Renal 3
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Questions and Answers

What indicates a potential urinary tract infection based on urinalysis?

  • Low osmotic concentration
  • Presence of nitrites (correct)
  • Presence of ketones
  • High specific gravity
  • Which component contributes to 95% of total urine volume?

  • Urea
  • Creatinine
  • Electrolytes
  • Water (correct)
  • What condition might be indicated by the presence of proteins in urine?

  • Dehydration
  • Diabetes insipidus
  • Liver failure
  • Kidney disease (correct)
  • What is the significance of a specific gravity value in the range of 1.003–1.030?

    <p>Reflects urine concentration (D)</p> Signup and view all the answers

    Which of the following substances may indicate diabetes mellitus when found in urine?

    <p>Glucose (C)</p> Signup and view all the answers

    What does a normal urine osmotic concentration range between?

    <p>855–1335 m Osm/L (A)</p> Signup and view all the answers

    What might a high volume of urine suggest?

    <p>Diabetes mellitus (B)</p> Signup and view all the answers

    What does Blood Urea Nitrogen (BUN) primarily measure?

    <p>Blood nitrogen levels related to amino acid catabolism (B)</p> Signup and view all the answers

    What does a steep rise in plasma creatinine levels indicate?

    <p>Severe decreases in GFR due to renal disease (D)</p> Signup and view all the answers

    Which method is considered the gold standard for estimating GFR?

    <p>Inulin clearance test (A)</p> Signup and view all the answers

    What does a high renal clearance of inulin indicate?

    <p>Efficient filtration and excretion (B)</p> Signup and view all the answers

    What is the primary purpose of PAH clearance tests?

    <p>To assess renal plasma flow (D)</p> Signup and view all the answers

    Which of the following conditions can result from kidney failure?

    <p>Decreased erythropoietin production leading to anemia (C)</p> Signup and view all the answers

    What occurs when the GFR drops too low?

    <p>Urine production decreases (A)</p> Signup and view all the answers

    Which of the following is NOT a consequence of kidney failure?

    <p>Improved kidney function (D)</p> Signup and view all the answers

    What are the most common causes of chronic kidney failure?

    <p>Diabetes and hypertension (D)</p> Signup and view all the answers

    What is a characteristic of acute kidney injury (AKI)?

    <p>Filtration function may recover in weeks to months (C)</p> Signup and view all the answers

    Which method is used to manage chronic kidney failure?

    <p>Restricting water, salt, and protein intake (A)</p> Signup and view all the answers

    How does hemodialysis function?

    <p>It employs an artificial membrane for blood regulation (C)</p> Signup and view all the answers

    What is true regarding kidney transplants?

    <p>Immunosuppressive drugs are necessary post-transplant (B)</p> Signup and view all the answers

    What is a potential treatment for acidosis in renal failure?

    <p>Ingesting bicarbonate ions (D)</p> Signup and view all the answers

    Which statement about dialysis is correct?

    <p>Dialysis relieves symptoms but is not a cure (D)</p> Signup and view all the answers

    What can cause acute kidney injury (AKI)?

    <p>Exposure to toxic substances (A)</p> Signup and view all the answers

    What is the primary function of the ureters?

    <p>To receive urine from the kidneys and conduct it to the urinary bladder (B)</p> Signup and view all the answers

    Which layer of the ureters is responsible for peristalsis?

    <p>Muscularis (B)</p> Signup and view all the answers

    What role do the rugae in the urinary bladder serve?

    <p>Expand and disappear as the bladder fills (D)</p> Signup and view all the answers

    Where is the internal urethral orifice located?

    <p>At the outlet of the urinary bladder (A)</p> Signup and view all the answers

    What anatomical feature helps prevent the backflow of urine into the ureters during bladder contraction?

    <p>Ureteric orifices (A)</p> Signup and view all the answers

    Which ligaments anchor the bladder to the pelvic and pubic bones?

