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PC3 > Vol.3-Ch.7 "Urology and Nephrology" > Flashcards

Vol.3-Ch.7 "Urology and Nephrology" Flashcards

1
Q

What are the leading 2 causes of end-stage renal failure?

A
  • Poorly controlled diabetes mellitus (1&2)

- uncontrolled hypertension

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2
Q

What forms in the liver when amino acids are broken down during gluconeogenesis?

How is it removed?

A

Ammonia forms from the break down of amino acids and is highly toxic for body cells, especially the brain.

Liver cells convert it to urea so that the kidneys can safely filter it through them to be excreted via urine.

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3
Q

What are renal calculi?

What is a Benign prostatic hypertrophy and at what rate does it affect men?

A

Renal Calculi = Kidney Stones

Benign Prostatic Hypertrophy = Noncancerous enlargement of the prostate gland (this can obviously cause problems when it blocks off urine flow)

The second one affects 60% of men by 50 and 80% by 80yo

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4
Q

What are the 4 major structures of the urinary system?

A
  • Kidneys
  • Ureters
  • Bladder
  • Urethra
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5
Q

The right and left kidneys lie next to which organs?

A

The Left Kidney is behind the spleen in the upper left quadrant; the Right Kidney is behind the liver in the upper right quadrant

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6
Q

How big are kidneys and how many nephrons are there per kidney (assuming a healthy kidney)

A

They about the size of a fist and contain about 1 million nephrons (the structures that produce urine)

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7
Q

At what age does the natural loss of nephrons begin?

A

About 10% of nephrons per decade after 40yo are lost

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8
Q

What is the overall flow chart of the function of a nephron?

A
  • Blood and chemicals enter through the GLOMERULUS (a collection of capillaries) surrounded by BOWMAN’S CAPSULE (hollow, cup shaped structure that houses the glomerulus and is considered the first structure of the nephron)
  • Next it flows into the PROXIMAL TUBULE and down the DESCENDING LIMB LOOP OF HENLE, next it goes back up the ASCENDING LLoH to the DISTAL TUBULE which then runs into a COLLECTING DUCT that receives what was not wanted for reabsorption (urine)
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9
Q

ANATOMY OF KIDNEY AND NEPHRON ON PG.303/304

REVIEW IT!

A

ANATOMY OF KIDNEY AND NEPHRON ON PG.303/304

REVIEW IT!

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10
Q

What 4 processes does the kidney either directly control or at least houses/takes major role in the process.

A

1) Maintaining blood volume with proper balance of water, electrolytes, and Ph
(Directly controls with formation and excretion of urine)

2) Retaining key compounds such as glucose while excreting wastes such as urea
(Directly controls with formation and excretion of urine)

3) Controls arterial blood pressure (relies on urine formation but also on the renin-angiotensin system)

4) Kidney cells regulate erythrocyte development
(this does not involve urine formation)

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11
Q

What is the first step of urine formation at the nephron level?

A

Filtering blood at the glomerulus; as blood flows through the capillaries of the glomerulus, water and chemicals filter out into the Bowman’s capsule

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12
Q

What is the Glomerular Filtration Rate (GFR)?

A

The rate at which blood is filtered ;

Average is 180 L/day which is about 60 complete passages of blood plasma through the glomerular filters

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13
Q

Filtration is a _____ process where as reabsorption back into the blood and secretion of substances into the renal tubule is a _____ process.

A

Filtration is a NONSELECTIVE process where as reabsorption back into the blood and secretion of substances into the renal tubule is a HIGHLY SELECTIVE process.

(filtration = the filtrate formed at the glomerulus)

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14
Q

Reabsorption and secretion involve _____ _____ which is _____.

A

Reabsorption and secretion involve INTERCEULLULAR TRANSPORT which is the movement of a molecule across a cell membrane to either enter or exit a cell.

(Occurs via simple, facilitated, or active transport)

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15
Q

What is simple diffusion?

What molecules ALWAYS move via simple diffusion?

A

Simple Diffusion (a mode of intercellular transport) is when molecules are small enough to pass through a cell membrane on their own so they come and go across it at random.

