The kidneys filter urine out of the blood as a waste product. It collects in Each kidney contains about 1 million nephrons, the functional
the renal pelvis and flows down the ureters into the bladder. The ureters units of the kidney. Each kidney is capable of providing adequate
are not simple tubes, but muscular passages that actively propel urine renal function if the opposite kidney is damaged or
into the bladder. At their lower end is a valve (the ureterovesical junction) becomes nonfunctional. The nephron consists of a glomerulus
that prevents urine from flowing backward into the ureter. The bladder containing afferent and efferent arterioles, Bowman’s capsule,
stores urine. The prostate gland surrounds the bladder outlet in males. proximal tubule, loop of Henle, distal tubule, and collecting ducts
Urine then flows through the urethra and out of the body as a waste (Fig. 43-2). Collecting ducts converge into papillae, which empty Signs and symptoms Why
product. into the minor calices, which drain into three major calices that Signs and symptoms
open directly into the renal pelvis. Acute: extreme flank plain on affected Buildup of pressure in the kidney
Because the urinary tract is closed save for the one opening at the Nephrons are structurally divided into two types: cortical and or
bottom, urine cannot escape. Instead, the parts distend. Rupture is rare juxtamedullary. Cortical nephrons are found in the cortex of the side; pain may radiate to groin ureter due to backflow of urine
unless there is violent trauma like an automobile accident. kidney, and juxtamedullary nephrons sit adjacent to the medulla. Chronic: mild discomfort over affected Kidney shifts downward, causing
The juxtamedullary nephrons are distinguished by their long side (sometimes described as dull overfilling of the renal pelvis or
Obstructed flow anywhere along the drainage route can cause swelling of
loops of Henle and the vasa recta, long capillary loops that dip and aching) blockage of the ureters
the upper urinary tract, but if the obstruction is below the bladder, the
into the medulla of the kidney. Anuria, oliguria, hematuria, polyuria Blockage of the urethra or ureters
ureterovesical valve will protect the upper tract to a certain extent. Even
The glomerulus is composed of three filtering layers: the capillary Urinary tract infection Backflow or stasis of the urine
then, with no place to go, the urine will back up all the way to its source.
endothelium, the basement membrane, and the epithelium. encourages bacterial growth
Eventually, the back pressure causes kidney function to deteriorate.
The glomerular membrane normally allows filtration of fluid and Nausea, vomiting, abdominal pain Body’s immune response
Obstruction need not be complete for problems to arise. Intermittent or small molecules yet limits passage of larger molecules, such as Asymptomatic If progression of hydronephrosis is
partial obstruction is far more common than complete blockage, allowing blood cells and albumin. Kidney function begins to decrease at a slow there may be no symptoms for
time for the parts to enlarge gradually. Furthermore, if a ureterovesical rate of approximately 1% each year beginning at approximately awhile
valve is absent or incompetent, the pressure generated by bladder Palpable mass over flank area Seen only in extreme cases; due to
emptying will force urine backward into the ureter and kidney, causing age 30. enlargement of obstructed area
dilation even without mechanical obstruction. related to the collection of urine
Strictures of the Ureter Hydronephrosis
Some patients are born with a narrowing of the ureter where it leaves the What is it?
kidney or where it enters the bladder. Scar tissue from previous surgery When urine outflow is obstructed, a large fluctuating collection—or
mass—of urine forms in the kidney. This mass subsides as retained urine What can harm my client?
or stones in the ureter can also cause narrowing of the ureter with _ End-stage renal failure.
blockage of the flow of urine from the kidney. These abnormalities can be finally passes into the ureters and bladder. Stagnation of urine in the
kidneys leads to infection. Hydronephrosis is distension of the kidney _ Infection.
treated using the ureteroscope to examine the area of narrowing and use _ Improper catheter irrigation technique. For example, using too much
a device through the ureteroscope to incise, or cut, the area of stricture with urine that leads to progressive atrophy and eventual destruction of
the kidney. The kidney ends up looking like a thin-walled shell filled with force can cause fluid and bacteria to travel back up into the kidney,
or scar tissue. After this procedure, a stent (a small tube that passes from
which can cause hydronephrosis.
the kidney, down the ureter to the bladder) is left inside the body for 1-4 fluid. The causative factor, obstruction, has several different types.
weeks. This stent helps to keep the kidney drained, and can usually be
easily removed in the office. If I were your teacher, I would test you on . . .