    <p>Lateral and medial umbilical ligaments (A)</p> Signup and view all the answers

    What is the main function of the urinary bladder?

    <p>Receive, store, and eliminate urine (A)</p> Signup and view all the answers

    What defines the trigone of the urinary bladder?

    <p>It is formed by the ureteral openings and the urethra entrance. (D)</p> Signup and view all the answers

    What physiological response occurs as the urinary bladder fills with urine?

    <p>Activation of stretch receptors (C)</p> Signup and view all the answers

    Which part of the nervous system is primarily activated during the micturition reflex?

    <p>Parasympathetic nervous system (B)</p> Signup and view all the answers

    What volume of urine in the bladder typically signals the brain to begin the process of urination?

    <p>200-400 mL (C)</p> Signup and view all the answers

    Which condition is characterized by excessively high urine production?

    <p>Polyuria (D)</p> Signup and view all the answers

    What serious condition may oliguria and anuria indicate?

    <p>Kidney failure (C)</p> Signup and view all the answers

    What effect does the micturition reflex have on the detrusor muscle?

    <p>Contraction, facilitating urine expulsion (D)</p> Signup and view all the answers

    What could increased urinary frequency indicate?

    <p>Irritation of the urinary tract lining (A)</p> Signup and view all the answers

    How does the pontine storage center influence the storage of urine?

    <p>Increases sympathetic activity to promote sphincter contraction (B)</p> Signup and view all the answers

    What type of muscle is the internal urethral sphincter composed of?

    <p>Involuntary smooth muscle (D)</p> Signup and view all the answers

    Which structure surrounds the urethral opening and serves as a muscular sphincter?

    <p>Internal urethral sphincter (C)</p> Signup and view all the answers

    Which section of the male urethra passes through the prostate?

    <p>Prostatic urethra (A)</p> Signup and view all the answers

    What is the primary function of the external urethral sphincter in both males and females?

    <p>To permit voluntary urination (C)</p> Signup and view all the answers

    How long is the female urethra compared to the male urethra?

    <p>About half the length (C)</p> Signup and view all the answers

    What type of epithelium lines the female urinary tract near the external urethral orifice?

    <p>Stratified squamous epithelium (D)</p> Signup and view all the answers

    Which layer of the urinary bladder is responsible for its contractions during urination?

    <p>Muscularis (D)</p> Signup and view all the answers

    What is the primary role of the mucosa in the urinary bladder?

    <p>To allow for expansion to hold urine (A)</p> Signup and view all the answers

    Flashcards

    Normal Urine pH Range

    The normal range for the acidity (pH) of urine is 4.5 to 8, with an average of 6.0.

    Normal Urine Specific Gravity Range

    The normal range for urine specific gravity is 1.003 to 1.030.

    Normal Urine Volume Daily

    The typical daily urine output is 700 to 2000 milliliters.

    Normal Urine Water Content

    Urine is mostly water, typically 93 to 97% by volume.

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    Urinalysis

    Urinalysis involves examining a urine sample to analyze its components for potential medical issues.

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    Urine Composition

    Urine is composed primarily of water, electrolytes, solutes from metabolism, and potentially exogenous substances or drugs.

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    Red Blood Cells in Urine

    Presence of red blood cells in urine suggests possible infection or kidney stones, but other sources are possible.

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    White Blood Cells in Urine

    Presence of white blood cells in urine potentially indicates infection in the urinary tract.

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    Blood Urea Nitrogen (BUN)

    Measures blood nitrogen, a part of urea resulting from amino acid breakdown. This rises with severe reduced kidney filtration (GFR).

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    Plasma Creatinine

    Measures creatinine levels in the blood, which comes from muscle breakdown. It also rises with decreased kidney filtration (GFR).

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    Inulin Clearance

    Measures how efficiently kidneys filter inulin out of the blood. High clearance = efficient filtration. Can be used to measure GFR.

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    GFR (Glomerular Filtration Rate)

    A measurement of how efficiently the kidneys filter blood. A drop in GFR signals kidney issues and impacts waste removal.

