Renal Flashcards by Nick Preston

What is reabsorbed by the PCT?

Na+, Cl-, H2O, glucose

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How much blood is filtered by the kidneys?

~120ml/min-1

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How is most of the H2O removed in the PCT?

Na+ is actively transported out and H2O diffuses along the new concentration gradient

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What is ADH, how does it work and where is it produced?

Antidiuretic hormone is produced in the hypothalamus and released from the post. pituitary gland.

It increases the H2O permeability of the CD and DCT promoting reabsorption of H2O.

Also increases arterial BP- vasopressin

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What is the renin-angiotensin-aldosterone system?

It stimulates ADH release, arterial vasoconstriction and promotes drinking.

Renin is produced by the juxtaglomerular apparatus –> catalyses conversion of angiotensin I- angiotensin II in the lungs –> stimulates the release of aldosterone.

This ^ reabsorption of Na+ & H2O

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What is Atrial natriuretic hormone?

Peptide released from the atria of the heart when extracellular volume is ^.

It increases natriuresis

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How is GFR calculated?

GFR = Urine conc x urine vol.
_____________________________
Plasma conc.

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What are the different types of shock?

Hypovolaemic- empty circulation
Cardiogenic- failure of the heart to pump
Obstructive- blockage of heart or major vessel- P.E.
Maldistributive- Abnormal dilatation small arteries - sepsis/anaphylaxis

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What happens in septic shock?

Vessels become leaky –> hypovolaemia = \/ cardiac output.
Myocardium damaged by cytokine storm
Hypoxia can occur from microvascular changes/intravascular coagulation
Mitochondrial failure = cell death

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What is anaphylactic shock?

Extreme hypersensitivity (Type 1) to a previously met antigen. 
--> massive degranulation of mast cells = histamine

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What is hypovolaemia?

~20% of blood volume is lost –> shock

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What are the treatments for hypovolaemic shock?

Stop active bleeding
ORS, ABCDE

70ml/kg hartmanns- don’t if BP stable >80 systolic

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What is the osmolality of the human body?

~290mOsm

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What is the osmolarity of 0.9% NaCl and why doe is only go extracellularly?

290mOsm, and because Na+ and Cl- are extracellular ions

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What is haematuria?

> 3 RBC per high power field in freshly voided, centrifuged urine

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Common causes of haematuria?

Glomerulonephritis, Infection,Amyloidosis, Diabetes, Autoimmune, Tumour, trauma, calculi, benign prostatic hyperplasia, infection, urethral stricture

What are the main types of renal cancer?

Benign: Oncocytoma, angiomyolipoma, papillary adenoma.
Malignant: Renal clear cell carcinoma (originates PCT)

What is a common renal cancer in children <5 y.o.?

Wilm’s tumour

What is the normal epithelium of the bladder?

Transitional epithelium

What is the most common bladder cancer in MEDCs?

Transitional cell carcinoma- aniline dyes are a risk factor and smoking.

What is the presentation of benign prostatic hyperplasia?

/\ urinary frequency and urgency
nocturia
Hesitancy, dribbling and intermittent flow

What are the main types of kidney stones?

Calcium
Infection (struvite)
Uric acid
Cysteine

What type of stone most often cause staghorn caliculi?

Infection stones- caused by infection that convert urea to ammnia

Where are the most common sites of lodging of kidney stones?

PUJ, Pelvic brim- where the ureter arches over the iliac vessels, VUJ

What is the classic presentation of kidney stones?

Loin-groin colic, restless and writhe. Pallor, N&V and sweating Inability to get comfortable or reduce the pain

Managements options for kidney stones?

NSAIDs Lithotripsy if <2cm Retrograde ureteroscopy Percutaneous nephrolithotomy

What are the most common types of testicular cancer?

Germ cell tumours: | Seminomas and non-seminomas

What are the risk factors for developing testicular cancer?

``` Cryptorchidism Testicular atrophy Inguinal hernia Hydrocoele Sydromes w/ abnormal testes PMHx of Mumps ```

What Genes have been associated with testicular cancer?

P53- promotes apoptosis | RB- suppression of inappropriate cycling

What is the presentation of testicular cancer?

``` Painless swelling of the testis ~50% Dull ache/heavy sensation ~30-40% Acute pain ~10% Metastatic symptoms ~10% Gynaecomastia ~5% ```

What investigations should be carried out for suspected testicular cancer?

Physical examination Testicular USS- very sensitive MRI Tumour markers

What are the tumour markers for testicular cancer?

a FP- /\ in 50-70% of NS-GCT b HCG- /\ in 40-50% of NS- GCT and /\ in 30% of seminomas One of these is /\ in >90% of NS GCTs LDH /\ in some seminomas

What is a hydrocoele?

``` Collection of fluid within the tunica vaginalis. Causes: -excess fluid production -patent processus vaginalis -idiopathic ```

What is an epididymal cyst?

Extratesticular, fluid filled, benign cyst usually in the head of the epididymis. Is a palpable mass separate from the testes

What is a spermatocoele?

A distended tubule from the rete tesis or epididymis forming a sperm filled, benign cyst.

What is a varicocoele and why is it more common on the left side?

Abnormal dilatation of veins in the pampiniform plexus. More common in the left due to the the testicular vein entering the renal vein prior to the IVC on the left side, and directly into the IVC on the right.

What can cause epididymitis or epididymo-orchitis?

STIs such as Gonorrhoea, chlamydia | G-ves such as e.coli and pseudomonas

What do the Sertoli cells do?

encourage sperm development when stimulated by FSH

what do Leydig cells do?

Secrete testosterone when stimulated by LH