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Pathophysiology > The Renal and Urologic System > Flashcards

The Renal and Urologic System Flashcards

1
Q

What organs are considered the Upper Urinary Tract?

A
  • Kidneys

- Ureters

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2
Q

What organs are considered the Lower Urinary Tract?

A
  • Urinary bladder

- Urethra

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3
Q

What are the functions of the kidneys?

A
  • maintains osmotic pressure
  • regulates the volume of the extracellular fluid (Na and H2O)
  • helps regulate acid-base balance
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4
Q

the kidneys excrete _____ when there is excess acid, and _____ when there is excess base

A

H+

HCO3-

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5
Q

Kidneys filter _____ L or bood/day and eliminates a min. of ___ L of urine/day

A

190 L

2 L

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6
Q

Kidneys regulate ____________ by regulating fluid volume/RAS system

A

blood pressure

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7
Q

Kidneys contribute to ________ function by producing erythropoeitin and renin

A

endocrine

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8
Q

Kidneys excrete _____

A

drugs

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9
Q

MOA for kidneys include:

Where does this take place?

A

filtration, reabsorption, and secretion which take place in the nephron

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10
Q

The ________ is a network of small blood vessels known as a ____, located at the beginning of a nephron in the kidney

A

Glomerulus

tuft

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11
Q

Blood enters the Glomerulus through _________ arterioles and exit into _________ arterioles

A

afferent

efferent

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12
Q

What surrounds the Glomerulus?

A

Bowman’s capsule

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13
Q

______ is filtered across capillary walls of glomerulus through glomerular filtration ______ - yields its filtrate into the Bowman’s capsule - goes into __________

A

Blood
barrier
proximal tubule

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14
Q

What is the Glomerular filtration barrier made up of?

A
  • endothelial cells
  • glomerular basement membrane
  • podocytes
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15
Q

Endothelial cells can be damaged from what disease?

A

DM

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16
Q

Why do podocytes cause a possible “chokepoint” in the kidneys?

A

they guide material into Bowman’s capsule and can get clogged making it harder for material to pass through

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17
Q

What are the possible choke points in the kidneys?

hint: basically throughout the whole urinary tract

A

between kidney–> renal pelvis–> ureter–> urinary bladder–> urethra

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18
Q

Where is the prostate located and what does it surround?

A

located just below the bladder and surrounds the top portion of the urethra

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19
Q

The urinary tract has a _________ & ___________ funcition

A

transportation & storage

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20
Q

Prolonged exposure of these organs and tissues to carcinogens can result in _______

A

cancer

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21
Q

Why are females at an increased risk of getting UTIs?

A

-the urethra lies close to the vaginal & rectal openings, allowing for relative ease of bacterial transport

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22
Q

The shorter ______ in females also contributes to the increased incidence of UTIs

A

urethra

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23
Q

What parts of the urethra are/ are not strerile?

A

Upper 2/3 is sterile

Lower 1/3 is not sterile

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24
Q

UTIs are common in what age population?

A

Elderly, especially in long term health care facilities

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25
Q

Risk factors for UTIs

A
  • age
  • immobility
  • catheter
  • atonic bladder (w/o tone)
  • UTO
  • Kidney stones
  • Prostatic hyperplasia (cannot completely clear bladder)
  • females
  • pregnancy
  • DM
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26
Q

Presence of UTI increases the risk for ________ infections

A

systemic

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27
Q

Signs and Symptoms of UTI

A
  • increased urinary frq.
  • greater urinary urgency
  • nocturia
  • pain
  • costovertebral tenderness
  • fever & chills
  • sepsis with AMS
  • painful urination (dysuria)
  • hematuria
  • pyruria (pus)
  • dyspareunia (pain during sex)
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28
Q

Specific infection sites for UTIs

A
  • pyelonephritis (kidney)
  • cystitis (bladder)
  • urethritis (urethra)
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29
Q

Pyelonephritis occurs when a UTI progresses to involve the _______ urinary system

A

upper

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30
Q

Urine flow in the kidney: Urine formed in kidney–>

A

passes through papilla at apex into major and minor calyx –> through renal pelvis into the ureter

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31
Q

Chronic Pyelonephritis can lead to scarring in the ______ of the kidney

A

calyces

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32
Q

How does scarring impact the contractions of smooth muscle?

