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Pathology 2420 Part 2 > Structure and Function of the Kidney and Urinary Tract > Flashcards

Structure and Function of the Kidney and Urinary Tract Flashcards

1
Q

Where are the Kidneys located?

A

In the Retroperitoneum, behind the abdomin, protected by lower ribs

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2
Q

How much blood supply do the kidneys receive from the heart?

A

~25%

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3
Q

What are the Kidneys function?

A
  • filter blood into urine, excreting waste products
  • regulation of water, salt, calcium, phosphorus, blood pH, and others
  • Endocrine function: Renin, Erythropoietin, regulates Vitamin D metabolism
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4
Q

How much blood do the kidney’s filter each day?

A

1700 L per day, to create 1 L of urine

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5
Q

What does Renin do?

A

regulate blood pressure

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6
Q

What connects the Kidneys to the Bladder?

A

Ureters

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7
Q

What are the Kidneys supplied by?

A

The renal artery

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8
Q

What is the outflow of blood from the Kidneys supplied by?

A

the renal vein

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9
Q

What is the Hilum?

A

Contains renal artery, renal vein, and ureter

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10
Q

What is the Cortex?

A

Contains glomeruli and tubules

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11
Q

What is the Medulla?

A
  • Contains collecting system (renal pyramids)
  • from which urine drains into renal calyces, renal pelvis, and ureter
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12
Q

What is the Ureter?

A

a muscular tube that connect the kidneys to and enters the bladder

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13
Q

What is the Bladder?

A

a hollow organ that is a reservoir for urine

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14
Q

What is the Urethra?

A

a fibromuscular tube from the bladder to the exterior

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15
Q

What are the main components of the Cortex?

A
  • Glomeruli
  • Tubules
  • Interstitium
  • Blood vessels
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16
Q

What is the Glomerulus? (4)

A
  • A functional unit of filtration
  • tuft of capillaries, with afferent (inward) and efferent (outward) arterioles
  • Capillaries are lined by glomerular basement membrane (GBM)
  • surrounded by double lining of epithelial cells, called Bowman’s capsule
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17
Q

What is the Bowman’s space?

A

The space between the epithelial layers, also called urinary space

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18
Q

What do the capillary endothelial cells contain?

A

Fenestrations (sieve-like holes)

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19
Q

What do Fenestrations do?

A
  • allow for passage of fluid and small molecules (water, electrolytes)
  • restricts passage of larger molecules (proteins) and blood cells
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20
Q

What surrounds the endothelial cells?

A

Glomerular basement membrane

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21
Q

What does the Glomerular basement membrane do?

A

Aids in filtrations, as physical barrier and charge barrier

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22
Q

What are the Glomerular basement membrane and the endothelial cells surrounded by together?

A

Podocytes, which contain foot processes with filtration silts

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23
Q

Where does blood in the capillary space pass through?

A
  • fenestrations
  • glomerular basement membrane
  • podocyte filtration slits
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24
Q

What occurs with the left over fluid in the urinary space?

A

It needs to be concentrated and therefore enters the proximal convoluted tubule

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25
Q

What abilities does the Proximal Convoluted Tubule have?

A
  • resorptive
  • secretory
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26
Q

Where does the fluid go after the Proximal Convoluted Tubule?

A

The Loop of Henle
- creates a concentration gradient in the kidney
- causes further reabsorption of water and salt

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27
Q

Where does fluid go after the Loop of Henle?

A

Distal convoluted tubule, and then collecting ducts

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28
Q

How many nephrons are in each kidney?

A

1-1.5 million

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29
Q

How does urine travel in the body?

A
  • emptied from the collecting ducts into the renal pelvis
  • travels down the ureter into the bladder
  • exits via the urethra
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30
Q

What are the renal pelvis, ureter and bladder all lined with?

A

Urothelium, which has special properties that allows the bladder to expand

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31
Q

What is Renal Cell Carcinoma?

A
  • Most common malignancy of the kidney
  • about 3% of adults
  • Usually in their 50-60s
  • More common in males 2:1
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32
Q

What are the risk factors for Renal Cell Carcinoma? (8)

A
  • smoking
  • Obesity
  • Hypertension
  • Unopposed estrogen
  • Chemical exposures
  • Chronic kidney disease
  • Acquired cystic disease
  • Rarely related to syndrome/familial
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33
Q

What are the signs and symptoms of Renal Cell Carcinoma? (5) or (8)

A

Classic Triad:
- flank pain
- palpable mass
- hematuria
Fever
Feeling unwell
weakness
weight loss

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34
Q

What is the treatment of Renal Cell Carcinoma?

A

Surgery (nephrectomy)

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35
Q

What is the most common subtype of Renal Cell Carcinoma?

A

Clear Cell Renal carcinoma

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36
Q

Macroscopically how does Clear Cell Renal Carcinoma look like?

A

Yellow with areas of hemorrhage (red)

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37
Q

What is Urothelial Carcinoma?

