Diseases of the Kidney and Urinary Tract

26 cards   |   Total Attempts: 183
  

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Describe the anatomy of the kidney.
- surrounded by insulating fat
- in connective tissue behind abdominal cavity (retroperitoneum)
- concave aspect (hilum) where blood vessels, nerves and urinary tract enter
- renal cortex is outer 1/3, inner 2/3 is medulla
- medulla consists of pyramids whose bases face the cortex and tips have small openings of collecting duct that empty into renal pelvis
Describe the anatomy of the urinary tract after the kidneys.
- urine propelled by contractions along ureter
- ureter goes to bladder that holds 500 cc
- bladder empties at base via urethra
Differentiate between male and female urethras.
- 20 cm in males
- 4 cm in females
- higher incidence of urinary tract infection and incontinence in women
- urethra passes through prostate in male - plays role in sexual function and when it enlarges, obstructs urinary tract in older men
What filters the blood?
- glomerulis (tuft of capillaries) with long epithelial tubes that collect and concentrate urine
- glomerulus surrounded by double walled epithelial capsule (bowman's)
- space inside capsule collects fluid that is pressed through capillaries
- fenestrations allow passage of fluid
- glomerular basement memrane is mesh where small molecules pass through and proteins can't leave
- GBM repel negatively charged proteins in blood
- both physical and charge barrier
- glomerular kidney disease - damage to GBM
- final barrier from capillary space to urinary space - podocytes (finger like processes) with slits
What happens to fluid after it leaves the glomerulus?
- enter proximal convoluted tubule which reabsorbs 2/3 of filtered water and sodium, glucose, amino acids
- travels to loop of Henle that goes towards middle of kidney and then back to cortex
- through active pumping, epithelial cells in loop are responsible for creation of concentration gradient that allows for further reabsorption of water and ions
- enters distal convuluted tubule and leaves through collecting duct
- this tubing forms the pyramids, and all cllecting ducts converge at tips of pyramids
- urine empties into renal pelvis and is propelled to bladder
Describe the anatomy of the pelvis, ureters, and bladder.
- all lined by multilayered epithelium of transitional cells
- surrounded by smooth muscle
What are the functions of the kidney?
- elimination of drugs, toxins, poisons, metabolic waste
- maintenance of electrolyte concentrations
- maintenance of water balance
- regulation of pH
- regulation of BP
- regulation of vitamin D by converting it to active form
- releasing hormone, erthropoietin
What are the causes of renal failure?
- pre-renal (septic shock, dehydration, hemorrhage, heart failure)
- renal (acute tubular necrosis, acute glomerulonephritis)
- post-renal (urinary tract obstruction)
What problems arise due to renal failure?
- edema
- increased levels of sodium, potassium, phosphate
- metabolic acidosis
- build up of nitrogenous wastes in blood
- decreased erythropoietin synthesis (anemia)
- hypertension (sodium and water retention, increased renin - renin regulates BP)
- bone disease (renal osteodystrophy) - increased blood phosphate and impaired reabsorption of calcium = low blood calcium... body reabsorbs more from bone; decreased activation of vit D
- accumulation of waste products (itching, nausea, vomiting, decreased appetite, ulcers, inflammation of tissue, blood clotting problems, WBC dysfunction, nerve and muscle dysfunction, drowsiness, coma, death)
What is the difference between acute and chronic renal failure?
- acute is reversible , rapid onset of symptoms
- chronic is irreversible and loss of function, can result from loss of glomeruli, hypertension, chrnic urinary tract obstruction, diabetes, lupus... clinically silent at first
Why are cystic diseases clinically important?
- major causes of chronic renal failure
- can be confused with malignant tumours
- some are hereditary and have implications for family members
Describe adult polycystic kidney disease.
- autosomal dominant inheritance
- mutations in three separate genes
- PKD1 gene on chromosome 16 codes for polycystin which is involved in cell-cell and cell-matrix interactions in kidney, liver, pancreas
- mechanisms are unclear, but los of protein results in altered growth regulation and differentiation of tubular epithelial cells... cysts form
- one of most common causes of renal failure
- affects BOTH kidneys... become enlarged and functional tissue replaced by thin-walled cysts which contain fluid
- cysts destroy nephrons, chrnic renal failure occurs... affects liver, pancreas, spleen
- predisposed to aneurysms in blood vessels of brain
Describe infantile polycystic kidney disease.
- different genes affected
- autsomal recessive inheritance
- develop in childhilld... earlier symptoms
- predisposed to liver fibrosis
- dilated cortical and medullary collecting ducts arranged radially... external surface smooth
What is the difference between primary and secondary glomerulopathies?
- primary - affect glomerulus primarily or exclusively
- secondary - affect multiple organs, including kidney... diabetes, lupus, vasculitis
What are glomerular disease usually a result of?
- abnormal immune reaction resulting in deposition of antibodies or antigen-antibody immune complexes in GBM