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Genitourinary system and urinalysis Flashcards

(52 cards)

1
Q

When obtaining a urine sample, why is important to get a midstream sample of urine (MSSU)

A

Some bacteria found on hand, skin and around urethra which can form part of the early urine. Hence not represetiave of real urine from kidney. MSSU is needed

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2
Q

How does creatinine change from bowman’s capsule to Collecting duct?

A

Freely filtered, Not reabsorbed. However, some is secreted so it will increase slightly

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3
Q

What could the following found in urine suggest:

  1. leukocyte
  2. Nitrite
  3. Ketones
  4. Bilirubin
  5. very dilute urine
A
  1. Leukocyte - URINARY TRACT INFECTION
  2. Nitrite - Bacteria in significant numbers especially Gram negative rods like E.coli
  3. Ketones- Calorei deprivation, starvation, fasting, diabetic ketoacidosis or aspirin poisoning
  4. Biirubin- Cirrhosis, gallstones, hepatitis or tumours of the liver or gall bladder
  5. Very dilute urine- Diabetes incipitus or Chronic renal disease
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4
Q

What could the following substances found in urine suggest:

  1. Glucose
  2. Protein
  3. blood
  4. Urobilinogen
A

Glucose- Diabetes Mellitus (or renal glycosuria if blood glucose conc is normal)

Protein- Glomerular damage. If in large amount, it could suggest nephrotic syndrome

Blood- Glomeruloephritis, kidney stones, tumours, infections

Urobilinogen- Haemolysis, cirrhosis or hepatitis

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5
Q

Why should immediately replace the lid on urine dip stick test strips container

A

Prevent airborne contamination

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6
Q

Why does urine appear yellow or white

A

Urobilin gives urine it’s yellow colour. If urine is concentrated it’ll look mor eye low. If urine is pale/white, there’s a lot mor water in urine

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7
Q

What does normal urine look like? What’s the significance

A

Pale yellow . No strong smell

if it’s red, it could mean blood. If it’s too white, maybe it’s diabetes incipidus or the person takes too much water

if it smells TOO strongly, it could be UTIs/etc

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8
Q

What could cause low specific gravity of urine . Normal and abnormal

A

Abnormal

  • Diabetes incipidus
  • Pyeloneprhritis

normal

  • excessive fluid intake
  • use of diuretics
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9
Q

How does inulin, water, sodium and glcuose in filtrate change as filtrate moves from bowmans capsule to collecting duct.

start at 100%

A
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10
Q

Look at this test strip

when (time) should you check leukocyte and specific gravity

A

Leukocyte - 2 min

Specifc gravity- 45s

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11
Q

What are the functions of the kidney

A

Excretion of metabolic products like urea, Uric acid

Excretion of foreign substances

regulation of body fluids, electrolyte and acid base balance

control of blood pressure

secretes hormones like erythropoietin and renin

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12
Q

LABEL this structure

A
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13
Q

Descirbe the blood flow in kidneys. What vessels does it flow and in what order

A
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14
Q

Label the following

A
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15
Q

What is the function of the Detrusor muscle and Trigone

A

Destrusor msucle- Contracts to build pressure in the urinary bladder to support urination

Trigone- this triangular region stretches to limit Brain signals about need to urinate

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16
Q

What’s the function of the internal and external sphincter. Contrast them

A

Internal sphincter- Involuntray control to prevent urination

External sphincter- Voluntary control to prevent urination

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17
Q

What’s the fucntion of the Bulbourethral gland?

A

This produces thick lubricant which is added to watery semen to promote sperm survival

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18
Q

LABEL this diagram

A
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19
Q

What are the parts of the loop of Henle

A

Thin descending limb

Thin ascending limb to

Thick ascending limb

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20
Q

What happens in the PCT and what does their epithelial cell contain?

A

Contains lots of mitochondria - proved energy for Na+/k+ ATPase

majority of water, Na+ and Cl- reabsorbed

solutes reabsorbed

all glucose reabsorbed

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21
Q

Contrast the epithelial cell content of the thick ascending limb and thin ascending and descending limb

A

Thick ascending limb- epithelial cells have lots of mitochondria

Thin ascending and thin descending limb- epithelial cells have low density of mitochondria

22
Q

Why does the cortex look granular and medulla has striated appearance

A

Medulla has lots of tubules (collecting duct draining and going down into ureter)

cortex has glomeruli

23
Q

What are the 2 different types of nephrons and mention their relative abundance

A

Surpeficial nephron

Jutamedullary nephrons- inside to inner medulla

Ratio of superficial to juxtamedullary is 10:1

24
Q

What are the constituents of the Juxtaglomerular apparatus and relate to their functions.

draw them in relation to each other

A

Macula densa cells in DCT- they regulate GFR through tubule-glomerular feedback mechanism

