chapter 18 Flashcards
1
Q
Anatomy of the urinary system
A
Kidneys, ureters, urinary bladder, urethra
2
Q
nephrons
A
Functional units of the kidneys
3
Q
each kindey has how many nephrons
A
over 1 mil
4
Q
Where does filtration take place?
A
Renal corpuscles
- large volume of fluid passes from glomeruler capillaries into the tubule (bowmans capsule)
5
Q
What is filtered in the kidneys
A
wasters, nutrients, electrolytes, other dissolved substances
6
Q
Reabsorption (kidneys): explain
A
reabsorption of essential nutrients, water and electrolytes into the peritubular capillaries
- control of pH and electrolytes
7
Q
What are the transport mechanisms of reabsorption
A
Active transport
Co-transport
Osmosis (water)
8
Q
Proximal convoluted tubules
A
h2o and glucose reabsorption
9
Q
Antidiuretic hormone (ADH): secreted from what
A
posterior pituitary
10
Q
ADH function
A
Reabsorption of water in distal convoluted tubules and collecting ducts
11
Q
Aldosterone: secreted from what
A
adrenal cortex
12
Q
Aldosterone function
A
sodium reabsorption in exchange for potassium of hydrogen
13
Q
Atrial natriuretic hormone comes from where
A
from the heart
14
Q
Atrial natriuretic hormone function
A
Reduced sodium and fluid reabsorption
15
Q
Specialized pattern of the blood flow through the kidneys
A
- renal artery
- interlobular artery
- arcuate artery
- interlobular artery
- afferent arteriole
- glomeruler capillaries
- efferent arteriole
- peritubular capillaries
- interlobular vein
10 arcuate vein - interlobar vein
- renal vein
16
Q
GFR: auto-regulation and hormones control pressure in the glomerular capillaries by what
A
- Vasoconstriction of afferent arteriole
- Dilation of afferent arteriole
- vasoconstriction of efferent arteriole
17
Q
Pressure control in the glomerular capillaries: vasoconstriction of afferent arteriole
A
decreases glomerular pressure – decreases filtrate
18
Q
Pressure control in the glomerular capillaries: Dilation of afferent arteriole
A
increased pressure in glomerulus – increases filtration
19
Q
Pressure control in the glomerular capillaries: vasoconstriction of efferent arteriole
A
increases pressure in glomerulus – increases filtration
20
Q
Control of arteriolar constriction is done by what 3 factors?
A
Autoregulation, SNS, renin
21
Q
Control of arteriolar constriction: auto-regulation
A
local adjustments in diameter of arterioles made in response to changes in blood flow in kidneys
22
Q
Control of arteriolar constriction: SNS
A
increases vasoconstriction in both arterioles
23
Q
Control of arteriolar constriction: Renin
A
Secreted by juxtaglomerular cells when blood flow to afferent arterioles is reduced
(renin-angiotensin mechanism)
24
Q
Enuresis
A
involuntary unination by child (or under 4 years)
- often related to developmental delay, sleep pattern, or psychological aspect
25
Stress incontinence
increased intra-abdominal pressure forces urine through sphincter (coughing, lifting, laughing)
more common in women especially those who had babies
26
Overflow incontinence
Incompetent bladder sphincter; weakened detrusor muscle may prevent complete emptying of bladder - frequency and incontinence
27
what may cause overflow incontinence
- age
- spinal cord injuries / brain damage
- neurological bladder
- interference with CNS and ANS voluntary control of the bladder
28
neurological bladder may be what
spastic or flaccid
29
Retention
inability to empty bladder
30
retention may be accompanied by what
overflow incontinence
31
what cause retention
spinal cord injury at sacral level blocks micturition reflex
may follow anesthesia (general or spinal)
32
incontinence
loss of voluntary control of the bladder
33
Urinalysis:
Straw colored with mild odor
| - normal urine
34
what is the specific gravity of normal urine
1.010 to 1.050
35
Urinalysis: cloudy
may indicate presence of large amounts of protein, blood, bacteria and pus
