Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CABS III > Renal/Male GU > Flashcards

Renal/Male GU Flashcards

1
Q

kidney functions include

A

removal of waste products, maintenance of fluid balance/volume, regulation of electrolytes, regulation of plasma osmolality, regulation of BP, regulation of acid/base, regulation of RBC production (EPO), maintenance of hormone levels, vitamin D activation, and gluconeogenesis (converting amino acids into glucose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

renal hilum

A

includes the renal artery, vein, lymphatics, nerves, and the ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

location of kidneys within the body

A

retroperitoneal around the level of L1-L3 where the left kidney is slightly higher than the right, surrounded by a fibrous capsule and embedded in renal fat (perinephric and paranephric) and fascia (anterior and posterior) which holds the kidney in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

renal cortex

A

extends between renal pyramids as columns and contains the glomeruli, the proximal tubule, and some of the distal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

renal medulla

A

contains 8-10 renal pyramids which taper at the papilla, contents from the papilla then drain into the minor calyces followed by the major calyces of the renal pelvis which ultimately drains into the ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

number of nephrons within the kidney

A

1.2 million nephrons/kidney which do not regenerate (after age 40, people lose about 10% every 10 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

renal blood supply

A

renal arteries which come off the aorta divide into anterior and posterior branches at the hilum, then into segmental arteries, interlobar arteries, arcuate arteries, cortical radiate arteries, afferent arterioles, glomerular capillaries, efferent arterioles, peritubular capillaries, and vasa recta within the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

percentage of cardiac output going to the kidneys

A

20-25% of CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

location of arcuate artery/vein within the kidney

A

runs along the cortical-medullary junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

nephron blood supply

A

arcuate artery branches into the afferent arteriole, the glomerular capillaries, the efferent arteriole, the peritubular capillaries, the vasa recta network, and then into renal venous circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

part of the kidney that enhances the regulation of hydrostatic pressure

A

its 2 sets of capillary beds - the glomerular and peritubular which are separated by efferent arterioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

functional unit of the kidney

A

the nephron which filters and concentrates urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

location of the renal corpuscle

A

within the renal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

location of the loop of Henle

A

the descending limb (thin segment) travels down within the renal pyramid/medulla whereas the ascending limb travels back up from the medulla into the cortex (thick segment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

renal corpuscle

A

includes the glomerulus, Bowman’s capsule, and the mesangial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

glomerulus

A

contains capillaries that loop together within Bowman’s capsule covered with modified epithelial cells referred to as podocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bowman’s capsule

A

composed of 2 layers - the visceral epithelial layer which contains podocytes and is tight around the glomerular capillaries, forming a network of intracellular clefts (moderates filtration), and the parietal layer which is the capsular outer layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

glomerular filtration membrane

A

includes the capillary endothelium, basement membrane (negatively charged), and podocytes which help with filtration and prevent large proteins and RBCs from passing through into the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

medullary collecting duct

A

where 8-10 cortical collecting ducts come together (each collects urine from about 4,000 nephrons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

proximal convoluted tubule (PCT)

A

contains cuboidal cells with brush border microvilli and is continuous with Bowman’s capsule, attaching to the descending loop of Henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PCT function

A

reabsorbs 90% of HCO3- into peritubular capillaries, actively reabsorbs sodium (which helps with the cotransport of other electrolytes), and reabsorbs glucose and amino acids, this area also secretes urate and creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

urea formation

A

amino acids are broken down into carbohydrates through deamination and release ammonia (NH3) which is converted to urea within the mitochondria of the liver, urea is then excreted within the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

loop of Henle function

A

the location where urine concentration is primarily determined (in addition to the distal tubule), includes the thin descending limb which is passively permeable to H2O, the thin ascending limb which is permeable to ions but not H2O, and the thick ascending limb which actively transports ions including NaCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

distal convoluted tubule (DCT) function

A

extends from the macula densa to the collecting duct and is poorly permeable to H2O unless ADH is present, allowing reabsorption of ions including potassium (determined based on aldosterone) diluting the urine and regulating calcium excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

renal pelvis function

A

contains contractile properties which push urine to the bladder for storage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ureter function

A

smooth muscle bundles that are 33 mm in diameter and 25-35 cm in length which will generate peristalsis when stretched (innerved by sympathetic and parasympathetic systems), function to carry urine from the kidney to the bladder, during micturition the bladder muscles close the ureters to prevent urine reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

blood supply to ureters

A

renal arteries, iliac arteries, abdominal aorta, gonadal arteries, and internal iliac arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

ureter sensory innervation

A

10th thoracic nerve root which sends pain to umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

location of bladder within the body

A

“basket weave” of smooth muscle (detrusor) that sits within the pelvis in adults but above the pubic symphysis in children, fills with urine passively and will stimulate micturition reflex (autonomic spinal cord reflex) when above the volume threshold which can be inhibited by cerebral cortex or brain stem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

location of ureter insertion into bladder

A

posterior and inferior on either side of the trigone muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

urethra

A

3-4 cm in women and 18-20 cm in men, lined by uroepithelium and contains glands that secrete mucous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

