hard questiosn urinary Flashcards
units of osmolarity
osm/l
how is countercurrent multiplication achieved
active salt resorption in thick limb, passive water reabsorption in decending loop
where is uta2
thing descending limb
2 pruposes of urea recycling
less water wasted
allows urine concentratio n
stimulatory factos for vasopressin
neausea
osmolarity up, bp down
angiotensin 2
nicotine
inhibitory factors for vasopressin
low osmolarity, bp up
anp
ethanol
mechanism of adh action
binds to v2 on collecting duct
g protein signalling
protein kinase a
aquaporins to membrae
what transporters are present in the dct
na/cl co
na/k atpase
na/ca
principal cell transporters
enac
na/k atpase
effects of adh on channels
increase aps uta1 and uta3 triple transpoter na/cl enac
how is siadh treated
vaptans
outline how the kidsney produces new hco3
glutamine - 2hco3
2 nh4
out as nh3 or as nh4 via na/h transporter
what is the role of phospahte in the dct
allows h to be neutralised without wasting hco3
what is the henderson hesselbach equation
[h+] = (24 x pCO 2)/ [HCO3]
What suppresses salt intake
glutamate and serotonin in the lateral parabrachial nucleus
how does the relationship betwwen rpf and gfr plateau
high tubular sodium, increased na/cl uptake
adenosine released from macula densa
detected by extraglomerular mesangial cells
less renin
afferent smc contact
role of the b1 sympathetics
increase na uptake
stimulate renin from juxtaglomerular cells
contract afferent arteriole
how is renin stimulated
less firing from juxtaglomerular cells
what is anp
a vasodilator
how does aldosterone work
binds to mineralocorticoid receptor hsp90 dissociates dimeriss into nucleus transcription
3 effects of aldosteroen
h out
na/k
enac
symptoms oh hypoaldosteronism
syncope
low bp
salt cravings
palpitation
symptoms of hyperaldosteronism
hypertension
muscle weaknes
polyuria
thirst
3 low pressure receptors
atria
right ventricles
pulmoary vasculature
3 high pressure receptors
carotid sinus
aortic arch
juxtaglomerular apperatus
where does anp bind
guanalyl cyclase
4 effects of anp
less na in lower renin etc less b1 activity lower bp vasodilates
how does insulin cause k uptake
na/h stimulation
how do cillia on dct help k leave
increase flow stimulate pdk 1 caclium in turns on k channel k out
syndrome of hypokalaemia
gitelmans synrome
symtoms of reduced sodium secretion
oedema
pulmonary odema
hypertension
how does acidosis cause weakness
casues catabolism nad anorexia
what causes hyperkalaemia
less dct secretion
acidosis (h in k out)
symotoms of hyperkalaemia
diarrhoea
vomiting
weakness
ecg changes in hyperkalaemia
tented t waves arrythmia ventriculat tachycardia / fib asystole o waves broaden qrs broadens
how can renal failure increase risk of cvd
hyperparathyroidsim as less 1- alpha hydrox.
also phosphate retention
3 hyperparathyroidism
how is hyperkalaemia treated acutely
nahco3
insulin dextrose
k sequesterants
ways of tensting kidney function
creatinine trend with egfr
how is ckd classified
proteinuria (<3, 3-30, 30)
gfr
albumin creatinine ratio
where is access needed for dialysis
arteriovenouos fistula
central venous line
what is done to match kidney
hla
bloods
serum match
risk factors for kidney cancer
dialysis
cancer
smoking (transitional cell)
radiotherapy
features seen with plapable kiney mass
wiehgt loss
polycythemia
anaemia
tests for painless visable haematuria
history
renal function
flex cyst
imaging for suspected renal cancer
ct renal
ct chest
bone scan
how is kidney cance rstaged
t1 less than 7cm
t2 greater than 7 cm
t3 insude perinephritic fat
if unfit for kiney surgery what si given
cryotherapy
chemo for metastatic kidney cnacer
immunotherapy and tyrosine kinase inhibotors
bladdeer: investigations for painless visable haematuria
ct urogram
renal function
flex yst
risk factors for kiney cancer
smoking
schistomoniasis
catherterisation
radiotherapy
how is kidney cnacer staged
ta - papillary tis - in situ t1 - subepithelial connective tidsue t2 - muscularis propria t3 in perivesicular fat t4 distal
management for non invasive bladder cancer
bcg
intravesicular chemo
what is bcg
i mmunological agnt preventing recurrence
how is prostate cncer diagnosed
psa and mri
then cystoscopy and biopsy to stage
how is prostate cance staged
t1 a less 5% b more 5 % c found after raised psa t2 a 1/2 of 1/2 b full half c whole
t3a - broken capsule
b - in semenal vesicle
surgery for stress incontinance
colposuspension
fascial sling
periurethral bulking
risk factors for overactive bladder
caffeine drugs bmi ibs prolapse
when investigasitng overactive bladder what must be first ruled out
enlarged prostate/prolapse
drugs for overactive bladder
antimuscarinics
b3 agonists
botox
how is oveactive bladder surgically treated
augmentation cystoplasty
urinaet diversion
causes of continuous incontinance
vesicovaginal fistulae
ectooic ureter
what imaging is doen for bph
uss
what is done in bph to rule out cance r
flex cyst
why are alpoha blockers given in bph
relax neck of bladder
why are 5 alpha reductase inhibitors given
stop dheas
