Urinary Tract

Question 1

Hilum

Answer 1

Part of the kidney where the renal artery, vein and ureter enter

Question 2

Primary function of urinary tract

Answer 2

Formation and excretion of urine
(ultra filtration of blood in the nephrons, urine enters the renal collecting system, through ureters to bladder, discharged through urethra)

Question 3

3 basic components of the nephron

Answer 3

1. Glomeruli
2. Tubules
3. Collecting ducts

Question 4

2 hormones kidneys can SYNTHESIZE (and their functions)

Answer 4

1. Renin: increase BP

2. Erythropoietin: stimulate RBC production in bone marrow

Question 5

3 hormones kidney function can be REGULATED BY (and their functions)

Answer 5

1. Antidiuretic hormone: stimulates water uptake in the distal convoluted tubules
2. Arterial natriuretic factor: stimulates water loss
3. Aldosterone: increase sodium reabsorption which increases body fluid volume

Question 6

Where is:
1. ADH
2. ANF
3. Aldosterone
synthesized?

Answer 6

1. hypothalamus
2. atrium of heart
3. adrenal glands

Question 7

Juxtaglomerular cells

Answer 7

Smooth muscle cells found in the wall of afferent arterioles

Secrete renin in response to decrease in BP

Question 8

Renal agenesis

Answer 8

A developmental disorder

Missing a kidney (unilateral) or both kidneys (bilateral)

Question 9

Horseshoe kidney

Answer 9

A developmental disorder
Kidneys have fused
Function usually isn’t impaired

Question 10

Polycystic kidney disease

Answer 10

Developmental disorder
Autosomal dominant (adult)
They become dysfunctional and really large
Have to be on hemodialysis until they can get a transplant
2 types
Develop symptoms of renal failure by age of 40-50 years
Present with: hematuria, oliguira, and flank pain
Usually related to gene polycystin-1

Question 11

2 types of Polycystic kidney disease

Answer 11

Gross: bilateral kidney involvement, massive enlargement (4kg), almost complete parenchymal replacement by cysts
Micro: cysts arise anywhere in nephron, epithelial lining, interstitial inflammation and fibrosis

Question 12

Oliguria

Answer 12

Unable to produce urine

Question 13

(Multi) Cystic renal dysplasia

cause, gross, histology, associated with

Answer 13

Sporadic, non-familial disorder due to an abnormaility in metanephric differentiation
Gross: can be uni or bilateral, kidneys enlarged and multicystic
Histology: immature ducts surrounded by undifferentiated mesenchyme often with focal cartilage, abnormal lobar organization
Most cases associated with ureteropelvic obstruction, ureteral agenesis or atresia, and other anomalies of lower UT

Question 14

3 most common causes of abdominal masses in infants

Answer 14

Multicystic renal dysplasia
Wilms’ tumor
Neuroblastoma of the adrenals

Question 15

Most important local symptoms of kidney disease (2)

Answer 15

1. Changes in urine volume (polyuria or oliguria)

2. Changes in urine composition (hematuria, glucosuria, or pyuria = pus)

Question 16

4 most important syndromes related to glomerular diseases

Answer 16

1. acute renal failure
2. nephritic syndrome
3. nephrotic syndrome
4. isolated hematuria/proteinuria

Question 17

Nephrotic syndrome

Answer 17

High protein (>3 or 3.5g/day)
Hypoalbuminemia
Edema
Hyperlididemia (and lipiduria)*
Thrombo-embolism (losing anti-thrombin and plasminogen, platelet activation)
Infection (loss of Igs)
Not a lot of inflammatory proteins seen

Question 18

Nephritic syndrome

Answer 18

Hematuria *
RBC casts, dysmorphic/fragmented RBCs in urinary sediment
Oliguria *
Proteinuria
Hypoalbuminemia
Edema, generalized
Hypertension
A lot of inflammatory related changes

Question 19

Crescentic GN

Answer 19

Severe glomerular injury accompanied by formation of a fibrinous exudate inside Bowman’s capsule
Typically occurs in patients with anti-glomerular basement membrane disease
Develip anuria and acute renal failure
Inflammatory cells form crescent shape
Very acute, and have to be able to recognize it fast

Question 20

Acute GN

Answer 20

Immune-mediated inflammation of the glomerulus that occurs 1-2 weeks after acute infection (strep throat)
Present with generalized edema, proteinuria, hematuria, oliguria, and hypertension
In pediatric patients can get high BP
Glomeruli appear hypercellular with increased mesangial cells and inflammatory cells

Question 21

Membranous Nephropathy

Answer 21

One of the most common causes of nephrotic syndrome in adults (25% of cases)
Immune-mediated glomerulopathy characteried by thickening of the basement membrane secondary to massive deposition of immune complexes

Question 22

Lipoid nephrosis

Answer 22

Minimal change disease
Most common cause of nephrotic syndrome in children
Hyperlipidemia and lipiduria
Fusion of the foot processes of epithelial cells seen by EM

Question 23

Diabetic Glomerulosclerosis

Answer 23

Most prevalent metabolic kidney disease
Hyperglycemia causes thickening of basement membrane
Proteinuria develops later
Prone to bacterial infections

Question 24

End-Stage glomerulopathy

Answer 24

Chronic renal failure from immune, metabolic or circulatory diseases
Kidneys appear shrunken, with fine surface granularity from loss of tubules
Progressive uremia

Question 25

4 most common forms of kidney stones

Answer 25

1. Calcium stones (CaPO4 or Ca oxalate stones = 75%)
2. Struvite stones (magnesium ammonium phosphate (or sulfate) = 15%)
3. Uric acid stones (5%)
4. Cystine stones (1%)

Question 26

Ascending vs descending routes of renal infection

Answer 26

Ascending: bacteria reach the urinary tract through the urethra, more common
Descending: bacteria reach the urinary tract from the blood

Question 27

Acute pyelonephritis

Answer 27

Infection
Kidney looks swollen and pale
Microabsecces may be visible in papillae and cortex

Question 28

Chronic pyeonephritis

Answer 28

May develop from repeated bouts of acute pyelonephritis
Leads to destruction of parenchyma
Kidney becomes small and irregularly scarred

Question 29

Acute cystitis

Answer 29

Congestion and mucosal hemorrhage
In severe cases, mucosa may be ulcerated or covered with pus
Patients present with fever, pain, hematuria, and pyuria

Question 30

3 circulatory disturbances

Answer 30

1. Acute tubular necrosis (sudden decrease in arterial pressure leads to acute hypoperfusion of the kidneys)
2. Nephroangiosclerosis (decreased blood flow due to renal artery atherosclerosis, which leads to glomerulosclerosis)
3. Hypertension