Renal and genitourinary system Flashcards
What is definition of polyuria,?
Production of abnormally large volumes of dilute urine.
What is the definition for haematuria, uraemia, and nocturia?
Haematuria = presence of blood in the urine.
Uraemia = presence of urea in the blood [major symptom of renal failure].
Nocturia = excessive urination at night.
What is the definition for
urolithiasis, cystolithiasis, nephrolithiasis,
Urolithiasis = the formation of stony concretions in the bladder or urinary tract.
Cystolithiasis = The presence of a urinary calculus in the bladder.
Nephrolithiasis = The process of forming a kidney stone, a stone in the kidney (or lower down in the urinary tract). Kidney stones are a common cause of blood in the urine and pain in the abdomen, flank, or groin.
What is the definition for azotaemia, myoglobinuria/myohaemoglobinuria, and urosepsis?
Azotaemia = abnormally high levels of nitrogen-containing compounds (e.g. urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood.
Myoglobinuria = the presence of myoglobin in the urine.
Urosepsis = a condition where a urinary tract infection spreads from the urinary tract to the bloodstream, causing a systemic infection that circulates through the body through the bloodstream.
Go through the structure of the kidney.
Renal capsule Cortex Medulla Calyces Renal pelvis
What is the function of the kidneys?
Remove waste products from the blood.
Along with other systems work to maintain homeostasis [regulates: acid-base balance, electrolytes, BP].
Regulate the volume and composition of body fluids [the main function of the kidney is not to produce urine, this is a product of filtration].
What is the definition of anuria?
Failure of the kidney’s to produce urine.
What is the definition of oliguria?
Production of abnormally small amounts of urine.
What is the definition of dysuria?
Painful or difficult urination.
What is the renal capsule made of?
A tough fibrous connective tissue which provides protection.
What is the cortex made of/look like?
The lighter coloured area surrounding the medulla with projections running between the pyramids.
What is the medulla made of/look like?
Darker coloured inner part of the kidney where the renal pyramids are found which house the nephrons.
What does the calyces made up of/do?
Collecting ducts which carry the urine from the medulla to the renal pelvis.
What does the renal pelvis do/look like?
Funnel shaped part of the kidney which moves urine from the kidney into the ureter for excretion.
What does the glomerulus do/look like?
Tight capillary network which receives blood from the afferent arteriole maintaining a high pressure to allow for filtration.
What does the bowman’s capsule do/look like?
Surrounds the glomerulus with podocytes [specialised cells] which allows for diffusion of the glomerular filtrate.
What does the renal corpuscule do?
Filtering component containing the Bowman’s capsule and glomerulus.
Where are the 3 networks of renal tubules?
Proximal convoluted tubule.
Loop of Henle.
Distal convoluted tubule.
What is the mechanism of urine formation?
The 3 stage process
- Glomerular filtration
- Tubular reabsorption
- Secretion
- 1 to 1.2L blood flows through the glomeruli each minute.
- The kidneys precess approx 180L of blood derived fluid daily [approx 1.5L leave body as urine, the rest is returned to the circulation].
What is glomerular filtration?
Is the first step in making urine.
It is the process that your kidneys use to filter excess fluid and waste products out of the blood into the urine collecting tubules of the kidney, so they may be eliminated from your body.
What is the glomerular filtration rate [GFR] ?
It is the total amount of filtrate formed per minute by the kidneys. It is governed by:
1. Total surface area available for filtration.
2. Filtration membrane permeability.
3. Net filtration pressure.
GFR = (urine concentration x urine flow) / plasma concentration.
How is urine formed?
Posterior gland releases anti diuretic hormone [ADH].
- It inhibits diuresis/urine output
- Causes water to pass easily from the cells into the interstitial space.
- In the presence of high levels of ADH nearly all of the water in filtrate is reabsorbed into the blood stream and highly concentrated minimal amount of urine is excreted.
- Concentrated urine is inextricably correlated to a person’s ability to survive with minimal hydration.
What are the 3 primary characteristics of urine?
COLOUR = cloudy urine may be indicative of an infection, clear to deep yellow in colour.
ODOUR = ammonia, drugs/vegetable/diseases
PH = normally acidic, protein produces acidic urine, vegetarian/vomiting/bacterial infection produces alkali urine
What is the process of micturition?
Also known as urination, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control. Average person 200mL is the threshold when stretch receptors respond. Incontinence and urinary retention.
List up to 7 genitourinary conditions.
- Acute renal failure/acute kidney injury.
- Haemodialysis/renal transplant patient.
- Haematuria/uraemia/proteinuria
- UTI/bacterial infections
- Renal colic/calculi
- Urinary retention
- Testicular torsion
What are the 3 types of acute renal failure?
- Prerenal
- Intrarenal/intrinsic
- Postrenal
What are the subsequent causes of prerenal - acute renal failure?
- Hypovolaemia
- Haemorrhagic shock
- Burns [loss of plasma]
- Severe D&V/intestinal obstruction/uncontrolled diabetes.
- Sepsis
- Cardiac Failure
What are the subsequent causes of intrarenal/intrinsic -acute renal failure?
