Lecture 9- Renal- Kidney structure and function

Question 1

2 main fxns of the kidney

Answer 1

regulation of water and salt balance

removal of metabolic wastes/drugs

Question 2

2 other functions of the kidney besides the main 2

Answer 2

gluconeogenesis

production of hormones

Question 3

3 hormones of the kidneys

Answer 3

erythropoietin

renin

1,25-dihydroxyvitamin D

Question 4

chronic ESRD requires

Answer 4

dialysis

Question 5

ESRD patients have a reduced ability to eliminate … and excess … is converted to …

Answer 5

nitrogenous wastes

nitrogen

ammonium

Question 6

excess ammonium in ESRD patients has direct effects on oral health– the blood is … which leads to an …. pH in the oral cavity

Answer 6

alkalized

increased

Question 7

manifestations of renal disease on oral health include…

Answer 7

ammonia breath

gingival enlargement

xerostomia

teeth problems (premature loss, narrow pulp chambers, necrosis beneath fillings/crowns)

Question 8

contraindications for ESRD patients

Answer 8

nephrotoxic drugs such as tetracycline, acyclovir, aspirin, NSAIDs

increased susceptibility to bleeding due to destruction of platelets

Question 9

the kidney is a … organ in the abdominal cavity with a … and …

Answer 9

retroperiotoneal

inner medulla

outer cortex

Question 10

kidney is composed of many …. which is the functional unit of the kidney

Answer 10

nephrons

Question 11

in the renal cortex, blood is filtered in … and filtrate passes through the tubules of the nephron

Answer 11

glomeruli

Question 12

in the renal medulla, there are portions of nephron tubule involved with … and … of urine

Answer 12

concentration

collection

Question 13

tubules empty into …. and then into the ureter

Answer 13

renal pelvis

Question 14

ureters drain into the …. and the… is drained by the urethra

Answer 14

bladder

Question 15

each kidney contains about …. nephrons

Answer 15

1.2 x 10^6

Question 16

a nephron includes a cluster of … and a long, hollow tube with a wall that is …

Answer 16

capillaries

one cell layer thick

Question 17

what are the parts of a nephron

Answer 17

renal corpuscle= glomerulus +capsule

proximal (convoluted) tubule

loop of henle

distal (convoluted) tubule

collecting duct (chared by several nephrons)

Question 18

there are 2 types of nephrons that differ in the position of the renal corpuscle and length of the medullary tubules

Answer 18

superficial or cortical nephrons

juxtamedullary nephrons

Question 19

regulating blood composition involves these 3 renal processes

Answer 19

1. filtration
2. secretion
3. reabsorption

Question 20

filtration occurs in the …. capillaries; … % of plasma entering glomerulus is filtered

Answer 20

glomerular

15-20%

Question 21

blood leaving the glomerular capillaries then flows into ….

Answer 21

peritubular capillaries (vasa recta)

Question 22

during filtration, solutes (and water they are dissolved in) pass from the blood into the … in the …

Answer 22

tubular fluid

renal capsule (Bowmans space)

Question 23

during secretion, substances are transported from the … in the peritubular capillaries into the ….

Answer 23

blood

tubular fluid

Question 24

during reabsorption, substances are transported from the … into the … in the peritubular capillaries

Answer 24

tubular fluis

blood

Question 25

what remains in the tubular fluid at the end of the collecting ducts is....

Answer 25

excreted

Question 26

a ... is a dense capillary bed where filtration occurs surrounded by renal capsule (bowmans capsule) which collects the filtrate from the blood entering via the afferent arterioles

Answer 26

glomerulus

Question 27

filtered blood leaves via .... and flows into peritubular capillaries

Answer 27

efferent

Question 28

blood flow through the glomerulus is regulated by several mechanisms:

Answer 28

smooth muscle contraction in afferent and efferent arterioles response of juxtaglomerular apparatus (JGA) sympathetic nervous system

Question 29

the .... is located at the intersection of the macula densa of distal tubule with afferent and efferent arterioles -- the ... secretes the hormone renin which regulates systemic BP and therefore glomerular blood flow

Answer 29

juxtaglomerular apparatus

Question 30

the ... drains the renal caosule

Answer 30

proximal tubule

Question 31

the proximal tubule reabsorbs .... of filtered salt and water

Answer 31

2/3

Question 32

the proximal tubule reabsorbs all filtered ... and ...

