Disorders of Renal

Function
Calculi_UTI
MS. Cres P. Quinzon RN MAN
Pathophysiology 2020-2021
Oman College of Health Sciences Dhofar
 Objectives

Describe the Etiology and

Pathogenesis of Renal Calculi and
Urinary Tract Infection.
 Disorders of Renal Function

Renal Calculi Or Renal Stones

● The most common cause of upper urinary tract
obstruction is urinary calculi.
● Although stones can form in any part of the urinary
tract, most develop in the kidneys.
● Kidney stones are polycrystalline aggregates
composed of materials that the kidneys normally
excrete in the urine.
 Etiology and Pathogenesis

Kidney stone formation

Supersaturated urine
(e.g., calcium salts, uric Presence of Deficiency of
acid, magnesium nucleus for crystal inhibitors of stone
ammonium phosphate, formation formation
cystine)

depends on urinary
pH, solute magnesium and
Crystal aggregation
concentration, ionic citrate
strength
Etiology and Pathogenesis
Urinary Tract Infection
 Urinary Tract Infections

Infections within the urinary tract

lower UTIs such as cystitis, and upper UTIs such as
pyelonephritis

Because of their ability to cause renal damage,

upper UTIs are considered more serious than lower
UTIs.
 Urinary Tract Infections

Etiology and Pathogenesis

Uncomplicated lower UTIs are caused by :

Escherichia coli
Staphylococcus saprophyticus
Proteus mirabilis,
Klebsiella species,
Enterobacter species, and Pseudomonas aeruginosa)
 Urinary Tract Infections

Etiology and Pathogenesis

Complicated UTI’s are caused by gram-positive cocci

(Staphylococcus aureus

Most UTIs are caused by bacteria that enter through the

urethra.

Bacteria can also enter through the bloodstream usually in

immunocompromised people and neonates.
 Urinary Tract Infections

Etiology and Pathogenesis

Washout phenomenon, in which urine from the bladder

normally washes bacteria out of the urethra.

When a UTI occurs, it is usually from bacteria that

have colonized the urethra, vagina, or perianal area.
 Urinary Tract Infections

Etiology and Pathogenesis

There is an increased risk for UTIs in people with:

• urinary obstruction and reflux

• neurogenic disorders that impair bladder emptying
• women who are sexually active
• postmenopausal women
• men with diseases of the prostate
• older adult
• diabetes
 Urinary Tract Infections

Etiology and Pathogenesis

most common predisposing factors for nosocomial UTIs:

• Instrumentation
• Urinary catherization
Etiology and Pathogenesis

Host-Agent Interactions (Host Defenses

01
and Pathogens Virulence)

02 Obstruction and Reflux

03 Cathether-Induced Infection
 Washout phenomenon
 Bladder lining- barrier to protect
against invasion
1. Host-Agent
 Body’s immune system
 Normal flora of the periurethral
Interactions
area in women consists of
organisms such as Lactobacillus, A. Host Defenses
in men, prostatic fluid has
antimicrobial properties that
of the bladder
protect the urethra from
colonization

 a decrease in estrogen levels

during menopause or the use of
antibiotics, can alter the
protective periurethral flora,
allowing uropathogens to colonize
and enter the urinary tract
 1. Host-Agent
 Virulence of the agent is derived 
from: Interactions
  its ability to  gain access to and 
thrive in the UT environment, 
 adhere to the tissues of the lower 
B. Pathogen Virulence
or upper UT,
 evade  the destructive effects of 
the host’s immune system, 
 and develop resistance to 
antimicrobial agents
 Of the many strains of E. coli, 1. Host-Agent
only those with increased
ability to adhere to the Interactions
epithelial cells of the urinary
tract are able to produce
UTIs.
B. Pathogen Virulence
 These bacteria have fine
protein filaments, called pili
or fimbriae, that help them
adhere to receptors on the
lining of urinary tract
structures
The obstruction may be anatomic or 2. Obstruction and
functional.
Reflux
 Anatomic obstructions
include urinary tract stones, prostatic
hyperplasia, pregnancy, and
malformations of the ureterovesical
junction.
 Functional obstructions include
neurogenic bladder, infrequent
voiding, detrusor (bladder) muscle
instability, and constipation.
Reflux: 2. Obstruction and
 Urethrovesical reflux - occurs when
urine from the urethra moves into
the bladder
Reflux
o can occur during
activities such as
coughing or squatting
 Vesicoureteral reflux, occurs at the
level of the bladder and ureter
o It is seen most
commonly in children
with UTIs and is believed
to result from congenital
defects of the ureter.
 2. Obstruction and Reflux

Urethrovesical Reflux Vesicouretral Reflux

occurs when urine from the urethra moves into
the bladder
can occur during activities such as coughing or
squatting
occurs at the level of the bladder and
ureter
Common in children with UTI with
congenital defects of the ureter
 Catheters are a source of irritation 3. Catheter-Induced
and provides a means for entry of
microorganisms into the UT.
 Bacteria adhere to the surface of
the catheter and initiate the
growth of a biofilm that then
covers the surface of the catheter.
 The biofilm tends to protect the
bacteria from the action of
antibiotics and makes treatment
difficult.
Thanks

Do you have any

CREDITS: This presentation template was
created by Slidesgo, including icons by

questions?
Flaticon, infographics & images by Freepik

Please keep this slide for attribution