Pathophysiology: Urinary System Disorders

Front 1

Fill in the blanks.
The two kidneys are located behind the _______ (that is, ______) on the _______ _____ wall.

Back 1

peritoneum
retroperitoneally
posterior abdominal

Front 2

The inside of each kidney is called the_____

Back 2

cortex, or outer layer

Front 3

What two structures lie in the medulla? Why are these structures important?

Back 3

renal pelvis and the calyces, through which urine flows into the ureter

Front 4

Define nephron

Back 4

functional units of the kidney

Front 5

What structure does the renal corpuscle contain?

Back 5

the bowmans/glomeular capsule which binds at the end of the proximal convoluted tubule

Front 6

The tubule consist of three parts. Name them.

Back 6

distal convoluted tubule
proximal convoluted tubule
loop of henle

Front 7

What is the role of the kidney tubule?

Back 7

-reabsorption of essential nutrients, water, and electrolytes
-secretion of certain wastes and electrolytes

Front 8

What is the role of the collecting ducts?

Back 8

to transport urine to the renal pelvis

Front 9

What specifically takes place in the proximal convoluted tubule?

Back 9

water is reabsorbed into the blood into the peritubular capillaries along with glucose, nutrients and electrolytes

Front 10

What kinds of transport does the tubules utilize?

Back 10

active transport

Front 11

Explain the transport/tubular maximum

Back 11

If a substance such as glucose is present in excessive amounts in the filtrate, there are insufficient carrier molecules in the tubules tubules for complete reabsorption. Thus, the excess glucose is present in the urine.

*310 mg/min for glucose

Front 12

Glucosuria is an indication of what disorder?

Back 12

-hyperglycemia (high concentration of sugar/glucose in the blood)

-associated with diabetes mellitus (a metabolic disease caused by failure of the pancreas to produce insulin, a hormone that allows glucose to be taken up by cells that require it for function.)

Front 13

Water is reabsorbed by what process?

Back 13

osmosis

Front 14

What is the origin of ADH? What is its role in the reabsorption process?

Back 14

pituitary gland

controls the reabsorption of water by altering the permeability of the DCT and collecting duct

Front 15

Aldosterone is secreted by what structure in the body? What is it's role in the reabsorption process?

Back 15

adrenal cortex

controls sodium reabsorption and water by exchanging sodium ions for potassium or hydrogen ions in the DCT

Front 16

Atrial natriuretic hormone is the third hormone involved in fluid balance and is secreted from what structure?

Back 16

heart

Front 17

Concurrently, the acid-base balance of the blood is maintained by_______

Back 17

removal of excess acids and replacement of buffers (bicarbonate)

Front 18

Secondary damage and progressive destruction of the kidney is exacerbated due to _____

Back 18

scar tissue

Front 19

Large amounts of blood enter and leave the kidney through what structure?

Back 19

hilum- through the renal artery and vein

Front 20

What is the purpose of the dual arterioles? What does it determine?

Back 20

to control the pressure in the glomeular capillaries and the glomeular filtration pressure.

determines the glomeular filtration rate (GPR)

Front 21

The degree of constriction of the arterioles is controlled primarily by what three factors?

Back 21

local autoregulation
SNS
renin-angiotensin mechanism

Front 22

What is the effect of autoregulation on the arterioles?

Back 22

make adjustments in the diameter of the arterioles in response to minor changes in blood flow in the kidney. maintains normal filtration rate

Front 23

What is the effect of SNS on the arterioles?

Back 23

increases vasoconstriction in both arterioles when stimulated

Front 24

What is the effect of renin-angiotensin on the arterioles?

Back 24

renin is secreted by the juxtaglomerular cells in the kidney when blood flow in the afferent arteriole is reduced. Renin acts on the plasma protein angiotensin to produce angiotensin II- a powerful systematic vasoconstrictor

Front 25

What is elevated with renal disease?

Back 25

blood pressure

Front 26

What specifically stimulates the release of aldosterone?

Back 26

angiotensin

Front 27

The renal pelvis, calcyes, ureters, and bladders are lined with what type of epithelium?

Back 27

transitional

Front 28

How long is the female urethra?

