The Urinary System

Front 1

name the parts of the urinary system.

Back 1

the kidneys, the ureters, bladder, urethra.

Front 2

Name the parts of the kidney.

Back 2

the cortex is the outside peel. the inside is the medulla many pyramid shaped inner parts (full of vessels which pour into the calyces, minor calyces are next to each individual medulla, a major calyce receives fluid from 3 medullas, spills it towards the agan kilya and from there it goes into the shofchan, the nearest of the 2 ureters. each kidney has a vein and artery.

Front 3

what is found inside each of the pyramid shaped medullas?

Back 3

inside each medulla is a glomerulus, a filtering organ with the vessels exiting it. the vessels are curvy while in the cortex. it is straight in the medulla and returns again to the cortex curvy again. all this is the nephron. .

Front 4

what takes place inside the glomerulus?

Back 4

blood vessels enter the glomerulus and do the primary blood filtration. water, salt and solvents which the body wants to be rid of leave the blood vessel into the glomerulus.

Front 5

what never leaves the blood?

Back 5

proteins and large solvents stay. only plasma, water and small solvents exit.

Front 6

what is renal failure? How is it caused?

Back 6

in renal failure, the GFR (glomelular filtration rate) decreases. Renal failure is sometimes caused by high blood pressure which increases kidney activity and causes "kristen" which raises blood pressure further.

Front 7

how is renal failure measured?

Back 7

renal failure is measured clinically by an increase in creatinine and urea in the blood.

Front 8

what are the three kinds of renal failure?

Back 8

CRF, ESRF, and ARF.

Front 9

Describe CRF, how it develops and what are its causes.

Back 9

Crf and is chronic renal failure. it develops slowly and is a result of
1.glomerulonephritis or
2. diabetes or
3. high blood pressure or
4. polycistic kidney or
5. blockage (by kidney stones or tumor) or
6. repetitive infections.
(polly brings in a carafe glowing with sugar and tries repeatedly to pump it but a stone blocks the way)

Front 10

what is ESRF and what is the treatment?

Back 10

ESRF is end stage renal failure and requires dialyisis or kidney transplant.

Front 11

what is ARF how does it develop and what does it require?

Back 11

ARF is acute or 'CHARIFA' in Hebrew and develops rapidly. the kidneys lose their ability to filtrate the blood and create urine. many of these cases require temporary dialysis until the disease is cured.

Front 12

what is UREMIA?

Back 12

Uremia refers to the symptoms of renal failure.

Front 13

What is the general name of diseases which usually are ARF? What are the symptoms? What is usually damaged?

Back 13

Nephritic Syndrome is the general name for diseases of ARF. The symptoms are;
1. the most dominant-Hematurea- blood in the urine
2. proteinuria in an amount of 3 grams per 24 hours maximum.
3. edema in legs and eyes
4.blood pressure increase
In this family of sicknesses, the tiny blood vessels in the glomerulus are damaged and allow passage of particles not normally allowed.
(Princess Nephriti is very cute. She has 4 handmaidens who serve her dinner; Hematuria -red wine, Proteinuria- a tiny piece of meat and she is upset. "what i only get 3 grams in 24 hours?" Her 2 other handmaidens try to comfort her while her eyes swell up and a Dr is called because she turns red.)

Front 14

what is the background of nephritic syndrome?

Back 14

The etiology is often a background of an attack on the kidney from an inflammation caused by;
1. infection
2. auto-immune disease
3. genetic disease
(Princess Nephriti wakes up to find her nose has an infected pimple. She calls the Doctor who notices she keeps hitting herself and can't stop. He asks to see the Queen and notices, so does her mother the queen on her throne.)

Front 15

What is the common cause of inflammation in nephritic syndrome? What does this do to the blood vessels?

Back 15

In most cases, sediment of the immune system, antibodies, immune complexes and other ingredients cause a severe inflammatory reaction. As a result the small blood vessels in the glomerulus are damaged.
(Princess Nephriti's dainty glass ornate shoes are full of sand full of tiny bodies and suddenly light up in flames)

Front 16

What diseases cause nephritic syndrome?

