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NME > Kidney and renal function > Flashcards

Kidney and renal function Flashcards

1
Q

The kidneys and urinary tract have a critical role in which four areas?

A

Excretion and elimination of waste products
Homeostasis
BP regulation
Endocrine function

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2
Q

What are the two main functions of the urinary system?

A

Excretion - removal of organic waste products

Elimination - Discharge of waste products into environment

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3
Q

What are the three broad functions of the kidney?

A

Homestasis
Excretion
Regulation

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4
Q

What does homeostasis help regulate in the kidneys?

A

Water and electrolyte balance

Acid-base balance

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5
Q

What is excreted from the kidneys?

A

Drugs and their metabolites

Endogenous waste products

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6
Q

The kidneys regulate and produce which hormones?

A

Erythropoietin
Renin
Prostaglandins
Active vit D

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7
Q

What vertebral level are the kidneys located at?

A

T12 to L3

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8
Q

What vertebral level is the renal hilum located at?

A

L2

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9
Q

What is renal agenesis?

A

born with one kidney

1 in 1000/2000 people

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10
Q

What are the two main layers of the kidney?

A

Cortex

Medulla

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11
Q

What is the cortex of the kidney and what does it contain?

A

Outer region

Glomerulus and convoluted tubules

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12
Q

What is the medulla of the kidney and what does it consist of?

A

Inner region
Pyramid-like structures
Consists of the bulk of the nephron structure

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13
Q

What is the nephron?

A

functional unit of the kidney

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14
Q

What is the nephron responsible for?

A

Urine formation/composition

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15
Q

During the early stages of CKD, the kidney can lose up to 50% of what?

A

Nephrons

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16
Q

What are the five distinct sections of the nephron?

A 
Glomerulus 
Proximal Convoluted tubule
Loop of Henle - descending and ascending limb
Distal convoluted tubule 
Collecting duct
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17
Q

What capsule contains the glomerulus?

A

Bowman’s capsule

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18
Q

Where does filtration happen in the kidney?

A

Glomerulus

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19
Q

Where does selective reabsorption happen in the nephron?

A

Proximal tubule

Distal tubule

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20
Q

Where does osmoregulation happen in the nephron?

A

Loop of henle - salt gradient

Collecting duct - water retention

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21
Q

What are the two types of nephrons?

A

Cortical

Juxtaglomerular

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22
Q

Tubular fluid travels through the collecting ducts deep into what structure?

A

Inner medulla of kidney

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23
Q

The tubular fluid that exits the collecting duct at the tip of the renal pyramid enters what?

A

Renal papilla

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24
Q

Why is the renal papilla clinically important?

A

common site of drug induced nephrotoxicity

Can lead to renal papillary necrosis

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25
Q

Which is the most abundant nephron?

A

cortical - 70-80%

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26
Q

Where are cortical and juxtaglomerular nephrons located?

A

cortical - In the cortex

Juxtaglomerular - In cortex but closer to medulla

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27
Q

What is the structural difference between cortical and juxtaglomerular nephrons?

A

Cortical - short loop of henle into medulla. Small glomerulus
Juxtaglomerular - Loop of henle extends deep into renal pyramids. Large glomerulus and vasa recta.

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28
Q

What is the juxtaglomerular apparatus and what does it secrete?

A

Specialised region associated with the nephron but separate from it.
Secretes renin from macula densa within JGA

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29
Q

Where is the juxtaglomerular apparatus located?

A

Between thick ascending limb and afferent arteriole

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30
Q

What are the three components to the juxtaglomerular apparatus?

A

Macula densa
Juxtaglomerular cells
Extraglomerular mesangial cells

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31
Q

What are the main glomerular diseases?

A

Diabetic nephropathy
Glomerulonephritis
IgA Nephropathy

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32
Q

What are the main renal tubular diseases?

A

Acute tubular necrosis
Glomerulonephritis
IgA Nephropathy

33
Q

What is the blood supply to the kidney?

A

Blood from renal artery
Into afferent arteriole to glomerulus
Exit through efferent arterioles into peritubular capillaries wrapped around tubules
Peritubular capillaries form vasa recta
Blood leaves through venues into renal vein

34
Q

The kidneys receive what percentage of cardiac output?

A

20-25%

35
Q

90% of blood in the kidneys supplies what?

A

The renal cortex

36
Q

Why does the majority of blood in the kidneys supply the renal cortex?

A

To maintain high active tubular cells.

Required for energy-consuming transport processes

37
Q

What is the major function of the cortical nephrons?

A

Regulate and excrete

38
Q

What is the major function of the juxtaglomerular nephrons?

A

Concentrate or dilute urine

39
Q

How does the sympathetic nervous system innervate the kidneys?

A

From the sympathetic chain and fibres from coeliac ganglion

40
Q

What parts of the kidneys are innervated by the coeliac ganglion and what does this cause?

