations in Renal and Urinary Function states that dilation of the ureter is referred to as hydroureter (accumulation of urine in the ureter), and dilation of the renal pelvis and calyces proximal to a blockage leads to hydronephrosis (enlargement of the renal pelvis and calyces) or ureterohydronephrosis (dilation of both the ureter and the pelvicaliceal system) (Figure 38-2). Dilation of the upper urinary tract is an early response to obstruction and reflects smooth muscle hypertrophy and accumulation of urine above the level of blockage (urinary stasis/retention). The increased pressure is transmitted to the glomerulus, which decreases filtration. Unless the obstruction is relieved, this dilation leads to enlargement with tubulointerstitial fibrosis and apoptosis affecting the distal nephron and renal function. Tubulointerstitial fibrosis is the deposition of excessive amounts of extracellular matrix (collagen and other proteins). Deposition of extracellular matrix is a normal process of organ repair and maintenance, and the deposition of extracellular matrix is balanced by its breakdown under the influence of metalloproteinases. Multiple cytokines and growth factors have been implicated in the process of tubulointerstitial fibrosis and irreversible loss of kidney function, including transforming growth factor-beta-1 (TGF-β1), angiotensin II, aldosterone, and various tumor necrosis factors. Apoptosis is a normal process that the body uses to replace damaged or senescent cells with new ones (see Chapter 1), but the imbalance in growth factors provoked by obstruction leads to excess cellular destruction and death, ultimately resulting in loss of functioning nephrons and kidney damage.