Urinary and Renal diseases

Question 1

Renal blood Circulation

Answer 1

~ 20-25% Cardiac output
>90% to cortex (filtration takes place here)
Filters ~1200 mls/min

Question 2

Renal Failure

Answer 2

Renal diseases very common
• Acute
        Hours-days
        Pre-renal
        Renal
        Postrenal
Predispose to chronic renal failure 

• Chronic
Weeks, months, years

Acute —> Necrosis —> clogs up nephron—> decrease in filteration rate and urine formation

Injury —> RAAS activated —> systemic hypertension, reduced urine formation

Question 3

How do the kidneys contribute to congestive heart failure?

Answer 3

Systemic hypertension —> left ventricular failure

By kidneys activating RAAS

Question 4

Explain the impact that renal failure has on the rest of the body.

Answer 4

Overactivation of RAAS

When PTH hormone is released, kidneys activate more vitamin D, without it, calcium is not absorbed
passively, kidneys allow calcium to be lost in urine. Leads to soft tissue calcification and osteomalacia. Increase in phosphate

Lack of EPO —> Anaemia

Acidosis —> hyperkalaemia—> predispose to arrhythmia

Increase in built up waste in blood

Question 5

What are the main malignancies that affect the male & female urinary systems?

Answer 5

Transitional cell carcinoma - renal calyces, pelvis, ureter and baldder
Renal cell carcinoma : - Clear cell carcinoma
- Papillary renal cell
- Chromophobe renal
Prostate cancer (adenocarcinoma)
Nephroblastoma

Question 6

What are common causes of glomerulonephritis & possible consequences?

Answer 6

Blood borne. Chronic impacting functional units due to special cases (autoimmune disorders)

Caused by: swelling of endothelium, decreased blood flow, inflammation altering permeability, focal loss of epithelium and endothelium

Consequence: Renal Failure
Bilateral , decreased urinary output, proteinuria, haematuria, hypertension and headaches

Question 7

Why is the renal papilla susceptible to toxic injury & ascending infections?

Answer 7

Renal pyramid protruding into waiting calyx

• First point of vulnerable tissue that ascending infections hit (from lower urinary tract)
• Urine is most concentrated
• Susceptible to injuries from drugs

Question 8

What are the possible consequences of urinary stones?

Answer 8

One stone predispose to more stones

Haematuria

Pain

Hydronephrosis

Cancer

Obstruction in kidney means more likely to get infections

Question 9

Why are ascending infections more common in females than males?

Answer 9

Urethra much shorter in women. Women do not have prostate which helps counter microbials. Trauma during birthing and sexual intercourse. Proximity to anal canal

Question 10

Descending infection

Answer 10

infection is travelling in blood. Renal failure.

Question 11

Causes of Chronic Renal Failure

Answer 11

• Hypertension
• Diabetes
• Obeseity
• Heart disease
• Smokers
• Over 60
• Aboriginals
• Family history of CKD
• Personal history of ARF

1 in 3 at risk (1.7mil australians)

Question 12

Common symptoms of chronic renal failure

Answer 12

Azotaemia/Uraemia: increased waste in blood 
Systemic Hypertension
Oedema
Acidosis
Hyperkalaemia (Potassium)
Muscle, Heart arrhythmias
Hyperphosphatemia
Muscle, nerves, bone 
Anaemia

Question 13

Renal physiology

Answer 13

Formation of urine – removal of wastes
Regulates plasma ions (Na+, Cl-, PO43-, K+, Ca2+)
Regulates pH (H+, HCO3-)
Endocrine Function (Vitamin D, RAAS, EPO)
Regulation of blood volume
Regulation of blood pressure
Metabolism – Deamination of αα, detoxification of drugs/toxins

Question 14

Ligand

Answer 14

hormone or growth factor interacting with receptors

Question 15

Agonist

Answer 15

drug that binds to receptor and stimulates it

Question 16

Antagonist

Answer 16

drug that binds to receptor and blocks it

Question 17

RAAS System

Answer 17

RAAS —> renin—> angiostenin ii —-> aldosterone —> increase water or sodium intake—> increase blood volume

