Anatomy / Pathology

The kidneys

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 1. Which bodies are the urinary system?

Abb. 1 www.m-ww.de/krankheiten/nephrologie/anatomie_funktion.html?gfx=1

Kidney-Ren or Nephros
Paarig planϖ

Retroperitoneal side (lateral) of the spine (TH 12 to L 3)

120-220 gϖ heavy, 10-12 cm long, ca.5 cm wide, 4 cm thick,
bohnenformig

Ureter - ureter
Paarig planϖ
If the renal pelvis showsϖ
Muskulöser tubeϖ about 30 inches long

3 physiological Engen, these are often the sites forϖ Steineinklemmungen

The auskleidende epithelium of the urinary system renalϖ pelvis is Urothel
Urinary bladder Vesica urinaria

Located in a small pool behind the Symphysis

In men shoves between urinary bladder and pelvicϖ ground floor prostate
Musklulöses Hohlorganϖ
ureter go diagonallyϖ into the urinary bladder wall, which results in a "valve, which prevents filled in the
urinary bladder into the kidneys back
Internal and externalϖ sphincter

Urethra - Urethra

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female urethraϖ
O If before the sheath
O exterior lies in the opening vaginal forecourt
O Ca. 4 cm long

male urethra
O Ca. 20 to 25 cm long
O Running spaltförmig on the glans of the male organ

2. What are the duties of the kidneys?

1. Regulation of ion and water budget (Na +, Ka +, Ca +)

2. Regulation of the acid-base budget
3. Excretion of harnpflichtigen substances zb Creatinine, foreign matter, for example, Drugs, environmental
toxins
4. Regulation of blood pressure (Renin-Angiotensin-Aldosteron-Mechanismus)
5. Production of hormones

Renin - (influenced electrolyte balance and RR) in the kidney, regulated as part of the renin Angoistensin
aldosterone. Mechanism blood pressure, sodium budget and renal blood flow
- Erythropoietin causes increased recharge the erythrocytes in bone marrow
- Conversion of vitamin precursor to the effective vitamin D (Calzitriol)

3. In the 3 zones, the kidney divided?

Figure 2 www.roche.de/.../ images / niere.jpg

renal cortex with the functional units -Nephroneϖ

Mark with Markϖ renal pyramids here is the Sammelrohrsystem of renal cortex of the kidney pelvis
renal pelvis - Pyelon with kidney chalice-here collects the Endharn

4. What is a Nephron

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Figure 3 www.m-ww.de/krankheiten/nephrologie/anatomie_funktion.html

Nephron is theϖ functional unit of the kidney

If in the renal cortexϖ
Ca. 1 millionϖ per kidney
Consists of:ϖ
O renal cell count-Glomerulum
O Bowmansche capsule
O Tubulusapperat with Henle loop

5. Explain the urine education and the way of elimination

The human body is leaving approximately 1.4 liters of water per day with the urine and makes a number of
chemical substances, known as degradation products.
O The amount of urine varies depending on the recorded fluid and sweat production.
O The urine will be eliminated:
electrolytes (regulation of acid-base-budget)
harnpflichtige substances creatinine and urea
degradation products ofϖ foreign materials (medicines, poison the environment, ect.)

Urine Education
O Ca .1500 l daily blood flow through the kidneys. This means that the entire blood cleaned several times a day.
O In the glomeruli, the passierende blood of water, electrolytes, glucose, urea, and foreign separated, blood cells,
so red and white blood cells and plasma albumin remain in the blood vessels.
This abgefilterte lot o-the primary urine (about 1500 l) now passes through the Tubulusapperat
O Here is now the water and electrolytes needed again zurückresorbiert
O There remains a residual of about 1500 ml - Endharn,
O This accumulates in the renal pelvis
O From there, he arrived in the ureter (ureter)
O Then, in the urinary bladder
O When he is filling enough on the urethra Ret

6. What is the difference between primary and Endharn?

The primary urine is a unkonzentrierte urinary fluid, which in the kidney by filtering the blood plasma.
The liquid created by the wall of the BOWMANschen capsule from the blood plasma into the interior of the
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 Nierenkanälchens pressed, in its composition corresponds to a eiweißfreien plasma. Blood cells and the majority
of protein molecules are too large than it through the fine pores of the walls could be pressed.
As Endharn known in the renal pelvis sammelndeund in the urinary bladder delivering concentrated filtrate of
the plasma, such a volume of 1.5 liters per day makes. He is seen as urine.

