kidney disease and bladder

Question 1

what efficiency does renal replacement therapy equivalent too?

Answer 1

15mil/min GFR

Question 2

how does peritoneal dialysis work?

Answer 2

dialysate put into the peritoneal cavity via a catheter
Equilibrates HCO3, Na+, water and essential ions also regulates acid base balance by having them at the same conc
dextrose used to maintain osmotic pressure
exchange happens through peritoneal membrane

Question 3

what is unique about the smooth muscle cells in the renal ureter?

Answer 3

send peristaltic waves that slowly propagate down the ureter encouraging urine flow

Question 4

what are the 2 ways kidney stones can be treated?

Answer 4

Can be treated via extracorporeal shock wave lithotripsy - high frequency ultrasound that attempts to break up crystals
Can also be treated via percutaneous nephrolithotomy - nephroscope inserted through the skin into the ureter to remove stones

Question 5

what is the capacity of the bladder?

Answer 5

500-1000ml

Question 6

what are the 4 layers of the bladder in order?

Answer 6

urothelium
lamina propria
detrusor
serosa

Question 7

how does the urothelium reduce permeability?

Answer 7

very tight junctions
umbrella cells present in the lower layers which spread their cytoplasm over the top

Question 8

how is the urothelium involved in signalling?

Answer 8

signals below lamina propria in case of infection, and therefore change voiding frequency if needed

Question 9

how is the urothelium adapted to stretch?

Answer 9

contains folds

Question 10

what is the main function of the lamina propria?

Answer 10

sensory - chemo and baroreceptors
to detect mechanical and chemical state of the bladder
contains supporting blood vessels for the urothelium

Question 11

what is the structure of the detrusor?

Answer 11

smooth muscle bundles arranged in a basket weave so that they can contract simultaneously

Question 12

what nerves mainly innervated the detrusor?

Answer 12

parasympathetic nerves using Ach as main NT onto M3 receptors

Question 13

what is the role of the sympathetic nerves in the bladder? how can they be therapeutically targeted

Answer 13

relaxation to promote continence
release NA which binds to B3 adrenoreceptors
rare receptor that makes it an easy therapeutic target

Question 14

what is the pelvic floor?

Answer 14

a group of muscles and connective tissue present at the bottom of the pelvis
Provides structural support for the bladder and ureter

Question 15

what are the 2 sphincters at the in the urethra and what muscle controls them

Answer 15

inner sphincter (smooth muscle)
outer sphincter (striated muscle)

Question 16

what problem to men commonly have with voiding?

Answer 16

long urethra = increased resistance hard to urinate
also prostate gland can become swollen which blocks the urethra

Question 17

explain the mechanism of voiding

Answer 17

baroreceptors in the urothelium detect the bladder stretch
when they detect that it is time to urinate, parasympathetic nerves release Ach on M3 receptors on the detrusor muscle causing the bladder to contract
(sympathetic nerves are inhibited)
sympathetic nerves that keep the internal urethra sphincter contracted are also inhibited leading to its relaxation
finally the external urethra sphincter must be relaxed by voluntary control of the striated muscle
sphincters relax before the bladder contracts

Question 18

what area of the brain is a large controller of the urinary signals?

Answer 18

Pons

Question 19

give 3 pharmalogical treatments for OAB

Answer 19

anti muscarinic drugs e.g. oxybutynin (M3 antagonist)
only a short term fix as tolerance build quickly
botulinum toxin may also be injected into the bladder to reduce parasympathetic nerve stimulation
B3 adrenoreceptor agonists

Question 20

what are the surgical treatments for stress incontinence?

Answer 20

synthetic mid urethral tape and open colposuspension

Question 21

what is a common cause of urinary obstruction in men?

Answer 21

prostatomegaly (begin enlargement)

Question 22

what are the treatments for prostate enlargement in men to aid voiding?

Answer 22

Transurethral resection of the prostate (TURP) tube inserted into urethra prostate carved out
Alpha adrenoreceptor antagonists e.g. terazosin help prostate relax by relaxing smooth muscle
5a reductase inhibitors - slow growth of prostate gland e.g. in begin prostatic hyperplasia so reduces hypertrophy

Question 23

what is micturition?

Answer 23

voiding

Question 24

what are the causes of urinary continence dysregulation?

Answer 24

UTI - changes chemical composition of urine = urge to void
pelvic floor injury e.g. tear during child birth
Stress incontinence - increased pressure but on bladder due to increase in abdominal pressure e.g. exercising , coughing or laughing causes bladder leaking
Common in women as anterior vaginal wall is so close to the bladder often associated with weak pelvic floor muscles etc
Atonic Bladder - loss of autonomic innervation can be secondary to autonomic neuropathy
As you get older bladder walls thicken decreases their capacity
Detrusor overactivity e.g. very sensitive to stretch as you get older, may be associated with outflow obstruction

Question 25

what does retention of phosphate lead to?

Answer 25

mineral imbalance calcium-phosphate complexes form deposited in heart and blood vessels
CV issues

Question 26

what does retention of urate count towards?

Answer 26

gout