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Anatomy & Physiology Review I > Chapter 26 - The Urinary System > Flashcards

Chapter 26 - The Urinary System Flashcards

1
Q

What does Urinary System consist of?

A

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

Maintain homeostasis by managing volume and composition of fluid reservoirs, primarily blood

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2
Q

What are Functions of Kidneys?

A

1- Regulation of blood ionic composition:
Na+, K+, and Cl-

2- Regulation of blood pH:
H+, HCO3-

3- Regulation of blood volume:
H2O

4- Regulation of BP

5- Maintenance of blood osmolarity

6- Production of hormones:
Calcitriol
Erythropoietin

8- Excretion of metabolic wastes and foreign substances (drugs or toxins)

9- Regulation of blood glucose level

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3
Q

What is Kidney?

A

Retroperitoneal, partly protected by lower ribs

Renal Hilum:
Indented area
Entrance for:
1- Renal Artery
2- Renal Vein
3- Ureter
4- Nerves
5- Lymphatics

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4
Q

What are External Layers of Kidneys?

A

External Layers:
(Superficial to deep)

1- Renal Fascia:
Anchors to other structures

2- Adipose Capsule:
Protects and anchors

3- Renal Capsule:
Continuous with Ureter

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5
Q

What is Internal Renal Anatomy?

A

1- Renal Cortex:
Outer layer

2- Renal Medulla:
Inner region

3- Renal Pyramids:
Secreting apparatus and Tubules

4- Renal Columns:
Anchor the Cortex

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6
Q

What is Path of Urine Drainage?

A

1- Collecting Duct
2- Papillary Duct
3- Minor Calyx
4- Major Calyx
5- Renal Pelvis
6- Ureter
7- Urinary Bladder

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7
Q

What is Kidney Blood Supply?

A

Receive 20-25% of resting cardiac output

Flow:
1- Renal Artery
2- Segmental Arteries
3- Interlobar Arteries
4- Arcuate Arteries
5- Cortical Radiate Arteries
6- Afferent Arterioles
7- Glomerular Capillaries
8- Efferent Arterioles
9- Peritubular Capillaries
10- Peritubular Venules
11- Cortical Radiate Veins
12- Arcuate Veins
13- Interlobar Veins
14- Renal Vein

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8
Q

What is Kidney Nerve Supply?

A

Renal Nerves primarily carry Sympathetic outflow
They regulate blood flow through Kidneys

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9
Q

What are Structures of a Nephron?

A

1- Renal Corpuscle:
Glomerulus
Glomerular Capsule

2- Proximal Convoluted Tubule

3- Nephron Loop:
Descending Limb of Nephron Loop
Ascending Limb of Nephron Loop

4- Distal Convoluted Tubule

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10
Q

What is Renal Corpuscle?

A

Consists of 2 parts:

1- Glomerulus:
Mass of capillaries
Fed by the Afferent Arteriole
Drains into Efferent Arteriole

2- Glomerular Capsule (Bowman’s Capsule):
Visceral layer of Podocytes which wrap around capillaries
Filtrate is collected between the Visceral and Parietal layers

Glomerular Endothelial Cells have large pores (fenestrations) and are leaky to filter out

Basal Lamina lies between Endothelium and Podocytes

Podocytes form Pedicels, between which are Filtration Slits

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11
Q

What is the Filtration Membrane?

A

1- Fenestration of Glomerular Endothelial Cell:
Prevents filtration of blood cells
But allows all components of blood Plasma to pass through

2- Basement Membrane of Glomerulus:
Prevents filtration of larger proteins

3- Slit Membrane between Pedicels:
Prevents filtration of medium-sized proteins

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12
Q

What is Cortical Nephron?

A

80-85% of Nephrons

Renal Corpuscle in outer portion of Cortex
Short Loops of Henle extend only into outer region of Medulla
Create urine with osmolarity similar to blood

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13
Q

What is Flow of Fluid through a Cortical Nephron?

A

1- Glomerular Capsule (Bowman’s Capsule)
2- Proximal Convoluted Tubule
3- Descending Limb of the Nephron
4- Ascending Limb of the Nephron
5- Distal Convoluted Tubule

Then drains into Collecting Duct, Papillary Duct, Renal Papilla, Minor Calyx, Urine

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14
Q

What is Juxtamedullary Nephron?

