M104 T3 flscs from Cat Flashcards
(100 cards)
1
Q
What vertebral levels do the kidneys span?
A
T12 - L3
2
Q
What vertebral level is renal pain usually referred to?
A
T12 (the cutaneous area, T12 - subcostal nerve)
3
Q
What is the weight of each normal adult kidney?
A
120-170 g
4
Q
What are the approximate dimensions of each kidney?
A
6x11x3 cm
5
Q
Approximately how many nephrons are there per
kidney?
A
1.25 million
6
Q
What are the two types of nephron?
A
cortical and juxtamedullary nephrons
7
Q
What proportion of all kidney nephrons are cortical nephrons?
A
70-80%
8
Q
Where are cortical nephrons located?
A
cortex - short loop of Henle into medulla
9
Q
What proportion of all kidney nephrons are juxtamedullary nephrons?
A
20-30%
10
Q
Where are juxtamedullary nephrons located?
A
closer to the medulla, LoH
11
Q
What is the depth of juxtamedullary nephrons like?
A
they extend deep into the renal pyramids
12
Q
What symp nerves innvervate the kidneys?
A
postganglionic fibres from the coeliac ganglion
13
Q
What is the efferent parasymp supply of the kidneys?
A
vagus nerve
renal plexus in hilum
14
Q
What is the blood supply of the kidneys?
A
ant&post renal arteries (supply from abd aorta)
l&r renal veins
15
Q
What is the effect of renal innervation?
A
can control tone of efferent arterioles, which involves modification of the GFR and RBF
16
Q
During glomerular filtration, what types of substances remain in the blood?
A
cells and large mlcs (RBCs, lipids, proteins, most drugs, metabolites
17
Q
What is the passage of water during tubular reabsorption?
A
passive osmosis along the osmotic gradient created by Na+ ions
18
Q
What type of substances can’t be filtered at the glomerulus and why?
A
some endogenous substances and drugs
due to their size or protein binding
19
Q
What are the two types of pumps involved in tubular secretion?
A
For organic acids or drugs (e.g. uric acid, diuretics, antibiotics - e.g. penicillin)
For organic bases or drugs (e.g. creatinine, procainamide)
20
Q
What are the five major stages of urine formation?
A
glomerulular filtration of blood PT - filtrate reabsorption, secretion into tubule LoH urine concentration DT urine modification CD - final urine modification
21
Q
What is the normal GFR?
A
125 mL/min = 180 L/day
22
Q
What is the normal normal plasma volume?
A
2-3 L
23
Q
What’s the first stage of urine formation?
A
glomerular filtration
24
Q
What cations are reabsorbed into the PT and by what %?
A
Na+ & K+ - 65 %
25
What anions are reabsorbed into the PT and by what %?
HCO3-, 80-90 %
| Cl-, 50 %
26
What waste products are reabsorbed into the PT and by what %?
```
glucose, 100 %
proteins & amacs, 100 %
H2O - 65 %
Ca2 & Mg2 - variable
urea, 50 %
```
27
What substances are secreted into urine and by what %?
urea - variable
creatinine - small amount
H+ & NH4+ - variable
28
What happens to the remaining fluid after it has passed through the PT?
enters the LoH
29
What is the function of the LOH?
to recover fluid and solutes from the glomerular filtrate
30
What are the two stages of extraction in the LoH?
h2o extraction in the desc. limb
| Na+ & Cl- extraction in the asc. limb
31
Through what passage is water extracted through into the thin descending limb?
Aquaporin-1 channels
32
How is the thin descending limb adapted for h2o extraction?
cells are flat
is freely permeable to water via AQP-1 channels
allows for passive h2o movement via tight junctions
33
Through what passage is Na+ and Cl- extracted through into the thick ascending limb?
Na+/K+/2CI- (NKCC2) co-transporters
34
What substances are extracted in the thick ascending limb?
Na+, K+ and CI-
35
How is the thick ascending limb adapted for Na+, K+ and CI- extraction?
h2o-impermeable tubular walls
| specialised NKCC2 co-transporters
36
What is the tonicity of fluid entering the LoH from the PT?
isotonic - 300 mOsm
37
What occurs in the desc. LoH?
water is reabsorbed
38
What is the tonicity of fluid at the tip of the LoH after the desc. LoH?
hypertonic - 1200 mOsm
39
What happens to the hypertonic fluid at the tip of the LoH?
the solutes contained in the hypertonic fluid are pumped out at the asc. LoH
40
What is the tonicity of the filtrate entering the DT?
hypotonic - 150 mOsm
41
What is the process by which the tonicity / conc of medullary filtrate varies (iso, hyper, hypo) over a short distance?
Countercurrent Multiplication
42
How does Countercurrent Multiplication result in varied tonicity in the medulla?
creates a large osmotic gradient within the medulla
| allows passive reabsorption of water from tubular fluid in desc. LoH
43
What transporter facilitates countercurrent multiplication in the asc. limb of the LoH?
Na+/K+/2CI-
44
SIADH Treatment:
V, receptor blockers (ADH inhibitors), e.g. demeclocycline, Tolvaptan
45
What happens to all that water and solutes reabsorbed from the tubule?
It is all taken back into the peritubular vessels and vasa recta surrounding the tubule
46
What occurs in the DT?
further adjustment of urine
| active absorption and secretion of solutes
47
What solutes are actively reabsorbed / secreted in the DT?
