Pathology CH 7 Urinary system

Kidney anatomy/location

two, removes waste from the bloodstream for excretion by forming urine. the site where urine is formed and excreted through the processes of filtration and reabsorption, involving up to 180 L of blood per day. Urine formed by this process amounts to approximately 1 L to 1.5 L per day and passes from the kidneys to the bladder through the ureters.The kidneys are retroperitoneal, normally located between the twelfth thoracic vertebra and the third lumbar vertebra. The right kidney lies slightly lower because of the presence of the liver superiorly. The kidneys are posteriorly rotated approximately 30o from the coronal plane, making the medial border of each kidney more anterior than the lateral border. Each kidney contains approximately one million nephrons.

Hilum

The notch located on the medial surface of each kidney. area where structures enter and leave the kidney. These structures include the renal artery and vein, lymphatics, and a nerve plexus.

Serum Creatinine

most common laboratory tests. In a normal adult, serum creatinine production and excretion are constant. The GFR may be estimated (eGFR) by using the serum creatinine value in combination with the individual’s age, race, and gender. IV contrast agents should not be used in persons with a BUN greater than 50 mg/dL or a serum creatinine greater than 3 mg/dL.

BUN

most common laboratory tests conducted. levels are influenced by urine flow and the production and metabolism of urea. BUN designates the ability of the urinary system to break down nitrogenous compounds from proteins to produce urea nitrogen. IV contrast agents should not be used in persons with a BUN greater than 50 mg/dL or a serum creatinine greater than 3 mg/dL.

Nephrostomy Tube

tube inserted through the abdominal wall into the renal pelvis to drain urine. may be left in place to provide drainage of an obstructed kidney or to allow for retrieval of a calculus with a basket catheter. Sometimes the procedure is used to relieve obstruction in individuals for whom immediate surgery is not possible. also provides a means for diverting urine in cases where there is perforation or a fistula from the ureters or the bladder which requires time to resolve. usually performed in fluoroscopy, is known as a nephrostogram or antegrade nephrostogram study. A nephrostogram may be performed to check tube placement, evaluate for resolution of a perforation or fistula, or to check healing of a urinary anastomosis.

connects the renal pelvis to the outside of the body. It is inserted percutaneously through the renal cortex and medulla into the renal pelvis to allow urine to drain outside of the body directly from the renal pelvis. Special care must be taken, as these individuals are readily prone to infections because of the direct opening into the urinary system.

Ectopic Kidney

kidney that is out of its normal position, usually lower than normal. often asymptomatic. Its drainage may be impaired by malposition of its ureter within the renal pelvis, which may require surgical repair with pyeloplasty. one that is out of its normal position, generally involving overascent or underascent. Underascent is more common and pelvic or sacral kidneys occur in approximately 1 in 1000 live births with a 3:2 male-to-female prevalence. In rare cases of overascent, the ectopic kidney may be in an intrathoracic location.

Polycystic Kidney Disease

familial kidney disorder in which innumerable tiny cysts that are present congenitally gradually enlarge during aging to compress and eventually destroy normal tissues. This anomaly results from mutations of the PKD-1 and PKD-2 genes, and occurs in 1 in 1000 live births.

Cystitis

Inflammation of the bladder as a result of its infection. which is an acute or chronic inflammation of the bladder, is a fairly common infection that is generally caused by bacteria such as E. coli and Staphylococcus saprophyticus. more prevalent in females than in males because the short urethra in females provides bacteria easier access into the bladder. includes antibiotic therapy and an abundance of fluids. Prevention of pyelonephritis is paramount.

Renal Colic

Severe, agonizing pain that refers along the course of a ureter toward the genital and loin regions in response to the movement of a renal calculus. mimic renal colic include appendicitis, diverticulitis, ruptured ovarian cyst, and leaking abdominal aortic aneurysms.