bladder innervation

A

the detrusor muscle and internal urethral sphincter are under involuntary control and innervated by the parasympathetic nervous system, the trigone muscle is innervated by the sympathetic nervous system (L2), and the external urethral sphincter is made of skeletal muscle and innervated by the pudendal nerve whereas it is under voluntary control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

juxtaglomerular apparatus

A

includes granular cells (or JG cells), which are smooth muscle cells that sense stretch, the macula densa, and the mesangial cells and is the area in which the afferent arteriole comes in contact with the thick ascending limb of Henle and the DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

juxtaglomerular apparatus function

A

functions to sense blood pressure or perfusion pressure as well as sodium concentration in urine, regulate renin release, and cause afferent vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

juxtaglomerular apparatus response to increased urine sodium

A

inhibits renin release from JG cells and causes afferent vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

macula densa

A

composed of modified epithelial cells that have chemoreceptor function which marks the end of the ascending thick limb of Henle and the beginning of the DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

macula densa function

A

monitors NaCl concentration in the DCT, releasing adenosine, which causes vasoconstriction of the afferent arteriole to decrease GFR, and inhibiting renin release from JG cells if NaCl concentration is high, if NaCl concentration is low (sensed by macula densa) or BP is low (sensed by JG cells), it stimulates renin release from JG cells and nitric oxide increases vasodilation of both the afferent and efferent arterioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

systemic and renal effects of angiotensin II

A

causes systemic vasoconstriction to elevate BP and constricts the efferent arteriole to increase glomerular capillary pressure and maintain GFR, increases reabsorption of sodium and H2O in the PCT to increase intravascular volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

immediate effect of systemic drop in BP on the kidney

A

drop in BP will stimulate baroreceptor stimulation and release of catecholamines which causes afferent arteriole vasoconstriction leading to decrease renal blood flow and decreased GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

creatinine

A

filtered readily by the glomerulus and should remain constant but will go up with increased creatinine creation (muscle breakdown, PO intake) or decreased excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

blood urea nitrogen (BUN)

A

not as reliable as creatinine and indicates the amount of systemic urea, either from consumption, hydration status, tissue breakdown, or decreased excretion - 50% of urea is passively absorbed in PCT (goes up with dehydration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

GFR

A

typically an estimated measurement most commonly calculated from creatinine using a formula that takes age and sex into consideration (Cockcroft-Gault equation), normal GFR = 120 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

volume filtered by glomeruli per day

A

180 L/day (99% of filtrate reabsorbed), typically 30 mL urine produced per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

components of urine

A

water and urea are the main components, typically no glucose or RBCs, specific gravity of 1.001 - 1.035, contains trace proteins primarily uromodulin (Tamm-Horsfall proteins) which is made in the loop of Henle and binds uropathogens preventing stone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

pH of urine

A

4.6 - 8, typically acidic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

total body water includes

A

intracellular fluid (2/3), interstitial fluid, plasma (both interstitial and plasma = 1/3), and insensible fluid (fluid lost by sweating, exhaling, urinating, and bowel movement) where water is able to readily pass between compartments via osmotic and hydrostatic forces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

primary driver of osmosis within the body

A

osmolality = the number of osmoles of solute per kilogram of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

primary driver of fluid movement in ECF

A

sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

primary driver of fluid movement in ICF

A

potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

primary driver of intravascular fluid

A

albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

tonicity

A

the ability of a solution to affect the fluid volume and pressure in a cell which determines cellular size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

tonicity is maintained by

A

intact thirst, functioning GFR, a functioning loop of Henle and DCT, appropriate functioning of ADH, and an appropriate response of the kidney to ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

tonicity is determined by

A

extracellular sodium level and osmolality whereas when it is increased, ADH is released stimulating increased H2O retention and increased thirst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

normal EC potassium range

A

3.5 - 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

normal chloride range

A

95 - 105

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

normal bicarbonate range

A

22 - 26

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

normal glucose range

A

90 - 120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

normal calcium range

A

8.5 - 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

normal EC magnesium range

A

1.4 - 2.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

normal urea nitrogen range

A

10 - 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

normal IC potassium range

A

130 - 140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

normal IC magnesium

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

normal EC sodium range

A

135 - 145

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

major drivers of fluid shift from intravascular to interstitial space

A

plasma or interstitial hydrostatic pressure (BP) and oncotic pressure (osmolality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

renal clearance

A

removal of waste (400 mL/day minimum), excess ions, urea, creatinine, hydrophobic drugs, and some hormones where there is a lower concentration of waste products within the renal venous system compared to the arterial system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

creatinine clearance (CrCl)

A

a measure of GFR and helps to indicate the functional status of the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

effect of low BP on the kidney

A

JG cells release renin which stimulates RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

effect of low BP on the liver

A

releases angiotensinogen which is converted to angiotensin I by renin (released from the kidney)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

effect of low BP on the adrenals

A

angiotensin II stimulates release of aldosterone which causes increased sodium reabsorption in the collecting duct and DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

effect of low BP on the brain

A

releases ADH which stimulates sodium and H2O reabsorption in the collecting duct and DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

effect of low BP on the heart

A

decreases production on ANP (BNP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

effect of low BP on the lungs

A

release angiotensin-converting enzyme (ACE) that converts angiotensin I to angiotensin II causing stimulation of the brain to release ADH and increased sodium reabsorption in the PCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

percentage of plasma entering Bowman’s capsule as filtrate

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

normal urinary output

A

30 mL/hour (determined by renal blood flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

juxtaglomerular cell function (JG cells)