Extraglomerular mesangial cells

Juxtaglomerular cells (Afferent arteriole)- they secrete renin for regulating BP

25
What are 4 renal processes that substances can undergo in the kidney
Glomerular filteration Reabsorption back into the blood Secreted from blood into tubular fluid excreted Different substance undergo different combination of these renal processes
26
Extensively describe the glomerular endothelial. Draw if possible. What substances can pass through which gap.
27
What factors drives glomerular filtration
**Passive process**: fluid pass through semi permeable capillary into bowmans capsule by hydrostatic pressure of the heart **Filteration barrier**: only permeable to fluids and small solutes and impermeable to cells and proteins
28
What are the participating pressures in glomerular filtration. What causes each
**Hydrostatic pressure** in blood AND interstitial fluid: *Fluid* exerts this pressure and **both solute and fluid are pushed out** Oncotic pressure in blood AND interstitial fluid: Solutes (proteins) exert this pressure. Only fluid **drawn in** across semi permeable membrane N:B. Oncotic pressure in tubular fluid is low
29
What is the equation for the Net ultrafiltration pressure (Puf)
Puf = HPgc - HPbw - πgc where π= Oncotic pressure in glomerular capillaries
30
What is the equation that links GFR to Net ultrafiltration pressure. Describe what affects any of the variables
GFR= Puf x Kf Kf is an ultrafiltration coefficient (depending on **membrane permeability** and **surface area** available for filtration ) any changes in Puf or K will result in GFR imbalances
31
What is the normal range of GFR for a healthy male and female. What does a fall in GFR signify
MALE- 90-140mL/min Females- 80-125mL/min A fall in GFR is the cardinal fetaure of renal disease with a build up of excretory products in the plasma
32
Describe the myogenic mechanism of regulating GFR
Arterial pressures rises Afferent arterioles stretch; this is detected and hence local signals causes Arteriole to contract vessel resistance increases Blood flow decreases GFR stays the same
33
Describe the Tubulo-glomerular feedback mechanism of regulating GFR
Increased GFR leads to Increads NaCl in loop of Henle Macula densa cells detects this change and then increase ATP and adenosine discharge Afferent arteriole constricts and GFR stabilises
34
What is Renal clearance (C) and whats the formulae
The amount of plasma in litres that has been cleared of a particular substance per unit time GFR can be calculated using this concept.
35
What are the conditions for which GFR equals renal clearance of the molecule
If the molecule is freely filtered and neither reabsorbed nor secreted in the nephrons. I.e the amount filtered is the equal to the amount excreted
36
What is the ideal molecule used for measuring GFR (by renal clearance). Give merits and problems
**Inulin-** plant polysaccharide Merits * Not toxic * Meaurable in urine and plasma * freely filtered and neither reabsorbed nor secreted Problems * Not founds in mammals so needs to be infused. Hence not comfortable for patient.
37
What is the commonly used substance used to measure GFR (via renal clearance)
Creaitnine- waste product form creatine in msucle metabolism Merits * amount of creatinine released is fairly constant * if renal function is stable, Creaitnine amount in urine is stable * Low **creatinine** clearance or **high plasma creatine** may indicate renal failure problems * Although freely filtered and not reabsorbed. A tiny amount is secreted into nephron. Not perfect N.B The process of estimations creaitnine in blood and urine can account for that to allow for GFR calculations
38
What substance is used to calculate renal plasma flow? Why
**Para aminohippurate (PAH)** This is because **all PAH** is removed from the plasma passing through the kidney through filtration and secretion
39
What is the equation for filtration fraction. What is the normal range
FF= GFR/ Renal plasma flow Normal range is 0.15-0.20
40
What are the renal tubules transport mechanisms?
Passive transport Active transport
41
Describe PASSIVE transport
Osmosis and diffusion Electrochemical gradient
42
What are the different types of Active transport
Primary active * via Na+/K+ ATPase * Endocytosis secondary acitve/coupled transport * symport * Antiport
43
What are the **different** ways in which substances can move form tubular fluid to blood and vice versa draw it with the best lowest resolution possible
44
Draw out the process of sodium and Bicarobnate reabsorption in PCT. What substance can influence this process and how?
Angiotensin II regulates Na+ reabsorption by increasing Na+ H+ antiporters
45
Draw the process of how glucose is reabsorbed in the PCT
N.B. Most (60-70%) of the substances are reabsorbed in PCT
46
What are the substances reabsorbed and secreted in the PCT. give %
Reabsorbed: * Na+, Cl- and water all 67% * HCO3-, 90% * 100% glucose AND amino acids * 50% UREA Secreted: Drugs, ammonia, bile salts, prostaglandins, vitamins (folate and ascorbate)
47
Summarise the whole of reabsorption in the loop of Henle. DRAW
Substances absorbed : 25% Na+ and Cl-. 15% water. Changes in osmolarity between ascending limb and collecting duct is what causes water conservation
48
Outline the Na+ and Cl- reabsorption in early DCT
49
Outline the process if active Ca2+ reabsorption in early DCT
50
In the distal DCT and collecting duct, what substances move via **principal** cells. Describe it by drawing it out what hormones affect this cells and how
Na+ reabsorption and K+ secretion Water reabsorption Hormones: * ALDOSTERONE: regulates Na+ reabsroption by increasing apical Na+ channels and basolateral Na+ K+ ATPase pumps * ADH: regulates water reabsorption by increasing APICAL aquaporins
51
In distal PCT and collecting duct what is the purpose of the intercalated cells and how do they achieve this?
Maintaining acid base balances alpha intercalated: this carries out HCO3- reabsorption and H+ secretion beta intercalated: this carries out HCO3- secretion and H+ reabsorption
52
What are the 2 cells in collecting duct? Describe their MORPHOLOGICAL differences
Principal cells- low in mitochondria iNTERCALATED- rich in MITOCHONDRIA