Urinary System

The URINARY SYSTEM, also known as the RENAL SYSTEM, is responsible for producing, storing, and
eliminating urine from the body. It plays a key role in maintaining the body's internal balance, or homeostasis, by
regulating water, electrolytes, and waste products.

The major components of the urinary system include:

1.) KIDNEY - is a pair of essential, bean-shaped organs located in the lower back, one on each side of the
spine. Their main role is to filter blood, removing waste, excess substances, and toxins to produce urine.

The kidneys are also crucial for several important bodily functions, such as:

i. Maintaining fluid and electrolyte balance: Regulating the levels of water, sodium, potassium, and other
key electrolytes in the body.

ii. Balancing pH: Helping control blood acidity by excreting hydrogen ions and reabsorbing bicarbonate
ions.

iii. Regulating blood pressure: By adjusting blood volume (through fluid balance) and producing the enzyme
renin, which helps manage blood pressure.

iv. Stimulating red blood cell production: The kidneys produce the hormone erythropoietin, which prompts
the bone marrow to create red blood cells when oxygen levels are low.

Each kidney contains about one million nephrons, the functional units that filter the blood, reabsorb
necessary substances, and excrete waste as urine. Additionally, the kidneys help detoxify the body and
maintain overall metabolic stability.

2.) URETER - has the primary function of transporting urine from the kidneys to the bladder. There are two
ureters in the body, one for each kidney.

Their specific functions include:

i.) Transporting urine: The ureters carry urine produced by the kidneys to the bladder. This is done through
rhythmic muscle contractions called peristalsis, which push the urine downward, despite gravity.

ii.) Preventing backflow: The ureters have one-way valves at the point where they enter the bladder. These
valves prevent urine from flowing backward from the bladder into the kidneys, which helps protect the
kidneys from infections and damage.

iii.) Facilitating smooth flow: The muscular walls of the ureters ensure a continuous and efficient flow of urine
from the kidneys to the bladder, supporting proper kidney function and urinary system health.

In summary, the ureter’s primary role is to transport urine from the kidneys to the bladder, ensuring that
urine flows in one direction and is stored until it is excreted from the body.

3.) BLADDER - is a hollow, muscular organ that temporarily stores urine before it is excreted from the
body.

Its main functions include:

i.) Storage of urine: The bladder collects and stores urine produced by the kidneys until it reaches a certain
volume (typically around 300-500 millilitres). It expands as it fills with urine, allowing for temporary
storage.

ii.) Controlled release of urine: When the bladder is full, stretch receptors in the bladder wall send signals to
the brain, creating the sensation of needing to urinate. The bladder then contracts, and the internal urethral
sphincter and external urethral sphincter muscles relax, allowing urine to flow from the bladder through
the urethra and out of the body.

iii.) Regulation of urination: The bladder works in coordination with the sphincter muscles (internal and
external) to control the release of urine. These muscles contract to hold urine in the bladder until it is
appropriate to urinate and relax to allow the release of urine.

iv.) Maintaining urine flow: The bladder’s ability to stretch and contract helps ensure a smooth, controlled
release of urine, preventing leakage or difficulty in emptying the bladder.

In essence, the bladder serves as a temporary reservoir for urine and plays a key role in the voluntary
control of urination.

4.) URETHRA - The urethra is a tube that carries urine from the bladder to the outside of the body during
urination. It is the final part of the urinary system and plays a key role in the elimination of urine.

Functions of the Urethra:

i.) Excretion of urine: The primary function of the urethra is to transport urine from the bladder to the
exterior of the body during the process of urination.

ii.) Regulation of urination: The urethra is surrounded by sphincter muscles, which help control the release of
urine. These muscles remain contracted to hold urine in the bladder and relax when it's time to urinate.

iii.) Sexual function (in males): In males, the urethra also serves as a passageway for semen during ejaculation,
making it part of both the urinary and reproductive systems.

Together, these organs help regulate fluid and electrolyte balance, eliminate metabolic waste, maintain
blood pressure, and support overall homeostasis.

