case 8 - the kidney and urinary tract

Question 1

how many glomeruli do normal people have

Answer 1

1-2 million in each kidney

Question 2

how many glomeruli do hypertensive people have

Answer 2

0.5-1 million

Question 3

what modify the glomerular ultrafiltrate

Answer 3

the nephron tubules and collecting ducts

Question 4

when is oedema especially severe

Answer 4

when severe proteinuria and hypoalbuminaemia are present

Question 5

what is this called

Answer 5

nephrotic syndrome

Question 6

what does blood and protein in the urine indicate

Answer 6

glomerular disease

Question 7

what do u see on a cardiogram if someone has hyperkalaemia

Answer 7

peaking T waves

Question 8

what does the renal tract include

Answer 8

the kidney, ureter and urinary bladder

Question 9

what is the bladder

Answer 9

The bladder is a low pressure reservoir which intermittently and completely expels urine per urethra

Question 10

what does the bladder contain

Answer 10

smooth muscle bundles under autonomic control

Question 11

what makers the urothelial layer watertight

Answer 11

uroplaquin

Question 12

what are the steps in the cycle of ureteric peristalsis

Answer 12

Relaxation
Begin contracting
Wave halfway down
Wave near bladder

Question 13

what happens when the pacemaker at the top of the ureter doesnt work

Answer 13

Pacemaker at top of ureter and when this doesn’t work you get a build up of urine at top of ureter called hydronephrosis

Question 14

what are the key clinical symptoms of LRT disease

Answer 14

dysuria
Frequency of micturition
Incontinence of urine
Poor urinary store
Haematuria
Pain (caused by acute bladder outflow obstruction, renal colic, urosepsis)

Question 15

what can primary disease of the lower tract cause

Answer 15

secondary kidney failure mediated by impairment of urine flow

Question 16

what are the two ways of classifying kidney and urinary tract diseases

Answer 16

congenital malformations
Acquired (non-tumour)
Acquired (tumours)

genetic causes
Environmental causes

Question 17

what does hypoplasia mean

Answer 17

too few nephrons

Question 18

what is dysplasia

Answer 18

undifferentiated kidney sometimes with cysts

Question 19

what is agenesis

Answer 19

absent kidney

Question 20

what is the most commonly mutated gene in kidney disease

Answer 20

HNF1B

Question 21

what is prune belly syndrome and what is it a mutation in

Answer 21

Prune belly syndorme seen in children - unable to enter their bladder and can be caused by a mutation in myocardin - which is involved in the formation of smooth muscle

Question 22

what are the pre renal causes if acquired kidney failure

Answer 22

Shock (e.g. massive blood loss, septicaemia)
►Cardiac and Liver failure

Question 23

what are the intrinsic kidney disease causes of acquired kidney failure

Answer 23

Glomerular disease (e.g. Alport syndrome, diabetes mellitus and immune-mediated glomerulonephritis)
Tubular disease (e.g. pyelonephritis, autosomal dominant polycystic disease, nephrotoxins)

Question 24

what are the post renal causes of acquired kidney failure

Answer 24

►Urinary flow impairment (e.g. stones, tumours and dysfunctional bladders); need to block both kidneys.

Question 25

what is glomerular disease - diabetes mellitus

Answer 25

Early on, glomerular filtration rate is actually increased… without treatment, there follows a progressive decline in renal function with sclerosis (scarring of glomeruli)

Question 26

what do therapies include

Answer 26

Therapies targeting the cyst epithelial in PKD - vasopressin receptor antagonists

Question 27

what are the kidney cancer tumours found in children

Answer 27

Children - Wilms tumours

Question 28

what are the kidney cancer tumours found in adults

Answer 28

clear cell carcinomas

Question 29

where do bladder cancers arise

Answer 29

the urothelium

Question 30

where do prostatic cancers metastasise to and how does this differ from other cancers

Answer 30

Prostate cancer usually metastasise to bones and called sclerotic metastases and not lytic like many other cancers