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1

The urinary system is composed of what 4 components?

1) Kidneys
2) Ureters
3) Bladder
4) Urethra

2

What do the kidneys produce?

Urine, which removes liquid waste products from blood

3

What part of the urinary system keeps a "metabolic balance of the blood?"

Kidney

4

What hormones do the kidneys produce?

Erythropeoietin, Calcitriol, and Prostaglandins

5

What hormone helps with red blood cell production?

Erythropoietin

6

What is the active form of Vitamin D?

Calcitriol

7

What do the ureters do?

Carry urine to the bladder

8

What does the bladder do?

Stores the urine produced

9

What does the urethra do?

Delivers the urine for excretion outside the body

10

Where is the left kidney located?

Level of T11 - L2

11

Where is the right kidney located?

Level of T12 - L3

12

The renal artery, renal vein, and ureter all leave the kidney through what?

An indention of the hilum (hilus) of each kidney

13

What covers the kidney?

A capsule

14

What 4 things consist of the internal kidney?

1) Cortex (including renal columns
2) Medulla (pyramids)
3) Minor Calyces, Major Calyces
4) Renal Pelvis

15

What endocrine gland is associated with the kidney (located on top)?

Adrenal gland

16

What is the main functional unit of the kidney?

Nephron

17

How many nephrons in each kidney?

1 million or slightly more

18

Where are nephrons located?

Both the renal cortex and the renal medulla

19

What does the nephron consist of?

Glomerulus, proximal convoluted tubule, loop of Henle, and distal convoluted tubule

20

Nephrons empty into collecting ducts that run out to the ______

Minor and Major calyx, and renal pelvis

21

What are the 2 nephron types?

1) Cortical
2) Juxtamedullary

22

Where are cortical nephrons located, and what appearance do they have?

Located mostly within the cortex, and have short length of the loop of Henle

23

Where are Juxtamedullary nephrons located and what is their appearance?

Extend deep into the medulla and have long loop of Henle

24

How do various regions of the nephron differ from one another?

Anatomically, and they consist of different types of epithelium related to their own functions

25

What are the 4 stages of Urine Formation?

1) Filtration (from blood to kidney)

2) Reabsorption (From kidney back to body)

3) Secretion (from body straight to kidney)

4) Excretion

26

Where does "Filtration" occur?

In Glomerulus

27

Where does "Secretion" occur?

Proximal convoluted tubule, loop of Henle, and Distal convoluted tubule

28

Where does "Excretion" occur?

In collecting duct, minor calyx, major calyx, and renal pelvis

29

20-25% of the blood leaving the left ventricle of the heart enters _________

The kidneys via renal arteries

30

Blood passes through the kidneys at a rate of ______

1200 ml/min, or 600 ml/min/kidney **

31

___1_____ arterioles carry blood to the ____2___ known as the _____3____

1) Afferent
2) Capillary Tuft
3) Glomerulus

32

___1____ arterioles that contain the remaining blood that was not filtered by the glomerulus form the __2___ in the cortex and ____3___ in the medulla

1) Efferent
2) Peritubular capillaries
3) Vasa Recta

33

Where are the peritubular capillaries?

Cortex

34

Where are the Vasa Recta?

Medulla

35

Where is the glomerulus located?

Between 2 arterioles

36

Each glomerulus is located in _______

Bowman's Capsule

37

What is the outer layer of the Bowman's capsule?

"Parietal" layer, and it is composed of squamous epithelium (aka parietal epithelial cells)

38

What is the inner layer of Bowman's capsule?

"Visceral" layer, and it is composed of specialized cells known as podocytes (aka visceral epithelial cells)

39

The epithelial layers of the glomerulus rest on what?

A thin basal lamina

40

What is "Bowman's Space?"

The space between the outer portion of the capsule and visceral portion of the capsule

41

Where does the filtrate of the blood pool?

Bowman's space

42

What does the glomerulus consist of?

Bowman's Capsule, Glomerular Tuft, and Juxtaglomerular Apparatus

43

What are the 3 major components of glomerular capillary wall (They help account for the glomerular filtration)?

1) Endothelial cells with fenestra

2) Glomerular Basement Membrane (GBM)

3) Visceral Epithelial cells, aka podocytes

44

Approximately 90-120 ml/min, or 1/5th of the renal plasma, is filtered through the glomeruli forming _______

The Ultrafiltrate *

45

Ultrafiltrate has the same composition as to blood plasma and includes:

Water, Electrolytes, Glucose, Amino Acids, Urea, Uric Acid, Creatinine, and Ammonia

46

What is a key indicator of kidney function and is used to check how well the kidneys are working, or monitor kidney disease progression?

Glomerular Filtration Rate (GFR)

47

What does GFR specifically estimate?

How much blood passes through glomeruli each minute

48

What is the normal result of GFR range?

90-120 ml/min

49

What is GFR proportional to?

