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Flashcards in Urinary Deck (64):
1

Course of ureters

cross pelvic brim at bifurcation of common iliac. Runs along lateral pelvic wall. Turns obliquely at level of ischial spine and ends bladder posteriolaterally

2

renal blood supply

renal to 3x segmental to interlobar to arcuate to interlobular to afferent

3

where is bladder anatomically

posterior to pubic symphysis

4

how does horseshoe kidney occur

kidneys ascend in development and can fuse and get stuck on IMA

5

what is patent urachus

urine from umbilicus

6

what is a common fistula of the bladder

exstrophy of bladder through abdo wall

7

give anatomy of kidney

see book
capsule, renal column and pyramid, minor calyx, cortex, renal pelvis

8

histo of PCT, thin AL, thick AL, DCT

PCT - cuboidal with brush border
thin AL - simple squamous
thick AL - cuboidal
DCT - cuboidal, larger lumen than PCT

9

bladder histology

urothelium, LP, 3x SM, adventitia

10

transporters in PCT

apical - NaH antiporter, SGLT1, AA vit symporters, Anion/cation exchangers
basolateral - NaKATPase

11

Ascending loop transports

apical - NaKCl, ROMK (to lumen)
basolateral - NaKATPase

12

DCT transporters

apical - NaCl symporter. Ca diffusion (PTH activated)
basolateral - NaKATPase

13

principal CD and intercalated CD

principal - ENaC, AQP2
intercalaed - reabsorb Cl, secrete H+

14

function of macula densa and location

lines thick AL. increase NaCl = constriction of afferent by adenosine. Decrease NaCl = dilate afferent by prostaglandin. NaCl detected by NaKCl

15

how measure GFR and RPF

GFR - inulin
PFR - PAH

16

what 4 mechanisms can be used to influence NaCl reabsorption

RAAS, sympathetic stimulation, ADH, Atrial natriuretic peptide (increase GFR and therefore increase excretion of Na)

17

how RAAS works and effects

juxtaglomerular cells reelase renin in response to - decrease Na reaching macula densa, or sympathetic, or decrease perfusion pressure by baroreceptors
Renin converts AG1 to AG2 which increase aldosterone which; increases ENaC, constricts afferent and efferent arterioles, increase NHX, increase thirst via ADH, decrease bradykinin

18

When and whereis ADH release

decreased pressure (by baroreceptors) or increased osmolarity.
detected by osmoreceptors in OVLT of hypothalamus but released by post pit

19

effects of ADH

increase AQP2 in CD and increase NaKCl

20

what is mild, moderate and severe HT

mild - 140-160 / 90-99
+20/10

21

causes of secondary hypertension

NSAIDs, CKD, cushings

22

what is symptoms and pathology of syndrome of inappropriate ADH. treaat?

increase ADH leads to increase BP. Retention of water but not solute results in hyponatremia which leads to N&V, lethargy, seizures
treat with ADH receptor anatgonists

23

how is corticopapillary osmotic gradient made?

inner medulla has higher osmolarity than cortex or outer medulla
1) ascending limb impermeable to water and therefore solutes enter medulla. filtrate hypotonic
2) descending limb impermeable to salts and therefore water enters medulle. filtrate hypertonic.
3) vasa recta absorbs salt and water.

24

where is calcium reabsorbed

10% in DCT under PTh. rest in PCT and LoH

25

causes, symptoms and treat of hypercalcaemia

causes - PT tumour, malignancy making PTrH
symptoms - stones, bones (bone pain), groans (lethargy), moans (abdo pain), thrones (polyuria polydipsia), psychiactric overtones (depression)
treat - loop diuretics (increase ca excretion). treat underlying

26

calcium stones risk factors

decreased urine, hypercalcaemia, high oxalate consumption

27

renal stones symptoms

haematuria, pain colic

28

how test for uti

urine dipstick increase nitrates and leukocytes esterases

29

actiosns of loop, thiazide and K sparing diuretics and eg

loop - NaKCl. decresae Ca reabsorb. e.g. furosemide
thiazide - NaCl. increase ca reabsorb. e.g. bendroflumethiazide
K sparing:
1) ENaC blockers - e.g. amiloride
2) aldost antag - e.g. spironolactone

30

what diuretic for HF, liver failure, HT, conns?

conns - aldost antag
HF - loop e.g. furosemide
liver failure - aldost antag and loop
HT - thiazide e.g. bendroflumethiazide

31

pathology and causes of conns

increased aldosterone leads to increase Bp and hypokalaemia. Vision, headaches, strokes, MI, AKI
cause - adrenal adenoma, adrenal hyperplasia

32

thiazide ADRs

hypokalaemia, hypercalcaemia, hyperuricaemia, ED

33

aldost antag ADRs

hyperkalaemia, gyno

34

all diuretics ADRs

hyponatremia, hypovolemia, anaphylaxis

35

acidic and alkalemic symptoms

acidic - hyperkalaemia, arrhythmia, decrease hepatic function
alkalemia - tetany, parasthesia, death

36

how is hydrogen buffered in urine

phosphate and ammonia.

