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Pathophysiology
Review of Urinary Anatomy & Physiology
• Located:
– Under back muscles
– Behind peritoneum
• Thus: retroperitoneal
– Below level of lowest ribs
– Right lower than left
– Adrenal gland on top of
kidney
• Cortex
• Medulla
– Contains Pyramids &
Papilla
• Pelvis
– Calyx = division of pelvis
• Pleural = calyces
• Bladder
– Lined with transitional
epithelium
• Can stretch
– Lined with rugae
– Trigone
• On posterior wall
• Where ureters & urethra
open
• Rigid area with NO rugae
– Micturition (voiding,
urination)
• Internal urinary sphincter
– Involuntary
• External urinary sphincter
– Voluntary
• Stretch receptors in
bladder wall
• Nephron = functional unit
– Consists of:
• Renal Corpuscle
• Renal Tubules
• Renal Corpuscle contains:
– Bowman’s capsule
• Part of collecting
system
– Glomerulus
• Afferent arteriole
• Efferent arteriole
• Renal Tubules
1. Proximal convoluted tubule
2. Loop of Henle
3. Distal convoluted tubule
4. Collecting tubule
• Key point:
– The cortex contains
all the structures of
the nephron
• Glomerulonephritis
– Acute
• Sx = proteinuria, edema, oliguria
• Etiol = 1-2 weeks post strept
infect.
– Chronic
• Etiol = autoimmune disease
– e.g. lupus, diabetes, hepatitis C
• Can lead to irreversible kidney
damage
• Nephrotic Syndrome
– Glomerular disorder where one loses the capacity
to retain protein, especially albumin
– Sx
– severe edema (anasarca)
* can get skin breakdown since
impaired arterial flow
– proteinuria
– hypoalbuminemia
– oliguria
– Etiol:
» Toxic agents (lead, mercury)
» Toxic drugs (aminoglycosides)
» Diseases (diabetes, lupus
» Key = any significant problem with
glomerulus can lead
to nephrotic syndrome
Obstructive Disorders
• Renal Calculi
– Etiology: Calcium, Uric • Tumors
acid, Urine crystals – Note that primary
– Symptoms: renal colic, N&V, symptom = hematuria
chills, fever – Renal Cell Ca = most
– Risk factors: prolong common, unilateral, adeno
dehydration, prolong Ca from tubular epithelium
immobilization, infection • See picture
– Treatment: – Bladder Ca = usually from
surgery,lithotripsy transitional epithelium
• Vesicoureteral reflux
• Due to ectopic insertion of ureter into bladder. If far away from
trigone, do not get adequate compression of ureter when voiding &
get reflux
• Incidence: 1/1000
• If one gets it each sibling(to be) has 50% incidence
• Girls> boys; 10:1 ratio
• Ectopic kidney
• May get kinking of ureter
• Usually in pelvis
• Asymptomatic
• Renal agenesis
• Usually unilateral & left kidney
• 2 types: (1) occurs randomly (2) genetic
• Asymptomatic
• Remaining kidney becomes large since compensatory hypertrophy
Congenital Diseases (cont)
• Polycystic kidney (2 types
– In adults (see picture)
• Genetic etiol ----- autosomal dominant
• Clinically seen in adults
– Between age 30 – 40 one begins to get renal
failure
• Tx = transplant
– In children
• Genetic etiol --- autosomal recessive
• Manifest at birth; usually fatal or infant stillborn
• Rare
• Wilm’s tumor (nephroblastoma)
• Most common tumor of children; usually
unilateral
• Etiol = autosomal recessive (on chromosome 11)
• Manifests between age 2 – 5 years & presents as
abdominal mass
– May produce hypertension
• 5 year survival = 90%
Renal Failure
• Acute renal failure
– Abrupt decrease in renal function
• Nitrogenous wastes accumulate
– Usually reversible
– Sx:
• Oliguria
• Drowsiness
• Altered levels of consciousness
– Etiol:
• Glomerular disease
• Severe pyelonephritis
• Nephrotoxins that damages
tubular epithelium
• Ischemic causes
– shock
• ATN (acute tubular necrosis)
» e.g. burns(hgb
accumulates)
» e.g. trauma (myoglobin
accumulates)
• Chronic Renal Failure
– Get slow progressive loss
of neurons
– Usually irreversible
– Course = gradual
– Etiol:
• Vascular disease
– e.g.
hypertension
– Disease called
nephrosclerosis
• Glomerular disease
– e.g. diabetes
• Tubular disease
– e.g. toxins
• 2 types:
– Hemodialysis
– Peritoneal dialysis
• Mechanism
– Simple diffusion for
wastes &
electrolytes
– Osmosis for water
balance