Back 28

3-4cm

Front 29

What specifically promotes infection of the bladder in women?

Back 29

The proximity to the vagina and anus

Front 30

How long is the male urethra?

Back 30

20 cm long

Front 31

Term for urination or voiding

Back 31

micturition

Front 32

Term for involuntary urination by a child after age 4-5

Back 32

enuresis

Front 33

Causes of enuresis

Back 33

developmental delay
sleep pattern
psychological aspects

Front 34

Causes of stress incontinence

Back 34

multiple pregnancies
coughing
lifting
laughing

Front 35

Name one cause of overflow incontinence

Back 35

a weakened detrusor muscle preventing a patient from complete emptying of the bladder.

*spinal injury at the sacral level blocks mictrution reflex causing overflow incontinence

Front 36

What is retention?

Back 36

an inability to empty the bladder

Front 37

Catheters can cause what type of problems in the body?

Back 37

infection of the urinary tract
(irritates tissue and introduces bacteria into the bladder)

Front 38

What color is normal urine? What is the normal pH range of urine?

Back 38

clear, and straw colored

4.5-8.0

Front 39

What would a cloudy appearance of the urine indicate?

Back 39

large amounts of protein, blood cells, or bacteria or pus

Front 40

What are urinary casts?

Back 40

microscopic-sized molds of the tubules, consisting of one or more cells, bacteria, protein, etc) indicating an inflammation of the kidney tubule

Front 41

What would an unpleasant or unusual odor of the urine indicate?

Back 41

infection, or result from certain dietary components or medications

Front 42

What does hematuria of the urine (represented by a dark color) indicate?

Back 42

infection, inflammation, or tumors in the digestive tract

Front 43

What does proteinuria in the urine (represented by a cloudy color) indicate?

Back 43

also known as albuminuria- indicates the leakage of albumin or mixed plasma proteins into the filtrate owning to inflammation and increased glomerular permeability

Front 44

What does specific gravity indicate?

Back 44

the ability of the tubules to concentrate the urine

Front 45

What does a low specific gravity (dilute urine) indicate?

Back 45

renal failure

Front 46

When diabetes mellitus is uncontrolled, what two structures are found in the urine?

Back 46

glucose and ketones

Front 47

What does decreased GFR cause?

Back 47

elevated serum urea
(blood urea nitrogen/BUN, and serum creatinine

indicate failure to excrete nitrogen wastes

Front 48

What does metabolic acidosis (decreased serum pH and decreased serum bicarbonate) indicate?

Back 48

decreased GFR and failure of the tubules to control acid-base balance

Front 49

What does anemia (low hemoglobin level) indicate?

Back 49

decreased erythropoietin (a glycoprotein secreted by the kidneys that stimulates the production of red blood cells)secretion and/or bone marrow depression, due to accumulated wastes

Front 50

Clearance tests such as creatinine and insulin clearance asses_______

Back 50

GFR

Front 51

Which type of test visualizes the lower urinary tract and may be used to remove kidney stones?

Back 51

cystoscopy

Front 52

What is the purpose of using diuretics or "water pills"?

Back 52

they remove excess sodium ions and water from the body, thus increasing water secretion through the kidneys and urinary output, reducing fluid volume in the tissues and blood

Front 53

In blood tests, poststreptococcoal glomerulonephritis are diagnosed using what titers?

Back 53

antistreptolysin O (ASO)
antistreptokinase (ASK)

Front 54

What is the point of taking hydrochlorothiazide? List some major side effects.

Back 54

It inhibits the reabsorption of Na+ and water in DCT

-excessive loss of electrolytes causing muscle weakness, and cardiac arrythmias
-loss of potassium

Front 55

When should diuretics be administered? why?

Back 55

in the morning because they often cause urinary frequency for a period of time.

Front 56

Xerostomia (dry mouth) and dental caries are side effects when taking which drug?

Back 56

diuretics

Front 57

What does an ascending infection entail?

Back 57

arising from organisms in the perineal area, traveling along the continuous mucosa in the urinary tract, to the bladder, along the ureters to the kidnet

Front 58

What is the most common causative organism?