Back 16

1. Berger disease, IgA Nephropathy. Proteins of the type of IgA settle in the kidney blood vessels and cause nephritic syndrome. (Princess Nephriti keeps getting sick from eating burgers with Ira)
2. Post- infectious glomerulo-nephritis shows itself in proteinuria and hematurea between 1-3 wks post infection, more often than not of the type strepA throat infection or empitygo (A week after Princess has strep and a skin rash she calls her royal Doctor)
3. Pauci immune glomerulo-nephritis is caused by inflamed vasiculite small blood vessels due to ANCA antibody sediment and an unknown pathogen. This can quickly turn into nephritic syndrome. (The Princess has a big belly pouch, she has Paul Anca music she is dancing to)
4. Lupus is an auto-immune disease which attacks organs, one of which is the kidneys, and it presents as nephritic syndrome. Since this complication is severe, lupus patients are regularly checked for kidney function and proteinurea. (Lu comes to visit the Princess)

Front 17

What diseases cause nephritic syndrome?

Back 17

1. Princess Nephriti has a cook Ira whose burgers maker her sick. Her throat gets all itchy and she gets upset when she looks in the mirror, she has a rash on her nose. She tries to cheer herself up by dancing to a paul anka music her father does not allow so she hides it in a pouch under her blouse, after he is shocked by seeing eggs and beets falling out of her royal gown, he insists Lu come to give her therapy regularly.

Front 18

What is the difference between nephritic and nephrotic syndrome?

Back 18

Nephrotic syndrome is more severe. It is usually chronic, with a gradual onset. (nephritic syndrome means hematurea, proteinurea up to 3gr per 24hr, eye and leg edema. high blood pressure.)
we find in Nephrotic syndrome;
1.Hematurea
2. proteinurea more than 3.5 in 24 hours a more significant loss
3. and therefore hypoalbuminemia too little protein in the blood, specifically albumin.
4. and therefore high cholesterol
in the same channel and the body tries to raise albumin level is on the same track as the cholesterol which is raised.
5. high blood pressure
6. results in exit of plasma into the tissues which means edema-(Princess Ruti pretends to be her, walks down a red carpet, raises suspicion by demanding 3 and a half eggs she eats them but they fall out of her mouth and she gets all greasy.She turns red and blows up like a tomato.)

Front 19

What diseases cause Nephrotic syndrome?

Back 19

The diseases which cause nephrotic syndrome are;
1. MCD-minimal change disease, mostly -80%- a children's disease which shows minimal or no glomerular difference in biopsy microscope but we can see with electronic microscope.
2. Membranous nephropathy- common in adults, the basal membrane of the glomerulus which helps selective filtratration, thickens from sediments stuck to it. it is distorted and may have holes and is less selective.
3. diabetes as protein loss becomes more massive as it develops.
4. Lupus
5. Amiloisdosis- protein sediment, called amiloid and disturbs filtration.
6. tumors and infectious diseases.
The fake Princess Ruti raises suspicions because she hates changing clothes. Nephriti loves her wardrobe. Someone sees her undress, she has a membrane between her toes with holes in it. In her bed she eats sugary fruit loops and has a conference call with Ami and Lois. She talks to them about the huge frog under her crown.)

Front 20

What areas are damaged in Berger? What may cause it?

Back 20

IgA antibody sediment disturbs by settling in the blood vesicles of the glomerulus. This is encouraged by infection, viral infection, Aids HIV, celiac, liver chirrosis, genetic predisposition,
A burger has a band aid on the bun. Nephriti opens it and inside is candy floss, a rose and liver, huge pimple, ephraim's matzoh and a photo of her mother)

Front 21

What should alert us once it has developed to Berger disease?

Back 21

1. tea colored or brown urine,from the red blood cells in the urine, presents after infection of the upper airways.
2. kidney pain lower back under the ribs,
3. edema in the legs,
4. elevated blood pressure. this must be treated in order to avoid complications.

Front 22

what is the treatment for berger disease?

Back 22

1. steroids to supress ammune respone and the creation of IgA antobodies.
2. treatment of hypertension

Front 23

what is the risk of Berger disease?

Back 23

Berger disease can deteriorate but it can also suddenly disappear in remission. It can become chronic but remain somewhat stable with minimal loss of function.

Front 24

what are the signs of minimal change disease?

Back 24

The MCD presents with some of the symptoms of nephrotic disease, but the protein which is found in the urine is albumin only.
there is usually NO hematurea or high blood pressure, there is some edema which develops over several weeks. There are no holes in smooth podocyte cells yet protein exits because of impaired T-cell function which secrete the material which causes decreased electicity and osmosis.

Front 25

What may the MCD disease indicate in adults? What is the treatment?

Back 25

An adult with MCD may have lymphoma or other malignant disease or be reacting to a drug. the treatment is steroids in order to supress immune reactivity and relax the T cells.

Front 26

What area of the kidney was affected in Berger and MCD?

Back 26

Both are diseases of the glomerulus.

Front 27

Where is the damage of the Interstitial Kidney disease? What are the symptoms?