USES NO ENERGY (PASSIVE)

Water Molecules are always moving via simple diffusion

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16
Q

What is Osmosis?
Osmolarity?
Hyperosmolar?
Hypo-osmolar?

A

Osmosis is the process in which water molecules move so that the concentration of particles dissolved in water are equivalent on both sides.

Osmolarity is the measurement of that balance

Hyperosmolar = a side with higher concentration (Less water more substance)

Hypo-osmolar = a side with lower concentration or a more diluted concentration (more water less substance)

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17
Q

What is Facilitated Diffusion?

What is an example of this?

A

Facilitated Diffusion (a mode of intercellular transport) is when molecules still move from high to low concentration but now there is a molecule-specific carrier in the membrane that can speed up specific molecules movement across the membrane, like a speed tunnel.

USES NO ENERGY (PASSIVE)

Glucose and Insulin is an example. Once Insulin attaches to a glucose-molecule specific carrier in the membrane, it is able to move across 10x faster. (like a key unlocking a faster tunnel)

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18
Q

What is active transport?

A

Active Transport (a mode of intercellular transport) is the use of energy to drive the action of the molecule-specific carrier in the membrane, which allows for the force of concentration from low to high.

USES ENERGY (ACTIVE)

This mode of transport is very important to the renal system as it allows for the precise balance of specific electrolytes and substances needed by the body

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19
Q

What are the 4 main electrolytes needed to maintain blood volume and ph?

Which one is the major cation of EXTRAcellular fluids and which is the major cation of INTRAcellular fluids?

A

Sodium (Na+), Potassium (k+), Hydrogen (H+), and Chloride (Cl-)

(Remember cations = pos. charge ; anions = neg charge)

Sodium (Na+) is major extracellular cation
Potassium (K+) is the major intracellular cation

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20
Q

Retention and control of _____ is key to maintaining blood volume? (2)

Retention and control of _____ is key to maintaining Ph balance? (3)

A

Retention and control of Na+ and osmotic retention of water is key to maintaining blood volume.

Selective Retention and control of K+ and H+ as well as anions such as Cl- is key to maintaining Ph balance and electrolytes.

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21
Q

What % of Na+, K+, and H20 is reabsorbed in the Proximal Tubule?

A

65%

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22
Q

Specific handling of ____ determines the pH of the venous blood leaving the kidneys and the urine being excreted from the body?

A

H+

More H+ = More acidic

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23
Q

What is the major difference in function between the Descending and Ascending loops of Henle?

A

Descending LLoH is dominated by simple diffusion and reabsorbs roughly another 20% of the water in the filtrate (after 65% already reabsorbed in the proximal tubule)

Ascending LLoH is IMPERMEABLE TO H20, but also has passive and active reabsorption of significant amounts of electrolytes at the same time

24
Q

Glucose and Urea are both _____ filtered through the glomerulus as a free element.

However, they differ in how the kidney handles them, explain how?

A

Glucose and Urea are both FREELY filtered through the glomerulus as an element of filtrate.

Glucose is almost entirely absorbed back into the tubule before it leaves the the proximal tubule up to 180 mg/dL. If the blood glucose goes higher than that, there is not enough active transport processes that can manually cause reabsorption, so the excess is excreted.
(When this happens however, as in Diabetes Mellitus 1,, much water is lost along side the excess glucose b/c of Osmotic Diuresis or the tendency of water to follow the higher concentration)

Urea, is only half absorbed back and passively (instead of active) throughout most of the tubule. It also depends on the Glomerulus Filtration rate, it must be adequate in order for enough to be filtered through and not cause a rise in urea levels

25
Q

What are two tests (1 indirect and 1 direct) that can test for adequate glomerulus filtration rate (GFR)?

A
  • Blood Urea Nitrogen Test (BUN) looks at how much urea there is in the blood. Since it is partially reabsorbed and partially not, it is only an indirect test.
  • Creatinine has larger molecules than urea and therefore will not be reabsorbed at all, and will be completely excreted in urine. B/c of this it is a Direct test for GFR
26
Q

What directly secretes Renin and what is the cascade of events once it is released? What is the resulting effect it has on blood pressure?

A

Juxtaglomerular cells (special cells adjacent to glomerular capillary cells) respond to low blood pressure by releasing the enzyme RENIN.

