case 8 - the kidney and urinary tract Flashcards
how many glomeruli do normal people have
1-2 million in each kidney
how many glomeruli do hypertensive people have
0.5-1 million
what modify the glomerular ultrafiltrate
the nephron tubules and collecting ducts
when is oedema especially severe
when severe proteinuria and hypoalbuminaemia are present
what is this called
nephrotic syndrome
what does blood and protein in the urine indicate
glomerular disease
what do u see on a cardiogram if someone has hyperkalaemia
peaking T waves
what does the renal tract include
the kidney, ureter and urinary bladder
what is the bladder
The bladder is a low pressure reservoir which intermittently and completely expels urine per urethra
what does the bladder contain
smooth muscle bundles under autonomic control
what makers the urothelial layer watertight
uroplaquin
what are the steps in the cycle of ureteric peristalsis
Relaxation
Begin contracting
Wave halfway down
Wave near bladder
what happens when the pacemaker at the top of the ureter doesnt work
Pacemaker at top of ureter and when this doesn’t work you get a build up of urine at top of ureter called hydronephrosis
what are the key clinical symptoms of LRT disease
dysuria
Frequency of micturition
Incontinence of urine
Poor urinary store
Haematuria
Pain (caused by acute bladder outflow obstruction, renal colic, urosepsis)
what can primary disease of the lower tract cause
secondary kidney failure mediated by impairment of urine flow
what are the two ways of classifying kidney and urinary tract diseases
congenital malformations
Acquired (non-tumour)
Acquired (tumours)
genetic causes
Environmental causes
what does hypoplasia mean
too few nephrons
what is dysplasia
undifferentiated kidney sometimes with cysts
what is agenesis
absent kidney
what is the most commonly mutated gene in kidney disease
HNF1B
what is prune belly syndrome and what is it a mutation in
Prune belly syndorme seen in children - unable to enter their bladder and can be caused by a mutation in myocardin - which is involved in the formation of smooth muscle
what are the pre renal causes if acquired kidney failure
Shock (e.g. massive blood loss, septicaemia)
►Cardiac and Liver failure
what are the intrinsic kidney disease causes of acquired kidney failure
Glomerular disease (e.g. Alport syndrome, diabetes mellitus and immune-mediated glomerulonephritis)
Tubular disease (e.g. pyelonephritis, autosomal dominant polycystic disease, nephrotoxins)
what are the post renal causes of acquired kidney failure
►Urinary flow impairment (e.g. stones, tumours and dysfunctional bladders); need to block both kidneys.
what is glomerular disease - diabetes mellitus
Early on, glomerular filtration rate is actually increased… without treatment, there follows a progressive decline in renal function with sclerosis (scarring of glomeruli)
what do therapies include
Therapies targeting the cyst epithelial in PKD - vasopressin receptor antagonists
what are the kidney cancer tumours found in children
Children - Wilms tumours
what are the kidney cancer tumours found in adults
clear cell carcinomas
where do bladder cancers arise
the urothelium
where do prostatic cancers metastasise to and how does this differ from other cancers
Prostate cancer usually metastasise to bones and called sclerotic metastases and not lytic like many other cancers
