pediagenosis: Urinary
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Showing posts with label Urinary. Show all posts
Showing posts with label Urinary. Show all posts

Thursday, February 18, 2021

PARTIAL NEPHRECTOMY

PARTIAL NEPHRECTOMY

PARTIAL NEPHRECTOMY

Although radical nephrectomy is the standard surgical treatment for large renal tumors, nephron-sparing surgery has become the new standard of care for small (<4.0 cm) renal masses (SRMs).

SIMPLE AND RADICAL NEPHRECTOMY

SIMPLE AND RADICAL NEPHRECTOMY

SIMPLE AND RADICAL NEPHRECTOMY

Simple nephrectomy refers to the surgical removal of the kidney without the renal fascia or ipsilateral adrenal gland. This technique may be employed to treat non-neoplastic, irreversible  kidney  disease that poses an ongoing threat to the patient’s health. Possible indications include chronic pyelonephritis, chronic renal obstruction, extensive untreated nephrolithiasis, trauma, and ischemic nephropathy secondary to renal artery stenosis.

RENAL REVASCULARIZATION

RENAL REVASCULARIZATION

RENAL REVASCULARIZATION

Renal artery stenosis (RAS) is defined as an anatomic narrowing of the main renal artery or its segmental branches, which can lead to secondary renovascular hypertension (RVH) and renal failure if sufficiently advanced. The pathophysiology and diagnosis of this lesion are demonstrated in Plates 4-36 and 4-37. Briefly, the major causes are atherosclerosis, which accounts for about 90% of cases, and fibromuscular dysplasia (FMD), which accounts for most of the remainder. Atherosclerosis, which tends to occur in older individuals with classic risk factors, involves the intimal layer of the artery and develops circumferentially to occlude a progressive fraction of the vessel lumen. FMD, in contrast, causes collagenous dysplasia of either the intimal or medial arterial layers.

PERCUTANEOUS NEPHROLITHOTOMY

PERCUTANEOUS NEPHROLITHOTOMY

PERCUTANEOUS NEPHROLITHOTOMY

Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the treatment of kidney stones. In this procedure, a surgical access tract is established between the skin and the renal collecting system. The tract is typically created under fluoroscopic guidance, with needle puncture followed by tract dilation.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive procedure for the treatment of nephrolithiasis. In this procedure, acoustic shock waves are generated external to the patient and focused on the renal stones, which are fragmented into small pieces that can be spontaneously passed in the urine. The skin and surrounding renal parenchyma receive a much smaller dose of energy and therefore remain largely unharmed.

Saturday, February 6, 2021

HEMODIALYSIS, PERITONEAL DIALYSIS, AND CONTINUOUS THERAPIES

HEMODIALYSIS, PERITONEAL DIALYSIS, AND CONTINUOUS THERAPIES

HEMODIALYSIS, PERITONEAL DIALYSIS, AND CONTINUOUS THERAPIES

When kidney dysfunction is severe enough to cause homeostatic abnormalities that cannot be corrected with diet or medications, dialysis is performed to artificially replace the kidney’s major functions. The major goals of dialysis are to support the elimination of nitrogenous waste products, restore fluid and electrolyte homeostasis, and restore normal plasma pH. The major indications are listed in the plate.

RENAL BIOPSY

RENAL BIOPSY

RENAL BIOPSY

A renal biopsy yields a small piece of renal parenchyma for histopathologic examination. Because many renal diseases have essentially indistinguishable clinical findings, renal biopsy is often crucial for establishing the correct diagnosis and devising an effective treatment plan. The procedure is generally uncomplicated and, in most cases, can safely be performed by a nephrologist at the bedside.

INHIBITORS OF THE RENIN-ANGIOTENSIN SYSTEM

INHIBITORS OF THE RENIN-ANGIOTENSIN SYSTEM

INHIBITORS OF THE RENIN-ANGIOTENSIN SYSTEM

As shown on Plate 3-19, the renin-angiotensin system plays an essential role in the regulation of systemic blood pressure. In brief, renin is released from juxta-glomerular cells in response to decreased renal tubular flow, sympathetic input, or decreased stretch of afferent arterioles. Renin catalyzes the conversion of angiotensinogen to angiotensin I, which is rapidly converted by angiotensin-converting enzyme (ACE) into angiotensin II (AII). AII increases blood pressure through direct vasoconstrictor effects on systemic vessels and through various other mechanisms, including increased sodium reabsorption from the renal tubules, potentiation of sympathetic tone, and stimulation of aldosterone and antidiuretic hormone release.

POTASSIUM-SPARING DIURETICS

POTASSIUM-SPARING DIURETICS

POTASSIUM-SPARING DIURETICS

ACTIONS AND MECHANISM

In the connecting tubule and cortical collecting duct, principal cells are responsible for K+ secretion through two major mechanisms. First, the reabsorption of Na+ through apical ENaC channels leaves a negative charge in the tubular lumen, which promotes the secretion of potassium through apical ROM-K channels. Second, increased flow rates through the distal nephron stimulate K+ secretion through apical maxi-K channels.