Answer 32

glucose amino acids

Question 33

will diuretics work in the proximal tubule?

Answer 33

yes, some will

Question 34

the loop of henle can be divide into these 3 segments

Answer 34

thin descending limb thin ascending limb thick ascending limb (TAL)

Question 35

the loop of henle is the site of .... needed to produce concentrated urine but the loop itself produces a .... filtrate

Answer 35

countercurrent multiplication dilute

Question 36

very powerful diuretics work in the ....

Answer 36

loop of henle

Question 37

the ... drains the loop of henle

Answer 37

distal tubule

Question 38

functions of the distal tubule

Answer 38

continued reabsorption of solutes regulation of calcium site of action for some diuretics

Question 39

the collecting duct extends from ... through the ...

Answer 39

cortex | medulla

Question 40

the collecting duct regulates ...., ..., and ...

Answer 40

Na, K, H2O

Question 41

do diuretics act in the the collecting ducts?

Answer 41

yes, some

Question 42

... is the rate of excretion of a solute through the kidney, expressed as amount per unit time

Answer 42

renal clearance

Question 43

... represents the volume of plasma from which all of a particular substance is removed to the urine and is a clinically important concept for monitoring renal fxn

Answer 43

renal clearance

Question 44

.... rate is the amount of blood filtered by the kidney, expressed as volume per unit time.

Answer 44

glomerular filtration rate

Question 45

can renal clearance be used to measure GFR?

Answer 45

yes based on 3 criteria: 1. substance is freely filtered in glomerulus 2. substance is not secreted 3. substance is not reabsorbed

Question 46

in a normal kidney, GFR (for all nephrons) is .... or ... in females and .... in males

Answer 46

125 ml/min 180 L/day 90-140 ml/min

Question 47

... and ... are substancces that can be used to measure renal clearance

Answer 47

inulin | creatinine

Question 48

.... is a small polysacharride; freely filteres and not secreted or reabsorbed

Answer 48

inulin

Question 49

.... is a product of muscle metabolism; freely filtered, not reabsorbed, almost no secretion

Answer 49

creatinine

Question 50

normal creatinine levels?

Answer 50

less than 1 + or - .5 mg/dl need dialysis if greater than 10

Question 51

glomerular capillaries are fenestrated; .... cells around the capillaries form filtration slits

Answer 51

podocytes

Question 52

filtrate is acellular and essentially ... free

Answer 52

protein

Question 53

glucose, salts and amino acids are freely....

Answer 53

filtered

Question 54

size is a factor in filtration: less than .... are free filtered more than .... not filtered

Answer 54

20 A 42 A

Question 55

charge is a factor in filtration because the basal lamina is .... charged so filtration of moderately sized .... charged solutes is limited

Answer 55

negatively negatively

Question 56

despite changes in BP, renal blood flow remains fairly .... which means GFR remains ....

Answer 56

constant constant

Question 57

autoregulation involves intrinsic mechanisms that adjust bloodflow through the glomerulus; it is achieved by these 2 mechanisms

Answer 57

1. myogenic mechanism | 2. tubuloglomerular feedback- feedback from the JGA adjusts afferent arteriole diameter and thus GFR

Question 58

GFR equations

Answer 58

(Pgc-Pbs)- (Oncgc- Oncbs)

Question 59

effect on renal blood flow and net ultrafiltration pressure: increased afferent resistance

Answer 59

decrease in both

Question 60

effect on renal blood flow and net ultrafiltration pressure: | decreased afferent resistance

Answer 60

increase both

Question 61

effect on renal blood flow and net ultrafiltration pressure: | increased efferent resistance

Answer 61

decrease flow increase filtration press

Question 62

effect on renal blood flow and net ultrafiltration pressure: | decreased efferent resistance

Answer 62

increase flow decrease filtration press

Question 63

4 extrinsic factors that affect RBF and GFR

Answer 63

diet dehydration symp. NS angiotensin 2, aldosterone, natriuretic peptide

Question 64

tubuloglomerular feedback: increase in GFR increases NaCl in tubular fluid which increases NaCl at the ....which causes an increase in .... in the afferent arterioles ultimately leading to a decrease in ...

Answer 64

macula densa resistance GFR