Key Differences Between Males and Females:

 In males, the urethra is longer (about 20 cm or 8 inches) and runs through the penis, serving both the
urinary and reproductive functions.

 In females, the urethra is shorter (about 4 cm or 1.5 inches) and opens above the vaginal opening, serving
only the urinary function.

Overall, the urethra plays a vital role in excreting urine and in sexual function for males.
 PHYSIOLOGY OF KIDNEY

The physiology of the kidney refers to the processes by which the kidneys filter blood, remove waste
products, regulate fluid balance, and maintain homeostasis in the body. The kidneys are responsible for
several vital functions, including excreting waste, regulating electrolytes, controlling blood pressure, and
producing hormones.

Here's an overview of the key physiological processes of the kidney:

1. Filtration
 Location: In the nephrons, the functional units of the kidneys.
 Process: Blood enters the kidneys via the renal arteries, which branch into smaller arterioles. Each
nephron contains a glomerulus, a cluster of tiny blood vessels, surrounded by a structure called the
Bowman's capsule.
 Glomerular filtration: Blood pressure forces water, ions, glucose, amino acids, and waste products (such as
urea and creatinine) from the blood in the glomerulus into the Bowman's capsule, forming glomerular
filtrate. The process is selective, as large proteins and blood cells remain in the bloodstream.

2. Reabsorption
 Location: In the proximal convoluted tubule (PCT), loop of Henle, distal convoluted tubule (DCT), and
collecting ducts.
 Process: As the filtrate passes through the renal tubules, essential substances (such as glucose, amino
acids, water, and electrolytes like sodium, potassium, and bicarbonate) are reabsorbed back into the
bloodstream.
 Proximal Convoluted Tubule (PCT): Most of the reabsorption of nutrients and electrolytes occurs here.
 Loop of Henle: Plays a critical role in concentrating urine by creating a concentration gradient in the
medulla of the kidney, allowing water reabsorption in the descending limb and sodium chloride
reabsorption in the ascending limb.
 Distal Convoluted Tubule (DCT): More reabsorption of sodium, calcium, and water occurs, under the
influence of hormones like aldosterone and parathyroid hormone.

3. Secretion
 Location: Mainly in the proximal convoluted tubule, distal convoluted tubule, and collecting ducts.
 Process: The kidneys also secrete waste products and excess ions (such as hydrogen ions, potassium, and
certain drugs) into the filtrate to be excreted in the urine. This helps regulate pH and maintain electrolyte
balance.

4. Excretion
 Location: In the collecting ducts and ureters.
 Process: The final urine, after filtration, reabsorption, and secretion, is collected in the collecting ducts,
which converge into larger ducts that drain into the renal pelvis. The urine then moves into the ureters, and
eventually into the bladder, from where it is excreted through the urethra.

5. Regulation of Fluid and Electrolyte Balance

The kidneys help regulate the balance of water and electrolytes (such as sodium, potassium, calcium, and
phosphate) in the body by adjusting the amount of water and ions reabsorbed or excreted.
The kidneys respond to changes in blood pressure, blood volume, and blood osmolarity (concentration of
solutes) to maintain homeostasis.
 6. Regulation of Blood Pressure
 Renin-Angiotensin-Aldosterone System (RAAS): When blood pressure drops, the kidneys release the
enzyme renin, which activates the angiotensinogen system, leading to the production of angiotensin II.
Angiotensin II increases blood pressure by constricting blood vessels and stimulating the release of
aldosterone from the adrenal glands, which increases sodium and water reabsorption by the kidneys, thus
increasing blood volume and pressure.
 Antidiuretic Hormone (ADH): When the body is dehydrated, the pituitary gland releases ADH, which
signals the kidneys to reabsorb more water in the collecting ducts, concentrating the urine and conserving
water.

7. Acid-Base Balance
 The kidneys help maintain the pH of the blood by excreting hydrogen ions (acid) and reabsorbing
bicarbonate ions (base). The kidneys also regulate the levels of carbonic acid in the body, thus helping to
balance the body's overall acidity and prevent conditions like acidosis or alkalosis.

