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urinary Flashcards

1
Q

what is the main function of aldosterone?

A
  • reabsorption of sodium and water
  • excretion of potassium
  • this increase blood volume
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2
Q

6y/o has facial and limb oedema. on admission she weighs 30kg and is discharged at 28.5kg. how much fluid has she lost, assuming the difference in weight is due to fluid?

A

1500mL

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3
Q

54y/o with syncopal episode. sweating profusely in the heat and not had anything to eat or drink in the last 7 hrs. BP= 102/88. plasma sodium high, plasma potassium fine, plasma glucose fine. what is the cause of syncope?

A

hypovolaemia

  • hypernatriaemia is due to increased loss of hypo-osmotic fluid in sweat and failure of water balance.
  • contracture of circulating volume lead to syncope
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4
Q

55y/o with hypertension. BP = 140/90 so prescribed with a thiazide diuretic. three days later has muscle cramps, BP of 135/78 and a low potassium level. what has contributed to the loss of serum potassium

A
  • Inhibition of Na+/ Cl- symporter in the DCT
  • this diuretic inhibits this symporter allowing increased delivery of sodium to CD causing increased NA uptake from lumen by apical epithelial Na channels (ENaCs)
  • causes basolateral NA/K exchanger to more actively exchange NA for K, which is then passively seceded into the lumen through apical channels, resulting in K loss.
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5
Q

what is an action of ADH?

A

vasoconstriction

- activation of V1 receptor on VSM to cause vasoconstriction triggering the thirst response in the hypothalamus

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6
Q

how would you define the cause of dipsogenic diabetes insipidus (psychogenic polydipsia)?

A

defect/ damage to the hypothalamus causing malfunction of the thirst mechanism

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7
Q

loss of which renal function is most likely to be identified by lab measurements of the urine specific gravity following water deprivation?

A

concentration

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8
Q

which hormones are stored in the post pituitary gland?

A

oxytocin and ADH

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9
Q

28 y/o presents with diabetes inspidius 10 days after basilar skull fracture. haematoma in the post lobe of the pituitary gland but no lesions in the hypothalamus or pituitary stalk. release of which hormone has been affected?

A

ADH

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10
Q

diagnosed with hyponatraemia due to SIADH. what physiological response is the primary cause of hyponatraemia in this patient?

A

excess water reabsorption in the collecting duct

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11
Q

70y/o works in the heat for 12 hrs. loss of 1.5kg body weight and plasma sodium is within normal range. urine osmolality max conc at 1800 mosmol/kg. stimulation of what physiological response will best help to restore his extracellular volume?

A

thirst

- ADH already at max conc of urine

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12
Q

68y/o with orthostatic hypotension . in this patient on standing what acute compensatory mechanism will occur in the nephron?

A
  • increase in glomerular filtration rate of the same nephron
  • on standing, BP falls this reduces the pressure to the afferent arterioles and it will relax- allow more blood to glomerulus
  • cells of the macula densa sensitive to conc of NaCl in the late thick ascending limb. decrease in conc causes signals to:
  • decrease resistance to blood flow in afferent arterials via vasodilation- increases golumerular capillary hydrostatic pressure and helps return GFR
  • increases renin release from Juxtaglomerular cells of the afferent and efferent arterioles
  • therefore decrease in NaCl= vasodilation of afferent arterioles, increased paracrine stimulation of JGCs.
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13
Q

what is the effect of aldosterone on BP, where is it produced and where does it act?

A
  • aldosterone increases salt reabsorption therefore increases BP
  • is a steroid hormone
  • acts at the distal tubule and CD
  • synthesised in the adrenal glands
  • major site is at the distal nephron (DCT)
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14
Q

sample of fluid from a nephron obtained- very low sodium, very low potassium, no glucose and a low osmolality. what features of the tubule that the fluid has most recently passed through has resulted with this?

A

permeable to ions but impermeable to water

  • fluid is hypo osmotic to plasma
  • this has occurred while moving through the ascending loop of Henle
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15
Q

55 y/o with hypertension. what adaptations in the kidney will have occurred in response to change in BP?

A

decreased release of renin

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16
Q

goes for a swim and needs to urinate. what actual effect is being mimicked by the increased pressure on her peripheral circulation due to being immersed in water?

A

effective circulating fluid volume increased

- increased external pressure of periphery tricks the body sensors into perceiving an increase in BP

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17
Q

28y/o feeling light headed and dizzy. BP = 90/50 mmHg. what chemical messenger will her juxtagolmerular cells release in an attempt to compensate for her hypotension?

A

Renin
Granular cells of the JGA secrete renin in response to 3 stimuli:
1. decrease in arterial BP as detected by baroreceptors
2. decrease in NaCl levels in the ultra filtrate of the nephron- flow measured by the macula densa of JGA
3. sympathetic nervous system activity - b1 adrenergic receptors

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18
Q

what class of hormone is aldosterone?

