HLSU241 Diagnostic Radiography

Urinary System Renal Failure

The anatomical feature of the urinary system would include the organ associated with it. The anatomical features that must be observed for the patient would focus mainly on the patient’s kidneys, urinary bladder, “urethra”, and renal pelvis. Although the total examination of the patient would require proper diagnosis and monitoring for what the actual problem would raise. It is thus necessary to understand the anatomical features of the patient being examined. Thus, under normal physiologic conditions, the patient with this system would function to filter the blood and would rather create urine as a waste product of fluid intake in our diet (Ferreira-Pêgo et al., 2015). Thus, for a healthy elderly individual, the normal output for the day would be usually in the range of 1000 to 1500 milliliter. Moreover, in individual, the water and sodium balance are strongly regulated under the normal physiological control system that is related to the neuroendocrine mechanism system overall. The overall body fluid homeostasis is maintained upon the intake capacity of sodium and fluid intake in the body. However, stimulated changes in the volume of electrolytes and extracellular fluid would compensatory regulate the sodium balance within the normal range (Stanhewicz and Larry Kenney, 2015).

Patient History

The 81-year-old African- Caribbean women who have been shifted to London in the early days were investigated by her physician over the experiencing tiredness that she had developed over the past 9 months. On monitoring by the physicians, she had told her physician that she had lost all her appetite and was feeling nausea all time, this feeling of nausea was experienced more at night. Furthermore, her history also tells that she had lost a weight of about 8.9 kg in the last 9 months. Also, from the past six weeks, these veteran women chiefly complained about cramping and itching in the body. Moreover, the women are also being suffering from hypertension for the past 15 years and were prescribed an anti-hypertensive medication “hydrochlorothiazide Microzide” (Sun 2015). At the age of 60, these women met with a car accident on the highway where she was rushed to a nearby hospital and had diagnosed with cerebrovascular syndrome for which the veteran had lost her mobility to walk and move his arms in full functionality (Kashiwazaki et al. 2015). The veteran under abnormal anatomical and physiological condition would require a proper care approach for her condition that needs to cope with the different care.

Examination Of a Patient Upon Looking For Her Sign And Symptoms.

The patient was examined under the physician where the doctor found that patient is having conjunctiva which is pale in colour. The pulse showed an 89/min regular interval with a blood pressure of about 195/120 mm Hg systolic upon diastolic range respectively (Verdecchia et al., 2015). The patient is having a mild case of fluid retention (oedema) in her left ankle. Although, other examination or diagnosis for the cardiovascular system and the respiratory system was in normal. The woman had symptoms of left upper motor neuronal facial palsy and was experiencing a mild weakness with greater reflexes in the left arm and legs consistently (Györi et al., 2018).

Patient Findings Upon Examination And Prevention From The Renal Failure

As the patient is suffering from severe renal failure which also has an eating disorder with discomfort sensation stomach and loss of weight that results in other sign such as fatigue with pruritus and cramps. The high elevated level of creatinine and urea thus confirms to be an example of renal failure for the veteran, but it is too early to distinguish that the patient is suffering from chronic or acute renal failure (Sawhney, Marks and Black 2016). Moreover, if the patient had earlier tested for the blood test from which it can be revealed that serum creatinine level would be an informal assessment tool for the renal failure was earlier present or not. Normochromic and normocytic anaemia reveal that there is a predominate erythropoietin deficiency in the kidneys which is an important source of erythropoietin production. On the other hand, X-Ray revealed that it shows the signs of hyperparathyroidism that would imply the long-term effect of renal failure which is an important criterion for distinguishing the condition of renal failure is either acute or chronic in condition (Madkhali et al., 2016). The ultrasound imaging of the patient was investigated for the kidneys to identify the root cause for the renal failure as a polycystic kidney disease-causing by the bilateral hydronephrosis in which urine is unable to drain into the kidney to the bladder of the patient obstructing urine output (Mao et al., 2020).  The assessment based on the ultrasound finds the patient had an asymmetrically sized kidney and was having nephropathy or sometimes called renovascular disease. The ultrasound also observed that there was a small 7-8 cm echogenic kidney (possibility of kidney failure) with long renal failure. It is observed that the African–Caribbean is more susceptible to developing hypertension from renal failure as compared to other ethnic groups of origins (Gill et al., 2017). The treatment and prevention for these conditions of renal failure would include antihypertensive medications and oral phosphate binders to control the secondary hyperparathyroidism, and an injection for erythropoietin for treating the women with anaemia. But the case here keeps to dilemma whether it will appropriate for dialysis to be given or not. But the women age and conditions and with comorbidity reveals that physicians may decide to go for renal transplantation (Peters-Sengers et al., 2017).

