Kidney Structure/Function/Disorders

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1. Women are more at risk to develop Urinary Tract Infections.

Explanation

Structure of the Female Urinary Tract. In general, the higher risk in women is mostly due to the shortness of the female urethra, which is 1.5 inches compared to 8 inches in men. Bacteria from fecal matter at the anal opening can be easily transferred to the opening of the urethra.

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Kidney Structure/Function/Disorders - Quiz

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2. There are two major groups of malignat tumors of the kidney: embryonic kidney tumors (i.e., Wilms tumor), which occur during _____, and renal cell carcinoma, which occurs in _____.

Explanation

wilms tumor is one of the most common malignant tumors of children. the most common presenting signs are a large abdominal mass and hypertension.

Renal cancer accounts for about 3% of all cancers, with a peak incidence between 55 and 84 years of age. Renal cell carcinoma accounts for 90% to 95% of kidney tumors. These tumors are characterized by a lack of early warning signs, diverse clinical manifestations, and resistance to chemotherapy and radiation therapy.

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3. Acute Renal Failure, _____ in serum BUN (Blood urea nitrogen) and creatinine,

Explanation

Acute Renal Failure
Acute shutdown in kidney function
Decrease in urine output
Increase in serum BUN and creatinine
Divided into categories based on cause of renal failure:
– Prerenal Failure
– Postrenal Failure
– Intrinsic Renal Failure

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4. High-pressure capillary system that works to dilate　or constrict in order to regulate glomerular　capillary pressure

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5. Regulate RBC production by releasing _____

Explanation

Erythropoietin controls erythropoiesis, or red blood cell production

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6. Obstruction in Postrenal Failure occurs

Explanation

Postrenal Failure
Results from obstruction of urine flow
Obstruction occurs:
– Ureter
– Bladder
– Urethra
Treatment includes removing cause of obstruction

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7. Work to maintain ____ via the Reninangiotensin- aldosterone system

Explanation

When blood volume is low, juxtaglomerular cells in the kidneys secrete renin directly into circulation. Plasma renin then carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin I is subsequently converted to angiotensin II by the enzyme angiotensin converting enzyme found in the lungs. Angiotensin II is a potent vaso-active peptide which causes blood vessels to constrict, resulting in increased blood pressure. Angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the tubules of the kidneys to increase the reabsorption of sodium and water into the blood. This increases the volume of fluid in the body, which also increases blood pressure.

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8. Where is blood filtered?

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9. Increases calcium absorption by activating _____

Explanation

When synthesized in the kidneys, calcitriol circulates as a hormone, regulating the concentration of calcium and phosphate in the bloodstream and promoting the healthy growth and remodeling of bone. Vitamin D prevents rickets in children and osteomalacia in adults, and, together with calcium, helps to protect older adults from osteoporosis. Vitamin D also affects neuromuscular function, inflammation, and influences the action of many genes that regulate the proliferation, differentiation and apoptosis of cells.

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10. Most common pathogen for Acute Pyelonephritis is E. Coli

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11. Which is the most common bacteria that causes UTI's?

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12. Generalized edema (hallmark of nephrosis)

Explanation

Nephrotic Syndrome
– Disorders that increase the permeability of the glomerular capillary membrane, causing massive losses of proteins in the urine
– Hyperlipidemia occurs due to the liver trying to compensate for the loss of proteins in the urine and increasing lipid synthesis
– Generalized edema (hallmark of nephrosis)

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13. Reflex bladder spasm and a decrease in bladder volume

Explanation

Spastic Bladder
– Failure to store urine
– Reflex bladder spasm and a decrease in bladder volume
– Caused by neurologic lesions such as spinal cord injuries, herniated discs, or tumors, above the level of the sacral cord that allows neurons in the micturation center to function without control from the brain

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14. Disorders that increase the permeability of the glomerular capillary membrane, causing massive losses of proteins in the urine

Explanation

Nephrotic Syndrome
– Disorders that increase the permeability of the glomerular capillary membrane, causing massive losses of proteins in the urine
– Hyperlipidemia occurs due to the liver trying to compensate for the loss of proteins in the urine and increasing lipid synthesis
– Generalized edema (hallmark of nephrosis)

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15. Which are the most common kidney stones?