A

Renal Corpuscle deep in Cortex with long Nephron Loops
Receive blood from Peritubular Capillaries and Vasa Recta (where body checks need for ions or not)
Ascending Limb has thick and thin regions
Enables Kidney to secrete very concentrated urine

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15
Q

What is Flow of Fluid through a Juxtamedullary Nephron?

A

1- Glomerular Capsule (Bowman’s Capsule)
2- Proximal Convoluted Tubule
3- Descending Limb of the Nephron
4- Thin Ascending Limb of the Nephron
5- Thick Ascending Limb of the Nephron
6- Distal Convoluted Tubule

Then drains in Collecting Duct, Papillary Duct, Renal Papilla, Minor Calyx, Urine

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16
Q

What is Juxtaglomerular Apparatus?

A

The Ascending Loop contacts the Afferent Arteriole at the Macula Densa

The wall of the Arteriole contains smooth muscle cells called Juxtaglomerular Cells (pump blood)

The Juxtaglomerular Apparatus regulates BP in the Kidney in conjunction with the ANS

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17
Q

What is Urine Formation?

A

Excretion of Solute = Glomerular Filtration + Secretion - Reabsorption

1- Glomerular Filtration:
In Glomerulus, blood plasma and dissolved substances (smaller than most proteins) get filtered into the Glomerular Capsule

2- Tubular Reabsorption:
All along the Renal Tubule and Collecting Duct, water, ions, and other substances get reabsorbed from the Renal Tubule Lumen into the Peritubular Capillaries and ultimately into the blood

3- Tubular Secretion:
All along the Renal Tubule and Collecting Duct, substances such as wastes, drugs, and excess ions get secreted from the Peritubular Capillaries into the Renal Tubule.
These substances ultimately make their way into the Urine

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18
Q

What is Glomerular Filtration?

A

Driven by BP
Opposed by Capsular Hydrostatic Pressure (How much dissolved in vessel hitting walls) and Blood Colloid Osmotic Pressure (bigger proteins in blood)
Water and small molecules move out of the Glomerulus
In one day, 150-180L of water pass out of the Glomerular Capsule

Net Filtration Pressure = Glomerular Blood Hydrostatic Pressure - Capsular Hydrostatic Pressure - Blood Colloid Osmotic Pressure

NFP = GBHF - CHP - BCOP

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19
Q

What is Glomerular Filtration Rate (GFR)?

A

Glomerular Filtration Rate (GFR):
Amount of filtrate formed by both kidneys each minute

Homeostasis requires kidneys to maintain relatively constant GFR

If GFR too high:
Substances pass quickly and not reabsorbed, most secreted

If GFR too low:
Nearly all reabsorbed and some waste products not adequately excreted

GFR averages:
1- Males:
125mL/min

2- Females:
105mL/min

GFR is controlled by:
1- Renal Autoregulation
2- Neural Regulation
3- Hormonal Regulation

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20
Q

What is Renal Autoregulation of GFR?

A

1- Myogenic Mechanism:
Smooth Muscle Cells in Afferent Arterioles contract in response to elevated BP

2- Tubuloglomerular Feedback:
High GFR diminishes reabsorption
Macula Densa inhibits release of NO
Afferent Arterioles constrict

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21
Q

What is Example of Negative Feedback Loop for High GFR?

A

1- GFR increased
2- Macula Densa Cells of Juxtaglomerular Apparatus detect it
(Detect increased delivery of Na+, Cl-, and water)
3- Juxtaglomerular Apparatus decrease secretion of NO
4- Afferent Arterioles constrict, which decreases blood flow through Glomerulus
5- GFR decreases

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22
Q

What is Neural Regulation of GFR?

A

Kidneys are richly supplied by Sympathetic fibers
In case of strong Sympathetic stimulation, such as exercise of Hemorrhage:

1- Afferent Arterioles are constricted
2- Urine output is reduced
3- More blood is available for other organs

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23
Q

What is Hormonal Regulation of GFR?

A

1- Decreased Angiotensin II constricts Afferent and Efferent Arterioles
Therefore decreasing GFR

2- Increased Atrial Natriuretic Peptide (ANP) relaxes Mesangial Cells
Increasing Capillary surface area and GFR

(Have opposite effects)
(ANP secreted in response to stretch of Cardiac Atria)

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24
Q

What is the Effect on GFR from Myogenic Mechanism?

