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anatomy > Test 3 (Urinary System) > Flashcards

Test 3 (Urinary System) Flashcards

1
Q

functions of the urinary system (4)

A
  • kidneys, filter blood. removes waste products and convert filtrate into urine
  • Ureters, transports urine from kidneys to bladder
  • Bladder, expandable muscular sac. Stores as much as 1 Liter of urine
  • Urethra, eliminates urine from the body
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2
Q

What are the functions of the kidneys/what processes occur as filtrate is converted to urine (5)

A
  1. elimination of metabolic wastes (urea)
  2. regulation of ion levels (Na, K, Ca2+)
  3. regulation of acid-base balance (pH); alters levels of H+ and HCO3-
  4. Regulation of blood pressure, kidneys play the biggest role in BP because movement of water causes ions to balance
  5. elimination of biologically active molecules (hormones, drugs)
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3
Q

Additional functions of the kidneys (3)

A
  • formation of calcitriol
  • production and release of erythropoietin
  • potential to engage in gluconeogenesis
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4
Q

when is EPO released and what does it stimulate?
how are the kidneys involved in gluconeogenesis?

A
  • in response to low blood oxygen; stimulates red bone marrow to increase erythrocyte production
  • During prolonged fasting/starvation; occurs in the kidney cortex; produces glucose from noncarbohydrate sources; maintains glucose levels
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5
Q

describe the location of the kidneys (4)

A
  1. located in the retroperitoneal space (posterior to the peritoneum)
  2. extends from T12-L3
  3. protected posteriorly by floating ribs
  4. anchored by various layers of connective tissue
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6
Q

describe the gross anatomy of the kidneys (4)

A
  1. two symmetrical beans shaped organs
  2. size of your hand to the second knuckle
  3. Hilum: concave MEDIAL border where vessels, nerves, and ureter connect to the kidney
  4. Adrenal gland rests on the superior portion of the lateral convex border
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7
Q

There are 3 connective tissue layers that encapsulate the kidneys, describe them

A

RENAL FASCIA: most superficial layer, dense irregular CT, surrounds both kidneys and adrenal glands, anchors

PERINEPHRIC/PERIRENAL FAT CAPSULE: Layer of adipose tissue, cushioning effect

RENAL CAPSULE: Directly covers outer surface of the kidney, dense irregular CT, helps prevent trauma and pathogen penetration

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8
Q

what is the renal cortex
what is the renal medulla
what is the renal pyramids
what are the major and minor calyces

A
  1. outer granular regions, reddish brown color, determination of vasculature, filters blood
  2. inner regions, composed of renal pyramids with striped appearance
  3. clusters of many nephrons and collecting ducts
  4. collect urine from renal lobes ( a pyramid and surrounding cortical tissue)
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8
Q

What are the parts of the internal kidney (4)

A

Renal cortex, renal medulla, renal pyramids, major and minor calyces

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9
Q

what is the structure and function of the ureters (4)

A
  • carry urine out of the kidneys and to the bladder
  • capable of peristalsis
  • connect to the bladder at an angle to prevent backflow of urine
  • further bladder filling also compresses the distal end of the ureter, further preventing backflow
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9
Q

T/F the cortex and medulla share the same function in the kidneys

A

FALSE; the cortex is where blood filtration occurs. The medulla removes uric acid, houses most nephron tubule space, and is where urine is produced and concentrated

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10
Q

describe juxtamedullary nephrons (3)

A
  • makes up 15% of nephrons
  • long loops extend DEEP into the medulla
  • main function is to concentrate urine
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10
Q

describe the microscopic anatomy of the ureters

A

MUCOSA: deepest layer, made of transitional epithelium, readily stretches to accommodate distension from urine filling

MUSCULARIS: middle layer, senses distension with urine filling and triggers reflexive peristalsis

ADVENTITIA: superficial layer, made of fibrous CT, anchors ureter in place

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11
Q

common features of the BLADDER in both men and women (5)

A
  • inner mucosa layer is made of transitional epithelia
  • the middle layer (detrusor) contains muscle that can contract to drive urination
  • the thick muscle near the urethra forms the internal urethral sphincter
  • epithelium transitions to stratified squamous near the urethra’s opening to the outside
  • Urine passes through a ring of skeletal muscle on its way out, the voluntary external urethral sphincter
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11
Q

describe the anatomy of the vasculature in the kidneys (4)

A
  • The renal artery and vein enter at the Hilum
  • The renal artery branches into several segmental arteries and further branches into interlobar arteries
  • interlobar arteries travel through the renal columns and branch into arcuate arteries in the cortex
  • arcuate arteries branch into cortical radiate arteries (interlobular) which further branch into microscopic afferent arterioles
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11
Q

what is a nephron

A

structural and functional unit of urine formation in the kidney

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11
Q

what is the difference between the urethra in men and women?

