Urinary Flashcards

Question

What are the 4 neurohumoral resonses controlling BP?

Answer 1

- RAAS - SNS - ADH - ANP

Answer 2

- reduced NaCl reaching distal tubule - reduced perfusion pressure - SNS stimulation to JGA

Answer 3

By granular cells of JGA in kidney.

Answer 4

- arteriorlar vasoconstriction - Stimulates SNS - increase thirst via increasing ADH - acts on kidney directly to increas NaCl reabsorption - acts indirectly on kidney via stimulation of aldosterone release, which increase Na+ reabsorption

Answer 5

If a substance is completely cleared from the plasma filtered i.e. all filtered is excreted, with no reabsorption or secretion, then its clearance rate is equal to GFR. Clearance rate= concentration of substance in urine x urine flow rate / concentration in plasma. Inulin clearance rate can be used, aswell as creatinine, even though some creatinine is secreted by organic cation secretory system in PT, as there is also a 10% error in measuring creatinine conc. in plasma.

Answer 6

a polypeptide hormone released by the parafollicular cells of the thyroid gland located in the base of the neck, anterior to the lower larynx and the upper trachea, which may help to preserve the maternal skeleton during pregnancy.

Answer 7

The plasma concentration of a substance at which the transport maximum is reached and the substance 1st starts to appear in the urine.

Answer 8

Solute and water reabsorption are proportional to each other.

Answer 9

Changes in plasma osmolarity

Answer 10

Primary action: increase permeability of CD to water, hence conserve water in the body by reducing loss in urine. Further actions: - increase NaCL reabsorption at ATL, distal tubule and cortical part of CD. -vasoconstriction at glomerulus reducing effective filtering SA. -H20 reabsorption at late distal tubule -K+ secretion in cortical CD -Increases permeability of medullary CD to urea, which adds to corticopapillary gradient maintained by vasa recta.

Answer 11

Name- V2 receptors which are GPCRs on basolateral membrane- binding of ADH to receptor activated a G protein-Gs-heterotrimeric structure, splits apart into its 3 subunits as GDP-GTP exchange, adenylyl cyclase then activated, increasing cAMP, activates PKA, resulting in AQP-2 channels being inserted into apical membrane.

Answer 12

Diluting segment- ions reabsorbed from filtrate without water reabsorption, so filtrate diluted.

Answer 13

Blood flows in the opposite direction in the vasa recta, to the tubular fluid in the nephron, so the descending vasa recta passes down through the hyper-osmotic interstitium, causing the blood to become very concentrated and so this blood is able to reabsorb water as it leaves the thin descending limb, drawn out by the increasing concentration of the interstitium, and as blood flow through the ascending vasa recta is towards the cortex, the reabsorbed water from the DTL is taken away from the concentrated middle of the kidney, so concentration gradient preserved.

Answer 14

Respiratory acidosis and alkalosis- primary disorders of CO2 handling by lungs. Metabolic acidosis and alkalosis- primary disorders of plasma HCO3- levels.

Answer 15

Buffers e.g. protiens-Hb in red cells, and phosphates. | Prinicpal ECF buffer= HCO3-

Answer 16

Volatile: pH decreases eventhough plasma HCO3- increases as CO2 reacts with water. Non-volatile: H+ buffered by HCO3-, so plasma HCO3- levels fall and pH falls.

Answer 17

Lung- minutes | Kidney- days

Answer 18

The difference between the sum of the measured concentrations of Na+ and K+ ions and sum of measured concentrations of Cl- and HCO3- ions.

Answer 19

High pCO2 in arterial blood and low pH. Usually caused by Hypoventilation but may result from CNS disorder- reducing ventilatory drive, air pump disorder- diseases affecting muscles of inspiration e.g. myasthenia gravis, processes that interfere with GE e.g. COPD.

Answer 20

Kidneys compensate by increasing HCO3- concentration, achieved by secreting more H+ and NH3 production.

Answer 21

Low pCO2 and high pH, always result of hyperventilation. This may occur with increased ventilatory drive or hypoxaemia.

Answer 22

Decrease [HCO3-] in plasma and low arterial pH. Can be compensated for by increase in ventilation to transfer volatile acid to atmosphere, and plasma HCO3- falls further.

Answer 23

Elevated [HCO3-] and arterial pH. May be caused by vomiting or diuretics. Compensation by reducing ventilation but this could lead to hypoxia. If patient is alkalotic due to vomiting, you want to correct fluid and electrolyte imbalance, and then patient can correct their condition with increased [HCO3-] excretion.

Answer 24

Kidney parenchyma: inner medulla and outer cortex. Cortex surrounded by fibrous capsule, perinephric fat, renal fascia, and paranephric fat. Anterior and post. parts of renal fascia don't meet - clinical significance.

Answer 25

Traction of SMA or abdominal aortic aneurysm.

Answer 26

Ureter- white cord, if prodded- peristaltic movement rather than pulsatile.

Answer 27

Ascending and descending arteries from renal, gonadal, common iliac, vesicular and uterine.

Answer 28

2 ureteral orifices at top of triangle and internal urethral meatus at bottom.

Answer 29

Macula densa cells of DCT, granular cells in afferenct arteriole and extraglomerular mesangial cells which have a supportive function.

Answer 30

Loop of Henle

Answer 31

Amount of solute filtered from arterial plasma into Bowman's capsule per unit time (so plasma conc x GFR)

Answer 32

Arise at pelviureteric junction and descend towards the bladder, passing over the transverse processes of the vertebrae and crossing the pelvic brim at the bifurcation of the common iliac arteries. They swing out laterally, before passing anteriorly and medially into the bladder. Retroperitoneal throughout their course.

Answer 33

Enable polarisation of epithelial cell- ion transporters remain on correct side of cell so that the luminal and basolateral membranes retain different properties.

Answer 34

- Na+pump- genrates Na+ gradient - Gradient used by Na+-H+ exchanger to expel H+ against its conc gradient - H+ reacts with HCO3- in lumen, producing H20 and CO2. - CO2 diffuses into cell and reacts with H20, producing H+ and HCO3-. - H+ recycled through Na+-H+ exchanger - HCO3- exported across basolateral membrane via sodium bicarbonate symporters and Cl--HCO3- antiporters.

Answer 35

ICF has higher volume, and K+ are at a higher concentration here due to action of Na+ pump- moves 3 Na+ out of cell for every 2 K+ moved in Mainly skeletal muscle, also liver, rbc and bone When we measure K+, we are talking about ECF K+- normal concentration= 3.5-5.0 mmol/L

Answer 36

K+ at high concentration inside cells due to Na+-K+-ATPase. K+ can diffuse out of cells, down its concentration gradient, via K+ channels, but Cl- unable to follow as channels not present, so cell is -ve on the inside with respect to the outside

Answer 37

Reduced K+ gradient across cell for K+ outward movement, so membrane depolarise, Na+ channels unable to be reprimed after inactivation, so membrane actually made less excitable.

Answer 38

Insulin promotes Na+/H+ exchange, so more Na+ brought into cell, increasing activity of Na+ pump so more K+ brought into cell. Beta 2 agonists activate Na+ pump, so more K+ brought into cell, reducing plasma concentration. B blockage can therefore increase plasma potassium. So plasma K+ tends to be higher in patients with diabetes.

Answer 39

When H+ enters cells, it displaces K+, as all cell will move ions around to try and control their own pH, so H+ moved out of cell, raising plasma K+ levels.

Answer 40

Promote Na+ pump synthesis, and can therefore cause hypokalemia

Answer 41

Cortical CD-ROMK channels present here, aswell as in ATL of loop of Henle

Answer 42

More Na+ results in increased activity of ENaC channels in CD, generating lumen -ve potential that drives K+ secretion via K+ channels (ROMK). ENaC Na+ reabsorption controlled by aldosterone.

Answer 43

Secretion reduced as ENaC channels inhibited, so less Na+ movement into CD cells, so less of a luminal -ve potential generated for K+ secretion. Also, less Na+ movement into cell will reduce activity of Na+ pump bringing K+ into cell.

Answer 44

Increased activity of Na+ pump on basolateral membrane, so more K+ brought into principal cells of CD, which can then be excreted across apical membrane via K+ channels

Answer 45

Aldosterone release stimulated when increased K+ levels detected in ECF of adrenal cortex.It promotes Na+ pump synthesis in cortical CD, and insertion of more Na+ pumps into basolateral membrane fpr K+ uptake into cell. Also stimulates Na+ and K+ channel activity, increasing Na+ reabsorption and K+ secretion.

Answer 46

Increases apical K+ channel activity and basolateral Na+ activity.

Answer 47

Mg blocks ROMK channels, reducing K+ secretion so if less Mg, inhibitory effect reduced, more K+ secreted and so K+ decreases.

Answer 48

increased as urinary flow rates increased which reduce luminal K+ concentration, so enhance K+ secretion.