A

1- Stimulus:
High BP increase stretching of smooth muscle in Afferent Arteriole wall

2- Action:
Stretched smooth muscle contract
Narrowing Lumen of Afferent Arteriole

3- GFR:
Decrease

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25
What is the Effect on GFR from Tubuloglomerular Feedback?
1- Stimulus: Rapid delivery of Na+ and Cl- to Macula Densa due to high BP 2- Action: Decreased release of NO by Juxtaglomerular Apparatus causes constriction of Afferent Arterioles 3- GFR: Decrease
26
What is the Effect on GFR from Neural Regulation?
1- Stimulus: Increased level of renal sympathetic nerve impulses release Norepinephrine 2- Action: Constriction of Afferent Arterioles through increased release of Renin 3- GFR: Decrease
27
What is the Effect on GFR from Angiotensin II?
1- Stimulus: Blood Volume or BP decreases stimulates production of Angiotensin II 2- Action: Constriction of Afferent and Efferent Arterioles 3- GFR: Decrease
28
What is the Effect on GFR from Atrial Natriuretic Peptide (ANP)?
1- Stimulus: Stretching of Cardiac Atria stimulates secretion of ANP 2- Action: Relaxation of Mesangial Cells in Glomerulus increases capillary surface area available for filtration 3- GFR: Increase
29
What is Tubular Reabsorption and Secretion?
Much of filtrate is reabsorbed, especially water, glucose, AA, and ions Secretion helps manage pH and rid body of toxic and foreign substances
30
What is Plasma, Filtrate and Urine Composition of Water?
1- Filtered (enters Glomerular Capsule): 180L 2- Reabsorbed (returned to blood): 178-178.5L 3- Secreted (to become Urine): 1.5-2L
31
What is Plasma, Filtrate and Urine Composition of Uric Acid?
1- Filtered (enters Glomerular Capsule): 8.5g 2- Reabsorbed (returned to blood): 7.7g 3- Secreted (to become Urine): 0.8g
32
What is Plasma, Filtrate and Urine Composition of Creatinine?
1- Filtered (enters Glomerular Capsule): 1.6g 2- Reabsorbed (returned to blood): 0g 3- Secreted (to become Urine): 1.6g
33
What are Reabsorption Routes?
1- Paracellular Reabsorption: Passive fluid leakage between cells ex: Tight Junction 2- Transcellular Reabsorption: Directly through the Tubule Cells Active Transport ex: Na+/K+ Pump (channels receive ions to be reabsorbed)
34
What are Transport Mechanisms in the Urinary System?
1- Primary Active Transport: Uses ATP, like Na+/K+ pumps At rest, accounts for 6% of total body ATP use 2- Secondary Active Transport: Driven by ion's electrochemical gradient Symporters move substances in same direction Antiporters move substances in opposite direction
35
What is Water Reabsorption?
1- Obligatory Water Reabsorption: 90% Water follows the solutes that are reabsorbed 2- Facultative Water Reabsorption: 10% Regulated by ADH
36
What is Reabsorption and Secretion in Proximal Convoluted Tubules?
1- Na+/Glucose Symporters 2-Na+/H+ Antiporters 3- Aquaporin-1: Membrane protein permeable to water
37
What is Passive Reabsorption in Late Proximal Convoluted Tubules?
1- Diffusion from Lumen in Tubule to Peritubular Capillary: Cl- K+ Ca2+ Mg2+ Urea 2- Osmosis of water from Lumen of Tubule to Peritubular Capillary
38
What is Reabsorption in the Loop of Henle?
1- Relatively impermeable to water, especially the Ascending Limb 2- Little Obligatory Water Reabsorption 3- Na+/K+/2Cl- Symporters
39
What is Reabsorption in early Distal Convoluted Tubules?
1- Na+/Cl- Symporters reabsorb ions 2- PTH stimulates reabsorption of Ca2+ Also inhibits Phosphate reabsorption in Proximal Convoluted Tubules enhancing its excretion
40
What is Late Distal Convoluted Tubule and Collecting Duct?
1- Principal Cells: Na+/K+ Pumps reabsorb Na+ 2- Aquaporin-2: Reabsorb Water Stimulated by ADH 3- Intercalated Cells: Reabsorb K+ and HCO3- (Bicarbonate) Secrete H+
41
What is Negative Feedback Loop of ADH?
1- Increased Osmolarity of plasma and interstitial fluid 2- Osmoreceptors in Hypothalamus send nerve impulses to Hypothalamus and Posterior Pituitary 3- Hypothalamus increase secretion of ADH through Posterior Pituitary 4- Principal Cells in DCT and Collecting Duct become more permeable to water, which increases Facultative Water Absorption 5- Decrease in plasma Osmolarity