8. Hormone Production
 Erythropoietin: The kidneys produce the hormone erythropoietin, which stimulates the production of red
blood cells in the bone marrow in response to low oxygen levels in the blood (hypoxia).
 Calcitriol: The kidneys convert vitamin D into its active form, calcitriol, which helps regulate calcium and
phosphate balance in the body and supports bone health.
 Renin: As mentioned earlier, renin is produced in response to low blood pressure or low blood volume,
triggering the RAAS system to help restore normal blood pressure.
 DEFINITION OF TERMS

DYSURIA - refers to painful or difficult urination. It is a common symptom of various urinary tract
conditions and can be described as a sensation of discomfort, burning, stinging, or aching while urinating.
The pain may be in the lower abdomen, pelvic region, or along the urethra (the tube through which urine
is excreted from the bladder).

NOCTURIA - refers to the condition where an individual wakes up one or more times during the night to
urinate. It is considered abnormal if it occurs frequently and disrupts sleep, leading to daytime fatigue or a
reduced quality of life.

HEMATURIA - is the presence of blood in the urine. This condition can be visible (gross hematuria) or
microscopic (microscopic hematuria).

Gross Hematuria: The blood is visible to the naked eye, and the urine may appear pink, red, or brown.
Microscopic Hematuria: The blood is not visible but can be detected under a microscope or via a urine test
(urinalysis).

FREQUENCY - in the context of urination refers to the need to urinate more often than normal. It is a
symptom characterized by the urge to pass urine at shorter intervals, often accompanied by a sense of
urgency or discomfort. The amount of urine passed each time may vary, and frequency can be related to a
variety of medical conditions.

URGENCY - refers to the sudden, strong, and often uncontrollable need to urinate. This is typically
accompanied by discomfort or a feeling of pressure in the bladder and is often difficult to delay. Urgency
can sometimes be so intense that it leads to urinary incontinence (involuntary leakage of urine) if the urge
isn't relieved quickly.

INCONTINENCE - refers to the inability to control urination, resulting in involuntary leakage of urine.
It can range from occasional, small dribbles to complete loss of bladder control. Incontinence is a common
condition, particularly in older adults, but it can affect people of all ages.

ENURESIS - refers to the involuntary urination (or bed-wetting) that occurs primarily at night but can
also happen during the day. It is often used to describe nocturnal enuresis, which specifically refers to bed-
wetting during sleep in children or adults. It is a common condition in children but can persist into
adolescence and adulthood in some cases.

PROTEINURIA - refers to the presence of excessive protein in the urine, specifically albumin, which is
the most common type of protein found in urine. Under normal circumstances, the kidneys filter waste and
excess substances from the blood, while retaining essential proteins like albumin. However, when the
kidneys' filtration system is damaged or overwhelmed, proteins may leak into the urine. Proteinuria can be
an indication of an underlying kidney disorder or systemic condition that affects kidney function.

MICTURITION - is the medical term for urination or the process of voiding urine from the bladder. It is
the bodily function by which the urinary system removes waste and excess fluid from the body. The
process involves a complex interaction between the brain, spinal cord, and urinary tract, including the
kidneys, ureters, bladder, and urethra. Micturition is also commonly referred to as urination, peeing, or
passing urine in everyday language.
 LABORATORY VALUES RELATED TO KIDNEY

1.) Serum Creatinine

 What it is: A waste product from muscle metabolism, filtered by the kidneys.
 Normal range:
 Men: 0.6 - 1.2 mg/dL
 Women: 0.5 - 1.1 mg/dL
 Significance: High levels may indicate kidney dysfunction (e.g., acute kidney injury or chronic kidney
disease).

2.) Blood Urea Nitrogen (BUN)

 What it is: A waste product from protein metabolism, also filtered by the kidneys.
 Normal range: 7 - 20 mg/dL
 Significance: High BUN levels may suggest kidney dysfunction, dehydration, or high protein intake.

