Crash Course Renal and Urinary System

Front Cover
Renal and Urinary Systems
Copyright
Series editor foreword
Prefaces
Acknowledgements
Contents
Chapter 1: Organization of the kidneys
Overview of the kidney and urinary tract
Functions of the kidney and the urinary tract
General organization of the kidneys
Macroscopic organization
The nephron and histology
Glomerulus
Proximal tubule
Loop of Henle
Distal tubule
Collecting ducts
Blood supply and vascular structure
Function of the renal blood supply
Juxtaglomerular apparatus
Hormones produced by the kidney
Renin
Erythropoietin
Clinical use of EPO
Vitamin D
Development of the kidneys
Congenital abnormalities of the kidney
Agenesis of the kidney
Hypoplasia
Ectopic kidney
Horseshoe kidney
Chapter 2: The glomerulus
Glomerular structure and function
Structure of the glomerular filter
Endothelial cells
Basement membrane
Epithelial lining
Mesangium
Process of glomerular filtration
Molecular size and electrical charge
Glomerular filtration rate
Forces governing tissue fluid formation
Forces governing glomerular filtration rate
Measurement of glomerular filtration rate
Clearance
Estimated glomerular filtration rate (eGFR)
Regulation of renal blood flow and glomerular filtration rate
Myogenic mechanism
Tubuloglomerular feedback mechanism
Renal blood flow and systemic blood pressure
Diseases of the glomerulus
Overview
The mechanisms of glomerular injury
Circulating immune complex nephritis
In situ immune complex deposition
Cell-mediated immunity
Activation of alternative complement pathway
Cytotoxic antibodies
Clinical manifestations of glomerular disease
Asymptomatic haematuria
Asymptomatic proteinuria
Nephrotic syndrome
Acute nephritic syndrome
Rapidly progressive GN
Chronic kidney disease (CKD)
Primary glomerulonephritis typically presenting with heavy proteinuria or the nephrotic syndrome
Minimal change disease
Membranous glomerulonephropathy
Focal segmental glomerulosclerosis
Primary glomerulonephritis typically presenting with the nephritic syndrome
IgA nephropathy (Berger's disease)
Rapidly progressive (crescentic) glomerulonephritis
Focal proliferative glomerulonephritis
Membranoproliferative glomerulonephropathy
Secondary glomerulonephritis
Post-streptococcal glomerulonephritis
Non-streptococcal glomerulonephritis
Systemic lupus erythematosus
Henoch-Schönlein purpura
Bacterial endocarditis
Diabetic glomerulosclerosis
Amyloidosis
Goodpasture's syndrome
Microscopic polyarteritis nodosa (also known as microscopic polyangiitis)
Wegener's granulomatosis
Hereditary nephritis
Alport's syndrome
Fabry's syndrome
Chapter 3: The tubules and the interstitium
Overview
Transport processes in the renal tubule
Transport mechanisms
Diffusion
Facilitated diffusion
Primary active transport
Secondary active transport
Ion channels
Regulation of body fluid pH
Buffers
Definition
Henderson-Hasselbalch equation
Physiological buffers
Bicarbonate buffer system
Renal regulation of plasma HCO3-
HCO3- reabsorption by the proximal tubule
HCO3- reabsorption by the distal tubule
Conversion of alkaline phosphate to acid phosphate - luminal buffer
Ammonia secretion - luminal buffer
Acid-base disturbances
Examples of acid-base disturbances
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Regulation of calcium and phosphate
Calcium
Calcium and phosphate homeostasis
Parathyroid hormone
Vitamin D
Calcitonin
Ca2+ transport by the kidney
Phosphate
Clinical features and causes of Ca2 disturbances
Hypocalcaemia
Hypercalcaemia
Regulation of potassium and magnesium
Potassium
Transport of potassium
K transport by the kidney
Hypokalaemia
Hyperkalaemia
Clinical features
Treatment
Magnesium
Renal handling of Mg2+
Hypomagnesaemia
Transport of other solutes in the tubules
Glucose
Amino acids
Urea
Sulphate
The loop of henle
Role of the loop of Henle
Structure of the loop of Henle
Thin descending limb
Thin ascending limb
Thick ascending limb
Countercurrent multiplication
Role of vasa recta and urea
Body fluid osmolality
Concepts of osmolality
Osmoreceptors
Sensitivity of osmoreceptors to osmotic changes caused by different solutes
Antidiuretic hormone (vasopressin)
Synthesis and storage
Release
Cellular actions
Aquaporins
Drugs affecting ADH release
Water clearance and reabsorption
Effect of solute output on urine volume
Adrenal steroids and urinary dilution
Disorders of osmolality
Hyponatraemia
Causes
Syndrome of inappropriate ADH secretion (SIADH)
Hypernatraemia
Causes
Diabetes insipidus
Diseases of the tubules and interstitium
Overview
Acute tubular necrosis
Ischaemic acute tubular necrosis
Toxic acute tubular necrosis
Rhabdomyolysis
Tubulointerstitial nephritis
Pyelonephritis
Acute pyelonephritis
Chronic pyelonephritis
Toxin- and drug-induced tubulointerstitial nephritis
Acute urate nephropathy
Hypercalcaemia and nephrocalcinosis
Multiple myeloma
Chapter 4: Body fluid volume
Control of body fluid volume
Basic concepts
Body fluids
Sodium balance
Handling of sodium by the kidney
Transport of sodium in the proximal tubule
The distal tubule and loop of Henle handling sodium
Renin-angiotensin-aldosterone system
Renin
Conversion of angiotensinogen to angiotensin
Aldosterone
Other factors affecting Na+ reabsorption
Starling's forces in the proximal tubule