The LIVER in response to renin release simultaneously starts producing the active hormone ANGIOTENSIN I

ANGIOTENSIN I then flows into the lungs where it is acted upon by ANGIOTENSIN CONVERTING ENZYME (ACE) that turn it into ANGIOTENSIN II the powerful vasoconstrictor that immediately raises arterial blood pressure

ANGIOTENSIN II then acts on both kidney tubule cells and adrenal cells, the latter secreting ALDOSTERONE (it also does like 5 other things, look them up)

ALDOSTERONE then tells the kidney to increase K+ secretion and decrease Na+ secretion, increasing blood volume

Overall it is a system that responds to low blood pressure and causes an INCREASE IN BP

27
Q

The kidneys produce _____ of the body’s Erythropoietin, the hormone that regulates the rate of erythrocyte maturation in the bone marrow.

A

The kidneys produce 90% of the body’s Erythropoietin, the hormone that regulates the rate of erythrocyte maturation in the bone marrow.

28
Q

What is the most anterior organ in the pelvis?

A

The Bladder

29
Q

What is the normal temp of the testes?

A

2-3degrees lower than the abdominal temp

30
Q

Sperm cells pass from the testis into the _____ and from there travel via the _____ through the substance of the prostate gland to its opening into the urethra.

A

Sperm cells pass from the testis into the EPIDIDYMIS and from there travel via the VAS DEFERENS through the substance of the prostate gland (what combines with sperm to become semen) to its opening into the urethra.

31
Q

The prostate is responsible for producing the fluid that combines with sperm to become semen, but how can it become apart of emergency care?

A

Because of it’s placement which surrounds the neck of the bladder and the first part of the urethra, so any enlargement of this can block the flow of urine

32
Q

What are the 2 main types of pain in urologic emergencies?

A

Visceral and referred, which is similar to abdominal emergencies which makes it very hard to differentiate if the pain is coming from an abdominal or urinary tract problem

33
Q

For pts with abdominal pain you never want to give ______ via _____.

Any pt with abdominal pain for ____or more is considered to be _____ until otherwise decided by the hospital.

A

For pts with abdominal pain you never want to give medications via an oral route.

Any pt with abdominal pain for 6 hours or more is considered to be a surgical emergency until otherwise decided by the hospital.

34
Q

What is Oliguria and what is it a sign of?

A

Oliguria is when urine output drops to less than 400-500mL per day.

This can be a sign of Acute Kidney Injury when it takes place over a rapid period of just a few days.

35
Q

What is Anuria?

A

When urine output drops to 0

36
Q

What is Prerenal Acute Kidney Injury?

(Accounts for most AKI 40-80%, and is OFTEN REVERSIBLE by increasing perfusion)

What are 4 causes?

A

It is when the dysfunction of the kidneys is caused by something before the level of the kidney.

This caused by insufficient blood supply to the kidneys which can arise from:

  • Hemorrhage
  • Heart Failure (MI or CHF)
  • Sepsis
  • Shock
  • *The latter effects blood supply either by low blood volume and/or low blood pressure but additionally:
  • direct blood flow can be affected by a thrombosis that increases renal vessel resistance higher than systemic vessels which effectively shunts blood away from the kidneys
37
Q

Normally kidney receive _____% of cardiac output in order to keep the GFR sufficient to filter the blood adequately. What happens when hypoperfusion is prolonged or worsened and the GFR drops?

A

Normally kidney receive 20-25% of cardiac output in order to keep the GFR sufficient to filter the blood adequately.

When hypoperfusion is prolongued or worsened in Prerenal AKI, it drops the GFR to a rate at which the blood is not adequately being filtered and Urea, Creatinine, H+, & K+ levels start rising in the blood causes acidosis. This creates stress on the cardiovascular system and begins lessen even more the perfusion to the kidneys. Eventually the nephrons will become ischemic and even tissue death will occur.

**At this level, we switch from Prerenal AKI to Renal AKI

38
Q

What is Renal AKI and what are the 3 main causes?

