Comprehensive Radiographic Pathology: Chapter 6: Urinary System Flashcards


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1

Nephron

functional unit of the kidney
Each kidney contains more than a million nephrons.

Functions: filter waste products from the blood, reabsorb water and nutrients (e.g., glucose and amino acids) from the tubular fluid, and secrete excess substances in the form of urine.

2

How much water do nephrons filter each day?

In an average person, the nephron filters about 190L of water out of glomerular blood each day

3

Formation of urine begins here

Glomerulus

4

Glomerulus

Tuft of capillaries with very thin walls and a large surface area

5

Erythropoietin

substance produced by the kidney stimulates the rate of production of red blood cells

6

Incontinence

involuntary emptying of the bladder at intervals caused by cerebral hemorrhage and spinal cord injury

7

Micturate

act of urinating

8

Unilateral renal agenesis

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A rare congenital anomaly in which only one kidney forms

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Unilateral renal agenesis image

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hypoplastic kidney

Appears as a miniature replica of a normal kidney, with good function

underdeveloped kidney

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hypoplastic kidney image

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Ectopic Kidney

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Abnormal position, such as in the pelvis (pelvic kidney) or high near the diaphragm (intrathoracic kidney)

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ectopic kidney image

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Supernumerary kidney

A rare anomaly in which a small, rudimentary third kidney forms
Functions normally, but are prone to infections that eventually may require their removal

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Supernumerary kidney image

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Horseshoe kidney

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Kidneys fused at the lower poles
The most common fusion anomaly

17

horseshoe image

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18

Ureterocele

Ureterocele is a cystic dilatation of the distal ureter
near its insertion into the bladder.

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two types of ureterocele

Simple (adult)
Ectopic

20

what age group is ureterocele normally found in? What is it commonly associated with?

Found almost exclusively in infants and children Commonly associated with ureteral duplication

21

ureterocele image

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22

Glomerulonephritis

is a nonsuppurative inflammatory process involving the tufts of capillaries (glomeruli) that filter the blood within the kidney. Glomerulonephritis is an antigen-antibody reaction that most commonly occurs several weeks after an acute upper respiratory or middle ear infection with certain strains of hemolytic streptococci.

23

What is glomerulonephritis caused by?

More frequently, the inflammatory process is caused by a chronic autoimmune disorder.

24

What is glomerulonephritis cause?

Causes the glomeruli to be extremely permeable, allowing albumin and red blood cells to leak into the urine (resulting in proteinuria or hematuria). It causes oliguria - a smaller-than-normal amount of urine.

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Glomerulonephritis image

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What is pyelonephritis? What is it caused by? What does it affect?

Pyelonephritis is a suppurative inflammation of the kidney and renal pelvis with patchy distribution. It is caused by pyogenic (pus-forming) bacteria. It affects the interstitial tissue between the tubules. It often affects only one kidney. It is asymmetric if both kidneys are involved.

27

Where does pyelonephritis infection originate?

Infection usually originates in the bladder, ascends the ureter to involve the kidneys.

28

Who is pyelonephritis more common in?

Pyelonephritis is more common in women
and children.

29

When does pyelonephritis develop? What is a contributing factor?

It develops in patients with obstruction of the urinary tract (enlarged prostate gland, kidney stone, congenital defect). It causes stagnation of urine - a breeding ground for infection. Instrumentation or catheterization of the ureter is also a contributing factor.

30

Symptoms of pyelonephritis are:

  • High fever
  • Chills
  • Sudden back pain that spreads over the abdomen
  • Dysuria
  • Pyuria
  • Bacteria can be cultured from the urine or
    observed in the urinary sediment
31

pyelonephritis image

card image
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Oliguria

a smaller-than-normal amount of urine

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Dysuria

painful urination

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pyuria

pus in the urine

35

What is the most common nosocomial infection?

Cystitis

36

Cystitis

Cystitis is an inflammation of the urinary bladder.