Back 58

e-coli

Front 59

Why are women more vulnerable to a UTI infection?

Back 59

because of the shortness and width of the urethra

Front 60

Why may an infection of the prostate or testes be likely to extend to the urinary structures?

Back 60

because the male reproductive tract shares some of the same structures of the urinary tract

Front 61

List some predisposing factors for UTIs in both men and women.

Back 61

incontinence
retention
obstruction to urine flow

*all causing a build up microbes

Front 62

Explain cystitis

Back 62

the bladder wall and urethra are inflamed, red, swollen and even ulcerated. the bladder wall is irritable and bladder capacity is reduced

Front 63

List some signs and symptoms of cystitis

Back 63

-pain in the lower abdomen
-dysuria
-urgency to void immediately
-nocturia (urination at night)
- cloudy urine with unsual odor
-urinalysis indicates bacteriuria

Front 64

List some systematic signs of infection of cystitis

Back 64

-fever
-malaise (psychical discomfort)
-nausea
-leukocytosis

Front 65

Explain pyelonephritis

Back 65

inflammation of the kidney and pelvis, exudate fills the kidney, pelvis, and calcyes and the medulla is inflamed causing abscesses and necrosis

Front 66

List some signs and symptoms of pyelonephritis

Back 66

-dysuria
-pain in the lower back resulting from inflammation that stretches the renal capsule
-urinalysis consist of urinary casts of leukocytes or renal epithelial cells reflecting the involvement of renal tubules

Front 67

List a prophylactic measure used for UTIs

Back 67

cranberry juice

Front 68

What class of microbes are responsible for initiating the immune disorder in the kidney, stemming glomerulonephritits?

Back 68

staphyloccous

Front 69

What does inflammatory response of the kidney cause?

Back 69

increased capillary permeability and cell proliferation, resulting in leakage of proteins and large numbers of erythrocytes into the filitrate

Front 70

What does decreased blood flow in the kidney stimulate? What does it lead to?

Back 70

renin secretion, which leads to elevated blood pressure and edema

Front 71

List some signs and symptoms of glomerulonephritis

Back 71

-dark, cloudy, urine
-facial and periorbitial edema
-elevated blood pressure
-flank back pain
-oliguria

Front 72

What happens in nephrosis?

Back 72

there is an abnormality in the glomeular capillaries and increased permeability allowing large amounts of plasma protein primarily albumin to escape into the filtrate

Front 73

Name a disorder caused by nephrosis

Back 73

hypoalbuminemia with decreased plasma osmotic pressure and generalized edema

Front 74

Name a parodoxical response of nephrosis

Back 74

the associated decreased blood volume increased aldosterone secretion, leading to more severe edema

Front 75

Nephrosis gives rise to high levels of ______ in the blood and _______ in the urine

Back 75

cholesterol
lipoprotein

Front 76

Name the significant sign of nephrosis

Back 76

edema (anasarca) associated with weight gain and pallor

Front 77

List some treatments of nephrosis

Back 77

-glucocorticoids to reduce inflammation of the kidney
-ACE inhibitors to decrease protein loss in the urine

Front 78

Term for kidney stones

Back 78

urolithiasis or calculi

Front 79

What causes kidney stones to form?

Back 79

excessive amounts of insoluble salts in the filtrate or when insufficient fluid intake creates highly concentrated filtrate

Front 80

What are most kidney stones composed of

Back 80

calcium salts (phosphate, oxalate, or carbonate) and uric acid

Front 81

In what environment are calcium stones most readily formed?

Back 81

when the urine is highly alkaline

Front 82

What type of stones are vegetarians most likely to form?

Back 82

calcium oxalate stones

Front 83

Name an significant sign of kidney stones in the body

Back 83

obstruction of the ureter causing an attack of "renal colic"- intense spasms of pain in the flank area radiating into the groin lasting until the kidney passes

Front 84

List some treatments of larger kidney stones

Back 84

ESWL
lithotripsy

Front 85

Where does renal cell carcinoma arise from?

