Lesson 14

Question 1

Physical exploration of the kidneys

Answer 1

Due to their location, the kidneys are not easily accessible.

We can however detect information about:

• Inspection to detect kidney enlargement
• Palpitation and percussion to detect pain
• Auscultation to detect murmurs when there is renal artery stenosis

Question 2

Functional exploration of the kidneys

Answer 2

We evaluate filtration: waste products / substance clearance

We evaluate tubular functioning: Fractional sodium excretion and thirst test

Question 3

Glomerular filtration evaluation, substance clearance

Answer 3

• Refers to the theoretical volume of plasma gets cleared of a substance as it passes through the kidneys (per unit of time)
• If the clearance of a substance decreases, its concentration in the blood will increase.

Question 4

Tubular function evaluation, fractional sodium excretion

Answer 4

• Consists of determining the % of filtered sodium that is
  eliminated in the urine.
• 1% correct.

Question 5

Tubular function evaluation: thirst test

Answer 5

• The tubular water management, which consist of depriving
  the patient of water for a few hours and controlling the density
  and osmolarity of the urine (it is necessary to see if the urine is
  concentrated)

Question 6

Imagining tests

Answer 6

X-ray: size and shape, location, calcifications

Pyelography IV: Radiopaque substance in peripheral vein

Renal angiography: Contrast medium, visualise renal vessels

Ultrasound: shape and size, lesions, stones

CT: High res version of ultrasound

Isotope scan: structure and function

Biopsy: Direct lesion study

Question 7

Urine test, Macroscopic test

Answer 7

400-2500 ml a day, 4-7 urinations, yellowish, smell, transparency

Question 8

Urine test, biochemical studies

Answer 8

Dentisty 1007-1035, pH 4.5-8, glucose and ketone bodies, protein (<150mg/dl), blood, leukocytes and nitrates

Question 9

Urine test, cells

Answer 9

3 red blood cells / field: hematuria

5 leukocytes / field:
leukocyturia or piuria

Presence of epithelial or malignant cells

Question 10

Urine test, crystals

Answer 10

• Associated with urolithiasis (kidney stones)
• Calcium oxalate, uric acid (acidic pH)
• Calcium phosphate (basic pH)

Question 11

Urine test, cylinders

Answer 11

Hyalines (proteins)
Red blood cells (hematuria)
Leukocytes (nephritis)
Epithelial (acute kidney injury)
Fatty (nephrotic syndrome)
Wide (advanced nephropaty)
Granules ( proteins
and cellular debris

Question 12

RENAL PATHOLOGY MANIFESTATIONS

Answer 12

Kidney disorders can be classed into:

• Urine alterations: quantitative or qualitative
• General manifestations: edema or hypertension

Question 13

QUANTITATIVE ALTERATIONS

Answer 13

Poliuria,

Oliguria, anuria