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Imaging Pathology 2nd Sem > Kidney- Powerpoint 1 > Flashcards

Kidney- Powerpoint 1 Flashcards

1
Q

Kidneys receive ___ of Cardiac Output

A

25%

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2
Q

How many mls is the Glomerular Filtration Rate (GFR)?

A

125mls per minute

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3
Q

What ways can renal failure occur?

A

1) Can be caused by blockage in the urinary tract (obstructive disorders)
2) Can be caused by damage directly affecting the renal tissue (e.g. toxins, infections)

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4
Q

What are the 3 types of kidney stones?

A

1) Struvite stones
2) Calcium based stones
3) Uric acid stones

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5
Q

What is nephrocalcin and what does it do?

A

Urine normally contains crystal inhibitors such as nephrocalcin which prevent crystal formation.

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6
Q

For Calcium based stones, what increases the risk of obtaining these stones? (3)

A

Risk increases with:
Calcium dietary supplements
Hypercalciuria
Prolonged immobilisation increases risk due to bone demineralisation

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7
Q

Struvite stones- what are these stones based with?

A

15% struvite (Magnesium, Ammonium and phosphate based stones)

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8
Q

What triggers struvite stones and what gender are they more common with?

A

Triggered by infections by organisms that produce urease enzymes (e.g. pseudomonas infections)
Occur more commonly in women

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9
Q

Uric acid based stones- what do these stones occur with? (3)

A

These stones occur with:
gout (elevated uric acid due to impaired liver metabolism)
Diets high in nucleic acids – meat, fish, poultry – G & A are purines which break down into uric acid.
Precipitation is more likely when urine is concentrated and acidic.

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10
Q

1% of the population get kidney stones. What % of kidney stones are calcium based stones?

A

75%-80%

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11
Q

1% of the population get kidney stones. What % of kidney stones are struvite stones?

A

15%

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12
Q

1% of the population get kidney stones. What % of kidney stones are uric acid based stones?

A

7%

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13
Q

What are the clinical manifestations for kidney stones? (what would the typical patient be feeling/experiencing) (4)

A

PAIN from the costovertebral angle down the lateral abdominal wall, or as low as the inguinal region.

Can require narcotic analgesia (morphine).

Frequently associated with nausea and vomiting.

Hematuria may be present

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14
Q

What treatment options are their available for kidney stones? (3)

A

Reduce concentration of the metabolite by increasing fluid intake/output

Reduce metabolite intake or inhibit production in the body

Remove large stones: ultrasound, laser lithotripsy or surgery are options

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15
Q

What is Neurogenic bladder?

A

Bladder paralysis or loss of voluntary reflex override

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16
Q

For Neurogenic bladder- explain the upper motor neurone lesions in relation to neurogenic bladder.

A

Upper motor neurone lesions allows the reflex to operate spontaneously (incontinence)
Associated incomplete emptying and retention, with greater infection risk

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17
Q

For Neurogenic bladder- explain the lower motor lesions in relation to neurogenic bladder.

A

Lower motor lesions (spinal cord) lead to retention with overflow incontinence
Both CNS problems cause functional obstruction to urine flow.

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18
Q

Neoplasms (Tumours) of the kidney- What is the most common?

A

Renal adenomas most common
(encapsulated benign tumours)
Usually cortical tumours
Usually removed once identified as they have the potential to become malignant (Renal Cell Carcinoma)

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19
Q

What are the signs of kidney tumors? early stage and advanced stage.

A

Little sign of these tumours in the early stage. Pressure on kidney tissue reduces kidney function as the tumour develops.
Flank pain, palpable abdominal mass, blood in urine are signs of advanced stage of disease.

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20
Q

Are neoplasms of the bladder usually benign or malignant? which people category are they more common in?

A

Usually malignant - 5th most common malignancy, more common in men over 60.

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21
Q

What makes a person at risk of developing neoplasms in the bladder?

A

High risk for smokers, people who work with chemicals.

22
Q

What are the clinical manifestations for neoplasms in the bladder?

A

Often asymptomatic, but causing a degree of obstruction. Pain, blood in urine and increased frequency occur with advanced bladder cancer.

23
Q

Urinary Tract Infections (UTI)-

How is a diagnoses made and what group of people are more at risk of getting a UTI?

A

More common in women due to the shorter urethra.
Diagnosis is by bacterial culture of a urine sample
(more than 100,000 bacteria per ml of freshly voided “clean catch” urine).

24
Q

Cystitis- What is it and what usually causes it?

A

Bladder infection, usually caused by E-coli.

Other bacteria include Proteus, Pseudomonas, Klebsiella, Staphylococcus

25
Q

What are the clinical manifestations of Cystitis?

A

Often asymptomatic, but typically frequency, urgency and pain on urination (dysuria), and perhaps lower back and or suprapubic pain.
Cloudy urine and blood in the urine (pink) indicate severe infection.

26
Q

Acute Pyelonephritis-

1) where is the infection established?

A

Infection is established in the renal pelvis and surrounding tissue.

27
Q

Acute Pyelonephritis-

What causes the infection?

A

Urinary obstruction and reflux are the most common cause of this type of infection.
The infection generates an inflammatory response with localised edema and WBC infiltration.
Infection tracks up collecting ducts into nephrons – not usually as far as glomeruli.
After resolution of the infection, scar tissue will block some nephrons which atrophy

28
Q

How do the symptoms differ between cystitis and pyelonephritis?

