NCM 103

Renal and Urinary Systems

 Function to maintain the body’s state of
homeostasis by regulating fluid and
electrolytes, removing wastes, and
providing hormones involved in red blood
cell production, bone metabolism, and
control of blood pressure.
 Structures:
 Kidneys
 Ureters
 Bladder
 Urethra
 Renal System
‫ ﭵ‬essentially regulatory organs which maintain the volume
and composition of body fluid by filtration of the blood and
selective reabsorption or secretion of filtered solutes.
‫ ﭵ‬take their blood supply directly from the aorta via the renal
arteries; blood is returned to the inferior vena cava via the
renal veins.
‫ ﭵ‬Urine (the filtered product containing waste materials and
water) excreted from the kidneys passes down the
fibromuscular ureters and collects in the bladder.
‫ ﭵ‬bladder muscle (detrusor) is capable of distending to
accept urine without increasing the pressure inside; large
volumes can be collected (700-1000ml).
‫ ﭵ‬When urine is passed, the urethral sphincter at the base
of the bladder relaxes, the detrusor contracts, and urine is
voided via the urethra.
Kidneys, Ureters, and Bladder
 Kidney Structure and Function
The kidneys are the main organs of excretion in the body,
removing wastes and excess water from the blood that would
otherwise harm the body. The wastes and excess water
removed are excreted as urine. Two healthy kidneys excrete
between 1.5 and 2.5 L of urine daily.
The kidneys, each about the size of a fist, are located near the
center of the back, just below the rib cage. Each kidney is
surrounded by a membrane known as the renal capsule. The
kidney is bean-shaped, with 2 main regions: the renal cortex
(outer section) and the renal medulla (inner section).
Blood enters the kidney through the renal artery and exits
through the renal vein. Urine is carried away from each kidney
by a ureter, which leads to the urinary bladder.
 Kidney Structure and Function
The filtering of blood by the kidneys takes place in tiny
functional units called nephrons. There are approximately 1
million nephrons in each kidney. In addition to filtration,
nephrons perform the functions of reabsorption and secretion.

In the nephron, capillaries (tiny blood vessels) are intertwined

with tubules (urine-carrying tubes) that carry away wastes and
water. Blood enters the nephron through the glomerulus.
During filtration, blood fluid is forced from capillaries into the
tubules; water, sodium, phosphorus, potassium, and glucose,
are selectively reabsorbed into the blood by the intertwined
capillaries.

In this way, the kidneys regulate the level of these vital

substances in the blood.
Internal Structure of the Kidney
 Kidney Structure and Function
The blood exits the nephron through the renal vein. The fluid
remaining in the tubules after reabsorption exits as urine into
the collecting duct, which eventually leads to the ureter.

In addition to removing wastes, the kidney releases 3 important

substances into the circulation:
- Erythropoietin, which stimulates erythropoiesis
- Renin, an enzyme that is important in blood pressure
regulation
- Calcitriol, an active form of vitamin D, which helps
maintain calcium balance
 Functions of the Kidney
 Regulation of water excretion
 Regulation of electrolyte function
 Regulation of acid-base balance—retain
HCO3- and excrete acid in urine
 Regulation of blood pressure--RAAS
 Regulation of RBCs
 Vitamin D synthesis
 Functions of Kidney cont.
 Secretion of prostaglandin E and
prostacyclin which cause vasodilation,
important in maintaining renal blood flow
 Excretion of waste products-body’s main
excretory organ. Urea, creatinine,
phosphates, uric acid and sulfates. Drug
metabolites.
The nephron is the unit of the kidney
responsible for ultrafiltration of the blood and
reabsorption or excretion of products in the
subsequent filtrate. Each nephron is made
up of:

 glomerulus
 proximal convuluted tubule
 loop of Henle
 distal convoluted tubule
 collecting duct
Nephron
A filtering unit- the glomerulus. 125ml/min of
filtrate is formed by the kidneys as blood is filtered
through this sieve-like structure. This filtration is
uncontrolled.

