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1
Q

What muscles does the kidney rest on?

A

Quadratus lumborum, psoas major

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2
Q

What artery blocks the ascension of the kidneys in the “horseshoe kidney” deformity?

A

IMA

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3
Q

What vertebral level do the kidneys start from and end?

A

Left - T11 - L2

Right - T12 - L3

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4
Q

What do the ureters pass on the way down to the bladder? (2 things)

A

Common iliac bifurcation AND
Men: Vas deferens
Women: Uterine artery

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5
Q

What is the standard GFR? What is its units?

A

125ml/min

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6
Q

Name 5 Kidney functions

A
  • Control extracellular fluid concentrations/electrolyte balance
  • Produce EPO/Renin
  • Manage blood pH
  • Metabolise Vitamin D
  • Excrete waste products
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7
Q

What are the components of the trigone?

A
  • Internal ureteric sphincters

- Internal urethral meatus

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8
Q

What is the bladder attached to the umbilicus via?

A

The Urachus

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9
Q

What is the definition of Osmolality?

A

The number of molecules per kilogram of solvent

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10
Q

What is the definition of Osmolarity?

A

The number of molecules per litre of fluid

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11
Q

What is an Osmole?

A

A molecule which does not cross the membrane freely

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12
Q

Where does secretion into the PCT come from?

A

Peri-tubular capillaries

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13
Q

What is the apical side of the lumen?

A

The inside

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14
Q

What is the basolateral side of the lumen?

A

The outside

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15
Q

What transporter is most common within the kidney on the basolateral side?

A

NaK/ATPase

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16
Q

What transporter is very useful in the PCT?

A

NaK/ATPase

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17
Q

What type of cells does the PCT have?

A

Simple Cuboidal with Brush Border

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18
Q

Name 3 things that are obligately reabsorbed in the PCT

A
  • Glucose
  • Amino acids
  • H+
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19
Q

Name 3 apical channels in the PCT

A

Na-H exchanger
Na-Glucose exchanger
Na-AA exchanger

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20
Q

What is the dominant anion in the PCT by the end?

A

Cl-

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21
Q

What channels are in the Loop of Henle?

A

NKCC2
ROMK
Na/KATPase

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22
Q

How would you describe the fluid exiting the Loop of Henle?

A

Hypotonic

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23
Q

What are the main channels in the DCT?

A

NCC (NaCl)

ENaC

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24
Q

What are the main channels in the CD?

A

ENaC

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25
Q

Name 3 Pre-Renal causes of AKI

A

Cardiogenic shock, Hypovolaemic shock, Normovolaemic shock

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26
Q

Name 3 Intra-renal causes of AKI

A

Nephrotoxic drugs:

  • NSAIDs (ACE if already bad)
  • Rhabdomyelosis (myoglobin)
  • Acute glomerulonephritis
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27
Q

Name 3 Post-renal causes of AKI

A
  • Renal calculi
  • Bladder cancer
  • BPH
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28
Q

Name 4 causes of CKD

A
  • Diabetes
  • Hypertension
  • Obesity
  • Age
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29
Q

What does a urine dip test for? (7)

A

pH, nitrites, leucocytes, blood in urine, glucose, ketones, protein

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30
Q

What does the Kidney develop from embryologically?

A

Urogenital ridge of the intermediate mesoderm

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31
Q

What germ layer does the kidney develop from?

A

Intermediate mesoderm

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32
Q

Name the 3 stages of kidney development

A
  • Pronephros
  • Mesonephros - sprouts ureteric bud
  • Metanephros
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33
Q

What does the kidney do after development?

A

Undergoes caudal-cranial shift - L4-T11

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34
Q

What separates the urogenital sinus from the hindgut?

A

The urorectal septum

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35
Q

What would a low amniotic fluid in a pregnant woman suggest?

A

Renal agenesis (bilateral)

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36
Q

What is Hypospadias?

A

Urethral fold fusion error - hole on underside of the penis

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37
Q

Name 3 imaging modalities used to check the kidney?

