Alterations of Renal and Urinary Tract Function
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Questions and Answers

Which factor is least likely to contribute to the development of renal cell carcinoma (RCC)?

  • Uncontrolled hypertension
  • Obesity
  • Cigarette smoking
  • Controlled hypertension (correct)

A 65-year-old male presents with gross, painless hematuria. Which type of tumor should be most suspected?

  • Renal cell carcinoma (RCC)
  • Acute cystitis
  • Renal adenoma
  • Renal transitional cell carcinoma (RTCC) (correct)

Which of the following is the most common causative agent of urinary tract infections (UTIs)?

  • Proteus mirabilis
  • Escherichia coli (correct)
  • Staphylococcus aureus
  • Klebsiella pneumoniae

A 25-year-old female reports bladder fullness, frequency, small urine volume, and chronic pelvic pain. Bacterial cultures are negative. Which condition is most likely?

<p>Painful bladder syndrome/interstitial cystitis (A)</p> Signup and view all the answers

Which of the following physiological responses is a key host defense mechanism against uropathogens in the urinary tract?

<p>Normal micturition (urination) flushing out bacteria (B)</p> Signup and view all the answers

Chronic pyelonephritis is most likely to develop in individuals who have renal infections combined with what other condition?

<p>An obstructive pathological condition (A)</p> Signup and view all the answers

Which of the following mechanisms is NOT typically associated with the injury observed in glomerulonephritis?

<p>Direct trauma to the kidney (C)</p> Signup and view all the answers

A patient with severe glomerulonephritis is likely to exhibit which combination of symptoms?

<p>Hematuria with red blood cell casts, proteinuria exceeding 3.5 g/day, and oliguria (B)</p> Signup and view all the answers

Which condition is characterized by the excretion of 3.5 g or more of protein in the urine per day due to glomerular injury?

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

In acute kidney injury (AKI), what is the primary cause of prerenal AKI?

<p>Impaired renal blood flow (D)</p> Signup and view all the answers

During which phase of acute kidney injury (AKI) is the kidney damage already established, with the lowest urine output and increasing levels of serum creatinine and blood urea nitrogen?

<p>Maintenance (oliguric) phase (A)</p> Signup and view all the answers

What characterizes the recovery (polyuric) phase of acute kidney injury (AKI)?

<p>Normal renal function re-established, diuresis common, and decline in serum creatinine (D)</p> Signup and view all the answers

What is a significant risk factor contributing to acute kidney injury (AKI) in patients with COVID-19?

<p>Mechanical ventilation and COVID-associated ARDS (C)</p> Signup and view all the answers

Which GFR range defines the 'moderate' stage of chronic kidney disease (CKD)?

<p>30 to 59 mL/min (D)</p> Signup and view all the answers

What systemic condition is frequently associated with chronic kidney disease (CKD)?

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

Which factor does NOT directly influence the severity of urinary tract obstruction?

<p>Patient's age (D)</p> Signup and view all the answers

What is the primary difference between hydroureter and hydronephrosis?

<p>Hydroureter involves dilation of the ureter, while hydronephrosis involves enlargement of the renal pelvis and calyces. (C)</p> Signup and view all the answers

Compensatory hypertrophy and hyperfunction in the kidneys, as a result of upper urinary tract obstruction, primarily aims to:

<p>Maintain normal kidney function despite the obstruction. (B)</p> Signup and view all the answers

Which of the following is NOT a known risk factor for the formation of kidney stones?

<p>High fluid intake (A)</p> Signup and view all the answers

Supersaturation, a key factor in kidney stone formation, refers to what condition?

<p>A higher concentration of a salt than can be dissolved in the available volume. (C)</p> Signup and view all the answers

What is the underlying cause of renal colic associated with kidney stones?

<p>Spasms of the ureter as it attempts to move the stone. (D)</p> Signup and view all the answers

Which treatment approach is LEAST likely to be used in the initial management of kidney stones?

<p>Surgical removal of the kidney (A)</p> Signup and view all the answers

What is dyssynergia in the context of neurogenic bladder?

<p>Coordination between the detrusor muscle and the urethral sphincter is disrupted. (B)</p> Signup and view all the answers

What is a common characteristic of overactive bladder syndrome (OBS)?

