NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
Recall the normal physiology of the kidneys
• Function: maintain stable internal environment for optimum cell &
tissue metabolism
o Involved in balance of solute & water transport
o Involved in removal of metabolic waste thru production of urine
o Conserve nutrients:
▪ Amino acids
▪ Proteins
▪ Vitamins
o Involved in acid-base balance
▪ Carbonic anhydrase, bicarbonate, chloride, etc
o Endocrine functions:
▪ Produce renin
▪ Involved in production of erythropoietin (stimulate production RBCs)
▪ Metabolize 125-dehydroxy vitamin D (involved in production of collagen, maintenance of
healthy muscle)
▪ Synthesize glucose from AA in severe distress
• Paired retroperitoneal organs
o Retroperitoneal = lying outside perineum that lines abdominal cavity
• Renal capsule: surrounds & protects each kidney
o Embedded in fat
o Covered by double layer renal fascia
• Outer cortex: contains glomeruli & proximal tubules
• Medulla: pyramids containing loop of Henle & collecting ducts
o Calyx (calyces): receive urine & empty into ureter
• Explain glomerular dysfunction
• Summarize the pathophysiology of urinary tract obstruction
• Compare nephrotic and nephritic conditions
• Discuss infections of the urinary tract
• Explain the development of acute kidney
injury The glomerulus: Basic physiology
Glomerular Filtration: Review (Flow of fluid)
• Afferent arterioles
• Glomerulus
• Bowman’s capsule (efferent arterioles)
• Proximal convoluted tubule
• Loop of Henle
• Distal convoluted tubules
• Collecting ducts
Glomerulus
• “tuft” of capillaries
• Provides driving blood pressure to filter water & solutes
• Initial blood flow into Bowman’s capsule
NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
, NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
o Cup-like sac helps to collect fluid from glomerulus
• Small proteins, water, small molecules (glucose, AA, urea) can pass filtrate
• Large molecules/proteins >30kDa (kilodalton), RBCs, & platelets will not pass
o RBC in urine damage to glomerulus
Proximal Convoluted Tubule
• Contains brush border cells (hair-like structures that help to increase surface area)
• Function: regulate pH by exchanging bicarbonate
o Excretes organic acids into filtrate
o Actively reabsorbs Na+ via Na+-K+ ATPase pump (requires energy)
• Joins into loop of Henle
Loop of Henle
• Descending loop of Henle
o Function: create concentration gradient where water leaves loop & Na+ other ions remain increase
osmolarity of fluid
• Ascending loop of Henle: impermeable to water but very permeable to ions reabsorbs ions but not water
o Thick segment
o Thin segment
o Uromodulin: glycoprotein binds to bacteria (such as E.coli) help protect against formation of renal calculi
Distal Convoluted Tubule
• Regulate Na+, K+, calcium
• Overall regulate by aldosterone, ADH, & PTH
Collecting Duct
• Connects nephron to ureter
• Anything not reabsorbed excreted in urine
• Anything reabsorbed return to circulation
Glomerulus to Bowman’s Capsule (water, AA, glucose)
Vit D: cholesterol metabolite to the active form in the kidney and involved in Ca+ regulation
Vitamin D: (not truly a vitamin) synthesized through skin
• Formed in kidneys
• Calcium regulation, bone & muscle strength, muscle reactivity
• Deficiency osteomalacia, osteoporosis
UTI’s
Acute Cystitis
• Infection & inflammation of the bladder
• Due to fecal colonization of urethra & bladder
• Bacterial
o E. coli 80-85% of acute cystitis
o Staph saprophyticus 10-20%
o Klebsiella proteus & pseudomonas in patients that have prolonged catheterizations/hospitalizations
• Fungal
o Candida albicans yeast infection
• Viral: uncommon
NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
, NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
o May be associated with hemorrhagic cystitis
o Adenovirus
o Cytomegalovirus
• Schistosomiasis
o Parasite that can cause UTI
o “flukes”
o Get by bathing in contaminated water swim up urethra into bladder
• Signs & symptoms:
o Asymptomatic (determined with urine sample)
o Frequency
o Urgency: sudden onset of urge to void
o Dysuria: painful urination
o Suprapubic pain: pain just above symphysis pubis
o Hematuria: blood in urine
• Diagnose:
o History & symptoms
o Urinalysis: presence of…
▪ Leukocyte esterase
▪ Nitrites
▪ Bacteria
▪ WBCs
o Culture:
▪ Grows greater than 100,000 colonies of bacteria
▪ Frequently done with elderly & chronic foley catheters
• Treatment
o Antibiotics
▪ Bactrim sulfonamide
• Inhibits folate (required for DNA production) synthesis pathway
• Bacteriostatic: inhibits further bacterial growth & allows natural body defenses to
destroy present bacteria
• Bacteriocidal: may kill bacteria itself
▪ Macrobid (Nitrofurantoin)
• Does not achieve bacteriostatic/bacteriocidal activity in blood (does not affect normal
gut flora)
• Penetrates tissues & accumulate in the urine therapeutic levels in urine bacteriocidal
▪ Penicillin’s
o Teaching
▪ Urination after intercourse
▪ Wipe front to back
▪ Cranberry juice help (not proven)
UTI: Ecoli, Umbrella cells, Fimbriae, Adhesins, IBC, Biofilms
Uropathogenic E. coli: most common cause of UTI
• Adapted to infect urinary tract
• Factors increased virulence:
o Enter tract through fecal contamination
o Invade superficial cells called umbrella cells (multinucleated, superficial cells that line the
bladder; protective layer of bladder)
o Has adhesive organelles that attaches itself to umbrella cells
o Use fimbriae (type 1 fimbriae)
NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