A

It is when you have disfunction within the renal parenchyma itself. This can be caused by:

  • Microangiopathy (injury to small blood vessels) and Glomerular capillary damage (both are usually immune mediated, and involve a preexisting immune disease)
  • Acute Tubular Necrosis (tubular cell death) which can be caused either Prerenal (through hypoperfusion) or renal if there is heavy metals, inorganic or organic compounds, or medications being filtered through too much
  • Interstitial Nephritis (chronic inflammation of nephrons) usually caused by toxic compounds and certain drugs
39
Q

What is Postrenal AKI and what causes it?

Least common of the AKIs and is OFTEN REVERSIBLE, by unblocking whatever is decreasing urine output

A

It is dysfunction caused after the kidneys, or blockage of the ureters, bladder, or urethra. Least likely damage will happen if one of the ureters are blocked because there are two, this is most often caused by blockage at the neck of the bladder b/c that is where the prostate sits (in men at least)

40
Q

What is the normal BUN to Creatinine ratio and what does it mean if it is high or low?

A

BUN to Creatinine is usually 20/1

If it is HIGHER it suggests pre or post renal failure

If it is LOWER it suggests renal failure

41
Q

What is the usual management for AKI and/or CKD?

A
  • Maintain ABCs
  • Give O2 for hypoxia (only as much as is needed for adequate Pulse Ox, avoid hyperoxia)
  • Give fluid resuscitation if needed (main goal here is to protect fluid volume and cardiovascular function)
  • BE CAREFUL in giving meds that may be nephrotoxic and if unknown then discontinue meds till you get to hospital
42
Q

What is Chronic Kidney Disease (CKD)?

How much damage to the kidneys must there be for this to be diagnosed?

A

It is inadequate kidney function due to permanent loss of nephrons

Usually there must be 70% (of the normal 1mill) of nephrons lost before significant clinical problems arise and a diagnosis is made.

At 80% however, a person is diagnosed with END-STAGE RENAL FAILURE (ESRF) aka end-staged kidney disease (ESKD) and must either have a transplant or go to dialysis

43
Q

What are the pathological reasons that cause CKD?

A

The same three that cause AKI!

  • Microangiopathy (injury to small blood vessels) and Glomerular capillary damage (both are usually immune mediated, and involve a preexisting immune disease)
  • Acute Tubular Necrosis (tubular cell death) which can be caused either Prerenal (through hypoperfusion) or renal if there is heavy metals, inorganic or organic compounds, or medications being filtered through too much
  • Interstitial Nephritis (chronic inflammation of nephrons) usually caused by toxic compounds and certain drugs
44
Q

With renal AKI and CKD what is the process of compensation and then damage after compensation to the kidneys?

A

It starts out with functional nephrons increasing GFR (by decreasing vascular resistance in the glomerular vessels) and then by increasing the workload of tubular reabsorption and secretion. Over time this damages the nephrons overworking to compensate (it mostly damages the glomerulus) and is visible by a characteristic loss of nephrons (or REDUCED NEPHRON MASS) which makes the kidneys look shrunken and scarred (REDUCED KIDNEY MASS)

45
Q

LOOK AT CHART 7-4 ON PAGE 316 TO SEE EFFECTS OF END-STAGE RENAL FAILURE ON OTHER PARTS OF THE BODY

A

LOOK AT CHART 7-4 ON PAGE 316 TO SEE EFFECTS OF END-STAGE RENAL FAILURE ON OTHER PARTS OF THE BODY

46
Q

What are the 2 forms of dialysis that are used today?

What complications can arise with both?

A

HEMODIALYSIS involves passing blood through a machine that contains a hypo-osmolar solution (called DIALYSATE) and an artificial semipermeable membrane. As blood flows over that semipermeable membrane the higher concentration of urea, creatinine, K+, and H+ flows into the hypo-osmolar solution much like the function of a nephron.

Complications:

  • Bleeding from needle puncture site
  • Local infection
  • Narrowing or closing of fistula (this can be noted by loss of thrill or bruit of the fistula access)

PERITONEAL DYALISIS (AKA Chronic Ambulatory Peritoneal Dialysis - CAPD) is where they place a catheter in the abdomen that introduces and removes the Dialysate (Hypo-osmolar solution) and they use the Peritoneum as a semipermeable membrane instead of an artificial membrane to filter. Where this is a closed system there is also a CHRONIC PERITONEAL LAVAGE in which the dialysate is introduced and allowed to remain for an extended period of time. This obviously requires a HEALTHY PERITONEUM

Complications:

  • infection of catheter
  • infection of abdominal tunnel containing the catheter
  • infection of the peritoneum itself
47
Q

Why is Peritoneal Dialysis sought after over hemodialysis in some cases?

