Urinary system :) Flashcards
what structures comprise the urinary system
kidneys
ureters
urinary baldder
urethra
where and through what process is urine formed ?
kidneys
filtration and reabsorption
how many L of blood is filtered per day ?
180 L
how much urine is formed via filtration/reabsorption per day ?
1 - 1.5 L per day
where is the hilum of the kidneys located?
medial surface
hilum (plural)
hilus (singular)
what is the functional unit of the kidney
and what is its function
nephron
froming and creating urine
what is the nephron unit composed of
glomerulus
bowmans capsule
convoluted tubules
where is blood filtered in the nephron system
glomerulus
were does the nepron unit terminate
collecting tubule
name the structures in which urine travels through out of the body
collecting tubule (opening at renal papilla)- minor calyx -- major calyces --which terminate at the renal pelvis
where do the ureters connect with the bladder
posteriolateral aspect in oblique angle
equidistant from the urethral orifice
(think trigone)
what is the function of the ureters
drain urine from kidneys to the bladder
orientate bladder and pubic symphysis
bladder is posterior to the pubic symphysis
what repro. function does the urethra serve in males ?
it passes through the prostate gland receiving seminal fluid via ejaculatory ducts (which open into the urethra through the prostate)
(3) sections of the male urethra
prostatic
membraneous
cavernous
KUB
kidneys, ureters, bladder
radiograph
what structure does the urethra open up into the exterior of the body ?
urinary meatus
what should be assessed before administering contrast for urinary anatomy?
patient renal function
urinary disorders clinical findings:
polyuria (lg vol of dilute) frequent urination oliguria (sm ammounts) dysuria obstructive sx flank pain
what is GFR
what is normal GFR
what does it test
what is eGFR
glomular filtration rate
> 90mL per min per 1.73 m cubed _norm
measures the rate of blood flow through the kidneys
level for contraindication of contrast not established
eGFR is the estimated measurement of serum creatinine value in combo with Pt age race and gender
individuals with low kidney function present with
high levels of creatinine and urea nitrogen in blood
what is BUN
what is BUN levels determined by
contraindication for radiograph
blood urea nitrogen
levels influenced by urine flow and production and metab of urea
no greater than 50mg/dL
serum creatine measure contraindicated for contrast
3mg/dL
embryonic development of the urinary system occurs in how many stages?
3
dev. of kidneys -from growth of ureteric duct
development of metanephric tissue
anomalies of the kidneys and ureters are caused by _____ and classified as either ___,_____,____ or _____
errors in dev
number, size&form, fusion, and position
congenital anomalies result in
impaired renal function and renal calculi
Number and size anomalies of the kidney:
4
renal aplasia
supernumerary kidney
hypoplasia
hyperplasia
compensatory hypertrophy
result of renal aplasia (unilateral absence of kidney) the existing kidney is larger than norm
in unilateral kidney aplasia which kidney is statistically more absent
left
which is usually lower in abdom cavity – right because of the liver
hypertrophic kidney is more prone to what
trauma
what is the absence of both kidneys refered to ?
bilateral agenesis (spell this) a-gene-sis
Potter syndrome
not conducive with life
renal aplasia
absence of one (unilateral) or both (bilateral) kindeys
detected via fetal US
bilateral renal aplasia is accompanied by compensatory hypertrophy (enlargement of the other kidney)
supernumerary kidney
presence of 3ed kidney
no paren-chy-mal attachment
prone to infection
hypoplasia
underdeveloped size
normal nephron development
req. renal arteriography to differentiate
hypertrophic changes from atrophy due to acquired vascular disease
usually accompanied with HTN
vol of the functioning kidney plays clinical role
Hyperplasia
overdevelopment of kidney
due usually to hypoplasia of the other kidney or hypertrophy
Fusion ano-mal-ies
how are they viewed
(2)
viewed via radiographs
horseshoe kidney
crossed ectopy
horseshoe kidney
lower poles of kidneys connected via band of soft tissue across the midline of the body
ureters exit anteriorly instead of medially
lower pole caylyces point medially rather than laterally
crossed ectopy
one kidney lies across the midline and is fused with the other kidney and usually lies inferoior to the other kidney with ureter crossing midline to conn with bladder on proper side
how are crossed ectopy and horseshoe kidney remided?
