Renal

Question 1

what is the primary function of the renal system

Answer 1

• maintain body water balance
• remove metabolic waste

Question 2

describe the location of the kidney

Answer 2

retroperitoneal
vertebrae T12-L3

Question 3

can the kidneys move with respiration

Answer 3

yes up to 4cm

Question 4

can kidneys be bumpy

Answer 4

yes, can be of embryological origin

Question 5

how is the kidney protected

Answer 5

ribs, however a fracture can damage them

Question 6

is one kidney smaller than the other

Answer 6

not necessarily, sometimes it looks like that on imaging

Question 7

how are kidneys investigated

Answer 7

CT, ultrasound to measure size

Question 8

what muscle causes the kidneys to rotate/tilt

Answer 8

psoas major (it’s balanced on this muscle)

Question 9

what is the renal fascia

Answer 9

a sheet fused to the peritoneum that looks to limit the movement of the kidney

Question 10

what is the renal capsule

Answer 10

a layer of renal tissue that limits the volume of the kidney

Question 11

what does fat look like on a kidney CT

Answer 11

black area around kidneys

Question 12

what is the kidney divided into

Answer 12

cortex (outside)
medulla (inside)

Question 13

how many pyramids to kidneys have

Answer 13

8-18

Question 14

where does the pyramid empty into

Answer 14

minor calyx –> major calyx –> renal pelvis –> ureter

Question 15

where are the constriction points / where stones might lodge in the ureter

Answer 15

• ureteropelvic junction
• brim of pelvis
• ureterovesicular junction

Question 16

what is the main cause of pain from kidney stones

Answer 16

peristaltic action from muscle contraction

Question 17

how is bladder rupture diagnosed

Answer 17

radio-opaque imaging

Question 18

what is micturition

Answer 18

expulsion of urine from the body by relaxation of internal & external sphincters, and contraction of the bladder wall

Question 19

where does most glomerular filtration occur

Answer 19

in the cortex

Question 20

what is the process of blood filtration in glomerular filtration

Answer 20

glomerulus –> Bowman’s capsule –> loop of henle –> collecting ducts

Question 21

what is a fenestrated capillary

Answer 21

a capillary with small holes to filter urine

Question 22

how is renal function measured

Answer 22

GFR = glomerular filtration rate = volume of fluid filtered from the glomerulus into the glomerular capsule = serum creatinine concentration

more creatinine = worse renal function because it’s not being filtered

Question 23

why do we try to avoid contrast studies

Answer 23

they can damage kidneys if a patient has impaired renal function

Question 24

how is renovascular disease investigated

Answer 24

CT with contrast dye or angiography

Question 25

name the phases of kidney at different time points

Answer 25

blood in arterial system/ medulla --> into pyramid --> into renal pelvis

Question 26

how long is the corticomedullary phase & what does it indicate

Answer 26

25-80 seconds delayed renal function

Question 27

how long is the nephrographic phase & what does it indicate

Answer 27

85 - 120 sec delayed renal function

Question 28

how long is the excretory phase & what does it indicate

Answer 28

3-5 min after delayed function & structure

Question 29

what is, and what is the purpose of urethrography and cystography

Answer 29

ureth = dye injected into urethra cysto = dye injected into bladder used to visualise blockages that lead to symptoms in patients e.g. trouble urinating

Question 30

is it possible to have severe reactions to contrast media

Answer 30

yes

Question 31

what are severe reactions to contrast media

Answer 31

decr. BP, shock, pulmonary oedema, anaphylaxis nephrotoxicity incr. with dehydration and preexisting low GFR

Question 32

what is an ectopic kidney

Answer 32

doesn't ascend from pelvis during development

Question 33

what is a horeshoe kidney

Answer 33

shape

Question 34

what is a double ureter

Answer 34

a kidney with 2 ureters

Question 35

what are symptoms of urinary tract disease

Answer 35

haematuria flank pain renal failure infection

Question 36

what is haematuria & how is it diagnosed

Answer 36

blood in urine from malignancy, trauma, urolithiasis (stones) CT urography

Question 37

what is urolithiasis & how is it diagnosed

Answer 37

stones from high urinary mineral concentrations, ph etc CT/ultrasound

Question 38

what a renal cysts

Answer 38

balls of fluid - benign or malignant more complex e.g. more tissues and blood supply is grade > 1 and requires investigation

Question 39

what % of renal tumours are malignant

Answer 39

90%

Question 40

how do you differentiate renal cysts and masses

Answer 40

enhancement media (tumours will be more enhanced due to blood supply)

Question 41

what is hydronephrosis

Answer 41

Dilation of the renal pelvis and calyces due to blockage that includes excess fluid in the kidneys from the inability to urinate congenital abnormality or outflow obstruction by calculi or prostatic hyperplasia or carcinoma (older adults)

Question 42

what causes renal infections & where can they ascend

Answer 42

intestinal flora, woman are more at risk due to shorter wider urethra they can ascend the tract from the bladder to the kidney

Question 43

what is pyelonephritis

Answer 43

infection of kidney

Question 44

how is renal trauma imaged

Answer 44

contrast enhanced CT

Question 45

what is renal failure

Answer 45

failure of the urinary tract to produce normal amounts of urine

Question 46

what is CKD & its symptoms

Answer 46

chronic kidney disease resulting in bilateral small kidney usually asymptomatic, so by the time it's found there is irreversible damage to kidneys and loss of function

Question 47

what is acute kidney injury and it's causes & prognosis

Answer 47

sudden loss of renal function that develops over a few days often reversible with no damage caused by impaired or decreased blood flow, intrinsic renal change, obstruction e.g. pre renal, renal, post renal

Question 48

what are the affects of CKD

Answer 48

incr. Ca, phosphate, decr. vitamin D = decr. bone strength = fracture = soft tissue calcification = cardiovascular disease