A

contractions will be reduced–> increased urine overflow–> urine cannot be eliminated–> kidneys become overflowed w/ urine

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33
Q

Risk factors of Pyelonephritis

A
  • revent incontinence

- urine reflux

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34
Q

Causes of chronic Pyelonephritis

A
  • chronic infection
  • urine reflux
  • ureter/bladder obstruction
  • atonic bladder
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35
Q

Pathogenesis of Pyelonephritis

A

scarring resulting in deformity of the calices (abnormal movement of urine)

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36
Q

Pyelonephritis is responsible for upwards of ____% of cases of end stage renal disease. This leads to??

A

25%

dialysis and transplantation

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37
Q

Urinary tract infections (UTIs) rank _______ only to upper respiratory tract infections in incidence of bacterial infections as possible comorbidities

A

second

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38
Q

PT role for patients with UTI

A

recognize risk factors and presentations

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39
Q

PT implications for UTI

A
  • N & V
  • > 102 temp
  • unexplained onset of back or shoulder pain
  • UTI increases risk of sepsis-systemic issue
  • personal hygiene
  • pelvic floor PT
40
Q

Problems secondary to kidney disease

A
  • cognitive issues
  • anemia
  • electrolyte imbalance
  • impaired drug metabolism
  • impaired muscle function
  • OP
41
Q

What is Glomerular filtration rate (GFR)?

A

an estimation of the rate at which materials in the blood are filtered by the kidneys

42
Q

What does GFR tell us?

A

it gives an assessment of the functionality of the kidneys

43
Q

Normal GFR=

A

> 90 ml/min/1.73m^2

44
Q

GFR can be estimated from the results of a blood _______ test

A

creatinine

45
Q

Acute Renal Failure (ARF) is an abrupt disease in renal function sufficient enough to result in _________ of nitrogenous waste and disrupt fluid and electrolyte __________.

A

retention

homeostasis

46
Q

ARF can be diagnosed by having increased _______ levels and decreased _________

A

serum creatinine levels

urine output

47
Q

Drug and toxins associated with renal failure mechanisms:

A
  • decreased renal perfusion
  • direct tubular injury
  • tubular obstruction/direct tubular damage
  • immunological-inflammatory
48
Q

Chronic Kidney Disease (CKD) is a condition characterized by a…..

A

gradual loss of kidney function over time

49
Q

Persistent ________ means CKD is present

A

proteinuria

50
Q

Causes of CKD

A

poorly managed/controlled DM and HTN!

51
Q

As the GFR number increases, kidney function ________

A

decreases

52
Q 
G1= \_\_\_\_\_\_\_\_
G5= \_\_\_\_\_\_\_\_\_
A

normal

kidney failure

53
Q

How many stages of kidney failure are there?

A

5 stages

54
Q

Stage 1 of CKD

A
  • microalbuminia

- elevated BUN & creatinine

55
Q

Stages 2-4 of CKD

A

Axotemia: accumulation of nitrogen containing waste products in the blood

56
Q

Stage 5

A

end stage renal disease (ESRD), uremia (excess amino acids)

-kidneys unable to excrete toxin, maintain pH, fluid or electrolyte balance

57
Q

Hemodialysis for CKD- movement is driven by…

A

cardiac function

58
Q

How does Hemodialysis work?

A

blood is removed from the body via vascular access and sends it across a semipermeable membrane and dialysate.

59
Q

The pressure gradient filter of Hemodialysis favors the removal of ____________

A

harmful substances.

60
Q

How many treatment sessions a week for Hemodialysis and how long is each?

A

3 sessions a week and 3-4 hours each

61
Q

Dialysis- urea reduction rate (URR) measures ________ adequacy

A

dialysis

62
Q

Each dialysis treatment should reduce _____ level

A

BUN

63
Q

Peritoneal dialysis-

A

solution is run through a tube into the peritoneal cavity

64
Q

Diet for patients on dialysis?

