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104 Cards in this Set
- Front
- Back
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What is the primary contributor of the lower urinary tract and male genital system
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mesonephros (mesonephric duct)
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what arises from the mesonephric duct
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ureteric bud
trigone of the bladder vas deferens seminal vesicles |
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what induces the metanephros to differentiate
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ureteric bud
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what gives rise to nephrons (glomeruli and tubules)
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metanephros
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what develops from the ureteric bud
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ureter
renal pelvis calyces collecting ducts |
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what happens if the ureteric bud does not develop normally
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renal agensis
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why is bilateral renal agensis incompatible with life
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fetal kidney are the main source of amniotic fluid - oligohydramnios sequence
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what two problems can arise from ureteral duplication
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reflux
obstruction |
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dilated renal pelvis and calyces
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hydronephrosis
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common site of ureteral obstruction
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junction of the ureter and pelvis - UPJ obstruction
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result in obstruction in the bladder neck in fetal life with bilateral hydroureter and hydronephrosis
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ureteral valves
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what is exstrophy of the bladder associated with
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epispadias
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what two types of cancers can develop from exstrophy of the bladder
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squamous carcinoma
adenocarcinoma *not transitional because of chronic irritation cause dysplasia |
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what normally closes producing the medial umbilical ligament
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urachas
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what causes urine to leak onto the abdominal wall through the umbilical stump
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patent urachus
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urethera fails to close on the upper surface
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epispadias
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a groove on the under side of the penis
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hypospadias
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most common cause of congenital uretheral obstruction occuring exclusively in males just below the bladder neck
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posterior uretheral valves
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why does renal dysplasia develop
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obstruction of urine flow during fetal life
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most frequent cause of an abdominal mass in newborns
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unilateral cystic dysplasia
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how does cystic dysplasia differ from polycystic kidney disease
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patients with polycystic kidney disease have normal renal histology except for the cysts
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what is the problem with unilateral hydronephrosis
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more susceptible to infection, may obstruct other organs if big enough
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why is bilateral renal agenesis not a problem in utero
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because the mother's kidneys compensate for baby's lack of function
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what is the major source of amniotic fluid
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fetal urine
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oligohydramnios sequence
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pulmonary hypoplasia
potter facies limb deformations |
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what do fetuses die of with bilateral renal agenesis
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respiratory distress before renal failure can occur
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maldevelopment of the kidney parenchyma at the tissue level which results in abnormal microscopic structure and poor function
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renal dysplasia
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progressive hereditary disorder of the kidney parenchyma, characterized by renal enlargement due to cyst formation
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polycystic kidney disease
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characteristics of infantile PKD
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autosomal recessive
huge kidneys at birth oligohydramnios cysts are small and confined to collecting ducts |
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characteristics of adult PKD
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autosomal dominant
PKD1 mutation on Ch 16 normal kidneys at birth cysts involve in small percentage (1-2%) of nephrons cysts can occur anywhere in nephron |
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15% adult PKD associated with
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berry aneurysms
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bilateral flank masses
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PKD
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most common inherited disorder leading to renal failure in adults
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PKD
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why are ureters subject to compression with an increased risk of infection in horshoe kidneys
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because the ureters face anteriorly and are compressed by viscera due inability to rotate properly
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cause of oligohydramnios sequence
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failure to produce urine in utero because of renal agenesis or urinary tract obstruction
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common cause of hyperureter in elderly men
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prostatic hyperplasia
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results from chronic urinary tract obstruction in utero
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renal dysplasia
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most most common route of a UTI
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ascending infection