A

Arteries - afferent and efferent arterioles and granular cells
Reduces blood supply during fight or flight

41
Q

What can the sympathetic supply to the kidneys be associated with?

A

HTN

42
Q

How does the parasympathetic nervous system innervate the kidneys?

A

Efferent supply from vagus

ganglion located in hilum

43
Q

What does the vagus nerve control in the kidneys?

A

Tone of efferent arterioles

Modifies GFR and renal blood flow

44
Q

Where is erythropoietin and prostaglandin produced within the kidneys?

A

Interstitium surrounding glomerulus

45
Q

what is the glomerular filtration barrier?

A

4 physical barriers ultra filtrate has to go through before it can enter lumen of bowman capsule

46
Q

What are the four barriers in the glomerular filtration barrier?

A

Glycocalyx
Capillary endothelium
Glomerular basement membrane
Podocyte foot processes

47
Q

What is glomerular filtration dependent on?

A

Blood pressure

Renal blood flow

48
Q

For glomerular filtration, the filtrate has to pass through what?

A

Pores in glomerular capillary endothelium
BM of Bowman’s capsule (+ contractile mesangial cells)
Epithelial cells of Bowman’s capsule (Podocytes) via filtration slits in capsular space

49
Q

How does filtrate pass through podocytes?

A

Through filtration slits

50
Q

Can proteins pass through the glomerular barrier?

A

No

51
Q

Where are mesangial cells located?

A

Centre of glomerulus

52
Q

What is the role of mesangial cells?

A

Phagocytic - clear Ag/Ab complexes

Contract due to AT II and ADH -> reduces GFR by reducing filtration surface

53
Q

What is the initial step in urine formation?

A

Glomerular filtration

54
Q

Examples of small molecules <60 KDa filtered through the glomerulus?

A 
Electrolytes
Amino acids
Glucose
Metabolic waste
Some drugs + metabolites
55
Q

Examples of molecules that cannot be filtered through glomerulus and remain in the blood?

A 
Cells and large molecules
RBC
Lipids
Proteins
Most drugs + metabolites
56
Q

What is the basic structure of a nephron?

A 
Glomerulus
Proximal convoluted tubule
Loop of henle
Distal convoluted tubule
Collecting duct
57
Q

What is ultrafiltration?

A

Solution moves via a pressure gradient

58
Q

What is the approx glomerular filtration rate?

A

125ml/min = 180L/day

59
Q

Does GFR change with blood pressure?

A

No remains constant due to autoregulation of renal blood flow

60
Q

What metabolite is affected first in AKI?

A

Creatinine

61
Q

Which marker would you use in CKD as an indicator for renal function?

A

GFR

62
Q

What are the three major functions of the nephron?

A

Filtration - of blood to produce filtrate
Reabsorption from filtrate
Secretion - of waste products into tubular fluid

63
Q

What is transcellular transport?

A

Passive or active transport through channels

Many passive secondary to active transport

64
Q

What is paracellular transport?

A

Movement driven by concentration, osmotic or electrical gradients
Through tight junctions between cells

65
Q

Some endogenous substances and drugs cannot be filtered into glomerulus due to size/protein binding. How do these substances get into the nephron?

A

Pumps in proximal convoluted tubule transports from plasma into nephron

66
Q

What are the two types of pumps in the proximal convoluted tubule for?

A

Organic acids or drugs (uric acid, diuretics, abx)

Organic bases or drugs (creatinine, procainamide)

67
Q

Where is the majority of water reabsorbed in the nephron?

A

Proximal convoluted tubule

68
Q

How is H20 reabsorbed into the tubules?

A

Passively along osmotic gradient created by solute (Na+)

Reuptake via aquaporins

69
Q

What % in total of electrolytes, H2O and nutrients are reabsorbed by the renal tubules?

A

99%

70
Q

What is the Glomerular Filtration Rate?

A

Rate the glomerulus filters per minute

71
Q

What is osmosis?

A

Movement of water by concentration gradient

72
Q

What is diffusion?

A

Movement of solute by concentration gradient

73
Q

What do epithelial cells in the glomerular basement membrane of the glomerular filtration barrier secrete?

A

Collagen

Glycoproteins

74
Q

What type of capillaries in the glomerulus helps facilitate filtration? (Continuous, fenestrated, or sinusoidal)

A

Fenestrated

75
Q

How many loops are in the glomerulus?

A

40

76
Q

What arteriole runs alongside the juxtaglomerular nephron to accommodate the longer loop of henle and supplies blood to the medulla?

A

Vasa recta

77
Q

What is the main blood supply to the kidneys?

A

Renal artery

78
Q

What problems can a reduced kidney function cause?

A

Anaemia - Reduced erythropoietin
Hypotension - reduced renin
Bone loss/fragility - Reduced Vit D
Toxin accumulation - uraemia

NME (9 decks)

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