A
  • fluid intake is limited (risk of UTI)
  • intake of salt, potassium, phosphorous, and other electrolytes is limited
  • getting enough calories is difficult
65
Q

Patients on dialysis are hypo or hypernatremic?

Preload?

A
  • hyponatremic

- increased preload

66
Q

What is the most common cause of CKD and how?

A

diabetic neuropathy (44%)

67
Q

Hyperglycemia leads to glomerular ___________, damaging the arterial capillaries in the glomerulus and ________ of BM

A

hyperfiltration

thickening

68
Q

CKD demands long term ________ control with a < ___% A1c

A

glycemic

7%

69
Q

PT implications for CKD and DM

A

Monitor BP and glucose levels, know A1c of pt

70
Q

HTN causes damage to _____/________ blood vessels

A

renal/glomerular

71
Q

How does uncontrolled HTN cause kidney disease?

A

Damage to blood vessels in glomerulus–>
BF to kidney is reduced and compromises kidney function
–> limited O2 and nutrient delivery to the nephron
–> damaged kidney loses ability to regulate whole body BP

72
Q

PT implications of CKD

A
  • Monitor BP with DM and HTN
  • Know A1C levels
  • Educate!
73
Q

Primary glomerular disease (PGD) is a group of disorders characterized by _______ alterations in normal glomerular structure and function, independent of systemic disease processes such as ____ and ____

A

pathologic

DM and HTN

74
Q

PGD results from damage to the kidney’s ___________ - the site of the initial steps in kidney function!!!

A

filtering units

75
Q

Deposition of ______/_______ complexes into some portion of the glomerulus → inflammatory response → _______ damage

A

antigen/antibody

sclerotic

76
Q

Damage to glomerular epithelial cells allows larger molecules (proteins) to escape the circulation and enter the ________ tubule resulting in ________

A

proximal

proteinuria

77
Q

Damage to capillary wall allows _____ to escape and enter proximal tubule and resulting in _________

A

RBCs

hematuria

78
Q

Clinical Signs of PGD

A
  • Edema
  • Hypoalbuminemia- due to low GFR
  • Proteinuria
  • Hematuria
  • HTN
79
Q

Treatment for PGD

A
  • fluid restriction
  • statins
  • glucocorticoids
80
Q

Renal calculi aka kidney stones are the ____ most common urinary tract disorder

A

3rd

81
Q

Kidney stones cause _______ obstruction and severe _____

A

urinary

pain

82
Q

Hydronephrosis is the distension and dilation of the __________ and ______, secondary to urine accumulation

A

renal pelvis

calyces

83
Q

Pain for kidney stones is most commonly felt in the flank, which is located…

A

lower ab and groin

84
Q

Treatment for kidney stones

A
  • watchful waiting
  • shock wave US
  • surgery
85
Q

Neurogenic bladder disorders occur when…

A

input to detrusor muscles lining the wall of bladder via parasympathetic neurons is inhibited

86
Q

Neural stimulation is required for _________

A

micturition

87
Q

Internal sphincters have _____ muscle and are innervated by ________ neurons

A

smooth

sympathetic

88
Q

External sphincters have _______ muscle and are under ________ control

A

skeletal

voluntary

89
Q

Micturition

A
  • Coordinated activity
  • Remove inhibition of detruser muscle
  • Remove stimulation of internal sphincter muscle
  • Reduce tonic activity to the external sphincter
90
Q

Urinary incontinence is the ________ loss of urine that is sufficient to be a problem and occurs most often when bladder pressure ______ sphincter resistance

A

involuntary

exceeds

91
Q

Risk factors for urinary incontinence

A
  • age

- pelvic floor weakness

92
Q

Functional Incontinence -

A

normal urine control but who have trouble reaching a toilet in time b/c of muscle or jt dysfunction

93
Q

Stress Incontinence -

A

loss of urine during activities that increase intra abdominal pressure (coughing, laughing, valsalva maneuver)

94
Q

Urge Incontinence -

A

sudden and unexpected urge to urinate and an inability to prevent the loss of urine

95
Q

Overflow Incontinence -

A

constant leaking of urine from bladder that is full but unable to be emptied
-drugs, DM, SCI

Pathophysiology (4 decks)

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