Week 109 - Renal Colic Flashcards
(41 cards)
In L/min what is the approximate Renal blood flow?
1.5L/min
Fluid and electrolyte balance takes place by the glomerulus and tubular resorption, what are the four controlling mechanisms?
ADH, Aldosterone, Macula Densa and Renin.
How does ADH control resorption of water?
- ADH is secreted by the posterior pituitary gland.
- It binds to Vasopressin II receptors on the wall of the collecting duct.
- This triggers a cascade; Adenylate Cyclase converts ATP>cAMP, the increased levels of cAMP trigger aquaporin-2 channels to move into the membrane allowing for greater reabsoprtion.
What triggers the secretion of ADH and where from?
• From the posterior pituitary gland, due to an increase in plasma osmolality or a decrease in plasma volume. And stimulation by Angiotensin II.
Where are the pressure receptors that detect reduced plasma volume?
In the carotids, veins and atria.
What receptors detect change in plasma osmolality and where are they located?
Osmoreceptors in the hypothalamus.
Where is Aldosterone secreted from and what causes it’s secretion?
Adrenal Cortex, Increased plasma levels of Angiotensin II and III and stretch receptors in the atria of the heart.
What does Aldosterone do?
It is the principle regulator of salt and water balance in the body. It binds to receptors in the distal tubule and collecting duct and upregulates the Na/K pumps, pumping K into the urine and Na into the blood, it causes a retention of water.
Where is the macula densa and what does it detect?
Specialised cells in the walls of the distal tubule, detect Na levels in the distal tubule.
When macula densa detects a low Na level what two actions does it take?
- Dilates afferent arterioles, decreasing resistance of the afferent arterioles, causing greater flow to the glomerulus.
- Releases prostaglandins that cause juxtaglomerular cells to release Renin.
Where is Renin synthesised, stored and secreted?
Juxtaglomerular cells that are mainly in the walls of the afferent arterioles of the nephron.
Renin is secreted for juxtaglomerular cells in response to which 3 stimuli?
1) A decrease in arterial blood pressure detected by baroreceptors.
2) Protaglandins secreted by the macula densa.
3) Sympathetic stimulation.
What does Renin do?
Renin, also known as angiotensinogenase, hydrolyses angiotensinogen into angiotensin I.
What converts angiotensin I into angiotensin II?
Angiotensin-converting Enzyme (ACE)
What is ACE and what does it do?
Angiotensin-converting Enzyme, converts angiotensin I into angiotensin II.
Where is ACE secreted from?
Mainly from the lungs but also the kidneys.
What are the five actions of Angiotensin II?
1) Increase in sympathetic activity.
2) Tubular Na,Cl resorption; K excretion; water retention.
3) Increased secretion of Aldosterone.
4) Vasoconstriction > Increased blood pressure.
5) Increased ADH secretion.
There are three types of significant Haematuria what are they?
1) Visible haematuria
2) Symptomatic non-visible haematuria (sNVH)
3) Persistant asymptomatic non-visible haematuria.
What are the initial investigations for Haematuria?
1) Exclude UTI or other transient causes.
2) Plasma creatinine/ eGFR
3) Proteinurea
There are three types of patient that should have a urological referral with haematuria, what are they?
1) Any patient with visible haematuria.
2) Any patient with sNVH.
3) Patient >40yrs with aNVH.
What are some of the causes of haematuria?
Stones, UTI, Trauma, Urothelial Malignancy, Benign prostate hypertrophy, Bladder Tumour, Prostate cancer, Kidney tumours, Nephrological causes.
What is the most common type of Kidney cancer and how much does it account for?
Renal Cell Carcinoma, 85%.
What is a definition of Renal Colic?
‘Kidney Pain’ begininning in the abdomen and often radiating to the hypochondrium or groin. Is often ‘colicky’ due to peristalsis but can be constant.
What initial investigations (excluding imaging) should be performed for renal colic?
Urine dipstick, Midstream urine for microscopy and culture, Blood tests, Pregnancy test (if of reproducing age.)