Back 85

tubule epithelium, more often in the renal cortex

Front 86

Two types of carcinomas most readily seen in smokers

Back 86

renal cell carcinoma
bladder cancer

Front 87

Name two paraneoplastic syndromes of renal cell carcinoma

Back 87

-hypercalcemia (increased parathyroid hormone)
-Cushing syndrome (increased adrenocorticotropic hormone)

Front 88

Renal cell carcinoma tends to be silent. What is the eventual treatment?

Back 88

nephrectomy (removal of the kidney)

*5 year survival rate at 50%

Front 89

Where do malignant tumors of the bladder arise from?

Back 89

transitional epithelium lining the bladder in the trigonal area

Front 90

What type of individuals have a higher incidence of bladder cancer?

Back 90

people working with chemicals in labs, particularly with dyes, rubber, and aluminum

Front 91

Explain nephrosclerosis

Back 91

involves vascular changes in the kidneys, causes thickening and hardening of the walls of the arterioles and narrowing or occlusion of lumina in the blood vessels

Front 92

Explain the effects of nephrosclerosis

Back 92

reduce the blood supply to the kidney, causing ischemia and atrophy, also stimulating the secretion of renin which increases blood pressure

Front 93

What causes vesicoureteral reflux?

Back 93

a defective valve in the bladder

Front 94

What is agenesis?

Back 94

developmental failure of one kidney to develop

Front 95

What is hyoplasia?

Back 95

failure to develop to a normal size

Front 96

What is an ectopic kidney?

Back 96

a kidney and its ureter are displaced out of normal position

Front 97

How does one transmit adult Polycystic kidney disease?

Back 97

it is a genetic disorder transmitted as an autosomal dominant gene on chromosome 16

Front 98

When do the first manifestations of adult polycystic kidney disease usually appear?

Back 98

40 years, when chronic renal failure becomes symptomatic

Front 99

Early diagnosis of APK is only possible when_____

Back 99

high blood pressure occurs and is difficult to control or when secondary polycythemia develops due to increased erythropoietin secretion

Front 100

What occurs in APK?

Back 100

Multiple cysts develop in both kidneys expanding over the years, first enlarging and then compressing until chronic renal failure occurs

Front 101

Name the most common tumor that occurs in children

Back 101

Wilm's tumor (nephroblastoma)

*child develops high BP

Front 102

How is wilm's tumor most readily diagnosed?

Back 102

large abdominal mass (often a waistband on clothes does not fasten or a unilateral bulge appears

Front 103

When does acute renal failure occur?

Back 103

both kidneys fail to function

*is reversible

Front 104

What are some causes of ARF?

Back 104

-acute kidney disease
-severe or prolonged shock (burns, crush injuries, sepsis)
-nephrotoxins (NSAIDs, penicillin, sulfa dugs, acetaminophen)
-mechanical obstructions

Front 105

What is the early stage of chronic failure called? How many nephrons are lost? Explain this stage.

Back 105

decreased reserve. 60% nephrons lost

there is a decrease in GFR, serum creatinine levels, no apparent clinical signs.

Front 106

What is the secondary stage of chronic renal failure called? How many nephrons are lost? Explain this stage

Back 106

renal insufficiency, 75% nephrons are lost

Sig. retention of nitrogen wastes (urea and creatnine), tubule function is decreased, excretion of large volumes of dilute urine, decreased RBC, high blood pressure

Front 107

What is the end stage of chronic renal failure called? How many nephrons are lost? Explain this stage

Back 107

Uremia. more than 90% nephrons lost

GFR is negligible, fluid, electolytes, and wastes are retained in the body and all body systems. Marked oliguria and anuria develops

Front 108

Name the key indicators of chronic renal failure

Back 108

-anemia
-azotemia (presence of nitrogen wastes in the blood)
-Acidosis (declines and tubule function is lost)

Front 109

Name some early signs of chronic renal failure

Back 109

-polyuria (assoc. nocturia)
-anorexia, nausea, fatigue
-bone marrow depression and impaired cell function
-high blood pressure

Front 110

Name some uremic designs of chronic renal failure

Back 110

-oliguria
-peripheral neuropathy (abnormal sensations in the lower limbs)
-impotence or menstruation problems
-arrhythmias and CHF
-failure of the kidney to activate vitamin D
-uremic frost on skin
-pneumonia