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Pathophysiology 2 > Urinary System > Flashcards

Urinary System Flashcards

1
Q

What is the major culprit for stubborn UTI?

A

Obstruction to urination

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2
Q

List functions of Kidneys

A

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)

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3
Q

How does the KD regulate blood pressure?

A

secrete renin

adjust renal resistance

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4
Q

The KD is located __________ and is protected by ______ ribs and by layers of ______ and ________

A

above the waist between peritoneum and; posterior wall of abdomen
11th and; 12th
adipose tissue
fascia.

*extend from T12-L3

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5
Q

Describe the path of urine drainage in the KD (level of nephron)

A

Papillary duct in renal pyramid

minor calyx

major calyx

renal pelvis

ureter

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6
Q

The KD receives ___% of resting cardiac output via renal arteries

A

25%

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7
Q

In the KD nephron, __________are formed between the afferent and efferent arterioles. Efferent arterioles give rise to _______ and ______

A

glomerular capillaries
peritubular capillaries
vasa recta

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8
Q

Glomerular filtration is where ________ occurs
Peritubular capillaries function to ________
Vasa recta supplies _________

A

filtration of blood

carry away reabsorbed substances from filtrate

nutrients to renal medulla w/o disrupting its osmolarity

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9
Q

KD has over ______ nephrons composed of a _______ and ______

A

1 million

corpuscle

tubule

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10
Q

80-85% of nephrons are _____ nephrons. The remaining 15-20% are _______ nephrons.

A

cortical

juxtamedullary

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11
Q

In Juxtamedullary nephrons, the renal corpuscles are located ________ and long loops of Henle extend into ________ enabling _________ of dilute or concentrated urine.

A

close to medulla
deepest medulla
excretion

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12
Q

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.

A

afferent arteriole
ascending limb
macula densa
muscle cells

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13
Q

Dysfunction of KD nephrons is not evident until function declines by ________

A

25% of normal

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14
Q

Nephrons and collecting ducts perform 3 basic processes. List them

A

glomerular filtration
tubular reabsorption
tubular secretion

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15
Q

Rate of excretion in renal physiology is defined as ________

A

rate of filtration + rate of secretion - rate of reabsorption

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16
Q

Glomerular filtrate is produced by _________

Filtering capacity is enhanced by _________

A

blood pressure

thinness of membrane, large surface area of glomerular capillaries, glomerular BP

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17
Q

Glomerular blood pressure is high due to ______

A

small size of efferent arteriole

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18
Q

In glomerular filtration the net filtration pressure is defined as _________

A

Glomerular blood hydrostatic pressure - capsular hydrostatic pressure - blood colloid osmotic pressure

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19
Q

KD nephron must reabsorb ____% of glomerular filtrate. Most tubular reabsorption occurs mostly in _______

A

99%

proximal convoluted tubules

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20
Q

Distal convoluted tubule is major site where ______ hormone stimulates reabsorption of ____. It is also where _____ are reabsorbed via symporters

A

parathyroid
Ca2+
Na+, Cl-

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21
Q

The best index of GFR is ________

A

serum creatinine

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22
Q

BUN stands for __________. It reflects the cumulative amount of ________ in _________

A

Blood Urea Nitrogen
ammonia
blood compartment

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23
Q

Specific gravity of urine can be defined as ______. It indicates ability of ________ to _________

A

the osmolarity of urine relative to the osmolarity of plasma

kidney tubules to concentrate urine

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24
Q

Normal urinary output is _____ per 24 hours. Minimum urinary output is _____ per one hour

A

700-2000mL

30-55mL

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25
Q

Excess H+ ions are deposited into the urine during which stage of urine formation?

A

Secretion

26
Q

How is bicarbonate ion reabsorbed into blood?

A

Na+ antiporters reabsorb Na+ and secrete H+ into tubular fluid. For each H+ secreted one filtered bicarbonate ion returns to blood via facilitated diffusion

27
Q

List normal constituents of urine

A

urobilinogen, electrolytes, ammonia, hormones, creatinine

28
Q

List abnormal constituents of urine

A

proteins, glucose, formed elements of blood

29
Q

Normal pH range of urine is _________

A

4.5-8

30
Q

What are general etiologies of:

1) respiratory acidosis?
2) metabolic acidosis?
3) respiratory alkalosis?
4) metabolic alkalosis?

A

1) Lungs not exhaling
2) Kidney not filtering/reabsobing
3) hyperventilation
4) persistent vomiting/diarrhea

31
Q

List signs and symptoms of urinary system disorders

A

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

32
Q

Dysuria generally indicates ________

Hesitancy of urination generally indicates _______

A

inflammation

obstruction!!

