The
urinary system (to be) ____the organ system that (to produce, to store, and to eliminate) _______________________________ urine. In humans it (to include) _______________ two kidneys, two ureters, the urinary bladder, two sphincter muscles, and the urethra.
The
kidneys (to be) ______ one of the various organs (together with the lungs, intestine and skin) that (to participate) ___________________ in the elimination of the wastes of the organism. The kidneys (to be) _______ bean-shaped organs about the size of a bar of soap. They (to be) _______ near the middle of the spine, just below the ribcage. They (to situate) _______________________ retroperitoneal to the organs of digestion within the abdominal cavity. Situated on the superior surface of each kidney (to be) ______an adrenal gland.
A kidney (to consist) _____________ of about 1 million filtering units. They (to term) __________ nephrons, each consisting of a glomerulus, ball -shaped network of capillaries, and a network of tubules. Blood plasma (to filter)________________by the glomerulus, and the resultant "prourine" (to pass) _____________ through the tubular system where water, and nutrients (to reabsorb) __________________ under the supervision of hormone activity and the autonomic nervous system.
Humans (to produce) _______________ about 1.5 liters of urine over 24 hours, although this amount may (to vary) _____________ according to circumstances. Increased fluid intake generally (to increase) ___________ urine production, while increased perspiration and respiration may (to decrease) _____________ the amount of fluid excreted through the kidneys. A reduced intake of water (to result) ______ normally _________________ in less urine production as well. Some medications (to interfere) ______________ directly or indirectly with urine production, such as diuretics.
The kidney (to play) _________a crucial role in regulating electrolytes in the human blood (e.g. sodium, potassium, calcium). pH balance (to regulate) ________________ by the removal of excess hydrogen ions (H+) from blood. In addition, they (to remove) ___________ urea, a nitrogenous waste product from the metabolism of proteins from amino acids. The metabolism process (to form) ________ ammonia which (to transport) ___________________by blood to the liver and (to detoxify) _________________ to a less harmful byproduct called urea.
Urine (to collect) ______________ in the renal pelvis (or pyelum), which (to connect) ______________ to the ureters, which (to carry) _____________ urine to the bladder. The ureters (to be) ______ about 200 to 250 mm (8 to 10 inches) long. Smooth muscular tissue in the walls of the ureters (to force) _______________ the urine downward. Small amounts of urine (to empty)_____________________ into the bladder from the ureters about every 10 to 15 seconds.
The urinary bladder (to be)______a hollow muscular organ shaped like a balloon. It (to locate) ___________ in the pelvic fossa. It (to hold) ________________ in place by ligaments attached to the pelvic bones.
The
bladder (to store) __________ urine; it (to swell) __________ into a round shape when it (to be) _____full and (to get) _______ smaller when empty. In the absence of bladder disease, it can (to hold) _________ up to 500 mL of urine comfortably for 2 to 5 hours. The epithelial tissue associated with the bladder (to call) ___________ transitional epithelium. It (to allow) ____________ the bladder to stretch to accommodate urine without rupturing the tissue.
Sphincters (circular muscles) (to regulate) _____________ the flow of urine from the bladder. The bladder itself (to have) _________a muscular layer that, when contracted, (to increase) ______________ pressure on the bladder and (to create) ________________ urinary flow.
Kidney diseases (to investigate and to treat) _____ normally ______________investigated and __________________ by nephrologists, while the specialism of urology (to deal) ___________ with problems in the other organs. Gynecologists may (to deal) ____________ with problems of incontinence in women.
Diseases affecting the urinary system (to include):
• There (to be) _____ numerous kidney diseases, many of which (to interfere) ____________ with the normal production of urine. Renal failure may (to be) ___________ acute or chronic, and may (to require) _______________ medication and dialysis.
• Kidney stones may (to be) _____ painful and (to cause) _________ long-term kidney damage.