The management of renal failure for these women would be practically addressed by the physician. The management here refers to the treatment of many life-threatening diseases that can attempt to halt or stop temporarily for any serious symptomatic cause for patient underlying renal failure of the women.  The nurse and nephrologists try to assess the patient based on overall renal recovery if possible. The treatment may also include a holistic approach for the patient to get managed properly by the virtue of different life-saving drug regime for the symptoms that the woman is experiencing. Thus, the assessment of these 84-year-old women would require proper diet, proper fluid intake, proper medication, and proper care of treatment to lead the life. Also, fluid balance treatment for the lesser severe analysis of acidosis and use of diuretics and dopamine and the obstruction for relief would help to manage the patient in a much better way (Joannidis et al., 2017).

Urinary System Development In The Fetus

The fetal and early childhood development is often conceptualized as the gift of mankind where the fetus or children learn by soaking information which is like sponge and water. The advantage of developmental science has created that development is regarded as a proactive regulated process which in general start early prenatal stage (Wainwright et al., 2015).

The development occurs very quickly which is the time between the conceptions and birth. The main development stages would help to develop the urinary system which lasts for about 29 to 30 weeks. Thus, in the fetus, the development of the urinary system is complex. The most important part of the development of a urinary system is the development of urogenital ridges which arises for development during the fourth week of pregnancy. The nephrogenic cord is a part of the urogenital ridge which is the important source of the urinary system to develop all information of developmental genes lies in these cord (Neirijnck et al., 2018).  The study forms the past has revealed that infant females are more susceptible to get a urinary tract infection due to the presence of bacteria E.coli present in the faeces which damages the urethra when the infant is being cleaned (Schroeder et al., 2015).

  Furthermore, the urinary system of infants is generally immature during birth and it would be difficult for the infants for urine to be concentrated. Usually, the kidneys of the fetus or infants are immature until 6 months of age. The infants have a limited capacity to adjust the fluid intake with limited water intake. They could not retain the urine due to the immature development of involuntary reflexes in the neuronal control. The infants thus need special care for the taking of fluid with adjusted water intake capacity per day which automatically would result in retention of sodium and potassium ions in the body. Moreover, any deviation in this intake capacity would result in a condition called “hypokalemia” which is associated with symptoms of arrhythmias (rate of the heart becomes faster) that may be fatal for the infant. These conditions arise because the infant’s urinary system is not immature, and their bladders are small where the urine cannot be retained as infants would urinate frequently (Veltri and Mason 2015).  

The interesting fact in the development of a fetus is that it has three sets of kidneys which are sequentially developed during the embryogenesis stage. The first stage is the pronephros which is non-functional and becomes regressed completely upon maturation. The second one is the mesonephros which is called the permanent adult kidney during the mature stage.  

The urine in the form of nitrogenous waste product is excreted into the amniotic fluid cavity by the fetus plays an important component of the amniotic fluid. It has been observed that urine formation begins towards the end of the first trimester that after eleven weeks and continues over fetal life. An anatomic location such as thoracic Spine-12 to lumbar vertebrae-3 in this region the kidney starts to develop. This development would generally happen during the ninth week.  The formation of a special cell called chromaffin cells starts to develop from the adrenal medulla which is indeed developed from the neural crest cells that tend to migrate in the cortex fetal. The differentiation and the de-differentiation of these cells is an important parameter for this stage to develop into mature cells and become functional at the early stage of childhood. Moreover, the urinary tract develops from the upper end of the urogenital sinus that continues in the allantois and lines in the region of the endoderm.   

The gonads that primary being in the developmental longitudinal ridges and stars with the epithelium. The gonad development is also known as the in the stage and rather involves the mesonephric ducts, (known as the Wolffian ducts) which are located laterally over the paramesonephric ducts, (known as the Müllerian ducts).  Moreover, it is of the sixth week of a gestation period of the primordial germ cell that comes to the with  the “gonadal ridge” and creates a for the development that in respect is huge for the  gonad into ovaries and testis to develop

Different genes associated with the development of the urinary system in the fetus. The kidney development begins with the formation of met nephrogenic mesenchyme this event of development depends on the different transcription factors such as Lim-1 and Pax-2 and its associated transcription factors like Eya-1 and Foxc-1. Furthermore, this mesenchyme secretes and stimulates the nearby Wolffian duct that produced and ureteric Bud (Duarte Azevedo, Sander and Tenenbaum 2020). The proteins of the Bone morphogenetic protein (BMP) family help to modulate ureteric bud branching and keeping the bud development with other tissue types. Proteins such as glycosaminoglycans for the matrix and receptors are useful for the development of this urinary system. Thus, in the urinary system, the main part plays are the nephrons, which are the structural and functional unit of the kidneys. The protein called WT-1 Notch-2, Lmx-1b and Hnf-1 and Jagged -1 are the regulators of transcription factors (Magella et al., 2018).

Reference

Duarte Azevedo, M., Sander, S. and Tenenbaum, L., 2020. GDNF, a neuron-derived factor upregulated in glial cells during disease. Journal of clinical medicine, 9(2), p.456.