36
Urinalysis: dark color
may indicate hematuria, excessive bilirubin, or highly concentrated urine
37
Urinalysis: unpleasant or unusual odor
infection or result from certain dietary components or medication
38
Urinalysis: small amounts of blood
Infection, inflammation or tumors or urinary tract
39
Urinalysis: large amounts of blood
Increase glomerular permeability or hemorrhage
40
Urinalysis: elevated protein level (proteinuria, albuminuria)
Leakage of albumin or mixed plasma proteins into filtrate
41
Urinalysis: bacteria (bacteruria)
Infection of urinary tract (UTI)
42
Urinalysis: urinary casts
Indicate inflammation of kidney tubules
43
specific gravity
Indicated ability of tubules to concentrate urine
44
Urinalysis: low specific gravity
Dilute urine (with normal hydration)
45
Urinalysis: high specific gravity
```
Concentrated urine (with normal hydration)
- related to renal failure
```
46
Urinalysis: glucose and ketones
Found when diabetes is not well controlled
47
Blood tests: electrolytes
Depend on related fluid balance
48
Blood tests: antibody level
Antistreptolysin O or antistreptokinase titters
Used for diagnosis of poststreptococcal glomerulonephritis
49
Blood tests: elevated renin levels
Indicated kidney as a cause of hypertension
50
Blood tests: elevated serum urea and serum creatinine levels indicate what
Indicate failure to excrete nitrogen wastes
51
Elevated serum urea and serum creatinine levels: cause
Decrease GFR
52
Blood tests: metabolic acidosis
Indicates decreased GFR
| Failure of tubules to control acid-base balance
53
Blood tests: anemia
Indicated decreased erythropoietin secretion and/or bone marrow depression
54
Culture and sensitivity studies on urine specimens
ID of causative organism of infection
| Help select appropriate drug treatment
55
Radiologic tests
Used to visualize structures and possible abnormalities, flow patterns and filtration rates
56
Clearance tests
Used to assess GFR
| Ex. Creatinine or insulin clearance
57
Cystoscopy
Visualizes lower urinary tract; may be used to perform biopsy or remove kidney stones
58
Biopsy
Used to acquire tissue specimens
59
Dialysis
Provides filtration and reabsorption
60
Two forms of dialysis
Hemodialysis
| Peritoneal dialysis
61
How often does one need to go to dialysis
Usually requires 3x a week - each lasts about 3 to 4 hours
62
Potential complications of dialysis
1. Shunt may become infected
2. Blood clot formation
3. Blood vessels involved in shunt may become sclerosed
4. Patient has increase risk of infection with HBV, HCV or HIV of standard precautions are not followed
63
Describe the process of hemodialysis
Patients blood moves from an implanted shunt/catheter in an artery to machine
º exchange of wastes, fluids, and electrolytes
º semipermeable membrane between blood and dialysis fluid (diastlsate)
— blood cells and proteins remain in blood
º after exchange is completed, blood retuned to patients vein
64
Peritoneal dialysis
Peritoneal membranes serve as the semipermeable membrane
Catheter with entry and exit points is implanted into the peritoneal cavity
Dialyzing fluid is instilled into a cavity
Dialysate is drained from cavity via gravity into container
65
Peritoneal dialysis requires what
More time
Loose clothing to fit the fluid bag
May be done at night (during sleep) or while patient is ambulatory
Usually done at outpatient basis
66
Major complication of peritoneal dialysis
Infection resulting in peritonitis
67
Why Is caution required with drugs when doing either type of dialysis
Toxic level buildup can occur
68
Why are UTIs more common in women and older men
Women: short urethra, close to butthole
| Older men: prostatic hypertrophy, urine retention
69
Common predisposing factors of UTI
Incontinence, retention, direct contamination with fecal matter
70
Is urine a good growth medium for bacteria?