Answer 49

antagonises effect of aldosterone

Answer 50

Stress- more catecholamines released- acts via B2 adrenergic receptors which in turn, stimulate Na+ pumps, which stimulates K+ uptake into cell.

Answer 51

Exercise- skeletal muscle contraction, so net release of K+ during recovery phase of AP, increasing plasma [K+] which is proportional to exercise intensity. Uptake of K+ by non-contracting tissues prevents hyperkalemia, inaddition to catecholamine release stimulated by exercise, which stimulates Na+ pump, so more K+ uptaken from plasma.

Answer 52

Hyperkalaemia. Severe trauma, rhabdomyolysis and chemotherapy can all destroy cells and so release K+ into plasma. Also occurs with IV haemolysis e.g. in G6PDD patients treated with primaquine- capacity to defend against ROS insufficient as NADPH defecit from PPP, so anti-oxidant lack and rebc subsequently destroyed.

Answer 53

Increase in plasma and ECF tonicity e.g. diabetic ketoacidosis, means water moves into ECF from cells, so [K+] inside cells increases, and K+ leaves down its concentration gradient, into ECF.

Answer 54

Acidosis cause H+ uptake into cells, resulting in reciprocal shift of K+ out of cells causing hyperkalaemia. Similarly, if hyperkalaemia, K+ will be removed from ECF into cell, and H+ will them move out of cell, causing an acidosis.

Answer 55

K+ is secreted by DT and cortical CD cells (prinicipal cells) but Na+ is only reabsorbed by kidney, not secreted.

Answer 56

Chemical gradient- Na+ pump on basolateral membrane that brings K+ into cell, so favourable concentration gradient for secretion across apical membrane. Electrical- ENaC channels on apical membrane bring Na+ into cell, creating lumen -ve potential, which attracts K+ to move out of cell.

Answer 57

K+ washed away more quickly so always a favourble concentration gradient for K+ to move out of cell and so be secreted.

Answer 58

It inhibits Na+ pump which accumulate K+ inside cells, so more in plasma, and reduces K+ channel permeability.

Answer 59

K+ absorbed actively by intercalated cells using H+-K+-ATPase in apical membrane.

Answer 60

RAAS activated, so increase aldosterone, which increases K+ excretion.

Answer 61

Renal excretion maintains our external balance of K+, so if this can't occur due to renal failure, K+ in ECF will increase.

Answer 62

Bacteria can ascend urethra between voiding, and as urethra shorter in females, infection is commoner.

Answer 63

DT and CD- both determine overall rate of K+ excretion as variable magnitude and direction of K+ transport

Answer 64

- Activity of basolateral Na+-K+-ATPase - Electrochemical gradient (driving force) for movement across apical membrane - Permeability of apical membrane to K+

Answer 65

No net effect on K+ excretion. Decreases tubular flow as more water reabsorbed, so reduces K+ secretion as less of a concentration gradient for K+ diffusion across apical membrane. BUT, also stimulates electrochemical driving force for K+ exit across apical membrane of prinicpal cells as stimulates Na+ reabsoption by prinicpal cells, so urinary K+ excretion maintained constant when fluctuations in H2O excretion.

Answer 66

These drugs are K+ sparing drugs, as they inhibit action of aldosterone which normally increases K+ secretion by increasing expression of Na+ pumps on BL membrane, and Na+ and K+ channels on apical membrane. This is important as hypokalemia can potentiate hepatic encephalopathy which may occur with a cirrhosed liver as the conditon results from a reduced detoxification ability of the liver, resulting in, for example, increased NH3 in systemic circulation, which can go on to damage the brain, so K+ levels need to be maintained.

Answer 67

It is a substance/drug that promotes a diuresis- increased formation of urine by the kidney, as a result of increased renal excretion of water and sodium, causing a reduction in ECF volume.

Answer 68

Competitive inhibition of intra-cellular aldosterone receptors, resulting in reduced Na+ reabsorption via ENaC, so more Na+ retained in filtrate, along with H20?

Answer 69

Inhibit Na+ and HCO3- reabsorption at PT by inhibiting action of carbonic anhydrase, increased HCO3- levels in filtrate oppose H2O reabsorption.

Answer 70

A plasma [K+] of less than 3.5mmol/L

Answer 71

PCT They inhibit NaHCO3 reabsorption, rather than NaCl reabsorption. There is less HCO3- in glomerular filtrate so reduced effect on Na+ reabsorption. Plasma HCO3- levels reduce with chronic drug use as increased urinary excretion, further limiting diuretic potency.

Answer 72

Glaucoma Reduce formation of aq humour. Also used in some unusual types of infantile epilepsy.

Answer 73

They inhibit NCC transporters on apical membrane in DCT, so less Na+ reabsorbed, so less entering cell, so increased concentration gradient for Na+ entering via NCX on basolateral membrane, so NCX stimulated, so more Ca2+ removed from cell into ECF, so more Ca2+ reabsorbed from lumen, reducing calcium stone formation in filtrate.

Answer 74

Filtered in glomerulus then not reasbsorbed, so remains in filtrate, and as H2O reabsorbed, osmolarity of filtrate increases until osmotic effect of mannitol opposes further water reabsorption, so sodium then reabsorbed without water. Na+ reabsorption eventually inhibited as gradient between filtrate and plasma increases to point at which Na+ leaks back into filtrate. Mannitol used to dehydrate brain cells in cerebral oedema. Enhances RBF by increasing EC and IV volume and reducing rc vol. abd blood viscocsity. Urinary concentrating capacity reduced as enhanced blood flow reduces medullary interstitial osmolarity.

Answer 75

All of it! | Na+ pump necessary for tubular reabsorption as generates a Na+ gradient for apical transporters.

Answer 76

They inhibit the Na+-K+-2Cl- co-transporter in apical membrane of ATL cells. Transporter normally results in lumen +ve potential as 1 Na+ reabsorbed with 2 Cl-, which stimualtes Ca2+ reabsorption. As this effect is inhibited, less Ca2+ is reabsorbed from filtrate, so more excreted.

Answer 77

- inhibit Na+ and H20 reabsorption, so increase flow rate of filtrate in lumen, so K+ secreted into lumen washed away faster, maintaining favourable gradient for K+ secretion so more lost. - reduced reabsorption means more Na+ in lumen in late DT and CD, so more Na+ reabsorbed by ENaC, creating lumen -ve potential for K+ secretion. - reduction in ECF vol. stimulates RAAS as reduced perfusion pressure of kidney, so increased aldosterone secretion, which increases Na+ reabsorption and K+ secretion.

Answer 78

A co-transporter that uses secondary AT to transport 2 different ions across PM in opposite directions

Answer 79

If low bacterial counts, evidence of contamination or sterile pyuria.

Answer 80

``` prior antibiotic fastidious organisms urethritis urinary TB appendicitis chemical inflammation vaginal infection/inflammation ```

Answer 81

3 day course of trimethoprim or nitrofurantoin

Answer 82

5 day course of trimethoprim, nitrofurantoin or cephalexin

Answer 83

14 day course of co-amoxiclav, ciprofloxacin or gentamicin

Answer 84

If 3 or more episodes in 1 yr with no treatable underlying condition. Trimethoprim or nitrofurantoin- single nightly dose.

Answer 85

1 L of ECF weighs 1 kg

Answer 86

They increase delivery of tubular fluid to K+ secretory portion of nephron, and increased aldosterone and ADH secondary to diuretic-induced decrease in ECF vol.

Answer 87

Inhibits Na+-Cl- co-transporter in apical membrane of cells lining early part of distal tubule. So more Na+ and H2O excreted in urine, reducing ECF volume, blood volume and CO.

Answer 88

Acts proximal to K+ secretory sites of nephron, increases tubular fluid flow rate to K+-secretory site, so K+ washed away more readily, maintaining concentration gradient for K+ secretion, so more secreted. Also, stimulation of aldosterone and ADH release.

Answer 89

Administer K+ sparing diuretic alongside thiazide. | Increase K+ intake in diet or with KCL tablets.

Answer 90

primary hyperparathyroidism- typically adenomas | haematological and non-haematological malignancies

Answer 91

Kidney stones, depression, abdominal pain, nausea, constipation, anorexia, hypertension, enhanced sensitivity to digoxin, polyuria and polydipsia.

Answer 92

Plasma PTH Plasma calcitriol Bone formation

Answer 93

As amino acid homology with N-terminal of PTH-active portion of PTH

Answer 94

``` Hydration Loop diuretic e.g. furosemide Bisphophonates Calcitonin Treat underlying condition ```

Answer 95

When abdominal pain. If painless, more likely to me malignancy

Answer 96

Chemotherapy- increases uric acid formation due to killing lots of cells Alcohol- competes with urate for excretion by kidney

Answer 97

Calcium (70-80% of stones)

Answer 98

Hypercalcuria- high Ca2+ in urine Reduced urine volume Low urine pH (<5.47) Process involves urine supersaturation with respect to calcium oxalate

Answer 99

Increase fluid itnake- urine output >2L daily, dietary restriction of oxalate and sodium, consider Ca2+ dietary restricition and animal proteins.