3.) Glomerular Filtration Rate (GFR)

 What it is: A measure of kidney filtration efficiency.
 Normal range: Above 90 mL/min/1.73m² (may vary based on age and other factors).
 Significance: A lower GFR (<60 mL/min/1.73m²) suggests kidney damage or chronic kidney disease.

4.) Urine Protein (Albumin)

 What it is: Protein levels in urine (albumin is the most common protein checked).
 Normal range: None or very small amounts.
 Significance: Increased protein in urine (proteinuria) can indicate kidney damage (e.g., diabetic
nephropathy, glomerulonephritis).

5.) Urine Albumin-to-Creatinine Ratio (ACR)

 What it is: A ratio used to assess the presence of protein (albumin) in urine.
 Normal range: Less than 30 mg/g creatinine.
 Significance: Values above 30 mg/g suggest early kidney damage, often seen in diabetes and hypertension.

6. Electrolytes (Sodium, Potassium, and Calcium)

 What they are: Important electrolytes that the kidneys help regulate.
 Normal ranges:
 Sodium (Na+): 135 - 145 mEq/L
 Potassium (K+): 3.5 - 5.0 mEq/L
 Calcium (Ca2+): 8.5 - 10.2 mg/dL
 Significance: Abnormal levels can indicate kidney dysfunction (e.g., hyperkalaemia from kidney failure or
low calcium from chronic kidney disease).

7.) Urine Specific Gravity

 What it is: Measures the concentration of urine.
 Normal range: 1.005 - 1.030.
 Significance: Abnormal values may indicate dehydration or kidney problems with concentration ability.

8.) Cystatin C
 What it is: A protein used as an alternative to creatinine to estimate kidney function.
 Normal range: 0.53 - 0.95 mg/L.
 Significance: Increased levels may indicate reduced kidney function, especially in early stages before
creatinine levels rise.

These tests are commonly used to assess kidney function, diagnose kidney diseases, and monitor treatment
effectiveness. Abnormal values usually indicate a need for further investigation.
 URINE FORMATION

Urine formation is a complex process carried out by the kidneys to eliminate waste, maintain fluid
balance, and regulate electrolytes and pH. It occurs in three main stages: filtration, reabsorption, and
secretion.

1. Filtration (Glomerular Filtration)

- Location: Glomerulus (in the renal corpuscle).
- Process: Blood enters the glomerulus, where a selective filtration barrier allows water, small molecules
(e.g., glucose, electrolytes), and waste products to pass into the Bowman’s capsule as glomerular filtrate.
- Key Points: Large molecules like proteins and blood cells remain in the bloodstream. The glomerular
filtration rate (GFR) is a measure of kidney function.

2. Reabsorption
- Location: Primarily in the proximal convoluted tubule (PCT), loop of Henle, distal convoluted tubule
(DCT), and collecting ducts.
- Process: Essential substances like water, glucose, amino acids, and electrolytes (e.g., sodium, chloride)
are reabsorbed from the renal tubules back into the bloodstream.
- In the PCT, most of the reabsorption occurs.
- In the loop of Henle, water is reabsorbed in the descending limb, and sodium is reabsorbed in the
ascending limb.
- In the DCT and collecting ducts, sodium reabsorption is regulated by aldosterone, and water
reabsorption is influenced by antidiuretic hormone (ADH).
- Key Points: This step ensures the body retains essential nutrients and maintains fluid and electrolyte
balance.

3. Secretion
- Location: Primarily in the PCT, DCT, and collecting ducts.
- Process: Certain waste products (e.g., creatinine, hydrogen ions (H ⁺), potassium ions (K ⁺) and excess
substances are actively secreted from the blood into the renal tubules.
- Key Points: Hydrogen ions help regulate pH, and potassium levels are maintained by secretion,
especially under the influence of aldosterone.