7. Which hormones are formed from the kidney

erythropoietin-regulates the oxygen content in the blood (stimulation of the formation of erythrocytes)
Renin-blood pressure regulation

Kalzitriol (= D-Hormon) - conversion of vitamin D-regulates calcium metabolism and the installation of
calcium in the bones

The kidney is also availableϖ as production and Extraction of hormones known.

prostaglandins

Other hormones affect the kidneys, the kidney or entertainment processed:

O insulin in the kidney is removed.
O hormones, which in the kidney effect, regulating hormones: Antidiuretisches hormone of
Hypophysenhinterlappens (water excretion), aldosterone the adrenal cortex (sodium and potassium excretion),
parathyroid hormone for parathyroid (phosphate excretion).

8. Identify important electrolytes of the human organism and explain its impact

sodiumϖ (Na +) - important for the regulation of osmotic pressure in Extrazellulären space; regulation of fluid
flow
potassium (K +) - important for theϖ electrical potential of the cells. This electrical potential is for the
necessary function of each cell, muscle contraction
chloride (Cl +) - important for the regulation of acid-base balance and osmolality.
calciumϖ (Ca +) - important for bone and tooth structure, controls enzymes together with the contraction of
muscles. Acts against inflammation and allergies.
inorganic phosphate component of the energy phosphates in the cell metabolism, skeletal element; regulation
on the kidney;
magnesium (Mg +) -. importantϖ for almost all metabolic processes (almost 300 enzymes exert their effect
until magnesium), the heart activity for a healthy skin, for the activities of the glands, for the relaxation of the
muscles
iron (Fe +) - a component ofϖ blood and muscle-dye, oxygen carriers

9. What is the physical Flüssigkeitsein- and export of people from

Imports: 1.5 to 2 liters of fluid at high temperatures and in more tangible efforts accordingly.
Caffeinated drinks or alcohol they accelerate the loss of body water. Equally, there is a drink that is rich in
carbohydrates and sugar, are also not in the daily imports into
With the solid food ingredients, in addition to 1000ml liquid Date
Export: Normal 1000-2000 ml in 24 hours spread over 4 - 5 Miktionen
More fluid loss through sweating and breathing and in the chair

"WATER, YOU HAVE NOT TASTE OR COLOR, OR AROMA. MAN YOU CAN NOT DESCRIBE.
SCHMECKT YOU MAN WITHOUT YOU TO KNOW. IT IS NOT SO, IS THAT YOU NEED TO
LIFE; DU BIST THE LIFE ITSELF! You penetrate U.S. at LABSAL WHOSE
Delicious NONE OF OUR SENSE Expression COMPETENT TO.
you TAKE NOT EACH TO COMPOUND, DULDEST NOT ANY CHANGES. YOU ARE AN EASY
most GOTTHEIT!
BUT YOU commerce U.S. ON Indescribably SIMPLE AND GREAT LUCK. "
Antoine de Saint-Exupéry

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 Anatomy / Pathology
The kidneys

1. Please describe the task for a urologist and a nephrologists

Urologist:
diagnosticϖ treatment of diseases of the harnableitenden bodies of the man and woman, also from kidney,
urinary bladder, ureter and urethra, and prostate
sex organsϖ of the man, so testis, epididymis, sperm head and penis
The Uruloge isϖ partly internistisch but also surgically.
Nephrologist:
diagnosis andϖ treatment of disorders of kidney disease renal replacement procedure (hemodialysis, peritoneal)
rehabilitation of Nierentransplantierten
The Nephrolgoge is purely internistisch.

2. Which diagnostic possibilities, the doctor for bladder disorders and kidney area to
determine
Nephrologisch:
Medical history, blood pressure measurement, Perkusion of renal camp, physical examination edema formation
Laboratory tests

Urine test: swab test on bacteria, proteins, blood sugar, etc., urine sediment
Blood test: creatinine, potassium, urea, uric acid
Stone investigations
Imaging
Ultrasound
X-ray contrast media representation of the kidney = iv-Pyelogramm
CT kidney
Magnetic kidney
Angiography of the kidney
Nuklearmedizinische procedures
Static Nierenszintigrafie
Nierenausscheidungsszintigrafie
Nierenperfusionsszintigrafie
Urologisch:
Laboratory
funds beam urine.: 24-h-Sammelurin
secretions investigations
Semen analysis
In fertility disorders ofϖ the male sperm must be investigated.

