AB-Renal Flashcards
the urinary system consists of:
kidneys
ureters
bladder
the principle functions of the urinary system:
excreting waste
regulating blood composition
normal kidney measurements:
9-12 cm long, 5 cm wide, 2.5 cm thick
a difference of 1.5-2cm in kidney lengths is concerning
the layers surrounding the kidney from lateral to medial
Gerota's Fascia Perinephric Fat True Capsule Cortex Sinus: Medulla and Renal Pyramids
The Kidneys are located in…
retroperitoneum
posterior to the peritoneum lining the abdominal cavity
the left renal A is located at…
the right renal A is located at…
4 o’clock
10 o’clock
where do kidneys develop and when do the move?
the developing kidneys ascend from the pelvis at 9 weeks and move to their normal location
Cortex
where veins, arteries, Bowman’s Capsule, and convoluted tubules are located
responsible for filtration of blood
Medulla
Responsible for absorption
Arcuate Arteries
located at the base of the pyramid
separates the medulla from the cortex
Nephrons
Functioning unit of the Kidneys
filters the blood and produces urine
2 main structures of Nephron
renal tubules
renal corpuscle
Renal Corpuscle
network of capillaries (glomerulus)
surrounded by a cup like structure (Bowman’s Capsule)
afferent arteriole:
efferent arteriole:
bring blood into glomerulus
takes blood away/leaving glomerulus
Juxtaglomerular apparatus:
structure that helps regulate blood pressure in the kidney
loop of Henle
goes down into the renal pyrimids
3 Constriction Typically seen along ureters
- where ureters leave the renal pelvis
- where it kinks as it crosses the pelvic brim
- where it pierces the bladder wall (UVJ)
Bladder
large muscular bag, the wall should measure < 3mm in trans when stretched, posterior and lat opening for the ureters to enter, anterior opening for urethra
UVJ
Ureterovesicular Junction
where ureters enter the bladder
most common site for kidney stones
vascular supply
aorta
renat arteries
segmental, interlobar, arcuate
Afferent in > Bowman’s > cleaned (Glomerulus) > Efferent to Vein
Urine Formation and Flow
nephrons remove waste thanks to the glomerulus. filtered fluid passes renal corpuscle, renal tubule. waste products pass into collecting ducts. Ducts drain into pyramids, down minor calyces into major calyces, into the renal pelvis, down ureters and into the bladder.
vascular supply to ureters
proximal- renal artery
mid- testicular/ovarian artery
distal (near bladder)- superior vesical
Lab Tests for Renal Disease
Urinalysis Hematocrit: Urine pH Hemaglobin Specific Gravity Protein Blood/Hematuria Serum Creatine Creatine Blood Urea Nitrogen (BUN)
CRF
Chronic Renal Faiure
most common cause is Diabetes
Normal Variants
Column of Bertin Dromedary Hump Junctional Parenchymal Fetal Lobulation Sinus Lipomatosis Extrarenal Pelvis Horseshoe Kidney
Renal Anomalies
Renal Agenesis Renal Hypolasia: incomplete devel. of kidney. Fewer than 5 calyces Incomplete Duplication Double Collecting system Renal ectopia polycystic
Ureterocele
cyst like enlargement of the lower end of the ureter
Bladder Pathology
diverticula
cystitis
bladder calculi
bladder tumors
Diverticula
appears as a pouch-like herniation of the bladder wall
congenital or acquired
cystitis
thickening of bladder wall, usually form infection
more common in females
bladder calculi
stone in bladder. can come from kidney of form in the bladder.