A

US guided biopsy
CT
IV angiogram

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38
Q

Name the sequential naming progression of the kidney blood supply to the nephron

A
  • Segmental
  • Interlobar
  • Arcuate
  • Interlobular
  • Afferent
  • Efferent
  • Peri-tubular capillaries
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39
Q

Describe the 3 layers of the glomerular filter

A
  • Endothelial layer with fenestrations
  • Glomerular basement membrane
  • Podocytes with pedicels
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40
Q

What charge is the glomerular basement membrane and what does this help with?

A

Negative - repels negatively charged proteins to prevent proteinuria

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41
Q

Name the two autoregulation responses within the kidneys

A
  • Myogenic autoregulation

- Tubular glomerular feedback

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42
Q

Describe the myogenic autoregulatory response

A

Afferent arteriole is vasodilated

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43
Q

Describe the tubular glomerular feedback response

A

Macula dense in the DCT, checks Na concentration
If reduced GFR: Renin and Prostaglandins released
If raised GFR: Increased Na+ -> ATP release -> Adenosine -> Afferent vasoconstriction

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44
Q

How much does GFR raised in pregnancy? What is the mechanism for this called?

A

150%

Compensatory hypertrophy

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45
Q

Define “Clearance”

A

The amount of plasma cleared per unit time

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46
Q

What is the equation for the excretion rate?

A

Amount of substance in urine x urine flow rate

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47
Q

What is the equation for clearance?

A

Amount in urine x Urine flow rate / Total amount in plasma

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48
Q

Does Creatinine over or under estimate GFR?

A

Over, since there is slight secretion back into the tubule

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49
Q

What factors affect Creatinine in the body?

A

Age
Race
Muscle proportion
Protein intake

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50
Q

What is eGFR used for? AKI or CKD?

A

CKD

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51
Q

Why is isotonic saline used to increased BP?

A

Increases extracellular fluid volume, but same osmolarity as the intacellular compartment, so no change in osmolarity and so no movement of fluid into the ICF

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52
Q

Where are the low pressure baroreceptors?

A

Aortic and Pulmonary bodies

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53
Q

Where are the high pressure baroreceptors? What nerves do these pass impulses along?

A

Aortic arch and carotid body - communicate via CN 9 and 10

54
Q

Describe pressure natriuresis

A

When BP increases, NaKATPase downregulated, so more Na passed out, so BP goes down

55
Q

What AQP is inserted into the apical side of the tubules by ADH?

56
Q

Name the drug that affects NKCC2 in the Loop of Henle

A

Furosemide

57
Q

What is the name of the drug that affects NCC in DCT 1?

58
Q

What is the name of the drugs that act on ENaC?

A

Amiloride - blocks the ENaC channels

Spironolactone - downregulation of Aldosterone effect on NaKATPase

59
Q

What other important anion is absorbed in DCT2 and by what channel? What is its expression controlled by?

A

NCX channel
Ca2+
Controlled by PTH and Vitamin D

60
Q

Where does HCO3- excretion occur in the CD?

A

Intercalated cells (principal cells have the ENaC channels)

61
Q

What is the normal osmolarity of blood?

A

275-295mmol/Kg

62
Q

Describe the body’s response to low BP (4)

A
  • RAAS activation
  • Sympathetic innervation increase to heart
  • Prostaglandins released
  • ADH released
63
Q

Describe the effects of Angiotensin 2

A

Causes Aldosterone release
Causes vasoconstriction of arterioles to raise BP
Increases sympathetic activity
Stimulates ADH

64
Q

Describe the effects of Aldosterone

A
  • Upregulates NaKATPase in DCT
  • Stimulates K+ secretion into DCT
  • Upregulates NCC in DCT
  • Upregulates ENaC
65
Q

Name 3 ADH-related diseases and their pathophysiology

A
  • Central diabetes insipidus - ADH too low, due to hypothalamus damage/ pituitary damage
  • Nephrogenic diabetes insipidus - ADH insensitivity
  • SIADH - too much ADH - leads to hyponatraemia
66
Q

What does SIADH lead to?