A
  • most common malignancy of the bladder
  • arise from urothelium (may occur in renal pelvis or ureter)
  • more common in males (3:1)
  • more common in older pts (50-80s)
  • more common in developed nations, urban dwellers
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38
Q

What are the Risk factors for Urothelial Carcinoma? (5)

A
  • smoking
  • industrial exposure to some chemical compounds
  • Parasitic infection
  • drugs (long term analgesics, heavy long term exposure to immunosppressive drugs)
  • Irradiation
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39
Q

What are the signs and symptoms of Urothelial Carcinoma?

A
  • painless hematuria
  • urinary frequency
  • burning with urination
  • urinary urgency
40
Q

What are the characterization of Low Grade Urothelial Carcinoma? (6)

A
  • slow growing
  • papillary
  • minimal atypia
  • frequently recur
  • usually not aggressive
  • rarely invasive
41
Q

What are the characterization of High Grade Urothelial Carcinoma? (6)

A
  • More aggressive
  • may be flat or nodular
  • high recurrence rate
  • more atypical
  • more likely to invade
  • may metastasize
42
Q

What is the treatment for low grade, noninvasive or minimally invasive Urothelial Carcinomas?

A
  • local excision
  • intravesical chemotherapy or BCG
43
Q

What is the treatment for high grade, or muscle invasive Urothelial tumours?

A

Cystectomy (resection of the bladder)

44
Q

What are the types of kidney infections?

A
  • acute Pyelonephritis
  • chronic Pyelonephritis
45
Q

What is Acute Pyelonephritis?

A
  • bacterial infection of the kidney, usually associated with UTI spreading
46
Q

What are the symptoms of Acute Pyelonephritis?

A
  • fever
  • flank/back pain
  • nausea/vomiting
  • associated bladder infections symptoms: pain with urination, urinary frequency, urgency
47
Q

What are the risk factors for Acute Pyelonephritis? (7)

A
  • urinary tract obstruction
  • instrumentation
  • vesicoureteral reflux
  • pregnancy
  • gender and age (often young females)
  • diabetes
  • immunosuppresion/immunodeficieny
48
Q

How is Acute Pyelonephritis diagnosed?

A

by urine culture

49
Q

How is Acute Pyelonephritis treated?

A

usually resolves with antibiotics

50
Q

What is Chronic Pyelonephritis?

A

Chronic inflammation and scarring of the kidney

51
Q

What are the causes of Chronic Pyelonephritis? (3)

A
  • reflux
  • long term obstruction
  • recurrent infection
52
Q

What are the different types of Renal Failure?

A
  • Acute
  • Chronic
53
Q

What is Acute Renal Failure?

A
  • occurs over hours to days
  • can be reversible if underlying cause is treated
54
Q

What is Chronic Renal Failure?

A
  • occurs over prolonged time
  • progressive, irreversible destruction of kidney
  • loss of function
  • may have no symptoms until later in disease course
55
Q

What is Acute Pre-Renal Failure?

A

a process that results in decreased blood flow to the kidney

56
Q

What are the Pre-Renal causes for Acute Renal failure?

A
  • decreased blood pressure (especially rapid)
  • dehydration
  • severe hemorrhage
57
Q

What are the causes of Acute Renal Failure? (6)

A
  • drugs
  • toxins
  • infections
  • inflammation
  • ischemic acute tubular injury
  • acute glomerulonephritis
58
Q

What is Acute Post-Renal Failure?

A

Obstruction of flow of urine

59
Q

What are the causes of Acute Post-Renal Failure?

A

Kidney stones

60
Q

What are the signs and symptoms of Renal Failure? (7)

A
  • Azotemia (increased blood urea niitrogen (BUN) and Creatinine)
  • Edema
  • Electrolyte disturbances
  • Metabolic acidosis (low blood ph)
  • anemia (low hemoglobin)
  • hypertension
  • bone disease
61
Q

What is End Stage Renal Disease? (6)

A
  • eventual end point of kidney diseases
  • sclerosis of glomeruli
  • scarring/fibrosis of interstitium
  • Loss of tubules (tubular atrophy)
  • Chronic inflammation
  • Thickened arteries
62
Q

What is the Treatment of Renal Disease?

A
  • lifestyle modifications
  • Medications
  • Dialysis when kidney function declines to end stage renal disease
  • kidney transplant
63
Q

What is Glomerular Disease?

A
  • damage to glomerular basement membrane; impairs filtration
  • Can be divided into primary or secondary glomerulopathies
64
Q

What is Primary Glomerulopathy?

A

affects the glomerulus alone or primarily

65
Q

What causes Primary Glomerulopathy? (4)

A
  • IgA nephropathy
  • post-infectious glomerulonephritis
  • membranous nephropathy
  • focal segmental glomerulosclerosis
66
Q

What is Secondary Glomerulopathy?

