urinary

Question 1

1. Renal corpuscle
   * site of plasma filtration found in renal cortex
2. Renal tubule
   * Tube extending from the glomerular
   capsule divided into parts
   * proximal convoluted tubule
   * loop of Henle dips down into medulla
   * distal convoluted tubule
3. Collecting ducts and papillary ducts
   * Drain urine to the renal pelvis and ureters

Answer 1

The Normal Nephron

Question 2

This is dependant on
1. Blood flow
2. Adequate hydration
3. Anatomically normal

Answer 2

function of the urinary tract is to form urine.

Question 3

1. Prerenal
   * Due to shock or heart insufficiency (heart attack)
   * Usually reversible
2. Intra renal
   * E.g.. Tubular necrosis
   * Also reversible
   * Chronic failure is lethal, and will lead to dialysis
3. Post renal
   – Prostatic disease
   – Stones of the bladder
   Both are treated surgically

Answer 3

Failure to produce adequate amount of urine

Question 4

Renal tubules are very specialized cells therefore sensitive to
lack of O2 and toxins. PCT are the most sensitive to lack of O2
* Many of the cells in the urinary tract are mitotic therefore undergo division. Also may have carcinogens in the urine

Answer 4

Major Kidney Diseases

Question 5

– Circulatory disturbances (e.g., prerenal renal
failure)

Answer 5

• Hemodynamic Disorders

Question 6

• Typically occurs after cardiac arrest
  and any form of Hypotensive shock
  (massive bleeding)

Answer 6

Acute Tubular Necrosis

Question 7

Atherosclerosis of major arteries (aorta
and major branches of the renal artery)
may lead to decreased lumen and thus
decreased blood flow to kidneys.
– loss of glomeruli, due to ischemic
glomerulosclerosis
– Problem of ischemia
– Tubular atrophy

Answer 7

Nephroangiosclerosis

Question 8

Arterial hypertension often affects
intrarenal arteries and arterioles

Answer 8

Hypertension

Question 9

Tumors are more often malignant than
benign.

Answer 9

Neoplasms of the Urinary Tract

Question 10

Tumor of infancy and childhood

Answer 10

Wilms’ Tumor or
Nephroblastoma

Question 11

• Lack of early warning signs so tumors are
  often far advanced at diagnosis

Answer 11

Renal Cell Carcinoma

Question 12

Signs and Symptoms
* Hematuria—most common finding (50%)
* Typical triad (hematuria, flank pain, palpable
abdominal mass) found only in 10%
* Nonspecific symptoms (weight loss, fever,
hypertension) common, often found accidentally
(“internist’s tumor”)
* Paraneoplastic syndromes—hypercalcemia,
erythrocytosis, or amyloidosis (20%)
* 5 year survival is only 45%, if tumour is
asymptomatic and small it is 70%

Answer 12

Renal Cell Carcinoma—Clinical

Question 13

• Most are caused by bacteria
• Bacteria can reach the urinary tract from either
  hematogenous infection or more often through an
  ascending infection
  Hematogenous Infection
• Typically preceded by septicemia
• Bacteria spreads through blood from another source to
  the urinary tract

Answer 13

Urinary Tract Infections

Question 14

Ascending Infections
* Most common form

Answer 14

Urinary Tract Infections

Question 15

results from
bacterial invasion of the renal
parenchyma
* Typically presents with :
– fever, back pain over the kidneys, dysuria,
hematuria, and frequency are possible but
not necessary

Answer 15

Acute Pyelonephritis

Question 15

• Chronic bacterial infection of the kidney
  – Results in destruction of the renal tissue and
  replacement with scar tissue
  – The affected kidney is smaller due to the loss of renal
  tissue
  – May evolve from acute pyelonephritis especially with
  recurrent acute infection

Answer 15

Chronic Pyelonephritis

Question 16

• Very common
• Most of these anomalies are
  asymptomatic and discovered by chance
  – E.g.. 1 in 800 people are born with only 1 kidney or
  horseshoe kidney (solitary kidney formed by fusion
  of the 2 kidneys at midline)

Answer 16

Developmental Disorders

Question 17

crystalline structure of
material that the kidneys usually excrete in
urine.

Answer 17

Urinary Stones

Question 18

More common in men than women
* Attacks usually begin at approx 20 - 30 years of age
Signs and Symptoms
– Severe and unrelenting pain
* Pain is caused by the stretching of the ureter due to the obstructing stone
– Hematuria
– Urinary colics (spasm of ureters)

Answer 18

Urinary Stones

Question 19

Massage Considerations
* Pt may come in with
complaint of low back pain
And your APR, muscle
testing does not confirm
any of this.

Answer 19

Urinary Stones

Question 20

Glomerular diseases are all diseases that
destroy the ability of the glomerulus to
function properly, ultimately resulting in
kidney failure.

Answer 20

Glomerular Diseases

Question 21

• It is important for the Massage Therapist
  to understand that with kidney failure the
  patient may present with bilateral leg
  swelling

Answer 21

Glomerular Diseases

Question 22

• If a patient has a end
  stage renal failure and
  is presenting with
  bilateral leg swelling it,
  we need to recognize
  that we should not
  attempt to change that
  swelling as we may
  overload the CV system
  and stress the patient.

Answer 22

Glomerular Diseases