Anatomy - Urinary System PDF

Renal System Dr Anthony Adefolaju Lecturer, Anatomy [email protected] Where opportunity creates success UM2010 1. Rev...

Renal System Dr Anthony Adefolaju Lecturer, Anatomy [email protected] Where opportunity creates success UM2010 1. Review the anatomy of the renal Learning Outcomes system 2. Outline common pathologies of the renal system 3. Outline the principal causes associated with acute kidney injury and chronic kidney disease 4. Explain how renal dialysis is used  Part 1 1. Review the anatomy of the renal system 2. Outline common pathologies of the renal system Structural overview Structural overview can be divided into 2 parts: Upper:Kidneys (retroperitorial), abdominal GU meters. of the part Lower:Waters (inferior part), bladder and GU wethra Structural overview Superior Urinary Organs retropiritemal are primary structures:Kidneys, Preters, Merels, suprarenal Glands >superomedial >superomedial · Pancreas, Antirosuperior - >Antiriomedial inferior O >superolateral -Antirainferior · Landmarks of leftkidney · Landmarks of Right kidney view ( (ventral Structural overview Superior part · of kidney his posterior to rib 11212. · inferior Rightkidney to left kidney (due to presence of liver J. Structural overview I oute to inner (nos. ( 2 S 6 3 I I X 4 : of renal tip pyramid 8 Structural and functional overview · large I will organised varculature. Renal artery enters from · abdominal aorta at 11-12. · Corter receives 10x more blood than medulla.  Renal vascular anatomy suprarimal artery supplies the Inferior DifferentBranches of Renal Artery adrenal gland. · Anterior Branch 2 Branch Porterial posterior >supplies Apical Segmental s Arteries region of kidney superior Segmental Arturis Middle/Ant. Inferior Segmental Arteries Segmental Inferier Arteries < The paired renal arteries take about 20% of the cardiac output. Renal vascular anatomy is important, particularly when undertaking partial nephrectomy. why partial nephrectancy is this can be done who the affecting blood supply of other parts of the kidney  · has million each kidney around 1.4 nephrons originate that from the contir. · The DCT is contact of in macula dense inner ( Histology of the Renal Corpuscle ① Paristal layer centerior Bowman's space of renal corpusch) a ↳ space blu glomerals Viral layer:formed by podocytes (pedicels). 3 and bowman's capsule · There 2 membranes basement both the visceral & layer. parital are accompanying Podocytes pedicels · have processes cald that wrap around the to capillaries filter blood. Blood farced under prusure through the fenestration capillary this · is becomes filtrate. the  Membrane > Podocyte + Basement Filtrates das NOT include large proteins (eg: RBC) Common Pathologies  Renal agenesis absence (congenital kidney ( of the Renal agenesis is usually unilateral. Bilateral renal agenesis (1 per 3000/4500 live births) Unilateral renal agenesis Found in roughly 1/1000 live births (higher in twins) fatal, often · not causes no additional symptoms. baby born w/ I kidney · other A if is - kidney grows Always confirm the presence of a larger compensate to to achine functions the of both. and kidney before renal or biopsy rephrectomy. Ectopic kidneys form in an abnormal site, usually the pelvis, but are otherwise structurally normal. · can had to kinked (tortuous) with. > Horseshoe kidneys Fusion of the two nephrogenic blastemas during fetal life results in the kidneys being fused, usually at the lower poles. kidney this isbecause the ascends develops pehins the in in fortus the then to 4-12 level.  An where the fund located anomaly kidneys are and · Crossed fused renal ectopia. side same on the the midline of malformation at Renal Cysts Cysts in the kidney, multiple or solitary, are common findings during ultrasound examinations and dissection of cadavers. Adult polycystic disease of the kidneys is an important cause of renal failure; it is inherited as an autosomal dominant trait. * kidney distorted is and enlarged by cyst. the MRI Nephrolithiasis (also called renal calculi, or urolithiasis), usually occurs in the upper urinary tract. multiple or solitary. Located parenchyma within the renal or within collecting system. badraphans the Stoms can cause obstruction wine backflow It is very common worldwide, with a lifetime risk of about 10%. >obstruction & infection causes permanent damage to the kidney  Causes of urinary tract stones Dehydration Hypercalcaemia Hypercalciuria Hyperoxaluria Jercs ocolate in ( wine Hyperuricaemia and hyperuricosuria Infection >high levels ↳ of daily vie wine aid aid in (after arid excretion blood of more L Cystinuria amounts associated gout w/ women. than 800 750 mg mg in men and ereurine of in cysteine Primary renal disease (polycystic kidneys, wine medullary sponge kidneys, renal tubular in acidosis) >congnital disorder: bidneys when do not acids formation of cysts small from remove blood Drugs either in tubules they should-raising or the as the aid and in collecting ducts. can reduce blood. the outward flow of kidneys. Types of urinary tract stones Different types of renal calculi have varying XR densities Approximately 75-90% are