A

steroid hormone

- derived from cholesterol

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19
Q

30y/o feeling light headed and nauseated for the last 2 days. BP= 90/50
what is the most appropriate physiological response by her macula densa cells?

A

stimulate JG cells to secrete renin

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20
Q

35y/o has urinary incontinence. activation of which nerves will cause detrusor contraction?

A

parasympathetic neurones from the spinal cord to the urinary bladder

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21
Q

decreased AP along which pathway will lead to relaxation of the external urethral spinchter?

A

somatic motor neurones

- EUS is under conscious control

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22
Q

void volumes between 60 and 180 ml with many episodes of urinary leakage. what fraction of normal functional bladder capacity is she routinely voiding?

A

10-45%

- normal functional bladder capacity= 400-500ml

23
Q

36y/o presents with involuntary loss of urine when coughing. urine dipstick is normal. USS shows no post-urination residue. what is the most likely cause of her incontinence?

A

stress incontinence

24
Q

40 y/o Sudanese man presents with 2 month history of frequency of micturition. he voids 100mls x 20 day and 100 mls x 10 night. he describes frank haematuria. what is the most likely cause of his urinary symptoms?

A

Schistomiasis

- schistosoma haematobium common in Africa

25
Q

30 y/o presents with urgency of micturition approx 10 times a week and cannot get to the toilet in time. pressure rises of 10-15cm of H2O were found which were associated with feelings of needing to void urgently. what is the most likely diagnosis for the frequency of micturition?

A

overactive bladder syndrome (OABS)

26
Q

68y/o having increasing urinary symptoms. difficulty in starting to urinate and in maintaining a strong urine stream. sometimes dribbles after passing urine and feels like bladder is not fully emptying. doesn’t have to get up during the night to urinate. what is the most likely diagnosis?

A

prostatic hyperplasia

  • prostatic enlargement can cause an obstruction to the flow of urine in the urethra.
  • increased urethral pressure leads to a failure to empty the bladder properly
27
Q

25 y/o woman has urinary incontinence. urodynamic filling cystometry used to monitor detrusor pressure during bladder filling. which nerves are most likely to have an increase in the frequency of APs?

A

urinary bladder to sacral region

- sacrum (S2,3,4)

28
Q

43 y/o has increasing tiredness for the past 3 weeks. BP= 150/95 mmHG with pitting oedema of the lower extremities to the knees. nothing usual in the dipstick. serum creatinine and BUN are both very high. what is a possible diagnosis?

A

membranous nephropathy

  • most common cause for nephrotic syndrome in adults.
  • diffuse thickening of the glomerular capillary basement from immune deposits
29
Q

60 y/o with an acute MI. for the next 3 days there is difficulty maintaining BP and tissue perfusion. serum lactate elevates and blood urea nitrogen and creatinine increases. which renal condition is she susceptible to with this history

A

acute tubular injury

  • pre renal form of azotemia
  • BUN: Cr ratio more than 20:1
30
Q

20y/o feeling tired for the past 5 days. passes dark coloured during. BP= 160/90. high serum creatinine, pH= 6, 3+blood, 1+protein, no glucose or ketones. there are numerous RBC casts. diagnosis of rapidly progressive glomerulonephritis is made. what pathological finding on renal biopsy is most likely?

A

glomerular crescents

  • crescents are characteristic for rapidly progressive glomerulonephritis - form of nephritic syndrome
  • form when there is a leakage of fibrinogen into Bownmans space, with proliferation of epithelia cells to form the crescent.
  • RBCs and RBC casts in the urine due to severe glomerular damage
31
Q

52y/o hospitalised for acute MI. decreased CO with hypotension. urine output drops over the next 3 days. BUN and creatinine increases . no protein or glucose on urinalysis. + trace blood, numerous hyaline casts. what pathological finding in his kidneys is most likely to have caused his azotemia?

A

acute tubular injury

  • has findings of ischaemic acute tubular necrosis from heart failure
  • > 20:1 ratio or ura nitrogen to creatinine which occurs early from prerenal azotemia
  • as the disease progresses, the ratio declines
32
Q

diagnosis of minimal change disease. patient observed to have prominent periorybital oedema at diagnosis. which urinalysis test finding most likely?

A

proteinuria >3.5 gm/24 hrs

- nephrotic syndrome , with significant albuminuria

33
Q

36y/o has urinary frequency with dysuria for the past 4 days. no flank pain or tenderness. no protein, glucose or blood, nitrite positive and many WBCs. what is the likely diagnosis?

A

acute cystitis

  • features of acute inflammation
  • no casts as infection only involves the bladder
34
Q

69 y/o man falls and sustains a contusion on his lower back. abdo CT shows 3 peripherally located small cysts in his kidneys. lab studies and urinalysis are both normal. microscopic urinalysis reveals a few oxalate crystals. what is the most likely diagnosis?

