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Urinary Flashcards

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1
Q

What is the route of the Ureter?

A
  1. Arises from the pelvis of each kidney
  2. Descends on the top of the psoas major
  3. Crosses in front of the common iliac arteries
  4. Runs postero-inferiorly on the lateral walls of the pelvis
  5. Curves antero-medially to enter the bladder
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2
Q

What is the vesicoureteric junction?

A

The junction between the distal ureter and the bladder

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3
Q

What is the pelviuteric junction?

A

Junction between the pelvis of the kidney and the proximal ureter.

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4
Q

At what spinal level would you find the right kidney?

A

T12-L3

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5
Q

At what spinal level would you find the left kidney?

A

T11-L3

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6
Q

Which kidney is lower and why?

A

Right kidney is 1cm lower due to the liver

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7
Q

What structures lie retroperitoneal?

A

SAD PUCKER

Suprarenal glands
Aorta/IVC
Duodenum (2nd+3rd part)

Pancreas
Ureters
Colon (ascending + descending branches)
Kidneys
oEsophagus
Rectum

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8
Q

What would we see on a CT at T12?

A

Hilium visible on left kidney but not right kidney

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9
Q

Which artery causes high pressure in the glomerular capillaries?

A

Efferent arteriole (and it’s resistance to flow)

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10
Q

What term best describes normal Bowman’s capsule oncotic pressure?

A

Negligible
(no proteins here so no oncotic pressure)

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11
Q

Which constituent of the filtrate has a rate of urinary excretion that is lower than it’s glomerular filtration rate?

A

Glucose
(most of it is reabsorbed)

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12
Q

What happens to the ultra-filtration process in lupus nephritis?

A

Unable to separate small and large molecules
The fluid found in the bowman’s capsule is not ultra-filtrate and appears more like plasma

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13
Q

How many nephrons does the human kidney have?

A

1,000,000

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14
Q

What components of plasma will be present in the glomerular filtrate immediately before it enters the loop of henle?

A

Electrolytes
Glucose
Amino Acids
Urea

Large molecular weight proteins aren’t

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15
Q

Which diuretic is a patient on that has hypokalaemia, uricemia and gout?

A

Thiazide like diuretic
(acts on the DCT)

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16
Q

Which diuretic is a patient on that has hypokaleamia, metabolic alkalosis and ototoxicity?

A

Loop diuretic

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17
Q

Which class of diuretic is Triamterene?

A

K-sparing diuretic
(blocks Na channels in the collecting duct)

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18
Q

What side effects can you get on spironalactone?

A

Gynecomastia
Impotence
BPH

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19
Q

Which drug is associated with a reduction of mortality in HF and LV dysfunction?

A

Spironolactone

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20
Q

What is the main action of ADH?

A

Vasoconstriction

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21
Q

How will a patient present with diabetes insipidus?

A

Excessively thirsty regardless of their fluid intake

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22
Q

How can high levels of ADH cause hyponatraemia?

A

Dilutional hyponatraemia
(Increase in aquaporin channels at collecting duct means more water is reabsorbed)

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23
Q

What effect does sweating all day without fluid intake cause?

A

Osmolarity increased, volume decreased

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24
Q

Which fluid regimen would give you a patient who is nil by mouth but euvolaemic?