A

It is difficult to distinguish acute pyelonephritis from cystitis, but usually includes the onset of fever and chills and costovertebral tenderness in addition to the cytitis symptoms. Onset can be sudden.

29
Q

Whats the treatment process for pyelonephritis?

A

2-3 weeks of organism specific antibiotics, but with obstructions or reflux the condition will reoccur.

30
Q

What is Acute Glomerulonephritis?

A

Following streptococcal infection, 7-10 days later circulating strep cell antigens stick in the filtration pores of the kidney (on the glomerular basement membrane)

Phagocytes are attracted to the antigen, and trigger an inflammatory response.

31
Q

What are the symptoms of acute Glomerulonephritis?

A

Symptoms will develop over the following week: blood in urine (hematuria), hypertension, peripheral edema, sometimes more central edema effects including ascites and pleural effusion.
Glomerular membrane thickening will reduce GFR.

32
Q

What are the treatments of acute Glomerulonephritis?

A

Treated with antibiotics to prevent the spread of the organism within the kidney tissue, the prognosis is good. Most individuals recover without significant loss of renal function.

33
Q

What is RPGN? and what age group does it affect?

A

Rapidly Progressive GlomeruloNephritis

Affects adults in the 50-70 age group

34
Q

Is RPGN associated with any other disease? how does RPGN progress?

A

Associated with kidney disease. Rapid progression- limited symptoms and by the time it is diagnosed renal insufficiency occurring.

35
Q

Chronic Glomerulonephritis- Explain the clinical manifestations..

A 
Gradual damage to nephrons along with;
Blood in urine (hematuria)
Proterinuria exceeding 3grams per day
Decreased GFR (after 10-20 yrs renal insufficiency)
Fluid waste retention
Hypertension
36
Q

Nephrotic syndrome- when does it occur?

A

occurs with chronic glomerulonephritis and other conditions where glomerular damage occurs. (e.g diabetics)

37
Q

What is Hypotension?

A

Loss of renal blood flow and filtration pressure e.g inshock

Mean BP must be over 80mmHg

Lack of filtration “bunrs out” tubule cells

38
Q

what would 8 hours of no filtration result in?

A

over 75% nephron loss and renal insufficiency

39
Q

What is Hypertension? explain the process of it

A

chronic hypertension -> renal vessel atherosclerosis.

lowered renal blood flow -> activation of renin/angiotensin/aldosterone pathway -> increase salt reabsorbtion raises BP -> worsens with time

40
Q

high concentration of what leads to renal poisoning..

A 
Organic solvents
Heavy metals 
Ethylene glycol
Pesticides
Poisonous mushrooms
Variety of antibiotics
41
Q

Incompatible Blood Transfusions explain what happens (3 points)

A

1) Red cells agglutinate and rupture with free Haemoglobin released into the plasma (HB)
2) HB is small enough to go through glomerular filration slits but gets stuck in the basement membrane causing a blockage
3) GFR is reduced with whole nephrons lost if the blockages are severe

42
Q

What causes Renal trauma?

A

Physical damage results in inflammation and repair processes.
Scar tissue will often block nephrons leading to their loss

43
Q

How long does healing take in renal trauma?

A

Slow healing- around 2 weeks for recovery of nephrons if it is still at all possible.

44
Q

If renal diseases develop- what are the two categories they are put into?

A

1) Acute- short term symptoms of renal failure

2) Chronic- over a long period of time

45
Q

What causes Acute Renal failure and what happens to the GFR?

A

Caused by a variety of conditions such as blockage, trauma, infection, hypotension, severe poisoning.

GFR reduced, urine production decreases to less than 400mls per day (oliguria).

46
Q

What is Uremic syndrome?

A

Develops when kidneys arent capable of excreting wastes and blanacing fluids and electrolytes.

47
Q

For uremic syndrome what do the following mean;
Hyperkalemia
Hypernatremia
Hypervolemia

A

Hyperkalemia- evelvated potassium

Hypernatremia- elevated sodium

Hypervolemia- retained fluid, increasing blood volume

48
Q

How long does ARF (acute renal failure) take to recover?

A

The oliguria will last 1-3weeks depending on the degree of the damage. Blood flow will be restored. Function can take a few weeks to recover whereas nephron damage can take as long as a year

49
Q

Chronic renal failure- where is the damage done?

A

Slow, progressive deterioration. Damage can affect the glomeruli or the nephron tubule cells. Chronic renal Failure is described by its pathology

1) Glomerular
2) Tubular

50
Q

For tubular pathology of CRF- what are the 4 potential causes of slowly developing tubule cell damage?

A

1) Chronic hypertension
2) Prolonged low grade infections such as pyelonephritis
3) poisons or toxins in low doses
4) obstructive conditions creating a back pressure. A significant back pressure for more than 4 months will destroy 3/4 of the kidney tissue and lead to renal insufficiency.

51
Q

End stage renal failure- what % of renal function is lost?

What do homeostatic imbalances cause?

A

90%.

Secondary diseases: neural, respiratory, cardiac dysfuntion.

52
Q

What treatment options are there for end stage renal failure?

A

1) Dialysis

2) Transplant

Imaging Pathology 2nd Sem (2 decks)

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