A

release renin in response to low urine osmolality and EPO in response to low circulating oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

effect of angiotensin II on glomerulus

A

stimulates vasoconstriction of the efferent arteriole to increase GFR in response to low renal blood flow (decreased GFR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

carbon dioxide (CO2)

A

a result of the cellular metabolism of carbs and fat which is 20X more soluble than O2 and will diffuse very quickly, the primary trigger for central chemoreceptors - increases with an increase in cellular metabolism (on average we produce 200 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

bicarbonate (HCO3-)

A

made in the kidneys to buffer acids, for every molecule of HCO3- made in the kidney, one molecule on H+ is eliminated in the urine, HCO3- is reabsorbed in the PCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

normal CO2 range

A

35 - 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

processes requiring pH balance

A

metabolic functioning, protein structure, enzymatic functioning, and cell wall integrity, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

effects of acidosis on the cardiovascular system

A

decreased cardiac output and LV contraction leading to compensatory tachycardia, vasodilation leading to hypotension, increased ectopic rhythms from unstable cellular function, and hyperkalemia (peaked T waves, P wave flattening, PR prolongation, and wide QRS complexes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

effects of alkalosis on the cardiovascular system

A

cardiac excitability, ventricular tachyarrhythmias, SVT, and hypokalemia (T wave inversions, ST depression, and prominent U waves)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

effects of acidosis on the respiratory system

A

tachypnea, a drop in CO2 to about 10 at the lowest point, and a right shift in oxyhemoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

effects of alkalosis on the respiratory system

A

low respiratory rate and a left shift in oxyhemoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

effects of acidosis on the CNS

A

decreased neurotransmitter release, decreased mental status, and lethargy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

effects of alkalosis on the CNS

A

increased action potentials, seizures, and tetany

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

medications effected by pH level

A

vasopressors, anesthetics, and insulin

88
Q

components of a buffering system

A

contain a weak acid and conjugate base with a positive and negative charge that can bind either H+ or OH-

89
Q

hemoglobin buffer system

A

a protein buffer that can help stabilize pH in the blood during the transportation of gases such as CO2 which can be diffused into plasma or bound to hemoglobin, within the RBC CO2 is converted to bicarbonate via the formation of carbonic acid from H2O and CO2 which then diffuses out into the plasma, the process must be reversed upon arrival in the pulmonary capillaries

90
Q

central chemoreceptors detect

A

changes in blood pH and blood CO2 concentration

90
Q

ionic shift that can occur with acidosis

A

an increase in H+ concentration outside the cell seen in acidemia (low pH) can cause H+ to enter the cell and be exchanged for K+ ions causing resultant hyperkalemia within hours

91
Q

ionic shift that can occur with alkalosis

A

a decrease in H+ concentration outside the cell seen in alkalemia (high pH) can cause H+ to exit the cell and be exchanged for K+ ions causing resultant hypokalemia within hours

92
Q

effect of insulin on ionic shifts

A

insulin drives K+ and glucose into the cell and as a general rule - if low = less K+ is inside the cell

93
Q

renal buffer system

A

most systemic HCO3- is reabsorbed in the PCT during filtration to keep pH neutral whereas for every H+ secreted into the urine, an HCO3- is regenerated and secreted into the bloodstream (maximum urine acidity = pH of 4.4 - 4.7)

94
Q

acid/base compensation

A

adjustments within the respiratory or renal systems to compensate for the primary pH abnormality which allows the pH to return to normal but the HCO3:CO2 ratio to be changed

95
Q

anion gap (AG)

A

distinguishes between acid gain and bicarb loss, calculated by subtracting primary serum anions (Cl + HCO3) from primary serum cation (Na+) where normal gap = 8 (> 10-12 is abnormal)

96
Q

causes of anion gap metabolic acidosis (AGMA)

A

MUDPILES = Methanol, Uremia, DKA, Paraldehyde, Isoniazid, Lactic acid (Hypotension), Ethylene glycol, and Salicylates

97
Q

nephrotic syndrome

A

basement membrane and podocyte injury causing disruption of negative charge allowing for inappropriate dumping of proteins into urine and excess loss of albumin and immunoglobulins resulting in decreased oncotic pressure and peripheral edema where filtered protein > reabsorption capability (greater than or equal to 3.5 g of proteinuria/day), compensation occurs by increasing ADH production to try and increase intravascular volume and aldosterone secretion

98
Q

minimal change disease

A

a most commonly idiopathic primary nephrotic syndrome that is most commonly seen in children and causes thinning of the podocyte foot processes due to abnormal T cell activation and cytokine release resulting in a loss of negative charge of the basement membrane, increased filtration membrane permeability, hypoalbuminemia, and proteinuria

99
Q

membranoproliferative glomerulonephritis

A

idiopathic complement activation or autoimmune response to antigen causing inflammation, thickening of the glomerular basement membrane, and deposits of inflammatory proteins (cytokines, complement, antibodies) leading to increased membrane permeability and proteinuria

