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Medical Conditions 2 > Renal and urologic systems > Flashcards

Renal and urologic systems Flashcards

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USMLE® Step 1 flashcards
1
Q

Micturition

A
  • mostly reflexive with som volitionally control
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2
Q

innervation of the bladder

A
  • sympathetic nerve supply: L1-L3 → hypogastric nerve
  • parasympathetic nerve supply: S2-S4 → pelvic nerve
  • somatic nerve supply: S2-S4 → pudendal nerve supply
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3
Q

Sympathetic nerve effect on bladder

A
  • relax bladder
  • no urination
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4
Q

Parasympathetic nerve supply effect on bladder

A
  • contraction of bladder
  • urination occurs
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5
Q

Pudendal nerve

A
  • controls external sphincter
  • contracts with sympathetic NS
  • relaxes with parasympathetic NS
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6
Q

Describe the renin-angiotensin-aldosterone system.

A
  • Decrease in BP/blood volume detected
  • liver secretes angiotensin and kidneys secrete renin
  • renin converts angiotensin to angiotensin 1
  • ACE enzyme (secreted by lungs) converts angiotensin 1 to angiotensin 2
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7
Q

What does angiotensin 2 do?

A
  • increase sympathetic activity
  • increase NA, Cl reabsorption
  • increase K excretion
  • increase Water retention
  • increase aldosterone secretion
  • arteriolar vasoconstriction
  • ADH secretion to retain water
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8
Q

What does a urinalysis look at

A
  • acidity (normal = pH of 4.5-8)
  • concentration of ions
  • protein
  • glucose (0-0.8 mmole /L)
  • ketones
  • bilirubin
  • evidence of infection (WBCs/Blood in urine)
  • blood
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9
Q

Blood tests to evaluate kidney function

A
  • BUN: 6-24; 2.1 to 8.5 mol/L
  • Creatinine
  • GFR v eGFR >90 is normal
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10
Q

Aging and the urologic system

A
  • gradual reduction of blood flow to the kidneys
  • reduction in nephrons
  • kidneys become less efficient at removing waste from the blood
  • changes in urine production and voiding
  • tendency toward greater renal vasoconstriction
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11
Q

UTI

A
  • Most commonly involve bladder and urethra
  • fecal associated gram-negative organisms
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12
Q

UTI clinical manifestations

A
  • frequency an urgency to use bathroom
  • dysuria (pain/difficulty urinating)
  • nocturne
  • children enuresis (bedwetting)
  • fever, chills malaise
  • confusion can be a sign in the elderly
  • cloudy, bloody or foul smelling urine
  • burning or painful sensation during urination or intercourse
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13
Q

Risks factors for UTI

A
  • age
  • immobility/inactivity
  • urinary retention
  • frequent catheterization
  • atonic bladder
  • increase sexual activity
  • spermicide
  • uncircumcised penis
  • renal calculi
  • prostatic hyperplasia
  • malformations
  • constipation
  • women > men
  • kidney transplant
  • diabetes M
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14
Q

Pyelonephritis

A
  • infection process involving the kidneys or a chronic inflammatory disease involving the kidney parenchyma and renal pelvis
  • typically treated with an appropriate antibiotic medication
  • typically results from bacteria ascending from bladder to infect kidneys
  • chronic pyelonephritis is a tubulointerstitial disorder characterized by scarring with deformity of the calyces
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15
Q

Renal cancers:

A
  • renal cell carcinoma
  • wilms tumor
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16
Q

Renal cell carcinoma

A
  • most common in adults
  • may be linked to hereditary disorders
  • kidney disease associated with ESRD
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17
Q

Risk factors for renal cell carcinoma

A
  • tobacco smoking,
  • moderate to heavy drinking (alcohol)
  • obesity
  • HTN
  • barbecued meat
  • occupational exposure to substances such as dust, organic solvents, and asbestos and acquired cystic kidney disease associated with ESRD
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18
Q