Answer 100

Inhibits PT Pi reabsorption, where 80 % Pi reabsorbed, and rest usually excreted, so PTH increases Pi excretion. PTH stimulates endocytic removal of apical transporters.

Answer 101

Increased ECF vol increases excretion as increased GFR and hence filtered load, reducing Na+-Pi coupled reabsorption and reduces plasma Ca2+ so PTH increased which increases excretion.

Answer 102

Acidosis increases excretion- Pi reabsorption inhibited by PT as glucocorticoid secretion. DT and CD can then secrete more H+ as titratable acid and generate more HCO3- as Pi is an important urinary buffer.

Answer 103

Fibroblast GF 23

Answer 104

Lined by transitional epithelium which is able to stretch without tearing to accomodate intraluminal volume increases. Inner longitudinal, middle circular, and outer longitudinal smooth muscle layer in wall which contract to increase intraluminal pressure locally and convey urine to the bladder by peristalsis- wave propagation aided by gap juntions electrically coupling SMCs.

Answer 105

Ureters enter bladder at an oblique angle, creating a valve that prevents ureteral reflux.

Answer 106

In neck of bladder by detrusor muscle and elastic tissue. Controlled by ANS (involuntary)

Answer 107

``` Skeletal muscle (voluntary) Only part of urinary system under voluntary control ```

Answer 108

Pudenal nerve (S2-S4)

Answer 109

SC T11-L2 segements and travel to UT via hypogastric nerve or descend in paravertebral chain and then travel in pelvic nerve.

Answer 110

B2 adrenergic | Relaxation of detrusor muscle, so urine can be stored and isn't emptied.

Answer 111

Constriction of bladder neck and urethra

Answer 112

PSNerves originate from S2-S4 sacral spinal segements, and travel in pelvic nerve to pelvic plexus and bladder wall. Stimulates detrusor muscle contraction, hence voiding, and relaxation of urethra and internal sphincter

Answer 113

All nephron segements except PT

Answer 114

Secretion by prinicipal cells, reabsorption by intercalated cells

Answer 115

As external balance (controlling whole body K+) is maintained by renal excretion.

Answer 116

Anticholinergics- acts on M2 and M3 muscarinic receptors. | Can cause a dry mouth-xerostomia- reduced salivary flow, and constipation- intestinal smooth muscle M3 receptors.

Answer 117

Oxybutynin

Answer 118

Cerebral cortex, to pontine continence or storage centre (L-region- in dorsal part), to sympathetic nuclei in cord, to detrusor muscle and external urethral sphincter motorneurones in sacral cord.

Answer 119

Voiding circuits which arise from: cerebral cortex, Pons (M-region), sacral levels of parasympathetic outflow, detrusor muscle contracts, and external urethral sphincter relaxes.

Answer 120

By altering osmolarity across a semi-permeable barrier

Answer 121

By capillaries invaginating developing tubules

Answer 122

Hypospadias occurs when the urethra opens onto the surface of the inferior penis. It is caused by failure of the urethral folds to fuse properly

Answer 123

Difficulty with micturition, mainly pain

Answer 124

Loin The pain is caused by obstruction to urine flow and subsequent distension and sometimes spasm of the ureters and collecting system upstream of the obstruction

Answer 125

Urinary tract obstruction is detected by ultrasound scanning which can visualise the distension of the collecting system upstream of the obstruction

Answer 126

To alter the volume and composition of filtered fluid

Answer 127

As Na+ is freely filtered. The proportion of Na+ reabsorbed is the same as the proportion of water reabsorbed in the PT, so the osmolarity of the filtrate doesn't change and remains the same as the osmolarity of the plasma, with the osmolarity of the fluid being reabsorbed being equal to the osmolarity of the filtrate, so osmolarity doesn't change, but the volume of filtrate is reduced.

Answer 128

Some proteins have aa side chains that are weak acids or bases

Answer 129

Vasa recta

Answer 130

infection, obstruction or other causes of urinary stasis and metabolic disorders causing high urine levels of stone forming substances or low levels of stone inhibiting substances e.g. citrate

Answer 131

SAD PUCKER suprarenal glands, aorta/IVC, duodenum (2nd and 3rd parts), pancreas, ureters, colon (ascending and descending), kidneys, oesophagus, rectum

Answer 132

Male- 20 cm | female- 4 cm

Answer 133

``` Pre-prostatic= between bladder and prostate Prostatic= passes through prostate Membranous= passes through deep perineal pouch Penile/spongy= passes through corpus spongiosum ```

Answer 134

In vaginal vestibule between anterior ends of labia minora and clitoris

Answer 135

White infarct Renal arteries= functional end arteries- supply sole source of blood to a particular area of kidney so occlusion to a particular artery means insufficient anastomoses to supply blood to the area normally supplied by that artery, hence the blood supply is cut off completely.

Answer 136

Psoas major, quadratus lumborum, transversus abdominis

Answer 137

Specific overflow aminoaciduria Phenylalanine unable to undergo metabolism to produce tyrosine as defective phenylalanine hydroxylase enzyme- autosomal recessive condition. Phenylalanine therefore undergoes metabolism via other pathways, producing phenylpyruvate which inhibits pyruvate uptake by the brain, necessary for energy production.

Answer 138

- temporary storage of urine (filling phase)- compliance- receptive relaxation (stress-relaxation phenomenon), sensation of bladder filling- sensory afferents in SM, no detrusor contraction - voiding- voluntary initiation via relaxation of external urethral sphincter, and complete emptying of bladder as mass contractor so once starts contracting, contracts all the way.

Answer 139

Complaint of any involuntary leakage of urine

Answer 140

When bladder pressure is greater than urethral sphincter pressure- detrusor pressure is high, or sphincter pressure low

Answer 141

Duloxetine- combined NA and serotonin uptake inhibitor

Answer 142

11th and 12th

Answer 143

As left renal vein longer than right, so something to do with anastomosis?

Answer 144

The left renal vein

Answer 145

More than 3 and a half g of protein lost in urine in a 24 hr period. Characterised by high protein content of urine=proteinuria, hyeprcholesterolaemia, oedema and hypoalbuminaemia.

Answer 146

UT infection, inflammation, benign prostatic hypertrophy, prostate cancer

Answer 147

Polycystic kidney disease

Answer 148

Bone- sclerotic (osteoblastic) metastases- visualised as hot spots on a bone scan (isotopic bone scans) or X-rays

Answer 149

Use of LHRH (luteinizing hormone releasing hormone/ GRH-gonadotropin releasing hormone) agonists. These are injected, and as an agonsit, mimic the action of LHRH which is released from the hypothalamus, and acts on the anterior pituitary to result in LH release, which then acts on the zona reticularis of the adrenal cortex to stimulate testosterone release, and testosterone drives the growth of prostate cancer. So initally (in the 1st week), giving the agonist means LHRH is present all of the time, so more LH and testosterone produced, but then the anterior pituitary becomes worn out from being overly stimulated, so LH and testosterone become reduced. May require combination with an anti-androgen

Answer 150

Afferent and efferent arterioles, with granular cells, macula densa cells and extra-mesangial cells

Answer 151

Gleason grading- low magnification

Answer 152

TNM staging of digital rectal exam- tumour size, extent of regional node metastasis and distant metastases. T1/T2- localised, T3- locally advanced, T4- advanced

Answer 153

Cortical- peritubular capillaries | JM- vasa recta

Answer 154

Podocyte- abnormal foot processes/subepithelial

Answer 155

Hypoalbuminaemia- decrease oncotic pressure of blood, so fluid moves out of capillaries into tissues, causing oedema. Associated Na+ and water retention, increasing hydrostatic pressure in capillaries, causing oedema.

Answer 156

Glomerular capillary hydrostatic pressure, hydrostatic pressure in Bowman's capsule, osmotic pressure difference between capillary and tubular lumen

Answer 157

Minimal change glomerulnephritis- generalised oedema, usually no progression to renal failure, no scarring, responsive to steroids but may recur.

Answer 158

Nephrotic syndrome seen in adults, less responsive to steroids, focal (less than 50% of glomeruli) and segmental (involving part of glomerular tuft) scarring seen, as damage resulted in collagen depostion, scars contain Ig and complement. Circulating factor causing podocyte damage. Progression to renal failure. Disease can recur after renal transplantation.

Answer 159

Most common cause of nephrotic syndrome in adults. Immune complex (antibody-antigen complexes) deposition on outside of BM (sub-epithelial). Most primary causes AI, may be secondary e.g. lymphoma. Minority develop end-stage renal disease.