A

In women its only 3-5 cm in length and functions only in the transport of urine. In men it’s 20 cm in length and functions to transport urine AND semen.

Men have a harder time passes kidney stones since it has to travel longer

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12
Q

What is the flow of fluid through a nephron?

A
  1. Proximal Convoluted tubule (PCT): located entirely within the cortex, contains simple cuboidal epithelium with microvilli
  2. Descending Tube (DT): descends into the medulla, alternates between thick and thin segments
  3. Loop of Henle (LH): connects the ascending and descending tubes
  4. Ascending Tube (AT): alternates between thick and thin segments
  5. Distal Convoluted Tubule (DCT): contains simple cuboidal epithelium that lacks microvilli
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12
Q

what are principal cells
what are intercalated cells

A
  1. responsive to hormones like aldosterone and antidiuretic hormone (ADH) Adjust urine in order to maintain body’s water, Na+, and K+ balance
  2. specialized epithelial cells that regulate urine and blood pH
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13
Q

describe the overall function of nephrons (3)

A
  • Afferent arterioles drain into the glomerulus
  • filtration occurs when fluid and solutes are forced from the blood in the glomerulus into the space in the surrounding Bowmans capsule
  • Blood is drained from the glomerulus by efferent arterioles
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13
Q

what are the two types of nephrons
what factors determines nephron classification

A
  • cortical and juxtamedullary
  • Relative position of renal corpuscle in the cortex and length of the nephron loop
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14
Q

describe a cortical nephron (4)

A
  1. orientated with renal corpuscles near the peripheral cortex
  2. short nephron loops barely penetrate the medulla
  3. most common type, 85%
  4. main function is solute reabsorption and excretion (ion/solute balance)
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15
Q
  1. where do nephrons drain
  2. where do collecting ducts drain
  3. within the ducts/tubules, what cells can be found
A
  1. collecting tubules; multiple CT drain into larger collecting ducts
  2. the papillary duct located within the renal papilla
  3. specialized epithelial cells (principal cells and intercalated cells)
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16
Q

describe the anatomy of the Juxtaglomerular Apparatus (JGA) (3)

A
  • occurs when a portion of the DCT comes into contact with the afferent arteriole
  • macula densa cells in the DCT monitor concentrations of Cl- and Na+ in the filtrate
  • Granular/juxtaglomerular cells respond to changes in blood pressure in the afferent arteriole
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17
Q

function of the JGA

A

helps regulate blood filtrate formation and systemic blood pressure

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18
Q

what are granular cells (4)

A
  • modified smooth muscle cells of the afferent arteriole
  • located near the entrance of the renal corpuscle
  • contract when stimulated by stretch or sympathetic stimulation
  • synthesize, store, and release renin
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18
Q

what are macula densa cells (3)

A
  • located on tubule side of DCT next to the afferent arteriole
  • detects changes in NaCl concentration of fluid in the lumen of the DCT
  • Signals granular cells to release renin through paracrine stimulation
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19
Q

what are the 3 interconnected human fluid pools of the body

A
  • intracellular fluid (fluid inside the cells)
  • intravascular fluid (fluid inside blood vessels)
  • interstitial fluid (fluid between cells)
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19
Q

t/f fluid pool solute profiles are identical

which fluid pools are extracellular

how many liters does each pool hold

A

false

interstitial and intervascular

intracellular fluid (28L)
extracellular (14L) > Plasma (3.5L), interstitial (10.5L)

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20
Q

describe intracellular fluid (3)

A
  • contains water, electrolytes, small molecules, non-electrolytes, proteins
  • 20-30% protein, pH of 7.0
  • K+, potassium, is the most common ion
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20
Q

describe extracellular fluid (3)

