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STUDY FOR BARRIERS > Renal > Flashcards

Renal Flashcards

1
Q

Under the age of 1, which gender has more UTIs

A

Males

More common in uncircumcised boys (2X)

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2
Q

Over the age of two, which gender has more UTIs

A

Males:females
1:10

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3
Q

Symptoms of UTI

A 
Fever
Unwell
Lethargic
Jaundice 
Poor feeding
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4
Q

Symptoms of cystitis

A

Frequency and dysuria but no fever necessarily or generalised feeling unwell

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5
Q

Screening for assumptomatic bacteremia in

A

Pregnant women

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6
Q

Type 1 and type II e.coli

A

Type 2 have fimbriae that are mannose resistant and allow bacteria to ascend –> pyelonephritis or septicaemia

(20% will only cause cystitis)

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7
Q

Diagnosis of UTI:

A

Urine dip stick analysis:
Positive leukocytes
Positive nitrites

Urine culture:
More than 10^5 bacterial/ml
Less than that suggests contaminated sample

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8
Q

Methods of urine collection

A

Bag urine - lot of false positive bc readily contaminated with skin and gut flora (<30% are true positives)
Approx 100% sensitivity
Useful screening test

Catheter urine

Midstream urine

Suprapubic aspirate (<2% contamination)

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9
Q

Infant <6months
Febrile with first UTI
Treatment?

A

IV antibiotics
Usually amoxicillin and gentamicin

Oral - very high rate of beta lactamase producing e.coli so ~50% resistant to amoxicillin

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10
Q

Signs of an atypical UTI

A 
Seriously ill
Septicaemia
Poor urine flow 
Abdominal mass
Raised creatinine 
Non-e.coli UTI 
Failure to respond to antibiotics <48 hrs
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11
Q

Recurrent UTI means:

Generates further investigation

A

2 episodes of pyelonephritis

Or

1 pyelonephritis + 1 cystitis

Or

3 or more episodes of cystitis

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12
Q

Kidneys contribute to body homeostasis by:

A

Eliminating metabolic waste
Regulating fluid and electrolyte balance
Influencing acid- base balance

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13
Q

The kidneys produce:

A

Prostaglandins (affect salt and water regulation and influence vascular tone)
EPO
1,25-dihydroxylcholecalciferol (enhances calcium absorption from gut and phosphate resorption by renal tubules)
Renin (acts on angiotensin pathway to increase vascular tone and aldosterone production)

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14
Q

Renal circulation starts with the renal artery and goes to…

A 
Segmental artery --> interlobar artery --> arcuate artery --> 
Cortical radiate arteries --> 
Afferent arterioles --> 
Glomerulus --> 
Efferent arteriole --> 
Peritubular capillaries --> 
Venules --> 
Interlobular veins --> 
Arcuate --> 
Interlobar veins -->
Renal vein
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15
Q

What does the juxtaglomerular apparatus release?

A

Renin

EPO

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16
Q

What is the function of endothelial cells in the glomeruli

A
  • role in charge-dependent filtration barrier
  • synthesis, release, and bind coagulation factors
  • participate in antigen presentation (express class 2 histocompatibility antigens)
  • synthesise and release a relaxing factor
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17
Q

What type of junctions are between the foot processes?

A

adherens-type junctions (filtration slit diaphragms)

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18
Q

Two types of mesangial cells:

A
  1. one type - contractile and contain actin filaments, attach to capillary BM (damage –> reduces strength of capillary –> micro-aneurysm)
  2. type two - resembles monocyte

both types - synthesise new matrix material and secrete cytokines responsible for cell prolif and attraction of inflam cells

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19
Q

What is the function of the mesangial area being attached to the endothelial cells (BM in between) in the central core area?

A

allows access of immune complexes and ability of mesangium to probe the capillary lumen

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20
Q

the GFR reflects :

A

the permeability of the capillary will together with hydrostatic and osmotic gradients

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21
Q

Three mechanisms affecting the GFR:

A

Involve the JGA

  1. autoregulation within glomerulus
  2. tubuloglomerular feedback
  3. neurohormonal influences
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22
Q

The macular densa

A

monitor the levels of chloride in the tubular luminal fluid

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23
Q

Reduced GFR leads to:

A

fall in luminal chloride level –> dilatation of aa and constriction of ea due to renin

24
Q

What hormones from the adrenal gland are involved in neurohormonal regulation?

A

angiotensin II - constricts ea more than aa
noradrenalin - constricts

both stimulate prostaglandin synthesis –> reduces arteriolar tone

25
Q

NSAIDs affect on the kindey

A

block the production of prostaglandins and therefore in patients who are hypoperfused, this can lead to acute renal failure

26
Q

angiotensin II –> renin –> aldosterone release from the adrenal cortex which

A

leads to increased sodium resorption by DCT

27
Q

What is the macula densa?

