Kidney

Question 1

• ________: cortical & juxtamedullary zones

Answer 1

Cortex (outer)

Question 2

• ________: pyramids → papillae

Answer 2

Medulla (inner)

Question 3

• Nephrons are in _________

Answer 3

parenchyma

Question 4

• Renal corpuscle:
• _________
• _________

Answer 4

• Glomerulus
• Bowman’s capsule

Question 5

• Renal tubule:
• _________
• _________

Answer 5

• PCT
• Loop of Henle (descending, ascending limbs) - DCT → Collecting duct

Question 6

• JGA = ______ + _______

Answer 6

Macula densa + JG cells

Question 7

RENAL PHYSIOLOGY

Answer 7

❑* Glomerular filtration
❑* Tubular reabsorption (99% of filtrate)
❑* Tubular secretion (wastes, drugs, ions)

Question 8

RENAL PHYSIOLOGY

1. ____________
   In the glomerulus, blood plasma and dissolved substances (smaller than most proteins) get filtered into the ________.
2. ____________
   All along the ______ and collecting duct, water, ions, and other substances get reabsorbed from the renal tubule lumen into the _________ and ultimately into the blood.
3. ____________
   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.

Answer 8

1. Glomerular filtration
   - glomerular capsule
2. Tubular reabsorption
   - renal tubule
   - peritubular capillaries
3. ## Tubular secretion

Question 9

GLOMERULAR FILTRATION

1. _____________: prevents filtration of blood cells but allows all components of blood plasma to pass through
2. _____________: prevents filtration of larger proteins
3. _____________: prevents filtration of medium-sized proteins

Answer 9

1. Fenestration (pore) of glomerular endothelial cell
2. Basement membrane of glomerulus
3. Slit membrane between pedicels

Question 10

NET FILTRATION PRESSURE

1. _______ = 55 mmHg
2. _______ = 15 mmHg
3. _______ = 30 mmHg

____________:
= GBHP- CHP - BCOP
= 55 mmHg - 15 mmHg - 30 mmHg = 10 mmHg

Answer 10

1. Glomerular blood hydrostatic pressure (GBHP)
2. Capsular hydrostatic
   pressure (CHP)
3. Blood colloid osmotic pressure (BCOP)

• Net filtration pressure (NFP):

Question 11

❑The amount of filtrate formed in all renal corpuscles of bot kidneys each minute

❑Male = 125 mL/min

❑Female = 105 mL/min

❑If the GFR is too high, needed substances may pass so quickly through the renal tubules that some are not reabsorbed and are lost in the urine.

❑If the GFR is too low, nearly all the filtrate may be reabsorbed and certain waste products may not be adequately excreted.

Answer 11

GLOMERULARFILTRATION RATE (GFR)

Question 12

RENAL AUTOREGULATION

1. ___________:
   - Increased stretching of smooth muscle fibers in afferent arteriole walls due to increased blood pressure.
   - Stretched smooth muscle fibers contract, thereby narrowing lumen of afferent arterioles.
   - DECREASE
2. ___________:
   - Rapid delivery of Na+ and Cl to the macula densa due to high systemic blood pressure.
   - Decreased release of nitric oxide (NO) by juxtaglomerular apparatus causes constriction of afferent arterioles.
   - DECREASE

Answer 12

1. Myogenic mechanism
2. Tubuloglomerular feedback

Question 13

Increase in activity level of renal sympathetic nerves releases norepinephrine.

• Constriction of afferent arterioles through activation of a receptors and increased release of renin.
• DECREASE

Answer 13

NEURAL REGULATION

Question 14

HORMONE REGULATION

1. ________:
   - Decreased blood volume or blood pressure stimulates production of angiotensin II.
   - Constriction of afferent and efferent arterioles.
   - DECREASE
2. ________:
   - Stretching of atria of heart stimulates secretion of ANP.
   - Relaxation of mesangial cells in glomerulus increases capillary surface area available for filtration.
   - INCREASE

Answer 14

1. Angiotensin II
2. Atrial natriuretic peptide (ANP)

Question 15

• Low blood volume or low blood pressure stimulates renin-induced production of angiotensin II.
• Stimulates activity of Na-H antiporters in proximal tubule cells.
• Increases reabsorption of Na* and water, which increases blood volume and blood pressure.

