Renal and urologic systems Flashcards
1
Q
Micturition
A
- mostly reflexive with som volitionally control
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
3
Q
Sympathetic nerve effect on bladder
A
- relax bladder
- no urination
4
Q
Parasympathetic nerve supply effect on bladder
A
- contraction of bladder
- urination occurs
5
Q
Pudendal nerve
A
- controls external sphincter
- contracts with sympathetic NS
- relaxes with parasympathetic NS
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
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
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
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
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
11
Q
UTI
A
- Most commonly involve bladder and urethra
- fecal associated gram-negative organisms
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
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
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
15
Q
Renal cancers:
A
- renal cell carcinoma
- wilms tumor
16
Q
Renal cell carcinoma
A
- most common in adults
- may be linked to hereditary disorders
- kidney disease associated with ESRD
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
18
Q
Renal cell carcinoma triad of symptoms and treatment
A
- flank pain
- hematuria
- palpable abdominal mass
- surgery is principle treatment
19
Q
Wilms tumor
A
- most common malignant kidney neoplasm in children
- hereditary syndromes can predispose children
- molecular genetic link
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
21
Q
Renal cystic diseases types
A
- polycystic disease (PKD) - leading cause of ESRD, frequently requiring dialysis and renal transplantation
- cystic diseases of renal medulla
- acquired cyst disease
- single cysts
- cystic renal dysplasia
- other
22
Q
PKD
A
- autosomal dominant or autosomal recessive (ARPKD)
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
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
