renal 4 Flashcards
what are the 5 consequences of urinary tract obstruction?
- Reduced glomerular filtration rate
- Reduced renal blood flow (after initial rise)
- Impaired renal concentrating ability
- Impaired distal tubular function
- Post-obstructive diuresis
what are the possible tubular dysfunctions that could occur?
- Nephrogenic diabetes insipidus
- Renal salt wasting
- Renal tubular acidosis
- Impaired potassium concentration
what happens to the Intraluminal pressure during acute urinary tract obstruction?
initially, it rises due to obstruction - increase in Peristalsis
after a few hours it decreases-due to Disorganised peristalsis dilation of tubules and ureter
what happens to the RBF during acute urinary tract obstruction?
initial rise due toVasodilation-Prostacyclin-ProstraglandinE2
after a few hours-decrease-due to Vasoconstriction-Angiotensin II
-Thromboxane A2
what happens to the GFR during acute urinary tract obstruction?
initial decrease due to Intratubular pressure
after a few hours- decrease due to-Continuing obstruction-vasoconstriction
how does one commonly differentiate between renal diseases?
Imaging of the urinary tract is frequently used to examine obstructions and differentiate between renal disease
what is the emergency treatment for any renal obstruction?
Narcotic analgesic for pain relief
Correction of fluid and electrolyte balances
Intravenous antibiotics
Relief obstruction
how would one determine pathogenesis of renal obstruction?
Stone analysis
fluid intake and dietary history
Family history genetic factors
Serum and urinary screening
how does one prevent further Prevent further calculi?
Increased fluid intake (2-3l/d)Modification of diet Specific treatment of metabolic abnormality
what size stone may pass through?
-Stones with diameters less than 1 cm may pass spontaneous
what is Lithotripsy?
(fragmentation of the stone i.e. ultrasonic)
stones lodged in proximal ureter are broken into fragments that are excreted in the urine
what is a Cystoscope?
passing catheter like instrument through cytoscope into ureter, which snares and removes stones lodged in distal ureter
how would you remove a stone in the renal pelvis/ kidney?
ESWL
open surgery
percutaneous nephrothlipotomy
how would you remove a stone in the upper ureter?
ESWL
ultrasonic destruction
leptosomic removal
open surgery
how would you remove a stone in the lower ureter?
ESWL
ultrasonic destruction
dornier basket obstruction
how would you remove a stone in the bladder?
cystopic destruction
open removal- if larger than hens egg
what are the 4 types of Glomerular diseases?
–Immunological injury
–Inherited abnormalities (Alport’s syndrome)
–Metabolic stress ( Diabetic mellitus)
–Deposition of extraneous materials(amyloid)
what are the 2 categories of glomerular diseases?
- Glomerulonephritis(the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood)
- Glomerulosclerosis(the scarring or hardening of the tiny blood vessels within the kidney)