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risk factors for urethra infection
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If the perinium becomes colonized by enteric organisms (most commonly E. coli) the urethre may also become colonized
female urethra catheterization or other instrumentation |
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risk factors for bladder infection
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urinary stasis or obstructive uropathy
pregnancy prostatic hypertrophy neurogenic bladder diabetes (glucose in urine) foreign body |
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risk factors for ureter and renal pelvis infection
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vesicoureteral reflux
congenital anomalies (especially in young boy with UTI) prlonged urinary/bladder obstruction |
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The possibility that a defect of compromise of normal urinary tract defenses are present in the presence of a UTI in a young male
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**
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tends to produce abscess and infecting organism differ such as: staphylococcus, aspergillus, and TB
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hematogenous infection of the kidney
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most likely causes of UTI in the following:
newborn (most often boys) pre-school girls sexually active females pregnant peri-and postmenopausal female middle-age and elderly male |
newborn - congenital malformation such as urethral valves
pre-school girl - wiping back to front sexually active female - irritation of urethra due transport of coliform bacteria from perineum pregnant - smooth muscle relaxation and urinary stasis peri-post menopausal female - pelvic relaxation middle-aged elderly male - prostatic hyperplasia |
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symptoms associated with acute cystitis
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frequency
urgency dysuria |
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most frequent organism associated with acute cystitis
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coliforms: E. coli, Proteus, Pseudomonas, Enterobacter
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laboratory diagnosis of cystitis
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>10^5 colonies/mL of single, pathogenic organism
red cells and leukocytes in the urine |
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differentiate ascending and hematogenous infection in acute pyelonephritis
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ascending - columns of pus cells in the medulla (tubules and collecting ducts) secondary to gram-negative bacteria
hematogenous - cortical abscesses from seeding of the kidney by bacteria such as S. aureus, GBS, Candida, Aspergillus |
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characteristics of acute pyelonephritis
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septicemia, back pain, and costovertebral tenderness
diagnosed by cellular casts in the urinary sediment severe cases can result in irreversible renal destruction and 1.010 urine |
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characteristics of chronic pyelonephritis
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chronic inflammation leads to tubular atrophy (thyroidization with dilated tubule)
U-shaped scares because of inflammatory damage eventually lead to renal failure |
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Michaelis-Gutmann bodies
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histiocytes containing inclusions of incompletely digested bacteria
associated with malakoplakia and primarily affects the bladder |
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Hunner Ulcer
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Chronic Interstitial Cystitis
transmural inflammation of bladder with chronic pelvic pain |
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polypoid mass of inflammatory tissue that occurs near the female urethral meatus
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Urethral Caruncle
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most common cause of acute renal failure
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acute tubular necrosis
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two leading causes of ATN
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ischemia
toxic or drug related |
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characteristics of ischemic ATN
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due to rapid decrease in blood flow or oxygen delivery to the kidneys
sloughing of some epithelial cells into the tubular lumen generally not confined to specific segments of the nephron |
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characteristics of toxic ATN
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ATN confined to specific segments of the nephron
associated with: aminoglycosides, heavy metals (Hg), anticancer agents, and ethylene glycol poisoning |
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associated with accumulation of calcium oxalate which obstructs renal tubules
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ethylene glycol poisoning (antifreeze)
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factors that contribute to renal failure in ATN
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intrarenal vasoconstriction and diversion of blood from the cortex to the medulla
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morphology of ATN
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necrosis of tubular cells involving the proximal segments leading to sloughing of tubular cells with protein leaking produing granular tubular casts
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clinical phases of ATN
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onset - renal function is normal and begins to deteriorate within one week
anuric phase - urine production decreases of stops and lasts for 10-12 days early diuretic phase - glomerular filtrate unmodified and urine resembles plasma (1.010) lasts about 12-14 days late diuretic phase - graduate return of concentration function over a period of weeks to months |
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characteristics of renal cortical necrosis
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confluent necrosis of the renal cortex (tubules and glomeruli) with sparing of the medulla
most commonly due to septic or endotoxic shock |
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acute interstitial nephritis
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most cases are hypersensitivity reaction to a drug:
NSAIDs, synthetic penicillins, cephalosporins, duretics) kidney interstitium infiltrated by lymphocytes and eosinophils |
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most common cause of analgesic nephropathy
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analgesics (phenacetin)
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associated with papillary necrosis
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analgesic nephropathy
diabetes pyelonephritis hydronephrosis sickle cell anemia |
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predisposing factor for nephrocalcinosis (calcium phosphate in renal tubules)
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hypercalcemia:
primary hyperparathyroidism osteolytic bone tumor vitamin D excess |
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most common type of kidney stone
