Urinary System Flashcards
What are the functions of the kidney?
Filter blood
Remove waste products
Retain solutes of nutritional
Balance water volume, ion concentration and manage blood pressure
Podocytes have __________ that filter blood based on _____
Processes
Size
What is renal failure?
Is a condition where the kidney fails to filtered wastes out of the blood adequately
What is chronic renal failure ?
Progressive loss of kidney function over a period of months - years
What is acute renal failure?
Abrupt loss of kidney function over a period of days, usually caused by critical illness
What are the symptoms of renal failure?
Loss of blood components :
Haematuria - Blood cells in urine
Proteinuria - Proteins in urine
Failure to remove wastes (Azotemia) - things like high levels of urea and creatinine
Break down of the ___________________ will cause larger substances and cells to enter the filtrate
Glomerular Filtration Membrane
What is End-Stage Renal Disease (ESRD)?
It is a condition caused by wastes reaching toxic levels in the blood, it is fatal if left untreated
What are the symptoms of ESRD?
Weakness
High BP
Weight gain
Increased salt and fluid retention
Give a brief overview of Haemodialysis:
It is the filtration of blood with an artificial membrane
Chronic Treatment - 3 times a week 3-4 hours
Acute treatment - temporary renal replacement therapy
What is peritoneal dialysis?
Dialysis using the patients peritoneal membrane as a filter, fluid is pumped into the abdomen and allowed to equilibrate
How do we diagnose renal failure?
- Clearance rates
- Screening for proteinuria
- Screening for haematuria
How do we do a blood and urine test?
[urine] / [plasma] x 24hr urine volume
What are clearance rates?
Clearance rates: measure the rate at which a marker (usually creatinine) is excreted
- Creatinine has a clearance rate of 100ml/min
- Requires a blood and urine test
- Low clearance rate = decline in renal function
_________ is the most abundant protein in the proteinuric urine
Albumin
Glomerular diseases may be characterised by:
Inflammation Scarring Membrane thickening Podocytes disorganisation Minimal change disease
Glomerular diseases are _________ in nature, glomerular tissue ________________
Progressive
Cannot regenerate
What is Glomerularnephritis?
A inflammatory disease of the glomerulus characterised by the presence of lots of cells including leukocytes in the glomerulus
What are the clinical features of glomerularnephritis?
Blocking of urine flow (Oliguria)
Podocyte damage can cause Proteinuria and/or Haematuria
What is Glomerulosclerosis?
A disease caused by damage to the glomerulus being repaired by laying down of collagen and other fibres. This affects the filtration membrane
Scarring of the glomerulus can be due to __________ or a secondary response to other diseases e.g. _______
Inflammation
Diabetes
What is Membranous Glomerulopathy?
A disease caused by the thickening of the capillary walls often with antibody deposits
The cause of membranous glomerulopathy is ________, it is linked to ________
Unknown
Diabetes
What is podocyte disruption?
It is the disruption of the regular structure, can be caused by flattening or detachment of podocytes
Tubular necrosis is caused by ______, ______ and _________. It is often _______ in nature requires _______ dialysis treatment
Ischaemia, Toxins and Chemicals
Acute
Temporary dialysis
Tubules can _______ after several weeks
Regenerate
Tubule necrosis causes tubules to _____________. There is loss of the _____________ meaning that solutes can not be absorbed as readily
Collapse on themselves
Brush-border
The concentration of electrolytes are measured in ___________, 1 _____ = 1 __________
Equivalents
1 charge = 1 equivalent
Most reabsorption occurs in the _____
PCT
What is reabsorbed in the PCT?
NaCl K Ca HCO3-, Glucose and AAs
What is secreted in the PCT?
H+
NH3
What is reabsorbed in the LoH?
H20
NaCl
Mg in the ascending limb
What is reabsorbed in the DCT?
NaCl
What is secreted in the DCT?
K+
What is reabsorbed in the collecting duct?
NaCl
H2O
Urea
What are diuretics?
Substances that promote water loss
What causes fluid disturbances?
Defective aquaporins (Diabetes Insipedus)
Vomiting - loss of water and electrolytes
Diarrhoea - loss of water and electrolytes
Electrolyte disturbances can be caused by:
Retention of electrolytes
Redistribution of electrolytes - movement to balance charges causes issues with transport and other processes
Defective transporters
Bicarbonate is reabsorbed in the ____
PCT
What causes Respiratory Acidosis?