Body size and varies with age and sex

50

Older people have __1___ normal GFR levels, because GFR ___2__ with age

1) Lower
2) Decreases

51

GFR test aka:

Clearance Test *

52

What does the GFR test (glomerular filtration rate) aka clearance test measure?

How well the kidneys are filtering creatinine * which is a waste product of creatine phosphate breakdown in muscles

53

For the Glomerular Filtration Rate test (GFR), what is required?

1) A 24 hour urine sample

2) Blood sample

54

When the kidneys aren't working as well as they should _______ builds up in the blood

Creatinine

55

What are "Threshold substances?"

Those substances which are almost completely reabsorbed by the renal tubules when their concentration in the plasma is within normal limits

56

In regards to tubular function, when the normal plasma level is exceeded, what happens?

The substance is no longer totally reabsorbed and it appears in the urine

57

Glucose is a high threshold substance, T/F?

TRUE

58

When does glucose appear in the urine?

When plasma concentration exceeds about 160 to 180 mg/dl *

59

What are some of the other threshold substances in tubular function?

amino acids, creatine, potassium, and sodium chloride

60

Tubular function of the proximal tubules reabsorbs what?

1) 100% of amino acids, proteins and glucose

2) HCO3

3) K+, NaCl, Ca

4) H20


*** NO REABSORPTION OF CREATININE *****

61

What does the proximal tubule secrete?

1) Uric Acid
2) Organic acids (antibiotics)
3) Creatinine
4) Hydrogen Ion

62

What is reabsorbed in the Loop of Henle?

1) H20
2) NaCl
3) Ca, Mg

63

What is secreted from the Loop of Henle?

Hydrogen ion and Ammonia

64

What is the key feature of the Descending loop of Henle?

PERMEABLE to water *


- Reabsorption of solutes does NOT occur in this part of the loop

65

What limb of the Loop of Henle is Nearly impermeable to water?

Ascending limb

66

Which limb of the loop of Henle has hydrogen ion and ammonia secreted?

Ascending Limb

67

What is the key function of the Ascending Loop of Henle?

Active Resorption of Solute** without water

(sodium chloride, calcium, and magnesium)

68

Fluid leaving the loop of Henle has a ___1____ osmolality than plasma because of lost ___2____

1) Lower
2) Sodium Chloride

69

What do the distal tubules reabsorb?

1) NaCl
2) H20
3) Ca

Not much reabsorption is happening

70

What do the distal tubules secrete?

1) K+
2) H+
3) Urea

71

What do the collecting ducts reabsorb?

1) Urea
2) NaCl
3) H20

Not much reabsorption is happening here either

72

What do the collecting ducts excrete?

1) H20
2) NaCl
3) K+
4) HCO3
5) CREATININE **

73

About 90% of the glomerular filtrate is reabsorbed by the time it reaches ______

The distal tubule

74

Where is urea absorbed?

In the Collecting Duct

75

Is there any reabsorption of creatinine in the "Tubular Reabsorption?"

NO

76

T/F, some reabsorption is passive and some requires energy for active transport across the cells?

TRUE

77

What does Tubular Secretion involve?

Sending molecules from the blood into the tubular filtrate

78

What does the tubular secretion account for?

Removal of unneeded foreign waste substances that are not filtered by the glomerulus including various toxins and medications (such as penicillin)

79

What type of ions are secreted during "tubular secretion?"

Removal of hydrogen ions and other ions to help regulate acid-base and electrolyte balance

80

What are the actual ions being being secreted?

ammonium, sodium, potassium, bicarbonate, and uric acid

81

Within the human body, the blood pH must be maintained within the narrow range of _____

7.35 - 7.45

82

Maintaining pH within the limits is regulated by proper functions of _______

lungs and kidneys

83

pH outside the range of 7.35 - 7.45 becomes incompatible with life. What happens during the process?

Proteins of the body are denatured and cells are destroyed enzymes lose their ability to function, and death is possible

84

What are hydrogen ions produced as?

Waste from metabolism and are generally secreted

85

What happens to bicarbonates in regards to the "Kidney's role in Ion secretion and acid-base balance?"

Bicarbonates can be secreted but they are more often reabsorbed, usually up to 100% to help maintain the proper blood pH

86

What plays a major role in the metabolic acid-base balance?

The kidneys, and they also help with compensation of respiratory acidosis or alkalosis

87

What are the 3 main functions of the distal and collecting tubules?

1) Adjustment of the pH, osmolality, and electrolytes

2) Secretion of potassium, ammonia, and hydrogen ions

3) Reabsorption of sodium and bicarbonate

88

What is a region of tissue found in each nephron in the kidney that is important in regulating blood pressure and body fluid and electrolytes?

Juxtaglomerular Apparatus (JGA)

89

What is a microscopic structure in the kidney that regulates the function of each nephron?

Juxtaglomerular Apparatus (JGA)

90

What are the 3 cellular components of the JGA?

1) Macula Densa of the distal convoluted tubule

2) Juxtaglomerular cells

3) Mesangial cells

***

91

Smooth muscle cells of the afferent arteriole are also known as what?

