Primary Glomerular Disease and on

Question 1

What is primary glomerular disease?

Answer 1

a group of disorders characterized by pathologic alterations in normal glomerular structure and function, independent of systemic disease processes such as HTN and diabetes

Question 2

How does primary glomerular disease occur?

Answer 2

damage to the kidney’s filtering units - the site of the initial steps in kidney fxn.

Question 3

When there is deposition of antigen complexes into the glomerulus, it will cause an inflammatory response and result in:

Answer 3

sclerotic damage and inflammation

Question 4

what is the pathogenesis of primary glomerular disease?

Answer 4

damage to glomerular epithelial cells will allow for larger molecules to escape circulation and enter the proximal tubule
or
damage to the capillary wall allows RBCs to escape and enter the proximal tubule which will result in hematuria.

Question 5

What structure do materials have to move through that will trap immune complexes in the basement membrane?

Answer 5

pseudocytes

Question 6

What are the clinical signs of primary glomerular disease?

Answer 6

proteinuria
hematuria
hypertension
edema
hypoalbuminemia

Question 7

What is the trx for primary glomerular disease?

Answer 7

fluid restriction
renal hypertension - acei and arbs
edema - diuretics
hypercholesterolemia - statins
anemia - erythropoietin
immune rxn associated injury - glucocorticoids

Question 8

What is another name for nephrolithiasis?

Answer 8

kidney stones

Question 9

how are kidney stones classified?

Answer 9

by the location
nephrolithiasis - kidney
ureterolithiasis - ureter
bladder

Question 10

Kidney stones will cause urinary _____________

Answer 10

obstruction

Question 11

What is hydronephrosis?

Answer 11

distention and dilation of the renal pelvis and calyces secondary to urine accumulation

Question 12

with kidney stones, where is pain most often felt?

Answer 12

In the flank (area between ribs and hips)
lower abdomen
groin

Question 13

what is the hallmark of stones?

Answer 13

excruciating intermittent pain that radiates from the flank to the groin or to the inner thigh

Question 14

What is trx for renal calculi?

Answer 14

Shock wave lithotripsy
just gotta wait
surgery when stones exceed 1 cm

Question 15

What muscle lines the wall of the urinary bladder

Answer 15

the detrusor muscles

Question 16

the detrusor muscles are innervated by _______________ neurons

Answer 16

parasympathetic

Question 17

is input to the detrusor muscle typically allowed?

Answer 17

no, it is normally inhibited

Question 18

What opens and closes the urethra?

Answer 18

sphincters

Question 19

The internal urethral sphincter is smooth or skeletal muscle?

Answer 19

smooth

Question 20

The external urethral sphincter is smooth or skeletal muscle?

Answer 20

Skeletal

Question 21

Is the external urethral sphincter under involuntary or voluntary control?

Answer 21

voluntary

Question 22

The sphincter is innervated by _________________ neurons.

Answer 22

sympathetic

Question 23

What are the events that have to occur for micturation to occur?

Answer 23

• remove inhibition of detrusor muscle
• remove stimulation of internal sphincter muscle
• reduce tonic activity of the external sphincter

Question 24

What initiates the voiding reflex?

Answer 24

the stretching of the bladder

Question 25

The voiding reflex will remove inhibition of the _______________ neurons which will cause the detrusor muscle to contract ____________.

Answer 25

parasympathetic; rhythmically

Question 26

Once the detrusor muscles contract rhythmically, this will initiate inhibition of the ________________ nerves which will reinnervate the internal urethral sphincter, which will allow it to relax and open.

Answer 26

sympathetic

Question 27

Urination occurs when:

Answer 27

the external sphincter relaxes.

Question 28

Can someone have voluntary control over the external sphincter

Answer 28

yes

Question 29

what is sensory neurogenic bladder?

Answer 29

disruption of sensory information to the spinal cord or CNS

Question 30

what is a motor paralytic bladder?

Answer 30

destruction of the parasympathetic nerves to the bladder. Inability to initiate or maintain a urine stream.

Question 31

What is reflex neurogenic bladder?

Answer 31

complete disruption between the sacral spinal cord and the brainstem (acute post-spinal cord injury)

Question 32

What is an autonomous neurogenic bladder?

Answer 32

neurologic isolation of the bladder from the spinal sacral cord. complete loss of sensory and motor input to and from the sacral spinal cord.

Question 33

Urinary incontinence will occur when:

Answer 33

bladder pressure exceeds sphincter resistance

Question 34

What increases the risk of urinary incontinence?

Answer 34

age pelvic floor weakness benign prostatic hyperplasia obesity XRT injury

Question 35

What is functional incontinence?

Answer 35

normal urine control but who have trouble reaching a toilet in time bc of muscle or joint dysfunction

Question 36

what is stress incontinence?

Answer 36

Loss of urine during activities that increase intra -abdominal pressure (coughing, lifting ,laughing, Valsalva maneuver)

Question 37

What is urge incontinence?

Answer 37

Sudden and unexpected urge to urinate and an inability to prevent the loss of urine.

Question 38

what is overflow incontinence?

Answer 38

Constant leaking of urine from a bladder that is full but unable to be emptied.