Answer 15

Angiotensin II

Question 16

• Increased angiotensin II level and increased level of plasma K* promote release of aldosterone by adrenal cortex.
• Enhances activity of sodium-potassium pumps in basolateral membrane and Na+ channels in apical membrane of principal cells in collecting duct.
• Increases secretion of K+ and reabsorption of Na+; increases reabsorption of water, which increases blood volume and blood pressure.

Answer 16

Aldosterone
e

Question 17

• Increased osmolarity of extracellular fluid or decreased blood volume promotes release of ADH from posterior pituitary gland.
• Stimulates insertion of water channel proteins (aquaporin-2) into apical membranes of principal cells.
• Increases facultative reabsorption of water, which decreases osmolarity of body fluids.

Answer 17

Antidiuretic hormone (ADH)

Question 18

• Stretching of atria of heart stimulates ANP secretion.
• Suppresses reabsorption of Nat and water in proximal tubule and collecting duct; inhibits secretion of aldosterone and ADH.
• Increases excretion of Na+ in urine (natriuresis); increases urine output (diuresis) and thus decreases blood volume and blood pressure.

Answer 18

Atrial natriuretic peptide (ANP)

Question 19

• Decreased level of plasma Ca2+ promotes release of PTH from parathyroid glands.
• Stimulates opening of Ca2+ channels in apical membranes of early distal tubule cells.
• Increases reabsorption of Ca2+.

Answer 19

Parathyroid hormone (PTH)

Question 20

Low ADH level

High urine volume

~65-70 mOsm/L

Loop of Henle Role:
- Solute reabsorption
- water not reabsorbed in ascending limb

Low (impermeable to water)

Eliminate excess water

Medullary osmotic gradient: Present but not fully utilized

Coutercurrent mechanism: Not significantly involved

Answer 20

Dilute Urine

Question 21

High

Low

Up to 1200 mOsm/L

Loop of Henle Role:
- Establishes medullary gradient

High (water reabsorbed due to ADH)

Conserve water during dehydration

Medullary osmotic gradient: Crucial for water reabsorption

Essential for concentrating urine

Answer 21

Concentrated Urine

Question 22

_______ of mucosa (allow expansion of urinary bladder as it fills)

Answer 22

Rugae

Question 22

__________ (holds urinary bladder in place)

Answer 22

Peritoneum

Question 23

_________ (triangular area)

Answer 23

Trigone

Question 24

___________ (involuntarily controls opening and closing of urethra)

Answer 24

Internal urethral sphincter

Question 25

__________ in deep muscles of perineum (voluntarily controls opening and closing of urethra)

Answer 25

External urethral sphincter

Question 26

_____________ (opening of urethra to outside)

Answer 26

External urethral orifice

Question 27

________ (contracts to push urine into urethra)

Answer 27

Detrusor muscle

Question 28

__________ (opening into urethra)

Answer 28

Internal urethral orifice

Question 29

_________ (passageway for discharging urine from body)

Answer 29

Urethra

Question 30

_________ (pubis)

Answer 30

Hip bone

Question 31

- Normal constituent of plasma - usually appears in only very small amounts in urine because it is too large to pass through capillary fenestrations. - Presence of excessive albumin in urine-albuminuria (al'-bu-mi-NOO-rē-a) - indicates increase in permeability of filtration membranes due to injury or disease, increased blood pressure, or irritation of kidney cells by substances such as bacterial toxins, ether, or heavy metals.

Answer 31

Albumin

Question 32

- Presence of glucose in urine-glucosuria ( - usually indicates diabetes mellitus. - Occasionally caused by stress, which can cause excessive epinephrine secretion. - Epinephrine stimulates breakdown of glycogen and liberation of glucose from liver.

Answer 32

Glucose

Question 33

- Presence of red blood cells in urine-hematuria - generally indicates pathological condition. - One cause is acute inflammation of urinary organs due to disease or irritation from kidney stones. - Other causes: tumors, trauma, kidney disease, contamination of sample by menstrual blood

Answer 33

Red blood cells (erythrocytes)

Question 34

- High levels of ketone bodies in urine-ketonuria - may indicate diabetes mellitus, anorexia, starvation, or too little carbohydrate in diet.