Answer 160

Most common primary (only kidneys affected) glomerular disease. Mesangial damage causes inflammation as IgA deposited there. IgA able to enter mesangium easily as doesn't have to pass through the BM. Classic presentation= young man who develops macroscopic haematuria 1-2 days after an upper RT infection. IgA= protects against mucosal infection, so when an infection, more IgA produced, so more deposited in mesangium, so patient may experience haematuria when they have a cold. Causes renal failure. Give supportive treatment.

Answer 161

Ureters cross pelvic brim at this point. Area of ureteric constriction- susceptible to renal stones

Answer 162

A focal glomerulonephritis affects some (<50%) but not all the glomeruli, a diffuse glomerulonephritis affects all the glomeruli. A segmental glomerulonephritis affects just a portion within the affected glomeruli (part f glomerular capillary tuft), a global glomerulonephritis affects all portions of affected glomeruli.

Answer 163

Autoantibodies to collagen IV bind to the glomerular BM and destroy it so filtration is blocked. Glomerular BM very similar to alveolar BM, so autoantibodies also target the lung BM, causing pulmonary haemorrage and haemoptysis.

Answer 164

Typically asymptomatic Lower urinary tract symptoms of obstruction Less common=symptoms of metastatic spread e.g. back pain, anaemia or weight loss.

Answer 165

Urinary incontinence | Erectile dysfunction

Answer 166

Raised prostate specific antigen in serum, digital rectal exam, transrectal ultrasound-guided needle biospy- histological apperance gives Gleason score, also staged using TNM

Answer 167

Reduced activity, resulting in reduced muscle tone of external urethral sphincter. As intravesical pressure increases, this can overcome tone of sphincter, hence urine is voided.

Answer 168

In pregnancy, the tone of the ureters is lowered and they may become dilated. This makes it more common for infection to ascend to the upper tract from the bladder during pregnancy

Answer 169

Glomerular Vascular Tubular Interstitial

Answer 170

PCT- as this is a region of very high metabolic activity

Answer 171

Maintains glomerulus and glomerular BM, provides nutrients to glomerulus, supports the glomerular capillaries

Answer 172

It gives charge as electron dense layer, so repels proteins with the same charge.

Answer 173

They have lots of interdigitating processes, forming a net

Answer 174

Blood supply leaving glomerulus goes on to supply rest of nephron, and anything abnormally filtered by the glomerulus goes on through the nephron, e.g. lots of protein- directly toxic to rest of nephron.

Answer 175

A genetic predisposition to develop allergic reactions (hypersensitivity reactions) to common environmental antigens. Examples: asthma, eczema, hayfever

Answer 176

Damage to microvasculature. Abnormal material deposited in glomerular BM itself, and mesangium, causing mesangial sclerosis, forming nodules, so its function to maintain the BM and podocytes is impaired, so filter leak, proteins enter urine. Thickened BM as material depos. here, so electron density disrupted, less able to repel proteins?

Answer 177

Inhibit Ang II production, hence reduce intraglomerular pressure by dilating efferent arterioles more than afferent arterioles, reducing proteinuria and glomerulosclerosis. May cause hyperkalaemia as reduced aldosterone prodcution so less K+ excreted, and renal impairment if renal artery stenosis present. Also, ACE degrades bradykinin, so ACIs result in high bradykinin, which can cause a cough.

Answer 178

Less than 500ml of urine per day, or less than 20 ml per hour

Answer 179

no urine, defined as less than 100 ml of urine per day. | usually indicates a blockage of urine flow

Answer 180

glomerular disease

Answer 181

If acidosis, H+ binds to proteins so there is an increase in free Ca2+ with less bound Ca2+. Opposite in alkalosis where Ca2+ bound to plasma proteins and taken up by bone, causing hypocalcaemia which can cause life-threatening tetany, espec. if respiratory muscle affected.

Answer 182

Medulla | Only receives its blood supply from vasa recta which descend from cortex into medulla

Answer 183

The epithelial cells lining the tubules

Answer 184

Chronic kidney failure

Answer 185

Hyperkalaemia Acidosis Pulmonary oedema Arise from loss of normal renal capacity to excrete K+, H+ and water

Answer 186

Chronic- decrease in GFR over mnths to yrs, rather than days. Chronic RF complications e.g.bone disease Size of kidneys- normal in acute, small in chronic

Answer 187

The kidney fails to excrete phosphate. This accumulates and calcium phosphate deposition can contribute to hypocalcemia. Homeostatic mechanism- decrease Ca2+. The low calcium level promotes excess parathyroid hormone secretion by the parathyroid gland. The kidney also fails to produce adequate vitamin D (calcitriol). This deficiency lowers gut calcium absorption and can contribute to hypocalcemia. Vitamin D also normally inhibits parathyroid hormone secretion, so loss of this inhibition promotes excess parathyroid hormone secretion. There are characteristic changes on a bone biopsy. Administration of vitamin D can help, by replacing the deficiency, promoting more healthy bone metabolism and inhibiting parathyroid hormone secretion.

Answer 188

Directly- via inhibition of Ang II production, indirectly as AngII stimulates SNS so ACEI reduce sympatheitic drive Potentiation of bradykinin- potent vasodilator- decrease TPR- decrease arterial BP

Answer 189

The balance between afferent and efferent arteriolar constriction

Answer 190

Increase renal calcium reabsorption at the thick ascending limb of LOH,distal tubule and collecting tubule

Answer 191

Downregulation of NaKCl co-transporter in ATL due to inactivating mutations in gene encoding sympoter, so mimic loop diuretics.

Answer 192

Can result in life-threatening hyperkalaemia as ACEIs reduce aldosterone secretion so less K+ secreted and late distal diuretics are K+ sparing e.g. amiloride as inhibit ENaC, so K+ retained

Answer 193

Liddle’s syndrome results from genetically determined hyperactivity of the luminal Na+ ion channels in the distal part of the nephron, causing raised BP, hypokaleamia, metabolic alkalosis and hyporeninaemia

Answer 194

An AI chronic disease that causes inflammation in various parts of the body. Antinuclear antibodies and antibodies to double-stranded DNA are suggestive of this disease in serology. Can causes a rash, fever, and may be responsible for acute glomerulonephritis