• Stenosis (blockage), reflux (backflow of urine into the kidney, causing damage)
• Urinary tract infections (UTIs), cystitis, incontinence (involuntary loss of urine), benign prostatic hyperplasia, prostatitis (inflammation of the prostate) and urinary retention (inability to pass urine).
• Bladder cancer, kidney cancer, and prostate cancer (to be) ______ examples of neoplasms affecting the urinary system.
The term "uropathy" (to refer) ___________ to a disease of the urinary tract, while "nephropathy" (to refer) ______ to a disease of the kidney.
Urinalysis (to be) ______a test that (to study) ___________ the content of urine for abnormal substances such as protein or signs of infection. This test (to involve) _________ urinating into a special container and leaving the sample to be studied.
Urodynamic tests (to evaluate) ______________ the storage of urine in the bladder and the flow of urine from the bladder through the urethra. It may (to perform) ______________________ in cases of incontinence or neurological problems affecting the urinary tract.
Ultrasound (to perform) _____commonly______________ to investigate problems of the kidney and/or urinary tract. An intravenous pyelogram (to study)_________________ the shape of the urinary system.
Renal failure or kidney failure (to be) ______ the condition in which the kidneys (to fail) ___________ to function properly. Physiologically, renal failure (to describe) _________________ as a decrease in the glomerular filtration rate. Clinically, this (to manifest) ______________ in an elevated serum creatinine. The serum creatinine (to be) _____ the most widely used blood-chemistry test to assess renal function. Serum creatinine levels (to depend) __________________ not only on kidney function, but on the person's existing muscle mass as well. Muscle mass (to vary) __________ with age, sex, and race. Typically, younger patients, male patients, and African-American patients (to have) __________ higher muscle mass. Certain disease states, such as liver failure, (to lead) ______________ to a decrease in muscle mass.
Renal failure can broadly (to divide) _________________into two categories: acute renal failure and chronic renal failure.
Chronic renal failure (CRF) (to develop) ______________ slowly and (to show) ____________ few symptoms initially. It can (to be) ____ the complication of a large number of kidney diseases, such as IgA nephritis, glomerulonephritis, chronic pyelonephritis and urinary retention. End-stage renal failure (ESRF) (to be) _____ the consequence, in which case dialysis (to require) _____ generally _______________ until a donor for a renal transplant (to find) _______________. Treatment modalities for ESRF (to include) ____________ peritoneal dialysis, hemodialysis, and transplantion from either a living or cadaveric donor. Of these, renal transplantation (to afford) ________________ the best quality and quantity of life to the patient, provided they (to be) _____ an appropriate candidate.
Acute renal failure (ARF) (to be) _____ a rapidly progressive loss of renal function, generally characterised by oliguria (decreased urine production, quantified as less than 400 mL per day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); body water and body fluids disturbances; and electrolyte derangement. An underlying cause must (to identify) _________________ to arrest the progress, and dialysis may (to be) _______ necessary to bridge the time gap required for treating these fundamental causes.
Kidney stones (to form) _______________ inside the kidneys or ureters. If stones (to grow) ________ to sufficient size before passage at least 2-3 millimeters--they can (to cause) ____________ obstruction of the ureter. This can (to cause) ____________ severe episodic pain, most commonly felt in the flank, lower abdomen and groin (This condition (to call) _____________ renal colic). Renal colic can (to associate) ___________ with nausea and vomiting due to the embyrological association of the kidneys and the intestinal tract. Recurrence rates (to estimate) _______________________at about 10% per year.
Kidney stones (to be) _____ usually asymptomatic until they (to obstruct) _________ the flow of urine. Symptoms can (to include) ____________ acute flank pain (renal colic), nausea and vomiting, restlessness, dull pain, hematuria, and possibly fever if an infection (to be) _______ present. Acute renal colic (to describe) _____________ as one of the worst types of pain that a patient can (to suffer) _______________.
