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What is included in the upper urinary tract?


R. kidney
R. renal pelvis
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Terms in this set (117)

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Select these 2
What is included in the collecting system?
Renal Pelvis
Ureter
Bladder


What is included in the lower urinary tract?
R. Ureter, urinary bladder, and urethra



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Select these 115
What is included in the upper urinary tract?
R. kidney
R. renal pelvis


What are the 5 functions of the kidney?
Eliminate waste
Regulate plasma osmolality
Regulate blood acid-base balance
Adjust blood vol and pressure
Stimulate RBC production


How does the kidney adjust blood volume and pressure?
Via renin


What is the role of juxtaglom?
Sense BP and secrete renin, also senses plasma concentration


What are the three layers of the glomerulus (inside-> out)
Vascular Endothelium
Basement membrane
Visceral epithelial cells


What brings the blood to the kidney and what brings it out?
Afferent- in
Efferent- away


What is bigger (afferent/efferent)?
Afferent


What does the filtrate consist of?
Salt, glucose, waste, amino acids


How much glomerular filtrate is made per day?
180 liters (50 gal. or large garbage bag)


How much of the filtrate is reabsorbed?
178-179 liters- (99%) by renal tubules



How much filtrate is formed as urine per day?
1-2 liters (1%)


How long does it take to filtrate the entire blood volume?
30 mins


How many times/day is plasma cleansed?
50x/day


What are the two ways to measure glomerular filtration rate (GFR)?
Insulin clearance test
Creatine Clearance test


Which of the two is the better measurement?
Creatine Clearance Test


What does low GFR mean?
Kidney failure


What is the function of the tubular processing of the glomerular filtrate?
The tube completely reabsorbs glucose and amino acid-base balance and osmolality by reabsorbing variable amounts of water, electrolytes, and acid.


What pass unaltered into urine?
Toxins; creatine and urea


What is filtration?
From blood into nephron


What is secretion?
From blood into tubule to be urinated out


What is reabsorption?
Back into blood; amino acids, glucose, sodium, potassium, and water


What is excreted?
Toxins, urea, creatine (urine)


What is glycosuria?
If blood glucose concentration is between 180-200 mg % (renal threshold)


What is aminoaciduria?
Occurs if protein concentration is above renal threshold


What are primary waste products in urine as products of protein metabolism?
Urea and creatine


What are typical lab measures to access renal function?
Blood urea nitrogen (BUN)- should be excreted
Creatine


What does the doubling of blood creatine concentration result in?
50% decline in glomerular function


What is never found in urine?
potassium, uria, phosphate


T/F: disease of one renal structure often affects others.
TRUE


What is most primary glomerular disease is caused by?
autoimmune reactions



What is a common cause of kidney disease?
High blood pressure


T/F: Renal tubules are vulnerable to oxygen deprivation.
TRUE


What is commonly found in urine?
Bilirubin- Break down of RBCs
Urobilin- gives urine its yellow-color
Urobilinogen- found in intestine, by-product of bilirubin
Clarity- cloudy means you have cells in urine
Odorless
Specific gravity of 1.0


What is abnormally found in the urine?
Nitrite- from gram neg bacteria
Glucose- blood glucose over 180 causes it in urine
Ketones- burn fat incompletely; diabetics
Casts- crystallized cells clumped together from the kidney (always pathologic)
RBC- renal failure
WBC-infection
Odor- lots of ketones, glucose
High pH(vegetarian)/ low- respiratory failure
Protein- should be reabsorbed in blood
Specific gravity of 1.1 (contains cells; glucose, protein)


What is the normal pH of urine?
4.5-8.0


What does high pH indicate?
Vegetarianism


What does low pH indicate?
Respiratory failure


What does renal failure indicate?
Loss of kidney ability to excrete waste, concentrate urine & conserve electrolytes


Diuresis
Increased urine output


Dysuria
Painful urination



Pyuria
WBC (pus) in urine


Hematuria
RBC in urine


Nocturia
nighttime urination (2X= abnormal)


Oliguria
Less than normal urination


Proteinuria
Protein in urine (not normal)


Glycosuria
Glucose in urine (not normal; Bs> 180mg/dl)


What percent of water is typically reabsorbed?
99%


Azotemia
Renal failure detectable only by lab tests (excess BUN), no S or Sx


Uremia
Excess BUN (lab tests) + renal failure with clinical S and Sx (blood in urine)


Acute nephritic syndrome
Renal failure, autoimmune, high BP, hematuria. Often after strep infection