Yes
71
Lower urinary tract infections are called
Cystitis
| Urethritis
72
Upper UTI name
Pyelonephritis
73
Common causative UTI organisms
E. Coli
74
Cystitis and urethritis is inflammation of what
```
Cystitis = bladder wall
Urethritis = urethra
```
75
Cystitis and Urethritis: cause
Hyperactive bladder and reduced capacity
76
Cystitis and Urethritis: common local signs
```
Pain in pelvic area
Dysuria
Urgency
Frequency
Nocturnal
```
77
Cystitis and Urethritis: systemic signs
Fever, malaise, nausea, leukocytosis
78
Cystitis and Urethritis: urine
Cloudy unusual odor
79
Cystitis and Urethritis: urinalysis indicated what
Bacteriurea, pyuria, microscopic hematuria
80
Pyelonephritis: what?
One or both kidneys involved - from ureter to kidney
Purple to exudate fills pelvis and calyces
81
Pyelonephritis: recurrent / chronic infection can lead to scar tissue formation - what results from this?
Loss of tubule function
Obstruction and collection of filtrate —> hydronephrosis
Eventual chronic renal failure is untreated
82
Pyelonephritis: signs of cystitis plus pain can be associated with renal disease - s/s of this
Dull, aching pain in lower back or flaunt area
83
Pyelonephritis: systemic signs
High tempuruate
84
Pyelonephritis: urinalysis indicates what
Similar to cystitis
| Urinary casts are present - reflection of renal tubule involvement
85
Treatment of UTIs
Antibacterial
| ? There is a long list on slide 26, not sure if I need to know all of these ?
86
Inflammatory disorder (Glomerulonephritis): types
Many forms
87
Inflammatory disorder (Glomerulonephritis): presence of antistreptococcal (ASO) antibodies —— what does this do?
Formation of antigen-antibody complex
Activates compliment system
Inflammatory response in glomeruli
Increased capillary permeability
88
Inflammatory disorder (Glomerulonephritis): inflammatory response
Congestion and cell proliferation
| Decreased GFR - retention of fluid and waste
89
Inflammatory disorder (Glomerulonephritis): urine
Dark and cloudy
90
Inflammatory disorder (Glomerulonephritis): edema
Starts with facial and periorbital edema - general edema follows
91
Inflammatory disorder (Glomerulonephritis): elevated BP why
Increased renin secretion and decreased GFR
92
Inflammatory disorder (Glomerulonephritis): flank or back pain, why
Edema and stretching of renal capsule
93
Inflammatory disorder (Glomerulonephritis): signs / symptoms
General signs of inflammation and decreased UOP
94
Inflammatory disorder (Glomerulonephritis): blood tests reveal what
Elevated serum urea and creatinine levels
Elevation of anti-DNase B, streptococcal antibodies, antistreptolysin, antistreptokinase
Complement levels decreased (use in renal inflammation)
95
Inflammatory disorder (Glomerulonephritis): how does it effect pH
Metabolic acidosis
96
Inflammatory disorder (Glomerulonephritis): urinalysis shows
Proteinuria, hematuria, erythrocyte casts
| No evidence of infection
97
Inflammatory disorder (Glomerulonephritis): treatment
Na+ restriction
Protein and fluid intake decreased (if severe)
Glucocorticoids (lower inflammation)
Antihypertensives
98
Nephrotic syndrome
Abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate
99
Nephrotic Syndrome: cause
May be idiopathic in children 2-6 years
Secondary to SLE
Exposure to nephrotoxins or drugs
100
Nephrotic Syndrome: patho
Hypoalbuminemia with decreased plasma osmotic pressure
º subsequent generalized edema
BP remains low or normal
º may be elevated depending on angiotensin II levels
Increased aldosterone secretion in response to reduced blood levels
º more edema
High blood cholesterol, lipoprotein in urine, lipiduria with milky appearance to urine
101
Nephrotic Syndrome: s/s
Proteinuria, lipiduria, cast
Massive edema
Sudden increase in girth
102
Nephrotic Syndrome: treatment
Glucocorticoids (lessen inflammation)
ACE inhibitors
Antihypertensives
Restrict Na+ intake
103
What are examples of urinary tract obstructions
Urolithiasis
Hydronephrosis
Tumors
104
Urolithiasis (Calculi)
Can develop anywhere in urinary tract
| Kidney stones - small or large
105
Urolithiasis (Calculi): tends to form with
Excessive amounts of solutes in filtrate
Insufficient fluid intake
UTI
106
Urolithiasis (Calculi): manifestations only occur what?