A
  • far less proteins, contains electrolytes
  • pH of 7.4
  • Na+, sodium, is the most common ion
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21
Q

how is thirst stimulated

A
  • exercise, eating salty food, dry mouth
  • a 1-2% increase in osmolarity
  • blood loss
  • release of ADH
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22
Q

what is osmolarity
how is thirst quenched

A
  • solutes/L, expressed as Osmoles/Liter; typical levels are 0.290-0.295 Osm/L
  • as soon as water contacts osmolarity receptors in our cheeks > happens to prevents over consumption of water
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22
Q

in what ways does water loss occur (4)

A
  1. Kidneys (60%)
  2. Lungs (28%) breathing
  3. Sweat (8% or more) depends on temperature, humidity, and activity level
  4. Feces (4%)
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23
Q

what is dehydration
what are the clinical symptoms of dehydration (6)

A
  • excessive water loss via sweating, diarrhea, vomiting, or little water ingestion
  • sticky oral mucus; dry flushed skin; reduced urine formation; thirst; weight loss; fever/CNS abnormalities/death
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24
Q

what is hypotonic hydration 4

A
  • rare
  • drinking too much water
  • decreases fluid pool osmolarity
  • CNS dysfunction
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24
Q

what is hypovolemia 3

A
  • loss of plasma volume (water in plasma)
  • loss of water and solutes
  • occurs with diabetes, burns, wounds, diarrhea, vomiting
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25
Q

what is hypervolemia (2)

A
  • too much water in the plasma volume
  • renal or liver failure; organs are overworked
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26
Q

how is filtrate formed

A

Blood flows through the glomerulus and both water and solutes that are filtered from blood plasma moves across the wall of glomerular capillaries and into the capsular space forming filtrate

26
Q

describe the layers of the filtration barrier

A
  1. capillary endothelium; inner most layer; fenestrated (permeable); allows passage of anything smaller than a cell
  2. basement membrane; fused (not as permeable); blocks everything except small proteins
  3. podocytes of glomerular capsule; pedicels create filtration slits; prevents passage of most molecules
27
Q

what 3 processes contributes to forming urine

A

filtration, reabsorption, secretion

28
Q

where does glomerular filtration occur
what is separated?
what causes filtration
what is the fluid called

A
  • occurs in glomerular capillaries
  • separates some water and dissolved solutes from blood plasma
  • water and solutes enter capsular space of renal corpuscle due to pressure differences across the filtration membrane
  • separated fluid is called filtrate
28
Q

how do you find the net filtration pressure

A

NFP = GBHP - (CHP + BCOP)

  • when pressures promoting filtration are greater than pressures opposing; the difference between the two is NFP
  • needs to be a positive number, 0 or below doesn’t allow for filtration
28
Q

What is GBHP
what is CHP
what is BCOP

A
  • glomerular blood hydrostatic pressure; blood pressure IN the glomerulus; drives filtration
  • Capsular hydrostatic pressure; pressure inside the glomerular capsule; opposes filtration, fights against GBHP
  • blood colloid osmotic pressure; osmotic pull of proteins not being filtered (pressure from proteins); opposes filtration
29
Q

what is glomerular filtration rate
how is it related to NFP

A
  • the total volume of filtrate formed by all of the glomeruli of both kidneys each minute.
  • the magnitude of NFP is directly proportional to GFR
29
Q

filtration is driven by __________ _________?

A

pressure differences

30
Q

what causes a decreased GFR
what causes an increased GFR

A
  • constriction of the afferent arteriole and dilation of the efferent arteriole causes a decreased glomerular filtration rate
  • dilation of the afferent arteriole and constriction of the efferent arteriole causes an increased glomerular filtration rate
31
Q
  • what is renal clearance?
  • what is it used for?
  • a substance with HIGH renal clearance is removed _________
  • what is the renal clearance of a substance that is neither reabsorbed nor secreted by the tubules
A
  • measurement of how quickly the kidneys remove a substance from plasma and excrete it in urine
  • used to determine how quickly a drug/chemical is eliminated by the kidneys
  • QUICKLY from the blood
  • this means that the renal clearance is equal to the GFR
32
Q

what are the assumptions for a substance to approximate GFR (2)