100
Q

focal segmental glomerulosclerosis

A

idiopathic (or sometimes associated with other disease processes - IgA nephropathy, HIV) thinning of podocytes, formation of hyaline deposits in mesangial cells and endothelial cells resulting in increased pore size, proteinuria, and fibrosis

101
Q

secondary nephrotic syndrome

A

glomerular dysfunction caused by systemic diseases including DM, amyloidosis, SLE, IgA vasculitis, infections, malignancies, and vascular disorders

102
Q

effect of NSAIDs on the glomerulus

A

constrict the afferent arteriole reducing GFR and can lead to kidney damage

103
Q

effect of ACEi/ARBs on the glomerulus

A

dilate the efferent arteriole increasing GFR and are renal protective

104
Q

nephrotic syndrome presentation

A

proteinuria causing edema and infection, hypoalbuminemia causing edema, hyperlipidemia causing atherosclerosis, lipiduria causing fat in the urine, low vitamin D causing low calcium and osteoporosis, and hypothyroidism

105
Q

nephritic syndrome

A

inflammation of the mesangium due to antigen deposition causing endothelial damage and RBC loss resulting in hematuria with RBC casts, it may be associated with infection (HBV, HCV, PSGN) or autoimmune causes

106
Q

post-infectious glomerulonephritis (nephritic syndrome)

A

associated with group A strep infection in children and staphylococcus infection in adults leading to IgG and complement deposits in the subepithelial area, this results in increased infiltration of neutrophils, cellular proliferation, and decreased GFR

107
Q

rapidly progressive glomerulonephritis

A

associated with initial injury and subsequent alterations of the glomeruli that occurs rapidly over days to months, a crescent formation can be seen within the glomeruli

108
Q

IgA nephropathy aka Berger disease

A

most common cause of primary glomerulonephritis that can be infection-related (post-URI or GI bug) causing increased serum IgA levels and IgA granular deposits leading to nephropathy and hematuria, may have oliguria and HTN

109
Q

Anti-GBM disease aka Goodpasture syndrome

A

nephropathy causing linear IgG deposits within the glomerular basement membrane and/or crescent formations that is associated with pulmonary hemorrhage and hemoptysis (will have positive anti-GBM antibodies)

110
Q

Polyangiitis with granulomatosis aka Wegener granulomatosis

A

ANCA small vessel vasculitis which is most commonly seen in older adults with few or no basement membrane deposits, can involve the nose and lungs, will have positive c-ANCA

111
Q

Alport syndrome

A

basement membrane collagen disorder causing nephritic syndrome and results in abnormally split and laminated GBM, presents with hematuria, edema, and HTN

112
Q

function of principle cells within the DCT and collecting duct

A

respond to ADH and aldosterone by reabsorbing sodium and water back into circulation when stimulated

113
Q

function of intercalated cells within the DCT and collecting duct

A

secrete H+ into urine ridding the body of excess acid (making urine acidic)

114
Q

acute kidney injury (AKI)

A

elevated serum urea and creatinine due to toxic waste accumulation which causes an increase in nitrogenous waste products presenting with fatigue, N/V, pruritis, anorexia, and neurologic dysfunction

115
Q

prerenal AKI

A

decreased renal blood flow leading to hypoperfusion and decreased GFR causing increased aldosterone (RAAS activation) and ADH secretion and increased sodium and water reabsorption in the DCT resulting in oliguria - improves with fluid administration

116
Q

causes of prerenal AKI

A

hypovolemia (dehydration), hypotension, shock, cardiac failure, massive PE, stenosis of renal artery, increased intraabdominal pressure, and medications such as NSAIDs

117
Q

intrarenal AKI

A

renal tubular injury most commonly associated with ischemia causing cast formation, necrosis, and tubular obstruction leading to increased tubular pressure and leakage and decreased GFR resulting in oliguria

118
Q

causes of intrarenal AKI

A

ATN, AIN (contrast, medications - RSVP), glomerulonephritis, vascular damage or embolism (DIC, vasculitis), malignant HTN, and acute bilateral pyelonephritis

119
Q

postrenal AKI

A

bilateral obstruction downstream of the kidney that causes increased intraluminal pressure, inflammation resulting in vascular endothelial cell injury, vasoconstriction, cellular/interstitial edema, and reduced GFR resulting in oliguria (can lead to intrarenal AKI)

120
Q

causes of postrenal AKI

A

obstructive disorders such as bilateral kidney stones, BPH, tumors, ureteral destruction, and neurogenic bladder

121
Q

complications of AKI

A

encephalopathy (uremic toxins), heart failure (fluid overload) and/or arrhythmia due to hyperkalemia, intestinal and microbiota disruptions, bone marrow and immune system effects, liver dysfunction (fluid overload), and lung injury (fluid overload), metabolic acidosis, decreased toxin clearance, uremia, volume overload, coagulopathy, and HYPERKALEMIA

122
Q

acute on chronic kidney injury

A

a sudden change in GFR in a patient with a chronic low GFR in the setting of increased physiological stress, increases risk of developing CKD