pyeloplastic surgery
Position anomalies of the kidneys:
2
malrotation
ectopic kidney
malrotation
incomplete or excessive rotation of the kidneys as they ascend from the pelvis IN UTERO
usually not problem unless obstruction occurs
ectopic kidney
out of normal position
usually found in the pelvis
asymptomatic 1-800 urologic exams
ureteropelvic junction obstruction or VUR is found
interthoracic location
nephroptosis
drooping of the kidney
nephro-ptosis
VUR
vesi-coure-teral
reflux
abnormal flow of urine from the bladder to the upper urinary tract
Renal pelvis and ureter anomolies
asymmetric
double renal pelvis
double ureter
impare renal dranage
infection and calculi
lower urinary tract anomalies
uretrocele
ureteral diverticula
bladder diverticula
uretheral valve obstruction
ureterocele
cystlike dialation of a ureter near opening to the bladder
result from stenosis
“cobra head”
ureterocele with ureteral duplication
“ectopic” ureterocele
causes obstruction to affect of renal falure due to infection
ureteral diverticula
dialated branched ureteric remnant
ureteral diverticula is best demonstrated with what mod
retrograde urography
uretheral valves
mucosal folds that protrude into the posterior urethera as a congenittal condition
obstructs urine flow
Polycystic kidney disease
PKD
many tiny cysts within nephron
results in renal failure
US plays role in identifing cysts and obtaining biopsy
autosomal dominant is asymptomatic untill adulthood
polycystic kidney disease in adulthood
visualized late stage after cysts in liver and kidneys cause impared function
bilateral enlargement of kidneys
poor defined capsule
calyceal streatching
development of uremia
require dialysis or kidney Tx
Medullary sponge kidney
congenital dialation of the renal tubules leading to urinary stasis and increased leveles of caPHO4
increase levels if caPHO4 in renal tubules
nephro-cal-cin-osis
sx of medullary sponge
dialation of the medullary and papillary pts of the collecting ducts (bilaterally)
Inflammatory diseases of urinary system
4
UTI
pyelonephritis
acute glomerulonephritis
cystitis
UTI
urinary tract infection
tx approach- quantative urine culture
Pyelonephritis
bacterial infection of the calyces and renal pelvis
what is the most common renal disease
pyelonephritis
what predisposed pt to pyelonephritis
stagnation or obstruction of ruine flow
bacterium reach kidneys via ascending ureters or bloodstream
pyuria
presence of pus in the urine
chronic reflux of infected urine into renal pelvis may result in
chronic pyelonephritis
commonly due to anatomy obstruction or childhood VUR
IVU vs UVR
IVU- An intravenous urogram (IVU) is sometimes called an intravenous pyelogram (IVP). This test uses X-rays to look at the kidneys, bladder, and the tubes that connect them (the ureters). Together these are called the urinary system
UVR- Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the kidneys. … Secondary VUR occurs when an obstruction in the bladder or urethra causes urine to flow backward into the kidneys.
chronic pyelonephritis can cause
destruction/scaring of the renal tissue
dialation of the calyces
reduction in kidney size
atrophy of renal pyramids
py-ram-ids
HTN
acute
glomeronephritis
antigen-antibody rx
in glomeruli inflammatory response to renal parenchyma
begins in the cortex
alt name for acute glomeronephritis
Bright’s disease
acute pyelonephritis primarly affects the:
interstitial tissue
acute glomeronephritis primarly affects the
nephron
gold standard for Dx of glomeronephritis
microscopic deposits in the glomerulus
(streptococcal)
collected with US or CT guidance
Cystitis
acute or chronic
inflammation of urinary bladder
how is VUR prevented
compression of bladder musculature on the ureters during micturition
congenital VUR is seen how
displaced laterall ureteric orifices
duplication of collecting systems & ureters w/ reflux into an ectopically placed ureter
neurogenic bladder
neurogenic bladder
bladder dysfunction
interference w nerve impulses- urination
bladder trabeculae
radiograph apperance of roughening of normally smooth bladder wall
what prevention is paramount when dealing with cystitis
pyelonephritis
urinary calcifications
renal calculi
urine/precipitate crystaline materials
ca salts
predisposing factors to renal calculi
metabolic disorders..hyperparathyroid
excessive ca intake
high urine concentration
chronic UTI
non calcific stones
uric acid stones
most stones are formed where
calyces
renal pelvis
staghorn calculus
large calculus
in shape of pelvicalyceal junction
what mods used to show stones?
US
CT - no contrast
dx flank pain
appendicitis - AAA- renal calculus
renal colic
movement/ obstruction
of stones
severe intermittent pain
renal calculi may cause
renal colic hematuria fever chills frequent urination secondary infection
degenerative diseases
3
nephrosclerosis
renal failure
hydronephrosis
nephrosclerosis
intimal thickening — sm vessels of kidney
aging, HTN, diabetes
what causes nephrosclerosis
reduced blood flow –ateriosclerosis = atrophy of renal parenchyma
collecting sys is intact–kidney is impaired
how does local infarction of renal parenchyma appear?
irregularity of the cortical margin
indentation
nephrosclerosis lab tests
and associated complications
BUN increase increase creatinine levels
HTN
what conditions cause the kidneys to appear smaller than norm
hypoplasia
atrophy after obstruction
nephrosclerosis
Renal failure
norm regulatory & excretion b/c loss of glomerular filtration = loss of parenchyma
renal falure usually is chronic and results from
2
chronic glomerulonephritis
PKD
uremia
characteristic of renal failure
retention of urea in the blood
what is r/o to dx acute renal failure
(progressive BUN/ serum creatinine increase)
urinary calculi (abdom radio) US/CT assess hydronephrosis kidney size
vascular abnorm – nuc med scan or renal angiography
biopsy
what changes in body syst result from renal failure
anemia
HTN
heart arrhythmia
CHF
electrolyte / acid-base imbalance
tx for renal failure
dialysis and transplantation
Hydronephrosis
obstructive disorder
causes dilation of the renal pelvis and calyces with urine
chronic hydronephrosis causes
intrarenal preasure= ischemia
parenchymal atrophy
loss of function
flank pain
Neoplastic Diseases of Renal system
4
renal cysts
renal cell carcinoma
nephroblastoma (wilms tumor)
bladder carcinoma
Bladder carcinoma
3* more in men
aka transtional cell carcinoma
squamous cell carcinoma
adenocarcinoma
main Sx of adenocarcinoma aka bladder carcinoma
painless hematuria
tumors located in trigone
IVU/ cystography - fillilng deficite
why is cystoscopy the method of choice for bladder carcinoma
hard to distinguish between
tumor, stone, blood clot
Nephroblastoma
aka wilms tumor
malignant tumor effecting 500 children a year
embryonal tumor
clinical dx via palpable immovable abdominnal mass
Renal cysts
asymptomatic
may rupture, hemorrhage, infection or obstruction
commonly forumnd in lower pole of kidney
how are tumors distinguished from cysts in the renal system
nephrotomography
cysts show absence of nephrogram phase after contrast medium injection