Back 27

The interstitial tissues between the tsinorot.
1. fever in about 80%
2. rash which disappears upon pressure.
3. joint pain (can be lupus, a systemic disease and not kidney disease)
4. urine and blood with high amount of esinophils
5. edema
6. high blood pressure

Front 28

what causes interstitial kidney disease? what does it cause?

Back 28

caused by
1. drugs like penicillin,
2. infection
3. Lupus-("valchunka" in Russian) can also damage this area (not just the glomerulus as we saw earlier)

Front 29

what is the treatment for IKD?

Back 29

1. cessation of the medicine which caused it.
2. drugs for edema
3. drugs for hypertension
4. steroids

Front 30

what is the prognosis for IKD?

Back 30

it is good relative to other kidney disease. about 30% complication until dialysis, most get better within a few weeks or months.

Front 31

What are the diseases of the tubes?

Back 31

Acute tubular Necrosis, ATN is the most common cause of acute nephritic syndrome. It is caused by;
1. aschemia, not enough blood bringing oxygen and nutrition, after a blockage or accident or low blood pressure or
2. toxins, either exogenic (drugs or toxins from the outside) or endogenic (toxins from inside) (which cause a nephrotoxic condition and destruction of epitheal cells of the nephrotic tubes causing a blockage and inflammation which detroy the structure If the cause if short term this is a reversible condition.

Front 32

What is the treatment for ATN?

Back 32

The treatment for ATN, acute tubular necrosis is;
1. Removal of the toxin exposure
2. Replace lost blood volume with IV for ischemia/
3. Prevental of complications.
4. fusid to lower blood pressure if it is too high and to relieve edema.

Front 33

Exogenic and Indogenic toxins of what sorts?

Back 33

ATN can be caused by exogenic toxins;
1. antibiotics called amino-glycosides - up to 25% can cause ATN
2. anti-fungal AmpB.
3. CT coloring contrast which is given in a drink or in the blood is one of the main causes of ATN, too toxic for some people and shows damage between one and two days after being administered. To decrease risk, much fluid IV should be given before and after contrast is given to dilute its effect.
4. A medicine called ziklosporin an immuno suppressant given to those with kidney disease with too much antibody sediment, in high dosage can make more damage in the kidney, by damaging the nephrotic tubes.

Front 34

What sort of endogenic toxins can be the cause of ATN?

Back 34

Good materials in the wrong places can be toxic.
1. Miaglobin is formed in the muscle for normal activity which as a result of disease or accident may leak from muscles and come into the kidney where it is toxic.
2. Hemoglobin can be toxic when blood cells are destroyed and hemoglobin is free in the blood or urine or kidney.
3. too much Uric acid in the blood, a product of breaking down of cellular breathing and produced normally, can be overproduced and toxic, and may cause either kidney stones or ATN.
4. A protein called Bence Jones is produced in the urine of patients with myeloma is toxic to the tubes and may cause blockage or other complications.

Front 35

What increases the risk of kidney stones?

Back 35

Kidney stone risk is increased by
1. Too much vitamin D
2. bypass surgery of the small intestine.
3. metabollic disturbances
4. exclusive dietary intake of fruit and vegetables, chocolate and walnuts, which are high in oxalt.
5. high uric acid.
6. concentration of urine!

Front 36

What are kidney stones?

Back 36

Kidney stones are when urine is concentrated and calcium forms chrystals alone or with oxalt or phosphate or uric acid, making a salty stone. They may not hurt and cause pain when dislodged towards exit. Drinking much water is recommended and if it does not exit, sound waves or even surgery may be required.

Front 37

What are the clinical symptoms of kidney stones?

Back 37

The clinical symptoms of kidney stones are
1. sharp pain at the hips ('motnayim') under the ribcage which radiates to the lower stomach, comes and goes as the stone moves or settles.
2. pain upon micturation.
3. urine color- pink, red or brown 4. urine strange odor
5. urine -high frequency and amount.
6. nausea and vomitting

Front 38

How is the diagnosis for kidney stones made?

Back 38

Kidney stones can be verified by;
1. blood test showing high amount of calcium or uric acid which can produce a kidney stone.
2. urine test to find blood (stone hurts blood vessels) or chrystals (which form stones).
3. imaging tests can give a final and definite diagnosis are CT, ultrasound showing presence, location and size.

Front 39

What is the treatment for kidney stones?

Back 39

kidney stones require
1.increased drinking of water to dilute them.
2. pain medication
3. medicine to relax the muscles to help the stones exit
4. if the stones are large, voice waves or surgery