123
Q

CKD

A

reduced GFR that lasts > 3 months causing epithelial damage, inflammation, and fibroblast deposition resulting in increased urine protein, RBC, WBC, and casts (patient can remain asymptomatic due to compensation until renal function drops to < 25% that of normal)

124
Q

causes of CKD

A

DM, HTN, SLE, chronic glomerulonephritis, obstructive pathology, and vascular disorders

125
Q

azotemia

A

elevated blood urea nitrogen (BUN > 28 mg/dL), creatinine (> 1.5 mg/dL), and nitrogenous compounds

126
Q

uremia

A

azotemia with signs or symptoms of renal failure, uremic syndrome

127
Q

uremic syndrome

A

associated with elevated urea and other toxins not removed by the kidneys causing platelet dysfunction, uremic pericarditis, uremic neuropathy, muscle spasms, fatigue, N/V, and acidosis

128
Q

systemic changes seen in CKD

A

fractures due to low vitamin D, pulmonary edema, Kussmaul respirations, LVH, cardiomyopathy, ischemic heart disease, HTN, accelerated atherosclerosis, encephalopathy, anemia due to reduced EPO, abnormal skin pigmentation, pruritis (increased waste, elevated calcium, and neuropathy), and reduced immune function

129
Q

effect of hyperglycemia on osmotic pressures

A

increased blood glucose leads to a change in osmotic gradients causing electrolyte shifts, a renal glucose threshold of 200 results in glucose dumping into the urine when reaching that level increasing urine concentration and amount of fluids excreted (polyuria), this results in dehydration which triggers osmoreceptors leading to an increase in thirst (polydipsia)

130
Q

CKD related to DM

A

elevated glucose causes inflammation and macro/microvascular changes leading to atherosclerosis of efferent arterioles and RAAS activation, elevated glomerular pressure causes podocyte injury and fibrosis of the GBM and mesangial cells leading to reduced GFR, vascular changes will also reduce oxygen delivery to renal tubules causing decreased reabsorption

131
Q

CKD related to HTN

A

increased pressure through glomerular capillaries causes increased filtration and protein dumping which corrects itself for the short term but will cause hypertrophy of the vascular walls long term and hyaline arteriosclerosis resulting in decreased oxygen delivery to the interstitium and tubules, inflammation is triggered by mesangial cells and fibrosis occurs leading to glomerulosclerosis

132
Q

acute tubular necrosis (ATN)

A

intrarenal cause of AKI most commonly associated with ischemia injury (hypovolemia, systemic vasodilation, coagulopathy), toxins (abx, contrast, etc.), and sepsis (systemic hypotension), corticomedullary junction more likely to be damaged, not limited to the tubules - may not lead to necrosis

133
Q

polycystic kidney disease

A

autosomal dominant pathology leading to thousands of renal cysts which can impede the normal function of the kidney, most commonly due to a chromosome 16 mutation that affects the PKD gene which normally assists with cellular signaling, helps with cellular growth, and kidney function - PKD1 codes for polycystin-1 which is very active in childhood within the cell membrane whereas PKD2 codes for polycystin-2 which transports Ca2+ into the cell (PKD1 has more severe presentation, PKD2 has a later onset of symptoms)

134
Q

PKHD1 gene

A

autosomal recessive mutation leading to polycystic kidney disease that is very rare but has a high mortality at a young age

135
Q

complications of polycystic kidney disease

A

patients are at increased risk for cysts in other organs such as the liver, HTN, hematuria, UTIs, stones, and aortic aneurysm

136
Q

WBC casts in urine indicate

A

interstitial nephritis (AIN) or pyelonephritis

137
Q

RBC casts in urine indicate

A

glomerulonephritis

138
Q

broad or waxy casts in urine indicate

A

chronic renal failure (CKD)

139
Q

hyaline casts in urine indicate

A

exercise, diuretics, or concentrated urine (formed of Tamm-Horsfall mucoprotein)

140
Q

fatty casts (oval fat bodies) in urine indicate

A

nephrotic syndrome

141
Q

muddy brown/granular casts in urine indicate

A

ATN

142
Q

renal tubular epithelial cell casts in urine indicate

A

ATN

143
Q

UTI

A

inflammation of the epithelium of the urinary tract which is most common in females secondary to the proximity of the anus and length of the urethra where infection moves in retrograde and causes inflammation of the bladder wall if reaches it, typically associated with E.coli, staph, klebsiella, proteus, pseudomonas, and candida

144
Q

UTI risk factors

A

female, young, sexually active, pregnant, recent antibiotic use, postmenopausal, catheter use, DM, and neurogenic bladder

145
Q

urinary defenses against bacteria

A

acidity, high osmolality, uromodulin, and uroepithelial secretions, the ureterovesical junction typically prevents reflux of urine back into the ureter

146
Q

UTI presentation

A

urinary frequency, urgency, dysuria, suprapubic discomfort, hematuria, pyuria, odor, and cloudy urine

147
Q

CAUTI

A

UTI caused by uropathic E.coli which have fimbriae that bind to latex catheters and flagella that allow them to move against the flow of micturition, have hemolysin, and are able to alkalinize the urine, fimbriae associated with pyelonephritis

