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Y2 > Uro > Flashcards

Uro Flashcards

1
Q

What makes up the juxtaglomerular apparatus

A 
Macula densa(DCT): GFR regulation
Extraglomerular mesangial cells
Juxtaglomerular cells(aff arteriole): renin
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2
Q

Healthy GFR

A

Male: 90-140 mL/min
Female: 80-125 mL/min

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3
Q

GFR regulation

A

Myogenic mechanism:
Afferent arteriole reacts to stretching and then constricts

Tubuloglomerular feedback mechanism:
Change in NaCl detected by macula densa
ATP and adenosine discharge
Afferent arteriole constricts/dilates

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4
Q

Renal clearance measurement

A

C=U*V/P mL/min

C=rate of clearance
U=concentration in urine
P=concentration in plasma
V=rate of urine production

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5
Q

What substances are used to measure GFR

A

Inulin: freely filtered,not reabsorbed, not secreted, not toxic

Creatinine: waste product of creatine, freely filtered, not reabsorbed, small amount secreted

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6
Q

Filtration fraction calculation and what substance used

A

FF = GFR/RPF
Usually 0.15-0.20
PAH(para aminohippurate)

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7
Q

What is reabsorbed in PCT

A

Na, HCO3

Glucose

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8
Q

What is reabsorbed in thin descending limb of LoH

A

Water(passive)

Causes tubular fluid to be hyperosmolar

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9
Q

What is reabsorbed in thin ascending limb of LoH

A

NaCl(passive)

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10
Q

What is reabsorbed/secreted in thick ascending limb of LoH

A

NaCl(active) reabsorbed

K is secreted

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11
Q

What is reabsorbed in DCT

A

NaCl

Ca

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12
Q

Types of cells in collecting duct

A

Principal cells(low mitochondria):
Na reabsorption
K secretion
Water reabsorption

Intercalated cell:
Alpha->H secretion, HCO3 reabsorption
Beta->HCO3 secretion, H reabsorption

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13
Q

Effect of AT2 on kidney

A

Na reabsorption in PCT

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14
Q

Effect of aldosterone on kidney

A

Na reabsorption in DCT

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15
Q

Action and effect of ADH

A

Upregulates aquaporin-2(apical), aquaporin-3(basolateral) in CD
Water reabsorption at DCT

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16
Q

Effects of kidney dysfunction

A 
Filtration failure(haematuria,proteinuria)
Hypertension/water retention
Metabolic acidosis
Anaemia
Vit D deficiency->secondary hyperPTH
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17
Q

UTI urine dipstick and signs

A 
Leukocytes ++
Nitrite +
Trace of blood
Suprapubic pain
Fever
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18
Q

Nephritic syndrome urine dipstick and blood test

A

Blood +++
Protein ++
High plasma urea, creatinine

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19
Q

Nephrotic syndrome urine dipstick and signs and blood test

A

Severe proteinuria
Peripheral oedema
Low serum albumin

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20
Q

Diabetic nephropathy signs

A

Microalbuminuria
Proteinuria
Diabetic nephropathy, retinopathy

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21
Q

Urinary tract stones signs and urine dipstick

A

Haematuria
Abdominal pain
Radio-opaque stones on imaging
Possible UTI

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22
Q

Liver disease/gall stones/haemolysis urine dipstick

A

Gall stone: high bilirubin

Haemolysis: high urobilinogen

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23
Q

Regulation of ADH production

A

Osmoreceptors in hypothalamus

Baroreceptors->signals to hypothalamus

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24
Q

Things that stimulate ADH production

A 
High plasma osmolarity
Hypovolaemia
Low bp
Nausea
AT2
Nicotine
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25
Q

Things that inhibit ADH production

A 
Low plasma osmolarity
Hypervolaemia
High bp
Ethanol
Atrial natriuretic peptide
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26
Q

How do kidneys raise blood pH

A

Secrete and excrete H
Reabsorb HCO3
Produce new HCO3

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27
Q

How is HCO3 produced in kidney

A

PCT: glutamine->NH4 which is secreted, A2- which is converted to HCO3 and then absorbed into blood

DCT & CD: alpha intercalated cell has carbonic anhydrase which produces H(secreted) and HCO3(reabsorbed)

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28
Q

How is dietary Na intake regulated

A

Lateral parabrachial nucleus either increases appetite for Na or causes aversion to Na