42
What is Histology of Proximal Convoluted Tubule?
Simple cuboidal epithelial cells With prominent brush border of Microvilli
43
What is Histology of Descending Limb of Nephron?
Simple squamous epithelial cells
44
What is Histology of Thin Ascending Limb of Nephron?
Simple squamous epithelial cells
45
What is Histology of Thick Ascending Limb of Nephron?
Simple cuboidal epithelial cells With brush border of Microvilli
46
What is Histology of most of Distal Convoluted Tubule?
Simple cuboidal epithelial cells
47
What is Histology of last part of Distal Convoluted Tubule and all of Collecting Duct
Simple cuboidal epithelium Consisting of Principal Cells and Intercalated Cells
48
What is Regulation of Tubular Reabsorption and Secretion by Angiotensin II?
1- Stimulus: Low blood volume or low BP Stimulates Renin-induced production of Angiotensin II 2- Action: Stimulates activity of Na+/H+ Antiporters in PCT 3- Effects: Increase Reabsorption of Na+ and water Which increases BP and blood volume
49
What is Regulation of Tubular Reabsorption and Secretion by Aldosterone?
1- Stimulus: Increased Angiotensin II level and increased level of plasma K+ Promote release of Aldosterone by Adrenal Cortex 2- Action: Enhance activity of Na+/K+ Pumps in Basolateral membrane And Na+ Channels in Apical membrane of Principal Cells in CT 3- Effects: Increase secretion of K+ and reabsorption of Na+ Increase reabsorption of water, which increase blood volume and BP
50
What is Regulation of Tubular Reabsorption and Secretion by Antidiuretic Hormone (ADH)?
1- Stimulus: Increased Osmolarity of ECF or decreased blood volume Promotes release of ADH from Posterior Pituitary Gland 2- Action: Stimulate insertion of water channel proteins (Aquaporin-2) into Apical membranes of Principal Cells 3- Effects: Increase Facultative Water Reabsorption Which decrease Osmolarity of body fluid
51
What is Regulation of Tubular Reabsorption and Secretion by Atrial Natriuretic Peptide (ANP)?
1- Stimulus: Stretching of Atria stimulates ANP secretion 2- Action: Suppresses reabsorption of Na+ and water in PCT and CT Inhibits secretion of Aldosterone and ADH 3- Effects: Increase excretion of Na+ in urine (Natriuresis) Increase urine output (Diuresis) Thus decrease blood volume and BP
52
What is Regulation of Tubular Reabsorption and Secretion by PTH?
1- Stimulus: Decreased level of plasma Ca2+ Promotes release of PTH 2- Action: Stimulate opening of Ca2+ Channels in Apical membrane of early DCT cells 3- Effects: Increase reabsorption of Ca2+
53
What is Urine Production?
Fluid intake is highly variable Homeostasis requires maintenance of fluid volumes within specific limits Urine concentration varies with ADH High intake of fluid results in dilute urine of high volume Low intake of fluid results in concentrated urine of low volume
54
What is Formation of Dilute Urine?
Glomerular Filtrate and blood have the same osmolarity (water concentration) at 300mOsm/L but Tubular osmolarity changes due to a concentration gradient in the Medulla When dilute urine is formed, osmolarity in the Tubule: 1- Increases in Descending Limb 2- Decreases in Ascending Limb 3- Decreases more in the Collecting Duct Thick Ascending Limb: 1- Symporters actively reabsorb Na+, K+, and Cl- 2- Low water permeability 3- Solutes leave, water stays in Tubule Collecting Duct: Low water permeability in absence of ADH
55
What is Formation of Concentrated Urine?
Juxtamedullary Nephrons with long loops Osmotic gradient is created by the Countercurrent Multiplier Solutes pumped out of Ascending Limb, but water stays in Tubule Medulla osmolarity is increased In presence of ADH, Collecting Ducts become very permeable to water (more ions, less water) Tubular fluid becomes very concentrated Movement of water also carries Urea into the Medulla, contributing to its osmolarity
56
What is Countercurrent Exchange?