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Calcium stone:
calcium phosphate calcium oxalate |
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common causes of urate nephropathy and uric acid stones
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gout
rapid cell killing due to cancer chemotherapy (loads of purine) metabolic or renal disorders interfering with excretion of uric acid |
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type of stone that is not visible on X-ray
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pure uric acid stones
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what type of bacteria are associated with alkaline urinary pH and the triple stone
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proteus or providencia
magnesium ammonium phosphate |
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rare inborn error of metabolism that is an important cause of urolithiasis in children
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cystinosis
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renovascular occlusion associated with adult females
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fibromuscular dysplasia
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V-shaped depressions in the kidney surface
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localized renal infarcts
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Goldblatt Kidney
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hypertension produced by gradual narrowing of one renal artery
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most common cause of renovascular hypertension
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atherosclerotic renal artery stenosis
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morphology of benign nephroslerosis
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intimal fibrosis of arteries and medial hypertrophy with hyalinization of afferent arterior of glomerulus
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benign nephrosclerosis
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renal vascular and glomerular sclerosis caused by systemic hypertension
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characteristics of malignant nephrosclerosis
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associated with severe hypertension
history of preceding benign hypertension in half of patients oozing of plasma components into the wall resulting in fibrinoid necrosis and intimal edema associated with papilledema and renal insufficiency |
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loss of functioning renal parenchyma due to progressive loss of injured blood vessels by scarring or thrombosis
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vasculitis
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associated with small vessel vasculitis
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Henoch-Schonlein purpura
Wegener's granulomatosis anti-GBM disease |
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associated with medium vessel vasculitis
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polyarteritis nodosa
Kawasaki disease |
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associated with large vessel vasculitis
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giant cell arteritis
Takayasu arteritis |
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what may be related to urethral caruncle
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urethral prolapse
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comprises the vast majority of carcinomas of the renal pelvis, ureter, and bladder
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transitional cell carcinoma
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where are 95% of TCC
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bladder
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etiological risk factors for developing TCC
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smoking
aniline dyes cyclophosphamide phenacetin schistosomiasis radiation therapy |
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hamartoma associated with tuberous sclerosis in the kidney
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angiomyolipoma
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an embryonal tumor of chilhood
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wilms tumor (nephroblastoma)
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where do wilm tumor arise from
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nephrogenic rests - persistent islands of embryonic cells
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familial wilms tumor
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tranmission is dominant, however penetrance is low (1%)
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the most common kidney cancer is adults
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clear cell renal cell carcinoma
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risk factors for developing RCC
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tobacco
phenatcetin inherited and acquired cystic disease |
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virtually all cases of sporadic clear cell RCC demonstrate what
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loss of one allele of the VHL gene
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most important prognostic indicator for RCC
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tumor stage
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classic triad of RCC
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flank pain
hematuria palpable mass |
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why can RCC mimic other medical conditions
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paraneoplastic phenomena:
hypertension - renin hypercalcemia - PTH polycythemia - EPO |
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where does RCC most commonly metastasize
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lung and bone
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characteristics of RCC
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located in the PCT
associated with 3p deletion of the VHL gene Cyst formation - can be confused with benign simple cyst |
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differentiate low and high grade TCC
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low grade - exophytic, papillary folds that grow into the urinary lumen with normal appearing epithelium
high grade - solid, flat plaques with ulceration and pleomorphic, enlarged nuclei |
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high-grade nuclear atypia with flat urothelium that does NOT invade
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TCC in situ
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what is a patient at high risk with TCC in situ
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development of invasive cancer
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associated with schistomiasis and bladder extrophy
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squamous cell carcinoma
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most common type of bladder malignancy in patients with bladder exstrophy
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adenocarcinoma
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botryoid tumor
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rhabdomyosarcoma in young children of the bladder and vagina
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