<p>Increased urinary frequency, urgency, and nocturia (A)</p> Signup and view all the answers

Low bladder wall compliance contributes to lower urinary tract obstruction by:

<p>Reducing bladder capacity and increasing pressure during filling. (A)</p> Signup and view all the answers

Which of the following conditions is a risk factor for the development of renal cell carcinoma (RCC)?

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

A 62-year-old male presents with gross, painless hematuria. Further examination leads to a diagnosis of cancer. Which type of cancer is most likely?

<p>Renal transitional cell carcinoma (RTCC) (C)</p> Signup and view all the answers

Which of the following bacteria is the most common cause of urinary tract infections (UTIs)?

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

A 30-year-old female reports experiencing bladder fullness, frequency, and chronic pelvic pain with negative bacterial cultures. Which of the following conditions is the most likely diagnosis?

<p>Painful bladder syndrome/interstitial cystitis (B)</p> Signup and view all the answers

Which factor is least likely to be associated with the development of acute pyelonephritis?

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

What is the initial physiological response of the kidneys to an upper urinary tract obstruction, aiming to maintain function?

<p>Compensatory hypertrophy and hyperfunction of the unobstructed nephrons. (D)</p> Signup and view all the answers

Which of the following best describes the process of hydronephrosis?

<p>Dilation of the renal pelvis and calyces due to urine backup. (B)</p> Signup and view all the answers

The deposition of circulating antigen-antibody complexes within the glomerulus is characteristic of which type of hypersensitivity reaction in glomerulonephritis?

<p>Type III (immune complex) hypersensitivity (B)</p> Signup and view all the answers

Postobstructive diuresis following the relief of a urinary tract obstruction can lead to excessive fluid loss and electrolyte imbalances. This condition is most closely related to what renal disorder?

<p>Nephrogenic diabetes insipidus. (A)</p> Signup and view all the answers

What key finding differentiates nephrotic syndrome from nephritic syndrome?

<p>Excretion of &gt;3.5 grams of protein in urine per day (D)</p> Signup and view all the answers

Which of the following factors is most directly involved in the initial formation of kidney stones?

<p>Supersaturation of salts in the urine. (A)</p> Signup and view all the answers

A patient is in the maintenance (oliguric) phase of acute kidney injury (AKI). Which set of biochemical findings is most consistent with this phase?

<p>Lowest urine output, increasing serum creatinine and BUN (A)</p> Signup and view all the answers

Upon analyzing a patient's kidney stone, it is found to be primarily composed of struvite. Which of the following factors is most likely associated with the formation of this type of stone?

<p>Chronic urinary tract infections with urease-producing bacteria. (A)</p> Signup and view all the answers

Why is increasing fluid intake a key recommendation in the management of kidney stones?

<p>To dilute the urine, reducing supersaturation and the risk of further stone formation. (D)</p> Signup and view all the answers

What is the primary mechanism by which impaired renal blood flow leads to prerenal acute kidney injury (AKI)?

<p>Decreased glomerular filtration pressure (C)</p> Signup and view all the answers

In the recovery (polyuric) phase of acute kidney injury (AKI), which of the following processes is occurring?

<p>Re-establishment of normal renal function with diuresis (A)</p> Signup and view all the answers

A patient experiencing renal colic due to kidney stones is most likely to exhibit which symptom?

<p>Severe, intermittent pain radiating from the flank to the groin. (A)</p> Signup and view all the answers

What is the primary mechanism behind detrusor hyper-reflexia in neurogenic bladder?

<p>Uncontrolled or overactive bladder contractions due to neurologic disorders. (C)</p> Signup and view all the answers

What is the rationale for paying careful attention to volume status in COVID-19 patients in order to mitigate the risk of acute kidney injury (AKI)?

<p>To minimize renal hypoperfusion and subsequent tubular damage (D)</p> Signup and view all the answers

Which of the following is a major contributing factor to lower urinary tract obstruction related to reduced bladder wall compliance?

<p>The bladder wall becomes stiff and less able to stretch, increasing pressure during filling. (C)</p> Signup and view all the answers

Which of the following is a common systemic condition associated with chronic kidney disease (CKD) that can accelerate its progression?

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

What is the most likely underlying cause of overactive bladder syndrome (OBS)?