Answer 195

``` Previous pelvic/ abdominal surgery history of prostatism history of renal stones single functioning kidney anuria ```

Answer 196

Most of our circulating volume is contained within our veins

Answer 197

renal Na+ excretion

Answer 198

PCT, DCT and collecting duct

Answer 199

They collapse the gradient by inhibiting the Na+-K+-2Cl- co-transporter, so reduce H20 reabsorption later in nephron and by thin descending limb where water is reabsorbed due to high osmolarity of interstitium

Answer 200

It is reduced as ions are washed out of the medulla, diminishing the osmotic gradient

Answer 201

inhibit Na+ reabsorption, so interior of tubular cell becomes more -ve, which increases the driving force for Ca2+ reabsorption across apical membrane via a Ca2+ channel

Answer 202

increased renal sympathetic nerve activity, resulting in constriction of resistance vessels- glomerular arterioles and small arteries

Answer 203

type of infection caused by parasites that live in fresj water. can increase risk of bladder cancer

Answer 204

activation of SNS and RAAS- reduced perfusion pressure to kidney makes it think body is under filled, so water retention and Na+ reabsorption increased to increase ECF volume, alter CO and BP

Answer 205

protein lost in urine, so hypoalbuminaemia. This lowers plasma oncotic pressure in capillaries, and liver can't compensate by increasing albumin, so fluid moves out of capillaries, into the tissues, reducing blood vol. and hence perfusion pressure to the kidney, so RAAS activated, with increased aldosterone stimulating H2O and Na+ retention

Answer 206

between renal medulla and cortex, at right angles ti interlobar arteries

Answer 207

ascend through cortex towards renal capsule

Answer 208

in region of connecting stalk- future umbilical cord- connects developing foetus to placenta

Answer 209

the posterior wall of the abdominal cavity

Answer 210

the metanephros

Answer 211

start of 4th wk | end of 4th wk

Answer 212

cell clusters in cervical region of embryo form the pronephros. Lateral portions of the cell clusters fuse, forming the mesonephric duct

Answer 213

mesonephros | but cranial tubules and glomeruli show degenrative changes, and majority have diasapperared at end of 2nd mnth

Answer 214

ureteric bud- sprouts from mesonephric duct

Answer 215

the cloaca

Answer 216

concentrate urine, | but this is not a problem due to aq environment of embryo

Answer 217

excretion is by the mother's kidneys, via the placenta

Answer 218

from wk 5 onwards

Answer 219

capillaries invaginate 1 end of each tubule.

Answer 220

in the pelvic region- about L4

Answer 221

trunk of embryo develops later than head and neck, with diminution of body curvature with growth of body in lumbar and sacral regions, so apparent shift

Answer 222

pelvic branch of aorta

Answer 223

at the superior or inferior kidney poles

Answer 224

supernumerary renal arteries- 2 or more arteries to a single kidney

Answer 225

the arterial fork: umbilical arteries return blood to placenta from foetus and form the arterial fork

Answer 226

a horseshoe kidney is formed when the inferior poles of the l and r kidneys fuse together during passage through the arterial fork as the kidneys are pushed so close together during their ascent. The root of the IMA then prevents ascent into lower thoracic/upper lumbar region.

Answer 227

the membrane is a region where mesoderm is absent, so no blood vessels will develop here, and so it will subsequently die of ischaemia, and hence form an opening to the external environment

Answer 228

the urogenital sinus anteriorly and the primitive anal canal posteriroly

Answer 229

the urorectal septum- mesoderm

Answer 230

a superoventral diverticulum of the hindgut, which is initially continuous with the bladder- formed from the urogenital sinus produced during dividing of the cloaca

Answer 231

the allantois

Answer 232

drain urinary bladder of foetus | GE of embryo with mother across placenta

Answer 233

the pelvic part of the urogenital sinus which is a narrow canal

Answer 234

the penile urethra in males

Answer 235

the pelvic part of the urogenital sinus

Answer 236

labia minora | folds don't fuse like in males as no testosterone

Answer 237

by absorption of mesoneophric ducts into wall of bladder

Answer 238

failure of ureteric bud to interact with intermediate mesoderm, so kidney absent

Answer 239

early splitting of ureteric bud. can be partial or complete double ureters. if 1 has an ectopic ureteral opening, this is symtomatic- by not draining into bladder, it is not subject to sphincter control mechanisms, so the patient will have incontinence

Answer 240

occurs when intra-embryonic lumen of allantois persists, so there is an abnormal connection between bladder and umbilicus, which allows urine to drain from the umbilicus can lead to septicaemia and severe infection if left untreated

Answer 241

if only a local area of the allantois persists, the secretory activity of its lining results in a cystic dilatation

Answer 242

ventral body wall defect where bladder mucosa exposed, part of bladder lies outside the body. Probably result of failure of lateral body wall folds from somatic portion of LP mesoderm to close in midline in pelvic region

Answer 243

can cause a hazard during surgery

Answer 244

passes over the pelvic brim

Answer 245

obturator nerve

Answer 246

urinary retention so the bladder has distended and now lies above the level of the pubis and is now exposed free of superifical peritoneum so a catheter can be inserted without damaging the peritoneum

Answer 247

peritubular and vasa recta capillary networks

Answer 248

133-146 mmol/L

Answer 249

3.5-5.3 mmol/L

Answer 250

22-29 mmol/L

Answer 251

2.5-7.8 mmol/L

Answer 252

60-120 micromol/L

Answer 253

3.3-6 mmol/L

Answer 254

95-108 mmol/L

Answer 255

275-295 mOsm/kg

Answer 256

2.1-2.6 mmol/L

Answer 257

1.1-1.4 mmol/L

Answer 258

osmotic pressure difference between glomerular capillary and tubular lumen increases as plasma proteins prevented from leaving capillaries by filtration barrier, so increase oncotic pressure of capillaries.

Answer 259

apical membrane=SGLUT2- high capacity, low affinity, glucose moved via secondary AT, as coupled to Na+ movement down its conc gradient generated by BL Na+ pump. BL=GLUT2- facilitated diffusion as glucose can move down its conc gradient into interstitium.

Answer 260

most glucose reabsorbed already, so need high affinity low capacity 2Na+-glucose co-transporter= SGLUT1. GLUT1 on BL membrane

Answer 261

200mg/100ml

Answer 262

PCT very permeable to H20 as AQP1 channels expressed on both membranes for transcellular water movement, and tight junctions also permeable to water, so water can be moved paracellularly H20 moved via osmotic gradient generated by solute reabsorption, which results in slightly higher osmolarity of interstitial fluid compared with tubular fluid

Answer 263

sustains PT with O2 and nutrients | clears recovered fluid from interstitium before it can accumualte and reduce gradients favouring reabsorption.

Answer 264

plasma oncotic pressure in peritubular capillaries

Answer 265

peritubular capillary hydrostatic pressure

Answer 266

due to fairly high resistance of efferent arteriole

Answer 267

Cl-base antiporter

Answer 268

amount of aa filtered eaches transport maximum in PT ever under resting conditions

Answer 269

aa movement coupled to Na+ movement as Na+ gradient generated by Na+ pump on BL membrane acidic aa recovered by excitatory aa transporter- exchanges H+, 2 Na+ and an aa fro K+/ Basic aa taken up in exchange for neutral aa- taken up either by a Na+ co-transporter or H+ cotransporter. BL membrane: basic aa and neutral aa exchanged for neutral aa plus Na+. Aromatic aa cross to interstitium by facilitated diffusion

Answer 270

``` 100% filtered nutrients e.g. glucose 80-90% filtered HCO3- 67% Na+ 65% water 50% Cl- 65% K+ ```

Answer 271

transport across BL membrane via passive carrier-mediated diffusion through uniporter due to electrical and chemical gradients established by Na+ pump. Apical membrane secretion via H+-OC+ exchanger driven by H+ gradient generated by Na+-H+ exchanger so OC+ moved out of cell into lumen, creating chemical gradient to that they can be taken into the cell across the BL membrane

Answer 272

approx. 1.1L/min, = flow through glomeruli in cortex, from renal artery

Answer 273

RPF/ 1-haematocrit

Answer 274

vol. of blood occupied by rbc

Answer 275

the amount of plasma that filters into Bowman's space approx. 20% = GFR/RPF

Answer 276

volume of plasma from which any substance is completely removed by the kidney in a given amount of time (usually 1 min)

Answer 277

PAH: para-aminohippurate

Answer 278

In PCT by a BL organic cation transporter

Answer 279

100ml of plasma per min would be completely cleared of substace X

Answer 280

GFR and conc of solute in plasma

Answer 281

amount of solute appearing in final urine, expressed as a fraction of the filtered load

Answer 282

amount excreted/filtered load X100 filtered load dependent on GFR and conc in plasma so filtered load= conc in plasma X urince conc of creatinine X urine flow rate/ plasma conc of creatinine

Answer 283

inhibts sodium bicarbonate reabsorption in PCT so increase HCO3- excretion

Answer 284

they are losing lots of protein in their urine- proteinuria, and this includes regulatory factors that prevent clotting, and patient with oedema tends to sit down all day, so limb immobilisation, not having the calf muscle contraction necessary to massage leg veins to aid venous return to the heart, so more likely to get blood stasis in deep leg veins.

Answer 285

nephrotic syndrome HF cirrhosis can do a urine dipstick to eliminate nephrotic syndrome by checking for protein in the urine

Answer 286

to make sure that a piece of cortex is biopsied as there are no glomeruli in the medualla

Answer 287

loop diuretics very potent as can increase fractional excretion of Na+ by 25% as 25% of filtered Na+ normally reabsorbed by ATL. In congestive HF, oedema occurs because pressure backs up into systemic circulation, with increase HP in capillaries, forcing fluid into the interstitium. CO falls, so reduced PP of kidney stimulates RAAS, with subsequent increase in Na+ and water retention. And then, when fluid has been moved into interstitium, RAAS is also activated as reduced intravascular volume.