Sympathetic drive from the renal nerves
Prostaglandins
Atrial natriuretic peptide (ANP)
Renal responses to systemic disorders
Congestive cardiac failure
Treatment and management
Hypovolaemia and shock
Cardiogenic shock
Vasodilated shock
Hypovolaemic shock
Treatment
Hepatorenal syndrome
Hypertension
Essential hypertension
Secondary hypertension
Renal causes
Endocrine causes
Drug causes
Coarctation of the aorta
Management of hypertension
Angiotensin-converting enzyme inhibitors (ACE i)
Diuretics
Osmotic diuretics
Loop diuretics
Thiazide diuretics
Potassium-sparing diuretics
Carbonic anhydrase inhibitors
Diseases of the renal blood vessels
Renal artery stenosis
Thrombotic microangiopathies
Haemolytic uraemic syndrome
Thrombotic thrombocytopenic purpura
Renal infarction
Embolic infarction
Diffuse cortical necrosis
Sickle-cell disease nephropathy
Benign nephrosclerosis
Malignant nephrosclerosis
Chapter 5: The lower urinary tract
Organization of the lower urinary tract
Overview
Ureters
Urinary bladder
Interior of the bladder
Male urethra
Female urethra
Prostate
Congenital abnormalities of the urinary tract
Ureteric abnormalities
Double and bifid ureters
Pelviureteric junction obstruction
Bladder abnormalities
Diverticula
Exstrophy
Urethral abnormalities
Hypospadias
Epispadias
Urethral valves
Micturition
Normal micturition
Neurological disorders of micturition
Lesion in the superior frontal gyrus
Lesion of afferent nerves from the bladder
Lesion of both afferent and efferent nerves
Spinal cord lesion
Spina bifida
Diabetes mellitus
Multiple sclerosis
Pelvic surgery
Urinary incontinence
Stress incontinence
Urge incontinence
Overflow incontinence
Continuous incontinence
Functional incontinence
Mixed incontinence
Nocturnal enuresis - bedwetting
Urinary tract obstruction and urolithiasis
Urinary tract obstruction
Congenital abnormalities
Tumours
Calculi (urolithiasis)
Pregnancy
Hyperplastic lesions
Inflammation
Neurogenic disorders
Hydronephrosis
Presentation of urinary obstruction
Urolithiasis (urinary calculi)
Presentation
Treatment
Inflammation of the urinary tract
Cystitis
Chronic cystitis
Interstitial cystitis
Malakoplakia vesicae
Schistosomiasis (bilharzia)
Urethritis
Disorders of the prostate
Prostatitis
Acute prostatitis
Chronic prostatitis
Chronic non-bacterial prostatitis
Benign prostatic hypertrophy
Incidence
Presentation
Pathology
Complications
Treatment
Medical treatment
Surgical treatment
Chapter 6: Neoplasia and cysts of the urinary system
Neoplastic disease of the kidney
Benign tumours of the kidney
Renal fibroma or hamartoma
Cortical adenoma
Malignant tumours of the kidney
Renal cell carcinoma
Incidence and risk factors
Presentation
Diagnosis
Pathology
Prognosis
Treatment
Wilms´ tumour (nephroblastoma)
Incidence and presentation
Pathology
Treatment and prognosis
Urothelial carcinoma of the renal pelvis
Neoplastic disease of the ureters and bladder
Tumours of the ureters
Benign tumours of the ureter
Malignant tumours of the ureters
Tumours of the bladder
Metaplasia
Benign tumours of the bladder
Transitional cell carcinoma of the bladder
Presentation
Pathology
Diagnosis, treatment and prognosis
Squamous cell carcinoma
Adenocarcinoma
Carcinoma of the prostate
Incidence and risk factors
Presentation
Pathology
Diagnosis
Treatment and prognosis
Cystic diseases of the kidney
Overview
Polycystic kidney disease
Adult - autosomal dominant
Incidence and presenting features
Pathology
Diagnosis
Prognosis
Treatment
Child - autosomal recessive
Incidence and presenting features
Pathology
Diagnosis, prognosis and treatment
Cystic renal dysplasia
Medullary sponge kidney
Incidence and presenting features
Pathology
Diagnosis, prognosis and treatment
Acquired cystic disease (dialysis associated)
Simple cysts
Chapter 7: Acute kidney injury and chronic kidney disease
Terminology
Uraemia
Acute kidney injury
Diagnostic approach to AKI
Management
Chronic kidney disease
Screening of people at risk
Causes
Preventing progression of CKD
Complications and management
Fluid retention
Hypertension
Increased cardiovascular risk
Osteodystrophy
Anaemia
Electrolyte disturbances
Acidosis
Uraemia
Renal replacement therapy
Haemodialysis
Haemofiltration
Peritoneal dialysis
Renal transplantation
Pharmacokinetics in renal disease
Absorption
Distribution
Metabolism
Elimination
Chapter 8: Clinical assessment of the renal system
History
History of presenting complaint
Past medical history
Drug history
Family history
Social history
Ideas, concerns and expectations
Examination
General inspection
Hands
Arms
Blood pressure
Face
Neck
Thorax
Respiratory system
Cardiovascular system
Abdomen
Inspection
Palpation
Percussion
Auscultation
Digital rectal examination
Legs
Testing the blood and urine
Haematuria
Causes
Diagnostic approach
Proteinuria
Imaging and other investigations
Plain radiography
Ultrasonography
Computed tomography
Intravenous urography and intravenous pyelography
Renal arteriography
Micturating cystourethrography
Urodynamic studies
Retrograde pyelography
Antegrade pyelography
Magnetic resonance imaging
Radionuclide scanning
Other imaging techniques
Cystoscopy
Renal biopsy
Single best answer questions (SBA)
Extended-matching questions (EMQs)
SBA answers
EMQ answers
Glossary
Index