Uroflowmetrie
O This investigation will bladder emptying disruptions to the routine. PSA-test
O The determination of the prostate-specific antigen in the blood allows for early detection of prostate diseases.
Imaging
Ausscheidungsurografie
These radiological investigation is a standard procedure in urology. Miktionszystourethrografie
A fluoroscopy during the bladder emptying showsϖ disorders. Books list:
Röntgendiagnostikϖ
Urethrografieϖ
Theϖ presentation of the urethra is a commonly practiced method. Pyelografie
The retrograde portrayal of ureter and renal pelvis is rarely applied. Pocket Atlas Adjustment technology. X-ray
diagnostics, angiography, CT, MRI.
Angiography
Using angiography and digital Subtraktions- Angiogafie areϖ mapped the kidney arteries. Ultrasound /
sonographic
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Ultrasound diagnosis
Endoscopic procedures
rigid and flexible endoscopy

Zystoskopie-bubble mirroring is most common endoscopic examination in the urology.

Ureterorenoskopie ureter and renal pelvis with the endoscopeϖ inspected.
Nephroskopie - is a reflection of kidney surgery, in which theϖ endoscope through incisions in the skin ceiling
will be introduced. Technical endoscopy. Principles and practice endoscopic investigations.
Cyclic

Prostata-Stanzbiopsie-a tissue sample is often used to clarify cancer.

renal biopsy-the puncture of the kidney often used to secure a suspected diagnosis.

3. Why ill urinary tract infections in women more often than men

In women leads the urethra in the immediate environment intestinal outputϖ and divide. This allows bacteria
from these regions much faster in the urinary tract. Moreover, the urethra is shorter in women than in men, the
bacteria can be quicker to the urinary bladder inside spread. There is an increased growth, especially when the
bladder is not only incomplete or regularly emptied.

A modified bacteria growth in the vagina, the incidence of urinary tract infections favor. It occurs through the
use of spermicides and / or Scheidendiaphragmen, and by excessive Genitalhygiene with Intimsprays and
Scheidenspülungen. Since an increased incidence of urinary tract infections in the context of sexual intercourse
occurred, it should after sexual intercourse, the bladder empties.
In women in or after the menopause affected by the hormonal change the nature of the vaginal mucosa. Again,
this could result in increased incidence of urinary tract infections.

4. Please describe the clinical picture of nephrolithiasis (causes, symptoms, treatment)

Kidney stones passion nephrolithiasis
Definition: Kidney stones are deposited in the kidneys courses and / or urinary paths. The latter are also known
as urinary stones (urolithiasis).

Formation Mechanism:
Certain substances in the urine in high concentrations to fall in place and then initially small crystals. These grow
over time, but more and more, in extreme cases, such kidney stones, the whole kidney basin fill. Hot weather and
so einhergehendes intense sweating favor the formation of kidney stones: The loss of body fluids leads to an
increase in calcium concentration in the urine. These calcium salts can come in the form of rocks deposited.

The origin is determined by the following factors:

diet, the body of water cut, and so the urine salts with sates,ϖ eg Asparagus and rhubarb.
Harnstauung by scars, narrowing or defects inϖ the kidney or urinary ways
Repeated urinary tract infectionsϖ
Tooϖ little fluid intake
weight loss

Symptoms
Kidney stones hurt only if they reach the ureter and then slowly migrate.
Renal colic
Depending on the location of the stone is too pungent, krampfartigen and undulating pain in the back or side in
the lower abdomen, flank pain
In deep seated ureter stones, the pain broadcast to the genital area.
nausea and vomiting
chair and Windverhalt (reflektorischer ileus)ϖ
reductionϖ in the amount of urine
In about one-third of the cases is visible blood inϖ the urine, through violation of the mucous membrane of the
urinary tract injury.
Chronic kidney stones may differ dumpfem pressure in the kidney area felt.ϖ It can also cause bacterial
infections, which often lead to complications: Possible follow-diseases are urinary tract infections, septisches

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urinary fever (Urosepsis), in which bacteria from the urinary routes into the bloodstream over, or
Schrumpfnieren, with a destruction of kidney tissue accompanied.

