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110 Cards in this Set
- Front
- Back
Fill in the blanks.
The two kidneys are located behind the _______ (that is, ______) on the _______ _____ wall. |
peritoneum
retroperitoneally posterior abdominal |
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The inside of each kidney is called the_____
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cortex, or outer layer
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What two structures lie in the medulla? Why are these structures important?
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renal pelvis and the calyces, through which urine flows into the ureter
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Define nephron
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functional units of the kidney
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What structure does the renal corpuscle contain?
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the bowmans/glomeular capsule which binds at the end of the proximal convoluted tubule
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The tubule consist of three parts. Name them.
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distal convoluted tubule
proximal convoluted tubule loop of henle |
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What is the role of the kidney tubule?
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-reabsorption of essential nutrients, water, and electrolytes
-secretion of certain wastes and electrolytes |
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What is the role of the collecting ducts?
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to transport urine to the renal pelvis
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What specifically takes place in the proximal convoluted tubule?
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water is reabsorbed into the blood into the peritubular capillaries along with glucose, nutrients and electrolytes
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What kinds of transport does the tubules utilize?
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active transport
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Explain the transport/tubular maximum
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If a substance such as glucose is present in excessive amounts in the filtrate, there are insufficient carrier molecules in the tubules tubules for complete reabsorption. Thus, the excess glucose is present in the urine.
*310 mg/min for glucose |
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Glucosuria is an indication of what disorder?
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-hyperglycemia (high concentration of sugar/glucose in the blood)
-associated with diabetes mellitus (a metabolic disease caused by failure of the pancreas to produce insulin, a hormone that allows glucose to be taken up by cells that require it for function.) |
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Water is reabsorbed by what process?
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osmosis
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What is the origin of ADH? What is its role in the reabsorption process?
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pituitary gland
controls the reabsorption of water by altering the permeability of the DCT and collecting duct |
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Aldosterone is secreted by what structure in the body? What is it's role in the reabsorption process?
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adrenal cortex
controls sodium reabsorption and water by exchanging sodium ions for potassium or hydrogen ions in the DCT |
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Atrial natriuretic hormone is the third hormone involved in fluid balance and is secreted from what structure?
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heart
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Concurrently, the acid-base balance of the blood is maintained by_______
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removal of excess acids and replacement of buffers (bicarbonate)
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Secondary damage and progressive destruction of the kidney is exacerbated due to _____
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scar tissue
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Large amounts of blood enter and leave the kidney through what structure?
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hilum- through the renal artery and vein
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What is the purpose of the dual arterioles? What does it determine?
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to control the pressure in the glomeular capillaries and the glomeular filtration pressure.
determines the glomeular filtration rate (GPR) |
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The degree of constriction of the arterioles is controlled primarily by what three factors?
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local autoregulation
SNS renin-angiotensin mechanism |
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What is the effect of autoregulation on the arterioles?
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make adjustments in the diameter of the arterioles in response to minor changes in blood flow in the kidney. maintains normal filtration rate
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What is the effect of SNS on the arterioles?
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increases vasoconstriction in both arterioles when stimulated
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What is the effect of renin-angiotensin on the arterioles?
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renin is secreted by the juxtaglomerular cells in the kidney when blood flow in the afferent arteriole is reduced. Renin acts on the plasma protein angiotensin to produce angiotensin II- a powerful systematic vasoconstrictor
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What is elevated with renal disease?
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blood pressure
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What specifically stimulates the release of aldosterone?
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angiotensin
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The renal pelvis, calcyes, ureters, and bladders are lined with what type of epithelium?
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transitional
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How long is the female urethra?
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3-4cm
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What specifically promotes infection of the bladder in women?
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The proximity to the vagina and anus
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How long is the male urethra?
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20 cm long
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Term for urination or voiding
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micturition
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Term for involuntary urination by a child after age 4-5
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enuresis
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Causes of enuresis
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developmental delay
sleep pattern psychological aspects |
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Causes of stress incontinence
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multiple pregnancies
coughing lifting laughing |
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Name one cause of overflow incontinence
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a weakened detrusor muscle preventing a patient from complete emptying of the bladder.
*spinal injury at the sacral level blocks mictrution reflex causing overflow incontinence |
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What is retention?
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an inability to empty the bladder
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Catheters can cause what type of problems in the body?
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infection of the urinary tract
(irritates tissue and introduces bacteria into the bladder) |
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What color is normal urine? What is the normal pH range of urine?
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clear, and straw colored
4.5-8.0 |
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What would a cloudy appearance of the urine indicate?
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large amounts of protein, blood cells, or bacteria or pus
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What are urinary casts?
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microscopic-sized molds of the tubules, consisting of one or more cells, bacteria, protein, etc) indicating an inflammation of the kidney tubule
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What would an unpleasant or unusual odor of the urine indicate?