With obstructed urine flow
- lead to infection
- hydronephrosis with dilation of calyces
- if located in kidney or ureter and atrophy of renal tissue
107
Urolithiasis (Calculi): calculi composed of calcium salts, meaning what
High urine calcium levels
| Form readily with highly alkaline urine
108
Urolithiasis (Calculi): uric acid stones —> hyperuricemia
Gout, high-purine diets, cancer chemo
Especially with acidic urine
I think this is asking for what causes hyperuricemia
109
What are the types of Urolithiasis (Calculi)
Uric acid stones
Struvite stones
Cystine stones
110
Urolithiasis (Calculi): stone formation depends on what
Predisposing factor
111
Urolithiasis (Calculi): s/s of stones in kidney or bladder
Often asymptomatic
- frequent infection may lead to investigation
- flank pain possible causde by distention of renal capsule
112
Urolithiasis (Calculi): s/s —> renal colic
Caused by obstruction of ureter
- spasms and flank pain radiation into groin until the stone passes or is removed
N/v, cool moist skin, rapid pulse
Radiologic examination confirms location of calculi
113
Urolithiasis (Calculi): treatment
```
Small stones eventually pass
Extracorporeal shock wave lithotripsy (ESWL)
Laser lithotripsy
Drugs to partial dissolve stones
Surgery
```
114
Urolithiasis (Calculi): prevention
Treatment of underlying condition
Adjustment of urine pH through dietary modifications
Consistent increased fluid intake
115
Hydronephrosis: what
Secondary condition caused by:
- complication of calculi
- tumors, scar tissue in kidney / ureter
- untreated prostatic enlargement
116
Hydronephrosis: s/s
Asymptomatic in early stages
117
Hydronephrosis: diagnosis
Ultrasounds, radionucleotide imaging, ct or renal scan
118
Hydronephrosis: what happens is cause not removed
Chronic renal failure
119
Renal cell carcinoma: where
Tumor arising from tubule epithelium - more often in renal complex
120
Renal cell carcinoma: s/s
Symptomatic in early stages
121
Renal cell carcinoma: where does it metastasize
Liver, lung, bone or CNS at time of diagnosis
122
Renal cell carcinoma: population
Men and smokers
123
Renal cell carcinoma: treatment
Removal of kidney
Immunotherapy
Radioresistant and chemo is not used in most cases
124
Renal cell carcinoma: manifestations
Painless hematuria (gross or microscopic)
Dull, aching flank pain
Palpable mass
Weight loss
Anemia or erythrocytosis
Paraneoplastic syndromes (hypercalcemia or Cushing’s syndrome)
125
Bladder cancer: where
Most are malignant and commonly arise from transitional epithelium of bladder
- often develop as multiple tumors
126
Bladder cancer: diagnosis
Urine cytology and biopsy
127
Bladder cancer: early signs
Hematuria, dysuria
| Infection
128
Bladder cancer: explain how these tumors are invasive through wall to adjacent structures
Metastasize to pelvic lymph nodes, liver and bone
129
Bladder cancer: predisposing factors
Working with chemicals (anilines, dyes, rubber, aluminum)
Cig smoking
Recurrent infections
Heavy intake of analgesics
130
Bladder cancer: treatment
Surgery removal of tumor
Chemo and radiation
Photoradiation in early cases
131
Vascular disorders (nephrosclerosis): involves what
Vascular changes in kidneys
| - some occur normally with aging
132
Vascular disorders (nephrosclerosis): patho
Thickening and hardening of walls of arterioles and small arteries in kidneys
133
Vascular disorders (nephrosclerosis): narrowing of blood vessel lumen has what effects
1. Loss of blood supply to kidneys
2. Stimulation of renin
3. Increased BP
4. Ischemia
5. Destruction of renal tissue
6. Chronic renal failure
134
Vascular disorders (nephrosclerosis): can be primary or secondary, how?