4. Excretion (Urine Formation)

- Location: Collecting ducts, renal pelvis, ureters, bladder, and urethra.
- Process: The final urine, containing water, urea, creatinine, and other waste products, is excreted from
the kidneys, transported through the ureters, stored in the bladder, and eventually expelled through the
urethra.
- Key Points: The concentration and volume of urine are adjusted based on the body's hydration status,
with ADH and aldosterone playing key roles in water and sodium retention.

Key Hormonal Regulators:

 Antidiuretic Hormone (ADH): Regulates water reabsorption in the collecting ducts, concentrating urine
during dehydration.
 Aldosterone: Increases sodium reabsorption and potassium secretion in the DCT and collecting ducts,
affecting fluid balance and blood pressure.
 Renin-Angiotensin-Aldosterone System (RAAS): Regulates blood pressure and volume, influencing
kidney function.
 Atrial Natriuretic Peptide (ANP): Reduces sodium reabsorption, increasing urine output when blood
volume is too high.

DISESASE SIGNS AND TREATMENT/MGT

RELATED SYMPTOMS
ACUTE KIDNEY Acute kidney injury The treatment of acute
INJURY (AKI) (AKI) is a sudden kidney injury (AKI) focuses
decline in kidney on addressing the
function that can result underlying cause, managing
from various causes. The symptoms, and preventing
signs and symptoms complications. Key steps
typically include: include:

 Reduced Urine Output: 1. Identify and Treat the

Oliguria (less than 400 Cause: Correct dehydration
mL/day) or anuria (no or heart failure in prerenal
urine output). AKI, stop nephrotoxic
 Fluid Retention: drugs in intrarenal AKI, and
Swelling, especially in relieve urinary obstruction
the legs, ankles, and feet, in postrenal AKI.
due to fluid buildup. 2. Fluid and Electrolyte
 Fatigue and Weakness: Management: Provide IV
Feeling tired or weak fluids for dehydration,
due to electrolyte carefully manage fluid
imbalances and toxin balance to avoid overload,
accumulation. and correct electrolyte
 Shortness of Breath: imbalances (especially
Caused by fluid buildup hyperkalemia).
in the lungs (pulmonary 3. Renal Replacement
edema). Therapy (RRT): Dialysis
 Nausea and Vomiting: may be needed if kidney
Toxin accumulation function doesn’t improve or
(uremia) can cause if life-threatening
gastrointestinal complications (e.g., severe
symptoms. hyperkalemia, acidosis)
 Confusion or Altered occur.
Mental Status: Resulting 4. Supportive Care: Monitor
from uremia and kidney function,
electrolyte imbalances. electrolytes, and acid-base
 Elevated Blood status; manage blood
Pressure: Due to fluid pressure; and avoid
retention and kidney nephrotoxic drugs.
dysfunction. 5. Nutritional Support:
 Electrolyte Imbalances: Adjust diet, especially in
Particularly high severe cases, to prevent
potassium further kidney strain.
(hyperkalemia), which 6. Prevention of
can be life-threatening. Complications: Prevent
infections, manage clotting
risk, and monitor for kidney
 recovery or progression to
chronic kidney disease
(CKD).
NEPHROTIC Nephrotic syndrome is a The treatment of nephrotic
SYNDROME kidney disorder syndrome focuses on
characterized by a group addressing the underlying
of signs and symptoms cause, managing symptoms,
caused by significant and preventing
protein loss in the urine. complications.
Key features include: Key approaches include:

 Edema: Swelling, 1. Treat the underlying

especially in the face, cause (e.g., corticosteroids
legs, and abdomen, due or immunosuppressants for
to fluid retention. primary glomerular
 Proteinuria: Excessive diseases, control of diabetes
protein in the urine, or lupus in secondary
typically more than 3.5 causes).
grams per day. 2. Manage edema with
 Hypoalbuminemia: Low diuretics, sodium and fluid
levels of albumin in the restriction.
blood, which contributes 3. Reduce proteinuria using
to edema. ACE inhibitors or ARBs.
 Hyperlipidemia: [Link] hyperlipidemia
Elevated cholesterol and with statins.
triglyceride levels in the 5. Prevent complications
blood. like blood clots
 Fatigue: Due to fluid (anticoagulation), infections
imbalances and other (antibiotics, vaccinations),
metabolic changes. and malnutrition (nutritional
 Foamy Urine: Due to support).
high protein content in [Link] kidney function
the urine. and adjust treatment as
needed.
In severe cases,
nephrotic syndrome can In summary, the goal is to
lead to complications treat the underlying disease,
like infections, blood control symptoms, and
clots, and malnutrition. prevent complications to
improve long-term
outcomes.
CHRONIC Chronic kidney disease Management of chronic
KIDNEY (CKD) progresses kidney disease (CKD)
DISEASE (CKD) gradually and may not focuses on slowing disease
show symptoms in the progression, managing
early stages. As the symptoms, and preventing
disease advances, signs complications:
and symptoms become
more evident and can 1. Control Underlying
include: Causes: Manage diabetes
 and hypertension with
 Fatigue and Weakness: medications like ACE
Due to anemia and toxin inhibitors, ARBs, and blood
buildup. sugar control.
 Edema: Swelling, 2. Symptom Management:
particularly in the legs, Use diuretics for edema,
ankles, and feet, due to phosphate binders for high
fluid retention. phosphate, and
 Urine Changes: erythropoiesis-stimulating
Decreased urine output, agents for anemia.
foamy or dark-colored [Link] Replacement
urine, or frequent Therapy (RRT): Dialysis
urination (especially at may be required as kidney
night). function declines (GFR <
 Shortness of Breath: 15), and kidney transplant is
Caused by fluid buildup an option for eligible
in the lungs (pulmonary patients.
edema). 4. Lifestyle Modifications:
 Nausea and Vomiting: Adhere to a low-protein,
From the accumulation low-sodium diet, restrict
of waste products in the fluids as needed, and
blood (uremia). engage in regular exercise.
 Hypertension: High [Link] Health:
blood pressure due to Use statins, aspirin (if
kidney dysfunction and indicated), and encourage
fluid retention. smoking cessation.
 Itchy Skin: Caused by 6. Regular Monitoring:
the accumulation of Track kidney function,
waste products and electrolytes, and blood
electrolyte imbalances. pressure to guide treatment.
 Anorexia and Weight [Link] Care: Educate
Loss: Loss of appetite patients, offer emotional
and unintentional weight support, and screen for
loss. complications.
 Altered Mental Status:
Confusion or difficulty In summary, CKD
concentrating, resulting management involves
from toxin buildup in the treating the underlying
blood (uremia). causes, managing
 Electrolyte Imbalances: complications, and
Particularly considering dialysis or
hyperkalemia (high transplantation as kidney
potassium) and low function declines.
calcium levels.

