Urinary System Flashcards
(52 cards)
Assess kidney function.
Filtration
Reabsorbtion
Secretion
Waste excretion Water level balancing Blood pressure regulation Red blood cell regulation Acid regulation
Describe obstructive disorders of the urinary tract.
Ureter (hydroureter)
– Calculi
– Pregnancy
– Tumour
Bladder and urethra – Tumour – Neurogenic bladder – Enlarged prostate – Urethral strictures
Neurogenic bladder
– Bladder dysfunction caused by neurological
disorders
– Types of dysfunction related to location of
nervous system lesion
- Detrusor hyperreflexia (brain & SC nerves)
- Flaccid bladder (sacral or peripheral nerves)
Obstruction to urine flow
– Urethral stricture, prostate enlargement (men)
– Pelvic organ prolapse (women)
Compare and contrast glomerular diseases (nephritic and nephrotic syndromes).
Nephrotic syndrome involves the loss of a lot of protein, whereas nephritic syndrome involves the loss of a lot of blood. Tip: Nephrotic & Protein both have an “O” which may help you remember! Nephritic: "PIG ARM" Poststreptococcal gn IgA nephropathy Goodpasture's syndrome Alport's syndrome Rapidly Progressive GN (RPGN) Membranoproliferative GN
Nephrotic: "Mum* Fights*** with Me** and i'm SAD" Membranous GN Focal segmental glomerulosclerosis Minimal change glomerulonephritis SLE nephropathy Amyloidosis Diabetic nephropathy
Distinguish between acute kidney injury and chronic kidney disease.
CAUSE
a - Event leading to kidney malfunction (dehydration,
blood loss, medications), often reversible
c - Long-term disease (high BP, DM) that damages kidney
and reduces function
SYMPTOMS
a - Fluid build up
Electrolyte imbalance
Dehydration, light-headedness, weak rapid pulse.
Symptoms reflect actual cause (eg – urinary tract
obstruction = haematuria, reduced urine output)
Sudden creatinine increased
c - May not develop until little kidney function remains.
Anaemia
Increased phosphates in blood
TREATMENT
a - Discontinue nephrotoxic meds Renal replacement
therapy (dialysis, haemofiltration).
c - First: dietary control, restrict protein, Na & fluid control,
Restrict K, manage lipids and EPO, ACE inhibitors
Later: Supportive, dialysis, transplantation
Treat anaemia: Epoetin alfa Vit D activation
Explain structural and functional abnormalities in children.
Enuresis – involuntary passage of urine beyond age of bladder control (4-5).
- Primary enuresis – Child has never been continent
- Secondary–Diurnal, nocturnal, or both
- Treatment: fluid measurement, diett herapy, drugs
(desmopressin), treat obstructive sleep apnoea,
behavioural modification therapy
Wilms’s Tumour (Nephroblastoma)
- Common primary neoplasm (3-6years)
- Affects transitional/squamous renal pelvis cells
- Solid mass–Rapid growth. Distorts kidney. Presents as
abdominal mass.
- Treatment: Surgery, chemo/radio therapy
List drugs used to treat UTIs.
Trimethoprim/Sulfamethoxazole (Bactrim) preferred treatment
Cephalexin (Keflex)
Ceftriaxone
• Location/nature of UTI determines treatment duration
• Most treated with oral medication
• Severe infections may require IV delivery
• HAI may be associated with resistance to Bactrim therefore
requires use of other drugs
Discuss neoplasia of the kidney.
- Two most common types: Renal cell carcinoma (RCC) - ~80% primary renal cancers, and transitional cell carcinoma (TCC)
- Common signs/symptoms: Haematuria, tiredness, loss of appetite, high temperature, weight loss, heavy sweating, abdominal pain.
- Causes: smoking, regular NSAIDs, obesity, family history, Hepatitis C, renal calculi, high BP
- Pathophysiology: Originates in renal tubule and renal pelvis.
- Treatment: Surgery, Chemotherapy, Radiotherapy, Immunotherapy
Discuss glomerular diseases and the differences between nephritic and nephrotic syndromes.
.
Discuss the relationship between the cardiovascular and renal systems.
Dosing should be minimal and slowly ↑ to avoid HTN and
adverse cardiovascular events associated with ↑ blood
viscosity due to excessively high haematocrit
Discuss the relationship between urinary tract infections and acute kidney injury.
.
Explain the connection between the GFR and progression to end-stage kidney disease.
GRF decreases as CKD progresses.
Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)
Explain the connection between urinary tract infection and confusion in the elderly.
.
Review RAAS
.
Review ACE inhibitors
.
List and explain the action of different types of diuretics.
.
Define kidney stones
Masses of crystals, protein or other substances that form within and may obstruct the urinary tract.
Renal Calculi Formation
Supersaturation of one or more salts
– Salt in a higher concentration than the volume able to
dissolve the salt
Precipitation of a salt from liquid to solid state
Growth into a stone via crystallization or aggregation
Type of kidney stones
Calcium oxalate or calcium phosphate, struvite, uric acid stones
Manifestations of kidney stones
– Renal colic (pain +++)
– Haematuria
– Nausea & vomiting
Treatment of kidney stones
– High fluid intake
– Decreasing dietary intake of stone-forming substances
– Stone removal
– Drug treatment
Manifestations of LUT infection
– Frequent voiding
– Nocturia
– Poor force of stream
– Intermittent urinary stream
– Urinary urgency, often combined with hesitancy
– Feelings of incomplete bladder emptying despite
micturition
Define UTI
Inflammation of the urinary epithelium caused by bacteria
Types of UTI
Lower urinary tract: bladder and urethra
Upper urinary tract: kidney (acute pyelonephritis)
Complicated UTIs: infection associated with underlying complication (calculi, IV line, prostatic hypertrophy etc)
Recurrent infections: > 3/yr, re-infection often due to sexual activity
Risk factors of UTIs
• Gender • Age • Intercourse • Indwelling urinary catheters • Obstruction and stagnation • Impaired host defences • Postmenopausal • Special populations: diabetes, pregnancy, children, elderly
