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Year 2 Urinary (JK) > Renal assessment and physiology of micturition > Flashcards

Renal assessment and physiology of micturition Flashcards

1
Q

What are 2 situations GFR is useful?

A

renal disease

drugs

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2
Q

What does the total GFR =?

A

Sum of all filtration by functioning nephrons so progression of disease indicated by decrease in GFR

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3
Q

Why is GFR important in terms of drugs?

A

eg antibiotics removed by filtration - excretion
drug concentration in plasma could become toxic
adjust dose

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4
Q

What tests are done to measure GFR (renal function)?

A

plasma clearance test

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5
Q

What does the plasma clearance test measure?

A

ability of kidney to clear plasma of various substances

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6
Q

What is important in plasma clearance tests - plasma or urine?

A

volume of plasma

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7
Q

What is the gold standard for plasma clearance tests?

A

inulin

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8
Q

Why is inulin the gold standard for plasma clearance tests?

A

no reabsorption or secretion
100% filtered is excreted
not metabolised by kidney
inulin clearance - GFR

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9
Q

If substances are filtered and reabsorbed what will their clearance be compared to inulin?

A

lower

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10
Q

If substances are filtered and secreted what will their clearance be compared to inulin?

A

higher

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11
Q

GFR value

A

125mls/min

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12
Q

What causes changes in GFR?

A

women - 10% less due to SA

lose 1ml/min/year after 30

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13
Q

In clinical practice what was the next best after inulin to measure GFR?

A

radioactive substance handled same as inulin

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14
Q

Why is the direct ways to measure GFR not used anymore?

A

Too complex
injections
expensive

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15
Q

What is routinely used to estimate GFR?

A

creatinine clearance

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16
Q

What is creatinine?

A

endogenous product of muscle creatine breakdown

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17
Q

Problem with creatinine clearance to measure eGFR

A

not a linear correlation

need to lose about 50% of GFR to notice difference in levels

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18
Q

3 factors affecting serum creatinine

A

muscle mass
dietary intake
drugs

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19
Q

Normal approx. GFR

A

100mls/min/1.73m squared

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20
Q

Glucose clearance and why

A

0 - all reabsorbed

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21
Q

Urea clearance and why

A

less than inulin as some is reabsorbed

22
Q

What is PAH used to measure?

A

renal plasma flow

23
Q

Why is PAH used to measure RPF?

A

freely filtered and remaining is secreted

more than 90% excreted in 1 transit

24
Q

Renal plasma flow value

A

660ml/min

25
Q

Penicillin clearance and why

A

higher than inulin as some secreted

26
Q

How does urine travel from kidneys to ureters?

A

peristaltic contraction of smooth muscle of ureters

27
Q

Does urine composition change once it leaves the kidneys?

A

no

28
Q

Bladder muscle name

A

detrusor muscle - spiral, longitudinal and circular

29
Q

Is the external or internal urethral sphincter a true sphincter?

A

external

30
Q

Epithelium in bladder

A

transitional

31
Q

Relations of bladder

A

midline
posterior to pubic bones
anterior to rectum and repro. organs

32
Q

What makes up the trigone?

A

2 vesicoureteric orifices

urethral opening

33
Q

Would urethral and ureter problems cause bilateral or unilateral kidney problems?

A

urethra - bi, ureter - uni

34
Q

Describe the pressure-volume curve of bladder

A

characteristic shape
long flat segment with initial urine
sharp rise as micturition reflex triggered

35
Q

Normal daily urine production

A

750-2500mls

36
Q

Motor innervation of bladder - parasympathetic

A

pelvic nerves contract detrusor muscle

S2-4

37
Q

Motor innervation of bladder - sympathetic

A

hypogastric nerves L1-3

inhibit bladder contraction and close internal sphincter

38
Q

Main function of hypogastric nerves

A

prevent semen reflux into bladder in ejaculation

39
Q

Motor innervation of bladder - somatic motorneurons

A

external urethral sphincter - keep it closed

S2-4

40
Q

Sensor innervation of bladder

A

stretch receptors –> spinal cord

41
Q

Consequence of activating stretch receptors in bladder

A

a - parasympathetic flow
b - inhibit sympathetic
c - inhibit somatic motorneurons to external sphincter
d - pathways to sensory cortex - sensation of fullness

42
Q

Volume needed to initiate micturition reflex

A

300-500mls

43
Q

How is delay of micturition accomplished?

A

descending pathways which stimulate somatic nerves, inhibit parasympathetic and over ride input from bladder

44
Q

What does voluntary initiation of micturition consist of?

A

stimulate parasympathetic

inhibit somatic motor neurons

45
Q

What does relaxing pelvic floor muscles do?

A

may cause sufficient downward tug of detrusor

46
Q

Significance of perineal and external sphincter muscles contracted voluntarily

A

prevent stopping midstream and prevent urine flow down urethra

47
Q

How does female urethra empty after urination?

A

gravity

48
Q

How does male urethra empty after urination?

A

contractions of bulbocavernous muscle

49
Q

3 major types of neural abnormalities of micturition

A

problems with afferent
problems with afferent and efferent
interruption of facilitatory and inhibitory descending pathways

50
Q

Significance of neural abnormalities of micturition

A

bladder contracts but not enough to expel all urine - high residual volume

51
Q

Ways paraplegics can have some control over micturition

A

rub/pinch thigh - mild mass reflex

mild noxious stimuli on skin

Year 2 Urinary (JK) (26 decks)

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