Some patients show no symptoms until their urine (to turn) ________ bloody—this may (to be) _____ the first symptom of a kidney stone. About 15% of proven kidney stone patients may not (to show) _________ even microscopic hematuria so this (not to consider) __________________________ a definitive diagnostic sign.
Diagnosis (to make) _____ usually __________ on the basis of the location and severity of the pain, which (to be) _______typically colic in nature (comes and goes in spasmodic waves). Radiological imaging (to use) ___________ to confirm the diagnosis and a number of other tests can (to undertake) _________________ to help establish both the possible cause and consequences of the stone. Ultrasound imaging (to be) _____also useful as it (to give) ___________________ details about the presence of hydronephrosis (swelling of the kidney - suggesting the stone (to block) ______________________________ the outflow of urine). It can also (to use) ________________ to show the kidneys during pregnancy. About 10% of stones (not to have) _____________ enough calcium to be seen on standard x-rays and may (to show up) _________________ on ultrasound although they typically (to see) _________________ on CT scans.
Investigations typically carried out (to include) ____________________:
• Microscopic study of urine, which may (to show) ______________ proteins, red blood cells, pus cells, and crystals.
• Culture of a urine sample to exclude urine infection
• Blood tests: Full blood count for the presence of a raised white cell count (Neutrophilia) suggestive of infection, a check of renal function and if raised blood calcium blood levels (hypercalcaemia).
• 24 hour urine collection to measure total daily urinary volume, magnesium, sodium, uric acid, calcium, and phosphate.
90% of stones 4 mm or less in size usually (to pass) ____________ spontaneously, however the majority of stones greater than 6 mm (to require) ________________ some form of intervention.
In many cases non-invasive Extracorporeal Shock Wave Lithotripsy or (ESWL) may (to use) ____________. Percutaneous nephrolithotomy or open surgery may (to be) _____ necessary for large or complicated stones or stones which (to fail) ___________ other less invasive attempts at treatment.
Preventive strategies (to include) ___________ dietary modifications and sometimes also taking drugs with the goal of reducing excretory load on the kidneys:
• Drinking enough water to make 2 to 2.5 liters of urine per day.
• A diet low in protein, nitrogen and sodium intake.
• Taking drugs such as thiazides, potassium citrate, magnesium citrate and allopurinol depending on the cause of stone formation.
• Depending on the stone formation disease, vitamin B-6 and orthophosphate supplements may (to be) _____ helpful.
Kidney cancer. Your kidneys (to be) _____two bean-shaped organs, each about the size of your fist. They (to locate) ______________________ behind your abdomen, one on each side of your spine. Like other major organs in your body, your kidneys can sometimes (to develop) __________________ cancer. In adults, the most common type of kidney cancer (to be) ______ renal cell carcinoma (renal adenocarcinoma or hypernephroma). It (to begin) ______________ in the cells that (to line) _______________ small tubes (tubules) within your kidneys. Children (to be) ________more likely to develop a kind of kidney cancer called Wilms' tumor. Kidney cancer seldom (to cause) _______________ problems in its early stages. But as a tumor (to grow) ___________, you may (to notice) ______________ blood in your urine or (to experience) ________________ unintentional weight loss or back pain that (not to go) _______________ away. Cancer cells may also (to spread) ______________ (to metastasize) outside your kidneys to nearby organs such as your adrenal glands, pancreas and spine, as well as to more distant sites in your body. An estimated 35,000 Americans are (to diagnose) _______________________ annually with kidney cancer and more than 12,000 (to die) ___________ of the disease. Yet if kidney cancer (to detect) ________________and (to treat) ________________early, the chances for a full recovery (to be) ______ good. Kidney cancer rarely (to cause) ______________ signs or symptoms in its early stages. In the later stages, the most common sign of both renal cell and transitional cell cancers (to be) ______ blood in the urine (hematuria). You may (to notice) ___________________ the blood when you (to urinate) ___________________, or it may (to detect) ____________________ by urinalysis, a test that specifically (to check) _________________the contents of your urine. Other possible signs and symptoms may (to include) ________________________: a pain in your back just below your ribs that (not to go) ______________ away, a mass in the area of your kidneys that (to discover) __________________ during an examination, weight loss, fatigue, and Intermittent fever
Pain in other parts of your body if the cancer (to metastasize) _______________________
Wilms' tumor usually (to have) ______________ no symptoms. Doctors often (to discover) __________________ this condition when examining a child's abdomen.
