lecture 2 part 1: male Flashcards
excretes nitrogenous waste products of metabolism, cleans blood, regulates body water and electrolytes
kidney
turns 1.5 L into urine
kidney endocrine organ- secretes hormones
renin
erythropoietin
renin- blood pressure
erythropoietin- proliferative effect on bone marrow
functional unit of kidney
nephron
3 morphologic components of nephron
glomeruli
convoluted tubules
collecting ducts
controls blood pressure
juxtaglomerular complex
juxtaglomerular cells in wall of afferent arteriole are sensor for
bp
macula densa in wall of distal convoluted tubule
sensor for sodium
associated with many primary renal disorders, elevation of blood urea nitrogen and creatinine levels, related the reduced glomerular filtration rate GFR
azotemia
hypoperfusion of kidneys decreases GFR in absence of parenchymal damage
post-renal azotemia
urine flow obstructed below level of kidney
post-renal azotemia
progression of azotemia to produce clinical manifestations and systemic biochemical abnormalities
-failure of renal excretory function
-metabolic and endocrine alterations
uremia
(glomerular syndrome) – heavy proteinuria,
hypoalbuminemia, severe edema, hyperlipidemia and lipiduria
Nephrotic syndrome
– (glomerular syndrome) – acute onset of grosslyvisible hematuria, mild-to-moderate proteinuria, azotemia, edema and
hypertension (classic presentation of acute post-streptococcal
glomerulonephritis)
Nephritic syndrome
oliguria or anuria with recent onset of azotemia. May
result from glomerular injury or acute tubular necrosis
Acute renal failure
prolonged symptoms and signs of uremia – the end
result of all renal disease
Chronic renal failure
– bacteriuria and pyuria –
symptomatic or asymptomatic - kidney (pyelonephritis)
or bladder (cystitis)
urinary tract infections
kidney stones - colic, hematuria
nephrolithiasis
A non-specific disorder in which the kidneys are damaged, causing them to leak large amounts of
protein from the blood into the urine.
severe edema
nephrotic syndrome
A non-specific disorder in which the kidneys are damaged, causing them to leak protein and red blood cells from the
blood into the urine.
hematuria
hypertension
nephritic
an immune mediated disease of the renal glomeruli
-treated with steroids
glomerulonephritis
- an infection of the kidney (not the glomerulus) usually
caused by bacteria and of retrograde origin
-treated with antibiotics
pyelonephritis
pathway of renal infection (pyelonephritis)
Hematogenous dissemination – least common
Ascending infection – most common
Fecal bacteria from perineal area
Culture and sensitivity – Bactrim
Pyelonephritis is much more common than
glomerulonephritis
-Common
-May cause obstruction
Pain
-Ascending infection
-Hematuria
-Pyuria
-Lithotripsy
-May be associated with hypercalcemia (for example,
hyperparathyroidism, multiple myeloma)
kidney stones (nephrolithiasis urolithiasis
simple stones too large to pass through, ultrasound shock waves crush stones, smaller pieces pass out in body in urine
ESWL
extracorporeal shock wave lithotripsy
-Accelerated coronary atherosclerosis
-Increased myocardial oxygen demand
-Ventricular remodeling
-Heart failure
-Increased risk for arrhythmias
cardiovascular system
-Atherosclerosis
-Aortic dissection
-Abdominal aortic aneurysm
-Peripheral vascular disease
peripheral vascular system
-Hypertensive nephrosclerosis
-End-stage renal disease
renal system
-Hemorrhagic CVA
-Thromboembolic CVA
CNS
-Retinal infarction
-Hypertensive retinopathy
-Blindness
visual system
-Affects arterioles
-Thickened walls reduce lumen
diameter causing ischemic injury
-*Hyaline arteriolosclerosis
Benign hypertension
Diabetes mellitus
-*Hyperplastic arteriolosclerosis
Malignant hypertension
arteriosclerosis
anterio-venous fistula
dialysis shunt
-Arises from renal tubular epithelium
-Often silent
-May grow into renal vein
renal cell carcinoma
-Children under 5 years
-Abdominal mass
-Chronic low-grade fever
-Histopathology consists of several cell types,
some of which resemble abortive glomeruli
and others that resemble skeletal muscle
-Better than 90% 5-year survival
wilm’s tumor (nephroblastoma)
-Arises from the urinary tract lining epithelium (transitional epithelium)
-Bladder most common site
-Painless hematuria
-Cigarette smoking, industrial solvents (betanaphthlylamine), chronic cystitis,
schistosomiasis, drugs (cyclophosphamide)
-Clinical significance depends on histologic
grade, differentiation and depth of invasion
urothelial carcinoma
3 major diseases of prostate
- prostatitis
- benign prostatic hyperplasia
- adenocarcinoma of prostate
-Protein present in the serum at low levels (nl: < 4 ng/mL)
-Increased levels may suggest the presence of prostate cancer
-Elevated in prostatitis
-Velocity of change significant
prostate-specific antigen- PSA
Physiologic functions
Liquefy semen, allowing sperm to swim freely
Dissolution of cervical mucous cap
prostate-specific antigen PSA
Acute bacterial disease treated with antibiotics
prostatitis
Obstruction to flow
Urinary frequency
Ascending infections
Rule-out neoplasia
Pharmacologic treatment
Surgical treatment (TURP)
nodular (benign) prostatic hyperplasia BPH
70% of men develop prostate cancer by 70-80 years of age
Digital prostate examination
Biopsy – multiple cores
Wide variation in clinical behavior
Gleason grading
adenocarcinoma of prostate
undescended testes
cryptorchidism
germ cell tumor (malignant)
seminoma
tuberculosis, mumps, syphilis, gonorrhea
infections
-Absence of one or both testes in the scrotum
-Failure of testis to descend from an abdominal position through the inguinal canal into
the scrotum (“undescended” testes)
-Infertility
-Increased risk for neoplasia
-Orchiopexy
cryptochidism
Most common germ cell tumor of testis
Young adults (15-34 years)
Surgery plus radiation therapy and chemotherapy
One of the most treatable and curable cancers
Over 95% long-term survival in early stages
seminoma
Complications rare in the young and more common in older individuals
infectious parotitis
-Developmental defect of the urethra in the male
-Abnormally placed urethral meatus
-Urethral meatus opens on the glans penis most
commonly (first degree hypospadias)
hypospadias
Foreskin cannot be fully retracted from the head of the penis
phimosis
-Erect penis or clitoris does not return to its flaccid state, despite the absence of
both physical and psychological stimulation, within four hours
-medical emergency
-hematologic diseases (sickle cell disease or leukemia)
-trauma
priapism