Answer 288

``` SLE bacterial endocarditis diabetes mellitus vasculitis antiGBM disease ```

Answer 289

urine microscopy- look for casts- more likely to be glomerular?, and urine culture assessment of renal function- urea, creatinine and creatinine clearance quantification of 24hr protein excretion immunological test- ANCA, CRP, auto-antibodies, serum protein electrophoresis renal imaging

Answer 290

flexible cytoscopy for exclusion of transitional cell carcinoma of the bladder

Answer 291

assessment of renal function- urea, creatinine eGFR quantification of 24hr protein excretion and urine protein to creatinine ratio blood sugar, serum albumin, serum cholesterol immunological tests- auto-antibodies, ANCA, complement, serum protein electrophoresis renal imaging renal biopsy if imaging is normal

Answer 292

nothing abnormal! | but on electron microscopy, there would be loss of podocyte foot processes

Answer 293

BM thickening with sub-epithelial deposition of electron dense deposits on electron microscopy 'spikes' on silver staining with light microscopy due to BM thickening between sub-epithelial deposits

Answer 294

sclerosis of some but not all glomeruli, and only portiom of glomerular tuft abnormal. predominantly JM glomeruli involved in early cases

Answer 295

level of protein leak e.g. protein creatinine ratio- can quantify protein leak

Answer 296

diabetic ketoacidosis renal failure diarrhoea severe shock or HF

Answer 297

testosterone

Answer 298

plasma- significantly more protein- can affect anion and cation distribution as net -ve charge, but effect=small

Answer 299

ingestions matches excretion e.g. via urine, sweat and faeces

Answer 300

this would change our plasma osmolarity, causing cells to swekk. So must add an isosmotic solution, but water can only be made to move by moving osmoles

Answer 301

10-15% | via AQP1 channels

Answer 302

approx. 5% | almost entirely impermeable to water when ADH absent

Answer 303

3% Na+ 5% water but water >24 during dehydration- ADH- insert AQP 2 channels into apical membrane

Answer 304

it remains the same

Answer 305

in S2-S3, can be reabsorbed paracellularly down electrical gradient produced by Na+ reabsoroption- Cl- can diffuse through tight junction- passive transport, and transcellular reabsorption- Cl--base antiporter on apical membrane

Answer 306

osmotic gradient from solute reabsorption hydrostatic force in interstitium oncotic force in peritubular capillary

Answer 307

basolateral plications/folds, assoc. with many mit. for site of ATP synthesis

Answer 308

H2O reabsorbed down an osmotic energy dependent gradient produced by thick asending limb which via counter current multiplication, concentrates the interstitium

Answer 309

fluid is hypo-osmotic to plasma

Answer 310

activa Na+ uptake through ENaC via gradient generated by Na+ pump on BL membrane, which creates a -ve charge in lumen

Answer 311

reduced enzyme activity, reduced cardiac and skeletal muscle contraction, reduced hepatic function and reduced glycolysis

Answer 312

hypokalaemia- hyperpolarisation | decrease free Ca2+, so repolarisation happens sooner, creating a re-entry loop

Answer 313

urine produced by metanephric kidneys

Answer 314

by an abnormality in the partitioning of the cloaca

Answer 315

as sustained increases quickly show partial adaptation to new pressure levels so reflex is reset to maintain pressure around the new level so the threshold for firing resets

Answer 316

control Na+ balance and so ECF vol.

Answer 317

pressure decrease detected by baroreceptors in afferent arteriorle

Answer 318

Beta 2 adrenergic receptors on granular cells, nerves innervate arteriole

Answer 319

on the surface of vascular endothelial cells

Answer 320

stimulates Na+-H+ exchanger

Answer 321

- it causes vasoconstriction of afferent and efferent arterioles via NA and dopamine relase, with NA and circulating adrenaline acting on alpha 1 adrenoreceptors, reducing renal blood flow hence GFR and Na+ excretion - activates apical Na+-H+ exchanger and basolateral Na+ pump in PCT to increase Na+ reabsorption - stimulates renin release via Beta 2 receptors

Answer 322

in the OVLT in the hypothalamus- organum vasculosum of the lamina terminalis, and the subfornical organ

Answer 323

prostaglandins

Answer 324

renovascular disease chronic renal disease aldosteronism Cushing's syndrome

Answer 325

renal artery occlusion, reduce perfusion pressure, increase renin prod. with RAAS activation, causing vasoconstriction and Na+ retention at other kidney. Could stent artery ACE inhibitors

Answer 326

initally, loss of vasodilators e.g. PGs. Later stage- Na+ retention and H20, as inadequate glomerular filtration. Volume-dependent hypertension

Answer 327

form of primary hyperaldosteronism, in this case, an aldosterone secreting adenoma of the adrenal glands- aldosterone normally secreted from zona glomerulosa as mineralocorticoid. Adenoma results in hypertension and hypokalaemia.

Answer 328

pheochromocytoma- secretes NA and adrenaline, can result in peripheral vasoconstriction and an increase in cardiac output

Answer 329

MI, HF, renal failure, retinopathy, stroke

Answer 330

it increases the afterload on the heart- so LV hypertrophy, leading to HF, and increased myocardial O2 demand, leading to ischaemia and MI arterial damage- potentiate atheroma formation- damage promotes platelet adhesion and monocyte adhesion, PDGF, SMCs proliferate and migrate, form foam cells as talke up LDLs, creates fatty streak, SMCs secrete collagen,simple plaque, fibrosis, loss of arterial wall elasticity, macrophages, endothelial cells and SMCs produce free radicals which oxidise LDls, and these are chemtactic for circulating monocytes- infiltrate intima, macrophages uptake oxidisesd LDLs, form foam cells- cytokine release- SMC proliferation, CT secretion, recruitment of other inflammatory cells. so atherosclerosis and weakened vessels- cause retinpathy, aneurysm, nephro-sclerosis and RF, CVD and stoke, MI.

Answer 331

hypertension osteoporosis infection e.g. oral candidiasis symtoms of Cushings e.g. purple striae, distended abdomen

Answer 332

decrease SV, CO and TPR

Answer 333

exercise, diet- reduce salt and alcohol intake

Answer 334

``` ACEIs AngII antagonists Thiazide diuretics Loop diuretics vasodilators- L type Ca2+ channel blockers, alpha 1 receptor blockers beta blockers ```

Answer 335

PCT | thin descending limb of LOH

Answer 336

increase fluid intake- to increase natural getting rid of bacteria from UT by voiding

Answer 337

an accumulation of cells (mostly mononuclear) within Bowman's space, often compress capillary tuft and assoc. with more severe disease

Answer 338

bone thickening (osteoblastic) but bone formed is weak and prone to fracture

Answer 339

squamous cell carcinomas- result of schistosomiasis infection- infection with schistosoma fluke, causing chronic bladder inflammation, with subsequent squamous metaplasia, progressing to squamous cell carcinoma

Answer 340

smoking occupational exposure- rubber- beta napthylamine, dyes, carbon combustion- polyaromatic hydrocarbons chronic bladder inflammation- schistosomiasis

Answer 341

frequency urgency painless haematuria dysuria

Answer 342

mitomycin C

Answer 343

flexible cytoscopy CT MRI urine cytology

Answer 344

transitional cell carcinoma

Answer 345

any filling defects

Answer 346

IgA nephropathy

Answer 347

DRE PSA blood test transrectal ultrasound guided biopsy of prostate

Answer 348

osteoblastic/sclerotic lesion

Answer 349

hormones- surgical castration -removal of testicles, medical castration- LHRH/GTRH agonists- cause anterior pituitary to get worn out as constant stimulation unlike normal LHRH release-pulsatile palliation- radiotherapy single dose to bone to releive pain bisphosphonates chemotherapy