148
Q

acute cystitis

A

inflammation of the bladder wall associated with typical UTI that causes edema, erythema, and suppurative exudates (WBC in UA), may have hemorrhage resulting in RBC in UA, can develop into ulcerative cystitis if prolonged infection with sloughing of the epithelial layer

149
Q

interstitial cystitis

A

painful bladder syndrome with symptoms of UTI but sterile environment thought to be autoimmune which can increase risk for UTI and may progress to fibrosis or hemorrhagic ulcers

150
Q

interstitial cystitis presentation

A

symptoms similar to UTI for > 6 months, frequency, urgency, nocturia, chronic pain, and increased rates of depression

151
Q

acute pyelonephritis

A

ascending UTI into the ureter, renal pelvis, and/or kidney interstitium most common in females associated with the same pathogens as UTIs leading to tubulointerstitial inflammation and renal edema, increases the risk for abscess (in renal medulla), necrosis of renal tubules and papillae, and may become bacteremic particularly if bilateral

152
Q

causes of acute pyelonephritis

A

stones causing obstruction, stasis, bacterial entrapment, vesicoureteral reflux, pregnancy due to dilation and relaxation of the ureter, neurogenic bladder which reduces sphincter tone and residual urine, instrumentation that may directly introduce bacteria, and sexual trauma

153
Q

complications of acute pyelonephritis

A

can develop into sepsis, scarring, fibrosis, atrophy of renal tubules, or AKI

154
Q

chronic pyelonephritis

A

associated with recurrent risk factors and progressive inflammation leading to the inability of tubules to concentrate urine, more commonly seen in CKD

155
Q

nephrolithiasis

A

collection of protein, crystals, or other substrates in the kidney, ureter, or bladder classified by the primary mineral that comprises the stone most commonly calcium oxalate or phosphate, uric acid, struvite, or other rare types as a result of supersaturation or overabundance of stone-forming mineral which precipitates into crystals (dehydration can increase rate of growth), can be staghorn calculi which fill minor or major calyces or non-staghorn calculi which vary in size and location, increases risk for MI due to increased atherosclerotic plaque buildup

156
Q

risk factors for calcium nephrolithiasis

A

alkaline urine, altered natural stone inhibitors within the kidneys/urine, genetic deficiencies, urine stasis, hypercalciuria, and hyperuricemia

157
Q

struvite nephrolithiasis

A

more likely to form if urine is alkaline due to urease-releasing bacteria such as Klebsiella, pseudomonas, and Proteus, can develop into staghorn

158
Q

nephrolithiasis will typically spontaneously pass if

A

< 5 mm (if 5-7 mm, 70% spontaneously pass)

159
Q

nephrolithiasis presentation

A

renal colic (location of pain may correlate with obstruction), N/V, hematuria

160
Q

male perineum muscles

A

include the external anal sphincter, the bulbospongiosus, and the ischiocavernosus

161
Q

bulbospongiosus function

A

sits around the lateral aspect of the bulb of the penis and proximal body, innervated by the pudendal nerve, and functions to support the pelvic floor, expel semen, and push blood from the bulb into the body of the penis

162
Q

ischiocavernosus function

A

helps maintain erection and compress venous flow

163
Q

root of the penis components

A

contains 3 sections of erectile tissue which are the crus laterally, the bulb centrally encasing the urethra, and the external urethral sphincter at the apex of the prostate

164
Q

body of the penis

A

suspended from the pubic symphysis, attached via the suspensory ligament, and contains erectile tissue - 2 corpora cavernosa dorsally and the corpus spongiosum ventrally (containing the urethra)

165
Q

glans of the penis

A

expansion of the corpora cavernosa which contains the external urethral orifice and the prepuce (foreskin)

166
Q

blood supply to penis

A

dorsal arteries between corpora cavernosa and deep arteries that facilitate erection that branch off of internal pudendal arteries, arteries of the bulb that supply the bulbous part of the corpus spongiosum, and superficial and deep branches of the external pudendal nerve

167
Q

innervation of penis

A

branches off of the pudendal nerve including the dorsal nerve (provides somatic innervation to the spongy urethra)

168
Q

blood supply to scrotum

A

anterior scrotal arteries come off of the external pudendal arteries and the posterior scrotal arteries come off the internal pudendal arteries

169
Q

lymph drainage for the scrotum

A

superficial inguinal lymph nodes

170
Q

innervation of scrotum

A

anterior scrotal nerves come off of the ilioinguinal nerve and genital branch of the genitofemoral nerve

171
Q

spermatocord

A

includes the vas deferens, the testicular artery, and the pampiniform plexus

172
Q

function of cremaster muscle

A

extension off the external oblique muscle which pulls the spermatocord upward

173
Q

testes

A

oval 3-6 cm in length and 3-4 cm wide and contain tortious duct of seminiferous tubules which leave the lobe through tubules rectus, all collecting toward the rete testis, then the efferent tubules, and finally the epididymis, the testes descend into the scrotum 3 months before birth through the inguinal canal and are suspended by the spermatocord, covered internally by the tunica albuginea and externally by the tunica vaginalis

174
Q

temp required for spermatogenesis

A

2-7 degrees Celsius below body temp or 3.5 - 12.6 degrees Fahrenheit below body temp which is adjusted by the cremasteric and dartos muscles