Diagnosis:
computer tomographyϖ
X-ray diagnosis of kidney andϖ urinary paths with and without X-ray contrast media
urine testing forϖ blood and infection
ultrasound examination of the urogenital tract

Therapy:
The therapy depends, among other things, the nature and size of the kidney stone.
renal colic: plenty of fluids, krampflösende drugs,ϖ which partly painkilling effect, and possibly a movement
therapy, such as hopping, the stone pasta.
Is a stone spontaneous departure is not possible or kidney injury, can be carried out following therapies:
uric acidϖ stones, the doctor may dissolve medication. They call this procedure Litholyse.
Extracorporeal Stoßwellen-Lithotripsie (ESWL): Kidney stones are locatedϖ on ultrasound and then using
shock waves shattered.
Percutaneousϖ Nephrolitholapaxie: With the help of a Punktionsnadel is a thin channel from the outside to
kidney drilled. About the channel is then introduced an optical instrument with which to view smashes and
kidney stones removed.
Ureterorenoskopische stone Distance: surgical method for ureter stones This is a rigid or flexible thin tube with
an optical instrument in view of the urethra into the bladder and into the ureter. Over a working channel of the
optical instrument can have different devices for demolition and removal of the ureter stones introduced. This
may include ultrasound, laser or special probes or tongs.
stone Prevention: nutritional changes, eg Salt restriction andϖ eiweißarmer food, ample fluid intake.

5. Why is the loss of both kidneys deadly

The loss of both kidneys leads to uremia - renal failure with urea and this untreated poisoning death.
A lasting Nierenersatztherapie- dialysis up to the possibility of a Tansplantation is the only therapeutic way.
General complications of dialysis treatment
The heart and circulatory diseases, infectious diseases

6. Identify symptoms and complications of cystitis and the Pyelonephritis

Cystitis

Symptoms:
pain andϖ burning during urination (Algurie).
The emptying of the bladder isϖ difficult (dysuria).
frequent urge to urination (pollakiuria) with small amounts of urine
pain above the pubic bone, possibly convulsions

Complications:
chronic cystitis training with a Schrumpfblaseϖ
spread of entzündungsverursachenden bacteria in the kidneys -Pyelonephritis

Pyelonephritis

Symptoms:
Acute renal pelvic inflammation
heavy feeling sick
suddenly occurring, high fever, chills possiblyϖ
severeϖ pain in the area of both flanks, Klopfschmerzen in the kidney area. Gastro-intestinal complaints and
headaches
painful, frequent and difficultϖ urination (dysuria)
Chronic renal pelvic inflammation
damages the kidneys slowly and steadily.
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unclear fever states
headache, fatigue,ϖ dull back pain, nausea
anything. High blood pressure and anemia

Complications:
Nierenabszess
renal failure

7. What is a kidney failure and complications which can be for the patients that result?

Kidney failure is a function of limiting the kidneys. It distinguishes between:

Chronic renal failure

Chronic renal failure is a slowly progressing, always expecting worse and protracted kidney disease. The causes
are varied, such as Diabetes mellitus (diab.Nephropathie), or following a bad set hypertonia.
The constant destruction of kidney tissue leads to a worsening of kidney function used by the increasing loss of
functional Nephrone. This destruction is not reversible

The disease is divided into several stages:

I. latency stage:
The function of the kidney is not sufficient reason by a progressive disease, but this is threatened.

IIa stage of full compensation

The performance of the kidney is limited, it is calling a limited filtration of urine indicates (decrease of
Glomerulumfiltrats). The creatinine remains roughly the normal range.

IIb stage of compensated Retention

III stage of congestive retention (Präurämie)

The no longer sufficient function of the kidney increasingly progressing.

The Serumkreatininwert increases to 8-12 mg / dl, GFR- reduction
Under 20 ml / min. This represents an increase in the concentration harnpflichtiger Subbstanzen in serum.
Acute renal failure
The acute renal failure (GCS) is in contrast to chronic renal failure, a sudden, violent progressing disease of the
kidney. This means that the kidney function drops rapidly. Causes may include: shock conditions (lack of renal
blood flow), Hypertensive Crises, poisoning
The GCS is, however rückbildungsfähig, also reversible.