33
Q

Hyperlipidemia in urinary system disorders generally indicates __________
Anemia in urinary system disorders generally indicates _______
Pruritus in urinary system disorders generally indicates ________

A

lipoproteins leaking through Kidney

Kidney not secreting EPO

Kidney not excreting bile salts

34
Q

List the modes of inheritance for:

1) Adult Polycystic Kidney Disease
2) Childhood Polycystic Kidney Disease

A

1) autosomal dominant

2) autosomal recessive

35
Q

Describe pathogenesis of ADPKD

A

Formation of cysts in Kidney -> cysts accumulate fluid, enlarge, separate from nephron, compress neighboring renal parenchyma (nephrons), progressively compromising renal function

36
Q

List clinical presentations of ADPKD

A

abdominal discomfort, hematuria, UTI, hypertension, abdominal mass, elevated serum creatinine, cystic kidneys on imaging studies

37
Q

Complications of ADPKD are ________

A

cerebral hemorrhage from ruptured intracranial aneurysm, renal cell carcinoma, nephrolithiasis, abdominal hernia, inguinal hernia

38
Q

List diagnostic methods for ADPKD

A

30+ years- renal ultrasonography

less than 30 years - CT, MRI

39
Q

List treatment methods of ADPKD

A

palliative care, hypertension medication, antibiotics for infected kidney cysts, kidney transplantation, medication to inhibit renin-angiotensin system

40
Q

Major risk factors for urolithiasis/nephrolithiasis are ______

A

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

41
Q

The most common kidney/urinary stones are ______ . What type of stones are radiolucent?

A

Calcium urinary stones (calcium oxalate)

Uric Acid stones

42
Q

What type of stones are radio-opaque? What is the composition of struvite stones? What is the origin/etiology of struvite stones?

A
  • calcium urinary stones
  • magnesium-ammonium-phosphate
  • urea-splitting bacteria in UTI
43
Q

Uric acid stones are associated with what disease?

A

gout

44
Q

What does pruritus indicate?

A

Excessive bile salts from LV or KD failure/issues.

45
Q

T/F blood in urine is not a red flag for referral

A

False - could indicate cancer!

46
Q

The kidneys are situated at the level of what vertebrae?

A

T12 - L3

47
Q

Glomerulonephritis is ____________

Pyelonephritis is ____________

A
  • auto-immune inflammation of glomeruli

- UTI affecting Kidney where all of nephron is inflamed except glomerulus

48
Q

In children with frequent UTI, one should suspect the following causes: ____________

A
  • anatomical abnormality
  • poor hygiene
  • immune deficiency
  • sexual abuse
49
Q

UTI in the elderly can present with ________ symptoms such as __________

How to treat an elderly patient with asymptomatic bacteriuria? Why?

A

psychiatric

agitation, anxiety

no treatment, treatment wiht antibiotics can later lead to antibiotic resistant pneumonia

50
Q

UTI in pregnancy is an emergency situation because ________

A

UTI can ascend to kidney causing preeclampsia and possible miscarriage

51
Q

List clinical presentation of UTI

A
  • urinary frequency
  • urgency
  • dysuria
  • lower abdominal and flank pain
  • urethral discharge (mostly males)
  • systemic symptoms (fever, nausea, vomiting, chills)
52
Q

The most common renal cancer is _______. It is most common in what population?

A

Renal Cell Carcinoma

males aged 30-50’s

53
Q

List risk factors for renal cell carcinoma

A

smoking, obesity, ADPKD, acquired cystic KD disease in dialysis patients, radiopaque contrast dyes, asbestos exposure, cadmium exposure, leather tanning exposure, petroleum product exposure

54
Q

List risk factors for Urinary Bladder cancer

A

smoking, chemotherapy, UB stones, industrial chemical exposure

55
Q

The most common cause of acute renal failure is ________

A

acute tubular necrosis

56
Q

Major causes of acute tubular necrosis are _______. Describe the pathogenesis of acute tubular necrosis

A

ischemia, toxins

Ischemia or toxins cause tubular damage with inability to secrete and reabsorb filtrate of glomeruli

57
Q

The clinical syndromes of glomerulonephritis are known as _______.

A

1) Nephritic syndrome

2) Nephrotic syndrome

58
Q

Describe etiology of Nephritic Syndrome and clinical presentations

A
  • damaged fenestration membranes of glomerul
  • presents with hematouria, HTN, slight proteinuria, periorbital edema, petechial skin hemorrhage, fever, flank pain, malaise
59
Q

Describe etiology of Nephrotic Syndrome and clinical presentations

A
  • damaged fenestration membranes and basement membranes of glomeruli
  • presents with severe proteinuria, generalized edema, hyperlipidemia, loss of albumins in blood compartment (hypoalbuminemia)
60
Q

Post-streptococcal glomerulonephritis results in ______ syndrome

A

nephritic

61
Q

What are some paraneoplastic effects of renal cell carcinoma?

A

secondary absolute polycythemia - excess EPO

HTN - excess renin

62
Q

Renal colic is a type of abdominal pain caused by ______. Describe the pain.

A

kidney stones

extreme flank pain often radiating to the hypochondrium or the groin

Pathophysiology 2 (8 decks)

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