Answer 350

sureveillence- monitor PSA level radical prostatectomy radiotherapy

Answer 351

surveillence hormones hormones and radiotherapy

Answer 352

``` age of patient PSA stage of cancer biopsy- gleason grading MRI scan and bone scan ```

Answer 353

segemental of global capillary collapse, presumed that there is little or no filtration across sclerotic area

Answer 354

traction of SMA causing L renal vein entrapment syndrome | renal cell carcinoma spread into IVC

Answer 355

tyrosine kinase inhibitors- target angiogenesis as requires GFs- act via TK linked receptors can also be used in some non small cell lung cancers- adenocarcinomas with EGF mutations*

Answer 356

nephro-ureterectomy- removal kidney, fat, ureter, cuff of bladder

Answer 357

ultrasound- hydronephrosis CT urogram- filling defect, ureteric stricture retrograde pyelogram ureteroscopy- biopsy and washings for cytology

Answer 358

K+ sparing so prevents hypokalaemia which can precipitate hepatic encephalopathy which the patient is susceptible to with LF as lose ability to detoxify- NH3 accumulates and enter blood where can travel to brain and cause cerebral oedema. AND ascites in LF result of PH, hypoalbuminaemia, and RAAS stimulation with detection of reduced circulating volume so aldosterone antagonist inhibits the effects of this system in relation to aldosterone stimulating Na+ and water retention which contributes to the ascites.

Answer 359

concentration of NaCl in the ECF

Answer 360

amount of Na+, NOT concentration

Answer 361

vagus | reflex involves increasing SNS outflow and ADH release when low blood vol. detected, most blood in veins

Answer 362

bainbridge reflex: | increases in R atrial pressure increase the HR, and reduces ADH, cortisol, and renin secretion, causing a diuresis.

Answer 363

vagus and glossopharyngeal

Answer 364

to maintain GFR

Answer 365

110-275 mmol/24h

Answer 366

25-125 mmol/24h

Answer 367

400-750mmol/24h

Answer 368

5-17 mmol/24h

Answer 369

150-250 mmol/24h

Answer 370

>3L of urine produced in a day

Answer 371

freely filtered neither reabsorbed nor secretied neither synthesised, broken down or accumulated by kidney physiologically inert

Answer 372

males 115-125ml/min | females 90-100 ml/min

Answer 373

Where the podocytes and the endothelial cells of the glomerulus contact each other, the two basal laminae fuse.

Answer 374

expanded portion of nephron comprising an outer parietal layer, and inner visceral layer- podocytes forming filtration slit diaphragm, and space between= bowman's space/urinary space into which the ultrafiltrate enters

Answer 375

basolateral Na+-K+-ATPase, generates Na+ gradient

Answer 376

to ensure fluid still isosmotic at end of PCT, but glucose has increased osmolarity, so water stays to maintain same osmolarity

Answer 377

polyuria means volume of urine produced increased, so decrease in patient's plasma volume, triggering thirst, and osmotic effects of high glucose on thirst centres in the brain

Answer 378

inadequate deamination by liver or seen in pregnancy with greatly increased GFR

Answer 379

genetically determined inability of liver to metabolise relevant amino acid

Answer 380

genetically determined lack of specific transport proteins

Answer 381

cystine- abnormally insoluble aa, especially in acidic urine

Answer 382

by altering the total amount of water

Answer 383

used to draw H20 from the thin descending limb and to later concentrate urine as it passes through the CDs

Answer 384

way in which corticopapillary osmotic gradient is generated by ATL of loop of Henle. Initially, all in equilibrium. Single effecr: Na+ reabsorbed by ATL, no water follows, increases osmolarity of interstitium, H20 then drawn from TDL next to ATL, TDL comes to equlibriate with interstitium. Fluid displacement: fluid enters from PCT, displacing higher osmolarity fluid around loop tip. Fluid entering- 300mOsm/kg, re-equlibrates with interstitium as water leaves tubule to dilute interstitial contents, but water can't leave the ATL so osmolarity stays the same. Single effect again: Na+ pump generates another 200mOsm/kg gradient between ATL and interstitium, but starting from more concentrated solution from further down the ATL in medulla as fluid has moved round the loop tip and H20 has been reabsorbed from this fluid, so intersitial osmolarity increase to 500 mOsm/kg. cycle repeats until maximal gradient- limited by diffusional processes

Answer 385

apical membrane- urea transporter-A1, which ADH causes PKA-dependent phospohorylation of to activate it. urea reabsorbed by facilitated diffusion, enters medullay interstitium, and can reenter ATL and DTL of LOH. descending vasa recta next to ATL able to take urea from intersititum by FD, so blood has increased osmolarity, preventing washout of osmotic gradient

Answer 386

worry that as capillaries are very leak vessels and osmolarity of medulla much higher than osmolarity of plasma, that fluid would leak out into interstitium and so the corticopapillary gradient would be washed away when trying to supply blood to the tubules.

Answer 387

allows a near-complete equilibrium of H20 and solutes as the blood is carried through the medulla

Answer 388

ADH receptor antagonsits

Answer 389

secretes ADH in an unregulated manner= syndrome of inappropriate ADH secretion

Answer 390

nausea,vomiting,headache,confusion,coma,lethargy,fatigue,cramps,spasms,muscle seizures, reduced consciousness

Answer 391

total amount of ion in body, both absorbed by GI tract and excreted by kidney distribution of ion within body- Ca2+ between bone and ECF, PO43- between body fluid compartments of ICF and ECF

Answer 392

acidosis- H+ binds to plasma proteins, so more Ca2+ free in plasma alkalosis- plasma proteins bind Ca2+, so lower free Ca2+, can cause life-threatening tetany

Answer 393

complexed with anions e.g. HCO3- and PO43-

Answer 394

It would increase the threshold, so a higher plasma concentration of Ca2+ would be necessary to reach Tm and so for it to 1st start to appear in the urine, hence more would be reabsorbed

Answer 395

bone- hydroxyapatite crystals

Answer 396

yes, if high enough conc of both as the conc at which this happens for calcium would depend on the conc product of the 2 ions, which would cause precipitation if the conc product exceeds the threshold

Answer 397

bound to proteins- proteins too large to pass through filtration barrier, and -ve charge repelled by glycoproteins in BM

Answer 398

PCT-80% | DCT-10%

Answer 399

PCT-70% ATL- 20% DCT- 9% CD-1% excrete 1%

Answer 400

Na+-PO43- sympoter- uses Na+gradient from Na+ pump on BL membrane, then moved into ECF via a phospate-inorganic anion antiporter

Answer 401

oily fish, eggs, cereals

Answer 402

25-hydroxylase

Answer 403

general predisposition for many infections, especially bacterial infection as increase glucose-attracts bacteria. In addition, diabetic neuropathy can result in poor bladder emptying and a residual bladder volume which is a further predisposition to infection.

Answer 404

``` frequency urgency nocturia hesitancy feeling of incomplete bladder emptying terminal dribbling ```

Answer 405

filtering and variably recovering HCO3-, and active secretion of H+- alpha intercalated cells via H+/K+ ATPase- same as that on canalicul in parietal cells of the stomach

Answer 406

hyperkalemia as K+ not being excreted by the kidney, so cardiac myocytes depolarised state- lesser change in ion conductance required for depolarisation as lesser concentration gradient for K+ movement out of cells, so Na+ voltage gated channels are unable to be reprimed for opening by repolarisation, so more remain in an inactivated state

Answer 407

tall, wide T waves- T wave peaked is 1st change representing rapid repolarisation, also loss of P waves, widening of QRS complex, loss of ST segement

Answer 408

lactic acidosis e.g. in septic shock- meningococcal meningitis diabetic ketoacidosis drugs- aspirin overodose also if decrease HCO3- e.g. diarrhoea

Answer 409

harder to control as respi compensation to limited extent as need to breathe sufficiently for sufficient O2 to be inspired alkalosi- tetany

Answer 410

will reduce as getting rid of acidic chyme, so higher pH in duodenal lumen, so secretin not stimulated to be released by S cells, so alkaline juice prod. by pancreatic ductal cells not stimulated, so HCO3- remains in blood, resulting in a met. alkalosis

Answer 411

in order for HCO3- to be rapidly excreted by the kidneys as decrease in ECF vol will stimulate RAAS, resulting in increased Na+ and H20 recovery which will form gradient for HCO3- reabsorption AND high rates of Na+ recovery facilitate H+ secretion

Answer 412

most in PCT- 80-90% | 10% in ATL of LOH

Answer 413

Na+ pump Na+ gradient for Na+-H+ exchanger H+ and HCO3- reaction in lumen via carbonic anhydrase CO2 diffusion into cell, and reaction with water H+ recycled HCO3- moved into ECF via Na+-3HCO3- symporter, and Cl--HCO3- antiporter Tight junctions- polarised cells, so maintain different membrane properties

Answer 414

PCT: metabolism of glutamine- production of alpha ketoglutarate* glutamine can be broken down to NH3 and glutamate, and glutamate can be broken down to alpha ketoglutarate- can be metabolised to produce glucose and then CO2 and H20 which react to form HCO3-, so we get NH4+ and HCO3- prod. from alpha ketoglutarate, HCO3- goes into blood and NH4+ into lumen via NHE DCT: H+ generated from metabolic CO2 in alpha intercalated cells, producing H+ and HCO3-, HCO3- enters ECF and H+ actively secreted via H+ K+ ATPase into lumen, where buffered by HPO42-, and excreted ammonia, NH4+ unable to be reabsorbed from lumen as no carrier so is excreted, so H+ excreted as titratable acid- reacts with luminal buffers- phosphate- from bone bdown and ammonia normally, excrete same amount of H+ as we produce to keep plasma HCO3- normal

Answer 415

change in pH of tubular cells as changes in rate of HCO3- export to ECF due to changes in HCO3- conc of ECF, but no neuroendocrine type loop

Answer 416

enhanced H+/Na+ exchange in PCT stimulated by AngII, allowing full recovery of HCO3- enhanced NH4+ prod in PCT- AngII stimulated increased capacity to export HCO3- from cells to ECF increased H+K+ATPase activity in DCT

Answer 417

10-15mmol/L

Answer 418

H+ produced with anion, H+ reacts with HCO3- so HCO3- reduced, and the conc of anion is increased, but this anion is not CL-, so not included in anion gap calculation, hence the reduced HCO3- increases the anion gap

Answer 419

HCO3- is reduced, but is replaced by the anion Cl- included in anion gap calculation, so no change

Answer 420

funcitoning of H+K+ATPase- activity will be increased so more H+ can be excreted, but K+ moved by transported into the cell, so increasing K+ in ECF hence hyperkalaemia