A
  • it must freely pass through the filtration membrane
  • it must neither be reabsorbed from nor secreted into the filtrate by the renal tubules
33
Q

describe reabsorption in the PCT (3)

A
  • does most of the reabsorption
  • Na+, HCO3-, Ca2+, Mg2+, PO4 3-, K+, Glucose, amino acids, proteins, and vitamins are reabsorbed by ACTIVE transport (moves against the concentration gradient)
  • water and other ions are passively reabsorbed by osmosis since more water is found in the filtrate (moves DOWN concentration gradient)
33
Q

what is the formula for renal clearance; what does it mean

A

C = UV/P

C= rate of renal clearance (mL/min)
U= concentration of substance in the urine
V= rate of urine formation
P= concentration of substance in the blood plasma

33
Q

what is tubular fluid
where does it flow

A
  • the new name for filtrate when it enter the proximal convoluted tubule
  • flows through the PCT > loop of henle > DCT > collecting tubules > collecting ducts > papillary duct within renal papilla
34
Q

when does “tubular fluid” become urine?

A

when it enters the papillary duct within the renal papilla

35
Q

The second step in urine formation is reabsorption. describe it (6)

A
  • tubular reabsorption is the movement of components within tubular fluid
  • components move by diffusion, osmosis, or active transport
  • components move from the lumen of tubules and collecting ducts across walls
  • components return to the blood within peritubular capillaries and the vasa recta
  • ALL vital solutes and MOST water is reabsorbed
  • excess solutes, waste products, and some water remains in the tubular fluid
36
Q

describe reabsorption in the ascending and descending loops (2)

A
  • majority of remaining water, Na+, Cl-, and K+ is reabsorbed
  • have opposing permeability: descending loop is permeable to water, the ascending loop is permeable to solutes
36
Q

describe the flow of URINE

A

papillary duct > minor calyx > major calyx > renal pelvis > ureter > bladder (stored here then excreted through the urethra)

37
Q

give a simple definition of glomerular filtration, tubular reabsorption, and tubular secretion

A

Glomerular filtration: the movement of substances from the blood within the glomerulus into the capsular space
Tubular reabsorption: the movement of substances from the tubular fluid back into the blood
Tubular secretion: the movement of substances from the blood into the tubular fluid (this process excretes larger molecules)

38
Q

the final step of urine formation is tubular secretion. describe it (4)

A
  • movement of solutes via active transport
  • solutes move out of the blood within peritubular and vasa recta capillaries
  • solutes then move INTO the tubular fluid
  • materials move selectively into tubules to be excreted
39
Q

what is a transport barrier

A

simple epithelium of the tubule wall that influences reabsorption and secretion

39
Q

what is transcellular transport 3

A
  • movement of substances through the cytoplasm of the epithelial cells
  • must cross the luminal membrane in contact with fluid as well as the basolateral membrane on the basement membrane
  • order depends on whether the substance is being reabsorbed or secreted
39
Q

what is paracellular transport

A

movement of substances BETWEEN epithelial cells, this type of transport is easier

40
Q

what is embedded within the luminal and basolateral membranes and what do they do

A

transport proteins > They control the movement of various substances

41
Q

what aids the peritubular capillaries in moving substances in and out

A
  • low hydrostatic (water) pressure and high oncotic (cell) pressure; facilitates the reabsorption of substances through bulk flow
42
Q

where does most reabsorption occur and why?

A

In the proximal convoluted tubule because it’s aided by microvilli to increase the surface area

43
Q

what is transport maximum (Tm) 4

A
  • the maximum rate of a substance that can be reabsorbed or secreted across the tubule epithelium per a certain time
  • depends on the number of transport proteins in the membrane
  • if 375 mg/min or below, glucose in the tubule is all reabsorbed
  • if greater than 375 mg/min, excess glucose is excreted in the urine
44
Q

what is renal threshold
what is the renal threshold for glucose

A
  • the maximum plasma concentration of a substance that can be transported in the blood WITHOUT appearing int he urine
  • the renal threshold for glucose is 180 mg/dl
45
Q

what is nitrogenous waste; list 3 examples

A

metabolic waste that contains nitrogen; urea, uric acid, and creatinine

46
Q

what is urea, how is it eliminated
what is uric acid, how is it eliminated
what is creatinine, how is it eliminated

