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Intro to urology

Clinical Medicine II

Nephrology study of the nephron and kidney
Urology study of the urinary drainage system
Do the kidneys move yes, slightly w/ respirations, excess can produce renal colic
Where do we commonly find malignant tumors in the renal vein
What is special about the L renal vein it receives the left testicular vein in the male, (rarely) can become blocked and produced varicocele in the L scrotum
Most diseases of the kidney present how painless (with HTN and DM ect)
3 sites of ureter narrowing pelviureteral jxn, pelvic brim, ureter enters the bladder
Where does colic come from at the level of ureter d/t peristalsis
Congenital anomalies double pelvis, bifid ureter, mega-ureter
How can we drain the bladder urination, catherization, needle thru abd wall: can cause trauma and urine can leak into abd cavity
Where does support of the bladder come from, diminished how levator ani muscle, diminished by labor and prostate surgery
Two parts to the nephron Cortex: glomerulus is here and Medulla: loop of henle
What is included in the renal corpuscle glomerulus and bowman’s capsule (in cortex)
Two parths to the nephrons cortical and juxtamedullary
Two segments of the proximal tubule convoluted, and straight (pars recta)
Two parts to the loop of henle thick descending limb and thin limb ( only in juxtamedulla nephrons), thick ascending limb
What % of all nephrons are juxtumedullary nephrons 20%
Where is the macula densa in the distal tubule
Where does filtration and reabsorbtion occur at glomerulus and at the proximal tubule ( a lot)
What seperates the cortex and medulla the arcuate arteries and veins
Most important fxn of the kidney regulate water
Indirect Fxns of kidney protects/hydrates organs, transport nutrients, gets rid of H2O from breathing, regulates body temp, eliminates toxins
Water represents what % in muscle, brain, bone, blood M: 75%, B: 75%, Bone: 22%, Blood:92, protects joints, and lubricate
Where is most of the water located within the body intra cellular fluid (ICF) 66%
Direct fxns of the kidney filtration, reabsorbtion, secretion
Movementof water and solutes from plasma in the glomerulus filtration
Movement of molecules out of the tubules into peritubular blood reabsorption (H20, NaCl, glucose, K+, AAs, HCO3, proteins, PO4)
Movement of molecules out of peritubular blood into tubule for excretion secretion (H+, urea, K+, drugs, foreign substances)
Two endocrine fxs of the kidney renin-aldosterone (BP) Ertythropoeitin (RBC)
Metabolic fxs of kidney Vit D for calcium metabolism, Gluconeogenesis, metabolism of endogenous compuds like steroids, insulin, prostaglandins, kinins
Amount of plasma filtered per unit time GFR glomerular filtration rate (related directly to blood flow)
Two ways to autoregulate blood flow myogenic-stretc in afferent arteriole, tubuloglomerular feedback, macula densa (JGA cells in distal tubule)
What are the sympathetic nerves that innervate the kidneys, where celiac ganglion and greater splanchinic nerves, innervates at afferent and efferent arterioles (flight or fight)
What does drop in BP in baroceptors do causes reflex renal arteriole, and vasoconstriction ↓ renal BF
Where is renin released from, in response to 3 things JGA cells 1) ↓ stretch from ↓ pressure in afferent arterioles, 2) Na+, concentration in DT 3) sympathetic n. stimulation
Fxn of renin cleaves angiotensinogen to angiotension I (I→II by ACE)
What is angiotension II stron vasoconstrictor notablyin afferent arterioles)
What does angiotensin II stimulate aldosterone secretion from adrenal cortex and ADH from post pit. Inhibits renin release
What is ANP and where is it secreted atrial natriuretic peptide and secreted by R atrium of heart in response to stretch (↑ vol, BP)
Fxn of ANP inhibits renin secretion, angiotension mediated aldosterone secretion, causes afferent vasodilation, efferent vasoconstrictions
What do NSAIDS, ACE/ARBs, HCTZ, Lasix, Spirolactone all act on N: afferent arterioles, ACE: efferent arterioles, HCTZ, just after LOH, L: ascending limb of loop of henly, S: DT
