Module 9 Kidney/Urinary Tract Flashcards
1
Q
Kidney Function
A
- Filter blood creating urine, excreting waste products
- 1700L of blood per day
- 1L of urine per day
2
Q
Kidney Regulates
A
- Water
- Salt
- Calcium
- Phosphorus
- Blood pH
3
Q
Endocrine Function
A
- Renin (BP)
- Erythropoietin (RBC)
- Vit D metabolism
4
Q
Hilum Contents
A
- Renal artery
- Renal vein
- Ureter
5
Q
Renal Cortex Contents
A
- Glomeruli
- Tubules
- Interstitium
- Blood vessels
6
Q
Medulla Contents
A
- Collecting system (renal pyramids)
- Pathway: renal calyces, renal pelvis, ureter
7
Q
Ureter
A
- Muscular tube entering bladder
8
Q
Bladder
A
- Urine reservoir (500mL)
9
Q
Urethra
A
- Fibromuscular tube from bladder to exterior
10
Q
Renal Cell Carcinoma
A
- Most common malignancy of kidney
- Older patients (50-60s)
- More common in males (2:1)
- CCRCC most common subtype
- Surgery (nephrectomy)
10
Q
Risk Factors of Renal Cell Carcinoma
A
- Tabaco smoking
- Obesity
- Hypertension
- Unopposed estrogen
- Exposure to heavy metals, petroleum products
11
Q
Presentation of Renal Cell Carcinoma
A
- Flank pain, palpable mass, hematuria (large tumours)
- Fever
- Weakness
- Weight loss
12
Q
Urothelial Carcinoma
A
- Most common malignancy of bladder
- Arise from urothelium
- M:F 3:1
- Common in older patients (50-80s)
- Developed nations, urban dwellers
12
Q
Urothelial Carcinoma Presentation
A
- Painless hematuria
- Sometimes urinary urgency, frequency, burning
- Papillary appearance by cystoscopy
- Sea anemone appearance
13
Q
Urothelial Carcinoma Risk Factors
A
- Cigarette smoking
- Industrial exposure to chemical compounds
- Parasitic infections
- Drugs
- Irradiation
14
Q
Low Grade Urothelial Carcinoma
A
- Slow growing
- Papillary
- Minimal atypia
- Frequent reoccurrence
- Not aggressive/invasive
15
Q
High Grade Urothelial Carcinoma
A
- More aggressive
- Flat or nodular
- High rate of reoccurrence
- Atypical
- Invasion
- Metastasize
16
Q
Urothelial Carcinoma Treatment
A
- Local excision
- Invasive chemotherapy/BCG (extensive)
- Cystectomy (high grade)
17
Q
Acute Pyelonephritis
A
- Bacterial infection of kidney
- Bladder infection symptoms
- Due to UTI
- Urine culture diagnosis
- Recover full kidney function
18
Q
Pyelonephritis Risk Factors
A
- Urinary tract obstruction
- Instrumentation
- Vesicoureteral reflux
- Pregnancy
- Gender/age (young females)
- Diabetes
- Immunosuppression/immunodeficiency
18
Q
Chronic Pyelonephritis
A
- Inflammation & scarring of kidney
- Causes reflux, long term obstruction
- Recurrent infection
19
Q
Acute Renal Failure
A
- Decreased blood flow to kidney
- Damage to kidneys
- Obstruction of flow of urine
20
Q
Chronic Renal failure
A
- Hypertension, diabetes, vasculitis
- Primary glomerular/chronic tubulointerstitial disease
- Chronic urinary tract obstruction
21
Q
Renal Failure Signs/Symptoms
A
- Azotemia (increase BUN & creatinine)
- Edema/swelling
- Electrolyte disturbances
- Metabolic acidosis (low pH)
- Anemia (low hemoglobin)
- Hypertension
- Bone disease
22
End Stage Renal Failure
- Endpoint of kidney diseases
- Sclerosis of glomeruli
- Scarring/fibrosis of Interstitium
- Loss of tubules
- Chronic inflammation
- Thickened arteries
23
Renal Failure Treatment
- Balanced diet (avoid Na, K)
- Exercise
- Medication for hypertension/diabetes
- Diuretics
- Dialysis
- Transplant
24
Glomerulus Disease
- Important cause of renal disease
- Affects rest of kidney
- Impairs filtration (damage to basement membrane)
25
Primary Glomerulopathies
- Systemic disease affecting primarily the glomerulus
26
Secondary Glomerulopathies
- Systemic diseases affecting multiple organs including kidney
27
Glomerulus Mechanism of Injury
- Antibodies reacting in situ within glomerulus
- Deposition of circulation preformed antigen-antibody complexes
28
Nephritic Syndrome
- Hematuria
- Azotemia
- Variable proteinuria
- Oliguria
- Edema
- Hypertension
29
Nephrotic Syndrome Signs
- Proteinuria >3.5g/day
- Hypoalbuminemia
- Hyperlipidemia
- Lipiduria
30
Renal Tubules Diseases
- Involve Interstitium
- Acute tubular necrosis/injury most common cause of acute kidney injury
31
Acute Tubular Injury/Necrosis Causes
- Ischemia (decreased blood flow)
- Toxic injury to tubules
32
Clinical Course of Acute Tubular Injury
- Decreased urine output
- Rise in BUN & creatinine
- Electrolyte abnormalities & metabolic acidosis
- Urine volume increases with recovery
- Outcome relates to duration & magnitude
- Most patients recovery completely
32
Atherosclerosis in the Kidney
- Narrowing of arteries due to plaque build up
- Decreased blood flow to kidney
- Kidney atrophy
- Chronic kidney failure
- Risk of clot
32
Hypertension Impacts
- Major cause of end stage renal disease
- Nephrosclerosis (sclerosis of renal arterioles)
- Scarring of glomeruli
- Chronic tubulointerstitial injury
- Decrease in renal mass & function
32
Reflux Complications
- UTI
- Pyelonephritis
- Hydroureter/hydronephrosis
- Chronic renal failure
33
Reflux
- Urine from bladder into ureters
- Congenital anatomical defect
- Conservative treatment resolve with growth/surgery
34
Urinary Tract Obstruction Classification
- Acute/chronic
- Partial/complete
- Unilateral/bilateral
35
Intrinsic Obstruction
- Lesions of urinary tract
36
Extrinsic Obstruction
- External compression
37
Acute Obstruction
- Flank pain
- Renal colic
38
Unilateral/Partial Obstruction
- Asymptomatic
- Unaffected kidney maintains renal function
39
Chronic Obstruction
- Chronic kidney disease
40
Urinary Tract Stones
- Form in kidney
- Most commonly men 20-30 years
- Familial predisposition
- Underlying medical condition
- Increase calcium in blood/urine
41
Urinary Stone Treatment
- Wait for stones to pass (fluids, pain management)
- Lithotripsy (sound waves shatter stones)
- Surgical removal
42
Determinants of Urinary Stones
- Increased urinary cone of stones (exceeds solubility)
- Changes in urinary pH
- Decreased urine volume
- Bacteria present
42
Urinary Stone Presentation
- Asymptomatic
- Cause severe renal colic
- Abdominal pain
- Kidney damage
- Hematuria (blood in urine)
- Predispose infection