radio opaque (visible) on plain X-rays and almost all are visible on CT Common types of stone Calcium oxalate – most common (75% of stones) and most radio-opaque Calcium phosphate – Most are radio-opaque Struvite – Generally radio-opaque; account for 15% of stones. Most staghorn calculi are struvite. Uric acid – Least radio-opaque. Usually radiolucent on XR but visible on CT. Account for 10% of stones. Common in patients with large branche le increased uric acid levels (e.g. gout) part of and extend re n a l the pelnis majority into the calices. of Nephrolithiasis - Clinical features VERY COMMON Ureteric colic occurs when a stone enters the ureter and either obstructs it or causes spasm during its passage down the ureter. >causes severe due pain to peristaltic movement of water. the Classically, pain radiates from the flank to the iliac fossa, testis or labia. Pallor, sweating and vomiting often occur and the patient is restless, trying to obtain relief from the pain. Haematuria often occurs. Untreated, the pain of I ureteric colic typically subsides after a few hours. some patients may be asymptomatic. Nephrolithiasis - Investigations Dipsticks are used to test for red cells, protein and glucose. A mid-stream specimen of urine should be taken for microscopy (crystals) and culture. Serum urea, electrolyte, creatinine (eGFR) and calcium levels should be measured. Ultrasonography shows kidney stones and renal pelvis dilation well but ureteric stones can be missed. Computed tomography of kidneys, ureters and bladder (CT-KUB) is the best diagnostic test available and has a sensitivity of >95%. It involves radiation and in young patients many physicians perform ultrasonographs as the first investigation. Extracorporeal shock wave lithotripsy In this procedure, acoustic shock waves are generated external to the patient and focused on the renal stones, which are fragmented into small pieces that can be spontaneously passed in the urine. skin and renal unharmed. > parenchyma are  Renal cell carcinoma Renal cell carcinomas (RCCs) arise from proximal tubular epithelium. They are the most common renal tumour in adults (accounting for 1–2% of all malignancies) and affect men more often than women (2:1). after usually present the age of 50, RCCs are highly vascular tumours rarely befor the age Characteristics/Clinical Presentation of 40. triad of: Macroscopic haematuria: 60% Flank pain: 40% Palpable flank mass: 30-40% This triad is however only found in 10-15% of patients  Glomerulonephritis Inflammation within the third retention in eyes, hands, glomeruli, which can and feet 1 abdominal regions. range from acute or chronic, usually stems from humoral immune reactions. Regardless of the source the accumulating -coca-cola coloured ~ were immune complexes can then elicit a local inflammatory response.  Pyelonephritis causative bacteria Benign Prostatic:enlargementof prostate. Usually the > seen in older can cause Hyperplasia men, symptoms uncomfortable winary of such as of an blocking the in usually from -> or problems. kidney Vericouteral:condition w h e re flows wine backward lowes > Rifler from bladder the to one or writers both and to sometimes bidneys. tract the winary  Cystitis Inflammation of the bladder mucosa, is the most frequent problem involving this organ. Such inflammation is common during urinary tract infections, but it can also be caused by immunodeficiency, urinary catheterization, radiation, or chemotherapy. · If the inflammation gets toochronic, then the epithelium urinary can became unstable to hading blade cancers. cystitis inflammation of bladder frequentbladder problem. · - the mucosa. Most  Urethritis Urinary tract infections, usually involving coliform bacteria or Chlamydia. due to shorter withra. · factor-female Risk gender a Such infections are usually accompanied by a persistent or more frequent urge to urinate, and urethritis may W produce pain or difficulty during urination (dysuria). polyvina * can cause cystitis  by infection, kidneys, affected renal failure, calculi, septicana. Prostate enlargement Causes: · BPH · Prostate cancer Ureters when cute becomes the normal due to than bigger backlog the of wine. Bladder Bladder outpouching Thickening of Bladde Walls Brethren Prostate observed as a bulge noticiable  End of Part 1 1. Reviewed the anatomy of the renal system 2. Outlined common pathologies of the renal system  Part 2 3. Outline the principal causes associated with acute kidney injury and chronic kidney disease 4. Explain how renal dialysis is used  Acute Kidney Injury (AKI) defined as An abrupt deterioration in renal function, usually over hours or days. Sudden decline · of GFR over a few hours or days. It is usually (but not always) reversible over days or weeks. · significantincrease serum in creativins, blood ura and levels. some electrolyte AKI may cause sudden, life-threatening biochemical disturbances as a medical emergency. Oliguria is often a feature. >production of abnormally small amounts of wine. root * meds often emurgney before dialysis c ause has been established. >every factor that reduces blood flow the to - kidneys. Causes of Acute Kidney Injury > detection ultrasound (for any obstruction). using ↳directly affects renal the parenchyma such as glomerular injury as problems of blood will supply or damage to the tubul that >conditions are external to kidney + caves back to excited wine. pressure  Chronic Kidney Disease The term ‘chronic kidney disease’ (CKD) has replaced terms like chronic renal failure or insufficiency. CKD is a descriptive term and is used for deteriorating kidney function of any underlying cause. include:prituriona, Symptoms nausea, deared mental acuity, dereared wine output. Some patients a re lab tests. asymptomatic - require * Inohus progressive renal function impairinest for 3 months or more.  