Condition characterized by ↑ retention of nitrogen byproducts azotemia: causes ↑urea and BUN
Where do NSAIDS, ACEi/ARBs, HCTZ, Lasix and spirolactone work N: afferent arteriole, Ace: efferenct arterioles, HCTZ: just after the loop, Lasix: ascending limb of the loop of henle, S: distal tubule
Azotemia abnormally high nitrogen products: urea, creatine,
When is it a prerenal problem azotemia d/t ↓ perfusion of kidney d/t vol deletion, hemorrhage, shock and CHF
When is it an intrarenal problem azotemia d/t intrinsic kidney failure (uremia) renal failure, glomerulonephritis, acute tubular necrosis
When is it a postrenal problem azotemia d/t blockage of urine in urinary track
Product of muscle metabolism, helps monitor what creatinine, asses for dehydration, renal failure, muscle atrophy/dystrophy
Nl creatinin and BUN C: .7-1.2mg/dl BUN: 10-20mg/dl
What two lab values are inverserly related Cr and GFR
Measures urea nitrogen BUN: end produce of protein break down in the blood
What does BUN reflect glomerular filtration and urine concentration capacity, asses for dehydration, renal failure, catabolic states, GI bleeding w/ reabsorption of blood, liver dz
Two labs for additional renal knowledge BUN/Cr ratio, FENA (Fractional exretion of Na+)
FENA >3% suggests what intrarenal dysf: ↑ Na+ lost d/t tubular damage or glomeruli damage resulting in hypervolemia
How can we predice GFR w/o urine specimine Cockcroft-Gault equation
When do we see glucose in the urine glucose >200mg/dl
When do ketones show up in the urine indicates metabolism s dependent upon fatty acids rather than glucose for energy
When does ketonuria occur diabetic acidosis, starvation, fasting, alcoholic ketoacidosis
Why do we want to examine urine w/i30mins casts may disintegrate
Dark yellow to green urine bilirubin
Red to black urine erythrocytes, hemoglobin, myoglobin
Purple to brown on standing to light porphyrins
Nl urine pH 4.6-6.0
What do we need to interpret urine pH serum pH to compare to identify where the infx is
Causes of increased pH infx w/ urea-spitting organism (proteus), systemic alkalosis,renal tubular acidosis, carbonic anhydrase inhibitors
What does a fixed specific gravity indicate (Isosthenuria), damage to renal medulla, severe renal damge
Causes of fixed specific gravity gout, Sickle Cell, myeloma kidney, prolonged K+ def, hypercalcemia
Nl protein, causes of mild and severe elevation 5-15mg/dl, Mild: Bening orthostatic proteinuria, fever, glomerulonephritis, pyleonphtritis, severe elevation: >3.5, Renal v. thrombosis, amyloidosis, SLE, DM, glomerunephritis
+bilirubin suggests what obstructive jaundice (Intrahepatic and extra) Hepatitis
Hemateuria causes infx, kidney damage, stones, malignancy: requires more tests
Reasons for renal US size, shape, location of kidneys, renal masses, obstruction, fluid collections, MAY detect nephrolithliasis
Indications for US hematuria, renal failure, flank pain safe during pregnancy
Indications for intravenous pyelogram (IVP) hematuria, suspected nephrolithiasis, obstruction or other abnormalities
Do we alwaysuse IVP rarely d/t the CT
MC used test for kidneys, indications CT scan, Evaluate for 1)nephrolithiasis (no contrast) 2) renal, prostate, other intraabd masses
If contrast is used in any test, what do we need to measure 1st creatnine level
When would we use a MRI/MRA over a CT abno tissues/masses such as malignancies
CIs for MRI metal in body: pacemakers, aneurysm clips, stents, values
VCUG voiding cystourethrogram: study to invision urine from bladder to urethra
Indications for VCUG recurrent UTIs, bladder trauma/rupture, suspected obstruction (CI: untreated UTI)
Indications for cystoscopy frequent UTI, hematuria, incontinence or overactive bladder, unusual cells in UA, painful urination, pelvic pain, intersticial cystitis, suspect malignancy. Invasive
Diagnostic test for masses biopsy: US guided, often done during surgery
Created by: becker15
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