A

simple cortical cysts

  • typically do not interfere with renal function
  • trauma may cause haemorrhage into a cyst
35
Q

52y/o experiences episodes of discomfort with urination for 3 months. +1 blood, microscopic urine shows numerous RBCs, few WBCs and no casts. urine culture is negative. . radiograph shows one rounded radiopaque lesion in the region of the bladder. what lab test is expected?

A

hypercalciuria

  • findings suggest a bladder calculus
  • stones composed of calcium with oxalate or phosphate
  • calcium content makes them radiopaque
36
Q

6y/o generalised oedema following a viral illness, and is diagnosed with nephrotic syndrome. what would the urine and serum show?

A

hypoalbuminaemia, proteinuria and raised urinary protein: creatinine ratio

37
Q

45 y/o man with no other notable history has a UTI with no other comorbidity issues. what is the recommended antibiotic regimen?

A

outpatient regimen of trimethoprim or nitrofurantoin for 7 days

38
Q

35 y/o female with 3 days of burning pain on urination and mild abdo discomfort. no cormibidity and fit and well. second UTI in the last 3 months. what is the best antibiotic regimen?

A

outpatient regimen including Nitrofurantoin for 3 days

39
Q

16 y/o reports urgent need to urinate frequently and has a strong burning sensation on urination. no previous history and suspect UTI. what gram neg bacteria is the most likely pathogen?

A

Escherichia Coli

- most uncomplicated infections

40
Q

68 y/o has a catheter following surgery. has a temperature and urine in the bag is cloudy and suspect a UTI. lab tests report gram positive cocci. what is the likely pathogen?

A

Staphylococcus epidermidis

- gram (+) coagulase neg cocci that is part of the normal flora

41
Q

23 y/o woman has a 12 hr history of suprapubic pain, dysuria and urinary urgency. sexually active and has no other medical history. UTI suspected. pathogen is coagulase (-)- what is the pathogen?

A

Staphylococcus saprophyticus

  • normal flora of female genital tract
  • sex increases risk = honeymoon cystitis
42
Q

when a microbe is first introduced to the body a typical humeral response is characterised by release of which immunoglobulin?

A

IgM

43
Q

50 y/o woman has fever and flank pain for the past 2 days. urinalysis: (-) for protein. has numerous poly-morphonuclear leukocytes and occasional WBC and casts. what organism is likely?

A

Escherichia coli

  • WBCs typical of inflammatory response
  • WBC and casts indicate infection probably occured in kidney as casts are formed in renal tubules
44
Q

68y/o with AKI. Diarrhoea and vomiting for the past 3 days. taking amlodipine, atorvastatin, metformin, naproxen and paracetamol. which medication is most likely to have contributed to her presentation?

A

Naproxen- NSAID which can cause haemodynamically mediated AKI (pre-renal / ATN), especially with another insult- here it was volume depletion.

45
Q

renal biopsy obtained from a patient with sickle cell nephropathy. there is an infarct within the renal medullary tissue in an area supplied by vessels that arise from the efferent article of large glomeruli situated close to the medullary border. the occlusion of which vessel is most likely to have caused the infarct?

A

vasa recta

  • vessel is in the medulla and comes from the EA of nephrons whose glomeruli lie close to the medullary border.
  • these can only be JM glomeruli and hence the vessel is the vasa recta
46
Q

what type of fluid has escaped from the collecting duct?

A

urine

- no further modification to the ultra- filtrate in the calyx, at this point it is classed as urine

47
Q

which vessel branches from the abdominal aorta at the vertebral level L1-L2?

A

renal artery

48
Q

patient has a reduced volume of cortical tissue, probably due to age related glomerulosclerosis. which vessel that branches into the cortical peritubular capillary beds will also have reduced in number

A

efferent arteriole

49
Q

the lower end of the mesonephric duct branches to form what?

A

ureteric bud

  • is a single epithelial branch forming from each mesonephric duct, that extends laterally into intermediate mesoderm as part of early metanephric formation
  • mesonephric duct does not form uterus or urethra
50
Q

which component of the kidney is derived from the ureteric bud?

A

collecting duct
- ureteric bud gives rise to the collecting system- the ureter, renal pelvis, major and minor calyces and collecting tubules

51
Q

palpable mass in the abdomen and CT scan shows a pelvic kidney. what developmental abnormality gave rise to this condition?

A

failure of cranial migration

- a pelvic kidney means that during development the kidney failed to ascend to its final location (T12- L1)

52
Q

what is the embryological derivation of detrusor?

A

the bladder is hind-gut derivative

53
Q

patient with renal disease has had an extended period of bed rest. tests reveal abnormally high conc of creatinine in his blood but a lower than normal level of creatinine in his urine. which condition is best indicated by these results

A

decreased kidney function

54
Q

which constituent of filtrate has a rate of urinary excretion that is always much lower than its rate of glomerular filtration in a healthy adult?

A

glucose

- filtered bet almost always reabsorbed during tubular reabsorption

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