Urinary System Flashcards
What is the major culprit for stubborn UTI?
Obstruction to urination
List functions of Kidneys
Excrete waste in urine
Regulate blood volume
Regulate blood composition
Regulate blood pH, osmolarity & glucose
Regulate blood pressure
Release erythropoietin
Participate in Vitamin D synthesis (calcitriol)
How does the KD regulate blood pressure?
secrete renin
adjust renal resistance
The KD is located __________ and is protected by ______ ribs and by layers of ______ and ________
above the waist between peritoneum and; posterior wall of abdomen
11th and; 12th
adipose tissue
fascia.
*extend from T12-L3
Describe the path of urine drainage in the KD (level of nephron)
Papillary duct in renal pyramid
minor calyx
major calyx
renal pelvis
ureter
The KD receives ___% of resting cardiac output via renal arteries
25%
In the KD nephron, __________are formed between the afferent and efferent arterioles. Efferent arterioles give rise to _______ and ______
glomerular capillaries
peritubular capillaries
vasa recta
Glomerular filtration is where ________ occurs
Peritubular capillaries function to ________
Vasa recta supplies _________
filtration of blood
carry away reabsorbed substances from filtrate
nutrients to renal medulla w/o disrupting its osmolarity
KD has over ______ nephrons composed of a _______ and ______
1 million
corpuscle
tubule
80-85% of nephrons are _____ nephrons. The remaining 15-20% are _______ nephrons.
cortical
juxtamedullary
In Juxtamedullary nephrons, the renal corpuscles are located ________ and long loops of Henle extend into ________ enabling _________ of dilute or concentrated urine.
close to medulla
deepest medulla
excretion
The Juxtamedullary nephron is the structure where ______ makes contact w/ ________ of loop of Henle. The ______ is the thickest part of the ascending limb. Juxtaglomerular cells are modified _______ in arteriole.
afferent arteriole
ascending limb
macula densa
muscle cells
Dysfunction of KD nephrons is not evident until function declines by ________
25% of normal
Nephrons and collecting ducts perform 3 basic processes. List them
glomerular filtration
tubular reabsorption
tubular secretion
Rate of excretion in renal physiology is defined as ________
rate of filtration + rate of secretion - rate of reabsorption
Glomerular filtrate is produced by _________
Filtering capacity is enhanced by _________
blood pressure
thinness of membrane, large surface area of glomerular capillaries, glomerular BP
Glomerular blood pressure is high due to ______
small size of efferent arteriole
In glomerular filtration the net filtration pressure is defined as _________
Glomerular blood hydrostatic pressure - capsular hydrostatic pressure - blood colloid osmotic pressure
KD nephron must reabsorb ____% of glomerular filtrate. Most tubular reabsorption occurs mostly in _______
99%
proximal convoluted tubules
Distal convoluted tubule is major site where ______ hormone stimulates reabsorption of ____. It is also where _____ are reabsorbed via symporters
parathyroid
Ca2+
Na+, Cl-
The best index of GFR is ________
serum creatinine
BUN stands for __________. It reflects the cumulative amount of ________ in _________
Blood Urea Nitrogen
ammonia
blood compartment
Specific gravity of urine can be defined as ______. It indicates ability of ________ to _________
the osmolarity of urine relative to the osmolarity of plasma
kidney tubules to concentrate urine
Normal urinary output is _____ per 24 hours. Minimum urinary output is _____ per one hour
700-2000mL
30-55mL
Excess H+ ions are deposited into the urine during which stage of urine formation?
Secretion
How is bicarbonate ion reabsorbed into blood?
Na+ antiporters reabsorb Na+ and secrete H+ into tubular fluid. For each H+ secreted one filtered bicarbonate ion returns to blood via facilitated diffusion
List normal constituents of urine
urobilinogen, electrolytes, ammonia, hormones, creatinine
List abnormal constituents of urine
proteins, glucose, formed elements of blood
Normal pH range of urine is _________
4.5-8
What are general etiologies of:
1) respiratory acidosis?
2) metabolic acidosis?
3) respiratory alkalosis?
4) metabolic alkalosis?
1) Lungs not exhaling
2) Kidney not filtering/reabsobing
3) hyperventilation
4) persistent vomiting/diarrhea
List signs and symptoms of urinary system disorders
dysuria, hesitancy of urination, urgency of urination, hematuria, hematospermia, albuminuria, edema, hyperlipidemia, turbid urine, excessively dilute/dark urine, pruritus, anemia, abnormal respiration pattern, elevated levels of creatinine/BUN
Dysuria generally indicates ________
Hesitancy of urination generally indicates _______
inflammation
obstruction!!
