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LCRS and LSS > Urinary system > Flashcards

Urinary system Flashcards

1
Q

Give x2 functions of the kidney

A
  1. Production of urine through selective reabsorption and filtration.
  2. Endocrine function
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2
Q

Which part of the kidney is more well perfused?

A

The cortex.

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3
Q

Name x5 landmarks within the kidney

A

The medulla, cortex, fibrous capsule, minor calyces, major calyces.

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4
Q

Which structure sits on top of the kidney?

A

The adrenal gland (suprarenal gland)

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5
Q

Where is the Loop of henle found in the kidney?

A

Within the medulla of the kidney

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6
Q

What type of molecules are filtered?

A

Molecules <50, 000 MW.

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7
Q

If substances are going to be absorbed from the kidney back into the blood, where will they be absorbed from?

A

The Proximal convoluted tubule.

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8
Q

Where is urine concentrated?

A

The collecting duct

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9
Q

What is the renal corpuscle?

A

The glomerulus + Bowman’s capsule

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10
Q

What is the glomerulus?

A

Bundle of fenestrated capillaries.

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11
Q

What does the ‘filtration barrier’ consist of?

A

Fenestrated capillary endothelium
Specialised basal lamina
Filtration slits between podocyte foot processes

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12
Q

Which part of the kidney adjusts ion concentration of Na+, K+, H+, NH4+?

A

The distal convoluted tubule.

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13
Q

Name x2 adaptations of the kidney for absorption.

A

Many mitochondria (Ascending loop of henle)
Many vesicles.
Brush border has a large surface area

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14
Q

The proximal convoluted tubule absorbs approximately how much of glomerula filtrate?

A

70%

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15
Q

The PCT has what type of epithelium?

A

Cuboidal with fairly tight junctions.

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16
Q

Which part of the kidney contains a larger amount of aquaporins?

A

The PCT.

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17
Q

Name x2 structures you would find many of in the PCT

A

Mitochondria

Aquaporins

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18
Q

Describe the extracellular fluid surround the kidney tubules.

A

Hyperosmotic.

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19
Q

Why is the structure of the descending loop of henle thinner and shorter than the ascending loop of henle?

A

Most transport of substances which occurs is passive. Fewer mitochondria. More aquaporins; movement is passive. Ascending loop of henle has less aquaporins; more pumps.

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20
Q

Compare the structure of the descending and ascending loop of henle.

A

Descending loop of henle: simple squamous epithelium, aquaporins
Ascending loop of henle: cuboidal epithelium, water impermeable tight junctions, few aquaporins, many mitochondria.

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21
Q

What is a hyperosmotic solution?

A

A solution with a greater concentration of solutes = draws water; lower water concentration.

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22
Q

Water being reabsorbed back into the blood has what effect on. the blood?

A

Blood becomes more concentrated

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23
Q

Describe the epithelium of the collecting duct.

A

Simple cuboidal epithelium.

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24
Q

Where does renin come from?

A

The Juxtaglomerula apparatus.

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25
Q

Where is the macula densa?

A

In the Distal convoluted tubule.

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26
Q

Are the kidneys intraperitoneal or retroperitoneal?

A

Retroperitoneal

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27
Q

At which level does the right kidney’s superior pole sit in relation to the left kidney?

A

Right kidney = lower down - 11intercostal space

Left kidney = 11th rib

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28
Q

Kidney needs a large blood supply. It takes what percentage of resting CO?

A

20-25%

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29
Q

What drives ultrafiltration by the glomerulus?

A

Blood pressure

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30
Q

Which renal artery is longer the left or the right?

A

The right renal artery is longer than the left beause the aorta lies to the left of the midline.

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31
Q

Where are the three constrictions of the ureters?

A

pelviureteric junction, where ureter crosses pelvic brim and entrance to the bladder

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32
Q

What is the relevance of the 3 constrictions on the ureters?

A

Where renal stones may try to pass and cause renal colic

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33
Q

Which way do the apex and the base of the bladder face?

A 
Apex = anterior
Base = posterior (think about it!)
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34
Q

What is urothelium?

A

Transitional epithelium

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35
Q

Does the bladder membrane have a high or low permeability?

A

Low permemability

36
Q

What is a trigone?

A

The triangular structure in the bladder made by the two entrances from the ureters and the exit to the urethra.

37
Q

What is the name of the ligament which wraps around the urethra?

A

Pubovesical ligament = holds urethra in place.

38
Q

Where is the external sphincter found?

A

Within the perineal membrane

39
Q

Describe the two urinary sphincters

A

Internal sphincter = smooth muscle, purely reflex

External sphincter = striated muscle, can control partly voluntarily

40
Q

Which nerve do we inhibit to urinary voluntarily?

A

The pudendal nerve which derives from s2, s3 and s4.

41
Q

The internal sphincter is in between which two structures in males?

A

The bladder and the prostate.

42
Q

How will urine be expelled?

A 
Bladder fills
Stretch receptors
\+Parasympathetic nerve (pudendal nerve)
Contraction of the detrusor muscle
relaxation of the internal sphincter
43
Q

What are the names of the nodes in ureters which allow for lymphatic drainage?

A

Para-aortic nodes.

Lymph flows in opposite direction to blood.

44
Q

The glomerulus is permeable and impermeable to which substances?

