Anatomy of the Kidneys and Adrenal Glands

Question 1

• which kidney is higher up?
• what are they covered by?
• they are located behind the peritoneal cavity, what is this term called?

Answer 1

• left higher
• covered by floating ribs
• retro-peritoneal

Question 2

adrenal glands cap what border of the kidneys

Answer 2

superior-medial border

Question 3

how many lobes are in a kidney

Answer 3

the number of meduallary pyramids (8-10)

Question 4

where does 90% of blood passing through the kidney go

Answer 4

cortex

Question 5

where are medullary rays in? what do they represent

Answer 5

cortex

represent aggregations of straight and collecting tubules

Question 6

what is a renal lobule

Answer 6

medullary ray with surrounding cortical material

Question 7

how many major calices are there

Answer 7

2-3

Question 8

the collecting ducts perforate the tip of the ______

Answer 8

medullary pyramid

ex. renal papilla

Question 9

what is the point of convergence of the 2-3 major calices

Answer 9

renal pelvis

Question 10

_______ nephrons contribute tubules to the loop of henle

Answer 10

juxtamedullary

Question 11

the kidney receives ____% of cardiac output

___% of flow is through the cortex

Answer 11

20%

90%

Question 12

blood supply to the medulla is derived from the _________ of ___________

Answer 12

efferent arterioles of juxtamedullary glomeruli

Question 13

the efferent arterioles juxtamedullary glomeruli give rise to _____ capillaries, and ______

Answer 13

peritubular capillaries (like other glomeruli) 
vasa recta (straight, long capillaries)

Question 14

what give rise to vasa recta?

Answer 14

arcuate arteries

efferent arterioles juxtamedullary glomeruli

Question 15

urea is a breakdown product of ….

Answer 15

protein and ammonia metabolism

Question 16

creatinine is a breakdown product of…

Answer 16

creatine (importnat part of muscle)

Question 17

plasma glucose > _____mg% will spill into the urine

Answer 17

> 180mg%

Question 18

what are the endocrine functions of the kidney

Answer 18

erythropoietin

renin

Question 19

what is erythropoietin (EPO) produced by

when is it released

Answer 19

peritubular capillary endothelium

-released in response to low blood oxygen (hypoxia or reduced hemotocrit)

Question 20

when is renin produced?
what system does renin stimulate?
what has the opposite effect as renin?

Answer 20

• produced when bp is low
• stimulates angiotensin system => increases blood pressure
• atrial natiuretic factor has the oppoiste effect

Question 21

what contains cells of the macula densa?
where does macula densa occur?
what does the macula densa do?

Answer 21

• distal convoluted tubule
• occurs where the distal CT makes contact w/ the JG cells on the arteriole feeding into bowman’s capsule
• monitors composition of fluid in tubular lumen

Question 22

what do extraglomerular mesangial cells (aka lacis cells) do

Answer 22

transmit information from macula densa to granular cells

Question 23

what do granular (JG) cells receive

Answer 23

the low sodium signal from cells of the macula densa

Question 24

what are granular cells

Answer 24

modified smooth muscle cells w/ epithelioid appearance located in afferent arteriole close to glomerulus
-synthesize the proteolytic enzyme renin

Question 25

the JG cells secrete renin in response to...

Answer 25

1. beta-1 adrenergic stimulation - contract blood vessels/increase BP 2. reduced renal perfusion presssure - detected directly by the JG cells 3. decreased NaCl reabsorption by the macula densa - due to reduction in glomerular filtration rate

Question 26

what catalyses conversion of angiotensinogen to angiotensin I

Answer 26

renin

Question 27

what converts angiotension I to II

Answer 27

ACE angiotensin converting enzyme -produced the epithelial cells in lung capillaries

Question 28

what do ACE inhibitors do

Answer 28

block production of angiotensin II

Question 29

angiotensin II is a very potent...

Answer 29

vasoconstrictor

Question 30

normally, _______ splits to form the 2 kidneys, if it doens't you will end up with a horseshoe kidney

Answer 30

primordial tissue

Question 31

what does metanephric duct develop to what does metanephric blastema develop to what does mesonephric duct develop to what are all other parts derived from (except methanephric blastema)

Answer 31

most mature kidney tissue nephrons and part of collecting duct bladder trigone and the gonads ureteric bud

Question 32

polycystic kidney disease - recessive or dom? - accounts for ____% of dialysis patients in the US - unilateral? bilater? - one of the most common.... - what is the leading cuase of this

Answer 32

- autosomal dominant disease - 10% - bilateral, progressive cystic dilation of the renal tubules - one of the most common inherited disorders - end stage diabetic nephropathy is the leading cuase

Question 33

there is an association btwn polycistic kidney disease and... (similar 7-10th week embryognetic stages)

Answer 33

blepharochalasis - inflammation of the eyelid => atrophy - tends to affect upper lid more - thought to stem from a problem at the same embryological development point as PKD

Question 34

what are some associated abnormalities btwn kidney and eye problems

Answer 34

severe myopia, cataracts, papilledema, peripheral retinal pigmentation

Question 35

constrictions prevent backflow of urine from where to wehre

Answer 35

bladder to kidney

Question 36

where are the 3 locations wehre preventing backflow would be problematic

Answer 36

1. where renal pelvis ends and ureter begins 2. at point where ureter passes from abdomen to pelvis around sacral prominence 3. where ureter obliquely enters bladder

Question 37

what is the detrusor muscle

Answer 37

the smooth muscle of the bladder | -outer longitudinal layer

Question 38

what is the detrusor muscle contolled by - what give feelings of fullness - what is the lumen lined by

Answer 38

parasmpathetic nervous system - sensory fibers give ruse to feelings of fullness - lumen lined by transitional epithelium

Question 39

what is incontinence

Answer 39

loss of bladder control | more common in women

Question 40

the first part of the male urethra travels through what

Answer 40

prostate

Question 41

what is benign prostatic hyperplasia

Answer 41

the constant feelings of needing to urinate

Question 42

what is reiter's disease

Answer 42

triad of arthritis, conjunctivits, or anterior uveitis, and urethritis -autoimmune disease

Question 43

what bacteria are known to cause Reiter's disease

Answer 43

``` shigella slamonella yersinia species campylobacter jejuni chlamydia trachomatis -these bacteria have proteins (antigens) w/ similar molecular structure to those in host => autoimmune reaction ```

Question 44

what are intravenous pyelogram used for what is the most common cuase of blockage -dye is injected and it filters throgh what before x rays are taken

Answer 44

to detect suspected obstruction to the flow of urine through the collecting system - most common cuase of blockage is a kidney stone (nephrolith) - dye is injected, it filters through kidneys and then x-rays are taken

Question 45

what is the capsule of the adrenal gland bound by | -where are the the adrean glands

Answer 45

renal fascia | -above the superior medial border of the kidneys

Question 46

in adrenal glands innervation is mostly _____ sympathetics that go to cells of the meulla

Answer 46

preganglionic

Question 47

what do zona glomerulosa zona fasciculata zona reticularis produce?

Answer 47

mineralcorticoids glucocoritcoids androgen/estrogen

Question 48

how do optometrists prescribe glucocorticoid steroids? for what? - how do these work - when the pt is taken off steroids what happens

Answer 48

topically or orally to treat inflammatory conditions - these steroids feed back to adrenals to turn off steroid production - their adrenals need time to bounce back - ocular steroids are tapered down slowly in pts that received topical steroids for more than a week