RAAS —> renin—> angiostenin ii —-> vasoconstriction —> vas resistance

RAAS —> renin—> abgiostenin ii —-> SNS activated—-> increased sympathetic tone —> increased HR —-> increased vascular resistance

Question 18

Oedema relationship with renal failure

Answer 18

• Due to increased HP
• Decrease in colloidal pressure
• Due to RAAS, increase in HP (constricted vessels and increased blood volume)
• Proteinuria  Reduced colloidal Pressure
  Renal failure —> systemic oedema happens through RAAS (retention of H20 and NA)

Question 19

Causes of Circulatory disease

Answer 19

Benign nephrosclerosis - Focal ischaemia & atrophy

Malignant- Damages renal arteries, arterioles & glomeruli
Rapid ↑ BP

Diabetes - atherosclerosis, systemic hypertension, lesions (aging) of kidneys

Question 20

Alterations in renal failure

Answer 20

Increased Na+  Increased H2O
Increased H+ Increased K+
Decreased Ca2+ Increased PO43-

Leading to acidosis
Increased hydrogen level can be replaced by potassium and leads to hyperkalaemia, predispose to cardiac arrhythmia

Question 21

Endocrine problems caused by renal failure

Answer 21

Increased renin-angiostenin-aldosterone (systemic hypertension)
Decreased Erythropoietin (anaemia)
Decreased activation of vit D (renal osteodystrophy)

Question 22

Renal Pathology

Answer 22

Congenital and Cystic Diseases
Glomerular Diseases
- Immunologically mediated

Tubular and Interstitial Diseases
- Infection & toxins

Circulatory Disorders

Stones & Tumours
- Obstruction

Question 23

Developmental disorders

Answer 23

Renal agenesis - bilateral or unilateral
Horseshoe kidney
Polycystic kidney disease
Nephroblastoma

Question 24

Cystic Disease

Answer 24

Cystic Renal Dysplasia

Autosomal Dominant (Adult) Polycystic Kidney Disease: born with normal kidneys, has genetic mutation. After birth, cysts forms. Loss of function. Significant level in Australia

Autosomal Recessive (Childhood) Polycystic Kidney Disease

Diseases of the Renal medulla

Question 25

Tubular and interstitial disease

Answer 25

Does not cause renal failure 
Tubules  Interstitium
Inflammatory
- Tubulointerstitial Nephritis
- Pyelonephritis (ascending infection, coming from lower urinary tract)

Question 26

Pyelonephritis

Answer 26

Bacterial infection in the kidney
Effects pelvis tubules & interstitium
Acute : Bacterial infection
Chronic: Repeated infections
Obstruction
Symptom: fever

Question 27

Carcinoma of the prostate

Answer 27

Most common
Unknown cause and risk factors
Hormonal inluences
Racial differences
Genetics
Cancer as a chronic disease

Question 28

Calculi composition

Answer 28

• Calcium oxalate and phosphate (70%)
• Magnesium ammonium phosphate (15%)
  Uric acid (6%)

Question 29

Urinary tract obstruction and causes

Answer 29

• Unilateral
• Urinary calculi/stones
• M>F & usually >30 years (male more likely)
• Any level (renal pelvis to bladder)

Predisposition
	• Stasis (obstruction)
	• Mucoproteins
	• pH
	• Infection
	• Dehydration
	• Calcium metabolism disorders
• Metabolic pyrophosphates & citrates inhibit formation

Question 30

Process of EPO

Answer 30

Hypoxia —> Kidney —> EPO —> Increased RBC production

Hypoxia —-> kidney —> no EPO —> Anaemia

Question 31

Process of Vitamin D increase in blood

Answer 31

Kidney —> does not activate vitamin D —> Gut does not increase calcium intake

Increased phosphate, decreased calcium —>PTH stimulated —> Increase in calcium –>soft tissue calcification, osteomalacia