A

Permeable to small solutes and fluids

Impermeable to proteins and cells.

45
Q

Define the term freely filtered

A

Solutes have the same concentration in the filtrate as in the plasma.

46
Q

What may be seen in the urine in gallstones, cirrhosis or hepatitis?

A

Bilirubin

47
Q

What may be seen in the urine in glomerula damage and nephrotic syndrome?

A

Protein

48
Q

What may be seen in the urine in kidney stones, tumours and glomerulonephritis?

A

Blood

49
Q

When will Urobilinogen be seen in the urine?

A

Haemolysis, cirrhosis and hepatitis

50
Q

What will urine be like in diabetes insipidus?

A

Very dilute

51
Q

Why is it important to get a midstream sample of urine (MSSU)?

A

To avoid contamination from bacteria in or around the urethra.

52
Q

Why do you think it is important to immediately replace the lid on the urine dipstick test strips container?

A

Prevents reagents on the strips reacting with air.

53
Q

Polycystic kidney disease is inherited. True or false.

A

True.

54
Q

Why is protein seen in the urine in glomerula damage?

A

Proteins are very large and could only get into the urine if the glomerula is damaged.

55
Q

What will you see mainly in the urine in alcoholics

A

Excess bilirubin

56
Q

What is specific gravity?

A

Measures concentration of urine.

High specific gravity = very concentrated urine.

Low specific gravity = very dilute urine.

57
Q

What may cause a low specific gravity of urine?

A

Individual has consumed a lot of water

Very dilute urine - as in Diabetes Insipidus.

58
Q

Name one sign other than colour of urine in kidney infection

A

Cloudy urine

59
Q

Osmolarity depends on which more - the number or nature of the particles?

A

Number

60
Q

What percentage of ultrafiltrate is reabsorbed?

A

99%

61
Q

Glomerula filtration is what kind of process?

A

Passive

62
Q

Na2HPO4 has how many mosmoles/L?

A

3mosmoles/L

63
Q

Reabsorption can occur through which mechanisms of transport?

A

Paracellular and transcellular

64
Q

What type of molecules require proteins on the membrane to pass through?

A

Hydrophilic molecules

65
Q

We do not have pumps for which 2 molecules transported in the kidneys?

A

Urea and H20; move massively through transpoters.

66
Q

Water can move through which two molecules?

A

Tight junctions (paracellular pathway) and aquaporins (transcellular pathway).

67
Q

Describe the distribution of solute reabsorption as you move down the nephron

A

60-70% in PCT
25% in Loop of Henle
8% in DCT
<5% IN CD

68
Q

What is the key energy driver for most transporters to function in the kidney?

A

Low intracellular calcium

69
Q

Describe the difference in epithelium type in the descending LoH compared with the ascending LoH.

A

Descending LoH: Squamous

Ascending LoH: Cuboidal

70
Q

Describe the nature of fluid once it leaves the Loop of Henle.

A

Becomes hypo-osmolar compared with plasma; water and salts have been heavily reabsorbed.

71
Q

What is the mechanism behind Furosemide?

A

Blocks triple transporter: Na+/Cl-/K+.

72
Q

Thiazide works through which mechanism?

A

Blocks the Na+/Cl- symporter.

Raises plasma calcium concentration, lowers iCa2+.

73
Q

Why do the DCT and CT require Vasopressin?

A

Would otherwise be impermeable to water as ADH inserts aquaporins (AQ-2) in the apical membrane.

74
Q

Which are the two cells of the collecting duct?

A

Intercalated cells: Regulate acid-base balance

Principal cells: Regulate Na+/K+/water movement.

75
Q

Describe the relationship between the Na+/glucose symporter and the Na+/K+ ATPase pump

A

The Na+/glucose symporter is passive and as both go into the cell, drives an electrochemical gradient for Na+ to leave cell via Na/K+ ATPase pump (active), bringing K+ into the cell. Transport from the Na+/K+ ATPase pump is therefore secondary.

76
Q

How does Na+ leave the ascending LoH compared with Cl-?

A

Na+ leaves passively

Cl- leaves actively.

77
Q

We know that normal GFR is 120ml/min, but what is the normal range?

A

90-150 ml/min.

78
Q

After the age of 40, what happens to the GFR?

A

Declines by 10ml/min every decade.

79
Q

What are the three components of Inulin which make it a suitable marker of GFR?

A
  • Not reabsorbed
  • Not secreted
  • Freely filtered at the glomerulus
80
Q

Carbonic anhydrase has what affect on sodium reabsorption?

A

Increases Na+ reabsorption

81
Q

Potassium is secreted by which cells in the collecting duct?

A

Principal cells

82
Q

Name x2 K+ sparing diuretics

A
  • Amiloride = blocks Na+ channel

- Spirinolactone = aldosterone antagonist.

83
Q

Furosemide is what type of diuretic?

A

Loop diuretic

84
Q

ACE inhibitors can cause….

A

Hyperkalaemia; x Ang II, x Aldosterone which usually works to excrete K+

85
Q

How does do Macula densa cells cause renin release?

A

Detect low Na+ due to a decrease in Na+ entering through the Na+/Cl/K+ pump = macula densa cell becomes hypoosmolar = water leaves, cell shrinks. Produces PGE2 and NO = stimulates renin.

86
Q

Where do K+ sparing diuretics act?

A

Collecting duct

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