A
  • a molecule produced form protein breakdown; 50% is excreted in the urine, the other 50% helps establish the concentration gradient in the interstitial fluid
  • produced from nucleic acid breakdown in the liver; eliminated by both reabsorption and secretion
  • produced from creatinine metabolism in the muscle; this product is ONLY secreted, does not get reabsorbed
47
Q

where does secretion occur most
what is commonly secreted
give examples of each category

A

PCT

the elimination of drugs and bioactive substances

drugs: penicillin, sulfonamides, aspirin
metabolic wastes: urobilin, hormone metabolites
hormones: human chorionic gonadotropin (tested for in pregnant women), and epinephrine

48
Q

is urea good or bad for us?

A

urea is a toxic chemical at high levels, however, moderate amounts can help drive the osmotic gradient and helps the concentrating process in the interstitial fluid

49
Q

describe the process of urea recycling 4

A
  • urea is removed from the tubular fluid in the collecting duct by uniporters
  • it diffuses back into the tubular fluid in the thin segment of the ascending limb
  • it remains within the tubular fluid until it reaches the collecting duct
  • then urea is recycled between the collecting tubule and the loop of henle
50
Q

what is hyponatremia; what does it cause 3

A
  • low plasma Na+
  • leads to renal disease, congestive heart failure, and Addison’s disease (symptoms are all CNS dysfunction)
51
Q

what is hypernatremia; what does it cause 3

A
  • high plasma Na+
  • dehydration, vomiting, diarrhea (symptoms are all CNS dysfunction)
52
Q

what is hypokalemia; what does it cause (4)

A
  • low plasma K+
  • vomiting, diarrhea, cushing disease, muscle weakness
53
Q

what is hyperkalemia; what does it cause (4)

A
  • high plasma K+
  • renal failure, Addison’s disease, muscle fatigue, heart abnormalities
54
Q

what is hypocalcemia; what does it cause (5)

A
  • low plasma Ca2+
  • muscle stiffness, spasms, hypotension, heart failure, arrhythmia
55
Q

what is hypercalcemia; what does it cause (5)

A
  • high plasma Ca2+
  • frequent urination, nausea, vomiting, muscle weakness, heart abnormalities
56
Q

what is the typical pH of blood

A

7.4, give or take 0.5 due to constant CO2 production during cellular metabolism

57
Q

t/f: any compound that has H+ is a base and any compound that accepts H+ is an acid.

A

FALSE: any compound that contributes H+ is an ACID and any compound that accepts H+ is a BASE.

58
Q

what does increased levels of CO2 do to pH
what does decreased levels do

A
  • increased CO2 drives the reaction to the right, increasing H+ concentration, making blood more acidic
  • decreased CO2 drives the reaction to the left, decreasing H+ concentration, making blood more basic
59
Q

what is the ph of acidosis
what is the ph of alkalosis

A

Acidosis: pH below 7.35
Alkalosis: pH above 7.45

60
Q

what are the 4 major buffering mechanisms in the body that resist significant changes in pH

A
  • carbonic acid/bicarbonate: CO2 + H2O <-> H2CO3- + H+
  • phosphate molecules: H2PO4 <-> HPO4- + H+ <-> PO4-2 + H+
  • ammonium/ammonia: NH4+ <-> NH3 + H+
  • amino acids in proteins: RCOOH <-> RCOO- + H+
61
Q

the 4 major buffer reactions are _________ and driven by ______________

A

reversible; driven by the concentration gradient of the reactants

62
Q

in the PCT, how do the kidneys regulate blood pH during acidosis
in the PCT, how do the kidneys regulate blood pH during alkalosis

A

Acidosis: Na+ secretion drives the secretion of HCO3- via co-transport receptors into the urine, making it more basic. Na+ secretion also drives the reabsorption of H+ into the blood via counter-transport receptors, making blood more acidic and LOWERING BLOOD PH.

Alkalosis: Na+ is reabsorbed into the PCT EPITHELIA in exchange for H+ protons into the urine via counter-transport receptors, making urine more acidic. Co-transport receptors are used to bring HCO3- (bicarbonate) and Na+ into the blood, making blood more basic and RAISING BLOOD PH.

63
Q

What do type A intercalated cells do?

