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Kidneys lie at WHAT level?
T12-L3
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The Right kidney sits where compared to the left kidney?
the right kidney is inferior and more anterior than the left
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The left kidney is -blank- than the right.
Longer
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Kidney's are surrounded by what?
fat capsule
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The outer layer of the kidney is called:
Cortex
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The inner layer of kidney is called:
Medulla
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Functional unit if Kidney is-
Nephron
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Each kidney contains how many Nephrons?
over 1 million
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Nephron filters how much water out of the glomerular blood each day?
190 Liters
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How much water is excreted back into the urine?
About 1-2Liters
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How much water is reabsorbed into the Tubular blood after it has been filtered out of the glomerular blood?
about 99%
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Ureters enter bladder where?
at Trigon
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Trigon of bladder is found where?
posterior aspect of bladder
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How is reflux prevented in bladder and ureters?
The angle of the ureter insertion into the bladder. (no valve is present)
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What are the 4 jobs of the Urinary System?
- 1: Maintain Homeostasis
- 2: Control concentration & Blood volume
- 3: Cleanse blood
- 4: Urine formation
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Urine formation occurs where?
in the Glomerulus
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Blood enters the kidneys through the:
Renal artery
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Blood travels from the Renal artery to?
Interlobar-Arcuate-Interlobular-Afferent-Glomerulus
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Initial urine travels to blank first, then to the loop of henle.
Proximal convoluted tubule
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What takes place in the loop of henle?
re-absorption of Salt and Water
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Urine travels from the loop of henle to?
Distal convoluted tubule
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the Distal convoluted tubule's job is what?
permits excretion of concentrated urine by actively secreting potassium & hydrogen ions
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Where is Bowman's capsule found?
around the glomerulus
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Is blood pressure higher in Bowman's capsule or Glomerulus?
Glomerulus
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What 2 things do not pass through the Bowman's capsule (unless there is something wrong)?
Protein and RBC's
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The amount of fluid re-absorbed back into the body (tubular blood) in influenced by 2 hormones...they are???
Antidiuretic and aldosterone
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ADH (antidiuretic hormone) is secreted by what gland?
Posterior pituitary gland
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Aldosterone is secreted by what gland?
Adrenal gland
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About how long does it take to cleanse all the blood in the body?
4 hours
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Ph of blood should be between what?
7.35-7.45
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if Ph of blood is lower than 7.35 then it is considered:
too acidic
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if Ph of blood is higher than 7.5 then it is considered:
too alkaline (base)
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What is Erythropoietin?
substance produced in the kidney that stimulates rate of RBC production
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What is the correlation between Renal failure and Anemia?
Kidneys control RBC production (by producing erythropoietin) so if kidney function starts to fail then so does RBC production resulting in decreased amount of RBC-anemia
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What is Renal agenisis?
Only 1 kidney develops it is also larger than normal due to compensatory hypertrophy
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supernumerary kidney is what?
presence of 3rd kidney
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supernumerary kidneys and ureters?
can have it's own separate ureter or can have a branch attaching to one of the ureters from one of the kidneys that are supposed to be there.
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does a supernumerary kidney function normal?
yes...but tends to get infections easier so it may be removed due to this complication
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What is a hypoplastic kidney?
a normal functioning kidney that is smaller than what is should be
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What is an Atrophic kidney?
Small but not normal functioning kidney-the calyces are enlarged due the parenchyma's small size
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What is compensatory hypertrophy?
acquired condition that develops when 1 kidney is forced to perform function normally carried out by 2 kidneys
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Compensatory hypertrophy is caused by:
Cell size (not number of cells)
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Compensatory hypertrophy is most common in which age groups?
Children (chances diminish in adulthood)
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Compensatory hypertrophy is associated with?
renal agenesis & hypoplastic kidney
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Malrotated kidney is what?
Normal functioning kidney that is in a unique orientation (rotation of some sort)
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What is an ectopic kidney?
Abnormally positioned kidney (it is not within it's normal parameters of T12-L3)
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Types of ectopic kidneys
Pelvic (kidney is found in true pelvis) & Intrathoracic (kidney is found above diaphragm)
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Which type of Ectopic kidney is more common?
Pelvic kidney
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How can you distinguish ectopic kidney from nephroptosis?
By the length of the ureter. If there is a long ureter and the kidney is not where it is supposed to be then it is a nephroptosis (it has fallen from where it was). If the kidney has a short ureter attached to it then it originally was located in the pelvis (it didn't fall so if is ectopic)
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Define "horseshoe" kidney.
Both kidneys are malrotated & the lower poles are joined by either band of renal parenchyma or connective tissue
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In "horseshoe" kidney the ureters exit where?
Anteriorly over the lower poles (instead of medially)
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In "horseshoe" kidney, the lower poles point:
medially
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What is a Crossed Ectopy?
Both kidneys lie on same side of body and are usually fused.
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What is complete fusion of the kidney?
There is No resemblance to renal structure. It is a single irregular mass.
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Complete fusion is AKA:
Disk, cake, lump, doughnut (can be S,C,L,J shapes)
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In a complete fusion is the kidney still able to function?
yes
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Hom many ureters enter the bladder when the kidneys are completely fused?
2
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Can complete fused kidneys be found within the pelvis?