A

Because it reduces the common risk involved with hemodialysis where there is the possibility of physiologically destabilizing shifts in blood volume and composition and arterial blood pressure.

48
Q

Vascular access is required for Hemodialysis in order to achieve blood flow of _____.

What are the two ways that are commonly used to gain arterial and venous access?

A

Vascular access is required for Hemodialysis in order to achieve blood flow of 300-400mL/minute.

  • A superficial, internal fistula is created surgically by anastomosing an artery and vein in the lower forearm (requires a healthy artery and vein at the site)
  • If a healthy artery and vein are not available to merge, surgeons can insert a special vascular graft made of artificial material between and artery and vein.
49
Q

What are some risk factors for kidney stones?

A
  • Being male (mostly 20-30 for calcium stones)
  • specific stone type suggest possible hereditary
  • Immobilization due to surgery
  • Certain meds (anesthetics, opiates, psychotropics)
50
Q

What are 3 types of kidney stones and what are they formed by/from?

A
  • Most common (75-85%) are from CALCIUM salts, usually in males (20-30yo), and hereditary, usually if yo have one you get another in 2-3 years
  • Next most common is STRUVITE Stones (MgNH4PO4) and are commonly caused by UTIs or frequent bladder catheterization. Making them more common in females
  • Least common are URIC ACID stones arise mostly in men especially those with GOUT
51
Q

What are two metabolic disorders that can increase chances of kidney stones (RENCAL CALCULI)

A
  • Gout

- Hyperparathyroidism (remember parathyroid hormone increases calcium levels)

52
Q

What pharmacology can be given for a PT with kidney stones?

A

Pain management

  • morphine
  • fentanyl
  • hydromorphone

Some reports say Ketorolac (Toradol) can be a useful anti-inflammatory

Anti-emetics can be given for nausea and vomiting which is likely

Iv fluid to help formation of urine and passing of stone

53
Q

What is a priapism?

What is the most common cause of nontraumatic priapism?

A

A priapism is a painful and prolonged erection (only affects the Corpora Cavernosa, NOT the Corpora Spongiosum)

This is normally caused by Sickle Cell Disease in which the sickling of erythrocytes prevents normal venous drainage of the penis

54
Q

What is testicular torsion and what makes certain men predisposed to it?

A

It is a twisting of the spermatic cord which cuts off the blood supply. Typically it takes surgery but it can be detorted manually, however something has to happen within 6 hours of onset to salvage the teste. The teste will usually be swollen, and high compare to the other. Severe pain in scrotum and abdomen.

Men with inadequate connective tissue within the scrotum (Bell-Clapper Deformity) are prone to this. Usually it is fixed during the surgery to detort the teste.
This is also common for infants and beginning adolescents.

55
Q

Where can a UTI occur?

What is the major cause of this?

A

A UTI can occur in the Urethra, bladder, kidney, or prostate (for men). Most are caused by colonization of bacteria in the bladder that entered through the urethra, which is why it is more common in women b/c they have a shorter urethra.

Any condition that causes URINARY STASIS puts a pt at high risk for this

56
Q

What are the two broad categories of UTIs?

A

Those of the LOWER UTIs (Urethritis (urethra), Cystitis (bladder), and Prostatitis (prostate gland)):

  • Most often you will see LOWER UTIs having both infection of the urethra AND the bladder. A high percentage is related to sexual activity and urinary stasis

and those of the UPPER UTIs (Pyelonephritis (kidney)):

  • usually involve sexually active and pregnant females who had infections in the lower tracts that were persistent in went upward into the kidney. This can cause INTRARENAL ABSCESSES which if those rupture and spill will cause PERINEPHRIC ABSCESSES.
57
Q

LOOK MORE INTO UTIs ON PG 321

A

LOOK MORE INTO UTIs ON PG 321

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