The proximal convoluted tubule. Controlled

absorption of glucose, sodium, and other solutes
goes on in this region.
The loop of Henle.
This region is responsible for concentration
and dilution of urine by utilising a counter-current
multiplying mechanism - basically, it is water-
impermeable but can pump sodium out, which in
turn affects the osmolarity of the surrounding
tissues and will affect the subsequent movement of
water in or out of the water-permeable collecting
duct.
The distal convoluted tubule.
This region is responsible, along with the
collecting duct that it joins, for absorbing water
back into the body - 99% of the water is normally
reabsorbed, leaving highly concentrated urine to
flow into the collecting duct and then into the renal
pelvis.
Formation of Urine
Physiology/Pathophysiology
Renin-angiotensin system
Stimuli for Renin Excretion

Angiotensinogen in liver

Renin release

Angiotensin I

Converting enzyme in lungs

Angiotensin II

Renal autoregulation

Increased BP, increased circulating volume

 Hormones influencing renal
function
 Renin—raises BP
 Bradykinins—increase blood flow and
vascular permeability
 Erythropoietin
 ADH
 Aldosterone—promotes sodium
reabsorption and potassium excretion
 Natriuretic hormones—released from the
cardiac atria and brain.
 Risk factors for renal or urologic
disorders
1. Hypertension
2. Diabetes mellitus
3. Immobilization
4. Parkinson’s disease
5. SLE
6. Gout
7. Sickle cell anemia, multiple myeloma
8. BPH
9. Pregnancy
10. SCI
 Gerontologic Considerations
 GFR decreases following 40 years with a
yearly decline of about 1 mL/min
 Renal reserve declines
 Multiple medications can result in toxic
metabolites
 Diminished osmotic stimulation of thirst
 Incomplete emptying of bladder
 Urinary incontinence
What do kidneys do?
1. remove toxic waste products
2. remove excess water and salts
3. play a part in controlling your blood
pressure (renin)
4. produce erythropoietin (epo for short)
which stimulates red cell production from
the bone marrow
5.help to keep calcium and phosphate in
balance for healthy bones (Alfacalcidol
or calcitriol)
6. maintain the blood in a neutral (non-acid)
state
Renin Angiotensin System
Renin Angiotensin System
 Diagnostic Studies
 Urinalysis and urine culture
 Renal function tests
 Ultrasonography
 CT and MRI
 Nuclear scans
 Intravenous urography, retrograde
pyelography, cystography, renal
angiography
 Endoscopic procedures
 Biopsies
Cystoscopic Examination
Is the following statement True or False?

Urea is an abnormal constituent of urine.

False

Urea is not an abnormal constituent of urine.

Glucose is an abnormal constituent of
urine.
Nursing Care of the Patient Undergoing
Diagnostic Testing of the Renal-Urologic
System—Assessment
 Patient knowledge
 Psychosocial and emotional factors;
fear, anxiety
 Urologic function, include voiding
habits/pattern
 Fluid intake
 Hygiene
 Presence of pain or discomfort
 Allergies
Nursing Care of the Patient Undergoing
Diagnostic Testing of the Renal-Urologic
System—Diagnoses

 Knowledge deficient
 Pain
 Fear
 Nursing Care of the Patient Undergoing
Diagnostic Testing of the Renal-Urologic
System—Planning

 Patient goals may include understanding of

procedures, tests and expected behaviors;
decreased pain or absence of discomfort;
and decreased apprehension and fear.
 Interventions
 Patient teaching: providing a description of
the tests and procedures in language the
patient can understand.
 Use appropriate, correct terminology.
 Encourage fluid intake unless
contraindicated.
 Instruct in methods to reduce discomfort;
sitz baths, relaxation techniques.
 Administer analgesics and antispasmodics
as prescribed.
 Assess voiding and provide instruction
related to voiding practices and hygiene.
 Provide privacy and respect.