Explanation

Calcium stones
– Most common
– Account for 70-80% of all stones
– Formed from calcium oxalate, calcium phosphate, or both
– Usually associated with increased levels of calcium in the blood and urine

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16. Cause of Acute Tubular Necrosis - Onset of initiating event and tubular injury

Explanation

Onset or initiating phase
– Onset of initiating event and tubular injury

Maintenance phase
– GFR falls
– Wastes accumulate
– Urine output decreases or ceases

Recovery phase
– Kidney repair begins
– Increase in urine output
– Slowly, serum BUN and creatinine levels normalize

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17. Which is the most common Clinical Manifestation of Bladder Cancer?

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18. Hyperlipidemia occurs due to the liver trying to compensate for the loss of proteins in the urine and increasing lipid synthesis

Explanation

Nephrotic Syndrome
– Disorders that increase the permeability of the glomerular capillary membrane, causing massive losses of proteins in the urine
– Hyperlipidemia occurs due to the liver trying to compensate for the loss of proteins in the urine and increasing lipid synthesis
– Generalized edema (hallmark of nephrosis)

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19. Failure that occurs due to structural damage within the kidneys – Glomerulus – Tubular components – Interstitial tissue

Explanation

Intrinsic Renal Failure
Intrarenal
Failure that occurs due to structural damage within the kidneys
– Glomerulus
– Tubular components
– Interstitial tissue

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20. Identify the glomerular filtration rate per minute.

Explanation

About 125 ml filtrate is formed each minute (glomerular filtration rate) and can be affected by dilation/constriction of afferent/efferent arteriole

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21. Characterized by hematuria, oliguria, high BP, and azotemia

Explanation

Nephritic Syndromes
– Caused by diseases that produce proliferative inflammatory responses
– Decrease the permeability of the glomerular capillary membrane and damages the capillary wall
– Allows RBC’s to escape into the urine (hematuria)
– Characterized by hematuria, oliguria, high BP, and azotemia

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22. When Kidneys Fail, ph imbalance is going to be ____

Explanation

When Kidneys Fail….
Less waste is removed

More waste remains in the blood
– Toxic to CNS, RBC’s, and platelets

Nitrogenous compounds build up in the blood
– BUN: Blood urea nitrogen
– Creatinine
Renal function apprroxiimatted by: initial creatinine level/current creatinine level

Imbalance of fluid and electrolytes
– Hyperkalemia, salt wasting, and HTN

Ph imbalance
– acidosis

Metabolic functions of kidneys decrease
– Decreased erythropoietin
– Decreased activation of Vitamin D

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23. What is the normal values of Serum Creatinine?

Explanation

Serum Creatinine
– Reflects the GFR
– Product of creatine muscle metabolism
– Normal values 0.6-1.2
– If a serum creatinine level doubles, the GFR and renal function, are approximately ½ the normal

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24. Results from obstruction of urine flow.

Explanation

Postrenal Failure
Results from obstruction of urine flow
Obstruction occurs:
– Ureter
– Bladder
– Urethra
Treatment includes removing cause of obstruction

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25. Acute Pyelonephritis contributing factors include:

Explanation

Pyelonephritis usually results from a UTI in the lower urinary tract, but can be caused from an organism in the bloodstream

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26. Increase in the cellular components of the glomerulus.

