Clinical Applications in the Renal System

Question 1

The ureters run directly over what muscles?

Answer 1

psoas muscle

Question 2

where do renal lymphatics drain?

Answer 2

renal lymphatics drin the capsule and parenchyma. they flow into the pre-aortic nodes before traveling up the throacic duct and into the subclavian vein.

Question 3

what is the role of renal lymphatics?

what is the critical component of lymphatic drainage from the urinary system?

Answer 3

they aid in the clearance of waste products of the kidneys and clearance of electrolytes, infectious products, or antibiotic products

the synchornous motion of the thoracic and pelvic diaphragms is a critical component of lymphatic drainage.

Question 4

what are some consequences of imaired lymphatic flow?

Answer 4

impaired lymphatic flow increases oncotic interstitial pressure and disrupts the countercurrent exchange eventually leading to a decreased ability to concentrate urine properly.

this ends up with an increased risk of kidney dmage because of ureteral obstruction

Question 5

What is the sympathetic innervation for:

kidney:

Ureters:

Bladder:

Urethra:

Answer 5

What is the sympathetic innervation for:

kidney: T10-L1

Ureters: T10-L1

Bladder: T10-L1

Urethra: L1-L2

Question 6

What effect does INCREASED sympathetic tone have on the kidney?

Answer 6

Increased sympathetic tone on the kidney

1. increases the sodium transport across the tubule walls and directly increases the release of renin from he JGA
2. vasoconstriction of afferent arterioles → decreased GFR → decreased urine volume

Question 7

What is the effect of chronic sympathetic stimulation on the kidney?

Answer 7

Chronic sympathetic stimulation results in retention of fluid and causes chronically elevated arterial pressure and essential hypertension

Question 8

What is the parasympathetic innervation to:

Kidney

Ureters:

Bladder:

Urethra:

Answer 8

Parasympathetic innervation to

kidney: vagus

Ureters: proximal 2/3 of ureters= vagus/ distal 1/3 is S2-S4

bladder: pelvic splanchnic nerves S2-4
urethera: S2-S4

Question 9

What is the effect of INCREASED Parasympathetic tone on:

1. kidney:
2. ureters:
3. Bladder:
4. Urethera:

Answer 9

INCREASED Parasympathetic tone on:

1. kidney: not known
2. ureters: increased peristalsis
3. Bladder: parasympathetic stimulation ocurs during voiding. Increased bladder wall tone (excitatory activity to the detrusor muscle and inhibitory on the trigone)
4. Urethera: relaxation of the urethera

Question 10

What nerves transmit the sense of bladder fullness?

Answer 10

visceral afferents transmit impulses to the L1-L2 spinal nerves

Question 11

where does the voluntary relaxation of the external urethral sphincter come from?

Answer 11

impulses from S2-S4 is parasympathetic along with sympathethc relaxation to the sphincter

Question 12

What is the effect of DECREASED parasympathetic tone to the GU:

Answer 12

decreased parasympathic tone results in

incomplete emptying of the bladder

impotence

tightening of internal urinary sphincter

Question 13

UTI

1. osteopathic considerations:
2. treatment:

Answer 13

1. osteopathic considerations for a UTI: rule out pubic symphysis and pelvic floor somatic dysfunction. Infection can result in incomplete emptying, reflux, and loss of normal ureteal peristalsis (increased sympathetic tone)
2. treatment:
   
   1. appropriate antibiotics
   2. treatment of pelvic floor somatic dysfunction
   3. Treatment of T10-L2 and SI joint

Question 14

Nephrolithiasis:

1. sympathetic/parasympathetic innervation
2. treatment:

Answer 14

Nephrolithiasis:

1. innervation:
   
   1. sympathetic: T10-L1
   2. parasympathetic innervation: vagus and S2-S4 (upper and lower ureters)
2. treatment: inhibit paraspinals T10-S2 (decrease ureteral spasm and aid in movement of stone), treat chapman’s points, improve lymphatic drainage

Question 15

Pyelonephritis:

1. Definition:
2. Innervation:
   
   1. sympathetic:
   2. parasympathetic:
3. Treatment:

Answer 15

Pyelonephritis:

1. Definition: an upper urinary tract infection involving the renal parenchyma and collecting. Can become chronic
2. Innervation:
   
   1. sympathetic: T10-L1/2
   2. parasympathetic: vagus
3. Treatment: antibiotics. OMT to T10-L2 and OA. Decrease sympathetic tone and reflex to involved areas

Question 16

Glomerulonephritis:

1. definition:
2. Sympathetic involvement:
3. Treatment

Answer 16

Glomerulonephritis:

1. definition: immunologic mechanism trigger inflammation and proliferation of glomerular tissue which ultimately refults in damage to the basement membrane, mesangial, or capillary endothelium.
2. Sympathetic involvement: T10-L1
3. Treatment: decrease sympathetic tone and limit reflex activity

Question 17

Prostatitis:

1. Definition
2. Innervation
   
   1. sympathetic
   2. parasympathetic:
3. Treatment:

Answer 17

Prostatitis:

1. Definition: inflammation within the prostate
2. Innervation
   
   1. sympathetic: T10-L2
   2. parasympathetic: S2-S4 and also T
3. Treatment: OMT to T12-L2 and S2-S4. This allows for improved penetration of antibiotics to the prostate and enhances the body’s natural defenses.

Question 18

Benign Prostatic Hypertryphy:

1. definition:
2. sympathetics:
3. treatment:

Answer 18

Benign Prostatic Hypertryphy:

1. definition: enlargement of the prostate that causes lower urinary tract obstruction
2. innervation
   
   1. sympathetics: L1-L2, T10-L1 because of the effects on the bladder
   2. Parasympathetics: S2-S4
3. treatment: OMT directed at pelvic floor muscles and diaphragm. Additional OMT to T10-L1 to reduce sympathetic tone.