Recall the normal physiology of the kidneys
• Function: maintain stable internal environment for optimum cell &
tissue metabolism
o Involved in balance of solute & water transport
o Involved in removal of metabolic waste thru production of urine
o Conserve nutrients:
▪ Amino acids
▪ Proteins
▪ Vitamins
o Involved in acid-base balance
▪ Carbonic anhydrase, bicarbonate, chloride, etc
o Endocrine functions:
▪ Produce renin
▪ Involved in production of erythropoietin (stimulate production RBCs)
▪ Metabolize 125-dehydroxy vitamin D (involved in production of collagen, maintenance of
healthy muscle)
▪ Synthesize glucose from AA in severe distress
• Paired retroperitoneal organs
o Retroperitoneal = lying outside perineum that lines abdominal cavity
• Renal capsule: surrounds & protects each kidney
o Embedded in fat
o Covered by double layer renal fascia
• Outer cortex: contains glomeruli & proximal tubules
• Medulla: pyramids containing loop of Henle & collecting ducts
o Calyx (calyces): receive urine & empty into ureter
• Explain glomerular dysfunction
• Summarize the pathophysiology of urinary tract obstruction
• Compare nephrotic and nephritic conditions
• Discuss infections of the urinary tract
• Explain the development of acute kidney
injury The glomerulus: Basic physiology
Glomerular Filtration: Review (Flow of fluid)
• Afferent arterioles
• Glomerulus
• Bowman’s capsule (efferent arterioles)
• Proximal convoluted tubule
• Loop of Henle
• Distal convoluted tubules
• Collecting ducts
Glomerulus
• “tuft” of capillaries
• Provides driving blood pressure to filter water & solutes
• Initial blood flow into Bowman’s capsule
NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
, NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
o Cup-like sac helps to collect fluid from glomerulus
• Small proteins, water, small molecules (glucose, AA, urea) can pass filtrate
• Large molecules/proteins >30kDa (kilodalton), RBCs, & platelets will not pass
o RBC in urine damage to glomerulus
Proximal Convoluted Tubule
• Contains brush border cells (hair-like structures that help to increase surface area)
• Function: regulate pH by exchanging bicarbonate
o Excretes organic acids into filtrate
o Actively reabsorbs Na+ via Na+-K+ ATPase pump (requires energy)
• Joins into loop of Henle
Loop of Henle
• Descending loop of Henle
o Function: create concentration gradient where water leaves loop & Na+ other ions remain increase
osmolarity of fluid
• Ascending loop of Henle: impermeable to water but very permeable to ions reabsorbs ions but not water
o Thick segment
o Thin segment
o Uromodulin: glycoprotein binds to bacteria (such as E.coli) help protect against formation of renal calculi
Distal Convoluted Tubule
• Regulate Na+, K+, calcium
• Overall regulate by aldosterone, ADH, & PTH
Collecting Duct
• Connects nephron to ureter
• Anything not reabsorbed excreted in urine
• Anything reabsorbed return to circulation
Glomerulus to Bowman’s Capsule (water, AA, glucose)
Vit D: cholesterol metabolite to the active form in the kidney and involved in Ca+ regulation
Vitamin D: (not truly a vitamin) synthesized through skin
• Formed in kidneys
• Calcium regulation, bone & muscle strength, muscle reactivity
• Deficiency osteomalacia, osteoporosis
UTI’s
Acute Cystitis
• Infection & inflammation of the bladder
• Due to fecal colonization of urethra & bladder
• Bacterial
o E. coli 80-85% of acute cystitis
o Staph saprophyticus 10-20%
o Klebsiella proteus & pseudomonas in patients that have prolonged catheterizations/hospitalizations
• Fungal
o Candida albicans yeast infection
• Viral: uncommon
NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
, NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
o May be associated with hemorrhagic cystitis
o Adenovirus
o Cytomegalovirus
• Schistosomiasis
o Parasite that can cause UTI
o “flukes”
o Get by bathing in contaminated water swim up urethra into bladder
• Signs & symptoms:
o Asymptomatic (determined with urine sample)
o Frequency
o Urgency: sudden onset of urge to void
o Dysuria: painful urination
o Suprapubic pain: pain just above symphysis pubis
o Hematuria: blood in urine
• Diagnose:
o History & symptoms
o Urinalysis: presence of…
▪ Leukocyte esterase
▪ Nitrites
▪ Bacteria
▪ WBCs
o Culture:
▪ Grows greater than 100,000 colonies of bacteria
▪ Frequently done with elderly & chronic foley catheters
• Treatment
o Antibiotics
▪ Bactrim sulfonamide
• Inhibits folate (required for DNA production) synthesis pathway
• Bacteriostatic: inhibits further bacterial growth & allows natural body defenses to
destroy present bacteria
• Bacteriocidal: may kill bacteria itself
▪ Macrobid (Nitrofurantoin)
• Does not achieve bacteriostatic/bacteriocidal activity in blood (does not affect normal
gut flora)
• Penetrates tissues & accumulate in the urine therapeutic levels in urine bacteriocidal
▪ Penicillin’s
o Teaching
▪ Urination after intercourse
▪ Wipe front to back
▪ Cranberry juice help (not proven)
UTI: Ecoli, Umbrella cells, Fimbriae, Adhesins, IBC, Biofilms
Uropathogenic E. coli: most common cause of UTI
• Adapted to infect urinary tract
• Factors increased virulence:
o Enter tract through fecal contamination
o Invade superficial cells called umbrella cells (multinucleated, superficial cells that line the
bladder; protective layer of bladder)
o Has adhesive organelles that attaches itself to umbrella cells
o Use fimbriae (type 1 fimbriae)
NRSG2312|NORTHEASTERN UNIVERSITY|MODULE 9 RENNAL PATHOLOGY REVIEW