CKD Causes Congenital and inherited disease Glomerular disease – (Primary glomerulonephritides, Secondary glomerular diseases) - of group disorders by intraglomerular inflammation, characterised hematoria and edema. by hypertension, clinically manifested Vascular diseases Tubulointerstitial nephritis inflammation > surrounding that affects tissue a of the tubules bidneys intiistitium). the and the idiopathic, due to drugs (especially nephrotoxic analgesics), immunologically mediated - Chinese herb nephropathy, Hypertension very common in CKD. >dircase w/associated carcinema. urothelial Diabetes mellitus – the most common cause of CKD Urinary tract obstruction  dirases similar. Both quite · are If AKD months · > 3 -> CKD. · CKD can had to Akp/AK1 and vice versa. https://pittccmblob.blob.core.windows.net/adqi/16fig.pdf  for renal Common indications biopsis: Renal replacement therapies  Transplantation Helps To- support elimination of nitrogenous and maste · Renal replacement therapy · products. p Rectors fluid and homeostaris electrolyte · Maintain normal plasma pH. About 3 million people worldwide either are treated by haemodialysis or peritoneal dialysis, or live with a functioning renal transplant. >end stage kidney In the UK, around 53,000 people receive treatment for ESKD; around P dears 50% have been transplanted, 42% are on haemodialysis and 8% are on peritoneal dialysis.  Haemodialysis Basic principles Anticoagulated blood from a patient is pumped around an extracorporeal circuit and through a biocompatible, semipermeable membrane (the dialyser, or ‘artificial kidney’) before being returned to the circulation  ar, actinonerous * constructed surgically 1 Patient has artiriovenus is required. fistula radiocephalic fistula -> this is by using achieved radial/brachial artery along of the cephalis win. -> Arterialised win can be then wrd exchange to blood blu the person's body dialysis and the machine. Haemodialysis team so ↳ written that doesn't compress the surgical it by acidentwhich may had to Effective dialysis needs blood flows of between 250 and 450 mL/min. formation of thromboris Procedure Includes Risk of: can also earily damage the fistula, · Bloodstream infections, athler malfunction, thrombier, to the cutting off access formation of venous stemesis or recursion. kidney.  to similar harmodialysis - is difference the use of solution replacement Haemofiltration - ↳ solution contains was connection => for blood purification. biochemical desired once blood chan, is itis returned to the patient. * and effective simple never trialment t han treatment, Peritoneal dialysis piritonal ↳ membrane as acts semipermeable membrane. This the avoids. heamedialysis. circulation need the for intracorporal of blood. Renal Transplantation -more complete form of renal replacementtherapy. I because transplant replaces kidney the functions of the Kidneys for kidneys. ( native transplantation may come from deceased or living donors; the latter are associated with a better long- term survival. The 1-year survival of renal transplants now Hazards: "may require uppersive immunes exceeds 90%, and the fiction amplications exerapoatiPresentful half-life of a renal can - also increase the risk of transplant is around malignancies 10 years. ↳better long for term survival from living kidney donor. * are stemic, arteries proudure for atherosclerotic If renal balloon angioplasty the can lision be performed.  Types of Renal Bypass Prociduous and Complications for stenor artery:by-pass surgery -> may performed. be Hepatorial bypass damaged artery · ligated is + saphenous graft. win · splenomenal blood bypass:Main supply to the spleen is cut, itstill but ricius blood from the short arteries. gastric The renal arteries -> are connected then to this cut protein of spline actory. -> Damaged artery ligated. remains bypass:saphenous -other to ways vin graft, or a graft synthetic be used. may Additional resources https://portal.uclan.ac.uk/bbcswebdav/pid-4535566-dt-content-rid-9547987_1/xid- 9547987_1?globalNavigation=false https://portal.uclan.ac.uk/bbcswebdav/pid-4533968-dt-content-rid-9537612_1/xid- 9537612_1?globalNavigation=false https://uclan.alma.exlibrisgroup.com/leganto/public/44UOCL_INST/citation/55866488300 03821?auth=SAML  End of Part 2 1. Reviewed the anatomy of the kidney 2. Outlined common pathologies of the renal system 3. Outlined the principal causes associated with acute kidney injury and chronic kidney disease