Yes
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Out of "horseshoe" and complete fusion-which is more common?
"Horse-Shoe" kidney
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What is an Ureterocele?
Cyst-like dilation of distal ureter proximal to the ureterovesical orifice (ureter insertion into bladder)
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Ureterocele's appear as -
"spring-onion" sign or "cobra" sign
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Ureterocele's are a result from what?
stenosis of ureterovesical orifice
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Ectopic Ureterocele's are found in what age group?
Almose exclusively in Infants & Children
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In US how does a ureterocele appear?
as a round-cystlike structure within the bladder.
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Children with ureteral duplication have how much of a chance of having associated ureteroceles?
80%
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Posterior Urethral Valves happens in which sex more?
Males
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What is Posterior Urethral Valves?
- Thin transverse membrane that cause the bladder obstruction & may lead to severe hydronephrosis, hydroureter & renal damage.
- The thin membrane works as a reverse valve into bladder.
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How is Posterior Urethral Valves best demonstrated?
with VCUG (able to see stricture of Urethra)
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What is Glomerulonephritis?
Nonsuppurative inflammatory process involving the glomeruli
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What is Gomerulonephritis caused by?
- Antigen-antibody reaction that occurs after a streptococci infection of upper respiratory tract or middle ear.
- Inflammatory process causes the glomeruli to become very permeable (which allows Albumin & RBC's to leak into urine)
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Glomerulonephritis can become chronic...
- Fibrotic reaction that causes kidneys to shrink & lose function
- Renal outline remains smooth
- Primarily involves parenchyma (glomeruli & tubules)
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What is Pyelonephritis?
- Suppurative inflammation of kidney and renal pelvis
- Affects interstitial tissue between the tubules
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Pyelonephritis is caused by what if found in descending portion?
Bacteria or Lymph
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Pyelonephritis is caused by what if found in ascending portion?
Stagnating urine due to an obstruction
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Symptoms of Pyelonephritis include:
Chills, high fever, back pain, sweating, dysuria, hematuria
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Define Dysuria
Painful urination
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Define Hematuria
Blood in urine
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Overall Radiograph Appearance of Pyelonephritis
- Patchy calyceal clubbing with overlying parenchymal scarring. (Most pronounced in poles.)
- Often involves only 1 kidney
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What is modality of choice for pyelonephritis?
- CT-shows cortical changes & can show abcess
- can also detect hydronephrosis (indicating Urinary Tract Obstruction)
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Chronic pyelonephritis is seen best with:
Ultrasound-shows loss of renal parenchyma
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Chronic pyelonephritis is caused by?
- Chronic reflux of urine from bladder to renal pyramids
- Leads to scarring of kidney and marked dilation of calyces
- Atrophy of parenchyma around dilated calyces is seen
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What is Emphysematous Pyelonephritis?
severe form of acute parenchymal & perirenal infection with gas forming bacteria
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Emphysematous pyelonephritis is found mainly in patients with....
Diabetes
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What is Cystitis?
Inflammation of urinary bladder
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Cystitis is more common in which sex?
females
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What causes Cystitis?
Escherichia Coli (E. Coli)
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Symptoms of Cystitis?
Urinary frequency, burning with urination
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Chronic cystitis is visualized how?
decrease in bladder size with irregularity of bladder wall
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Define Calculi:
Kidney Stones
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How do Calculi form?
precipitation of urine products (calcium salts) out of urine soulution
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Calculi are cause by:
- Familial tendency
- Underlying metabolic abnormality (hypercalcemia from hyperthyroidism)
- Large doses of Vitamin C
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Calculi are asymptomatic till what?
Until they descent or cause an obstruction (otherwise no symptoms are present)
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80% of kidney stones are what?
- radiopaque-due to calcium content
- (difficult to visualize when using contrast)
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What is Lithotripsy?
Shock wave to blow calculi apart (means of treatment)
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ESWL?
Extracorporeal shock wave - Calculi are crushed with acoustic shock wave in the kidney (Not the Ureter).
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PUL?
Percutaneous Ultrasonic Lithotripsy - use shock wave to blow stone apart and then retrieve pieces through sides of the abdomen
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What are Staghorn Calculus made of?
Composed of Magnesium ammonium phosphate (stuvite) calculi
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What is a Staghorn calculus?
a stone that fills the entire renal pelvis which causes a Urinary Tract Obstruction
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Best treatment for Staghorn calculus?
PUL-percutaneous Ultrasonic Shockwave
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Hydronephrosis is what?
- Kidney is dilated with urine
- Dilation of calyces and pelvis with atrophy of parenchyma if it is chronic
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Define Hydroureter:
- Ureter is dilated with urine
- There is a Urinary Tract obstruction somewhere distal to the dilation in the ureter.
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Urinary tract obstructions can cause what if prolonged?
Renal failure
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Renal cysts are normally found where?
in lower pole of kidney
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In CT how does a renal cyst density appear?
The density remains the same after injecting contrast - No vascularity
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Polycyctic kidney disease is what?
- Many tiny cysts present at birth that gradually enlarge as patient ages (30's)
- Ends up compressing & destroying normal kidney tissue
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Patients usually have End Stage renal disease by what age when have Polycystic Kidney Disease?
40 yrs old
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