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29
Q

Normal plasma osmolarity

A

285-295 mosmol/L

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30
Q

Things that increase Na reabsorption

A

Sympathetic activity
AT2
Aldosterone
JGA->renin production

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31
Q

Things that decrease Na reabsorption

A

Atrial natriuretic peptide(ANP)

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32
Q

What regulates aldosterone production

A

AT2

Baroreceptors

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33
Q

Effects of hypoaldosteronism

A

Dizziness, low bp, salt craving, palpitations

High renin, AT2, ADH

34
Q

Effects of hyperaldosteronism

A

High bp, muscle weakness, polyuria, thirst

Low renin, AT2, ADH
High ANP, BNP

35
Q

What is Liddle’s syndrome

A

Aldosterone receptor always activated

High bp from Na retention

36
Q

Where are baroreceptors found and which are high/low pressure

A 
Atria(low)
Right ventricle(low)
Pulmonary vasculature(low)
Carotid sinus(high)
Aortic arch(high)
JGA(high)
37
Q

What is atrial natriuretic peptide(ANP)

A

Released in atria when stretched

Vasodilation
Inhibit Na reabsorption in PCT &CD
Inhibit renin/aldosterone release
Lowers bp

38
Q

Diuretic drugs and where their effects take place

A 
ACEi->PCT
Carbonic anhydrase inhibitors->PCT
Loop diuretics(furosemide)->LoH
Thiazide->DCT
Potassium sparing diuretics(spironolactone)
39
Q

Things that affect K reabsorption in DCT and CD

A

Plasma K levels
Aldosterone
pH
Tubular flow rate

40
Q

Major outcome of CKD

A

Cardiovascular disease

41
Q

Signs of kidney failure

A

Low salt/water excretion->hypertension
Acidosis
Hyperkalaemia

AKI usually hypovolaemia(tubulointerstitial disease)

42
Q

Kidney failure initial management

A

Fluid balance

Treat hyperkalaemia: NaHCO3, diuretics, potassium binders

43
Q

Kidney failure long term management

A

Erythropoietin injections
Vit D
Phosphate binders
Diuretics

Haemodialysis
Peritoneal dialysis

Transplant(avoid transfusion due to sensitisation)

44
Q

Kidney cancer risk factors

A 
Smoking
Hypertension
Obesity
Family history
Kidney disease that needs dialysis
45
Q

Kidney cancer signs and symptoms

A 
Painless haematuria
Microscopic haematuria
Loin pain
Palpable mass
Bone pain/haemoptysis(metastasis)
46
Q

Kidney/bladder cancer investigations

A 
CT urogram
Renal function
Flexible cystoscopy
Ultrasound
CT chest(staging)
Bone scan if symptomatic
47
Q

TNM for RCC(renal cell carcinoma)

A

T1- tumour <7cm
T2- tumour >7cm
T3- extends outside kidney but not beyond adrenal/perinephric fascia
T4- surrounding structures

N1- single regional lymph node
N2- 2 lymph nodes or more

M1- distant metastasis

48
Q

RCC(renal cell carcinoma) management

A

Excision is good standard(partial/radical nephrectomy)
Cryosurgery is small tumour and patient unfit for surgery
Tyrosine kinase inhibitors for metastasis

49
Q

Types of bladder cancer

A

Transitional cell carcinoma(>90%)

Squamous cell carcinoma

50
Q

Bladder cancer risk factors

A

Smoking
Rubber/dye industry
Schistosomiasis(SCC)

51
Q

Bladder cancer signs and symptoms

A 
Painless haematuria
Persistent microscopic haematuria
Suprapubic pain
UTI
Bone pain/lower limb swelling(metastasis)
52
Q

TNM bladder cancer

A 
Ta- noninvasive papillary carcinoma
Tis- carcinoma in situ
T1- subepithelial connective tissue
T2- muscularis propria
T3- perivesical fat
T4- surrounding organs/structures

N1- 1 regional lymph node
N2- >1 regional lymph node
N3- common iliac lymph node

M1- distant metastasis

53
Q

Bladder cancer management

A

Cystoscopy+TURB->histology and can be curative
Non-muscle invasive: TURB&chemo/BCG
Muscle invasive: cystectomy, radiotherapy, palliative treatment, chemotherapy

54
Q

Prostate cancer type of carcinoma and symptomatic/asymptomatic?

