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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
Things that inhibit ADH production
``` Low plasma osmolarity Hypervolaemia High bp Ethanol Atrial natriuretic peptide ```
26
How do kidneys raise blood pH
Secrete and excrete H Reabsorb HCO3 Produce new HCO3
27
How is HCO3 produced in kidney
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)
28
How is dietary Na intake regulated
Lateral parabrachial nucleus either increases appetite for Na or causes aversion to Na
29
Normal plasma osmolarity
285-295 mosmol/L
30
Things that increase Na reabsorption
Sympathetic activity AT2 Aldosterone JGA->renin production
31
Things that decrease Na reabsorption
Atrial natriuretic peptide(ANP)
32
What regulates aldosterone production
AT2 | Baroreceptors
33
Effects of hypoaldosteronism
Dizziness, low bp, salt craving, palpitations High renin, AT2, ADH
34
Effects of hyperaldosteronism
High bp, muscle weakness, polyuria, thirst Low renin, AT2, ADH High ANP, BNP
35
What is Liddle’s syndrome
Aldosterone receptor always activated High bp from Na retention
36
Where are baroreceptors found and which are high/low pressure
``` Atria(low) Right ventricle(low) Pulmonary vasculature(low) Carotid sinus(high) Aortic arch(high) JGA(high) ```
37
What is atrial natriuretic peptide(ANP)
Released in atria when stretched Vasodilation Inhibit Na reabsorption in PCT &CD Inhibit renin/aldosterone release Lowers bp
38
Diuretic drugs and where their effects take place
``` ACEi->PCT Carbonic anhydrase inhibitors->PCT Loop diuretics(furosemide)->LoH Thiazide->DCT Potassium sparing diuretics(spironolactone) ```
39
Things that affect K reabsorption in DCT and CD
Plasma K levels Aldosterone pH Tubular flow rate
40
Major outcome of CKD
Cardiovascular disease
41
Signs of kidney failure
Low salt/water excretion->hypertension Acidosis Hyperkalaemia AKI usually hypovolaemia(tubulointerstitial disease)
42
Kidney failure initial management
Fluid balance | Treat hyperkalaemia: NaHCO3, diuretics, potassium binders
43
Kidney failure long term management
Erythropoietin injections Vit D Phosphate binders Diuretics Haemodialysis Peritoneal dialysis Transplant(avoid transfusion due to sensitisation)
44
Kidney cancer risk factors
``` Smoking Hypertension Obesity Family history Kidney disease that needs dialysis ```
45
Kidney cancer signs and symptoms
``` Painless haematuria Microscopic haematuria Loin pain Palpable mass Bone pain/haemoptysis(metastasis) ```
46
Kidney/bladder cancer investigations
``` CT urogram Renal function Flexible cystoscopy Ultrasound CT chest(staging) Bone scan if symptomatic ```
47
TNM for RCC(renal cell carcinoma)
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
RCC(renal cell carcinoma) management
Excision is good standard(partial/radical nephrectomy) Cryosurgery is small tumour and patient unfit for surgery Tyrosine kinase inhibitors for metastasis
49
Types of bladder cancer
Transitional cell carcinoma(>90%) | Squamous cell carcinoma
50
Bladder cancer risk factors
Smoking Rubber/dye industry Schistosomiasis(SCC)
51
Bladder cancer signs and symptoms
``` Painless haematuria Persistent microscopic haematuria Suprapubic pain UTI Bone pain/lower limb swelling(metastasis) ```
52
TNM bladder cancer
``` 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
Bladder cancer management
Cystoscopy+TURB->histology and can be curative Non-muscle invasive: TURB&chemo/BCG Muscle invasive: cystectomy, radiotherapy, palliative treatment, chemotherapy
54
Prostate cancer type of carcinoma and symptomatic/asymptomatic?
Usually adenocarcinoma | Usually asymptomatic unless metastatic
55
Prostate cancer risk factors
Age Western country Ethnicity->African/carribean
56
Prostate cancer investigations
Prostate specific antigen(PSA)-> prostate specific but not prostate cancer specific MRI Transperineal prostate biopsy
57
TNM prostate cancer
``` 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
Gleason score prostate cancer
2-6: well differentiated 7: moderately differentiated 8: poorly differentiated
59
Prostate cancer management
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
Post prostatectomy actions
Monitor PSA->undetectable/<0.01ng/mL | If >0.01 -> relapse
61
Prostatectomy side effects
Damage to proximal urethral sphincter ->urinary incontinence | Damage to cavernous nerves->ED
62
Infant and adult micturition difference
Infant: local spinal reflex->void when high pressure Adult: higher centre control of external urethral sphincter
63
Micturition innervation
M3 receptors stimulated as bladder fills ->detrusor contraction Parasympathetic->inhibit internal US After voiding->beta 3 receptors activated ->detrusor relaxation
64
Types of urinary incontinence
``` Stress Overactive bladder(urge) Overflow Continuous Functional ```
65
Stress urinary incontinence symptoms and pathology
Involuntary leakage on exertion/cough Impaired urethral/bladder support and urethral sphincter
66
Stress urinary incontinence risk factors
Smoking Obesity Age Pregancy and route of delivery
67
Stress urinary incontinence investigations
Stress test->noticeable urine loss | Intrabdominal pressure->urodynamics urinary leakage
68
Stress incontinence management
Pelvic floor exercise and physio Surgical mid urethral sling Colposuspension Periurethral bulking agents
69
Urge urinary incontinence symptom and pathology
Urinary urgency with frequency and nocturia Involuntary detrusor contraction
70
Urge urinary incontinence risk factors
Age Obesity IBS Bladder irritants(caffeine, nicotine)
71
Urge urinary incontinence investigations
``` Exclude UTI Voiding diaries Assess post void residual Urodynamics Cystoscopy ```
72
urge urinary incontinence management
``` Bladder retraining Lifestyle change Antimuscarinic drugs Beta 3 agonist Botox Neuromodulation Augmentation cystoplasty+urinary diversion ```
73
What is overflow incontinence and causes of it
Leakage due to chronic retention secondary to obstruction/atonic bladder Outlet obstruction Underactive detrusor Bladder neck stricture Urethral stricture
74
What is continuous incontinence
Continuous urine loss Vesicovaginal fistula Ectopic ureter
75
What is functional incontinence
Normal bladder function | Cognitive impairment/immobility
76
Risk factors and pathology of benign prostatic hyperplasia(BPH)
Age Hormonal effect of testosterone Hyperplasia of lobes->compress urethra
77
BPH signs and symptoms
``` Hesitancy in starting urination Poor stream Dribbling post micturition High frequency, nocturia Acute retention ```
78
BPH investigations
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
BPH management
``` Weight loss Reduce caffeine/fluids in evening Alpha blocker->bladder neck relaxation 5alpha reductase inhibitor TURP ```
80
BPH prognosis
Bladder distention->chronic painless retention and overflow incontinence Can cause upper tract obstruction
81
What is released after increased dietary K intake and where does K uptake happen
Insulin release | Tissue uptake
82
Urea reabsorption and secretion
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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