- Acute Tubular Necrosis.
- Coagulation Defects.
What are the subsequent causes of postrenal - acute renal failure?
- Enlarged prostate.
- Ureteral obstruction [tumours/stones/clots]
How does prerenal acute renal failure present?
- Dizziness
- Dry mouth/thirst
- Hypotension
- Tachycardia
- Weight loss
How does intrarenal acute renal failure present?
- Fever
- Flank pain
- Joint pain
- Headache
- Hypertension
- Oliguria
- Rhabdomyolysis
How does postrenal acute renal failure present?
- Urine retention
- Distended bladder
- Gross haematuria
- Non-traumatic lower back pain [abdomen/groin/genitals]
- Peripheral oedema
How do you manage acute renal failure?
- General care and management
- Treat underlying condition to help restore function/perfusion to kidneys
- Intake vs. output (?)
- Analgesia/pain management
- Thorough Hx taking for provisional diagnosis.
- Hx taking should include drug therapies, recent invasive therapies, family Hx of renal disease, cardiac disease/failure, Hx of infection, N&V&diarrhoea, diabetes
What are the 2 primary types of renal dialysis?
- Haemodialysis
2. Peritoneal dialysis
What problems are associated with the dialysis patient?
- Vascular access problems
- Haemorrhage
- Hypotension
- Chest pain
- Severe hyperkalaemia
- Disequilibrium syndrome
- Air embolism
What causes haematuria?
- Infections
- Neoplasia
- Prostatic hyperplasia
- Nephrolithiasis
- Glomerulonephritis
- Schistosomiasis
- Expanding Abdominal Aortic Aneurysms
- Renal Vein Thrombosis (RVT) [pregnancy, dehydration, nephrotic syndrome]
- Trauma to the kidneys, ureters, urinary bladder and urethra
What is your management plan for haematuria?
- General management.
- If possible treat the cause then transport
- Gain from the patient Hx possible causes
- If shocked and if indicated treat with appropriate fluid therapy.
What is a UTI ?
Upper tract infection associated with kidney infection [pyelonephritis].
Lower tract infection associated with urethritis [urethra] and cystitis [bladder].
What causes a UTI ?
- Catheterisation
- Reflux
- Obstruction
- Sexual activity/contraception/STI/STD
- Pregnancy
- Ageing
How does UTI present?
- Dysuria
- Urinary frequency
- Haematuria
- Abdominal pain
- Hx of current infection
- Chills
- Fever [more likely upper]
- Loin pain
- Confusion
How would you manage a UTI ?
- Prevent deterioration: e.g. take the Pt to hospital for further assessment and treatment.
- General management
- Consider fluid therapy if patient septic.
What is renal colic/calculi?
Stone formation [nephrolithiasis] within the kidneys is a common disorder. The common complaint is a sudden onset of intermittent and often unbearable pain. Stones [calculi] are most commonly formed within the collecting system of the kidney [renal calyces and pelvis]. Calculi will then pass into the ureter before being passed through the rest of the urinary tract.
How are calculi’s formed?
- Super saturation of stone forming crystals within the collecting ducts, commonly calcium, phosphate, oxalate, cystine and urate.
- Decreased urine volume
- Lack of inhibitory chemicals [magnesium, citrate and pyrophosphate]
Infection can also assist in the formation of renal calculi.
What causes renal calculi/colic?
- Gout
- Hormonal disorders
- Heritable
- Diet
- UTI’s
- Repeated catheterisation
- Some medications
- Summer
- Lifestyle factors [sedentary lifestyles]
How does renal colic present?
- Severe pain originating in the flank with radiation to the groin or abdomen.
- Pain may be intermittent or constant
- Associated N&V, anxiety and diaphoresis
- Haematuria
- Urinary urgency, frequent voiding and urge incontinence may be present
- Inability to find a position of comfort [good for differential diagnosis]
What are the risk factors of renal colic?
- Prolonged immobilisation and sedentary lifestyle.
- Hyperparathyroidism
- Peptic ulcer disease
- Small bowel disease
- Gout
- Medications
- Prolonged or recurrent dehydration
- UTI
How would you manage renal colic?
General management, pain relief, anti-emetics and fluid therapy.
What differential diagnosis’ should be considered for renal colic?
- AAA
- Appendicitis
- Hernia
- Testicular torsion
- Musculoskeletal injury
- Renal infarction
- Biliary colic
- Ectopic pregnancy
- Ovarian cyst
- Diverticulitis
- UTI
- Renal failure
What causes urinary retention?
- Urethral stricture
- Enlarged prostate
- CNS dysfunction
- Foreign body obstruction
- Certain drugs
How does urinary retention present?
- Dysuria
- Severe abdominal pain
- Urgent need but inability to urinate
- Distended bladder
- Hx of not voiding bladder in one continuous stream.
- Gross haematuria dependent on chronic distension of bladder following catheterisation of urethra.
What is testicular torsion? Time frame?
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum.
Sudden onset of pain. Precipitated by vigorous activity or athletic event. It must be treated/diagnosed within 4-6hrs to prevent loss of the testis from ischaemic infarction.