Ferreira-Pêgo, C., Guelinckx, I., Moreno, L.A., Kavouras, S.A., Gandy, J., Martinez, H., Bardosono, S., Abdollahi, M., Nasseri, E., Jarosz, A. and Babio, N., 2015. Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide. European journal of nutrition, 54(2), pp.35-43.

Gill, P., Haque, M.S., Martin, U., Mant, J., Mohammed, M.A., Heer, G., Johal, A., Kaur, R., Schwartz, C., Wood, S. and Greenfield, S.M., 2017. Measurement of blood pressure for the diagnosis and management of hypertension in different ethnic groups: one size fits all. BMC cardiovascular disorders, 17(1), pp.1-8.

Györi, E., Przestrzelski, C., Pona, I., Hagmann, M., Rath, T., Radtke, C. and Tzou, C.H.J., 2018. Quality of life and functional assessment of facial palsy patients: a questionnaire study. International Journal of Surgery, 55, pp.92-97.

Joannidis, M., Druml, W., Forni, L.3., Groeneveld, A.B.J., Honore, P.4., Hoste, E., Ostermann, M., Oudemans-van Straaten, H.7. and Schetz, M., 2017. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017. Intensive care medicine, 43(6), pp.730-749.

Kashiwazaki, D., Akioka, N., Kuwayama, N., Noguchi, K., Tanaka, K. and Kuroda, S., 2015. Pathophysiology of the acute cerebrovascular syndrome in patients with carotid artery stenosis: a magnetic resonance imaging/single-photon emission computed tomography study. Neurosurgery, 76(4), pp.427-434.

Madkhali, T., Alhefdhi, A., Chen, H. and Elfenbein, D., 2016. Primary hyperparathyroidism. Turkish Journal of Surgery/Ulusal cerrahi dergisi, 32(1), p.58.

Magella, B., Adam, M., Potter, A.S., Venkatasubramanian, M., Chetal, K., Hay, S.B., Salomonis, N. and Potter, S.S., 2018. Cross-platform single cell analysis of kidney development shows stromal cells express Gdnf. Developmental biology, 434(1), pp.36-47.

Mao, W., Liu, S., Wang, K., Wang, M., Shi, H., Liu, Q., Bao, M., Peng, B. and Geng, J., 2020. Cystatin C in evaluating renal function in ureteral calculi hydronephrosis in adults. Kidney and Blood Pressure Research, 45(1), pp.109-121.

Neirijnck, Y., Reginensi, A., Renkema, K.Y., Massa, F., Kozlov, V.M., Dhib, H., Bongers, E.M., Feitz, W.F., van Eerde, A.M., Lefebvre, V. and Knoers, N.V., 2018. Sox11 gene disruption causes congenital anomalies of the kidney and urinary tract (CAKUT). Kidney international, 93(5), pp.1142-1153.

Peters-Sengers, H., Berger, S.P., Heemskerk, M.B., Al Arashi, D., Van Der Heide, J.J.H., Hemke, A.C., Ten Berge, I.J., Idu, M.M., Betjes, M.G., Van Zuilen, A.D. and Hilbrands, L.B., 2017. Stretching the limits of renal transplantation in elderly recipients of grafts from elderly deceased donors. Journal of the American Society of Nephrology, 28(2), pp.621-631.

Sawhney, S., Marks, A. and Black, C., 2016. Discharge after acute kidney injury: recognising and managing risk. Clinical Focus Primary Care.

Schroeder, A.R., Chang, P.W., Shen, M.W., Biondi, E.A. and Greenhow, T.L., 2015. Diagnostic accuracy of the urinalysis for urinary tract infection in infants< 3 months of age. Pediatrics, 135(6), pp.965-971.

Stanhewicz, A.E. and Larry Kenney, W., 2015. Determinants of water and sodium intake and output. Nutrition reviews, 73(suppl_2), pp.73-82.

Sun, Z., 2015. Aging, arterial stiffness, and hypertension. Hypertension, 65(2), pp.252-256.

Veltri, K.T. and Mason, C., 2015. Medication-induced hypokalemia. Pharmacy and Therapeutics, 40(3), p.185.

Verdecchia, P., Reboldi, G., Angeli, F., Trimarco, B., Mancia, G., Pogue, J., Gao, P., Sleight, P., Teo, K. and Yusuf, S., 2015. Systolic and diastolic blood pressure changes in relation with myocardial infarction and stroke in patients with coronary artery disease. Hypertension, 65(1), pp.108-114.

Wainwright, E.N., Wilhelm, D., Combes, A.N., Little, M.H. and Koopman, P., 2015. ROBO2 restricts the nephrogenic field and regulates Wolffian duct–nephrogenic cord separation. Developmental biology, 404(2), pp.88-102.

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