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    Kidney Failure

    Condition in which kidneys fail to effectively filter wastes, impacting overall body function.

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    PAH Clearance

    Measures the amount of plasma processed by the kidneys per minute. It's used to measure how fast blood flows through the kidneys.

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    Renal Plasma Flow

    The volume of plasma passing through the kidneys per minute, essential for kidney function.

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    Kidney Function Evaluation

    Methods including urinalysis, blood tests like BUN & creatinine, and clearance tests (like inulin and PAH) used to assess kidney health and function.

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    What are the parts of the urinary tract?

    The urinary tract is comprised of the ureters, bladder, and urethra.

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    What does each ureter do?

    Ureters transport urine from the kidneys to the bladder.

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    What is the bladder's function?

    The bladder stores urine and releases it through the urethra.

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    What does the urethra do?

    The urethra carries urine from the bladder to the outside.

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    What does the term 'peristalsis' mean?

    Peristalsis is the wave-like muscular contractions that move substances through the body. It's how ureters move urine to the bladder.

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    What is the bladder's location?

    The bladder sits just behind the pubic bone, outside of the peritoneal cavity.

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    What are 'rugae' in the bladder?

    Rugae are folds in the urine bladder's lining that disappear as the bladder expands.

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    What is the 'trigone' in the bladder?

    The trigone is a triangular region in the bladder formed by the two ureter openings and the urethra entrance.

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    Chronic Kidney Failure

    A gradual decline in kidney function over time, often caused by diabetes or hypertension. It's not reversible, but progression can be slowed.

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    Acute Kidney Injury (AKI)

    A sudden and rapid decline in kidney function, typically caused by toxins, ischemia, obstruction, or trauma. Recovery is possible, but the kidney may be damaged.

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    How does AKI happen?

    This occurs due to a sudden disruption of the kidney's filtration system, often caused by toxins (drugs, medications), lack of blood flow (ischemia), blockage (obstruction), or physical injury (trauma).

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    Managing Chronic Kidney Failure

    This involves reducing the strain on kidneys by limiting water, salt, and protein intake. This minimizes urine volume and nitrogenous waste.

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    Acidosis in Renal Failure

    Renal failure often leads to acidosis, where the blood becomes too acidic. This can be countered by ingesting bicarbonate ions, which neutralize acid.

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    Hemodialysis

    A type of dialysis using an artificial membrane outside the body to filter blood. It removes waste products and regulates blood composition.

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    Kidney Transplant

    A surgical procedure where a healthy kidney is transplanted from a donor into a recipient with renal failure. It is the only cure for severe kidney failure.

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    Urinary Bladder Neck

    The area surrounding the opening of the urethra in the urinary bladder. It contains a muscular sphincter that controls the flow of urine.

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    Internal Urethral Sphincter

    A muscular ring of smooth muscle located within the neck of the urinary bladder. It's involuntary, meaning you don't consciously control it.

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    External Urethral Sphincter

    A ring of skeletal muscle that surrounds the urethra, located below the prostate in males and at the pelvic floor in females. It's voluntary, meaning you can consciously control it.

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    Urinary Bladder Layers

    The bladder is made up of four main layers: mucosa, submucosa, muscularis, and connective tissue.

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    Urinary Bladder Mucosa

    The innermost layer of the bladder, characterized by rugae and transitional epithelium. It allows the bladder to expand and hold urine.

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    Detrusor Muscle

    The muscle that controls the contraction of the urinary bladder. It consists of three layers: inner longitudinal, circular, and outer longitudinal.

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    Male Urethra

    The male urethra is longer than the female urethra, and it carries both urine and semen.

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    Female Urethra

    The female urethra is shorter and only carries urine. It opens to the exterior between the clitoris and the vagina.

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    What is the Micturition Reflex?

    The Micturition Reflex, also known as the urination reflex, is the process of coordinating urine release from the bladder. It involves both a localized reflex pathway and a central pathway through the brain.

