Day 11 5/28/15 Flashcards Preview

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Flashcards in Day 11 5/28/15 Deck (14):
1

Two Primary Functions of the Bladder

1. storage phase
2. emptying/voiding/micturition phase

2

Parasympathetic Innervation of the Lower Urinary Tract

-innervate detrusor muscle; activation results in dtrusor muscle contaction and micturition
-S2-S4
-autonomic

3

Sympathetic Innervation of the Lower Urinary Tract

-inhibits detrusor contraction and inc. tension in the smooth muscle of bladder neck and urethra, preventing micturition
-T10-L2
autonomic

4

Motor Innervation of the Lower Urinary Tract

-bladder, pelvic floor, and urethral sphincter arise from segments S2-S4 of spinal cord

5

Steps of Micturition Cycle

1) Increase in wall tension in the bladder
2) Afferent input overcomes the pontine micturition center
threshold and provides cortical egress micturition begins
3) Pudendal nerve activity ceases, the external sphincter/pelvic floor relaxes, detrusor neurons are freed and discharge
4) Proximal urethra opens
5) Bladder immediately contracts

6

Types of Incontinence

-stress incontinence: involuntary, sudden loss of urine during inc. in intra-abdominal pressure (more common in women)
-urge incontinence: urgency, with or without incontinence, usually with frequency and nocturia (more common in men)

7

Common Causes of Lower Urinary Tract Obstruction in Men

-benign prostatic hyperplasia
-urethral stricture
-cancer

8

Indications for Starting Dialysis

• Dialysis is typically initiated when the risks of uremic complications exceed the risks of dialysis therapy
• Possible indications for dialysis include:
– Volume overload refractory to diuretics
– Hyperkalemia refractory to medical therapy
– Uremic pericarditis
– Uremic symptoms
– Other metabolic derangements (metabolic acidosis, severe hyperphosphatemia, calcium abnormalities)

9

Modalities of Dialysis

-hemodialysis
-peritoneal dialysis

10

Types of Vascular Access for Hemodialysis

-AV fistula (best)
-AV graft
-dialysis catheter

11

Effect of HLA System in Human Kidney Transplantation

• Unless donor/recipient are HLA identical, recipient T cells will recognize foreign donor HLA antigens as “non-self” and mount a response (rejection).

12

2 Types of Transplant Rejection

1) Cellular (T-cell mediated)
• T cells within tubular basement
membranes
• Treatment: IV steroids, anti
thymocyte globulin (thymoglobulin)

2) Antibody (B-cell mediated)
• Complement activation in peri-
tubular capillaries
• Treatment: remove antibodies
(plasmapheresis), inhibit antibody production (IVIG, rituximab)

13

Immunosuppressive Agents Used in Kidney Transplant

1. calcineurin inhibitor: cyclosporine, tacrolimus
-nephrotoxicity, HTN, diabetes

2. proliferation inhibitor: MMP, sirolimus
-cytopenias, GI toxicity

3. predisone
-wieght gain, HTN, diabetes, hyperlipidemia, bone loss, cataracts

14

Differential Dx of Transplant AKI

-prerenal: volume depletion, hypotension, renal artery thrombosis, CNI effects

-renal: delayed graft function, acute rejection, recurrent primary kidney disease, infection

-post renal: obstruction