Can be primary lesion developed in kidney
| May be secondary to essential hypertension
135
Vascular disorders (nephrosclerosis): treatment
Antihypertensives agents
Diuretics
Beta blockers
Sodium intake should be reduced
136
Congenital kidney disorders: vesicoureteral reflux
Not in slides, look it up
137
Congenital kidney disorders: agenesis
Failure of one kidney to develop
138
Congenital kidney disorders: ectopic kidney
Kidney and ureter not in normal position
139
Congenital kidney disorders: “horseshoe” kidney
Fusion of 2 kidneys
140
Congenital kidney disorders: hypoplasia
Failure to develop to normal size
141
Adult polycystic kidney: what
Autosomal dominant gene on chromosome 16
| - no indications in child and young adults
142
Adult polycystic kidney: when do manifestations begin
Around 40 years
143
Adult polycystic kidney: multiple cysts develop in both kidneys leading to what
Enlarged kidneys
Compression and destruction of kidney tissue
Chronic renal failure
144
Adult polycystic kidney: diagnosis
Abdominal CT or MRI
145
Wilms’ Tumor: what
Most common tumor in children
Defects in tumor suppressor genes on chromosome 11
- may occur WITH other congenital disorders
146
Wilms’ Tumor: usually what
Unilateral
| - large encapsulated mass
147
Wilms’ Tumor: what may be present at diagnosis
Pulmonary metastasese
148
Acute renal failure: causes
1. Acute bilateral kidney diseases
2. circulatory shock or heart failure
3. Nephrotoxins
4. Mechanical obstruction
149
Acute renal failure: onset
Sudden
| Hence “acute”
150
Acute renal failure: blood tests show what
Elevated serum urea nitrogen and creatinine levels
Metabolic acidosis
Hyperkalemia
151
Acute renal failure: treatment
Fix primary problem to minimize risk of necrosis and permanent damage
Dialysis to normalize body fluids and maintain homeostasis
152
Chronic renal failure: what
Gradual irreversible destruction of the kidneys over a long period of time
153
Chronic renal failure: s/s
Asymptomatic in early stages
154
Chronic renal failure: may result from
Chronic kidney disease
Congenital polycystic kidney disease
Systemic disorders
Low-level exposure to nephrotoxins over sustained period of time
155
Chronic renal failure: stages
Decreased renal reserve
Renal insufficiency
End-stage renal failure
156
Chronic renal failure: decreased renal reserve
1. Decrease in GRF
2. Higher than normal serum creatinine levels
3. No apparent clinical symptoms
157
Chronic renal failure: Renal insufficiency
1. Decreased GFR to about 20% of normal
2. Significant retention of nitrogen wastes
3. Excretion of large volumes of dilute urine
4. Decreased erythropoiesis
5. Elevated BP
158
Chronic renal failure: end-stage renal failure
1. Negligible GFR
2. Fluid, electrolytes and wastes retained in body
3. Anemia’s
4. All body effected
5. Oliguria or Anuria
6. Dialysis or kidney transplantation
159
Chronic renal failure early signs and complete failure
Slide 51
160
Chronic renal failure: diagnostic tests
Metabolic acidosis becomes decompensated
Azotemia
Anemia becomes severe
Serum electrolytes may vary depending on the amount of water retained in the body. Usually hyponatremia and hyperkalemia occur, as well as hypocalcemia and hyperphosphatemia
161
Chronic renal failure: treatment
```
Drugs to stimulate erythropoeisis
Drugs to treat CV issues
Fluid restriction
Dialysis
Transplant
```