Explanation

Cellular Changes That Occur With Glomerular Disease
• Proliferative
– Increase in the cellular components of the glomerulus
• Sclerotic
– Increase in noncellular components, mostly collagen
• Membranous
– Increase in the thickness of the glomerular capillary wall

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27. Blood flows into the the glomerular capillaries　through the　EFFERENT arteriole and flows out　through the AFFERENT　arteriole to the tubular　capillaries　

Explanation

Blood flows into the the glomerular capillaries　through the AFFERENT arteriole and flows out　through the EFFERENT arteriole to the tubular　capillaries

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28. Complete failure of an organ to develop

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29. Failure to empty urine

Explanation

Flaccid bladder
– Failure to empty urine
– Occurs when there is an injury or disorder that affects the neurons in the sacral cord or peripheral nerves that control detrusor muscle contraction and bladder emptying
– Flaccid bladder can be the result of peripheral neuropathies from diseases such as diabetes mellitus

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30. Involuntary loss of urine during activities such as laughing, coughing, sneezing, or lifting

Explanation

Stress Incontinence
• Involuntary loss of urine during activities such as laughing, coughing, sneezing, or lifting
• Activities that increase intra-abdominal pressure > increase bladder pressure and cause urinary leakage, usually due to weak pelvic floor muscles and poor support of the vesicoureteral sphincter

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31. Cause of Acute Tubular Necrosis – Kidney repair begins – Increase in urine output – Slowly, serum BUN and creatinine levels normalize

Explanation

Onset or initiating phase
– Onset of initiating event and tubular injury

Maintenance phase
– GFR falls
– Wastes accumulate
– Urine output decreases or ceases

Recovery phase
– Kidney repair begins
– Increase in urine output
– Slowly, serum BUN and creatinine levels normalize

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32. Caused by diseases that produce proliferative inflammatory responses

Explanation

Nephritic Syndromes
– Caused by diseases that produce proliferative inflammatory responses
– Decrease the permeability of the glomerular capillary membrane and damages the capillary wall
– Allows RBC’s to escape into the urine (hematuria)
– Characterized by hematuria, oliguria, high BP, and azotemia

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33. Which is NOT Tubular Components?  

Explanation

Filtrate passes through each of these sections before reaching the pelvis of the kidney.

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34. Urine-filled dilation of the renal pelvis and calicies which causes atrophy of the kidney due to impaired urine outflow

Explanation

•If not treated, the kidney will eventually be destroyed
• With hydronephrosis, the patient will have pain,difficulty voiding

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35. S/S of Prerenal Failure _____ in urine output (EARLY SIGN!!) _____ in BUN and Creatinine levels

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36. Most common cause of Intrinsic Renal Failure

Explanation

Causes of Intrinsic Renal Failure
Most common cause of Intrinsic Renal Failure:
– Acute tubular necrosis
Injury to the tubules caused by ischemia or toxins from infections or drugs

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37. End-stage renal disease

Explanation

End-stage renal disease
– GFR – Reduction in renal capillaries
– Glomeruli scarring
– Atrophy and fibrosis of tubules
– Signs of uremia
Urine in the blood
– Must treat with dialysis or transplant

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38. Bladder Cancer is 3 times more common in _____ than _____.

Explanation

Bladder Cancer
• Most frequent form of urinary tract cancer in the U.S.
• 3 times more common in men than women
• Range from low-grade to highly invasive high-grade
• Increased risk in people with frequent bladder stones and infections
• High risk in those people exposed to carcinogens that are excreted in the urine and stored in the bladder

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39. Kidneys do not develop to normal size

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40. Allows RBC's to escape into the urine (hematuria)

Explanation

Nephritic Syndromes
– Caused by diseases that produce proliferative inflammatory responses
– Decrease the permeability of the glomerular capillary membrane and damages the capillary wall
– Allows RBC’s to escape into the urine (hematuria)
– Characterized by hematuria, oliguria, high BP, and azotemia

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41. Failure to store urine

Explanation

Spastic Bladder
– Failure to store urine
– Reflex bladder spasm and a decrease in bladder volume
– Caused by neurologic lesions such as spinal cord injuries, herniated discs, or tumors, above the level of the sacral cord that allows neurons in the micturation center to function without control from the brain

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42. Inflammation of the kidney that affects the tubules, interstitium, and renal pelvis.

