Urinary and Renal Disorders Flashcards
What are some of the functions of the kidney?
Maintain stable internal environment, filter blood, excrete metabolic waste, maintain acid-base balance, retain nutrients, manage water/solute transport, regulate endocrine functions
What is erythropoietin?
Produced by the kidneys, important in the production of RBC’s
What is a nephron?
Tubular structure, the main functional unit of the kidney
What is included inside the nephron?
Glomerulus, proximal convuluted tubule, loop of Henle, distal convuluted tubule, collecting duct
What is special about glomerular capillaries?
Have specialized, fenestrated epithelium
What is filtrate?
Fluid and molecules filtered out of Bowman’s capsule–contains sodium, glucose, amino acids, etc.
What occurs in the proximal convoluted tubule?
Sodium and water absorption, glucose is reabsorbed via protein transporters
What occurs in the distal tubule?
Hormones such as aldosterone and vasopressin will act to fine tune the reabsorption of water and salts
Which part of the nephron does ADH act upon?
The collecting duct and distal convoluted tubule
What is the muscle that lines the bladder called?
Detrusor muscle
What are the cells that line the bladder?
Transitional epithelial cells that expand to accomodate large amounts of fluid
What should not be present in the urine?
Glucose, ketones, protein, bacterial/parasitic organisms
What is GFR?
Glomerular filtration rate, amount of fluid filtered through Bowman’s capsule per unit of time
What happens to the aging kidney?
Get smaller, number of nephrons decreases, loses ability to respond to changes in pH, changes to muscles and nerves
What happens as a result of a urinary blockage?
Causes backup to Bowman’s capsule, affects filtering abilities of nephrons, decreases GFR and sustained pressure with cause damage, promote scar tissue. Also creates urinary stasis
What is considered the upper urinary tract?
Kidneys, ureters
What is considered the lower urinary tract?
Bladder, urethra
What is a nephroliathiasis?
Kidney stone–formation of crystals, protein, other substances within kidney or ureters and can block flow downstream
What are some anatomical obstructions that cause resistance to urine flow?
Prostate enlargement, urethral stricture, severe pelvic organ prolapse, low bladder wall compliance, neurogenic alterations
What would be the result of damage between C2 and S1?
Detrusor hyperreflexia with veiscosphincter dyssynergia
What would be the result of damage below S1?
Detrusor areflexia with or without urethral sphincter incompetence
What would be the result of damage/lesions above C2?
Detrusor hyperflexia
What are some possible symptoms of urinary obstruction?
Abdo pain, renal colic, urgency, frequency, disruption of flow and retention, hematuria ?
What is the most common UTI organism?
E.Coli
What occurs in chronic pyelonephritis?
Persistent/recurring infections, cause scarring, release of ROS and cytokines that cause damage. If too many nephrons killed off, can lead to chronic kidney failure
What are glomeruli?
Intricate capillary networks where filtration takes place
What is glomerulonephritis?
Inflammation of the glomerulus caused by injury, prevents efficient filtration of blood and poor control on what is filtered into the nephrons
What are some potential causes of primary glomerulus?
Immunological responses, ischemia/lack of blood flow to kidney, infection, toxins
What are some potential causes of secondary glomerulus?
Another systemic disease, such as diabetes (excess sugar in blood can damage)
What is the typical cause of acute glomerulonephritis?
Antigen-antibody complexes–can either result in type III or type II hypersensitivity, can also have cell-mediated/type IV reactions
What are some clinical manifestations of glomerulonephritis?
Hematuria, proteinuria, severe cases can result in oliguria/hypertension/renal failure
What can glomerulonephritis result in?
Chronic glomerulonephritis, kidney failure, nephrotic syndrome or nephritic syndrome
What are the clinical manifestations of nephrotic syndrome?
Massive proteinuria, hypoalbuminemia, edema, hyperlipidemia
What are the clinical manifestations of nephritic syndrome?
Hematuria, oliguria, decreased GFR, hypertension
What type of pressure does albumin provide?
Provides 80% of colloid-oncotic pressure (serves to hold water in vascular space)
What is renal insufficiency?
Decline of function to approx 25% of normal
What is renal failure?
Significant loss of renal function
What is end-stage renal failure?
When less than 10% of renal function occurs
What is the criteria to guide diagnosis of renal injury?
RIFLE (risk, injury, failure, loss, end-stage disease)
How can the pathophysiology be divided for renal injuries?
Prerenal, intrarenal, and postrenal
What typically causes prerenal injury?
Hypoperfusion, could be d/t renal artery thrombosis or hypotension/hypovolemia from hemorrhage and dehydration
What typically causes intrarenal injury?
Damage within kidney itself, could be from glomerulonephritis, acute tubular necrosis, acute interstitial nephritis
What could be the cause of postrenal injury?
Rare, usually consequence of urinary tract obstruction
What is the intact nephron hypothesis?
Surviving nephrons sustain normal kidney function
What is stress urinary incontinence?
Associated with sudden increase in intra-abdominal pressure (laughing, coughing, sneezing, exercise)
What is urge urinary incontinence?
Loss of urine, strong/unstoppable urge to urinate–can be neurologic or non-neurologic (depending on where lesion is)
What is overflow urinary incontinence?
Overdistension of bladder resulting in involuntary urine loss
What is mixed urinary incontinence?
Combination of stress and urge incontinence
What is functional urinary incontinence?
Involuntary loss of urine due to dementia or immobility, cannot get to and from the bathroom
What is benign prostatic hyperplasia?
Enlarged prostate, not cancerous, can restrict the urethra
What is the flow of filtrate?
Bowman’s capsule–>proximal convoluted tubule–> descending loop of Henle—> distal tubule—> collecting duct–> renal papillae–> minor calyces–> renal pelvis–> ureter–> bladder
What would result in a decreased GFR?
Increased hydrostatic pressure in Bowman’s capsule (could happen from an obstruction)
Which capillaries can accept filtrate from Bowman’s capsule?
Peritubular capillaries
Which ions are actively secreted into the filtrate by the renal tubules?
Hydrogen and potassium
What % of filtered creatinine is excreted into the urine?
100%, renal tubules are impermeable to creatinine
