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Urinary Flashcards

1
Q

What is the route of the Ureter?

A
  1. Arises from the pelvis of each kidney
  2. Descends on the top of the psoas major
  3. Crosses in front of the common iliac arteries
  4. Runs postero-inferiorly on the lateral walls of the pelvis
  5. Curves antero-medially to enter the bladder
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2
Q

What is the vesicoureteric junction?

A

The junction between the distal ureter and the bladder

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3
Q

What is the pelviuteric junction?

A

Junction between the pelvis of the kidney and the proximal ureter.

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4
Q

At what spinal level would you find the right kidney?

A

T12-L3

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5
Q

At what spinal level would you find the left kidney?

A

T11-L3

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6
Q

Which kidney is lower and why?

A

Right kidney is 1cm lower due to the liver

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7
Q

What structures lie retroperitoneal?

A

SAD PUCKER

Suprarenal glands
Aorta/IVC
Duodenum (2nd+3rd part)

Pancreas
Ureters
Colon (ascending + descending branches)
Kidneys
oEsophagus
Rectum

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8
Q

What would we see on a CT at T12?

A

Hilium visible on left kidney but not right kidney

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9
Q

Which artery causes high pressure in the glomerular capillaries?

A

Efferent arteriole (and it’s resistance to flow)

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10
Q

What term best describes normal Bowman’s capsule oncotic pressure?

A

Negligible
(no proteins here so no oncotic pressure)

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11
Q

Which constituent of the filtrate has a rate of urinary excretion that is lower than it’s glomerular filtration rate?

A

Glucose
(most of it is reabsorbed)

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12
Q

What happens to the ultra-filtration process in lupus nephritis?

A

Unable to separate small and large molecules
The fluid found in the bowman’s capsule is not ultra-filtrate and appears more like plasma

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13
Q

How many nephrons does the human kidney have?

A

1,000,000

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14
Q

What components of plasma will be present in the glomerular filtrate immediately before it enters the loop of henle?

A

Electrolytes
Glucose
Amino Acids
Urea

Large molecular weight proteins aren’t

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15
Q

Which diuretic is a patient on that has hypokalaemia, uricemia and gout?

A

Thiazide like diuretic
(acts on the DCT)

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16
Q

Which diuretic is a patient on that has hypokaleamia, metabolic alkalosis and ototoxicity?

A

Loop diuretic

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17
Q

Which class of diuretic is Triamterene?

A

K-sparing diuretic
(blocks Na channels in the collecting duct)

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18
Q

What side effects can you get on spironalactone?

A

Gynecomastia
Impotence
BPH

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19
Q

Which drug is associated with a reduction of mortality in HF and LV dysfunction?

A

Spironolactone

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20
Q

What is the main action of ADH?

A

Vasoconstriction

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21
Q

How will a patient present with diabetes insipidus?

A

Excessively thirsty regardless of their fluid intake

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22
Q

How can high levels of ADH cause hyponatraemia?

A

Dilutional hyponatraemia
(Increase in aquaporin channels at collecting duct means more water is reabsorbed)

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23
Q

What effect does sweating all day without fluid intake cause?

A

Osmolarity increased, volume decreased

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24
Q

Which fluid regimen would give you a patient who is nil by mouth but euvolaemic?

A

0.18% sodium chloride, 4% dextrose over 12 hours

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25
Q

What fluid regimen would you give to a patient who has suspected AKI?

A

1 litre 0.9% Sodium Chloride over 8 hours
(8 hours to not overload AKI)

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26
Q

What can BPH lead to in the kidneys?

A

Renal Cortical atrophy

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27
Q

A patient has an AKI following trauma and hypotension. What has caused this?

A

Acute tubular injury

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28
Q

Why can a patient develop an AKI after a MI?

A

Acute tubular injury

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29
Q

Which disease is it important to to screen for kidney disease in using the albumin-creatinine ratio?

A

Diabetes

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30
Q

How does parathyroid hormone affect the kidney’s handling of phosphate?

A

Decreases phosphate reabsorption in the PCT

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31
Q

What is an early indicator of glomerulosclerosis in diabetic patients?

A

Microalbuminuria

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32
Q

A patient has urinary incontinence, which nerve endings are more likely to fire APs?

A

Urinary bladder to the sacral region (S2,S3,S4)

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33
Q

Why could a patient with an AAA get flank pain and nausea?

A

Ureter entrapment

34
Q

Which parts of the kidney is derived from the ureteric bud?

A

Collecting duct
Ureter
Renal pelvis
Major + minor calyces

35
Q

Where is the bladder derived from?

36
Q

What will an older man complain of with an UTI?

37
Q

A woman has been diagnosed with her second UTI in 3 months. What treatment should you give her?

A

Trimethoprim for 3 days

38
Q

A catheterised man has a UTI. The culture shows a gram positive cocci, what is the likely pathogen?

A

Staphylococcus epidermidis

39
Q

When a microbe is first introduced to the body, which immunoglobulin is first to be released?

40
Q

What’s the typical prognosis with polycystic kidney disease?

A

Steadily progressive CKD

41
Q

Which type of inheritance does polycystic kidney disease show?

