Introduction to Nephrology

Question 1

surgery

• adrenal, kidney, bladder, ureter, male genitals, prostate

Medical

• voiding dysfunction, infertility, stones, cancers, incontinence, ED, peds concerns, refractory UTIs

Answer 1

urologist

Question 2

deals with

• HTN
• acid base
• acute kidney injury
• chronic kidney injury
• kidney stones
• ESRD- dialysis
• electrolytes/fluid balances

Answer 2

Nephrologists

Question 3

outer portion of the kidney

Answer 3

cortex

Question 4

inner portion of the kidney, goal to be hyperosmotic

Answer 4

medulla

Question 5

functional unit (>1 million/kidney)

Answer 5

nephron

Question 6

collection of capillaries, which leak their filtrate out into the bowman’s space

Answer 6

Glomerulus

Question 7

where does filtration take place

Answer 7

glomerulus

Question 8

• primary site of reabsorption
• also secretion H+ (helps maintain acid/base balance)

Answer 8

proximal convuluted tubule

Question 9

• sets up the concentration gradient into the medulla to make it hypertonic
• water passively leaves the membrane of descending part

Answer 9

loop of henle

Question 10

• ion exchange
• juxtagomerulous aparatatus (sets up hormornal regulation via RAAS)

Answer 10

Distal convuluted tubule

Question 11

• urine concentration (secondary to concentration gradient created by the loop of henle
• where ADH acts

Answer 11

collecting duct

Question 12

feedback mechanisms that works to maintain constant blood flow thru kidneys (along w/ stable GFR) in spite of mean arterial pressure changes

Answer 12

Juxtaglomerular complesx

Question 13

What is the function of the juxtaglomerular apparatus? What is it comprised of?

Answer 13

• Functions in renal autoregulation

Comprised of:

• macula densa of DCT
  senses sodium- feeds info back into JG cells which release renin in response to low NaCl delivery to macula densa; inhibits renin secretion with increased NaCl delivery to macula densa
• juxtaglomerular cells
  site of synthesis, storage and release of renin
  release renin in response to sodium reabsorption (above)
  release renin in response to decreased perfusion pressure to the kidneys
  release renin with sympathetic nerve activation

Question 14

• like aldosterone it can help increase blood volume or maintain Na and H2O
• secreted from posterior pituitary in response to: high Na, low BP
• increases water reabsorption in the DCT and colelcting ducts
• causes vasoconstriction
• alcohol & caffeine inhibit ADH

Answer 14

ADH (vasopressin)

Question 15

what stimulates the release of ADH

Answer 15

hyperosmolality (high Na)
volume depletion (low BP)

Question 16

what inhibits release of ADH?

Answer 16

Hypoosmolality (low Na)
volume overload (high BP)

Question 17

what are major actions of ADH?

Answer 17

Fluid retention
vasoconstriction

Question 18

under normal conditions water deprevation would result in?

Answer 18

increased ADH