Modules 5.1-5.3 Flashcards
What is the micturition reflex?
- Reflex governs voluntary bladder movements
What is the difference between urinary incontinence and retention?
Incontinence: loss of voluntary control over bladder
Retention: inability to empty bladder, spinal cord injury at sacral level can block micturition reflex
What are the three stages of incontinence?
Urge: involuntary urination of child from ages 4-5, not physical defect
Stress: intraabdominal pressure forces urine through sphincter
Overflow: incompetent bladder sphincter, such as weakened detrusor muscle or spinal cord injuries
What do the different colours of urine tend to mean?
Red: bleeding
Pink: small blood loss, chlorpromazine
Orange: dehydration, warfarin or rifampicin
Brown: blood loss, haemoglobin (same as pink)
Bright yellow: Vit B & C causes
Blue/green: hypercalcaemia: indomethacin
Turbid: infection
What are used to test for renal system disorders in blood tests?
- Raised blood urea nitrogen (failure to excrete waste)
- Metabolic acidosis (decreased glomerular filtration rate)
- Anaemia (erythropoietin secretion dys.)
- Abnormal electrolytes
What is the function of osmotic diuretics?
- Inc. solute conc. in filtrate, leading to water retention, occurs in prox. convoluted tubule (PCT) and dec. LoH
- Adv. inc. ECF volume
- Mannitol
What is the function of carbonnic anhydrase inhibitors?
- Inhibits carbonic anhydrase enzyme, prevention Na and H2CO3 reabsorption in PCT
- Adv. metabolic acidosis, inc. risk of kidney stones
- Acetazolamide
What is the function of loop diuretics?
- inhibits Na/K/Cl symporter in asc. LoH, leading to ^^ loss in urine
- Adv. HTN, heart failure, pulmonary oedema
- Furosemide
What is the function of thiazide diuretics?
- inhibits Na/Cl symporter in Dct leading to Na/Cl/K loss in urine
- Adv. HTN, mild congestive HF
- Hydrochlorothiazide
What is the function of K-sparing diuretics?
- inhibits Na reabsorption and inc. K excretion in collecting duct
- Adv. Hyperkalaemia, metabolic acidosis
- Spironolactone
What is dialysis?
- ‘artificial kidney’
- Used for patient who has acute renal failure
- Cleans toxic blood from patients arterial circulation, sends clean blood back into venous circulation while toxins diffuse through dialyzer membrane to be drained
What is haemodialysis?
- uses machine to filter blood through an Fistula (connection between artery and vein) or graft (synthetic tube connecting them)
- draws wastes products out by diffusion
- nurse checks for vibration in site for blood flow
What is Peritoneal dialysis?
- uses peritoneal membrane in abdo as natural filter
- surgical insertion of catheter into abdo
- dialysate solution (glucose eg) infused into peritoneal space, allows for wastes to be drawn into solution and fluid is eventually drained
What is nephrolithiasis?
- kidney stones (renal calculi)
- Formed when solutes in urine precipitate and crystallize
- Caused by solute supersaturation, dehydration or natural inhibitors (Mg eg)
- Diagnosed by US, CT or urinalysis
- Meds. K+ citrate, Antiinflams, or CC blockers
What are the different types of kidney stones?
- Calcium oxalate (black, acidic)
- Calcium phosphate (white, alkaline)
- Uric acid (red-brown, high purine)
- Struvite/infection (white, UTI RF inc.)
- Cystine (yellow/pink)
- Xanthine (red-brown, purine breakdown)
What are the most common urinary tract cancers?
- Renal cell carcinoma: epi. cells of tubule
- Wilm’s tumour: most common solid tumour in children
- Bladder cancer: bladder epi. cells (urothelium)
What is the pathophysiology of a UTI?
- a resident microbial community existing near the distal urethra can contaminate the urinary tract, so despite the flushing of urine into bladder causes sterility, it can become contaminated
- E. coli is main cause, adhering to bladder muscosa
- more freq. in women
What are the different inflammations of the renal systems termed?
Urethra: urethritis
Bladder: cystitis
Ureter: Ureteritis
Kidney: pyelonephritis (rapid onset bacterial infection of kidney due to ascending infection, from bladder) (antibiotics)
What are the causes of Acute Kidney Injury (AKI)?
AKI: abrupt dec. in kidney function, rise in serum creatinine reater than 26 umol/L within 48 hrs
Prerenal cause: occur upstream of kidney, due to disruptions in renal blood supply
Intrarenal cause: occur within kidney itself
Postrenal cause: obstructions of urine flow, UT stones
What are the main functions of the kidneys (hint A WET BED)?
Acid Base balance
Water balance
Electrolyte balance
Toxin removal
Blood Pressure Control
Erythropoietin Production
Vit D Activation
What are the treatments of AKI?
- Restore blood flow, reverse nephrotoxic agent, treat infection, remove obstructions
What are CM of CKD (aka end stage renal failure)?
- Inc. urinary output (polyuria)
- General signs
- Bone marrow depression
- HTN
- Uremia signs (fluid overload, electrolyte imbalance, physiological changes and metabolism abnormalities
What are the differences in staging between AKI and CKD?
AKI: Utilises serum creatinine, urine output or GFR
CKD: GFR only
What are causes of CKD?
- HTN: inc. pressure in glomerulus causes arteriosclerosis, red. blood flow and O2 delivery, causing cytokine release and dec. kidney function
- Diabetes: high BGL causes inc. O2 stress and inflam, causes AS ^^ and pressure backup, inc. GFR and permeability leading to glomerulosclerosis and dec. kidney function