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    Stretch Receptors in Bladder

    Stretch receptors in the bladder wall detect bladder distension as it fills with urine. They send signals to the brain and spinal cord.

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    Sympathetic Stimulation During Bladder Filling

    When the bladder fills, sympathetic nerves stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, preventing urination.

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    Pontine Storage Center

    The pontine storage center in the brain helps regulate bladder storage by decreasing parasympathetic activity (relaxation) and increasing somatic motor nerve activity (contraction) of the external urethral sphincter.

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    What happens during Micturition?

    During urination (micturition), the pontine micturition center triggers the detrusor muscle to contract and the internal urethral sphincter to relax, allowing urine to flow out.

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    Role of the Cerebral Cortex

    The cerebral cortex receives signals from the bladder and controls voluntary relaxation of the external urethral sphincter, allowing for voluntary urination.

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    Polyuria

    Polyuria is the production of excessive urine, often caused by hormonal or metabolic problems like diabetes or kidney disease.

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    Oliguria and Anuria

    Oliguria is a decrease in urine production, while anuria is the near complete absence of urine output. Both indicate serious kidney problems.

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    Study Notes

    Urinary System Evaluation Part 3

    • Normal Urine Composition: Normal urine volume is approximately 1200 mL per day, with an osmotic concentration of 1000 mOsm/L.
    • Changes in urine composition can indicate abnormalities in the urinary system or elsewhere.
    • General Characteristics of Normal Urine:
      • pH range: 4.5-8 (average 6.0)
      • Specific gravity range: 1.003-1.030
      • Osmotic concentration (osmolarity) range: 855-1335 mOsm/L
      • Water content range: 93-97%
      • Volume range: 700-2000 mL/day
      • Color: Pale yellow
      • Odor: Varies with composition
      • Bacterial content: None (sterile)

    Normal Urine Composition (Detailed)

    • Water: Makes up 95% of total urine volume.
    • Remaining 5% (Electrolytes):
      • Solutes derived from cellular metabolism (e.g., urea from protein breakdown, creatinine from creatine phosphate breakdown in muscle fibers, uric acid from nucleic acid breakdown, urobilinogen from hemoglobin breakdown)
      • Exogenous substances (e.g., drugs, fatty acids, pigments, enzymes, hormones)
      • Small quantities of other substances.

    Urinalysis

    • A sample of urine is analyzed to determine individual substances.
    • Substances that can be analyzed:
      • Red blood cells: May indicate infection or kidney stones but can be from other sources
      • White blood cells: May indicate infection in the urinary tract
      • Nitrites: Some bacteria convert nitrates to nitrites, indicating infection in the urinary tract
      • Leukocyte esterase: Indicates infection in the urinary tract
      • Proteins: May indicate kidney disease
      • Glucose: May indicate diabetes mellitus
      • Other substances

    Blood Tests

    • Blood Urea Nitrogen (BUN): Measures blood nitrogen, part of urea resulting from catabolism and deamination of amino acids. Levels may sharply increase with decreases in glomerular filtration rate (GFR) due to renal disease.
    • Plasma Creatinine: Measures plasma levels of creatinine, a result of creatine phosphate catabolism in skeletal muscle. Levels sharply increase with decreases in GFR due to renal disease. Used to estimate GFR (eGFR).
    • Inulin Clearance: Measures the volume of blood that is cleansed of inulin per unit of time, and measures kidney efficiency in removing inulin from the blood. High renal clearance indicates efficient filtration and excretion, while low renal clearance indicates inefficient filtration and excretion. It is considered a gold standard for GFR measurement.
    • PAH Clearance: Measures the amount of plasma passing through the kidneys in a minute. (typically 650 mL/min)
      • PAH (para-aminohippuric acid) is used to measure renal plasma flow, as it is completely filtered and secreted in a single pass.