A

Secrete HCO3- to be reabsorbed by the blood and actively transports H+ into the lumen of the collecting duct (into urine)

64
Q

what do type B intercalated cells do?

A

Actively secrete H+ which gets reabsorbed by the blood and secretes HCO3- into the lumen of the collecting duct (into urine)

65
Q

what is respiratory acidosis (2)

A
  • the inability to dispose of CO2 in the lungs
  • Commonly caused by cardiac failure or opioid overdose
66
Q

what is metabolic acidosis (4)

A
  • overproduction of non-volatile organic acids
  • caused by diabetes, exercise, or starvation
  • kidney damage prevents proton secretion
  • leads to severe diarrhea causes excessive bicarbonate loss
67
Q

what is respiratory alkalosis (2)

A
  • hyperventilation (fast and shallow breathing) and excessive CO2 loss at the lungs
  • can be acute (rare) or chronic (high altitude sickness)
68
Q

what is metabolic alkalosis

A
  • over-secretion of stomach acid/vomiting (hard to achieve)
69
Q

what process do the kidneys use to regulate BP; describe it

A

Renin-Angiotensin-Aldosterone-System
1. blood pressure falls to 100 mm Hg or lower causing kidneys to release RENIN enzyme into the bloodstream
2. Renin splits ANGIOTENSINOGEN (inactive) protein into ANGIOTENSIN 1
3. ANGIOTENSIN-CONVERTING ENZYME splits angiotensin 1 (inactive) into ANGIOTENSIN 2 (active hormone)
4. Angiotensin 2 causes vasoconstriction, ADH release from posterior pituitary, Aldosterone release from adrenal cortex, and increased thirst

70
Q

how does vasoconstriction, ADH, Aldosterone, and thirst raise BP

A

vasoconstriction: increases peripheral pressure and raises BP
ADH: increases water reabsorption and sodium retainment in the kidneys, increases blood volume, increases BP
Aldosterone: increases Na+ reabsorption in the kidneys and causes K+ excretion, increases water reabsorption, increases blood volume, increases BP
thirst: increases water intake, increases blood volume, increases BP

71
Q

what is renal ptosis
what is it caused by
what can it lead to

A
  • inferior (downward) movement of a kidney in the abdominal cavity
  • due to loss of adipose tissue in elderly folks or individuals with anorexia nervosa
  • can cause kinks in the ureter which blocks urine flow, this backup can result in kidney swelling (hydronephrosis), which can lead to kidney failure
72
Q

what is renal failure
what is it caused by
what happens if your kidney is destroyed
treatment (2)

A
  • greatly diminished or absent renal functions
  • caused by chronic disease that affects nephrons, the glomerulus, or small blood vessels; autoimmune disease; high blood pressure; diabetes
  • it will not function again
  • dialysis or kidney transplantation
73
Q

what is renal calculi
what are the risk factors (4)
difference between small and large stones.
what is the magic number
treatment?

A
  • kidney stones formed from crystalline minerals building up in the kidneys
  • inadequate fluid intake, reduced urinary flow, frequent UTIs, abnormal chemical/mineral levels in urine
  • smaller stone are asymptomatic, larger stones obstruct the kidney, renal pelvis, and ureter causing severe pain along the “loin-to-groin” region
  • most pass on their own if less than 4mm in diameter
  • lithotripsy or ureteroscopy
74
Q

what are UTIs
who is more affected
how does it spread
symptoms (6)
how is it diagnosed and treated

A
  • Urinary tract infection; occurs when bacteria/fungi multiply within the urinary tract
  • women are 30X more prone due to having a short urethra and close distance to the anus
  • first develops in the urethra (urethritis), spreads to the bladder (cystitis), can spread to the kidneys (pyelonephritis)
  • painful urination (dysuria), frequent urination, pressure on pubic region, pyelonephritis causes flank pain, back pain, and nausea
  • diagnosed through urinalysis and treated with antibiotics
75
Q

what is glucosuria
what concentration level must it surpass
how does glucose act as an osmotic diuretic
symptoms 3

A
  • the excretion of glucose in the urine
  • plasma glucose concentration of above 300 mg/dL
  • it pulls water into the tubular fluid and causes a loss of fluid in the urine
  • classic symptoms of diabetes, frequent urination, thirst

anatomy (17 decks)

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