Renal Flashcards
what is the primary function of the renal system
- maintain body water balance
- remove metabolic waste
describe the location of the kidney
retroperitoneal
vertebrae T12-L3
can the kidneys move with respiration
yes up to 4cm
can kidneys be bumpy
yes, can be of embryological origin
how is the kidney protected
ribs, however a fracture can damage them
is one kidney smaller than the other
not necessarily, sometimes it looks like that on imaging
how are kidneys investigated
CT, ultrasound to measure size
what muscle causes the kidneys to rotate/tilt
psoas major (it’s balanced on this muscle)
what is the renal fascia
a sheet fused to the peritoneum that looks to limit the movement of the kidney
what is the renal capsule
a layer of renal tissue that limits the volume of the kidney
what does fat look like on a kidney CT
black area around kidneys
what is the kidney divided into
cortex (outside)
medulla (inside)
how many pyramids to kidneys have
8-18
where does the pyramid empty into
minor calyx –> major calyx –> renal pelvis –> ureter
where are the constriction points / where stones might lodge in the ureter
- ureteropelvic junction
- brim of pelvis
- ureterovesicular junction
what is the main cause of pain from kidney stones
peristaltic action from muscle contraction
how is bladder rupture diagnosed
radio-opaque imaging
what is micturition
expulsion of urine from the body by relaxation of internal & external sphincters, and contraction of the bladder wall
where does most glomerular filtration occur
in the cortex
what is the process of blood filtration in glomerular filtration
glomerulus –> Bowman’s capsule –> loop of henle –> collecting ducts
what is a fenestrated capillary
a capillary with small holes to filter urine
how is renal function measured
GFR = glomerular filtration rate = volume of fluid filtered from the glomerulus into the glomerular capsule = serum creatinine concentration
more creatinine = worse renal function because it’s not being filtered
why do we try to avoid contrast studies
they can damage kidneys if a patient has impaired renal function
how is renovascular disease investigated
CT with contrast dye or angiography
name the phases of kidney at different time points
blood in arterial system/ medulla –> into pyramid –> into renal pelvis
how long is the corticomedullary phase & what does it indicate
25-80 seconds
delayed renal function
how long is the nephrographic phase & what does it indicate
85 - 120 sec
delayed renal function
how long is the excretory phase & what does it indicate
3-5 min after
delayed function & structure
what is, and what is the purpose of urethrography and cystography
ureth = dye injected into urethra
cysto = dye injected into bladder
used to visualise blockages that lead to symptoms in patients e.g. trouble urinating
is it possible to have severe reactions to contrast media
yes
what are severe reactions to contrast media
decr. BP, shock, pulmonary oedema, anaphylaxis
nephrotoxicity incr. with dehydration and preexisting low GFR
what is an ectopic kidney
doesn’t ascend from pelvis during development
what is a horeshoe kidney
shape
what is a double ureter
a kidney with 2 ureters
what are symptoms of urinary tract disease
haematuria
flank pain
renal failure
infection
what is haematuria & how is it diagnosed
blood in urine from malignancy, trauma, urolithiasis (stones)
CT urography
what is urolithiasis & how is it diagnosed
stones from high urinary mineral concentrations, ph etc
CT/ultrasound
what a renal cysts
balls of fluid - benign or malignant
more complex e.g. more tissues and blood supply is grade > 1 and requires investigation
what % of renal tumours are malignant
90%
how do you differentiate renal cysts and masses
enhancement media (tumours will be more enhanced due to blood supply)
what is hydronephrosis
Dilation of the renal pelvis and calyces due to blockage that includes excess fluid in the kidneys from the inability to urinate
congenital abnormality or outflow obstruction by calculi or prostatic hyperplasia or carcinoma (older adults)
what causes renal infections & where can they ascend
intestinal flora, woman are more at risk due to shorter wider urethra
they can ascend the tract from the bladder to the kidney
what is pyelonephritis
infection of kidney
how is renal trauma imaged
contrast enhanced CT
what is renal failure
failure of the urinary tract to produce normal amounts of urine
what is CKD & its symptoms
chronic kidney disease resulting in bilateral small kidney
usually asymptomatic, so by the time it’s found there is irreversible damage to kidneys and loss of function
what is acute kidney injury and it’s causes & prognosis
sudden loss of renal function that develops over a few days
often reversible with no damage
caused by impaired or decreased blood flow, intrinsic renal change, obstruction
e.g. pre renal, renal, post renal
what are the affects of CKD
incr. Ca, phosphate, decr. vitamin D
= decr. bone strength = fracture
= soft tissue calcification = cardiovascular disease