    Kidney (Renal) Failure

    • Definition: Occurs when kidneys cannot adequately filter waste from blood and maintain homeostasis because GFR is too low.
    • Consequences: Impairs all body systems, resulting in:
      • Decreased urine output
      • Rises in blood pressure
      • Anemia due to decreased erythropoietin production
      • Central nervous system problems (sleeplessness, seizures, delirium, coma)

    Chronic Kidney Failure

    • Causes: Diabetes and hypertension are the most common causes.
    • Progression: Kidney function deteriorates gradually, and associated problems accumulate over time.
    • Management: Reduced water, salt, and protein intake to reduce strain on the urinary system and minimize urine volume and the amount of nitrogenous waste generated. Acidosis (a common complication) can be addressed with bicarbonate.

    Acute Kidney Injury (AKI)

    • Definition: Rapid deterioration of kidney function over a few days to weeks.
    • Causes: Sudden slowing or stopping of filtration, including:
      • Exposure to toxic drugs
      • Renal ischemia
      • Urinary obstruction
      • Trauma
      • Allergic response to certain medications (antibiotics or anesthetics)

    Dialysis

    • Process: Passive diffusion across a selectively permeable membrane.
    • Hemodialysis: Method of filtering waste and excess fluid from the blood using an artificial membrane.

    Kidney Failure Treatment

    • Dialysis: Relieves symptoms but is not a cure.
    • Kidney Transplant: The only real cure for severe renal failure. Survival rates are over 90% at two years post-transplant, with closer relative donors having a higher success rate.
    • Immunosuppressive drugs: Necessary to prevent transplant rejection.

    The Urinary Tract

    • Components: Ureters, bladder, urethra
    • Ureters: Transport urine from kidneys to bladder via gravity and peristalsis; muscular tubes about 30 cm long, retroperitoneal.
    • Bladder: Stores and receives urine; is subperitoneal, anchored to pelvic/pubic bones by ligaments. Mucosa shows rugae (folds) during filling to allow expansion, with two openings (ureteral orifices) on the posterior inferior surface to prevent backflow. It has three layers: mucosa, muscularis (detrusor muscle), and adventitia (outer CT). The internal urethral orifice is where the urine exits the bladder and enters the urethra.
    • Urethra: Conducts urine from bladder to exterior; different lengths/functions in males (longer, passes through prostate) versus females. Lined with stratified epithelium (transitional at the neck, stratified columnar at midpoint, stratified squamous near the external orifice). Has a thick, elastic lamina propria, longitudinal folds in the mucous membrane, mucin-secreting cells. The external sphincter is under voluntary control.

    Urination (Micturition Reflex)

    • Storage Reflex: Stretch receptors in the bladder wall activate afferent fibers to the pontine storage center, which inhibits parasympathetic pathways and stimulates somatic motor nerves, thereby contracting the external urethral sphincter.
    • Micturition Reflex: Coordinated process involving both a local reflex pathway and a central pathway through the brainstem and cerebral cortex. Afferent signals, relayed to the thalamus and cortex, provide conscious recognition of bladder fullness.
    • Stretch receptors trigger local reflex pathway leading to detrusor muscle contraction and relaxation of internal urethral sphincter; voluntary relaxation of external sphincter initiates urination.

    Urinary Disorders

    • Primary signs: Changes in volume and appearance of urine, change in frequency, pain.
    • Polyuria: Excessive urine production (hormonal/metabolic problems like diabetes, or glomerulonephritis)
    • Oliguria: Reduced urine production (50-500 mL/day)
    • Anuria: Severely reduced urine production (0-50 mL/day).
    • Incontinence: Inability to control urination voluntarily.
    • Urinary retention: Initially normal renal function, but urination doesn't occur. In males often due to enlarged prostate gland compressing prostatic urethra.
    • Pain: Pain in superior pubic region (bladder/bladder disorders), lumbar region/flank (kidney infections/stones), associated with dysuria (painful/difficult urination).
    • Fever: Indicates infection of the urinary system (cystitis, pyelonephritis).

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