Nephrotic syndrome
Renal failure with marked proteinuria and edema. Evolves from many glomerular disease


Occult hemturia
Microscopic blood in urine (not visible) could be an early sign of glomerular disease


Nephrolithiasis
Kidney stones (various types)


Acute renal failure
Immediate, oliguria, anuria, azotemia, common cause= acute tubular necrosis


Chronic renal failure
Over time, oliguria, uremia, progresses to end-stage renal disease- tubular interstitial disease


Urinary tract infection
Bacteriuria, pyuria, cystitis


Urinary tract obstruction
acute= prostatitis
Chronic = tumor, scar, stones


Occult proteinuria
Protein in urine, no S and no Sx, fever, UTI, exercise, may precede glomerular disease or renal damage of HTN


T/F: Each syndrome can be caused by a number of different diseases.
TRUE


What are the steps of acute nephritic syndrome?
Autoimmune Glomerular inflammation-> Reactive Glomerular hyperplasia-> Impairs glomerular blood-flow and cannot reach juxtaglomerular apparatus-> Increases renin-> hypertension-> Hematuria (RBCs leak into filtrate) and oliguria (decreased blood flow and GFR)


T/F: Acute nephritic syndrome is always autoimmune.
TRUE- results from acute glomerulonephritis, often following strep throat


Hyperlipidemia
Liver overproduces albumin and apoprotein increasing LDL and albumin


Lipiduria
there is so much lipids they spill into the urine


What does a normal urinary (Bowman) space look like? Abnormal?
Normally filled with clear glomerular filtrate, but when abnormal-contains a large amount of protein-rich fluid, which takes a smooth, red stain


What occurs abnormally in tubules?
Dense red deposits dense material- protein that has condensed into casts, which will be flushed out as a diagnostic clue in the urine sediment


What does -otic or -osis refer to?
Protein loss


T/F: Simple cysts are common.
TRUE


What is adult Polycystic disease?
Autosomal dominant, 10% of chronic renal failure, Sx after 30 years old


What is childhood polycystic disease?
Autosomal recessive, perinatal death or liver cirrhosis (cysts) if one survives


Renal dysplasia
In utero obstruction of urinary outflow (ureter). Increased pressure causes failure of glomeruli to develop, kidney enlarges and tubule become cysts. Squeezing out parenchyma or prevent it from developing


what is a developmental kidney disease?
Horseshoe kidney- abnormal embryogenesis; No clinical consequences


Renal agenesis
1 or both kidneys fail to develop. if one, the other enlarges; if both fail= fatal


What is type 3 glomerulonephritis?
Circulating immune complexes formed elsewhere are deposited on the glomerular basement membrane (GBM)- causes direct damage


What is a type 2 glomerulonephritis?
Antibody attachment (attack) to native antigens on the glomerular basement membrane.


T/F: All primary glomerular disease is autoimmune.
TRUE


Post-streptococcal glomerulonephritis
Autoimmune, presents as acute nephritic syndrome incline hematuria, HTN, incr. BUN and Cr. antigen-antibody deposits in glomerulus


Rapidly progressive glomerulonephritis
Autoimmune, arcs (crescent) of cells (masses) form in Bowman's space and collapse glomerulus


Membranous glomerulonephritis
Autoimmune deposits thicken basement membrane of glomerulus
Immune complexes paint over membrane


Minimal change glomerulonephritis
Glomerular epithelial cells change slightly, seen only with electron microscopy. Less serious, typically children 2-6 y. o.


IgA glomerulonephritis
Antibodies deposit in support (mesangial) cells of glomerulus MOST COMMON glomerulonephritis worldwide


Chronic glomerulonephritis
Long term renal failure or "smoldering" autoimmune state, seen finally as occult protein in urine, fatigue d/t anemia. 50% of patients on renal dialysis carry this diagnosis


Crescentic glomerulonephritis
Crescent of epithelial cells proliferates along the parietal rim of the glomerular space and obliterates the glomerulus
It is an anatomic finding in progressively worsening glomerulonephritis of many types


Secondary glomerular disease
Diabetic glomerulosclerosis- most common cause of renal failure in US


Renal ablation glomerulopathy
Damage to 1/3-1/2 of glomeruli increases workload on other glomeruli and burns out (end-stage contracted kidney)


What are characteristics of a benign nephrosclerosis?
Kidney has shrunken and is granular
-HTN accelerates
-Hyaline arteriosclerosis
-loss of parenchyma, nephrons