Renal cell carcinoma triad of symptoms and treatment

A
  • flank pain
  • hematuria
  • palpable abdominal mass
  • surgery is principle treatment
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19
Q

Wilms tumor

A
  • most common malignant kidney neoplasm in children
  • hereditary syndromes can predispose children
  • molecular genetic link
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20
Q

Signs and treatment for Wilma tumor

A
  • palpable abdominal mass that is identified typically once it gets large enough to cause pain
  • multimodality therapy with surgery, while abdomen radiotherapy and three drug chemotherapy
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21
Q

Renal cystic diseases types

A
  1. polycystic disease (PKD) - leading cause of ESRD, frequently requiring dialysis and renal transplantation
  2. cystic diseases of renal medulla
  3. acquired cyst disease
  4. single cysts
  5. cystic renal dysplasia
  6. other
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22
Q

PKD

A
  • autosomal dominant or autosomal recessive (ARPKD)
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23
Q

PKD risk factors and treatment

A
  • HTN
  • multiple pregnancies
  • males
  • expression of genetic mutation are linked to rapid progression
  • tx: BP management and pain management
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24
Q

Renal calculi
- what is it and risk factors

A
  • urinary stone disease or nephrolithiasis
  • over excretion and hyper saturation of calcium or oxalate
  • risk factors: acidic urine pH, gout, dehydration
25
Q

classic presentation of renal calculi

A
  • acute colicky flank pain radiating to the groin or perineal areas
  • hematuria/dark colored during g
  • severe pain in back and with urination
  • size is typically less than 5mm in diameter
26
Q

Chronic kidney disease

A
  • kidney dysfunction that lasts 3 months or longer GFR<60
27
Q

Most common causes of Chronic kidney disease

A
  • diabetes
  • HTN
  • glomerulonephritis
28
Q

Pathogenesis of chronic kidney disease (CKD)

A
  • diabetes: damage to nephron by hyperglycemia
  • Diabetes and HTN: release of angiotensin 2 damage nephron
  • long term glomerular inflammation will impede flow
29
Q

Normal GRF rate

A
  • 90- 120
30
Q

Stage 1 of CKD

A
  • protein in urine but GRF normal or increased
  • prephase
31
Q

Stage 2: CKD

A
  • increased albumin in urine
  • GFR 89-60
  • important to control HTN to limit progression
  • can stay in stage 2 for years
32
Q

Stage 3 CKD

A
  • increased albumin in urine, decreased in blood
  • GRF: 59-30
  • increase in BUN, creatinine
  • azotemia = accumulation of waste products in blood
  • confusion can occur
33
Q

stage 4 CKD

A
  • proteinuria
  • GRF 29-15
  • BUN and creatinine increase
  • renin production increase and causes HTN
34
Q

Stage 5 CKD

A
  • kidney failure
  • kidneys do not excrete toxins
  • imbalances of fluids and electrolytes
  • uremia
  • lethargy, pruritic
  • sensory an motor neuropathy
  • pericarditis, impaired heart function
  • seizures and asterisks
  • dialysis and transplant
35
Q

Clinical manifestations of CKD

A
  • anemia: changes in hemoglobin/hematocrit
  • cardiovascular: HTN
  • MSK: arthralgia
  • GI systems: nausea, vomiting
  • renal osteodystrophy - extraskeletal calcification (changes with breaking down bone and increase calcium deposits in areas)
  • neurological system: confusion and seizures
36
Q

Medical management of CKD

A
  • HTN: ACE Inhibitors, alpha blockers
  • Diet: limit protein, K, and Na
  • restricted fluid intake
  • may need diuretics
  • Renal replacement therapy: dialysis/transplant (stage 5)
37
Q

Hemodialysis

A
  • AV (artery and vein) fistula put in
  • blood taken from artery through machine
  • machine removes waste, excessive fluids, adds electrolytes and return to vein
  • usually preformed at a center 3 times/week for 3-4 hour treatments
38
Q