<p>Neurological dysfunction affecting bladder control. (D)</p> Signup and view all the answers

Why might mechanical ventilation in COVID-19 patients increase the risk of acute kidney injury (AKI)?

<p>It often leads to hypotension and reduced renal perfusion (C)</p> Signup and view all the answers

A patient with glomerulonephritis presents with hematuria, mild proteinuria, and hypertension. Which of the following underlying mechanisms is the most likely cause of these findings?

<p>Immune-mediated glomerular injury (C)</p> Signup and view all the answers

What is the underlying cause of proteinuria in nephrotic syndrome?

<p>Damage to the glomerular filtration barrier (D)</p> Signup and view all the answers

Flashcards

Renal Tumors

Tumors affecting the kidneys, including renal adenomas and renal cell carcinoma (RCC).

Bladder Tumors

A type of renal tumor, most common being Renal Transitional Cell Carcinoma (RTCC).

Urinary Tract Infection (UTI)

Inflammation of the urinary epithelium caused by bacteria.

Acute Cystitis

Inflammation of the bladder. Manifestations include frequency, dysuria, urgency, and lower abdominal/back pain

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Acute Pyelonephritis

Acute infection of the ureter, renal pelvis, and interstitium; often due to reflux.

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Glomerulonephritis

Inflammation of the glomerulus, often due to immunological abnormalities, ischemia, or toxins.

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Glomerulonephritis Injury Mechanisms

Deposition of antigen-antibody complexes, antibodies reacting against antigens, or nonimmune factors causing damage to the glomerulus.

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Glomerulonephritis Manifestations

Hematuria with red blood cell casts and proteinuria (3-5g/day), often accompanied by oliguria, hypertension and edema.

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Nephrotic Syndrome

Excretion of 3.5g or more of protein in the urine per day due to glomerular injury which leads to Hypoproteinemia, Edema, Dyslipidemia and lipiduria and Vitamin D Deficiency.

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Prerenal AKI

Caused by impaired renal blood flow, leading to decreased GFR and filtration pressure.

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Intrarenal AKI

Acute tubular necrosis (ATN), often postischemic or nephrotoxic, is the most common cause.

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Postrenal AKI

Occurs with urinary tract obstructions that affect both kidneys.

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AKI Initiation Phase

Kidney injury is evolving, and intervention may prevent progression.

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AKI Maintenance (Oliguric) Phase

Established kidney injury with decreased urine output, increased serum creatinine and BUN.

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AKI Recovery (Polyuric) Phase

Injury repaired, normal renal function returns, diuresis is common, creatinine and urea decline.

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Urinary Tract Obstruction

Interference with urine flow at any point in the urinary tract, due to anatomical or functional defects.

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Hydroureter

Dilation/accumulation of urine in the ureter.

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Hydronephrosis

Enlargement of the renal pelvis and calyces due to urine backup.

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Ureterohydronephrosis

Dilation of both the ureter and the pelvicalyceal system.

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Hypertrophy

The enlargement of an organ or tissue from the increase in size of its cells.

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Hyperfunction

Increased functional activity of an organ or tissue.

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Postobstructive Diuresis

Increased urination following the release of urinary tract obstruction, leading to loss of sodium, water, and potassium.

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Kidney Stones (Calculi)

Crystals, proteins, or other substances that form in the urinary tract.

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Neurogenic Bladder

A bladder dysfunction caused by neurologic damage.

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Detrusor Hyperreflexia

Bladder muscle overactivity, causing frequent urination, urgency, and nocturia.

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Renal Cell Carcinoma (RCC)

A type of kidney tumor; risk factors include smoking, obesity, and hypertension.

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Escherichia coli (E. coli)

A common bacterial cause of UTIs.

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Painful Bladder Syndrome / Interstitial Cystitis

Nonbacterial cystitis, common in women 20-30; causes bladder fullness, frequency, and pelvic pain.

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Compensatory Hypertrophy

Enlargement of an organ or tissue due to increased cell size after obstruction.

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Compensatory Hyperfunction

Increased functional activity of an organ or tissue after obstruction.

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Chronic Pyelonephritis

Persistent or recurring episodes of acute pyelonephritis leading to scarring.

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Acute Kidney Injury (AKI)

Reduced kidney function ranging from renal insufficiency to end-stage kidney disease (ESKD).

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Study Notes

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