A

0.18% sodium chloride, 4% dextrose over 12 hours

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25
What fluid regimen would you give to a patient who has suspected AKI?
1 litre 0.9% Sodium Chloride over 8 hours (8 hours to not overload AKI)
26
What can BPH lead to in the kidneys?
Renal Cortical atrophy
27
A patient has an AKI following trauma and hypotension. What has caused this?
Acute tubular injury
28
Why can a patient develop an AKI after a MI?
Acute tubular injury
29
Which disease is it important to to screen for kidney disease in using the albumin-creatinine ratio?
Diabetes
30
How does parathyroid hormone affect the kidney's handling of phosphate?
Decreases phosphate reabsorption in the PCT
31
What is an early indicator of glomerulosclerosis in diabetic patients?
Microalbuminuria
32
A patient has urinary incontinence, which nerve endings are more likely to fire APs?
Urinary bladder to the sacral region (S2,S3,S4)
33
Why could a patient with an AAA get flank pain and nausea?
Ureter entrapment
34
Which parts of the kidney is derived from the ureteric bud?
Collecting duct Ureter Renal pelvis Major + minor calyces
35
Where is the bladder derived from?
Hind-gut
36
What will an older man complain of with an UTI?
Dysuria
37
A woman has been diagnosed with her second UTI in 3 months. What treatment should you give her?
Trimethoprim for 3 days
38
A catheterised man has a UTI. The culture shows a gram positive cocci, what is the likely pathogen?
Staphylococcus epidermidis
39
When a microbe is first introduced to the body, which immunoglobulin is first to be released?
IgM
40
What's the typical prognosis with polycystic kidney disease?
Steadily progressive CKD
41
Which type of inheritance does polycystic kidney disease show?
Autosomal dominant
42
A women has smoked all her life and has pain in her pelvis, abdomen and she has a right loin mass. What is her most likely diagnosis?
Renal cancer (is linked to smoking and mets to the bone)
43
What components of the renal nephron and renal capillary network create urine?
The loop of henle Vasa recta
44
What effect does angiotensin II have on glomerular pressure?
Increases glomerular pressure (constricts the efferent arteriole more than the afferent arteriole)
45
How does the RAAS system increase BP?
1. Decreased renal perfusion 2. RAAS activated 3. Angiotensin II causes systemic vasoconstriction and synthesis of aldosterone 4. Aldosterone causes increased Na reabsorption at the DCT 5. Water follows
46
A boy presents with nephrotic syndrome, what is your differential diagnosis?
Minimal change Disease Glomerulonephritis
47
How does the bladder prevent reflux?
The ureters entry into the bladder is at an oblique angle and the detrusor muscle has a flap that covers the ureter opening when the volume in the bladder goes up.
48
What is the trigone?
Triangular region at the base of the bladder between the ureteric and urethral openings.
49
What can radiotherapy cause?
Vesico-vaginal fistulas
50
What region of the abdomen is the bladder?
Hypogastric
51
What is the major anion component of sweat?
Cl
52
Where do the renal arteries arise from?
Abdominal aorta just below the SMA
53
What effect on the kidney will primary hyperparathyroidism have?
Increased excretion of phosphate in urine
54
A patient has had a fall and is dehydrated due to not drinking for 24 hours. The absorption of which ion will be increased at the DCT?
Sodium (Aldosterone release in response to the decreased plasma volume)
55
What would you call the fluid in the CD?
Urine (no further changes after this)
56
What fat surrounds the kidneys?
Perirenal fat
57
What vessel branches into the cortical peritubular capillary beds?
Efferent arteriole
58
Which vessel arises from the efferent arteriole and is close to the medullary border?
Vasa recta
59
What happens to the GFR if glomerular oncotic pressure decreased?
GFR increases
60
What happens to the GFR if the tubular hydrostatic pressure increases?
GFR decreases (tubular hydrostatic pressure opposes capillary hydrostatic pressure)
61
Which substance rate of urinary excretion is virtually identical to GFR?
Creatinine
62
What changes happen in the nephron to compensate for postural hypotension?
Increase in GFR
63
What is the equivalent of ml to g?
1ml weighs 1g
64
What fluid regimen would you give someone who has had diarrhoea?
0.9% Sodium chloride (stays in ECF) AND 40mM of K (K lost in diarrhoea)
65
A patient with severe sepsis has an AKI that's not sorted with meds, what's the next treatment?
Haemofiltration (causes less CVS strain than haemodialysis)
66
Which nerves cause detrusor muscle contraction?
Parasympathetic neurones from the spinal cord to the urinary bladder
67
Stimulation of which receptor would increase continence?
B3 (NA)
68
Which embryonic structure drains the bladder and what does it become?
Allantois Becomes the median umbilical ligament
69
A child has a father with polycystic kidney disease and the mother doesn't. What's the odds the child will get it?
50% (autosomal dominat)
70
A renal biopsy shows deposits of amyloid material, what's the diagnosis?
Multiple myeloma
71
A patient that's taken nebulized salbutamol has hypokalemia, why?
B2 stimulates entry of K into cells through increased cAMP of NaK
72
What's the urinary pole?
Junction between the bowman's capsule and the PCT
73
What effect does sweating have on plasma osmolarity and volume?
Osmolarity normal, volume decreased
74
What is activated to cause a decrease in GFR after haemorrhage?
Sympathetic NS
75
When does the kidney become the definitive adult kidnye?
After birth (metanephros before that)
76
What has caused an UTI if it is a coagulase-negative coccus?
Staphylococcus saphrophyticus
77
Which structures would lie on either side of the uterus on a pelvis CT?
Ureters (water under the bridge)
78
Loss of hypo-osmotic sweat will have what effect on urine osmolarity and Na clearance?
Urine osmolarity - increased (sweat is hypo-osmotic) Sodium clearance - decreased (Some Na lost in sweat)
79
What effect will sweating have on PLASMA osmolarity and volume?
Osmolarity - unchanged Volume - decreased
80
How would minimal change disease show up on light or electron microscopy?
Light microscopy - normal Electron - Effacement of podocyte foot processes
81
Why does nephrotic syndrome cause odema?
Damage to glomerulus allows protein and albumin into the filtrate
82
What effect would dehydration have on urine osmolarity and volume?
Osmolarity increased Volume decreased

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