Peritoneal dialysis

A
  • dialysis complete via catheter in peritoneal cavity
  • dialyzing solution put in catheter then drained
  • this causes a flooding of system and it filters things out
  • completed at home
  • 4 times per day or overnight
  • complications: peritonitis, hyperglycemia
39
Q

Transplantation of a kidney

A
  • limited by available donors
  • living donor preferred
  • risk of rejection
  • long term immunosuppressive meds/antirejection meds
40
Q
  • examples of anti-rejection meds and their side effect
A
  • Cyclosporin, azathioprine

Side effects

  • opportunistic infections
  • osteoporosis
  • nausea, vomiting, rash
  • renal disease
41
Q

Nephogenic systemic fibrosis

what is it and signs and symptoms

A
  • Fibrotic CT that disrupts normal cells
  • illness occurs with kidney disease
  • presents as firm, erythematous, indurated plaques of the skin associated with subcutaneous edema
42
Q

Glomerular disease

A
  • group of conditions - damage the kidneys filtering units
  • most common cause of ESRD world wide
43
Q

Bladder cancer Common types

A
  • transitional cell carcinomas
  • squamous cell carcinomas
  • adenocarcinomas
44
Q

Clinical manifestations of bladder cancer

A
  • painless hematuria
  • clots in urine.
  • incontience issue
  • increase frequency or urgency
  • dysuria: difficult to empty fully
45
Q
  • Urinary incontinence
A
  • involuntary loss of urine that is sufficient to be a problem an occurs most often when bladder pressure exceeds sphincter resistance
46
Q

Types of urinary incontinence

A
  • functional
  • stress
  • urge
  • overflow
47
Q

Functional incontinence

A
  • not of the bladder but rather an inability to get to the bathroom in time
48
Q

stress incontinence

A
  • lifting, holding breath, coughing, sneezing caused
  • increase in abdominal pressure pushes urine out
49
Q

urge incontinence

A
  • feel urge to go premature
  • cannot stop it
  • problem with controlling the muscle sphincter
50
Q

overflow icontinence

A
  • full bladder
  • bladder doesn’t empty fully and body gets use to resting level
  • bladder gets full and the person doesn’t realize
51
Q

Neurogenic bladder

A
  • voiding dysfunction associated with neurological pathology
  • anything that affects the pathway to the bladder
  • may need to be put on a voiding schedule
  • clinical manifestations vary based on cause
52
Q

causes of neurogenic bladder

A
  • cerebrovascular accident
  • dementia
  • parkinsons disease
  • MS
  • brain tumors
  • Spinal cord lesions
53
Q

Interstitial cystitis (painful bladder syndrome)
- Diagnosis
- etiology/risk factors

A
  • diagnosed by cystoscopy
  • risk factors not clear
54
Q

Pathophysiology of interstitial cystitis

A
  • permeability of the bladder wall - exchange in layer of the bladder
  • overactivity of the pelvic floor muscles
  • visceromuscular reflex
  • hypersensitivity and neurologic irritation
55
Q

Clinical manifestations of interstitial cystitis

A
  • urgency and frequency increase
  • nocturia
  • pain in the bladder, urethra or vagina (can happen in males but more common in females)
  • supra pelvic pain
  • dull low back pain
56
Q

treatment for interstitial cystitis

A
  • symptoms management
  • stress relief
  • PT
57
Q

Common side effects of diuretics/HTN medication

A
  • orthostatic hypotension - vasodilators/diuretics
  • dyspnea- beta blockers (blunted exercise)
  • negative chronotropic effects - beta blockers
  • negative inotropic effect = decrease strength of contraction
  • altered potassium levels
58
Q

Altered potassium levels with HTN drugs and hyperkalemia

A
  • potassium sparing diuretics Beta blockers, drugs that affect RAAS
59
Q

Altered potassium levels from HTN drugs causing hypokalemia

A
  • loop and thiazide diuretics

Medical Conditions 2 (22 decks)

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