PATHOPHYSIOLOGY
A. Anatomy & Physiology
The kidney and urinary system include the kidneys, ureters, bladder and urethra. Urine is
formed by the kidney and flows through the other Structures to be eliminated from the body.
Kidneys
The kidneys are a pair of bean-shaped, brownish-red structures located red structure located
retroperitoneally on the posterior wall of the abdomen-from the 12th thoracic vertebra to the 3rd
lumbar vertebra in the adult. The rounded outer convex surface of each kidney is called the
hilum. The average adult kidney weighs approximately 113 to 170 g and is 10 to 12 cm long, 6
cm wide, and 2.5 cm thick. The right kidney is slightly lower than the left due to the location of
the liver.
Nephrons
Each kidney has 1 million nephrons that are located within the renal parenchyma and are
responsible for the formation of filtrate that will become urine. The large number of nephrons
allows for adequate renal function even if the opposite kidney is damaged or becomes
nonfunctional. If the total number of functioning nephrons is less than 20% of normal, renal
replacement therapy needs to be considered.
Ureters, Bladder and Urethra
The movement of urine from each renal pelvis through the ureters into the bladder is facilitated
by peristaltic contraction of the smooth muscle in the ureter wall. Each ureter has three narrow
areas that are prone to obstruction by renal calculi (kidney stones) or stricture. The urinary
bladder is a distensible muscular sac located just behind the pubic bone (Weber & Kelley,
2014). The urethra arises from the base of the bladder: In the male it passes through the penis;
in the female, it opens just anterior to the vagina. In the male, the prostate gland, which lies just
below the bladder neck, surrounds the urethra posteriorly and laterally.
The healthy human body is composed of approximately 60% water. Water balance is regulated
by the kidneys and results in the formation of urine. Urine is formed in the nephrons through a
complex three-step process: glomerular filtration, tubular reabsorption, and tubular secretion.
Water, electrolytes, and other substances, such as glucose and creatinine, are filtered by the
glomerulus; varying amounts of these substances are reabsorbed in the renal tubule or excreted
in the urine.
Reference: Hinkle, J. L., Cheever, K. H. (2018) Brunner and Suddarth’s Textbook of Medical
Surgical Nursing (Fourteenth Edition Vol. 2). Wolter Kluwer. P1615
B. Overview of Disease
Urinary tract infections (UTIs) are caused by pathogenic microorganisms in the urinary tract (the
normal urinary tract is sterile above the urethra). UTIs are generally classified as infections
involving the upper or lower urinary tract and further classified as uncomplicated or complicated,
depending on other patient-related conditions.
Lower UTIs include bacterial cystitis, bacterial prostatitis, bacterial urethritis. Acute or chronic
pyelonephritis, interstitial nephritis, and kidney abscess. Upper and lower UTIs are further
classified as uncomplicated and complicated, depending on whether the UTI is recurrent and
the duration of the infection. Most uncomplicated UTIs are community acquired (Hopkins
McCroskey, Reeves, et al., 2014). Complicated UTIs usually occur in people with urologic
abnormalities or recent catheterization and are often acquired during hospitalization.
Reference: Hinkle, J. L., Cheever, K. H. (2018) Brunner and Suddarth’s Textbook of Medical
Surgical Nursing (Fourteenth Edition Vol. 2). Wolter Kluwer. P1615
C. Contextual mapping/ Schematic Diagram
Predisposing Factors:
Age
Sex
Precipitating Factors:
Etiology: Increased salt intake
Poor feeding
Escherichia Coli 70-95%
Lifestyle
Klebsiella
Proteus mirabilis
Pseudomonas aeruginosa
Contamination of urethra of bacteria
Attachment and colonization of bacteria in the periurethral area
Ascending bacteria to the bladder
Multiplication of bacteria, immune system evasion
Inflammation
Urinary urgency Dysuria Hematuria Burning sensation
Urinary Tract Infection
If not treated:
If treated:
Provide analgesic Kidney infection
drugs
Application of
Urosepsis
heating pad to
painful area
Death
Recovery
