Week 11: General kidney anatomy and dz Flashcards
3 layers of the kidney, from outside to inside
- Capsule
- Cortex
- Medulla
Describe where, within the kidney, waste travels to get to the bladder
- Nephrons
- Pyramids
- Minor calyces
- Major calyces
- Renal pelvis
- Ureters
- Bladder
During inspiration, what direction do kidneys move towards
Kidneys move downwards
Around what spine level are the kidneys located
T12-L3
In what 2 ways might pharyngitis affect the kidneys
- IgA nephropathy
2. Post-strep glomerulonephritis
Symptoms of hyper-phosphataemia
- Itch
2. Lethargy
Symptoms of uraemia (aka azotemia)
- N n V
- Pericarditis (chest pain)
- Confusion (uraemic encephalopathy)
- Uraemic flap
- Uremic frost (deposition of urea crystals in skin)
- Tendency to bleed
What does frothy urine indicate?
What sort of conditions is this associated with?
Frothy = heavy proteinuria
eg amyloidosis, nephrotic syndrome
What kidney conditions may cause loin pain
- Kidney stones
- Infection
- Haematuria
- Polycystic kidney disease
- IgA nephropathy
What kidney condition may cause oedema
Nephrotic syndrome (heavy proteinuria causes decrease in oncotic pressure)
Why does uraemia (aka azotemia) cause a tendency to bleed
Urea makes platelets less likely to stick together, so less clot formation
Describe the anatomy of the nephron, starting with the glomerulus and subsequent pathway of filtrate
- Glomerulus
- Proximal convoluted tubule
- Loop of Henle
- Distal convoluted tubule
- Collecting duct
How goes the glomerular basement membrane normally prevent blood proteins from leaking out
Type 4 collagen has a negatively charged coat which repels negatively charged albumin
Which part of the nephron do loop diuretics act on
Ascending loop of Henle
inhibit NaK2Cl co-transporter
Which part of the nephron do thiazide diuretics act on
Distal tubule
inhibit NaCl co-transporter
Where in nephron are glucose and amino acids reabsorbed
Proximal tubule
Where in nephron is water reabsorbed
60-80% in proximal tubule
Remainder in collecting duct
Where in nephron is sodium reabsorbed
60-70% in proximal tubule (Na/K ATPase)
5% in distal tubule (Na/Cl co-transporter)
Some in loop of Henle (Na/K/Cl co-transporter, Na/K ATPase)
2% in collecting duct (aldosterone sensitive Na channels)
Urine dipstick:
Specific gravity increases/ decreases with dehydration
Specific gravity increases with dehydration
Urine dipstick:
Describe the significance of the following types of casts
- Red cell casts
- White cell casts
- Granular casts
- Hyaline casts
- Red cell casts: Glomerulonephritis
- White cell casts: Acute Pyelonephritis
- Granular casts: glomerular/ tubular disease (distintegration of cell debris)
- Hyaline casts: NORMAL (from mycoprotein precipitated in renal tubules)
What drug can cause a false positive for raised creatinine
Trimethoprim
Physiological cause for low serum creatinine
- Pregnancy
2. Elderly with lower muscle mass
What investigation is done when haematuria found on urine dipstick
Do urine culture and microscopy (may be myoglobulin, need to confirm it’s RBC)
2w cancer referral for haematuria
> 45yo +
unexplained visible haematuria (no UTI) OR
visible haematuria that persists after successful treatment of UTI
> 60yo +
unexplained visible haematuria + increased WBC