Loop and Duct Cells require nutrients and oxygen from blood supply Capillaries that feed them (Vasa Recta) form loops like those of Nephron Loops in the Medulla Incoming and outgoing blood will have a similar osmolarity This maintains Medulla concentration gradient 1- Symporters in Thick Ascending Limb cause buildup of Na+ and Cl- in Renal Medulla 2- Countercurrent flow through Nephron Loop establishes osmotic gradient 3- Principal Cells in Collecting Duct reabsorb more water when ADH is present 4- Urea recycling causes buildup of Urea in Renal Medulla
57
What is Evaluation of Kidney Function?
Routine Urinalysis primarily evaluates for the presence of abnormalities in the urine: 1- Albumin 2- Glucose: Pancreas not secreting Insulin enough Filtration for urine but still Glucose in urine Metabolism of Ketones Ketones acidic pH of blood decrease Ketoacidosis Urine acidic 3- RBC 4- Ketone Bodies Insulin level low Glucose out of cells into blood Starving for glucose Ketone Bodies breakdown Elevated Ketone breakdown for energy Diabetes 5- Microbes
58
What is Urine Transportation and Storage?
Each Ureter transports urine from a Renal Pelvis by Peristaltic waves, Hydrostatic Pressure, and gravity No anatomical valve at the opening of the Ureter into Bladder When Bladder fills, it compresses the opening and prevents backflow The Bladder is a hollow, distensible, Muscular organ, with a capacity averaging 700-800mL
59
What is Ureter, Bladder, and Urethra Anatomy?
1- Right and Left Ureters: Transport urine from Kidneys to Bladder 2- Ureteral Openings: In Bladder 3- Peritoneum: Holds Urinary Bladder in place 4- Rugae of Mucosa: Allow expansion of Urinary Bladder as it fills 5- Detrusor Muscle: Contracts to push urine into Urethra 6- Trigone: Triangle area from the 2 Ureteral Openings to the Internal Urethral Orifice 7- Internal Urethral Orifice: Opening into Urethra 8- Internal Urethral Sphincter: Involuntary controls opening and closing of Urethra 9- Urethra: Passageway for discharging urine from body 10- External Urethral Sphincter: In deep muscles of Peritoneum Voluntarily controls opening and closing of Urethra 11- External Urethral Orifice: Opening of Urethra to outside
60
What is Micturition?
The discharge of urine involves voluntary and involuntary muscle contractions Stretch Receptors trigger a Spinal Reflex, which we learn to control in childhood The Urethra carries urine from the Internal Urethral Orifice to the exterior of the body In males, it discharges Semen as well as urine
61
What is Urethra in Males?
1- Prostatic Urethra: Passes through Prostate Gland Besides urine, it receives secretions containing sperm, sperm motility and viability factors, and substances that neutralize the pH of the Urethra 2- Intermediate Urethra: Passes through Perineum Shortest segment 3- Spongy Urethra: Passes through Penis Longest segment Receives secretions including mucus and substances that neutralize the pH of the Urethra During ejaculation in the male, the semen passes through all segments of the Urethra to the outside
62
Male vs Female Urethra?
1- Urethra 5x longer in males than females 2- Urethra is divide into 3 segments in males, but only 1 short tube in females 3- Urethra is a common duct for the Urinary and Reproductive systems in males, these 2 systems are entirely separate in females
63
What is Waste Management?
1- Body buffers 2- Blood 3- Liver 4- Lungs 5- Sweat 6- GIT
64
What is Development of Urinary System?
During 3rd week of fetal development, a portion of the Mesoderm begins to differentiate inot the Kidneys: Pronephros Mesonephros
65
How does Aging affect Urinary System?
1- Kidneys shrink in size: Lose about 1/3 their mass 2- Experience a decrease in blood flow: Glomerular vessels are damaged or decrease in number 3- Experience a decrease in filtration
66
What are some Urinary System Disorders?
1- Renal Calculi (Kidney stones) 2- Urinary Tract Infection (UTI) 3- Glomerular disease 4- Renal failure 5- Polycystic Kidney disease 6- Urinary Bladder Cancer 7- Kidney transplant 8- Cystoscopy

Anatomy & Physiology Review I (30 decks)

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