A

Hyponatraemia

67
Q

How does the Vasa recta work with the counter current mechanism to generate a hyperosmotic interstitium?

A

Vasa Recta is very hypertonic - passes past the descending limb and absorbs water as it travels up

68
Q

Explain the role of Urea in the counter current exchange system

A

Urea is usually an ineffective osmole, but can pass through AQPs with water, increasing the osmolarity of the fluid

69
Q

List 4 causes of hyponatraemia

A

Diuretics
Diarrhoea/Vomiting
SIADH
Heart failure - body tries to maintain volume by retaining fluid

70
Q

What is a risk of giving hypotonic saline too quickly to fix Na balance?

A

Central Pontine Demyelination Syndrome

71
Q

What happens to the NaKATPase during acidosis?

A

Downregulated - means K+ cannot exit, meaning hyperkalaemia even worse

72
Q

Name 4 causes of Hyperkalaemia

A 
AKI
Addison's disease - reduced Aldosterone, reduced secretion
Diabetic Ketoacidosis
Cell Lysis (injury)
73
Q

What does Hyperkalaemia cause?

A

Heart block/arrhythmias - depolarises the heart tissue, leads to more inactive Na+ channels
Also causes paralytic ileus

74
Q

What is the treatment for hyperkalaemia?

A

IV Calcium Gluconate
Insulin + Dextrose
Calcium Resonium

75
Q

What does Hypokalaemia cause?

A

Arrhythmias - heart more excitable

Paralytic ileus

76
Q

How do NKCC2 channel blockers (Furosemide) cause Hypokalaemia?

A

ROMK is not inactivated, but NKCC2 is - K+ moved back into urine

77
Q

How do NCC channel blockers (Thiazide) cause Hypokalaemia?

A

NCC block leads to more Na+ downstream, so Renin release and Prostaglandins, leading to aldosterone upregulation (and thus increased NaKATPase, so more Na out and more K+ being secreted/excreted)

78
Q

How does congestive heart failure lead to Oedema?

A

Increased venous pressure + RAAS activation, which increases fluid retention

79
Q

How does Cirrhosis lead to ascites?

A

Leads to:

  • reduced albumin creation, so lower oncotic pressure, so less fluid re-enters the blood vessels
  • portal hypertension
80
Q

What controls storage?

A

Sympathetic

81
Q

What levels of the spinal cord control Sympathetic urine storage?

82
Q

What control voiding?

A

Parasympathetic

83
Q

What levels of the spinal cord control Parasympathetic urine storage?

84
Q

What centre in the brain controls storage?

85
Q

What centre in the brain controls voiding?

A

M-centre supplied by para-central lobules

86
Q

Describe the storage of urine

A

Stretch receptors
B3 of detrusor acted on to cause relaxation
A1 of IUS acted on to cause constriction
nAcH of EUS acted on by pudendal nerve to constriction

87
Q

Describe the voiding of urine

A

Stretch receptors
M3 of destrusor acted on to cause contraction
Sympathetics inhibited by M centre

88
Q

What is the boundary of the Cauda Equina?

89
Q

Why does Cauda Equina lead to incontinence?

A

S2,3,4 inibited, no para, no voiding ability
Pudendal nerve also lost, so no EUS
Sympathetics still active though
Needs catheterisation

90
Q

How does an Upper Motor neurone lesion lead to incontinence?

A

Parasympathetic neurones that are inhibitory will be destroyed

91
Q

Describe the 3 types of urinary incontinence

A

Stress - involuntary leakage on exertion
Urge - leaking with sudden urgency
Overflow - overfull bladder

92
Q

At what volume is urine felt?

93
Q

At what volume is urine voided?

94
Q

Give 4 causes of Urinary Incontinence

A

Pregnancy, BPH, Prolapse, Obesity

95
Q

What is Glomerulosclerosis?