Na+ and CI- ; reabs
| K+ reabs, swapped in for H+
48
The exchange of which ions in the DT results in the further adjustment of urine?
exchange of K+ in for H+ - secreted into the tubular fluid
49
How is the collecting duct adapted for Na+, K+ and CI- extraction?
it's relatively impermeable to h2o & solute movement
| but ADH can increase its permeability
50
What are the major two forms of Diabetes Insipidus?
nephro and neurogenic
51
What causes nephrogenic Diabetes Insipidus?
renal inability respond normally to ADH
52
What causes neurogenic Diabetes Insipidus?
decreased neural synthesis of ADH
53
What types of drugs are used to treat neurogenic Diabetes Insipidus?
ADH analogue - desmopressin
| anti-convulsive - carbamazepine
54
What types of drugs are used to treat nephrogenic Diabetes Insipidus?
diuretics - chlortalidone
| anti-inflammatory - indometacin
55
What are the four types of Diabetes Insipidus?
nephrogenic DI
neurogenic DI
Dipsogenic DI
Gestational DI
56
What is the opposite condition of Diabetes Insipidus and what's it caused by?
SIADH - excessive release of ADH
| due to; head injury or the unwanted effects of drugs
57
What are some of the effects of SIADH?
hyponatraemia and possibly fluid overload
58
What drug type is used to treat SIADH?
ADH inhibitors
59
What bones make up the posterior abdominal wall?
Ribs 11 & 12
Lumbar vertebrae
Sacrum
60
What muscles make up the posterior abdominal wall?
Diaphragm
Quadratus Lumborum
Psoas Major (& Minor)
lliacus
61
Abdominal Aorta Branches Bifurcates into the common iliac vessels at
L4/5
62
Greater, lesser and least splanchnic nerves synapse at
| suprarenal glands.
the coeliac and aorticorenal ganglion to innervate the suprarenal glands.
63
Abdominal Pain Somatic
Well localised, sharp or stabbing, Felt in skin, muscle, fascia and parietal peritoneum
64
Abdominal Pain Visceral
Poorly localised, dull ache or throbbing, Caused by stretching, ischaemia or chemical damage
65
Dermatomes Stomach:
felt in skin of dermatomes T5-9
66
Dermatomes Appendix:
T10 (umbilicus)
67
Dermatomes Gallbladder:
T7-9
68
Dermatomes parietal peritoneum involvement:
C3,4
69
Two modes of action of diuretics
2) Modification of content of the filtrate 1) Direct action on the cells of the nephron (more common)
70
Two major applications of diuretic agents:
1) Reduce circulating fluid volume 2) Removal of excess body fluid (oedema)
71
Two major applications of diuretic agents:
1) Reduce circulating fluid volume 2) Removal of excess body fluid (oedema)
72
What is the number of nephrons in each kidney affected by?
age - numbers decline
73
What is the number of nephrons in each kidney affected by?
age - numbers decline
74
What is the significance of the line of Brodel?
is an important access route for both open and endoscopic surgical access of the kidney, as it minimises the risk of damage to major arterial branches
75
What is the significance of the line of Brodel?
is an important access route for both open and endoscopic surgical access of the kidney, as it minimises the risk of damage to major arterial branches
76
Which renal artery is longer and why?
the right, bc it has to cross the vena cava posteriorly
77
Which renal artery is longer and why?
the right, bc it has to cross the vena cava posteriorly
78
What are the two divisions of the renal artery?
anterior (75% of the blood supply)
| posterior (25%)
79
What are the two divisions of the renal artery?
anterior (75% of the blood supply)
| posterior (25%)
80
What are the two main symptoms of diabetes insipidus?
polydipsia and polyuria
81
What are the two main symptoms of diabetes insipidus?
polydipsia and polyuria
82
Is diabetes insipidus related to diabetes?
no but it does share some of the same signs and symptoms
83
Is diabetes insipidus related to diabetes?
no but it does share some of the same signs and symptoms
84
What is the most important water homeostatic hormone?
ADH
85
What is the Mw of ADH?
x>1000
86
What is the Mw of ADH?
x>1000
87
In the late DT and early CD, what cell type is involved in Na/K exchange?
principal cells
88
In the late DT and early CD, what cell type is involved in Na/H exchange?
a & b-intercalated cells
89
What processes occur in a-intercalated cells?
acid (H+) secretion in exchange for Na+ or K+
via ATPase or H/ATPase
HCO3- reabsorption
90
What processes occur in b-intercalated cells?
acid (H+) reabsorption
via Pendrin
HCO3- secretion
91
What do a & b-intercalated cells help regulate?
acid-base regulation
92
In the late DT and early CD, what cell type is involved in Na/K exchange?
principal cells - this exchange forms part of the RAAS
93
What do a & b-intercalated cells help regulate?
acid-base regulation
94
What's the half life of ADH in plasma circulation?
10-15 min
95
What cell type and receptors are acted on by ADH?
V2 receptors
| principal cells on the DT/CD basal membranes
96
What is the effect of ADH stimulation of V2 receptors?
intracellular AQP2 water channels are activated
97
What happens to tubule reabsorbed water and solutes?
It is all taken back into the peritubular vessels and vasa recta surrounding the tubule
98
What happens to tubule reabsorbed water and solutes?
It is all taken back into the peritubular vessels and vasa recta surrounding the tubule
99
What's an example of a drug that can cause SIADH?
ecstasy
100
What are two examples of ADH inhibitors used to treat SIADH?
demeclocycline, Tolvaptan
