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.systems based core clinical specialties > Urinary System > Flashcards

Urinary System Flashcards

1
Q

Water only moves _______ in the kidney

A

Passively

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2
Q

Thick asending limb (loop of henle)

A

Impermeable to water and actively removes Na and Cl from urine

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3
Q

Distal tubule and collecting duct

A

Selectively permeable to water (vasopressin/ ADH opens pumps so water can be reabsorbed)

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4
Q

Urea in the kidney

A

In the collecting duct, recycled into the medulla passively down a concentration gradient (helps with concentration)
Acquired from diet (through liver)

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5
Q

How the kidney concentrates urine:

A

Glomerulus → proximal renal tubule→ Loop of Henle → collecting tubules

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6
Q

Glomerulus

A

Blood supply, filtration (small molecules) and supplies the kidney with nutrients

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7
Q

Normal SG

A

300 osmol= 1.008-1.012
Less than= dilute

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8
Q

Proximal renal tubule

A

Absorbs water and electrolytes (non-selectively)

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9
Q

Loop of Henle

A

Separates water from electrolytes : Na, Cl- pumps from ascending limb → renal interstitial
Dilutes urine

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10
Q

Dilution

A

Remove solutes in excess of water (urine less concentrated)

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11
Q

How does the renal medulla become hyperosmotic?

A

@ the Loop of Henle (ascending limb)
Na/Cl pumping electrolytes out of limb into the central medulla

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12
Q

Counter current multiplier

A

Forming a concentrated urine
Loop of henle generates an hyperosmotic medulla for separation of water an solutes
Requires energy, hairpin configuration and separation of water from solute

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13
Q

How is the hyperosmotic medulla maintained after water enters

A

Vasa recta: water moves in to dilute hyperosmotic medulla → collects water from medulla and brings it back to the urinary system circulation (prevents solute washout)

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14
Q

Vasa recta (counter current exchanger)

A

Blood supply to the medulla bringing nutrients and O2 and removing waste
OG from JG nephrons

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15
Q

Requirements for the counter current exchanger

A

Hairpin configuration
High permeability to water and solutes
Slow circulation to allow diffusion

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16
Q

What 2 things are required to form a concentrated urine?

A

Hyperosmotic renal medulla and ADH (vasopressin)

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17
Q

Water deficit

A

↑ extracellular osmolality, ADH secretion, plasma ADH, H2O and urea permeability, H2O and urea reabsorption and ↓ H2O excretion
done to conserve water

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18
Q

Water excess

A

↓extracellular osmolality, ADH secretion, plasma ADH, H2O and urea permeability, H2O and urea reabsorption and ↑H2O excretion
excreting water and diluting urine

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19
Q

Kidney function (maintaining homeostasis)

A

Filter our metabolic waste
Maintain hydration and electrolyte balance (P,K, Na)
Prevent plasma protein loss
Acid base and calcium balance
BP control
RBC production

20
Q

33% kidney function

A

Concentrating function is impaired
<1.025-1.030 in dogs
<1.035 and 1.040 in cats

21
Q

25% of kidney function

A

Impaired kidney function and azotemic

22
Q

Primary Renal azotemia

A

Elevation or buildup of nitrogenous products (BUN< creatinine, SDMA) in the blood due to ↓ kidney function
Ex: acute and chronic kidney disease

23
Q

Kidney failure

A

Failure to maintain homeostasis, destruction of 3/4 of functional mass of both kidneys
Creatinine >1.5 mg/dl or BUN >33mg/dl
SG: 1.008-1.030 (1.035 in cats)

24
Q

T/F: When the creatinine is almost normal (little ↑), there’s a big drop in GFR

A

TRUE
important for kidney disease

25
Q

T/F: Large reductions of high creatinine minimally affect GFR

A

TRUE
kidney function not affected much

26
Q

Prerenal azotemia

A

↑ creatinine and BUN
SG adequate: >1.030 in dogs and >1.035 in cats

27
Q

Renal Azotemia

A

↑ creatinine and BUN
SG inappropriate: 1.007-1.029 in dogs and 1.007-1.034 in cats
Kidney not functioning well

28
Q

Postrenal azotemia

A

↑ creatinine and BUN
SG variable
Detection of urinary obstruction or rupture (clinically sick)

29
Q

All manifestations of disease are the result of two processes:

A
  1. What the disease induces
  2. The body’s compensatory response
30
Q

Disease induced → body’s response

A

Polyuria → polydipsia
Polydipsia → polyuria
Trauma → inflammation
Systemic infection → fever
Hypoxemia → tachypnea

31
Q

If chronic kidney disease is driving PU/PD, what happens to serum sodium? (↓ 25% kidney function/ azotemia)

A

Primary polyuria
Serum [Na+] is higher because more water is urinated out first (hemoconcentrated)

32
Q

If hyper-anxiety is driving PU/PD, what happens to the serum sodium?

A

Primary polydipsia
Diluting out the components in your blood
Serum [Na+] is lower because more water consumed

33
Q

Proteinuria

A

Lab abnormality implying urine protein excretion in excess

34
Q

Pre-renal proteinuria

A

Detected if ↑ concentration of small proteins in blood, functional (Hb, myoglobin)

35
Q

When does pre-renal proteinuria happen?

A

Intravascular hemolysis
Myoglobinemia
Myeloma

36
Q

Pre-renal proteinuria urinalysis

A

Red color
High protein (could be 2 or 3 +)

37
Q

Renal proteinuria

A

Glomerular (can lead to renal failure, chronic)- albumin
Renal tubular disease and interesital disease (mild and not as common)

38
Q

Renal proteinuria urinalysis

A

Protein in the urine (1+ …)
No RBCs and WBCs
Low SG
run urine protein creatinine ratio

39
Q

Post-renal proteinuria

A

Ureter, bladder, urethra disease
Urinary obstruction or leakage in the body
Most common, doesn’t relate to kidney disease

40
Q

Post-renal proteinuria urinalysis

A

Protein (norm)
Color: red
TNTC WBCs, RBCs, and epithelial cells

41
Q

Tests for proteinuria

A

Urine dipstick (urinalysis- albumin)
Urine protein to creatinine ratio (renal proteinuria)
Sulfasalycyclic acid turbidity and electrophoresis)

42
Q

Components to uroliths (urinary stones)

A

Nidus (Ca++ oxalate how stone formed)*
Stone
Shell
Surface crystals

43
Q

Why stones form?

A

Precipitation crystallization**
Matrix nucleation
Crystallization inhibition
Homogenous or heterogenous nucleation

44
Q

Homogenous or heterogenous nucleation

A

Homo: requires energy and forms initiation of crystal
Hetero: Something initiates it

45
Q

Struvite stones

A

Magnesium amonium phosphate
pH causes stone to from (↑ urine alkalinity)
Acidify urine to reverse stones

46
Q

What causes urolith formation?

A

Hepatic disease
UTI
Genetic abnormalities
Hypercalemic disorders
Altered pH
Vitamin and Mineral Excesses in Diet
Sequela to drug admin
Hypovolemic disorders

.systems based core clinical specialties (27 decks)

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