37

Who is cystitis most common in? why?

It is most common in women.
Due to a shorter urethra

38

what is a major cause of cystitis? other?

Major: Spread of bacteria present in fecal materia

Other: Instrumentation or catheterization of the bladder
Retrograde flow from urine bag
• Bag must be kept below the patient to prevent retrograde
flow.
Sexual intercourse

39

cystitis symptoms

Urinary frequency, urgency, and burning sensation

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cystitis image

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41

Urinary calculi most commonly form in the kidney as ___________.

kidney stones

42

kidney stone symptoms

They are asymptomatic until they lodge in the ureter and cause partial obstruction. This results in extreme pain that radiates from the area of the kidney to the groin.

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Cause of kidney stones varies.

  • Often reflect an underlying metabolic abnormality, such as hypercalcemia (resulting from hyperparathyroidism).
  • Any cause of increased calcium excretion in the urine
  • Urinary stasis and infection
44

Most accurate modality for kidney stones

CT

45

what can kidney stones cause?

Can cause hydronephrosis
Blockage above the level of the bladder

46

Staghorn calculus

Renal calculus that completely fills the renal pelvis

47

Nephrocalcinosis

a condition in which calcium levels in the kidneys are increased

48

Hydronephrosis

distention of the pelvis and calyces of the kidneys

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Hydronephrosis cause

blockage above the level of the bladder

50

the most common unifocal mass of the kidney.

renal cyst

51

Renal cyst

  • Fluid-filled, usually unilocular-Septa sometimes divide the cyst into chambers
  • They vary in size.
  • They may occur at single or multiple sites in one or both kidneys.
52

most common renal neoplasm

Renal cell carcinoma, also known as hypernephroma

53

what age group is renal cell carcinoma most common in?

It occurs predominantly in patients older than 40 years.

54

where does renal carcinoma originate in?

Renal carcinoma originates in the tubular epithelium of the renal cortex.

55

Classic symptom triad of renal cell carcinoma:

  • Hematuria
  • Flank pain
  • Palpable abdominal mass
56

the most common abdominal neoplasm of infancy and childhood.

Wilms’ Tumor (Nephroblastoma)

57

Where does Wilms' Tumor arise from?

It arises from embryonic renal tissue.

58

What does Wilms' Tumor appear as?

It may be bilateral.
It tends to become very large and appear as a palpable mass.

59

who is renal vein thrombosis most common in?

Renal vein thrombosis occurs most frequently in children who are severely dehydrate.

60

modality of choice for renal vein thrombosis

ultrasound

61

what is the main reason for adults to get renal vein thrombosis?

In adults, is most often a complication of another renal disease

62

Malrotation

Rotation on the longitudinal or horizontal axis; asymptomatic

63

Crossed ectopia

An ectopic kidney lies on the same side as the normal kidney and is very commonly fused

64

Complete fusion and varied names

A rare anomaly that produces a single irregular mass has no resemblance to a renal structure

Varied names - disk, cake, lump, and doughnut kidney

65

Duplication (duplex kidney)

A common anomaly that varies from a simple bifid pelvis to a completely double pelvis, ureter, and ureterovesical orifice.

66

what can complete duplication of the kidney be complicated by?

Complete duplication can be complicated by obstruction or by vesicoureteral reflux with infection.

67

Posterior Urethral Valves

  • Posterior urethral valves are thin transverse membranes in the urethra.
  • Found almost exclusively in males
  • Cause bladder outlet obstruction
  • They may lead to severe hydronephrosis, hydroureter, and renal damage.
68

What is posterior urethral valves best demonstrated on?

This is best demonstrated on a voiding cystourethrogram.

69

What is renal tuberculosis? How is it spread?

Renal tuberculosis usually occurs as a secondary infection from lung involvement Hematogenous spread It can evolve from other sites.

70

When does renal tuberculosis manifest?

manifests 5 to 10 years after the primary infection.

71

What may renal tuberculosis lead to the development of?