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infection, or result from certain dietary components or medications
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What does hematuria of the urine (represented by a dark color) indicate?
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infection, inflammation, or tumors in the digestive tract
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What does proteinuria in the urine (represented by a cloudy color) indicate?
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also known as albuminuria- indicates the leakage of albumin or mixed plasma proteins into the filtrate owning to inflammation and increased glomerular permeability
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What does specific gravity indicate?
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the ability of the tubules to concentrate the urine
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What does a low specific gravity (dilute urine) indicate?
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renal failure
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When diabetes mellitus is uncontrolled, what two structures are found in the urine?
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glucose and ketones
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What does decreased GFR cause?
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elevated serum urea
(blood urea nitrogen/BUN, and serum creatinine indicate failure to excrete nitrogen wastes |
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What does metabolic acidosis (decreased serum pH and decreased serum bicarbonate) indicate?
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decreased GFR and failure of the tubules to control acid-base balance
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What does anemia (low hemoglobin level) indicate?
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decreased erythropoietin (a glycoprotein secreted by the kidneys that stimulates the production of red blood cells)secretion and/or bone marrow depression, due to accumulated wastes
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Clearance tests such as creatinine and insulin clearance asses_______
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GFR
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Which type of test visualizes the lower urinary tract and may be used to remove kidney stones?
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cystoscopy
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What is the purpose of using diuretics or "water pills"?
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they remove excess sodium ions and water from the body, thus increasing water secretion through the kidneys and urinary output, reducing fluid volume in the tissues and blood
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In blood tests, poststreptococcoal glomerulonephritis are diagnosed using what titers?
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antistreptolysin O (ASO)
antistreptokinase (ASK) |
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What is the point of taking hydrochlorothiazide? List some major side effects.
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It inhibits the reabsorption of Na+ and water in DCT
-excessive loss of electrolytes causing muscle weakness, and cardiac arrythmias -loss of potassium |
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When should diuretics be administered? why?
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in the morning because they often cause urinary frequency for a period of time.
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Xerostomia (dry mouth) and dental caries are side effects when taking which drug?
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diuretics
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What does an ascending infection entail?
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arising from organisms in the perineal area, traveling along the continuous mucosa in the urinary tract, to the bladder, along the ureters to the kidnet
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What is the most common causative organism?
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e-coli
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Why are women more vulnerable to a UTI infection?
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because of the shortness and width of the urethra
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Why may an infection of the prostate or testes be likely to extend to the urinary structures?
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because the male reproductive tract shares some of the same structures of the urinary tract
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List some predisposing factors for UTIs in both men and women.
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incontinence
retention obstruction to urine flow *all causing a build up microbes |
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Explain cystitis
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the bladder wall and urethra are inflamed, red, swollen and even ulcerated. the bladder wall is irritable and bladder capacity is reduced
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List some signs and symptoms of cystitis
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-pain in the lower abdomen
-dysuria -urgency to void immediately -nocturia (urination at night) - cloudy urine with unsual odor -urinalysis indicates bacteriuria |
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List some systematic signs of infection of cystitis
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-fever
-malaise (psychical discomfort) -nausea -leukocytosis |
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Explain pyelonephritis
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inflammation of the kidney and pelvis, exudate fills the kidney, pelvis, and calcyes and the medulla is inflamed causing abscesses and necrosis
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List some signs and symptoms of pyelonephritis
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-dysuria
-pain in the lower back resulting from inflammation that stretches the renal capsule -urinalysis consist of urinary casts of leukocytes or renal epithelial cells reflecting the involvement of renal tubules |
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List a prophylactic measure used for UTIs
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cranberry juice
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What class of microbes are responsible for initiating the immune disorder in the kidney, stemming glomerulonephritits?
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staphyloccous
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What does inflammatory response of the kidney cause?
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increased capillary permeability and cell proliferation, resulting in leakage of proteins and large numbers of erythrocytes into the filitrate
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What does decreased blood flow in the kidney stimulate? What does it lead to?
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renin secretion, which leads to elevated blood pressure and edema
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List some signs and symptoms of glomerulonephritis
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-dark, cloudy, urine
-facial and periorbitial edema -elevated blood pressure -flank back pain -oliguria |
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What happens in nephrosis?
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there is an abnormality in the glomeular capillaries and increased permeability allowing large amounts of plasma protein primarily albumin to escape into the filtrate
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Name a disorder caused by nephrosis
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hypoalbuminemia with decreased plasma osmotic pressure and generalized edema
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Name a parodoxical response of nephrosis
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the associated decreased blood volume increased aldosterone secretion, leading to more severe edema
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Nephrosis gives rise to high levels of ______ in the blood and _______ in the urine
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cholesterol
lipoprotein |
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Name the significant sign of nephrosis
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edema (anasarca) associated with weight gain and pallor
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List some treatments of nephrosis
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-glucocorticoids to reduce inflammation of the kidney
-ACE inhibitors to decrease protein loss in the urine |
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Term for kidney stones
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urolithiasis or calculi
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What causes kidney stones to form?