37

how hyper and hypokalemia affects ph?

hyper is acidosis
hypo is alkalosis

38

effects of aldosterone on K. How doe K stimulate aldosterone release

increases K excretion
high K in plasma stimulates aldosterone release

39

what is internal and external balance of K

internal - in and outof cells
external - kidneys

40

K shift into cells

alkalosis via KHX, exercise, insulin, aldosterone, increase K ecf

41

K shift out of cells

acidosis, decrease K ECF, trauma, plasma hyperosmolarity

42

causes of hypokalaemia

alkalosis, vomiting, diarrhoea, diuretics, conns

43

symptoms, ECG and treat hypokalaemia

symptoms - paralytic ileus, muscular weakness, CD dysfunction
ECG - shallow T wave to prominent U wave to ST depression
treat - oral/IV K, K sparing diuretic

44

hyper Kalaemia causes, ECG and treat

causes - CKD, NSAIDs, acidemia
ECG - tall tented T waves, prolonged PR, widened QRS, VFib
treat - IV calcium gluconate, insulin, oral K binding resin, decrease intake

45

Bladder PS, somatic and symp innervations

PS - S2-4
somatic - S2-4 pudendal
symp - T10-L2 hypogastric

46

what controls micturition

pontine micturition centre

47

what is stress urge and overflow UI

stress - excess pressure on bladder leads to leaking
urge - urgent desire + leaking
overflow - no urge to pee, overfull bladder + leaking

48

how manage UI

less caffeine, weight loss, stop smoking, bladder training, botulism, B3 agonist, anticholinergic, sling, artifical urinary sphincter

49

AKI pre renal causes

hypovolemia, NSAIDs, ACEi

50

AKI renal causes

renal artery occlusion, glomerulonephritis, toxins (gentamicin), pre-eclampsia

51

AKI post renal causes

tumour, BPH, ureteric stricture, megaureter

52

AKI investigation

FENa, BP, urinalysis, imaging

53

AKI management

IV fluids
if high K - calcium gluconate
if acidosis - protein restrict and bicarb

54

causes of macroscopic haematuria

myoglobin, IgA nephropathy

55

symptoms of nephrotic and nephritic

nephrotic - oedema, hypoalbuminaemia, proteinuria, hyperlipidaemia

nephritic - haematuria, increase BP, small proteinuria, oligouria

56

causes of nephritic

PIG ARM - IgA nephropathy, good pastures, alport, rapidly progressive Gn, membrane proliferative GN

57

causes nephrotic

Mum Fight Me im SAD
Membranous GN, FSGS, Minimal change GN, SLE, Amyloidosis, diabetic nephropathy

58

pathology and type of hypersensitivity of membranous GN, diabetic neph, IgA neph, alport, goodpasture, vasculitis

membranous GN - IgG depostion. T3HS
diabetic neph - thick BM, microvascular disease, mesangial sclerosis
IgA neph - IgA in mesangium. T3HS
alport - abnormal collagen IV and therefore abnormal BM. deafness, X linked
good pasture - IgG targets collagen IV. T2HS
vasculitis - ANCA leads to BV damage. T2HS

59

gene affecting prostate cancer. symptoms. diagnosis

BRCA2 gene
symptoms - asymptomatic till late. haematuria, bone pone of mets.
diagnosis - DRE, serum PSA, USS

60

TNM staging

size/4, nearby lymph/3, mets/1

61

caues of CKD and symptoms

causes - infection, hypertension, diabetes, polycystic kidney disease, alport
symptoms - acidosis, pericarditis, anemia, osteomalacia, hypervolemia, osteitis fibrosa cystic (increase phosphate reduces calcium reabsorb increases PTH). Fatigue, breathlessness, pain, N&V, coma

62

CKD investigate and manage

investigate with 24 hour creatinine clearance
manage - lifestyle, ACEi, statin, treat BP

63

sensory inervation of kidneys and ureter

kidneys - T10-11
ureter - T12-L2

64

blood supply of ureter

1/3 - renal arteries
2/3 - common iliac, AA, gonadal
3/3 - internal iliac