Hydronephrosis

obstructive disease of the urinary system that causes a dilation of the renal pelvis and calyces with urine. Dilated renal pelvis and calyces caused by an obstructive process. US or CT can assess kidney size and screen. occur as a congenital defect or because of a blockage of the system by a tumor, stricture, blood clot, or inflammation. Individuals often complain of flank pain, and their urine may contain blood (hematuria) or pus (pyuria). The long-term changes are reversible if the cause of obstruction is relieved early in the process.

Renal Cell Carcinoma

The most common malignant tumor of the kidney is RCC, an adenocarcinoma arising from renal tubular epithelium in the cortex of the kidney. It occurs two to three times more frequently in males than in females, with an increased incidence after 50 years of age, and accounts for approximately 2% of adult cancer-related deaths. Because pulmonary metastases are common, chest radiography should be performed immediately upon discovering a renal carcinoma.

Horseshoe Kidney

condition in which the lower poles of the kidney are joined across midline by a band of soft tissues, resulting in a rotation anomaly on one or both sides. the most common fusion anomaly, is a condition affecting approximately 1 in 400 live births, with males affected twice as frequently as females. The incidence is higher in individuals with Down syndrome and Turner syndrome. Persons with horseshoe kidney are more prone to duplication anomalies of the collecting systems, stone formation, UPJ obstruction, and UTIs.

Vesicoureteral Reflux

The backward flow of urine out of the bladder and into the ureters.

Pyuria

The presence of pus in urine, created by its drainage from renal abscesses into the kidney’s collecting tubules. Urinalysis demonstrates pyuria, the presence of pus (white cells) created by the body’s reaction to the infection.

Pyelonephritis

Bacterial infection of the kidney and its pelvis. considered the most common renal disease, is a bacterial infection of the calyces and renal pelvis. is rare in males with a normal urinary tract but is common in females, especially pregnant females following urinary catheterization or as the increased size of the uterus compresses the ureter and decreases urinary clearance of bacteria. also a problem for females who have had recurrent UTIs and as a result have E. coli bacteria (80%) that have progressed up the ureter and infected portions of the kidney. Persons with acute have fever, flank pain, and general malaise.

Nephroblastoma

A malignant tumor of the kidney generally occuring in children under 5 years of age is an

The amount of urine formed in a typical day is 1L to 1.5 L. Urine is formed and excreted in the nephron, the microscopic unit of the kidney

True about the anatomy and function of the urinary system

Blood urea nitrogen level, creatinine blood level, coloration of urine

Urinary system disorders may be suggested by an abnormal

Fusion

Horseshoe kidney is an anomaly of

Crossed ectopy exists when one kidney lies across the midline, fused to the other. ureteroceles are retail dilations near the ureters termination.

True of urinary system anomalies

Major calyx

Vesicoureteral reflux refers to the backward flow of urine into the

Doppler sonography

Arterial and venous renal blood flow in a person who has received a kidney transplant is best assessed by using

Atrophy following obstruction, chronic Pyelononephritis, Hypoplasia

Condition can make kidney appear smaller than normal

CT, renal sonography

The procedure will most likely be preformed to image a nonfunctioning kidney

Renal failure

Gradual and chronic deterioration of the renal parenchyma eventually results in

Urea/ creatinine check*

Renal failure is characterized by the abnormal retention of which of the following substances of blood

Precipitation of solutes out of urine is the pathogenesis stones tend to asymptomatic until they move or cause obstruction

True about renal calculi

Hydronephrosis

significant dilation of the renal pelvis and calyces as a result of an obstruction from a stone is characteristic of

Chronic inflammation from obstruction may result in adenocarcinoma, early excision of nephron blastoff has shown very high cure rate

True of neoplastic diseases in the urinary system

Creatinine above 1.5 mg/dl requires caution.

blood values checked before injected with Iv contrast, maximum values allowed for contrast administration

Ascending Infection, Hematogenous spread Lymphatic spread

Three mechanisms through which bacteria can enter urinary tract

Loss of functioning nephrons

in renal failure what causes the kidney to lose its normal regulatory and excretory functions