175
Q

blood supply to testes

A

internal spermatic artery

176
Q

innervation of the testes

A

adrenergic fibers

177
Q

location where sperm is produced

A

made by Sertoli cells in the seminiferous tubules, stimulated by Leydig cells, during/after puberty in the outer aspect of the testes (basal lamina) and then move centrally to the lumen when mature

178
Q

pampiniform plexus

A

venous vascular attachment for the testes which helps to regulate temp and is part of the spermatic cord

179
Q

epididymis

A

situated posteriorly over the top of the testes measuring about 5-7 cm (6 meters when uncoiled) and helps with the continued maturation and motility of sperm, takes 12 days for sperm to move along the epididymis where they obtain nutrients and testosterone, they are then stored in the epididymal tail which attaches to the vas deferens

180
Q

vas deferens

A

muscular duct that peristalses sperm through the inguinal canal and toward the urethra when stimulated by the sympathetic nervous system, it connects to the ampulla, seminal vesicles which create seminal fluid, and the ejaculatory duct

181
Q

inguinal canal

A

contains the spermatic cord, gonadal vessels, and lymphatics which extends from the internal inguinal orifice and exits at the external inguinal orifice (about 4-6 cm in length)

182
Q

Leydig cells

A

stimulated by LH in males and produce testosterone

183
Q

Sertoli cells

A

stimulated by FSH in males to produce androgen bonding protein and create spermatogonia (diploid cells) which continue to mature as stimulated by chemicals within the seminiferous tubules (testosterone and androgen bonding protein)

184
Q

spermatozoa

A

consists of a head that contains the nucleus with DNA and an acrosome, a midpiece that contains large amounts of mitochondria, and a tail with flagella that is composed of filaments

185
Q

seminal vesicles

A

sit posterior to the bladder above the prostate and produce seminal fluid which accounts for the majority of semen, can contract to help push semen along the ejaculatory duct where the semen contains fructose for sperm metabolism and prostaglandins which alkalize the fluid to protect from the vagina

186
Q

prostate

A

size of a walnut and surrounds the urethra consisting of alveoli of glands surrounded by fibromuscular tissue which contracts during ejaculation, glandular tissue secretes PSA, cytokeratin, and prostate-specific membrane antigen which contributes to ejaculate

187
Q

prostate function

A

regulated by androgens and functions to alkalinize semen further and add fibrinolysis to increase sperm motility (gives milky appearance)

188
Q

bulbourethral glands

A

secrete mucous near the base of the penis

189
Q

semen pH

A

7.5

190
Q

normal ejaculation contains

A

2 - 6 mL of fluid and 75 - 400 million sperm which accounts for about 10% of total fluid volume, the rest is seminal fluid (the bulk which forms a mucoid consistency), prostatic fluid (forms a white color and allows sperm to initially form a coagulated body at the cervix which is broken down over 15 minutes), and urethral fluid

191
Q

sperm motility

A

minimal movement occurs while sperm is within the male because of a heavy cholesterol coating around the acrosome, this is lost when entering the vaginal environment allowing an influx of calcium causing the flagellum to become more motile

192
Q

common ejaculatory duct

A

formed by the vas deferens and the seminal vesicle which produces seminal fluid

193
Q

erection

A

stimulated by the parasympathetic nervous system (which may begin centrally in the hypothalamus - paraventricular nucleus) that sends fibers to the pelvic nerve (S2-S4) which acts on the erectile tissue of the corpus cavernosum releasing Ach resulting in the release of NO in Helicine arteries causing vasodilation and filling of erectile sinusoidal tissue with blood, increased volume in the erectile tissue compresses venous drainage out of the penis, detumescence occurs when there is a loss of NO

194
Q

ejaculation

A

stimulated by the sympathetic nervous system (T4-L2) when the cerebral cortex inhibits parasympathetic activity causing the release of norepinephrine at the epididymis followed by contraction resulting in sperm being pushed down the vas deferens, upon reaching the seminal vesicles that are simultaneously being constricted, it joins the seminal fluid and flows down the common ejaculatory duct through the prostate and into the prostatic urethra, sympathetic stimulation causes constriction of the internal urethral sphincter to prevent exchange between urine and semen, the pudendal nerve release Ach in bulbospongiosus causing contraction and pushes semen down the penile urethra

195
Q

capacitation of the spermatozoa occurs

A

1 - 10 hours after ejaculation into the vagina which releases hyaluronic acid and proteolytic enzymes

196
Q

hypospadias

A

idiopathic or congenital abnormality resulting in a ventral location of the urethral opening where the urethral groove forms inappropriately and does not close completely that is androgen-mediated, placement may be near the glans, in the scrotum, perineum, or anywhere in between, the prepuce is unable to close distally and there is a hooded foreskin, may also see chordee - leads to abnormal or poor urine stream, increased bed wetting, incomplete voiding, and spraying of stream

197
Q

epispadias

A

urethral opening on the dorsal side of the penis in which severity can differ greatly, causes incontinence, reflux, and UTI, and severe cases can lead to bladder exstrophy

198
Q

paraphimosis

A

urological emergency!! prepuce that has been retracted proximal to the glans that occurs when a patient has pulled the prepuce back and not returned it to its typical location, edema ensues which becomes constrictive causing a tourniquet effect and can result in necrosis of the glans

