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PBL SEM 4 > the kidney and urinary tract: what are they and how can they go wrong? > Flashcards

the kidney and urinary tract: what are they and how can they go wrong? Flashcards

1
Q

what is the cortex full of?

A

glomeruli and PCT

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2
Q

how many glomeruli in normotesnives?

A

1-2 million per kidney

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3
Q

how many glomeruli per kidney in people with essential hypertension?

A

0.5-1 million per kidney

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4
Q

why do most people with kidney disease have arterial hypertension?

A

kidney failure — can’t excrete salt and water — retained in body in circulation system — increases BP

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5
Q

what is a good way to treat hypertension in kidney failure?

A

remove excess salt and water — dialysis, diuretics (eg. furosemide)

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6
Q

why do you get oedema in kidney disease?

A

excess salt and water build up and kidney leaks a lot of protein and oncotic pressure falls —> high BP and excess salt and water leak into interstitial space causing oedema

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7
Q

what do the kidneys have a vital role in excreting?

A

K+

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8
Q

how does hyperkalaemia present on ECG?

A

peaked T waves

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9
Q

how can hyperkalaemia be treated?

A

dialysis, or injection of insulin intravenously with glucose

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10
Q

what does the urinary bladder do?

A

low pressure reservoir which intermittently and completely expels urine per urethra

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11
Q

what is the bladder made of?

A

smooth muscle bundles under autonomic nervous control

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12
Q
A
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13
Q

what is the urothelium surface covered in?

A

hexagonal plats made of uroplakin

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14
Q

what is the function of uroplakin?

A

makes the urothelium water tight and prevents water and all the excretory products (like urea) from diffusing back into the body

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15
Q

what do parasympathetic nerves release?

A

ACh

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16
Q

what nerves make the bladder contract, detrusor muscle contract and make rhe bladder void?

A

parasympathetic nerves

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17
Q

what effect does the adrenergic system have on the bladder?

A

makes it relax

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18
Q

what happens when the wave of smooth muscle contraction from the top to the bottom of the ureter doesnt work?

A

build up of urine at the top of ureter — hydronephrosis

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19
Q

what are the key clinical symptoms and signs of disease of the lower renal tract?

A
  • dysuria
  • frequency of micturition
  • incontinence of urine
  • poor urinary stream
  • haematuria
  • pain (caused by acute bladder outflow obstruction, renal colic, urosepsis etc)
20
Q

what dont you get a lot of in LOWER urinary tract disease?

A

proteinuria

21
Q

proteinuria + haematuria = ?

A

glomerular kidney disease

22
Q

primary disease of the lower tract can cause what?

A

secondary kidney failure mediated by impairment of urine flow

23
Q

what are they 2 ways of classifying kidney and urinary tract diseases?

A

CONGENITAL malformations

ACQUIRED — tumorus and non-tumours

genetic and environmental causes

24
Q

what are the 3 main histological varieties of kidney malformations?

A
  1. hypoplasia (too few nephrons)
  2. dysplasia (undifferentiated kidney sometimes with cysts)
  3. agenesis (absent kidney)
25
Q

what are the most common mutations in malformed kidneys?

A

HNF1B mutations

26
Q
A
27
Q

what is prune belly syndrome?

A
  • aka. Eagle-barrett syndrome
  • rare genetic birth defect
  • about 97% if those affected are male
  • triad of symptoms : partial or complete absence of the stomach (abdominal) muscles, failure of both testes to descend into the scrotum (bilateral cryptorchidism), and/or urinary tract malformations.

babies have massively large bladders

28
Q

descirbe one of the mutations in prune belly syndrome

A

mutation in myocardin = necessary for formation of smooth muscle —> mutated means smooth muscle in bladder not working properly so can’t empty bladder

29
Q

what are ‘pre-renal’ causes of acquired kidney failure?

A

cant make urine
- shock eg. massive blood loss, septicaemia
- cardiac and liver failure — poor kidney perfusion

30
Q

what is instinsic kidney disease?

A

= disease of the kidney itself

  • glomerular disease (eg. Alpert syndrome, diabetes mellitus and immune-mediated glomerulonephritis)
  • tubular disease (eg. pyelonephritis, autosomal dominant polycystic disease, nephrotoxins)
31
Q

what are ‘post-renal’ causes of acquired kidney disease?

A
  • urinary flow impairment eg. stones tumours and dysfunctional bladders); need to block BOTH kidneys
32
Q

what is anti-glomerular basement membrane nephritis?

A

acquired antibodies that attack glomerular basement membrane

33
Q

what is glomerular filtration rate in early diabetes mellitus?

A

actually INCREASED

34
Q

what happens to glomerular disease in diabetes mellitus without treatment?

A

there is a progressive decline in renal function with sclerosis of glomeruli

35
Q

tubular vs glomerular epithelia?

A

tubular epithelia have the capacity to regenerate, glomerular dont

36
Q

what does infectious pyelonephritis cause?

A

tubular disease

37
Q

describe autosomal dominant polycystic kidney disease (ADPKD)

A
  • ADPKD affects 1/1000 people
  • UK Renal Registry: Polycystic kidney disease is the cause of 9% end-stage renal failure in adults
  • kidney tubules initially form normally, but as young et older they dilate and squash the useful nephrons in between them —> kidney failure around 40 years old
38
Q

how is PKD treated?

A

tolvaptan = vasopressin receptor antagonist — slows down the progression of cyst growth

39
Q

what kind of kidney stones don’t show up on plain x rays?

A

uric acid stones

40
Q

what is the Wilms tumour?

A

kidney cancer in children

41
Q

what is the name of the common kidney tumour in adults?

A

clear cell carcinoma — arises in the proximal tubule

42
Q

what is the commonest bladder cacner?

A

transitional cell carcinoma

43
Q

where does prostate cancer like to metastasise to? describe

A
  • bone
  • unlike many other cancers, the bone metastases of prostate cancer are sclerotic - dense areas (vs lytic - make holes in bone)
44
Q

what feeling of prostate is suggestive of cancer in DRE?

A

bumpy and hard

45
Q

kidney failure does not cause one of these signs/symptoms?

A - difficulty breathing
B - high BP
C - jaundice
D - leg swelling
E - sudden death from hyperkalaemia

A

jaundice

46
Q

which of these suggests a glomerular cause of kidney disease?

A - bacteria grown from the urine
B - enlarged prostate on palpation
C - family history of kidney disease
D - RBCs and protein in urine
E - renal colic

A

D - rbcs and protein in urine

PBL SEM 4 (50 decks)

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