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BIOS5092 > Renal system > Flashcards

Renal system Flashcards

1
Q

where are the location of the kidneys?

A

located in retroperitoneum (behind peritoneum)- correspond to vertebrae T12-L3- right kidney slightly lower (due to liver)

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2
Q

how does the psoa major muscle affect kidneys?

A

20 degree tilt of kidney to vertical (upper pole is closer to midline) & 30 degree rotation of kidneys (medial surface more anterior than lateral border)- upper poles are more posterior than lower poles

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3
Q

how far does do kidneys move with respiration?

A

up to 1 cm- images are usually expiratory in supine patient

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4
Q

how is the kidney protected?

A

renal fascia attaches kidney to abdominal wall (fused to peritoneum)- layer of adipose tissue within abdominal cavity (provides enough contrast to make outline visivle on plain radiograph)- fibrous capsule adheres to renal tissue- damage to kidneys could lead to haemorage

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5
Q

what is renal hilus entry/exit point for?

A

renal artery, renal vein, ureter

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6
Q

what are the divsions of the kidney?

A

outer cortex & inner medulla

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7
Q

what does the cortex project into medulla as?

A

projects into medulla as columns

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8
Q

what do the columns divide medulla into?

A

pyramids

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9
Q

what does each pyramid empty into?

A

minor calyx

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10
Q

what do minor calyces empty into?

A

major calyces

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11
Q

what do calyces converge to form?

A

renal pelvis

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12
Q

where does the renal pelvis drain in to?

A

ureter

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13
Q

what is a lobe made up of?

A

pyramid, overlying cortex, surrounding column

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14
Q

what is the blood supply of kidneys?

A

renal arteries originating from aorta- number 1 job is to filter the blood

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15
Q

what does the renal artery divide in to?

A

segmental artery to interlobar arteries move out through coluums to cortex to arcuate arteries and run along border between cortex & medulla to interlobular arteries to supply cortex via afferent arterioles

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16
Q

what do afferent arterioles supply?

A

glomerular capillaries (place where blood is filtered & urine production occur)

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17
Q

what do efferent arterioles drain?

A

glomerular capillaries

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18
Q

what are the phases of renal enhancement?

A

corticomedullary phase, nephrographic phase, excretory phase

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19
Q

what is the volume & rate of contrast medium in kidneys?

A

volume is 150mL & rate is 2-3mL/sec

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20
Q

what is the corticomedullary phase?

A

occurs 24 to 80 secs after start of injection, will be delayed with renal dysfunction, blood is in cortical capillaries so cortex is enhanced & contrasts with medulla

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21
Q

what is the nephrographic phase?

A

begins 85 to 120 secs after injection- fluid in tubule system carries contrast medium (cortex & medulla appear similar)- also delayed in renal dysfunction

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22
Q

what is the excretory phase?

A

begins 3 to 5 mins after injection- fluid containing contrast medium has reached calyces- may indicate mass/renal tumour or cysts if it doesn;t have contrast

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23
Q

what are the ureters?

A

continuos with renal pelvis, vary in diameter from 1mm-1cm- urine conveyed from kidneys to urinary bladder by peristaltic contractions of ureters

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24
Q

what is the course of ureters?

A

course along psoas major, pass over common iliac vessels, enter bladder dorsolaterally

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25
Q

what are 3 constriction points of the ureters?

A

ureteropelvic junction, brim of pelvis, uterreovesicular junction

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26
Q

where is urinary bladder located in females?

A

anterior to uterus & vagina, posterior to pubic symphysis

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27
Q

where is urinary bladder in males?

A

anterior to rectum, posterior to pubic symphysis

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28
Q

what is urinary bladder made up with & lined with?

A

detrussor muscle (Smooth muscle) & lined by transitional epithelium with rugae

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29
Q

what the 3 openings of bladder?

A

2 for ureters & 1 for urethra- form the trigone

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30
Q

how many pelvic fractures result in ruptured bladder?

A

occurs in 10% of pelvic fractures- can show via contrast injected in to the bladder and if it leaks out it oculd indicate a rupture- urine can be contained by the peritoneum- US would be better to view free fluid in abdomen

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31
Q

what does the urethra run between?

A

urinary bladder & external urethral orifice

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32
Q

what occurs to detrussor muscle during fillind of bladder?

A

detrussor must relax to fill while urethral sphincter remain closed

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33
Q

what is the role of internal & external urethral sphincters?

A

internal sphincter (smooth muscle- involuntary control)- external sphincter (skeletal muscle- voluntary control- made up of muscles of pelvic floor)

34
Q

what is the role of female urethra?

A

conveys urone only- opens anterior to vaginal orifice

35
Q

what is the role of male urethra?

A

conveys urine & semen- three parts: prostatic, membraneous, penile

36
Q

how much cardiac output goes to kidneys?

A

approx. 25%- 180L of flomerular filtration per day to produce 2L of urine- the rest is absorbed

37
Q

what is the GFR?

A

how much filtration is occuring the kidneys- indicate how well a persons kidneys are functioning & risk of adverse reactions to contrast media- GFR decreases as they age

38
Q

how can glomerular filtrate rate (GFR) be estimated?

A

serum creatinine concentration, age, sex - provides indication of renal function & risk of adverse reactions to contrast media

39
Q

does GFR decrease with age?

A

yes but is offset by diminshing muscle bulk & creatinine excretion - creatinine is from muscles

40
Q

is glomerular filtration selective?

A

non-selective only blood cellls & proteins are not filtered

41
Q

where does reclamation of essential substances occur?

A

tubule system

42
Q

what is micturition (urinating) controlled by?