most common primary bladder neoplasm:
Transitional Cell Carcinoma (TCC)
TCC accounts of 90% of malignancies that involve bladder, renal pelvis, and ureters
Polycystic Kidney Disease
ADPKD- Autosomal Dom./Adult Polycystic disease
ARPKD- Autosomal Recessive- relatively rare
Angiomylolipoma
Most common Benign Tumor (Hamartoma)
mass composed of fat, blood vessels, smooth muscle
usually discovered incidentally
highlyechogenic
Medullary Sponge Kidney
developmental anomaly (interlobar renal calcification) occurs in medulary pyramids consist of cystic or fusiform dilation of the distal collecting ducts cause unknown
Renal Cell Carcinoma
Hypernephroma or Grawitz’s tumor
most common neoplasm-85% of kidney tumors
seen in 60-70 yr patients
Nephroblastoma
Wilm’s Tumor
most common abdominal malignancy in children
90% of patients are younger than 5yr
50% arise from adrenal medulla
2x-8x more common in patients with horseshoe kidneys
Oncocytoma
uncommon renal tumor usually benign
increased in middle aged to older patients
Renal Fungal Disease
Candida Albican
most common form of fungal urinary track infection
Pyonephrosis
contains pus -sick sick patients
pyelonephritis
inflammation of the kidney
cortex large compressing renal sinus
treated with antibiotics
Pyonephrosis and Renal Fungal Disease
have the same clinical symptoms
Hydronephrosis
Urinary Tract Obstruction (UTO)
interconnected fluid filled calyces
it is graded 1-4 for severity
Acquired causes of Hydronephrosis:
bladder tumor normal pregnancy prostate enlargement calculi pelvic mass carcinoma of cervix Retroperitneal Fibrosis neurogenic bladder
intrinsic causes of Hydronephrosis
bladder neck obstruction calculus congenital defect stricture UPJ obstruction inflamation posterior urethral vallues pyelonephritis utererocele
Nephrolithasis
Urolithiasis
stone within the kidney
stone within the urinary tract
Renal Infartion
part of the tissue under goes necrosis after cessation of blood supply
usually a result of artery occlusion.
Posterior Urethral Valves
an obstructing membrane in the posterior male urethra as a result of abnormal in utero development. It is the most common cause of bladder outlet obstruction in male newborns. The disorder varies in degree, with mild cases followed conservatively.
Staghorn Calculus
stones that are large and fill the renal collecting system
always within the Kidney
hormomes resposible or flight or flight
Epinephrine: Excelorator
Noreipinephrine: Vasoconstrictor
-produced in the medulla
sex hormone
Adrogen- male sex hormone
Estrogen- female sex hormone
controlled by the adrenocorticotropic hormone (ACTH) from the pituitary gland
hormomes responsible or flight or flight
Epinephrine: Excelorator
Noreipinephrine: Vasoconstrictor
-produced in the medulla
Adrenal Cortex
outer portion, secretes steroids that help to regulate electrolytes metabolism, carbohydrate metabolism and sex hormones
cortisol
help diminish the allergic response to inflammatory disease of the body
Conn’s Syndrome
(aldosteronism) -common
caused by excessive secretion of aldosterone due to adenoma of glomerulosa cells
clinical signs of Conn’s Synd.
muscle weakness, High Blood Pressure, Abnormal EKG
Glucocorticoids
play an important role in the metabolism of carbohydrates
primary: Cortisone and Hydrocortisone
Cushing’s Syndrome
excessive secretion of cortisol usually form a tumor of the adrenal gland (adenoma or carcinoma)
clinical signs of Cushing’s Syndrome
“moon face”
truncal obesity with pencil thin extremities
psychisatric disturbances
Hypofuntion of adrenal gland
adrenocortical insufficiency
Addison’s disease
primary causes of Addison’s Disease
autoimmune disease, TB, inflammatory process, primary neoplasm or metastises
Clinical signs of Addison’s
tissue edema
fatigue
muscle and bone weakness
hyper-pigmentation of the skin
Adrenogenital Syndrome (adrenal virilism)
increased secretion of sex hormones
Waterhouse-Friderichsen Syndrome
bilateral adrenal hemorrhage that is complicated by adrenal insufficiency
caused by sever bacterial meningococcal infection
A resistive index greater than___
it is suggested you have cancerous lymphnodes
.7
adrenal vascular supply
3 arteries supply each gland
1 vein from the hilum drains to the IVC on the right
the left drains into the left renal
primary retroperitoneal tumors
lymphoma
leiomysarcoma
fibrosarcoma
teratomas
Ormond’s Disease
Retroperitoneal Fibroisis (RPF)
unknown cause
assoc. w/ a mallignant process
may encase and obstruct ureters and vena cava
clinical signs of Ormond’s Disease
flank pain, back pain, weight loss, nausea and vomiting
3 categories of steroids
Mineralocoricoids
Glucocorticoids
Sex Hormones