The risk of renal cell carcinoma (to increase) _________________ as you (to age) __________. This type of kidney cancer (to occur) __________________ most often in people between the ages of 50 and 70. Men (to be) ________________ more than twice as likely as are women to develop renal cell carcinoma, and black men (to have) _____________ a slightly higher risk than white men (to do) ______________. Other risk factors for renal cell carcinoma (to include) _________________:
Smoking. Smokers, especially those who (to smoke) ____________ pipes or cigars, (to be) _______ at greater risk than (to be) ___________ nonsmokers. The risk (to increase) ___________ the longer you (to smoke) ____________ and (to decrease) after you (to quit) _____________.
Obesity. A strong link (to exist) ____________ between excess weight and renal cell carcinoma in both men and women.
High blood pressure (hypertension). Researchers (to find) ____________________ a link between high blood pressure and renal cell carcinoma. Although it (to appear) _____________ that your risk (to decrease) _________________ when you (to treat) ______________ for high blood pressure.
Environmental toxins. Coal oven workers in steel plants (to have) _________________ high rates of kidney cancer. So (to do) ____________ people who (to expose) _____________ to asbestos.
Dialysis. People who (to receive) __________________ long-term dialysis to treat chronic renal failure (to be) _________at greater risk of developing kidney cancer, possibly because renal failure (to depress) __________ the immune system. People who (to have) _____________ a kidney transplant and (to receive) ____________________ immunosuppressant drugs also (to be) _______ more likely to develop kidney cancer.
Radiation. In some cases, exposure to radiation may (to increase) ________________ your risk of kidney cancer.
In addition to taking a complete medical history and performing a physical exam, your doctor (to recommend) _______________________ blood and urine tests. You may also (to have) ______________ one or more of these tests to check for growths or tumors: Intravenous pyelogram (IVP), Ultrasound examination, Computerized tomography (CT) or magnetic resonance imaging (MRI) scan, and biopsy.
Treatments for renal cell carcinoma (to include) ___________________: surgical removal, arterial embolization, radiation therapy, immunotherapy, chemotherapy.
The following steps may (to reduce) ____________________ your risk and (to help) ____________ you stay healthy:avoidance of smoking. Smokers (to be) __________ twice as likely to develop kidney cancer as (to be) _____ nonsmokers. (to llimit) _________ fat in your diet. (to stay) ___________ physically active. (to maintain) ________________ a healthy weight. (to avoid) ______________ exposure to environmental toxins. (to reduce) _______________________ high blood pressure.
Chronic kidney failure usually (to develop) ______________ slowly. High blood pressure and diabetes (to be) _______ the most common causes. The signs and symptoms of kidney failure (to vary) __________. They (to depend) __________________on whether the failure (to be) ________ acute or chronic. Acute kidney failure (to occur) ________________ when your kidneys suddenly(to stop) _____________ filtering waste products from your blood. The signs and symptoms may (to include) _____________: fluid retention, bleeding, often in your stomach or intestines, confusion, seizures, and coma According to the National Kidney Foundation, almost 20 million adult Americans (to have) __________ chronic kidney disease and another 20 million (to be) _______ at risk of developing it. Over time, chronic kidney failure can (to lead) __________________ to congestive heart failure, weak bones, stomach ulcers and damage to the central nervous system. Unfortunately, signs and symptoms often (not to appear) ___________________ until irreversible damage (to occur) __________________. They (to include) __________________: high blood pressure, unexplained weight loss, anemia, nausea or vomiting, malaise or fatigue, headaches, decreased urine output, decreased mental sharpness, muscle twitches and cramps, bleeding in the intestinal tract, persistent itching, and sleep disorders.