A

modified tubular cells of the thick loop of Henle

28
Q

what type of junctions in the tubular epithelial cells

A

tight junctions

29
Q

Main things absorbed in the PCT

A

sodium
- cotransports glucose, phosphate, amino acids

water

80% of all bicarb reabsorbed (sodium also exchanged with hydrogen ions)

30
Q

Which part of the loop of henle is permeable to water but not ions?

A

descending loop

31
Q

What happens in the DCT

A

impermeable to water
co-transporter for sodium and chloride - activity of which is governed by the chloride content in the lumen

calcium transport - influences by vitamin d3 and parathyroid hormone (in adjacent segments as well)

32
Q

Two main cell types on the collecting duct:

A
  1. principal cells - sodium and water resorption (under influence of ADH)
  2. intercalated cells - acid-base balance (hydrogen ion excretion)
33
Q

What are the capillaries that supply the tubules called?

A

vasa recta

come off efferent arteriole

34
Q

the commonest site of urinary calculi

A

renal pelvis

35
Q

renal calculi present as:

A

renal colic - pain from stone passing through ureter
dull ache in the loins
recurrent and intractable UTI

36
Q

Most common types of renal calculi

A

calcium oxalate, (often mixed with uric acid) (75-80%)
(10% have hyperparathyroidism or some other cause of hypercalcaemia, most have reabsorption defect leading to excess calcium in urine)

uric acid stones (6%) - most commonly assoc with gout

37
Q

Are uric acid stones radiolucent or radio-opaque?

A

radiolucent

38
Q

congenital lesions of the ureter

A

hydroureter (dilatation) and tortuosity - though to be related to neuromuscular disorder

congenitally short terminal segment which is not oblique –> vesico-ureteric reflux –> renal infection and scarring

39
Q

the bladder responds to obstruction to outflow by

A

muscular hypertrophy

40
Q

presentation of cystitis

A

dysuria
lower abdominal pain
frequency
occasionally haematuria

sometimes general malaise and pyrexia

predisposition to pyelonephritis

41
Q

epithelial cells of prostate release

A

PSA

acid phosphatase
seminal fluid secretions

42
Q

clinical features of BPH

A

hyperplastic nodules distort the course of the ureter
interference of sphincter mechanism
contraction of hyperplastic SM in stroma
inflamm cell infiltration

43
Q

lymphatic drainage of the testis is into

A

para-aortic lymph nodes

44
Q

Capsule around the kidneys consists of two layers. What are they?

A

Outer layer - fibroblasts and collagen (strength)

Inner layer - myofibroblasts (important in fibrosis and scarring and they secrete collagen)

45
Q

Histology - PCT vs DCT

A

PCT -
Small uneven lumen
Brush border
Intense cytoplasm

DCT -
Smaller cuboidal cells
Larger lumen
Less dense cytoplasm

46
Q

What makes up the wall of the ureter?

A

Transitional epithelium (urothelium)
Lamina propria
Two smooth muscle layers - inner longitudinal and outer circular
(opposite to alimentary tract)

47
Q

What makes up the bladder wall?

A

Transitional urothelium
Connective tissue in bundles (laminar propria)
Muscularis layer - three layers - detrusor

48
Q

Common bacteria causing uncomplicated UTI

A 
Escherichia Coli 
Staphylococcus saprophyticus (5-10%)
49
Q

Common bacteria causing complicated UTI

A

E. coli

Plus
Proteus 
Klebs 
Enterococcus faecalis 
Streptococcus agalactiae (group b strep) 
Etc
50
Q

Diagnosing tests for UTI

A

Urine dipstick
Leukocyte estarase
Nitrate reductase (false neg with enterococcus spp and pseudomonas bc they concert nitrate to nitrite)

Phase microscopy
Cell count - leukocytes erythrocytes and epithelial cells
Bacteria - rods motile (e.coli)
Casts, crystals

51
Q

What bug commonly colonises a catheter?

A

Pseudomonas aureginosa

52
Q

What is the role of the prostrate ?

A

Makes part of seminal fluid

Blocks off urethra during erection

53
Q

Sterile pyuria

A

Leukocytes in urine without growth on culture

54
Q

Host defences for UTI

A 
Flow and voiding 
Antibacterial activity of urine (pH, organic acids, urea, osmolality) 
Mucosa (negatively charged barrier form urine) (bacteriocidal activity, cytokines) 
Inhibitors of adhesion( tamm-horsfall protein) (mucopolysaccharide)
Inflammatory response (PMNs, cytokines) 
Innate immune system predominantes (phagocytosis by PMNs and secretory iga may be protective)
55
Q

UTI bacterial virulence factors

A 
Adherence 
Motility 
Urease (proteus spp) 
Capsule (prevents opsonisation - klebsiella) 
Haemolysin 
Endotoxins (decrease peristalsis

STUDY FOR BARRIERS (11 decks)

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