A

Destroyed glomerular capillaries

96
Q

What is Glomerulonephritis?

A

Inflammation of the glomerulus

97
Q

What is the difference between Primary and Secondary Glomerulonephritis?

A 
Primary = Disease of the Kidney
Secondary = Systemic disease
98
Q

What is Nephrotic syndrome?

A

Damage to the filter of the glomerulus - podocytes and glomerular basement membrane

  • Proteinuria
  • Hypoalbuminaemia
  • Oedema
99
Q

What is Nephritic syndrome?

A

Damage with inflammation

  • Haematuria
  • Hypertension
  • GFR reduction
100
Q

List 3 causes of Nephrotic syndrome

A

Minimal change, FSGS, Membranous

Diabetes

101
Q

List 3 causes of Nephritic syndrome

A

IgA nephropathy, Anti-GBM, ANCA vasculitis

102
Q

List 3 treatments for Nephrotic syndrome

A

Diuretics (for oedema), salt and fluid restriction, steroids, ACE

103
Q

List 3 treatments for Nephritic syndrome

A

ACE for hypertension, Diuretics if oedema, immunosuppressants

104
Q

Describe the effects of diabetic nephropathy

A
  • Hyperfiltration (osmotic diuresis)
  • Thickening of the basement membrane
  • Mesangial thickening
  • Overt proteinuria develops eventually
    Leads to ESRD
105
Q

What is another name for a Lower UTI?

106
Q

What is another name for an Upper UTI?

A

Pyelonephritis

107
Q

Name 3 risk factors for UTIs

A

Women (shorter urethra), BPH, incontinence (neurological problems leading to incomplete voiding)

108
Q

What does a fever imply in a UTI?

A

Upper Urinary tract infection

109
Q

What are the drugs given for a Lower UTI? How long for complicated vs uncomplicated?

A

Nitrofurantoin

Trimethoprim

110
Q

What is the drug given for an Upper UTI (pyelonephritis)?

A

Co-amoxiclav

111
Q

What is measured on a urine dipstick?

112
Q

What is the infective organism in a nitrite negative dip?

A

Coagulase negative Staph

113
Q

What are the symptoms of an AKI?

A

Oliguria, acidosis, oedema, fatigue, nausea and vomiting, ureamia

114
Q

What is Acute Tubular Necrosis?

A

Develops from AKI if left for too long - PCT fucked

115
Q

Name 1 intraluminal causes of Ureteric obstruction

A

Renal calculi,

116
Q

Name 1 intramural causes of Ureteric obstruction

117
Q

Name 3 extramural causes of Ureteric obstruction

A

Fibroid, bladder cancer, retroperitoneal fibrosis

118
Q

What is Pyonephrosis?

A

Pus build up caused by infection, urological emergency, can get loss of function

119
Q

What is Hydronephrosis?

A

Swelling of kidney due to urine build-up

120
Q

What is a Renal angiogram used for?

A

Renal artery stenosis

121
Q

What is a Diuretic urogram used for?

A

Obstructions

122
Q

What is the treatment for a ureteric obstruction?

123
Q

What is removed in a radical nephrectomy?

A

Kidney, ureter, peri-renal fat

124
Q

How is a TCC treated?

A

Trans-urethral resection of the bladder

125
Q

What section of the prostate is affected in Prostate Cancer?

A

Peripheral

126
Q

What section of the prostate is affected in BPH?

A

Transitional

127
Q

Name a gene associated with prostate cancer

128
Q

Name 2 reasons for an increased PSA value (prostate specific antigen)

A

Just had a DRE done
Infection
Age increase

129
Q

How is prostate cancer diagnosed?

A

Ultrasound guided biopsy of the prostate

130
Q

What are the cancers that metastasise?

A 
British Transport Keeps People Late
Breast
Thyroid
Kidney
Prostate
Lung
131
Q

What is the most common presenting complain for patients with Adult Polycystic Kidney Disease?

A

Hypertension

Urinary ESA 3 (1 decks)

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