Factors that can (to cause) _______ your kidneys to shut down suddenly (to include) ______________:complicated surgery, severe burns or trauma, renal ischemia, drugs, toxins, heatstroke, multiple organ failure, obstructed urine flow, kidney disease (nephritis), diabetes, high blood pressure (hypertension), obstructive nephropathy, renal artery stenosis, lead poisoning, kidney disease.
To help confirm a diagnosis of kidney failure, you may (to have) ____________ the following tests: ultrasound imaging, computerized tomography (CT) scan, magnetic resonance imaging (MRI), and renal biopsy. Chronic kidney failure can (to affect) ___________________ almost every part of your body. Potential complications may (to include) ___________________: fluid retention, a sudden rise in potassium levels in your blood, weak bones that (to fracture) ________________ easily, anemia, stomach ulcers, changes in skin color, damage to your central nervous system, and insomnia.
Treatment for kidney failure varies (to depend) _____________________on whether the problem (to be) _______ acute, chronic or end-stage. In many cases acute kidney failure (to be) _____ reversible.
Your doctor may (to prescribe) _____________ calcium or glucose to prevent the ac-cumulation of high levels of potassium in your blood. You may also (to need) __________ to undergo dialysis to help remove toxins and excess fluids from your body while your kidneys (to heal) ____________. Chronic kidney failure (to have) _____________ no cure, but treatment can (to help) ____________ control symptoms, (to reduce) ________________ complications and (to slow) _________________ the progress of the disease. The first priority (to be) _______ controlling the condition responsible for your kidney failure and its complications. If you (to have) ___________ diabetes or high blood pressure (hypertension), for instance, that (to mean) ______________________ carefully following your doctor's recommendations for diet and exercise and taking any medications as directed. In addition, following a proper diet (to be) _____ extremely important in treating kidney failure itself. Restricting the amount of protein you eat may (to help) __________ slow the progress of the disease. It can also (to help) __________ ease such symptoms as nausea, vomiting and lack of appetite. You'll likely (to need) ____________ to limit the amount of salt in your diet to help control high blood pressure. Over time, you may also (to need) ________________ to restrict the amount of potassium and phosphorous you (to consume) ___________. If you (to have) ______________ high blood pressure, your doctor (to prescribe) _______________ medications that both (to lower) ______________ your blood pressure and (to help) _________________ preserve kidney function. These (to include) _____________________ the blood pressure-lowering medications known as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (A-II) receptor blockers.
There (to be) __________ several different types of kidney dialysis. They (to in-clude)_____________________: Hemodialysis. The most common form of dialysis (to know) ________________ as hemodialysis. It (to remove) _______________ extra fluids, chemicals and wastes from your bloodstream by filtering your blood through an artificial kidney (dialyzer). Blood (to pump) ______________out of your body to the artificial kidney through a vascular access that (to create) _____________ surgically, usually in your arm or leg. Inside the artificial kidney, your blood (to move) ______________ across membranes that filter out wastes. Less than 1 cup of blood is outside your body at any one time. Most people (to require) _________________ approximately 12 hours of dialysis each week, usually divided into three sessions. Peritoneal dialysis. Instead of filtering your blood through a machine, this type of dialysis (to use) _____________ the vast network of tiny blood vessels in your own abdomen (peritoneal cavity) to filter your blood. First, a small, flexible tube (catheter) (to implant) _______________ into your abdomen. Then, a dialysis solution (to infuse) _____________ into and (to drain) __________________ out of your abdomen for as long as (to be) necessary to remove waste and excess fluid.