It may lead to the development of small granulomas scattered in the cortical portion of the kidneys.

72

Papillary necrosis

is a destructive process involving a varying amount of the medullary papillae and the terminal portion of the renal pyramids.

73

Predisposing factors include of papillary necrosis:

  • Diabetes
  • Pyelonephritis
  • Urinary tract infection
  • Urinary tract obstruction
  • Sickle cell disease
  • Phenacetin abuse
74

Polycystic kidney disease

an inherited disorder in which multiple cysts of varying size cause lobulated enlargement of the kidneys and progressive renal impairment.

75

One-third of patients with polycystic kidney disease also have? Does it interfere with hepatic function?

One-third of patients also have liver cysts.
Do not interfere with hepatic function

76

Complications of polycystic kidney disease

About 10% have one or more saccular (berry) aneurysms of cerebral arteries

May rupture and produce a fatal subarachnoid hemorrhage

Many are hypertensive.

77

how is polycystic kidney disease diagnosed? why?

Most tend to be asymptomatic during the first three decades of life

Early diagnosis is made either by chance or by specific search due to family history

78

where does carcinoma of the bladder most commonly originate?

most commonly originates in the epithelium.

79

what is carcinoma of the bladder referred to as? who is it most common in?

It is referred to as urothelial carcinoma
Previously - transitional cell carcinoma
It is most common in men over age 50.
It is the fourth most common cancer in men.

80

predisposing factors of bladder cancer:

  • Industrial chemicals
  • Cigarette smoking
    • Presumably due to carcinogenic metabolites being excreted in urine
81

what is acute renal failure? what does it result in?

Acute renal failure is a rapid deterioration in kidney function.
It results in the accumulation of nitrogencontaining wastes in the blood.
It causes a characteristic urinelike odor or “fishy” breath.

82

Two types of acute renal failure:

Prerenal
Postrenal

83

Prerenal failure causes include:

  • Decreased blood flow to the kidneys (hemorrhage, dehydration, surgical shock)
  • Cardiac failure
  • Renal artery obstruction
84

Postrenal failure causes:

Urine outflow obstruction from both kidneys
• Prostatic disease
• Functional obstruction of the bladder neck

85

Other causes of acute renal failure:

  • Kidney diseases, such as glomerulonephritis, bilateral acute pyelonephritis, and malignant (severe) hypertension
  • Nephrotoxic agents (antibiotics, radiographic contrast material, anesthetic agents, heavy metals, organic solvents)
  • Intravascular hemolysis
  • Large amounts of myoglobin (muscle protein) in the circulation from muscle trauma or ischemia
86

what makes chronic renal failure reflect?

may reflect prerenal, postrenal, or intrinsic kidney disease.

87

Causes of chronic renal failure include:

  • Bilateral renal artery stenosis
  • Bilateral ureteral obstruction
  • Intrinsic renal disorders, such as chronic glomerulonephritis, pyelonephritis, and familial cystic diseases
88

acid-base balance

stable concentration in body fluids

89

Bowman's capsule

cup-shaped end of renal tubule

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collecting tubule

funnels urine into the papillary ducts in the renal pelvis

91

complete fusion

occurs in the kidneys and produces a single irregular mass that has no resemblance to a renal structure

92

electrolyte balance

equilibrium of electrolytes in the body

93

hydroureter

dilation of the ureter

94

hypernephroma

most common renal cell carcinoma

95

intrathoracic kidney

kidney located in the thoracic cavity

96

loop of henle

U-shaped portion of the renal tubule

97

nephrocalcinosis

calcium deposits within the substance of the kidney

98

pelvic kidney

kidney located in the pelvis

99

proximal convoluted tubule

second part of the Nephron, first part of renal tubule

100

supernumerary kidney

an extra kidney

101

trigone

triangular area of the posterior bladder, between the opening of the ureters and urethra

102

uremia

presence of excessive amounts of urea and nitrogen in the blood