Answer 34

Ketone bodies

Question 35

- When red blood cells are destroyed by macrophages, the globin portion of hemoglobin is split off and heme is converted to biliverdin. - Most biliverdin is converted to bilirubin, which gives bile its major pigmentation. - Above- normal level of bilirubin in urine is called bilirubinuria

Answer 35

Bilirubin

Question 36

- Presence of urobilinogen (breakdown product of hemoglobin) in urine is called urobilinogenuria (ū'-rō-bi-lin'-ō- je-NOO-ré-a). - Trace amounts are normal, but elevated urobilinogen may be due to hemolytic or pernicious anemia, infectious hepatitis, biliary obstruction, jaundice, cirrhosis, congestive heart failure, or infectious mononucleosis.

Answer 36

Urobilinogen

Question 37

- tiny masses of material that have hardened and assumed shape of lumen of tubule in which they formed, from which they are flushed when filtrate builds up behind them. - named after cells or substances that compose them or based on appearance (for example, white blood cell casts, red blood cell casts, and epithelial cell casts that contain cells from walls of tubules).

Answer 37

Casts

Question 38

- Number and type of bacteria vary with specific urinary tract infections. - One of the most common is E. coli. - Most common fungus is yeast Candida albicans, cause of vaginitis. - Most frequent protozoan is Trichomonas vaginalis, cause of vaginitis in females and urethritis in males.

Answer 38

Microbes

Question 39

❑The crystals of salts present in urine occasionally precipitate and solidify into insoluble stones called renal calculi or kidney stones. - They commonly contain crystals of calcium oxalate, uric acid and calcium phosphate ❑Cause: ingestion of excessive calcium, low water intake, abnormally alkaline or acidic urine, and overactivity of the parathyroid glands ❑Tx: Shock-wave lithotr

Answer 39

RENAL CALCULI

Question 40

❑an infection of a part of urinary system. ❑Types: urethritis, cystitis, pyelonephritis ❑Symptoms: painful or burning urination, urgent and frequent urination, low back pain, bed- wetting. ❑Tx: Co-trimoxazole, Nitrofurantoin, Fosfomycin, Cefalexin ❑Drinking cranberry juice can prevent the attachment of E. coli bacteria to the lining of the urinary bladder so that they are more readily flushed away during urination.

Answer 40

URINARY TRACT INFECTIONS

Question 41

❑__________ (aka Nephritic Syndrome) Symptoms: glomeruli inflamed, swollen, and engorged with blood, hematuria, proteinuria Causes: allergic reaction to the toxins produced by streptococcal bacteria

Answer 41

Glomerulonephritis

Question 42

❑________ Symptoms: proteinuria, hyperlipidemia, hypoalbuminemia, edema Causes: systemic disorders such as diabetes mellitus, systemic lupus erythematosus (SLE), a variety of cancers, and AIDS Tx: Diuretics, steroids

Answer 42

Nephrotic Syndrome

Question 43

❑__________ Symptoms: edema, hematuria, high potassium which can lead to cardiac arrest, anemia, osteomalacia also may occur. Causes: multiple organ dysfunction syndrome, drugs Tx: dialysis_

Answer 43

Acute Renal Failure (ARF)

Question 44

Causes: chronic glomerulonephritis, pyelonephritis, polycystic kidney disease, or traumatic loss of kidney tissue

Answer 44

Chronic Renal Failure (CRF)

Question 45

❑ _________ = ↑ N wastes ❑ _________ = painful urination ❑ _________ = bed-wetting ❑_________ = kidney swelling ❑_________ = excess urine

Answer 45

❑Azotemia = ↑ N wastes ❑Dysuria = painful urination ❑Enuresis = bed-wetting ❑Hydronephrosis = kidney swelling ❑Polyuria = excess urine

Question 46

❑_________ = toxic urea in blood ❑_________ = contrast X-ray ❑_________ – voiding or urination ❑_________ - lack of voluntary control over micturition (Stress, Urge, Overflow, Functional)

Answer 46

❑Uremia = toxic urea in blood ❑Intravenous pyelogram (IVP) = contrast X-ray ❑Micturition – voiding or urination ❑Incontinence - lack of voluntary control over micturition (Stress, Urge, Overflow, Functional)