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excessive amounts of insoluble salts in the filtrate or when insufficient fluid intake creates highly concentrated filtrate
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What are most kidney stones composed of
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calcium salts (phosphate, oxalate, or carbonate) and uric acid
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In what environment are calcium stones most readily formed?
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when the urine is highly alkaline
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What type of stones are vegetarians most likely to form?
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calcium oxalate stones
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Name an significant sign of kidney stones in the body
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obstruction of the ureter causing an attack of "renal colic"- intense spasms of pain in the flank area radiating into the groin lasting until the kidney passes
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List some treatments of larger kidney stones
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ESWL
lithotripsy |
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Where does renal cell carcinoma arise from?
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tubule epithelium, more often in the renal cortex
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Two types of carcinomas most readily seen in smokers
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renal cell carcinoma
bladder cancer |
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Name two paraneoplastic syndromes of renal cell carcinoma
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-hypercalcemia (increased parathyroid hormone)
-Cushing syndrome (increased adrenocorticotropic hormone) |
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Renal cell carcinoma tends to be silent. What is the eventual treatment?
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nephrectomy (removal of the kidney)
*5 year survival rate at 50% |
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Where do malignant tumors of the bladder arise from?
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transitional epithelium lining the bladder in the trigonal area
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What type of individuals have a higher incidence of bladder cancer?
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people working with chemicals in labs, particularly with dyes, rubber, and aluminum
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Explain nephrosclerosis
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involves vascular changes in the kidneys, causes thickening and hardening of the walls of the arterioles and narrowing or occlusion of lumina in the blood vessels
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Explain the effects of nephrosclerosis
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reduce the blood supply to the kidney, causing ischemia and atrophy, also stimulating the secretion of renin which increases blood pressure
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What causes vesicoureteral reflux?
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a defective valve in the bladder
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What is agenesis?
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developmental failure of one kidney to develop
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What is hyoplasia?
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failure to develop to a normal size
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What is an ectopic kidney?
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a kidney and its ureter are displaced out of normal position
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How does one transmit adult Polycystic kidney disease?
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it is a genetic disorder transmitted as an autosomal dominant gene on chromosome 16
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When do the first manifestations of adult polycystic kidney disease usually appear?
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40 years, when chronic renal failure becomes symptomatic
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Early diagnosis of APK is only possible when_____
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high blood pressure occurs and is difficult to control or when secondary polycythemia develops due to increased erythropoietin secretion
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What occurs in APK?
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Multiple cysts develop in both kidneys expanding over the years, first enlarging and then compressing until chronic renal failure occurs
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Name the most common tumor that occurs in children
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Wilm's tumor (nephroblastoma)
*child develops high BP |
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How is wilm's tumor most readily diagnosed?
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large abdominal mass (often a waistband on clothes does not fasten or a unilateral bulge appears
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When does acute renal failure occur?
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both kidneys fail to function
*is reversible |
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What are some causes of ARF?
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-acute kidney disease
-severe or prolonged shock (burns, crush injuries, sepsis) -nephrotoxins (NSAIDs, penicillin, sulfa dugs, acetaminophen) -mechanical obstructions |
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What is the early stage of chronic failure called? How many nephrons are lost? Explain this stage.
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decreased reserve. 60% nephrons lost
there is a decrease in GFR, serum creatinine levels, no apparent clinical signs. |
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What is the secondary stage of chronic renal failure called? How many nephrons are lost? Explain this stage
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renal insufficiency, 75% nephrons are lost
Sig. retention of nitrogen wastes (urea and creatnine), tubule function is decreased, excretion of large volumes of dilute urine, decreased RBC, high blood pressure |
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What is the end stage of chronic renal failure called? How many nephrons are lost? Explain this stage
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Uremia. more than 90% nephrons lost
GFR is negligible, fluid, electolytes, and wastes are retained in the body and all body systems. Marked oliguria and anuria develops |
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Name the key indicators of chronic renal failure
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-anemia
-azotemia (presence of nitrogen wastes in the blood) -Acidosis (declines and tubule function is lost) |
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Name some early signs of chronic renal failure
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-polyuria (assoc. nocturia)
-anorexia, nausea, fatigue -bone marrow depression and impaired cell function -high blood pressure |
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Name some uremic designs of chronic renal failure
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-oliguria
-peripheral neuropathy (abnormal sensations in the lower limbs) -impotence or menstruation problems -arrhythmias and CHF -failure of the kidney to activate vitamin D -uremic frost on skin -pneumonia |