A

Usually adenocarcinoma

Usually asymptomatic unless metastatic

55
Q

Prostate cancer risk factors

A

Age
Western country
Ethnicity->African/carribean

56
Q

Prostate cancer investigations

A

Prostate specific antigen(PSA)-> prostate specific but not prostate cancer specific
MRI
Transperineal prostate biopsy

57
Q

TNM prostate cancer

A 
T1- non-palpable, only on imaging
T2a- <1/2 of one side
T2b- >1/2 of one side
T2c- both sides
T3- beyond prostatic capsule
T4- adjacent structure

N1- regional lymph node

M1a- non regional lymph node
M1b- bone
M1x- other sites

58
Q

Gleason score prostate cancer

A

2-6: well differentiated

7: moderately differentiated
8: poorly differentiated

59
Q

Prostate cancer management

A

Young/fit:
High grade->radical prostatectomy/radio
Low grade->active surveillance(PSA,MRI)

Old/unfit:
High grade->hormone therapy
Low-grade->watchful waiting(PSA)

60
Q

Post prostatectomy actions

A

Monitor PSA->undetectable/<0.01ng/mL

If >0.01 -> relapse

61
Q

Prostatectomy side effects

A

Damage to proximal urethral sphincter ->urinary incontinence

Damage to cavernous nerves->ED

62
Q

Infant and adult micturition difference

A

Infant: local spinal reflex->void when high pressure
Adult: higher centre control of external urethral sphincter

63
Q

Micturition innervation

A

M3 receptors stimulated as bladder fills ->detrusor contraction
Parasympathetic->inhibit internal US

After voiding->beta 3 receptors activated ->detrusor relaxation

64
Q

Types of urinary incontinence

A 
Stress
Overactive bladder(urge)
Overflow
Continuous
Functional
65
Q

Stress urinary incontinence symptoms and pathology

A

Involuntary leakage on exertion/cough

Impaired urethral/bladder support and urethral sphincter

66
Q

Stress urinary incontinence risk factors

A

Smoking
Obesity
Age
Pregancy and route of delivery

67
Q

Stress urinary incontinence investigations

A

Stress test->noticeable urine loss

Intrabdominal pressure->urodynamics urinary leakage

68
Q

Stress incontinence management

A

Pelvic floor exercise and physio
Surgical mid urethral sling
Colposuspension
Periurethral bulking agents

69
Q

Urge urinary incontinence symptom and pathology

A

Urinary urgency with frequency and nocturia

Involuntary detrusor contraction

70
Q

Urge urinary incontinence risk factors

A

Age
Obesity
IBS
Bladder irritants(caffeine, nicotine)

71
Q

Urge urinary incontinence investigations

A 
Exclude UTI
Voiding diaries
Assess post void residual
Urodynamics
Cystoscopy
72
Q

urge urinary incontinence management

A 
Bladder retraining
Lifestyle change
Antimuscarinic drugs
Beta 3 agonist
Botox
Neuromodulation
Augmentation cystoplasty+urinary diversion
73
Q

What is overflow incontinence and causes of it

A

Leakage due to chronic retention secondary to obstruction/atonic bladder

Outlet obstruction
Underactive detrusor
Bladder neck stricture
Urethral stricture

74
Q

What is continuous incontinence

A

Continuous urine loss

Vesicovaginal fistula
Ectopic ureter

75
Q

What is functional incontinence

A

Normal bladder function

Cognitive impairment/immobility

76
Q

Risk factors and pathology of benign prostatic hyperplasia(BPH)

A

Age
Hormonal effect of testosterone

Hyperplasia of lobes->compress urethra

77
Q

BPH signs and symptoms

A 
Hesitancy in starting urination
Poor stream
Dribbling post micturition
High frequency, nocturia
Acute retention
78
Q

BPH investigations

A

Exclude prostate cancer, CES, UTI, STI, stones
Urine dipstick, post void residual, diary
PSA
USS for upper urinary tract
Urodynamics
Cystoscopy if suspect cancer

79
Q

BPH management

A 
Weight loss
Reduce caffeine/fluids in evening
Alpha blocker->bladder neck relaxation
5alpha reductase inhibitor
TURP
80
Q

BPH prognosis

A

Bladder distention->chronic painless retention and overflow incontinence
Can cause upper tract obstruction

81
Q

What is released after increased dietary K intake and where does K uptake happen

A

Insulin release

Tissue uptake

82
Q

Urea reabsorption and secretion

A

Reabsorbed by UT-A1(apical) and UT-A3(basolateral) in collecting duct
Urea enters vasa recta by UT-B1
Secreted by UT-A2 in thin descending LoH

Y2 (10 decks)

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