In summary, CKD
symptoms develop
slowly and may include
fatigue, edema, urine
changes, nausea,
 shortness of breath, high
blood pressure, and
metabolic disturbances
as kidney function
declines.
UTI Urinary tract infections The treatment of a urinary
(UTIs) can affect the tract infection (UTI)
bladder (cystitis) or includes:
kidneys (pyelonephritis)
and present with various 1. Antibiotics: First-line
symptoms. Key signs treatment for uncomplicated
and symptoms include: UTIs includes medications
like nitrofurantoin,
 Frequent Urination: The trimethoprim-
need to urinate more sulfamethoxazole, or
often, especially with fosfomycin. For
small amounts. complicated UTIs or
 Painful Urination: A pyelonephritis,
burning sensation or fluoroquinolones (e.g.,
discomfort while ciprofloxacin) are used.
urinating (dysuria).
 Cloudy or Foul-Smelling 2. Symptom Management:
Urine: Urine may appear Phenazopyridine can be
cloudy, dark, or have a used for pain relief, and
strong odor. increased fluid intake helps
 Lower Abdominal Pain flush out bacteria.
or Pressure: Discomfort
in the pelvic or lower [Link]: For recurrent
abdomen area. UTIs, low-dose antibiotics
 Hematuria: Blood in the may be prescribed for
urine, which may cause prevention, along with
pink or red-colored lifestyle measures like
urine. proper hydration, frequent
 Fever and Chills: More urination, and proper
common in upper hygiene.
urinary tract infections
(pyelonephritis), which [Link] UTIs:
may cause more severe Hospitalization, IV
symptoms. antibiotics, and imaging
 Nausea and Vomiting: may be needed for severe
May occur in cases of cases or if there’s an
pyelonephritis, underlying issue like
particularly if the urinary obstruction.
infection has spread to
the kidneys. 5. Special Populations:
 General Malaise or Treatment in pregnant
Fatigue: A feeling of women and children
overall illness or requires specific antibiotics,
tiredness. and in the elderly, UTIs
may present with atypical
 In summary, UTIs symptoms and require
typically cause frequent, tailored management.
painful urination, cloudy
or foul-smelling urine, In summary, UTIs are
lower abdominal treated with antibiotics,
discomfort, and possibly symptom relief, and
fever, especially if the preventive measures, with
infection involves the further investigation and
kidneys. follow-up needed for
complicated or recurrent
infections.
RENAL CALCULI Renal calculi (kidney Treatment for renal calculi
stones) are hard deposits (kidney stones) involves:
of minerals and salts that
form in the kidneys. [Link]
Symptoms typically Management: Increase fluid
occur when the stones intake and use pain relievers
move through the (NSAIDs or opioids).
urinary tract. Alpha-blockers may help
Key signs and pass smaller stones.
symptoms include: 2. Stone Removal: Larger
stones may require
 Severe Flank Pain: treatments like shockwave
Sharp, intense pain in lithotripsy (SWL),
the back or side, often ureteroscopy, or
radiating to the lower percutaneous
abdomen or groin, nephrolithotomy (PCNL).
caused by the stone 3. Prevention: Modify diet
moving or blocking the (reduce oxalates, increase
urinary tract. calcium) and use
 Hematuria: Blood in the medications like thiazide
urine, which may cause diuretics or potassium
it to appear pink, red, or citrate to prevent
brown. recurrence.
 Frequent Urination: The 4. Complications: Treat
need to urinate more infections with antibiotics,
often, especially in cases and relieve obstructions
where the stone is near caused by stones with
the bladder. surgical intervention if
 Painful Urination: needed.
Burning or sharp pain
during urination, In summary, treatment
especially if the stone is focuses on pain
near the urethra. management, stone
 Nausea and Vomiting: removal, and prevention
Caused by the severe through hydration, dietary
pain and the body's changes, and medications.
response to the
obstruction.
 Cloudy or Foul-Smelling
 Urine: A sign of
infection, which can
occur if a stone causes a
blockage that leads to a
urinary tract infection.
 Fever and Chills: May
indicate an infection
associated with the
stone, especially if the
stone causes a blockage
and urine becomes
infected.

In summary, kidney
stones typically cause
severe flank pain,
hematuria, frequent or
painful urination, and
possibly nausea,
vomiting, and fever if
there is an associated
infection.
 TYPES OF DIALYSIS

HEMODIALYSIS
- With hemodialysis, a machine removes blood from your body, filters it through a dialyzer (artificial kidney)
and returns the cleaned blood to your body. This 3- to 5-hour process may take place in a hospital or a
dialysis center three times a week.

- You can also do hemodialysis at home. You may need at-home treatments four to seven times per week for
fewer hours each session. You may choose to do home hemodialysis at night while you sleep.

What happens before hemodialysis?

- Before you start hemodialysis, you’ll undergo a minor surgical procedure to make it easier to access the
bloodstream. You may have:

 Arteriovenous fistula (AV fistula): A surgeon connects an artery and vein in your arm.
 Arteriovenous graft (AV graft): If the artery and vein are too short to connect, your surgeon will use a graft
(soft, hollow tube) to connect the artery and vein.
AV fistulas and grafts enlarge the connected artery and vein, which makes dialysis access easier. They also help
blood flow in and out of your body faster.