A

spinal reflexes influenced by higher centres

43
Q

what is inconinence caused by?

A

brainstem, cerebellar & cerebral lesions cause overflow, oestrogen deficiency reduces sympathetic sensitivty, congenital ectopic ureters & urinary fistulas (investigated by imaging)

44
Q

how common is congenital abnormalities?

A

10% of people- common due to complexiity of embryological development

45
Q

what are examples of renal congential abnormalities?

A

duplicated collecting system/partial duplication bifid renal pelvis, horseshoe kidney (joined across midline), crossed ectopia, pelvic or intrathoracic kidney, renal hypoplasia, renal agenesis

46
Q

what are the main indication for imaging urinary system?

A

haematuria (calculi, tumours), flank pain (tumours), renal failure (presence of obstruction, size of kidneys), infection

47
Q

what can plain radiographs identify in kidneys?

A

calcifications, size, shape- use is decreasing (60% sensitivty in detecting calculi & poor in detecting tumours)-

48
Q

what are plain radiographs used for in kidney?

A

primary study before contrast media, identigy residual contrast from previous studies, assessing position of drains & stents, assess trauma

49
Q

what can intravenous urography used for in kidney?

A

detects calculi- requires bolus injection of contrast medium- used from visualising renal collecting system & ureters, idetify urethral obstruction, demonstrate renal function- replaced by CT

50
Q

what is the gold standard for imaging renovascular disease?

A

angiography - also good to use if person has high BP

51
Q

what is uroradiology?

A

urethrography & cystography- contrast medium into urethra bladder

52
Q

what is visualised during voiding cysturethrography?

A

contrast filled bladder & urethra are visualised during voiding

53
Q

what is CT used for in diagnosing kidneys?

A

characterisation of a renal or peri-renal mass, tumour staging, identify calculi, used to evaluate excretion

54
Q

what can haematuria (blood in urinary tract) be caused by?

A

urolithiasis (formation of stones), UTI, malignancy, iatrogenic causes & trauma

55
Q

what is CT urography?

A

noncontrast phase for identification of stones, nephrogenic phase for evaluating renal masses, excretory phase for assessment of filling defects in collecting system

56
Q

what is urolithiasis (calculi)?

A

calcium oxalate & struvite most common, radioopaque appearance- result for high urinary mineral concentration, changes in pH and factors such as drugs & diet - associated with UTI’s- stones form in calyces & bladder- cause hydronephrosis (swelling of kidneys)

57
Q

what are clinical signs of urolithiasis?

A

pain & haematuria

58
Q

how is urolithiasis cured?

A

muscle relaxtant to release passage for stones

59
Q

what is the most common renal tumour?

A

renal cell carcinoma

60
Q

what is most common bladder tumour?

A

transitional cell carcinoma

61
Q

what is the main issue in identifying tumours?

A

differentiating cysts from masses- most identified incidentially during imaging for other clinical reasons

62
Q

what cysts are more likely to be malignant?

A

more complex cystic masses

63
Q

what is more useful for imaging tumours?

A

imaging more useful than biopsy

64
Q

what are masses composed of?

A

vascularised tissue (enhance with contrast agent) - contain little or no fluid

65
Q

how do we characterise a cyst?

A

precontrast & postcontrast images as confusion arises when there is soft tissue density in cysts- benign cysts can also show internal nonenhacing soft tissue

66
Q

what does it indicate when there is an enhancement of solid components in cyst?

A

a malignant lesion- simple cysts are totally fluid filled

67
Q

what is hydronephrosis due to?

A

distension of calyces & pelvis due to anatomical abnormaltiy or outflow obstruction in calculi of adult or prostatic hyperplasia or carcinoma in older adults- use imaging to identify obstruction- ultrasound is best

68
Q

what are infection of urinary tract system caused by?

A

intestinal flora- more common in women due to short, wider urethra- can ascend the tract from bladder to kidneys

69
Q

what is pyelonephritis?

A

UTI that generally begins in your urethra or bladder and travels to one or both of your kidneys- imaging not usually necessary but it is used to evaluate renal infection in high-risk patients & evaluation for complications- pus present in the kidneys

70
Q

what is the initial screening for trauma of kidney?

A

FAST (Focused Assessment with Sonography for Trauma) is initial screen

71
Q

what is the gold standard for screening abdominal trauma?

A

contrast-enhanced CT of abdomen & pelvis- can impact renal function - levels of creatinine increase by 25%

72
Q

what is used to diagnose collecting system leaks?

A

excretory phase CT in patients with suspected UTI

73
Q

what is used to investigate male urethra trauma?

A

retrograde urethrography

74
Q

when does contrast induced nephropathy appear?

A

25-48 hours after procedure- characterised by 25% increase in serum creatinine

75
Q

what is renal failure?

A

acute or chronic- disease may have been developing for many years - need dialysis or kidney transplant to survive

76
Q

where can acute kidney injury occur?

A

prerenal, renal & post renal (obstructive)

77
Q

what occurs to kidney is chronic or acute kidney disease?

A

chronic (smaller kidneys due to contraction of scar tissue)- acute (large due to swelling & inflammation)

78
Q

what happens if you can’t differentiate between cortex & medulla?

A

could indicate a disease

79
Q

what is a congenital ectopic ureter?

A

urine leaks out of urehtra causing incontinence- ureter goes directly to urethra and bypasses the sphincter

80
Q

why is imaging the prostate better than biopsy?

A

very invasive- have to go through perineum - not accurate- MRI may be better to investigate

81
Q

what are the 2 types of tumours found in kidneys?

A

ball type (bulges out) & bean type (contain within capsule)

BIOS5092 (17 decks)

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