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ESA 3 steven > Urinary > Flashcards

Urinary Flashcards

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0
Q

What is the overall structure of the urinary system?

A

Each kidney connects to the bladder via a ureter. The bladder then empties via the urethra

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1
Q

What are the main functions of the kidney?

A

Regulation, excretion, endocrine and metabolism

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2
Q

Where are the kidneys located?

A

Between T12 and L3

Right kidney is slightly more caudal

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3
Q

What part of the trilaminar disc is the kidney derived from?

A

Intermediate mesoderm

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4
Q

What part of the kidney forms first, when and what does it do?

A

Pronephros - week 4 - it has no function as a kidney but extends the pronephric duct which drives the later stages

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5
Q

What is the second part of the kidney that forms, when and what does it do?

A

Mesonephros - end of week 4 - acts as an embryonic kidney and sprouts the ureteric bud for the definitive kidney. No part of the mesonephros becomes the definitive kidney

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6
Q

What is the third part of the kidney that forms, when and what does it do?

A

Metanephros - week 5 - becomes the final kidney. The collecting system is derived from the ureteric bud and the excretory system is formed from the mesoderm under the influence of the ureteric bud

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7
Q

Describe the ascent of the kidneys

A

Undergoes an apparent caudal to cranial shift as the embryo moves but the kidney does not. Laterally displaced and rotated 90 degrees

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8
Q

What is renal agenesis and how might it occur?

A

Failure of the renal system to develop. Due to the ureteric bud failing to interact with intermediate mesoderm

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9
Q

What are some potential problems with the migration of the kidneys?

A

May not cross the arterial fork and stay lower down

The kidneys ascend close together and may fuse to make a horseshoe kidney

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10
Q

What is the pathology behind an ectopic ureter?

A

Ureteric bud splits. Opening could be elsewhere

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11
Q

What are the types of cystic kidney disease?

A

Multicystic - ureter atresia

Polycystic - poor prognosis

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12
Q

How might abnormal renal vessels form and why are they problematic?

A

As the kidney ascends it creates new blood supply and destroys the old ones. Sometimes they aren’t lost however. Problematic because they are an end artery and the area they supply isn’t reached my the main renal artery

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13
Q

What does the urogenital sinus become?

A

Upper - bladder

Lower - pelvic and phallic

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14
Q

What is the difference between the male and female urogenital sinus?

A

Male gets independent openings from the ureteric bud and the mesonephric ducts. Female just gets the opening from the ureteric bud as the mesonephric duct regresses

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15
Q

What are the parts of the male urethra?

A

Preprostatic
Prostatic
Membranous
Spongy

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16
Q

Explain exstrophy of the bladder

A

Bladder is outside the abdominal wall

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17
Q

What is hypospadias

A

The urethra opens on the ventral wall of the penis not at the end of the glans

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18
Q

What is the excretory portion and the collecting portion of the kidney?

A

Excretory - nephron

Collecting - collecting duct, pelvis, ureter, bladder and urethra

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19
Q

What is the epithelium in the PCT, thin and thick limb of the loop of Henle, DCT, ureter and bladder

A 
Simple cuboidal with brush border
Simple squamous
Simple cuboidal - no brush border
Simple cuboidal - no brush border
Transitional
Transitional
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20
Q

How does the concentration of various substances in the ultrafiltrate compare to the plasma?

A

They’re the same except the ultrafiltrate has no large proteins and cells

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21
Q

What forces contribute to filtration?

A

Hydrostatic pressure in capillary
Hydrostatic pressure in Bowmans capsule
Osmotic pressure difference between capillary and tubular lumen

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22
Q

How is filtration auto regulated?

A

Myogenic response - BP increase causes afferent arteriole constriction and vice versa
Tubular glomerular feedback - if GFR increases Na+/Cl- increases in the DCT, detected by macula densa cells which release adenosine causing constriction. If it falls the prostaglandins are released causing dilation

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23
Q

What is the physiological range for GFR in men and women?

A

Men: 115-125
Women: 90-100

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24
Define clearance
Volume of plasma from which any substance is completely removed by the kidney in a given time
25
What is GFR
The glomerular filtration rate is the amount of plasma the kidney filters. It is estimated using creatinine clearance rate as creatinine is neither reabsorbed or secreted
26
What happens if a clearance rate is over 125ml/min? Or under?
Over means its being secreted | Under means its being reabsorbed
27
What is transport maximum?
The maximum transport capacity. Anything over this is not reabsorbed and excreted in the urine
28
From deep to superficial what are the layers of tissue that surround the kidney?
Renal capsule Peri renal fat Renal fascia Pararenal fat
29
Outline the passage urine takes within the kidney
Renal pyramid/minor calyx/major calyx/pelvis/ureter
30
Describe the locations of the kidneys vasculature
Right renal artery is longer and posterior to IVC. Distal to superior mesenteric Left renal vein is longer and anterior to AA
31
Where do the ureters turn anteromedially?
Ischial spine
32
Where are ureteric narrowings?
Uretopelvic junction Pelvic brim Ureters entrance to bladder
33
Why are ureters vulnerable during an ovarectomy and hysterectomy?
Pass close to ovaries and posterior to uterine artery
34
What defines the trigone?
Two ureters and urethra | Smooth wall
35
How is Na+ taken in and removed?
Food | Sweat, faeces, urine
36
What are the percentages of Na+ reabsorbed in the various parts of the nephron?
PCT - 67 LoH - 25 DCT - 5 CD - 3
37
What is Na+ reabsorbed along with in the PCT?
Glucose, amino acids, H+, phosphates, water and chloride
38
What drives water reabsorption?
Osmosis, hydrostatic forces and oncotic forces
39
How are salts and water reabsorbed in the loop of henle?
Descending limb - just water | Ascending - salts via NaKCC2 channels
40
What channels facilitate Na+ reabsorption in the DCT and the CD?
NCC ENaC
41
What four neurohormonal ways does the body control blood volume over long time periods?
Renin angiotensin aldosterone system Sympathetic nervous system Anti diuretic hormone Atrial natriuretic peptide - opposes the other 3
42
Outline the RAAS pathway
Renin converts angiotensinogen into angiotensin I which is converted to angiotensin II by ACE
43
What are the effects of angiotensin II? And the other effect of ACE?
Vasoconstrict, increase aldosterone production, increase Na+ reabsorption in the kidney! increase thirst Breakdown bradykinin thereby causing further vasoconstriction
44
How does the sympathetic nervous system affect blood volume?
Decreases blood flow and therefore Na+ excretion Increase NHE and Na pumps Increase renin production
45
How does ADH affect blood volume?
Increase Na+ and water retention
46
How does ANP affect blood volume?
Dilate afferent arteriole this increasing GFR | Inhibit Na+ reabsorption
47
What do prostaglandins do and what are they affected by?
Clinical use as vasodilators | NSAIDS stop there formation
48
What are the two types of hypertension?
Essential - unknown cause - 95% | Secondary - as a result of a primary condition - 5%
49
Explain how renal artery stenosis can cause secondary hypertension
Narrowing of the artery reduces perfusion and therefore increases the RAAS system
50
What are some adrenal causes of hypertension?
Conn's syndrome Cushings Pheochromocytoma
51
How do you treat hypertension?
``` ACE inhibitors Diuretics Vasodilators Beta blockers Exercise, diet, reduce Na+ and alcohol intake ```
52
What happens to plasma osmolarity if water intake < excretion
Increases
53
What senses plasma osmolarity?
Hypothalamic osmoreceptors
54
Where is ADH released from, what stimulates it and what is its effect?
Posterior pituitary An increase in osmolarity Increase water reabsorption and slightly increases salt reabsorption
55
What is the ADH mechanism of action?
ADH-->G protein-->ATP->cAMP-->PKA-->insert aquaporin into apical membrane
56
What is SIADH
Syndrome of inappropriate ADH secretion | ADH isn't inhibited by low osmolarity so excess water is retained causing hyponatremia
57
Outline the basis of the corticocapillary osmotic gradient
Filtrate enters the descending limb Water moves out and into the vasa recta which remove it. This concentrates the filtrate Ascending limb pumps out salts creating a gradient for water
58
What are some causes of hypercalcaemia and symptoms? How is it treated?
Primary hyperparathyroidism, (non)haematological malignancies, PTHrP Stones, depression, constipation Increase hydration and diuretics to increase excretion Bisphosphatase stop inhibit bone breakdown
59
What is the effect on the body of alkalaemia?
Parasthesia and tetany
60
What is the effect on the body of acidaemia?
Affect muscle contractility, glycolysis and hepatic function
61
How does the kidney respond to acidaemia?
Recover all HCO3- and make more using the CO2 produced by the kidney. The H+ is excreted in urine
62
How is acid secretion in the urine kept safe?
Buffered by phosphate | Attached to ammonia
63
Explain the anion gap
If HCO3- is replaced but not by Cl- | It increases if metabolic acid is produced
64
What is the kidneys response to alkalosis and why might this not always be possible
Excrete HCO3- | Because if there is volume depletion HCO3- is recovered along with Na+
65
What is the function of ICF potassium?
Maintain volume, regulate pH, control enzymes, DNA/protein synthesis, cell growth
66
What is the effect on the cell membrane if ECF K+ increases?
Depolarise the membrane as it's less negative inside
67
Where in the nephron is the controllable portion of K+ secretion?
Principal cells
68
What factors increase K+ excretion and how?
Aldosterone - increase Na pumps and ENaCh Hyperkalaemia - increase aldosterone Alkalaemia
69
What increases K+ movement from ECF to ICF?
High concentration, insulin, Catecholamines, aldosterone, alkalosis
70
What is the effect of hyper and hypokalaemia on the heart?
Hypo - hyperpolarise cell making more excitable | Hyper - depolarise cell making less excitable as fewer Na+ channels open
71
What factors increase chance of a UTI?
Shorter urethra - females Obstruction - prostate, pregnant, stone, tumours Neurological - incomplete emptying Ureteric reflux - ascending infection
72
What factors enable bacteria to infect? What is the usual bacteria?
Fimbriae to attach Urease break down urea for favourable environment Capsule Coliforms like E. coli gram -ve
73
What are symptoms of UTIs?
Lower - fever, dysuria, frequency, urgency | Upper - fever, loin pain
74
What investigations do you do for a UTI?
Uncomplicated - don't culture Complicated (male, child, recurrent, pregnant) - mid stream urine sample/collection bag/catheter - urine dipstick and cultures
75
When is it not useful to use dipstick tests?
Acute uncomplicated women Men with severe Catheters Older
76
How are UTIs treated?
Fluids Treat underlying disorder 3-5 day course of trimethoprim Pyelonephritis - 14 days co amoxiclav
77
How and when should UTIs be prevented?
3+/year and no treatable cause | Trimethoprim prophylactic
78
Why might you have sterile pyuria?
Can't culture UTI due to antibiotics, chlamydia, TB, appendicitis
79
Define dieresis and when are diuretics used?
Increased formation of urine by kidney | When water and Na+ retention causes ECF expansion
80
What are the main types of diuretic, where do they work and on what channel?
Loop diuretics - loop of Henle - NaKCC Thiazides - early DCT - NaCl Spironolactone - CD/late DCT - inhibit aldosterone Amiloride - CD/late DCT - ENaC
81
When might loop diuretics be used?
Heart failure, nephrotic syndrome, renal failure, hypercalcaemia Very potent
82
When might thiazides be used?
Hypertension | Less potent
83
When are K+ sparing diuretics used?
Hyperaldosteronism, cirrhosis
84
Explain how congestive heart failure causes oedema
Increase venous pressure --> oedema | Decrease CO --> RAAS --> fluid retention --> oedema
85
Explain how nephrotic syndrome and cirrhosis lead to oedema
Decrease protein --> decrease oncotic pressure --> oedema
86
Explain the mechanism behind loop diuretics causing hypokalaemia
Increase Na+ and H2O excretion means a faster flow and more K+ washed away. Blocking NaKCC means less K+ reabsorbed
87
What else has diuretic effects and why?
Alcohol - decrease ADH Coffee - increase GFR and decrease Na+ reabsorption Diabetes
88
What are the three layers of the Detrusor muscle and the function of this arrangement?
Inner longitudinal Middle circular Outer longitudinal Strength in all directions
89
What are the internal and external urethral sphincter made of?
Smooth muscle - physiological sphincter and main continence muscle Pelvic floor muscles - anatomical sphincter under somatic control
90
What is the innervation to the Detrusor muscle and the urethral sphincters?
Detrusor - parasympathetic - pelvic nerve - contract Sympathetic - hypogastric nerve - relax Internal urethral sphincter - sympathetic - hypogastric - contract External urethral sphincter - somatic - pudendal - contract
91
Outline the voiding reflex pathway
Brain micturition centres --> spinal micturition centres --> parasympathetic neurones --> Detrusor contracts --> cerebral cortex stimulates external urethral sphincter to relax
92
Outline how the bladder stores urine
Distend so pressure doesn't increase Sympathetic via hypo gastric cause the Detrusor to relax and internal urethral sphincter to contract Pudendal nerve contracts external urethral
93
Explain the main types of incontinence
Stress urinary incontinence - leakage on exertion (sneezing) Urge urinary incontinence - urge to urinate Mixed urinary incontinence Overflow urinary incontinence - bladder struggles to empty so overflow causes a leak
94
What are risk factors for incontinence?
Weak pelvic floor muscles - childbirth
95
How is urinary incontinence managed?
Modify fluids, stop smoking, lose weight, reduce caffeine Pelvic floor muscle training Bladder training Anticholine and botulinum to reduce Detrusor contraction Women - vaginal tape Men - artificial sphincter
96
What is acute kidney injury?
An abrupt decline in GFR | <0.5ml urine 6 hours
97
What are the causes of acute kidney injury?
Pre renal Intrinsic renal Post renal
98
Explain pre renal causes of AKI
Reduced perfusion - hypovolaemia, systemic vasodilation, cardiac failure Compensation overwhelmed - NSAIDS constrict afferent arteriole, ACE inhibitors dilate
99
Explain acute tubular necrosis
Ischaemia, nephrotixins, sepsis cause | Cells can't reabsorb salts and water so fluid resuscitation can overload
100
Contrast pre-renal and ATN when diagnosing
In pre-renal Na+ is actively reabsorbed so low urinary Na+ | ATN it is higher >20mmol
101
Name some nephrotoxins
Myoglobin, bilirubin | ACEi, amino glycosides, NSAIDS, gentamicin
102
What is rhabdomyolysis?
Muscle necrosis releasing myoglobin. A crush injury | Elderly people, unconscious drug users, wars
103
Explain post renal failure
An obstruction such as stones, tumour, prostate, stricture
104
What are some risk factors for AKI?
``` Old Female Heart/liver disease Diabetes Sepsis Ill Trauma ```
105
How is AKI treated?
``` Treat underlying cause Reduce Na+ and water Ca2+ gluconate and reduce K+ Sodium bicarbonate Dialysis ```
106
What is nephrotic syndrome?
A non specific disorder that damages the kidneys and leak protein Proteinuria, hypoalbuminaemia, oedema
107
What is nephritic syndrome?
Collection of signs associated with disorders affecting the kidneys - small pores in podocytes allowing protein and RBCs to enter
108
Differentiate between nephrotic and nephritic syndrome
Nephritic - abrupt onset, raised blood pressure, red cell cast Nephrotic - more oedema and proteinuria than nephritic. Low BP
109
What are some risk factors for prostate cancer?
Age, family history, ethnicity (black>white>Asians)
110
What are some problems due to screening?
Overdiagnosis and treatment Reduced quality of life due to treatment Costs Other causes for positive test - infection, inflammation and large prostate all cause raised PSA
111
How might a patient with prostate cancer present?
Asymptomatic Urinary symptoms Bone pain Haematuria
112
What investigations are done if prostate cancer is suspected?
Digital rectal exam, serum PSA
113
How is prostate cancer treated?
Prostatectomy, surveillance, radiotherapy, hormones
114
Suggest some causes for haematuria
Cancer - renal/transitional/bladder/prostate | Stones, infection, inflammation, prostate hyperplasia
115
Define chronic kidney disease
Irreversible, sometimes progressive loss of renal function over a period of months/years
116
What are some causes of chronic kidney disease?
Glomerulonephritis, pyelonephritis, polycystic kidney disease, hypertension, diabetes
117
What are the pros and cons of haemodialysis?
Effective, 4/7 days free, less responsibility Fluid/diet restriction, limit holiday, access problems, CVS instability
118
What are the pros and cons of peritoneal dialysis?
Done at home, done by self, mobility, less food/fluid restriction Frequent 4x a day, peritonitis, responsibility
119
What are the pros and cons of a renal transplant?
Restore renal function and improved survival Limited supply, operation risk, immunosuppresion

ESA 3 steven (5 decks)

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