Explanation

Glomerulonephritis
• Inflammation of glomerular structures

Hydronephrosis
• Urine-filled dilation of the renal pelvis and calicies which causes atrophy of the kidney due to impaired urine outflow

Cystitis
• Majority of UTI’s are bladder infections (cystitis) and affect women

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43. Decrease the permeability of the glomerular capillary membrane and damages the capillary wall

Explanation

Nephritic Syndromes
– Caused by diseases that produce proliferative inflammatory responses
– Decrease the permeability of the glomerular capillary membrane and damages the capillary wall
– Allows RBC’s to escape into the urine (hematuria)
– Characterized by hematuria, oliguria, high BP, and azotemia

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44. Most common form of acute renal failure.

Explanation

Prerenal Failure
Most common form of acute renal failure
Characterized by a decrease in renal blood flow
Kidneys usually receive 20-25% of cardiac output
Normally, the kidneys can tolerate large reductions in blood flow before damage occurs

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45. Increase in the thickness of the glomerular capillary wall.

Explanation

Cellular Changes That Occur With Glomerular Disease
• Proliferative
– Increase in the cellular components of the glomerulus
• Sclerotic
– Increase in noncellular components, mostly collagen
• Membranous
– Increase in the thickness of the glomerular capillary wall

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46. Which nervous system is Voluntary control?

Explanation

Control of Bladder Function
• Involuntary control (ANS)
– Parasympathetic nervous system
– Sympathetic nervous system

• Voluntary control
– Somatic nervous system

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47. Failure of an organ to develop normally

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48. Cause of Acute Tubular Necrosis – GFR falls – Wastes accumulate – Urine output decreases or ceases

Explanation

Onset or initiating phase
– Onset of initiating event and tubular injury

Maintenance phase
– GFR falls
– Wastes accumulate
– Urine output decreases or ceases

Recovery phase
– Kidney repair begins
– Increase in urine output
– Slowly, serum BUN and creatinine levels normalize

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49. 65% of all reabsorption and secretion processes occur in the _____  

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50. Which is not Outer cortex?

Explanation

Inner medulla– Renal pyramids

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51. Which is the most common manifestations of Renal Calculi?

Explanation

Pain
– Renal colic
• Most common
• Acute, intermittent, excruciating pain in the flank and upper, outer quadrant of the abdomen
• Pain may radiate lower
• Associated with N/V

– Non-colicky pain
• Caused by stones that cause distention of the renal pelvis
• Deep, dull ache in the flank made worse by drinking fluids

Kidney stones may cause obstruction….the most damaging effects of obstruction are:
– Stasis of urine
– Infection
– Hydronephrosis

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52.  Increase in noncellular components, mostly collagen.

Explanation

Cellular Changes That Occur With Glomerular Disease
• Proliferative
– Increase in the cellular components of the glomerulus
• Sclerotic
– Increase in noncellular components, mostly collagen
• Membranous
– Increase in the thickness of the glomerular capillary wall

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53. Which are mostly found in the presence of bacteria or alkaline urine, etc.?

Explanation

Magnesium ammonium phosphate stones
– Struvite or staghorn stones
– Form only in alkaline urine
– Form only in the presence of bacteria (UTI) that release an enzyme, urease, that splits urea into ammonia and carbon dioxide
– Ammonia causes the urine to become more alkaline
– Can grow to become large

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54. Overactive Bladder

Explanation

Urge Incontinence
• Overactive Bladder
• Clinical syndrome that includes urgency, frequency, dysuria, and nocturia
• May occur without incontinence
• Characterized by hyperactive bladder contractions caused by:
– Neurogenic disorders
– Myogenic disorders

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55. Glomerulonephritis, in _____ hypersensitivity responses, antigen-antibody complexes float around and damage the tissue where they settle….many settle in the glomerular membrane

Explanation

Most primary and some secondary cases of glomerulonephritis are immune responses

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56. Glomerulus drains Bowman's Capsule

Explanation

Glomerulus encased in Bowman’s capsule
Proximal Convoluted Tubule drains Bowman’s Capsule

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57. Chronic Pyelonephritis caused by bacterial infection.