If dialysis needs to happen quickly, your provider may place a catheter (thin tube) into a vein in your neck, chest or
leg for temporary access.

Your provider will teach you how to prevent infections in your fistula or graft. This provider will also show you
how to do hemodialysis at home if you choose to do so.

What happens during hemodialysis?

During hemodialysis, the dialysis machine:

 Removes blood from a needle in your arm.

 Circulates the blood through the dialyzer filter, which moves waste into a dialysis solution. This cleansing
liquid contains water, salt and other additives.
 Returns filtered blood to your body through a different needle in your arm.
 Monitors your blood pressure to adjust how fast blood flows in and out of your body.

What happens after hemodialysis?

Some people experience low blood pressure during or immediately after hemodialysis. You may feel nauseous,
dizzy or faint.

Other side effects of hemodialysis include:

 Chest pain or back pain.
 Headaches.
 Itchy skin.
 Muscle cramps.
 Restless legs syndrome.

PERITONEAL DIALYSIS
 - With peritoneal dialysis, tiny blood vessels inside the abdominal lining (peritoneum) filter blood through
the aid of a dialysis solution. This solution is a type of cleansing liquid that contains water, salt and other
additives.

Peritoneal dialysis takes place at home. There are two ways to do this treatment:

 Automated peritoneal dialysis uses a machine called a cycler.

 Continuous ambulatory peritoneal dialysis (CAPD) takes place manually.

What happens before peritoneal dialysis?

- About three weeks before you start peritoneal dialysis, you’ll have a minor surgical procedure. A surgeon
inserts a soft, thin tube (catheter) through your belly and into the peritoneum. This catheter stays in place
permanently.

A healthcare provider will teach you how to perform peritoneal dialysis at home and prevent infections at the
catheter site.

What happens during peritoneal dialysis?

During peritoneal dialysis, you:

 Connect the catheter to one branch of a Y-shaped tube. This tube connects to a bag that has dialysis
solution. The solution flows through the tube and catheter into the peritoneal cavity.
 Disconnect the tube and catheter after about 10 minutes, when the bag is empty.
 Cap off the catheter.
 Go about your usual activities while the dialysis solution inside the peritoneal cavity absorbs waste and
extra fluids from the body. This process can take 60 to 90 minutes.
 Remove the cap from the catheter and use the other branch of the Y-shaped tube to drain the fluid into a
clean, empty bag.
 Repeat these steps up to four times a day. You sleep with the solution in your stomach all night.
Some people prefer to do peritoneal dialysis at night. With automated peritoneal dialysis, a machine called a cycler
pumps the fluid in and out of the body while you sleep.

What happens after peritoneal dialysis?

- The liquid in your belly can make you feel bloated or full. It might feel uncomfortable, but the treatment
isn’t painful. Your stomach may stick out more than usual when it’s filled with fluid.

Risks / Benefits
What are the potential risks or complications of hemodialysis?
Some people have problems with the AV fistula or graft. You may develop an infection, poor blood flow or a
blockage from scar tissue or a blood clot.

Rarely, the dialysis needle comes out of your arm, or a tube comes out of the machine, during dialysis. A blood
leak detection system alerts you or the medical staff to this problem. The machine temporarily shuts off until
someone fixes the problem. This system protects you from blood loss.

What are the potential risks or complications of peritoneal dialysis?

Some people develop skin infections around the catheter. You’re also at risk for peritonitis, an infection that occurs
when bacteria get inside the abdomen through the catheter. You may experience fever, abdominal pain, nausea and
vomiting.
Using the abdominal catheter and pumping your belly full of fluid can weaken abdominal muscles over time. You
may develop a hernia. This condition occurs when an organ like the small intestine pokes through the abdominal
muscles. You may feel a bulge near the belly button or in the groin area between the abdomen and upper thigh.
Your doctor can repair a hernia with surgery.

During peritoneal dialysis, your body absorbs dextrose, a sugar, from the dialysis solution. Over time, this extra
sugar can lead to weight gain