A

Autosomal dominant

42
Q

A women has smoked all her life and has pain in her pelvis, abdomen and she has a right loin mass. What is her most likely diagnosis?

A

Renal cancer (is linked to smoking and mets to the bone)

43
Q

What components of the renal nephron and renal capillary network create urine?

A

The loop of henle
Vasa recta

44
Q

What effect does angiotensin II have on glomerular pressure?

A

Increases glomerular pressure
(constricts the efferent arteriole more than the afferent arteriole)

45
Q

How does the RAAS system increase BP?

A
  1. Decreased renal perfusion
  2. RAAS activated
  3. Angiotensin II causes systemic vasoconstriction and synthesis of aldosterone
  4. Aldosterone causes increased Na reabsorption at the DCT
  5. Water follows
46
Q

A boy presents with nephrotic syndrome, what is your differential diagnosis?

A

Minimal change Disease
Glomerulonephritis

47
Q

How does the bladder prevent reflux?

A

The ureters entry into the bladder is at an oblique angle and the detrusor muscle has a flap that covers the ureter opening when the volume in the bladder goes up.

48
Q

What is the trigone?

A

Triangular region at the base of the bladder between the ureteric and urethral openings.

49
Q

What can radiotherapy cause?

A

Vesico-vaginal fistulas

50
Q

What region of the abdomen is the bladder?

A

Hypogastric

51
Q

What is the major anion component of sweat?

52
Q

Where do the renal arteries arise from?

A

Abdominal aorta just below the SMA

53
Q

What effect on the kidney will primary hyperparathyroidism have?

A

Increased excretion of phosphate in urine

54
Q

A patient has had a fall and is dehydrated due to not drinking for 24 hours. The absorption of which ion will be increased at the DCT?

A

Sodium
(Aldosterone release in response to the decreased plasma volume)

55
Q

What would you call the fluid in the CD?

A

Urine (no further changes after this)

56
Q

What fat surrounds the kidneys?

A

Perirenal fat

57
Q

What vessel branches into the cortical peritubular capillary beds?

A

Efferent arteriole

58
Q

Which vessel arises from the efferent arteriole and is close to the medullary border?

A

Vasa recta

59
Q

What happens to the GFR if glomerular oncotic pressure decreased?

A

GFR increases

60
Q

What happens to the GFR if the tubular hydrostatic pressure increases?

A

GFR decreases
(tubular hydrostatic pressure opposes capillary hydrostatic pressure)

61
Q

Which substance rate of urinary excretion is virtually identical to GFR?

A

Creatinine

62
Q

What changes happen in the nephron to compensate for postural hypotension?

A

Increase in GFR

63
Q

What is the equivalent of ml to g?

A

1ml weighs 1g

64
Q

What fluid regimen would you give someone who has had diarrhoea?

A

0.9% Sodium chloride (stays in ECF)
AND
40mM of K (K lost in diarrhoea)

65
Q

A patient with severe sepsis has an AKI that’s not sorted with meds, what’s the next treatment?

A

Haemofiltration (causes less CVS strain than haemodialysis)

66
Q

Which nerves cause detrusor muscle contraction?

A

Parasympathetic neurones from the spinal cord to the urinary bladder

67
Q

Stimulation of which receptor would increase continence?

68
Q

Which embryonic structure drains the bladder and what does it become?

A

Allantois
Becomes the median umbilical ligament

69
Q

A child has a father with polycystic kidney disease and the mother doesn’t. What’s the odds the child will get it?

A

50% (autosomal dominat)

70
Q

A renal biopsy shows deposits of amyloid material, what’s the diagnosis?

A

Multiple myeloma

71
Q

A patient that’s taken nebulized salbutamol has hypokalemia, why?

A

B2 stimulates entry of K into cells through increased cAMP of NaK

72
Q

What’s the urinary pole?

A

Junction between the bowman’s capsule and the PCT

73
Q

What effect does sweating have on plasma osmolarity and volume?

A

Osmolarity normal, volume decreased

74
Q

What is activated to cause a decrease in GFR after haemorrhage?

A

Sympathetic NS

75
Q

When does the kidney become the definitive adult kidnye?

A

After birth
(metanephros before that)

76
Q

What has caused an UTI if it is a coagulase-negative coccus?

A

Staphylococcus saphrophyticus

77
Q

Which structures would lie on either side of the uterus on a pelvis CT?

A

Ureters (water under the bridge)

78
Q

Loss of hypo-osmotic sweat will have what effect on urine osmolarity and Na clearance?

A

Urine osmolarity - increased (sweat is hypo-osmotic)
Sodium clearance - decreased (Some Na lost in sweat)

79
Q

What effect will sweating have on PLASMA osmolarity and volume?

A

Osmolarity - unchanged
Volume - decreased

80
Q

How would minimal change disease show up on light or electron microscopy?

A

Light microscopy - normal
Electron - Effacement of podocyte foot processes

81
Q

Why does nephrotic syndrome cause odema?

A

Damage to glomerulus allows protein and albumin into the filtrate

82
Q

What effect would dehydration have on urine osmolarity and volume?

A

Osmolarity increased
Volume decreased

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