The classical GCS runs in four stages:

I injury stage
Duration: hourly days. There are no signs of poisoning urine, the urine output is not affected.

Stage II of oliguria
Oliguria means decreased urinary excretion (20 ml / h). Duration: 9-12 days
It can be a proteinuria, hematuria or Zylindrurie.
Also charged are signs of uremia, which is not different from those of chronic renal insufficiency differ (affected
are the heart and circulatory, respiratory system, nervous system, digestive organs ...).

III polyuria
The propagation stage of urinary lasts about 2-3 weeks.
Characteristic for this stage, urine excretion over 3-5 Liter/24h (polyuria), lack of concentration ability of the
kidneys, Leukozyturie and bacteria.

Phase IV restitution
The phase of restoring the kidney can take up to a year,
Complications of kidney failure
Renal Hypertension
Renal failure-uremia
Functional limitations which requires dialysis treatment
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8. Please describe the clinical picture of uremia
The primary role of the kidneys is to filter the blood and it harnpflichtigen endogenous substances (such as urea)
and körperfremden substances to liberate. Harnpflichtige substances are substances used exclusively by the
kidney. The kidney failure, these substances poison the body. Uremia is the end stage of renal failure.

Characteristics of uremia:
Disrupted excretion ofϖ metabolic waste products (urea, creatinine)
Disrupted excretion ofϖ electrolytes and water, and thus disturbance in acid-base budget
hormoneϖ disturbance in the household with kidney impairment of the blood pressure, blood and bone
formation

Causes for uremia:

Acute uremia occurs five to tenϖ days after acute renal failure. Lack of kidney blood flow (shock kidney),
poisoning, inflammation or Harnstauungen lead to partial or total loss of the excretory function of the kidney.

The chronic uremia emerges from years ofϖ progressive kidney disease:
O kidney damage caused by poorly controlled diabetes mellitus (Diabetic nephropathy), years of poorly treated
high blood pressure
O Repeated, severe kidney inflammation lead to scarring of the kidney tissue
O kidney damage caused by congenital cysts (polyzystische kidney degeneration)
O damage caused by certain painkillers, such as Paracetamol
O diseases of the kidney blood vessels (vasculitis)

Symptoms of uremia:
Urinartiger smell of the breath and skin (urämischer Fötor),ϖ itching and yellowish-brown discoloration of the
skin
disorders of theϖ central nervous system: concentration, fatigue, seizures, unconsciousness until uraemic coma
The urinary excretion goes back, it comes to the flooding ofϖ the body.
The consequences are:
O weight gain, the liquid in the storage tissues (bone edema) and the lungs (pulmonary edema) with increasing
shortness.
O heart and circulatory disease: high blood pressure with damage to the heart (left heart load), cardiac
arrhythmia, fluid accumulation in the heart bag (Perikarderguß)
O gastrointestinal tract: vomiting, diarrhea, anemia (renal anemia), and bleeding
O skeletal system: metabolic disorder of the bone with bone pain, bone fractures and muscle weakness (renal
osteopathy)

Treatment of uremia:
The renal replacement therapy-dialysis:
If the blood ofϖ harnpflichtigen substances cleaned
If the blood excess fluid removed
If the blood disorder in the electrolyte and acid-base budget corrected

Conservative therapy:
In an acute or chronic injury to the kidneysϖ with uremia, the following measures are important:
O treatment of the underlying disease of the kidney
O protein arms, but kalorienreiche diet: It reduces the resulting urea.
O Engmaschige control of body weight and the amount of urine
O Recognized fluid intake: The drink depends on the ability of the kidneys, which again recorded liquid market.
O Wassertreibende drugs (diuretics), the water and electrolyte secretion and increase the excretion of urea.
O potassium poor diet (less fruit, vegetables, chocolate)
O treatment of high blood pressure with the aid of appropriate medications

Prognosis
Without treatment, a renal failure with urine poisoning death.
The prognosis of acute uremia is treated depends on whether the triggering underlying disease can be treated and
overcome.
The chronic uremia requires a permanent renal replacement therapy. Ten years after the start of dialysis treatment
are still approximately 60 percent of the treated patients. Transplant patients after ten years of work and about
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half of the transplanted kidney. Complications of chronic uremia are:
General complications of dialysis treatment
heart and circulatory diseasesϖ
infectious diseasesϖ

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