Hyperlipidemia in urinary system disorders generally indicates __________
Anemia in urinary system disorders generally indicates _______
Pruritus in urinary system disorders generally indicates ________
lipoproteins leaking through Kidney
Kidney not secreting EPO
Kidney not excreting bile salts
List the modes of inheritance for:
1) Adult Polycystic Kidney Disease
2) Childhood Polycystic Kidney Disease
1) autosomal dominant
2) autosomal recessive
Describe pathogenesis of ADPKD
Formation of cysts in Kidney -> cysts accumulate fluid, enlarge, separate from nephron, compress neighboring renal parenchyma (nephrons), progressively compromising renal function
List clinical presentations of ADPKD
abdominal discomfort, hematuria, UTI, hypertension, abdominal mass, elevated serum creatinine, cystic kidneys on imaging studies
Complications of ADPKD are ________
cerebral hemorrhage from ruptured intracranial aneurysm, renal cell carcinoma, nephrolithiasis, abdominal hernia, inguinal hernia
List diagnostic methods for ADPKD
30+ years- renal ultrasonography
less than 30 years - CT, MRI
List treatment methods of ADPKD
palliative care, hypertension medication, antibiotics for infected kidney cysts, kidney transplantation, medication to inhibit renin-angiotensin system
Major risk factors for urolithiasis/nephrolithiasis are ______
hypercalcuria, hypercalcemia (parathyroid), hyperthyroidism, excessive/deficient intake of calcium supplements and oxalates, excessive Vitamin C supplementation, increase in global temperatures, Crohn’s disease, malignancies, persistent UTI, excessive protein-based diet, metabolic acidosis
The most common kidney/urinary stones are ______ . What type of stones are radiolucent?
Calcium urinary stones (calcium oxalate)
Uric Acid stones
What type of stones are radio-opaque? What is the composition of struvite stones? What is the origin/etiology of struvite stones?
- calcium urinary stones
- magnesium-ammonium-phosphate
- urea-splitting bacteria in UTI
Uric acid stones are associated with what disease?
gout
What does pruritus indicate?
Excessive bile salts from LV or KD failure/issues.
T/F blood in urine is not a red flag for referral
False - could indicate cancer!
The kidneys are situated at the level of what vertebrae?
T12 - L3
Glomerulonephritis is ____________
Pyelonephritis is ____________
- auto-immune inflammation of glomeruli
- UTI affecting Kidney where all of nephron is inflamed except glomerulus
In children with frequent UTI, one should suspect the following causes: ____________
- anatomical abnormality
- poor hygiene
- immune deficiency
- sexual abuse
UTI in the elderly can present with ________ symptoms such as __________
How to treat an elderly patient with asymptomatic bacteriuria? Why?
psychiatric
agitation, anxiety
no treatment, treatment wiht antibiotics can later lead to antibiotic resistant pneumonia
UTI in pregnancy is an emergency situation because ________
UTI can ascend to kidney causing preeclampsia and possible miscarriage
List clinical presentation of UTI
- urinary frequency
- urgency
- dysuria
- lower abdominal and flank pain
- urethral discharge (mostly males)
- systemic symptoms (fever, nausea, vomiting, chills)
The most common renal cancer is _______. It is most common in what population?
Renal Cell Carcinoma
males aged 30-50’s
List risk factors for renal cell carcinoma
smoking, obesity, ADPKD, acquired cystic KD disease in dialysis patients, radiopaque contrast dyes, asbestos exposure, cadmium exposure, leather tanning exposure, petroleum product exposure
List risk factors for Urinary Bladder cancer
smoking, chemotherapy, UB stones, industrial chemical exposure
The most common cause of acute renal failure is ________
acute tubular necrosis
Major causes of acute tubular necrosis are _______. Describe the pathogenesis of acute tubular necrosis
ischemia, toxins
Ischemia or toxins cause tubular damage with inability to secrete and reabsorb filtrate of glomeruli
The clinical syndromes of glomerulonephritis are known as _______.
1) Nephritic syndrome
2) Nephrotic syndrome
Describe etiology of Nephritic Syndrome and clinical presentations
- damaged fenestration membranes of glomerul
- presents with hematouria, HTN, slight proteinuria, periorbital edema, petechial skin hemorrhage, fever, flank pain, malaise
Describe etiology of Nephrotic Syndrome and clinical presentations
- damaged fenestration membranes and basement membranes of glomeruli
- presents with severe proteinuria, generalized edema, hyperlipidemia, loss of albumins in blood compartment (hypoalbuminemia)
Post-streptococcal glomerulonephritis results in ______ syndrome
nephritic
What are some paraneoplastic effects of renal cell carcinoma?
secondary absolute polycythemia - excess EPO
HTN - excess renin
Renal colic is a type of abdominal pain caused by ______. Describe the pain.
kidney stones
extreme flank pain often radiating to the hypochondrium or the groin