Explanation

Chronic
– More complex
– Includes bacterial infection and reflux

Acute
– Caused by bacterial infection

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58. Diminished renal reserve

Explanation

Diminished renal reserve
– Occurs when GFR drops to 50% normal
– BUN and creatinine are normal
– No symptoms of renal impairment
– Most people can survive with this, as long as no other insult to their kidneys occur

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59. Renal insufficiency

Explanation

Renal Insufficiency
– GFR 20-50% normal
– Kidney cells attempt to adapt to insufficiency by changing size and increasing function
– Isosthenuria
Polyuria with urine that has more water that solute
– Azotemia, anemia, and HTN common
– Treat underlying factors
Good DM and BP control; appropriate abx for infections; low protein diet

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60. Identify the muscle of micturation.  

Explanation

Detrusor muscle
– Muscle of micturation or passage of urine
– When it contracts, urine leaves the bladder

Internal sphincter is a continuation of the detrusor muscle.

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61. Process approximately _____ liters of blood daily and combine its waste products into ____ liters of urine

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62. What is normal value of Blood Urea Nitrogen?

Explanation

Blood Urea Nitrogen
– By-product of protein metabolism found in the liver
– Excreted totally by the kidneys
Generally, a high blood urea nitrogen level means your kidneys aren't working well, particularly if the result is above 50 mg/dL (17.85 mmol/L). But, elevated urea nitrogen can also be due to urinary tract obstruction, congestive heart failure or gastrointestinal bleeding. Your blood urea nitrogen level may also increase as a result of dehydration, shock, burns or fever. Certain medications, such as corticosteroids, may increase urea nitrogen levels, too. In addition, a high protein diet can cause your BUN level to increase.

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63. _____ is a neurotransmitter that plays a huge role in the function of the ANS in regards to urine control

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64. Treatment for acute pyelonephritis includes...  

Explanation

If not treated, may lead to sepsis and renal failure

Renal Calculi
• Treatment
– Supportive Care
– Pain meds
– IV fluids
– Strain urine
– Analyze stones
– Prevent future stones
– Lithotripsy

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65. Select bladder function of Somatic control.

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66. Renal failure

Explanation

Renal failure
– GFR 20-5% normal
– Kidneys no longer able to regulate volume
and solute composition of extracellular fluids
– Hyperkalemia
– Metabolic acidosis
– Edema
– Uremia

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67. UTI's in special populations….

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68. The pontine micturition center cordinates the action of the _____ and the ______, whereas cortical centers permit conscious control of micturition.

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69. Identify the most common cause of kidney obstruction • • • • •

Explanation

Horseshoe kidney
-The upper or lower poles of the kidneys are fused making the horseshoe appearance

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70. Which definisions are Cortical nephrons?

Explanation

Other definitions for Juxtamedullary nephrons

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71. Select causes of Prerenal Failure.

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72. Identify dietary management of chronic renal failure.  

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73. Which is the most common risk factor of Bladder Cancer?

Explanation

Bladder Cancer is more frequent among persons harboring the parasite "Schistosoma Haematobium" in their bladder. P675

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74. Select Clinical Manifestations of UTI's affecting the lower urinary tract

Explanation

• S/S vary with upper and lower UTI’s
• Depends if acute or chronic
• Majority of UTI’s are bladder infections (cystitis) and affect women

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75. Select bladder function of Sympathetic control

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76. Each nephron contains:

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77. Urine Formation Depends on….

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78. Select bladder function of Parasympathetic control

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79. Select Clinical Manifestations of Chronic Renal Failure  

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80. Select Signs of Urine Obstruction and Retention  

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81. Select Clinical Manifestations of Acute Pyelonephritis

Explanation

Clinical Manifestations of UTI’s affecting the lower urinary tract
• S/S vary with upper and lower UTI’s
• Depends if acute or chronic
• Majority of UTI’s are bladder infections (cystitis) and affect women
• Frequency
• Urgency
• Dysuria
• Foul-smelling urine
• Lower back or abdominal pain
• Usually no fever!