Answer 421

intracellular pH made acidic, favouring H+ excretion and HCO3- reabsorption

Answer 422

we retain 1mol of HCO3-

Answer 423

H+ Na+ water

Answer 424

regular flushing via voiding | antibacterial secretions into urine and urethra

Answer 425

staph.saprophyticus

Answer 426

``` K antigens urease adhesion faecal flora haemolysins ```

Answer 427

sample refrigeration or collection in containers with boric acid to prevent bacterial multiplication in transit

Answer 428

obstruction to urine flow, creates a back pressure which inhibits filtration- * can relate to pressures affecting filtration, 1 of which is the HP is bowman's capsule which despite inhibiting filtration, is useful for forcing ultrafiltrate through the tubules, this would increase if back up of pressure?

Answer 429

has to be bilateral!

Answer 430

to provide sensations of bladder filling and pain to allow bladder to relax and accomodate increasing vol.s if urine to initiate and maintain voiding so that bladder empties completely, minimising residual vol.-increase risk of UTIS e.g. diabetes-peripheral neuropathy* to provide integrated regulation of smooth muscle and skeletal muscle sphincters of the bladder

Answer 431

prevent retrograde ejaculation into the bladder

Answer 432

voiding centres: cortical micturition centres- executive concsious decision to pass urine, command pontine micturition centres (M region) to increase PNS output to spinal micturition centres and reduce sympathetic output

Answer 433

cerebral cortex | makes conscious executive decisions

Answer 434

somatic motor neurones

Answer 435

most definitive test to determine cause of voiding dysfunction and lower urinary tract symptoms

Answer 436

from bladder irritation and temp sensation. sensory afferents- stretch receptors, in SM of bladder wall contrast to visceral organs where pain referred

Answer 437

when voiding initiated, bladder detrusor muscle starts contracting and it contracts all the way to expel out as much urine as possible with minimal residual volume

Answer 438

any SC problems will affect control of micturition

Answer 439

bladder lies within the lesser pelvis in adults when empty, and enters the greater pelvis as it fills, bladder lies initially in abdominal cavity in children, then descends into greater than lesser pelvis. Lies post to pubic bone in adults, superior to it in children. Hollow, smooth-muscle organ, hindgut derived- endoderm. bilaterally innervated- midline structure, so neural supply can be preserved if 1 sided problem

Answer 440

loops of detrusor muscle encircle the orifices and tighten when the bladder contracts

Answer 441

slight elevation of trigone

Answer 442

superior edge of the pubic symphysis

Answer 443

layers of detrusor muscle orientated in 3 different directions

Answer 444

as the smooth muscle is stretched on bladder filling, the muscle relaxes more rather than resiting strectching as occurs with the myogenic response, so intra-luminal pressure doesn't increase as bladder fills, limiting reflux

Answer 445

arcuate (Douglas) line

Answer 446

continuation of bladder detrusor muscle and elastic tissue at the bladder neck- connection between bladder and urethra. Change in conformation of tissues in bladder around the neck on filling, forming a valve- closes.

Answer 447

localised circular muscle thickeing to facilitate action | contraction constricts the urethra to hold in urine

Answer 448

Onuf's nucleus

Answer 449

somatic can be switched on or off, so voiding phase- somatic input to external urethral sphincter off to allow relaxation, but ANS is always on

Answer 450

detrusor-sphincter dyssenergia

Answer 451

the continence centre in the L region of the Pons

Answer 452

sensory afferents within SM of bladder wall, signals relayed to SC via pelvic and hypogastric nerves when threshold reached so stimulate a reflex increase in PNS activity. Voiding circuits, and executive concious decision made by micturition centre in cerebral cortex to void. Overall, strong detrusor muscle contraction via PNS, causes an increase in intravesical pressure which overcomes the external urethral sphincter pressure as there is relaxation of both sphincters. so micturition centres of cerebral cortex communicate with those of the M region of the Pons, which signal to sacral levels of PNS outflow, to cause detrusor muscle contraction via pelvic nerve. Cerebal cortex- volunatary decison to urinate, and somatic NS stimulation to external urethral sphincter is reduced, this voluntarily relaxes.

Answer 453

cortical storage system reciprocally inhibits micturition system

Answer 454

predisposing: family predisposition, anatomical abnormality, neurological abnormality, race promoting: age, UTI, menopause- vaginal tone lost, obestiy, co-morbidities, cognitive impairment, intra abdom. pressure increase O and G: pregnancy and childbirth, pelvic prolapse and surgery

Answer 455

involuntary leakage of urine

Answer 456

on effort or exertion, coughing or sneezing, result of increased abdom pressure with weakened pelvic floor or sphincter, common after childbirth

Answer 457

detrusor overactivity so leakage of bladder as perceived to be full common in elderly

Answer 458

assoc with urgency and with exertion and effort

Answer 459

removal of obstruction e.g. if prostatic hypertrophy | condition ca also be caused following SC injury or in women with cystoceles

Answer 460

urine passage due to inability to get to toilet because of disability

Answer 461

height weight DRE- prostate abdom exam- exclude palpable bladder neurolgoical e.g. urge UI females- external genitalia stress test, vaginal exam-prolapse digital assessment of pelvic floor muscle contraction

Answer 462

frequency but not passing much urine each time, may be sensory causes, overactive bladder or less compliant bladder e.g. urinary TB can determine from a frequency volume chart

Answer 463

frequency of micturition | incontinence- no pads patient uses, is leakage continuous or intermittent, and precipitating factors

Answer 464

catheter inserted into bladder, and pressure probe into rectum to measure abdom pressure. Catheter fills bladder with fluid. abdom and detrusor pressure put together to get total vesicular pressure. if on filling, detrusor pressure increasing, then msut be contracting, so indicates bladder overactivity- urge UI. acontractile bladder- lots of abdom muscle activity to increase pressure to void

Answer 465

mandatory urine dipstick, culture UTI non-invasive urodynamics- frequency vol charts invasive urodynamics- pressure flow studies, pad tests- weight, cytoscopy- look inside bladder

Answer 466

indwelling catheter but INFECTION sheath device- like an adhesive condom, attached to catheter tubing and a bag incontinence pads

Answer 467

indwelling catheter but INFECTION sheath device- like an adhesive condom, attached to catheter tubing and a bag incontinence pads

Answer 468

females: vaginal tape, open retropubic suspension procedures, classical sling procedures temporary- intramural bulking agents- mucosa injected to be built up males: male sling- stress UI usually iatrogenic e.g. prostatic surgery damaging external sphincter artificial urinary sphincter- can close urethra but infection, erosion and device failure, so needs replacing

Answer 469

bladder training- voiding schedule

Answer 470

urge UI, but SE of urinary retention

Answer 471

urge UI, but SE of urinary retention

Answer 472

sacral nerve neuromodulation autoaugmentation- some of detrusor muscle removed to increase functional capacity and decrease intravesical pressure created by involuntary detrusor contractions augmentation cytoplasty- bowel added to bladder to increase functional capacity, but UTIs, self-catheterise and stones urinary diversion- ileal conduit- part of ileum excised and prox part anastomosed to ureters, distal end of segment brought out as stoma, with or without cystectomy- bladder removal

Answer 473

renal replacement therapy e.g. dialysis

Answer 474

steroids | immunosuppressants

Answer 475

hyperkalaemia

Answer 476

females- uterine prolapse due to weakened ligaments | males- prostatism

Answer 477

organisms remain in area e.g. bladder for a long time so have time to multipy

Answer 478

female-shorter urethra obstruction neurological ureteric reflux

Answer 479

ureters don't enter bladder diagonally and orifice enlarged so during voiding, urine is refluxed up the ureter to renal pelvis of kidney, and can then cause reflux into medulla, can cause chronic pyelonephritis

Answer 480

``` female prostatism diabetes renal stones pregnancy tumour reflux catheters renal transplant- immunosuppressants? ```

Answer 481

midstream urine sample collected to ensure not collecting bacteria that were present in urethra before voiding and prevent skin contamination visual inspection- turbidity- turbid mainly result of white cells dipstick testing- blood, pH, leucocyte esterase, nitrite, proteins culture urine if complicated UTI microscopy- wbc, rbc, sqauamous epithelial cells- contamination, red cell casts

Answer 482

``` adhesion- adhesins and fimbriae haemolysins urease producing K antigens e.g.E coli can resist host defences by polysaccharide capsule production faecal flora ```

Answer 483

``` frequency urgency dysuria pyuria haematuria ```

Answer 484

may be asymptomatic- covert bacteriuria - excess pathogens in urine but no symtoms, pregnancy- upper UTI can lead to prematurity, early labour

Answer 485

agar gel in petri dish- colour changes occur with changes in pH- met reaction has occurred

Answer 486

symptoms of UTI but no +ve urine culture

Answer 487

singly nightly dose of trimethoprim or nitrofurantoin

Answer 488

inner longitudinal, middle circular, outer longitudinal

Answer 489

pseudostratified columnar except at distal end- stratified squamous.

Answer 490

upregulates apical Ca2 channel and PMCA on BL membrane

Answer 491

3 Na+ and 1 Ca2+

Answer 492

metabolic alkalosis low K+ diet as kidneys can't reduce K+ excretion to same low levels as for Na+ loop diuretics

Answer 493

IV insulin and glucose IV calcium gluconate to reduce effect on the heart dialysis to remove excess K+

Answer 494

``` ECF concentration aldosterone acid base balance increased tubular flow rate increased Na+ delivery ```

Answer 495

Beta 3- sympathetic | M3- parsympathetic

Answer 496

beta 2 adrenoreceptors

Answer 497

neuromuscular dusfunction causes smooth muscle of SI to become paralysed so normal peristaltic activity is lost, causing constipation

Answer 498

acidosis low insulin increased plasma osmolarity

Answer 499

low T waves high U waves low ST segment

Answer 500

aldosterone antagonisits e.g. spironolactone

Urinary Flashcards

(546 cards)