Inefficient CO2 removal, pulmonary disease
What causes Respiratory Alkalosis?
Hyperventilation, too much CO2 removal
Anxiety and drugs
What causes Metabolic Acidosis?
Excess H+
Renal failure
What causes Metabolic Alkalosis?
Excess HCO3-
Ingestion of antacids
How does the body respond to Respiratory Acidosis?
Kidneys reabsorb more HCO3 in the PCT
How does the body respond to Respiratory Alkalosis?
Kidneys don’t reabsorb HCO3 in the PCT
How does the body respond to Metabolic Acidosis?
Lungs blow off more CO2
Kidneys reabsorb more HCO3 in the PCT
How does the body respond to Metabolic Alkalosis?
Lungs blow off less CO2
Kidneys don’t reabsorb HCO3 in the PCT
What is the worst pH related disorder and why?
Metabolic Alkalosis because the body’s response is usually inadequate, to reduce CO2 we have to reduce O2 gain
Give a brief description of kidney formation:
Kidneys start off as buds off of the bladder and ascend into position in the embryo
What is agenesis of the kidney?
1 kidney fails to form
The kidney that is left is often enlarged to cope with the extra load
One of the kidneys may fail to ________ this doesn’t causes issues unless there is _______ of the ureter
Ascend
Kinking
______ of the kidneys can occur if they fail to ascend, this this doesn’t causes issues unless there is _______ of the ureter. Most common type is ________
Fusion
Kinking
Horseshoe
There can be ____________________ of the ureter, these patients may be predisposed towards _______ if drainage doesn’t occur properly
Full or partial duplication of the ureter
Infection
What is a simple cyst?
A thin epithelial layer enclosing a clear fluid
Simple cysts often _____________
Go undetected
How do cysts occur?
Mutation causes cell proliferation and fluid secretion into the space in between cells due to mutation in fluid transporters
What is polycystic kidney disease?
A progressive genetic disease
Function declines as nephrons are destroyed and flow is impacted
Can be asymptomatic or painful
What are the 2 different types of Polycystic kidney disease?
Childhood - Autosomal recessive
- Cysts at birth
- Death in early infancy
Adult - Autosomal dominant
- Can be asymptomatic until 40-50s
- Relatively common
What are medullary cysts?
Cysts that occur in the medulla
Can seriously impact flow
What are acquired cysts?
Cysts that develop in long term dialysis patients
What causes urinary obstructuction?
Congenital anomalies Calculi (Stones) Prostatic Hypertrophy Tumours Inflammation Inflammation
What is Hydronephrosis and Hydroureter?
Blockage causes backwards pressure that causes dilation of the renal pelvis and medulla or ureter
What are renal calculi?
Stones formed from the precipitation of salts like uric acid and calcium in the urine
What encourages renal calculi?
- High salt concentrations
- Urine stagnation
- Infection
What is a staghorn calculus?
A renal calculi that is shaped like the renal pelvis
Stones may cause _______ or _______ the ureter lining and thus cause _______
Blockage or Tearing
Haematuria
What is Lithotripsy?
A surgery to remove stones by ultrasonic waves that shatter them into small particles that can be excreted
Micro-organisms in the urinary system are usually ________________
Flushed out with urine
When can infection can occur?
When urine is stagnant (Flow obstruction)
Ureter lining is damaged
Patient has a catheter
What is cystitis?
Infection of the bladder
What is pyelonephritis?
Infection in the kidney
Organisms that cause urinary infections are usually __________________
The patients enteric flora
Where can pyelonephritis originate from?
The blood (Haematogenous) Backwards flow from the bladder
How do we treat UTIs?
Treatment with antibiotics is usually successful if underlying cause is corrected as well
Recurrent Pyelonephritis can lead to _________ of renal tissue and therefore _____________
A decrease in function
Summarise benign kidney tumours:
Frequently found in the cortex
Usually not harmful
If in medulla can cause blockage and be a breeding ground for infection
Summarise features of the main malignant kidney tumour in adults:
Renal cell carcinoma
- Can invade the calyces, pelvis, renal vein, and ureter
- Can cause bleeding .’. we get Haematuria
- Prognosis is bad because the by the time it’s identified it’s already metastasised
What are Wilms tumours?
A highly malignant tumour in children that occurs from spontaneous genetic abnormalities
It causes a swollen abdomen and Haematuria
How do we treat Wilms tumours?
Nephrectomy
Radiotherapy
Prognosis is generally favourable