A

Systemic disease (affect multiple organs), which affect kidney

67
Q

What causes Secondary Glomerulopathy? (3)

A
  • diabetes
  • systemic lupus erythematosus
  • vasculitis
68
Q

What are mechanisms of Glomerular Injury? (2)

A

1) Antibodies reacting in situ within the glomerulus
- bind to intrinsic glomerular antigens, or
- bind to extrinsic antigens deposited within the glomerulus
2) deposition of circulating preformed antigen-antibody complexes within the glomerulus

69
Q

What are the manifestations of Nephritic Syndrome? (6)

A
  • Hematuria
  • Azotemia
  • Variable proteinuria
  • Oliguria
  • Edema
  • Hypertension
70
Q

What are the manifestations of Nephrotic Syndrome? (4)

A
  • Proteinuria (>3.5 g/day)
  • Hypoalbuminemia
  • hyperlipidemia
  • lipiduria
71
Q

What are the common causes of Acute Tubular Injury/Necrosis?

A
  • Ischemia
  • Toxic injury to tubules: endogenous agents, and exogenous agents
72
Q

What is the clinical course of Acute Tubular Injury? (6)

A
  • initial inciting event
  • decreased urine output
  • rise in BUN and creatinine
  • Electrolyte abnormalities and metabolic acidosis
  • Urine volume increases with recovery
  • Outcome related to magnitude and duration of ATI
73
Q

What is the Prognosis of Acute Tubular Injury?

A

Most pts who survive initial events recover completely

74
Q

What is Atherosclerosis? (5)

A
  • Narrowing of arteries due to plaque buildup
  • leads to decreased blood flow to the kidney
  • Kidney atrophy
  • chronic kidney failure
  • Risk of thromboembolism (clot), with renal infarct
75
Q

What is Hypertension? (6)

A
  • major cause of end stage renal disease
  • leads to nephrosclerosis
  • scarring of glomeruli
  • chronic tubulointerstitial injury
  • decrease in renal mass
  • decline in renal function
76
Q

What is Vesicoureteral Reflux?

A

When urine from the bladder enters the ureters

77
Q

What is a cause of Vesicoureteral Reflux?

A

Anatomical defect (often congenital)

78
Q

What are the complications of Vesicoureteral Reflux? (3)

A
  • urinary tract infection, pyelonephritis
  • hydroureter/hydronephrosis
  • chronic renal failure (if advanced)
79
Q

What are the treatment options for Vesicoureteral Reflux?

A
  • Conservative Treatment: some cases will resolve as child grows
  • surgical reimplantation of ureter
80
Q

What Is Intrinsic obstruction? (5)

A
  • lesions of urinary tract
  • stones
  • congenital/acquired strictures
  • tumours of urinary tract
  • functional disorders (often neurogenic)
81
Q

What is Extrinsic Obstruction? (4)

A
  • external compression
  • pregnancy
  • inflammation/scarring of surrounding organs
  • tumours in surrounding organs
82
Q

What are the different types of Urinary Tract Obstruction?

A
  • acute or chronic
  • partial or complete
  • unilateral or bilateral
83
Q

What occurs in Acute Urinary Tract Obstructions?

A

Often have flank pain (renal colic)

84
Q

What occurs in Unilateral/partial Urinary Tract obstructions?

A

Asymptomatic
- unaffected kidney can maintain renal function

85
Q

What occurs in Chronic Urinary Tract Obstructions?

A

results in chronic kidney disease

86
Q

What are Urinary Tract Stones? (5)

A
  • form in the kidneys
  • men more than women
  • 20-30 years
  • familial predisposition
  • may arise due to underlying medical condition
87
Q

What are the different types of Urinary Tract Stones?

A
  • Calcium oxalate/phosphate 70-80%
  • Struvite (magnesium ammonium phosphate) 5-10%
  • Uric Acid 5-10%
  • Cystine 2%
88
Q

What does Calcium oxalate/phosphate stones cause?

A

Increased calcium in blood or urine

89
Q

What does Struvite (magnesium ammonium phosphate) cause?

A
  • bacteria convert urea to ammonia, which combines with magnesium and phosphate
  • large, staghorn stones
90
Q

What does Uric Acid cause?

A
  • may have hyperuricemia (patients with gout)
  • low urine pH
91
Q

What does Cystine cause?

A

Genetic defects in cystine reabsorption

92
Q

What are the most important determinants for Urinary Tract Stones?

A
  • increased urinary concentration of stone’s constituents
  • exceed solubility (supersaturation)
93
Q

What are other factors influencing factors of Urinary Tract Stones? (3)

A
  • changes in urinary pH
  • decreased urine volume
  • presence of bacteria
94
Q

What is the presentation of Urinary Tract Stones? (6)

A
  • may be asymptomatic
  • may cause severe renal colic, abdominal pain
  • may cause significant kidney damage
  • hematuria (blood urine)
  • Predispose patient to infection
  • Diagnosis aided by imaging
95
Q

What is the treatment for Urinary Tract Stones?

A
  • wait for stones to pass: drink fluids, pain management
  • lithotripsy (sound waves shatter stones)
  • surgical removal

Pathology 2420 Part 2 (6 decks)

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