THIAZIDE DIURETICS

THIAZIDE DIURETICS

THIAZIDE DIURETICS

ACTIONS AND MECHANISM

In the distal convoluted tubule, Na+ and Cl are reabsorbed across the apical surface of the tubular epithelium on NCC symporters. The thiazide diuretics enter the nephron through the organic anion pathway in the proximal tubule, then they bind to the apical surface of NCC symporters and inhibit them.

LOOP DIURETICS

LOOP DIURETICS

LOOP DIURETICS

ACTIONS AND MECHANISM

In the thick ascending limb (TAL), Na+, K+, and Cl- are reabsorbed across the apical surface of the tubular epithelium on NKCC2 transporters. Such reabsorption is essential for the maintenance of a high medullary interstitial solute gradient, which permits urine concentration in the collecting duct (see Plate 3-15). In addition, recycling of the reabsorbed potassium back into the lumen through apical ROMK channels establishes the positive intraluminal charge required for reabsorption of Ca2+ and Mg2+ (see Plate 3-11).

Monday, December 21, 2020

Glomerulus

Glomerulus


Glomerulus
The glomerulus (or renal corpuscle) consists of the glomerular capillaries and the epithelium-lined sac that surrounds and invests them, known as Bowman’s capsule.
Renal Microvasculature

Renal Microvasculature


Renal Microvasculature
The renal segmental arteries divide into lobar and then interlobar arteries, which enter the renal (cortical) columns and course alongside the pyramids (see Plate 1-10). As each interlobar artery approaches the base of its adjacent pyramid, it divides into several arcuate arteries.
Overview Of The Nephron

Overview Of The Nephron


Overview Of The Nephron
Eachkidney possesses an average of 600,000 to 1,400,000 tubular structures called nephrons, which contain a series of histologically distinct segments that alter the concentration and contents of urine. The major segments of each nephron are known as the glomerulus, proximal tubule, thin limb, distal tubule, and collecting duct. The proximal and distal tubules are both divided into convoluted and straight parts, while the thin limb is divided into descending and ascending parts.
Innervation Of Urinary System

Innervation Of Urinary System


Innervation Of Urinary System
The urinary system receives a rich nerve supply from the autonomic nervous system, which is accompanied by visceral afferent nerve fibers. The autonomic nervous system facilitates bladder filling and stimulates emptying, whereas visceral afferent fibers from the bladder convey sensations produced by distention.
Ureters: Position, Relations, Gross Structure

Ureters: Position, Relations, Gross Structure


Ureters: Position, Relations, Gross Structure
The ureters are paired muscular ducts that convey urine from the kidneys to the bladder. Each ureter begins medial to the ipsilateral kidney as a continuation of the renal pelvis and ends upon insertion into the posterior bladder wall. The ureters are retroperitoneal for their entire length, which is approximately 30 cm.
Proximal Tubule

Proximal Tubule


Proximal Tubule
The proximal tubule receives urine from Bowman’s space. It plays a major role in the transport of material from the urine back into the blood (reabsorption) and vice versa (secretion). In humans, the entire proximal tubule is approximately 14 mm long. It is divided into two sections: the proximal convoluted tubule (pars convoluta) and the proximal straight tubule (pars recta). The latter forms the first part of the loop of Henle.

Monday, November 9, 2020

CARBONIC ANHYDRASE INHIBITORS

CARBONIC ANHYDRASE INHIBITORS

CARBONIC ANHYDRASE INHIBITORS

ACTIONS AND MECHANISM

Carbonic anhydrase (CA) catalyzes the interconversion of carbon dioxide and water to bicarbonate (HCO ) ions and protons. There are multiple CA isoforms, which serve different functions in cells throughout the body. In the renal tubules, the epithelial cells involved in acid-base handling such as those in the proximal tubule, thick ascending limb, and the cortical collecting duct possess cytoplasmic CA-II and luminal membrane- bound CA-IV. Several other CA isoforms also appear to be present throughout the nephron, with their locations and functions still under active investigation.

OSMOTIC DIURETICS

OSMOTIC DIURETICS

OSMOTIC DIURETICS

ACTIONS AND MECHANISM

In the nephron, water reabsorption is a passive phenomenon that relies on the transcellular osmotic gradients established during the reabsorption of solutes, especially sodium. Osmotic diuretics alter these gradients to produce diuresis. After intravenous administration, such agents undergo filtration at the glomerulus but then cannot be reabsorbed. As sodium and water are reabsorbed, osmotic diuretics become more concentrated in the tubular lumen, eventually generating an osmotic gradient that interferes with further fluid reabsorption. In the proximal tubule, the decreased fluid reabsorption also establishes a transepithelial sodium concentration gradient, normally prevented by the iso-osmotic reabsorption of water, that limits further sodium reabsorption.

TUMORS OF THE BLADDER

TUMORS OF THE BLADDER

TUMORS OF THE BLADDER

More than 90% of bladder cancers arise from the mucosa and are known as urothelial (transitional cell) carcinomas. These tumors are the main focus of this section. Less common tumors include squamous cell carcinomas (5% in the United States, but most common worldwide), adenocarcinomas (2%), small cell carcinomas, and nonepithelial tumors. Metastatic tumors from other primary sites including the prostate, ovary, uterus, colon, rectum, and lung have also been described.

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