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Women are more at risk to develop Urinary Tract Infections.
There are two major groups of malignat tumors of the kidney: embryonic...
Acute Renal Failure, _____ in serum BUN (Blood urea nitrogen) and...
High-pressure capillary system that works to dilate　or constrict in...
Regulate RBC production by releasing _____
Obstruction in Postrenal Failure occurs
Work to maintain ____ via the Reninangiotensin- aldosterone system
Where is blood filtered?
Increases calcium absorption by activating _____
Most common pathogen for Acute Pyelonephritis is E. Coli
Which is the most common bacteria that causes UTI's?
Generalized edema (hallmark of nephrosis)
Reflex bladder spasm and a decrease in bladder volume
Disorders that increase the permeability of the glomerular capillary...
Which are the most common kidney stones?
Cause of Acute Tubular Necrosis...
Which is the most common Clinical Manifestation of Bladder Cancer?
Hyperlipidemia occurs due to the liver trying to compensate for the...
Failure that occurs due to structural damage within the kidneys...
Identify the glomerular filtration rate per minute.
Characterized by hematuria, oliguria, high BP, and azotemia
When Kidneys Fail, ph imbalance is going to be ____
What is the normal values of Serum Creatinine?
Results from obstruction of urine flow.
Acute Pyelonephritis contributing factors include:
Increase in the cellular components of the glomerulus.
Blood flows into the the glomerular capillaries　through...
Complete failure of an organ to develop
Failure to empty urine
Involuntary loss of urine during activities such as laughing,...
Cause of Acute Tubular Necrosis...
Caused by diseases that produce proliferative inflammatory responses
Which is NOT Tubular Components?  
Urine-filled dilation of the renal pelvis and calicies which causes...
S/S of Prerenal Failure...
Most common cause of Intrinsic Renal Failure
End-stage renal disease
Bladder Cancer is 3 times more common in _____ than _____.
Kidneys do not develop to normal size
Allows RBC's to escape into the urine (hematuria)
Failure to store urine
Inflammation of the kidney that affects the tubules, interstitium, and...
Decrease the permeability of the glomerular capillary membrane and...
Most common form of acute renal failure.
Increase in the thickness of the glomerular capillary wall.
Which nervous system is Voluntary control?
Failure of an organ to develop normally
Cause of Acute Tubular Necrosis...
65% of all reabsorption and secretion processes occur in the _____...
Which is not Outer cortex?
Which is the most common manifestations of Renal Calculi?
 Increase in noncellular components, mostly collagen.
Which are mostly found in the presence of bacteria or alkaline urine,...
Overactive Bladder
Glomerulonephritis, in _____ hypersensitivity responses,...
Glomerulus drains Bowman's Capsule
Chronic Pyelonephritis caused by bacterial infection.
Diminished renal reserve
Renal insufficiency
Identify the muscle of micturation.  
Process approximately _____ liters of blood daily and combine its...
What is normal value of Blood Urea Nitrogen?
_____ is a neurotransmitter that plays a huge role in the function of...
Treatment for acute pyelonephritis includes...  
Select bladder function of Somatic control.
Renal failure
UTI's in special populations….
The pontine micturition center cordinates the action of the _____ and...
Identify the most common cause of kidney obstruction...
Which definisions are Cortical nephrons?
Select causes of Prerenal Failure.
Identify dietary management of chronic renal failure.  
Which is the most common risk factor of Bladder Cancer?
Select Clinical Manifestations of UTI's affecting the lower urinary...
Select bladder function of Sympathetic control
Each nephron contains:
Urine Formation Depends on….
Select bladder function of Parasympathetic control
Select Clinical Manifestations of Chronic Renal Failure  
Select Signs of Urine Obstruction and Retention  
Select Clinical Manifestations of Acute Pyelonephritis
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