What are characteristics of malignant nephrosclerosis?
Very high BP
Hall mark is onionskin hyperplasia or the renal arteriole (>160/110 mmHg)
Renal failure, vascular stress (MI, CHF), increased intracranial pressure (seizure, headache, nausea, vomit, visual impairment)
25% die within 5 yrs


Renovascular hypertension
Increased BP due to renal ischemia (atherosclerosis of renal artery)
Tx- remove effected kidney


What are characteristics of acute tubular necrosis?
Paleness of the renal cortex is caused by tubular epithelium
Pyramids are congested


What is spared during acute tubular necrosis?
Glomeruli and tube epithelial cells re-grow over a few weeks if the basement membrane is still intact


When is there a period of small urine vol?
During the acute phase


When is there a period of large urine vol?
During the recovery phase


What occurs until the cells are mature?
A lack of water reabsorption


What is the common end-result of most renal diseases?
Tubulointerstitial nephritis- interstitium is filled with chronic inflammatory cells (lymphocytes) and fibrosis
Tubules are dilated and filled with protein casts; tubular epithelium is atrophic


What do obstruction and reflux of the kidney encourage?
Infection and contribute directly to hydronephrosis and tubulointerstitial nephritis (damage is not always direct to infection, reflux or ureteral peristalsis, reflux into ureter)


What does the urinary tract health need?
Unobstructed urine flow


What dilates due to obstruction in the lower urinary tract?
Renal pelvis, calyces and ureter


Hydronephrosis
The pelvis and calyces are markedly dilated and the cortex is very thin, reflecting loss of functional tissue (parenchyma is pushed out)


What are characteristics of acute pyelonephritis?
Multiple small abscesses are present. the ureters are normal.


What is most acute pyelonephritis is caused by ?
Ascending infection by Escherichia coli and other fecal bacteria that ascend to the kidney from the bladder- common in females due to a short uethra


What are symptoms of acute pyelonephritis?
Pain and fever, neutrophilia, pyuria, cystitis, dysuria, possible sepsis


What are characteristics associated with chronic pyelonephritis and a UTI?
The presence or absence of bacteria in the urine (NOT helpful in diagnosis)
Often associated with obstruction or reflux
Could be asymptomatic for a while
Symptoms of repeated episodes of fever
Responsible for about 10% of patients on chronic dialysis
A major cause is renal failure


What do urinary stones often present with?
urinary bleeding (hematuria) or flank pain (renal colic)


What are calcium stones (affect 75%)
Occur in people with high urinary calcium. Blood calcium is normal
Others have high blood calcium (hyperparathyroidism- breakdown of bone for calcium)


What are infection stones (15%)?
Bacteria change pH to alkaline precipitating a magnesium stone


What are uric acid stones (5%)?
Often big toe
25% of patients with gout- form kidney stone


Staghorn calcus
Large stone in renal pelvis that cannot pass, will remain in renal pelvis & mold into the shape of the calyces


When kidney tumors are malignant, what is the treatment of choice?
Nephrectomy


What are the two most important malignancies of the kidney?
Renal cell carcinoma, tubular epithelium
Transitional cell carcinoma, pelvis


What is renal cell carcinoma?
90% of malignancies; 5yr survival rate: 50% if malignant, 75% if non-metastatic, 15% if renal vein is invaded, 1/3 linked to tobacco use


What is transitional cell carcinoma?
10% of malignancies; 5 yr survival rate= 66%


What occurs during renal cell carcinoma?
Renal vein and vena cava are filled with invasive tumor
-poor 5 yr survival rate (15%)
Can potentially extend into inferior vena cava, metastasizing to lung or bone


What are common signs & symptoms of renal disease?
Aminoaciduria
Anuria
Bacteriuria
Diuresis
Dysuria
Hemturia
Hemoglobinuria
Lipiduria
Nocturia
Oliguria
Polyuria
Proteinuria
Pyuria


What are common syndromes of renal disease?
Acute nephritic syndrome
Acute Renal failure
Chronic Renal failure
Nephrotic syndrome
Nephrolithiasis
Occult Hematuria
Occult Proteinuria
Uremia
Urinary Tract Infection
Urinary Tract Obstruction


What is renal failure?
Loss of the ability of the kidneys to excrete waste, concentrate urine, and conserve electrolytes


T/F: Renal diseases may appear first as one syndrome and evolve into another syndrome as the disease progresses.
TRUE; Acute nephritic syndrome may evolve into acute renal failure, which in turn may lead to uremia