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FNP Advanced Pathophysiology > Urinary System Part 1 > Flashcards

Urinary System Part 1 Flashcards

1
Q

External Structures of the Kidney:

A

-Kidneys
Retroperitoneal- location
Renal capsule- surrounds each
- Imbedded in mass of fat
Renal fascia- fibrous tissue surrounding the capsule and fat layer that attaches the kidney to posterior abdominal wall
- Hilum- medial indentation for entry/exit blood vessels, nerves, lymph vessels, ureter

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2
Q

Structures of the Kidney

A
  • Renal cortex
  • Renal medulla
  • Renal pyramids
  • Renal columns
  • Minor calyx
  • Major calyx
  • Renal pelvis
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3
Q

Nephron

A 
Nephron
 1.2 million nephrons per kidney
 Functional unit of the kidney
 3 kinds
 Superficial cortical nephrons
 Extend partially into medulla
 Midcortical nephrons
 Juxtamedullary nephrons
 Extend deep into medulla- urine concentration
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4
Q

Nephron- Tubular structure with subunits that contribute to urine formation

A
  • Renal corpuscle
  • Proximal convoluted tubule
  • Loop of Henle
  • Distal convoluted tubule
  • Collecting duct
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5
Q

Nephron- Tubular structure with subunits that contribute to urine formation:

A

-Renal corpuscle
Glomerulus- “tuft of capillaries”
Bowman capsule
Mesangial cells-support, contractile, phagocytic, produce vasoactive substances, control flow
Bowman space- Space inside Bowman’s capsule

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6
Q

Nephron

A
  • Glomerular filtration membrane (wall of glomerular capillary for filtration)
    • Glomerular endothelium
    • Basement membrane

–Capillary epithelium
Also referred to as podocytes or visceral epithelium
Filtration slits

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7
Q

Nephron

A

Juxtaglomerular apparatus

  • Juxtaglomerular cells- around the afferent arteriole where it enters renal corpuscle
  • Macula densa- portion of distal convoluted tubule with specialized sodium and chloride sensing cells.
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8
Q

Nephron

A 
- Renal tubules
 Proximal tubule
 Loop of Henle
 Distal tubule
 Collecting duct
--- Principal cells-resorb  
Na and H2O, secrete K
--- Intercalated cells- secrete H, bicarbonate, resorb K
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9
Q

Structures of the kidney: Blood Vessels

A
  • Renal arteries
  • Interlobar arteries
  • Arcuate arteries
  • Interlobular arteries
  • Afferent arterioles
  • Glomerular capillaries
  • Efferent arterioles
  • Peritubular capillaries and vasa recta
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10
Q

Ureters

A
  • 30 cm long
  • Long, intertwining muscle bundles
  • Pass obliquely though posterior aspect of bladder
  • Peristaltic activity
  • Micturition compresses the lower end of the ureter to avoid urine reflux
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11
Q

Bladder

A
  • Detrusor muscle
  • Transitional epithelium-barrier to prevent water and solutes moving between urine and blood
  • Trigone- between openings ureters and urethra
  • Micturition reflex
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12
Q

Urethra:

A
  • internal and external sphincters (muscles)
  • 3 to 4 cm in females
  • 18 to 20 cm in males
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13
Q

Renal Blood flow:

A

 Receive 1000 to -1200 mL of blood per minute

-Glomerular filtration rate (GFR)
1) Plasma vol per unit
time
2) Directly related to
perfusion pressure
in glomerular
capillaries
3)Directly related to
renal blood flow
(RBF)

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14
Q

Regulation of Renal Blood Flow:

A
  • Autoregulation
  • Try to keep RBF and GFR constant
  • Myogenic mechanism
    1) ↓Arterial pressure → ↓ stretch afferent arteriolar SM → arteriole relaxes → increase RBF

2) ↑ Arterial pressure → ↑ stretch afferent arteriolar SM → arteriole contracts → decrease RBF

-Tubuloglomerular feedback
 –Macula densa cells sense flow and sodium and triggers compensatory changes in arteriolar resistance and GFR

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15
Q

Regulation of Renal Blood Flow:

A

Neural regulation
 -Baroreceptor reflex response to Systemic BP
- Sympathetic ANS- NE stimulates
vasoconstriction when systemic BP decreases

Hormones

  • Renin- angiotensin systems
  • Natriuretic peptides- atrial natriuretic peptide (ANP) from right atrium
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16
Q

Renal Blood Flow: Nephron Function

A

-Glomerular filtration

 The process of forming a protein-free plasma across the glomerular capillaries

 Net filtration pressure
- Glomerular hydrostatic pressure
-Capsular hydrostatic pressure
- Blood oncotic pressure
 
Filtration rate
17
Q

Glomerular Filtration: Nephron Function

A
  • Tubular reabsorption
    -Tubular secretion
    -Excretion
    -Tubular transport
    Proximal tubule
    Loop of Henle and distal tubule
    Glomerulotubular balance- proximal tubule adjusts rate to counter GFR to maintain Na and water balance
18
Q

Tubular reabsorption:

A
  • Movement fluids and solutes from the tubular lumen to the peritubular capillary plasma
  • Mechanisms are both active and passive
19
Q

Tubular Secretion:

A
  • transfer of substances from the plasma of peritubular capillary to the tubular lumen
  • Not water
  • Transport mechanisms are both active and passive
20
Q

Excretion:

A

-Elimination of urine

21
Q

Tubular Transport:

A

-General name for movement of ions or water across the tubule membranes

22
Q

Nephron Function- Simultaneous

Concentration and Dilution of Urine

A

Countercurrent exchange system

  • Contributes to production of concentrated urine
  • Fluid flows in opposite direction through parallel tubes
  • Fluid moves up and down the parallel limbs of the loop of Henle
  • The longer the loop, the greater the concentration gradient
23
Q

Concentration and Dilution of Urine:

A
  • Urea
  • Catecholamines
  • Antidiuretic hormone (ADH)
  • Urodilantin
  • Natriuretic peptide
  • Diuretics
24
Q

Renal Hormones:

A
  • Vitamin D

- Erythropoietin

25
Q

Tests of Renal Function:

A 
- Clearance and glomerular filtration rate
 Inulin
 Creatinine
-Clearance and renal blood flow
- Blood tests
 Plasma creatinine concentration
 Plasma cystatin C concentration
 Blood urea nitrogen (BUN)
26
Q

Tests of Renal Function: Urinalysis

A

-Urine color
-Urine pH
-Specific gravity
-Urine sediment
 RBCs
 Casts
 Crystals
 WBCs

27
Q

Tests of Renal Function: Urinalysis

A 
-Urinalysis
 Reagent strips (dipsticks)
 Glucose
 Bilirubin
 Urobilinogen
 Leukocyte esterase
 Nitrates
 Ketones
 Proteins
 RBCs, hemoglobin, 
     and myoglobin
28
Q

Aging and Renal Function:

A
  • Decrease in kidney size
    -Decrease in renal blood flow and GFR
    -Number of nephrons decrease due to renal vascular and perfusion changes
    -Glomerular capillaries atrophy
    -Tubular transport response decreases
    -Increased bladder symptoms
     Urgency, frequency, and nocturia

FNP Advanced Pathophysiology (6 decks)

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