199
Q

phimosis

A

when the prepuce is stuck over the glans of the penis and in unable to be retracted, it can develop a scar tissue ring, may be physiological in children with the formation of adhesions that will eventually separate

200
Q

complications of phimosis

A

can become pathologic if associated with skin conditions or balanitis and can cause scarring or urinary obstruction, smegma may increase risk or continue to develop if not improved

201
Q

erectile dysfunction

A

inability of a man to form or maintain an erection sufficient for satisfying sexual activity due to several underlying causes including issues with NO and inability to compress venous structures, atherosclerosis, DM, CVD, decreased testosterone, surgery complication, neurological issues, endocrine dysfunction, psychological problems (psychogenic), or medication SE

202
Q

Peyronie’s disease

A

fibrous deposition within the tunica albuginea of the corpora cavernosa associated with plaque deposition with a vasculitis-like inflammatory reaction, the fibrosis and calcium deposition which forms a fibrous plaque is palpable along the dorsal aspect of the penis causing a bend in the penis associated with Dupuytren contracture (degree of bend/change is typically 15-22 degrees), can cause pain with intercourse and difficulty with erection

203
Q

priapism

A

erection lasting > 4 hours not associated with sexual stimulation which is a urological emergency!! that can be low-flow (more common and due to decreased venous return) or high-flow (less common and associated with trauma due to increased arterial flow) caused by spinal cord trauma, sickle cell disease, tumors, infection, penile trauma, cocaine use, mediations (trazodone, lithium, and those for ED), or can be idiopathic - can lead to edema, fibrosis, and ED

204
Q

dihydrotestosterone (DHT)

A

metabolite of testosterone metabolized by 5-alpha-reductase that is required for prostate growth

205
Q

prostate growth

A

grows fairly rapidly from puberty to age 30 y/o and then stops and starts to grow again in the 40-50 y/o range

206
Q

BPH

A

hyperplasia of the prostate which affects 50% of men > 50 y/o and 90% of men > 70 y/o, is thought to be caused by dysregulation of hormonal balance in DHT and estrogen (estrogen is metabolized from testosterone via aromatase) causing enlargement, remodeling, inflammation, angiogenesis, and increased fibroblast activity of the prostate at the periurethral gland site resulting in urethral compression, bladder outflow obstruction, urinary urgency, urinary retention, overflow incontinence, and difficulty starting and stopping stream

207
Q

complications of BPH

A

increases the risk for hematuria, UTI, pyelonephritis, hydroureter, and hydronephrosis

208
Q

prostatitis

A

inflammation of the prostate which can be caused by acute bacterial infection, chronic bacterial infection, or inflammation without infection typically associated with ascending infection with GI pathogens such as E. coli, also can be associated with STI, causes enlarged, tender, firm, and boggy prostate in which the pain may be worse with standing because of the muscles of the perineum tightening around the prostate more

209
Q

acute bacterial prostatitis presentation

A

symptoms of enlarged prostate and infection including fever, perineal pain, dysuria, urinary retention, nocturia, dysorgasmia, and possibly bacteremia - can develop into chronic bacterial infection

210
Q

hydrocele

A

painless collection of fluid between the parietal layer and the visceral layer of the tunica vaginalis most commonly causing scrotal swelling common in newborns (patent processus vaginalis) where primary hydroceles are typically idiopathic and secondary are associated with infection or trauma, tunica vaginalis usually reabsorbs fluid

211
Q

varicocele

A

commonly occurring dilation of the pampiniform plexus vessels referred to as a “bag of worms” where 95% occur on the left side, caused by poorly functioning valves resulting in venous backflow and blood pooling that may be associated with a tumor or compression, can reduce fertility and blood flow to the testes

212
Q

epididymitis

A

inflammation of the epididymis most commonly associated with STIs such as gonorrhea and chlamydia and with anal bacterial like E. coli, H. flu, and Tb in MSM, if > age 35 y/o, Enterobacteriaceae from intestinal flora most common cause, may be associated with chemical irritation such as urine reflux

213
Q

epididymitis presentation

A

scrotal pain/inflammation, acute discomfort, swelling on the epididymis starting at the tail and ascending, urethra abutting the spermatic cord causing urinary obstruction, +/- pyuria - increases the risk for abscess formation, infertility, and infarction

214
Q

orchitis

A

inflammation of the testes associated with bacteremia or direct spread up the urethra, through the prostate, up the vas deferens, and through the epididymis and testes referred to as epididymo-orchitis which is classically associated with mumps beginning 3-4 days after parotitis causing fever and may be bilateral

215
Q

testicular torsion

A

urological emergency!! twisting of the testes resulting in rotation and cessation of blood flow from the spermatic cord which can be spontaneous or after exertion, may twist and then untwist spontaneously, decreased blood flow in the spermatic cord causes testicular pain, swelling, elevated testis, and loss of cremasteric reflex

216
Q

blue dot sign

A

seen in testicular torsion as the testis becomes necrotic, the testicular appendage will necrose becoming cyanotic and appearing as a weird little vestigial dingleberry

CABS III (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions