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Flashcards in Urinary System Deck (62)
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1

What is the major culprit for stubborn UTI?

Obstruction to urination

2

List functions of Kidneys

Excrete waste in urine
Regulate blood volume
Regulate blood composition
Regulate blood pH, osmolarity & glucose
Regulate blood pressure
Release erythropoietin
Participate in Vitamin D synthesis (calcitriol)

3

How does the KD regulate blood pressure?

secrete renin
adjust renal resistance

4

The KD is located __________ and is protected by ______ ribs and by layers of ______ and ________

above the waist between peritoneum and; posterior wall of abdomen
11th and; 12th
adipose tissue
fascia.

*extend from T12-L3

5

Describe the path of urine drainage in the KD (level of nephron)

Papillary duct in renal pyramid

minor calyx

major calyx

renal pelvis

ureter

6

The KD receives ___% of resting cardiac output via renal arteries

25%

7

In the KD nephron, __________are formed between the afferent and efferent arterioles. Efferent arterioles give rise to _______ and ______

glomerular capillaries
peritubular capillaries
vasa recta

8

Glomerular filtration is where ________ occurs
Peritubular capillaries function to ________
Vasa recta supplies _________

filtration of blood

carry away reabsorbed substances from filtrate

nutrients to renal medulla w/o disrupting its osmolarity

9

KD has over ______ nephrons composed of a _______ and ______

1 million

corpuscle

tubule

10

80-85% of nephrons are _____ nephrons. The remaining 15-20% are _______ nephrons.

cortical

juxtamedullary

11

In Juxtamedullary nephrons, the renal corpuscles are located ________ and long loops of Henle extend into ________ enabling _________ of dilute or concentrated urine.

close to medulla
deepest medulla
excretion

12

The Juxtamedullary nephron is the structure where ______ makes contact w/ ________ of loop of Henle. The ______ is the thickest part of the ascending limb. Juxtaglomerular cells are modified _______ in arteriole.

afferent arteriole
ascending limb
macula densa
muscle cells

13

Dysfunction of KD nephrons is not evident until function declines by ________

25% of normal

14

Nephrons and collecting ducts perform 3 basic processes. List them

glomerular filtration
tubular reabsorption
tubular secretion

15

Rate of excretion in renal physiology is defined as ________

rate of filtration + rate of secretion - rate of reabsorption

16

Glomerular filtrate is produced by _________
Filtering capacity is enhanced by _________

blood pressure

thinness of membrane, large surface area of glomerular capillaries, glomerular BP

17

Glomerular blood pressure is high due to ______

small size of efferent arteriole

18

In glomerular filtration the net filtration pressure is defined as _________

Glomerular blood hydrostatic pressure - capsular hydrostatic pressure - blood colloid osmotic pressure

19

KD nephron must reabsorb ____% of glomerular filtrate. Most tubular reabsorption occurs mostly in _______

99%

proximal convoluted tubules

20

Distal convoluted tubule is major site where ______ hormone stimulates reabsorption of ____. It is also where _____ are reabsorbed via symporters

parathyroid
Ca2+
Na+, Cl-

21

The best index of GFR is ________

serum creatinine

22

BUN stands for __________. It reflects the cumulative amount of ________ in _________

Blood Urea Nitrogen
ammonia
blood compartment

23

Specific gravity of urine can be defined as ______. It indicates ability of ________ to _________

the osmolarity of urine relative to the osmolarity of plasma

kidney tubules to concentrate urine

24

Normal urinary output is _____ per 24 hours. Minimum urinary output is _____ per one hour

700-2000mL

30-55mL

25

Excess H+ ions are deposited into the urine during which stage of urine formation?

Secretion

26

How is bicarbonate ion reabsorbed into blood?

Na+ antiporters reabsorb Na+ and secrete H+ into tubular fluid. For each H+ secreted one filtered bicarbonate ion returns to blood via facilitated diffusion

27

List normal constituents of urine

urobilinogen, electrolytes, ammonia, hormones, creatinine

28

List abnormal constituents of urine

proteins, glucose, formed elements of blood

29

Normal pH range of urine is _________

4.5-8

30

What are general etiologies of:
1) respiratory acidosis?
2) metabolic acidosis?
3) respiratory alkalosis?
4) metabolic alkalosis?

1) Lungs not exhaling
2) Kidney not filtering/reabsobing
3) hyperventilation
4) persistent vomiting/diarrhea

31

List signs and symptoms of urinary system disorders

dysuria, hesitancy of urination, urgency of urination, hematuria, hematospermia, albuminuria, edema, hyperlipidemia, turbid urine, excessively dilute/dark urine, pruritus, anemia, abnormal respiration pattern, elevated levels of creatinine/BUN

32

Dysuria generally indicates ________
Hesitancy of urination generally indicates _______

inflammation

obstruction!!

33

Hyperlipidemia in urinary system disorders generally indicates __________
Anemia in urinary system disorders generally indicates _______
Pruritus in urinary system disorders generally indicates ________

lipoproteins leaking through Kidney

Kidney not secreting EPO

Kidney not excreting bile salts

34

List the modes of inheritance for:
1) Adult Polycystic Kidney Disease
2) Childhood Polycystic Kidney Disease

1) autosomal dominant

2) autosomal recessive

35

Describe pathogenesis of ADPKD

Formation of cysts in Kidney -> cysts accumulate fluid, enlarge, separate from nephron, compress neighboring renal parenchyma (nephrons), progressively compromising renal function

36

List clinical presentations of ADPKD

abdominal discomfort, hematuria, UTI, hypertension, abdominal mass, elevated serum creatinine, cystic kidneys on imaging studies

37

Complications of ADPKD are ________

cerebral hemorrhage from ruptured intracranial aneurysm, renal cell carcinoma, nephrolithiasis, abdominal hernia, inguinal hernia

38

List diagnostic methods for ADPKD

30+ years- renal ultrasonography
less than 30 years - CT, MRI

39

List treatment methods of ADPKD

palliative care, hypertension medication, antibiotics for infected kidney cysts, kidney transplantation, medication to inhibit renin-angiotensin system

40

Major risk factors for urolithiasis/nephrolithiasis are ______

hypercalcuria, hypercalcemia (parathyroid), hyperthyroidism, excessive/deficient intake of calcium supplements and oxalates, excessive Vitamin C supplementation, increase in global temperatures, Crohn's disease, malignancies, persistent UTI, excessive protein-based diet, metabolic acidosis

41

The most common kidney/urinary stones are ______ . What type of stones are radiolucent?

Calcium urinary stones (calcium oxalate)

Uric Acid stones

42

What type of stones are radio-opaque? What is the composition of struvite stones? What is the origin/etiology of struvite stones?

-calcium urinary stones

- magnesium-ammonium-phosphate

- urea-splitting bacteria in UTI

43

Uric acid stones are associated with what disease?

gout

44

What does pruritus indicate?

Excessive bile salts from LV or KD failure/issues.

45

T/F blood in urine is not a red flag for referral

False - could indicate cancer!

46

The kidneys are situated at the level of what vertebrae?

T12 - L3

47

Glomerulonephritis is ____________

Pyelonephritis is ____________

- auto-immune inflammation of glomeruli

- UTI affecting Kidney where all of nephron is inflamed except glomerulus

48

In children with frequent UTI, one should suspect the following causes: ____________

- anatomical abnormality
- poor hygiene
- immune deficiency
- sexual abuse

49

UTI in the elderly can present with ________ symptoms such as __________

How to treat an elderly patient with asymptomatic bacteriuria? Why?

psychiatric

agitation, anxiety

no treatment, treatment wiht antibiotics can later lead to antibiotic resistant pneumonia

50

UTI in pregnancy is an emergency situation because ________

UTI can ascend to kidney causing preeclampsia and possible miscarriage

51

List clinical presentation of UTI

- urinary frequency
- urgency
- dysuria
- lower abdominal and flank pain
- urethral discharge (mostly males)
- systemic symptoms (fever, nausea, vomiting, chills)

52

The most common renal cancer is _______. It is most common in what population?

Renal Cell Carcinoma

males aged 30-50's

53

List risk factors for renal cell carcinoma

smoking, obesity, ADPKD, acquired cystic KD disease in dialysis patients, radiopaque contrast dyes, asbestos exposure, cadmium exposure, leather tanning exposure, petroleum product exposure

54

List risk factors for Urinary Bladder cancer

smoking, chemotherapy, UB stones, industrial chemical exposure

55

The most common cause of acute renal failure is ________

acute tubular necrosis

56

Major causes of acute tubular necrosis are _______. Describe the pathogenesis of acute tubular necrosis

ischemia, toxins

Ischemia or toxins cause tubular damage with inability to secrete and reabsorb filtrate of glomeruli

57

The clinical syndromes of glomerulonephritis are known as _______.

1) Nephritic syndrome

2) Nephrotic syndrome

58

Describe etiology of Nephritic Syndrome and clinical presentations

- damaged fenestration membranes of glomerul

- presents with hematouria, HTN, slight proteinuria, periorbital edema, petechial skin hemorrhage, fever, flank pain, malaise

59

Describe etiology of Nephrotic Syndrome and clinical presentations

- damaged fenestration membranes and basement membranes of glomeruli

-presents with severe proteinuria, generalized edema, hyperlipidemia, loss of albumins in blood compartment (hypoalbuminemia)

60

Post-streptococcal glomerulonephritis results in ______ syndrome

nephritic

61

What are some paraneoplastic effects of renal cell carcinoma?

secondary absolute polycythemia - excess EPO

HTN - excess renin

62

Renal colic is a type of abdominal pain caused by ______. Describe the pain.

kidney stones

extreme flank pain often radiating to the hypochondrium or the groin