Juxtaglomerular cells

92

What do juxtaglomerular cells produce and secrete?

Renin

93

Mesangial cells secrete what?

Erythropoietin

94

What is Renin?

An ENZYME produced by the juxtaglomerular cells, it is secreted and reacts with the precursor angiotensin in the blood to convert into angiotensin 1

95

Angiotensin 1 passes through the lungs where the enzyme ________

Angiotensin Converting Enzyme (ACE) changes it to the active angiotensin II

96

Angiotensin II results in:

Systemic vasoconstriction including the afferent and efferent arterioles

97

Angiotensin II results in systemic vasoconstriction by triggering the release of what hormone?

Aldosterone (from the adrenal glands), which increases sodium reabsorption

98

Besides Angiotensin II triggering the release of Aldosterone, what other hormone does it trigger the release of?

Antidiuretic hormone aka VASOPRESIN, from the posterior pituitary gland

99

What is aldosterone secreted by?

Adrenal cortex (zona glomerulosa)

100

What is the most precise thing that aldosterone does?

Increases blood sodium reabsorption in the distal tubules of the nephron, which in turn increases blood volume as water follows salt, raising blood pressure (could contribute to hypertension)

101

What does aldosterone enhance?

Potassium/sodium ions in distal tubules of the nephron

102

Andtidiuretic Hormone aka

Vasopresin

103

Where is ADH aka Vasopresin synthesized?

Hypothalamus

104

Where is ADH/ vasopressin stored?

In vesicles released from the posterior pituitary gland (neurohypophysis)

105

What does ADH/vasopresin regulate?

Absorption of water in the collecting ducts

106

What makes walls of the collecting ducts permeable?

Antidiuretic Hormone/ADH/ Vasopresin

107

Production of ADH depends on the body's state of _______

Hydration

108

Insufficient ADH results in ______

Diabetes Insipidus (DI)

109

DI (diabetes insipidus) is a problem of 2 possible things, what are they?

1) Decreased production of antidiuretic hormone (Central DI)

2) Abnormal kidney's response to antidiuretic hormone (nephrogenic DI)

110

What is "Syndrome of Inappropriate ADH (antidiuretic Hormone) Secretion" characterized by?

Excessive release of antidiuretic hormone from the posterior pituitary gland or another source

111

Syndrome of Inappropriate ADH Secretion aka

SIADH syndrome

112

80% of SIADH syndrome is caused by ______ ?

Small cell lung carcinoma (aka oat cell carcinoma)

113

What might SIADH result from?

Complication of brain injury, tumor growth, and certain medications

114

What is also characterized by continuous secretion of ADH in spite of plasma hypotonicity and normal or expanded plasma volume?

Syndrome of Inappropriate ADH aka SIADH syndrome

115

What are the 5 main things Syndrome of Inappropriate ADH secretion results in?

1) High plasma volume

2) Low serum osmolarity

3) Low plasma sodium (hyponatremia)

4) High urine osmolarity

5) Higher than normal urine sodium

116

In general, increased ADH causes water retention _______

WITHOUT* extracellular fluid volume expansion and without edema or hypertension

117

When hyponatremia is severe, what symptoms will occur?

Cerebral edema become prominent (irritability, confusion, seizures, and coma)

118

Fluids filtered at the glomerulus:

90-120 ml/min

119

Final urine volume Excreted as urine:

1ml/min on average

120

Dehydration reduces urine production to _____

0.3 ml/min

121

Excessive hydration increases urine production to ______

15ml/min

122

Average adult urine daily volume of urine:

1200-1500ml

123

More urine is produced during _____

the day

124

What is the normal total urine range ?

600-2000 ml/ 24 hours

125

What is polyuria?

Abnormal increase in the volume of urine (2500 ml and > per 24 hours), as in diabetes insidious and diabetes mellitus

126

What is Oliguria?

Decrease in urinary volume, such as occurs in shock and acute glomerulonephritis.

127

What is oliguria defined as?

Being < 400 ml/24 hr

128

What is Anuria?

Designates the complete suppression of urine formation

129

What is Anuria sometimes defined as?

Being < 75 ml/24 hours during 2-3 consecutive days, in spite of a high fluid intake

130

In 24 hours the body excretes approximately ___1__ of dissolved material, half of which is ___2___

1) 60 g

2) UREA

131

What is in ABNORMAL urine?

1) Bilirubin
2) Blood
3) Glucose
4) Ketone Bodies
5) Porphyrins
6) Protein

132

What is in the "sediment" of urine?

1) Cells
2) Crystals
3) Casts


Some of these are considered to be normal, while others are seen in various renal and metabolic disorders

133

What is inflammation of the bladder?

Cystitis

134

Nephritis can be present with bacterial infection, what is that called?

Pyelonephritis

135

Nephritis can be present WITHOUT bacterial infection, what is that called?

Glomerulonephritis