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Renal System Flashcards

1
Q

What diseases is oral health associated with?

A 
Cardiovascular disease
Rheumatoid arthritis
Respiratory disease
Metabolic disease
Kidney disease

Shared common risk factors for oral and systemic disease e.g. diet, socioeconomic status

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2
Q

In 2017, what percentage of all death globally were attributed to inflammation related disease

A

73.4%

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3
Q

What is the function of kidneys

A

1) Excretory organs
Process blood
Rid body of waste products of metabolism via urine

2) Maintain internal homeostasis of fluid

fluid + electrolytes

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4
Q

Gross anatomy of kidney

A

Two kidneys (produce urine) ->
Ureters (convey urine) ->
Bladder (store urine) ->
Urethra (void urine)

Common iliac artery -> Abdominal aorta -> renal artery
Common iliac vein -> inferior vena cava -> rena vein

top view
Back: spinous process of vertebra
kidneys in renal fat pad
in front: peritoneum and peritoneal cavity

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5
Q

Macroscopic kidney structure

A

3 sections:

1) Cortex
85% of kidney tubules/ nephrons

2) Medulla
Urine is concentrated
prevents excess water loss

3) Pelvis
Collection of urine -> ureter

(consult diagram for other structures)

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6
Q

Blood vessels of the kidney

A

Abdominal aorta-> (blood) -> renal artery -> kidney

Blood: 1.2L/min (1/5th of cardiac output)

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7
Q

What is the pathway of blood vessels of the kidney

A 
Renal artery 
Segmental arteries
lobar arteries
Interlobar arteries
Arcuate arteries
Interlobular arteries
Afferent arteries
Glomercular capillaries
Efferent arteries
Peritubular capillaires (vasa recta) - Medulla 
Interlobular arteries
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8
Q

In the kidney where is the site of filtration?

A

Glomerular capillaries (glomerulus)

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9
Q

What is the basic functional unit of the kidney

A

The nephron

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10
Q

What does the nephron consist of?

A

Cortex:
Glomerulus
Bowman’s capsule
proximal convoluted tubule

Medulla:
Loop of Henle

Cortex:
Distal convoluted tubule
Collecting tubule

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11
Q

What are the types of nephron

A

Cortical nephron - short loop of henle

Juxtamedullary nephron - where urine is concentrated, reabsorbs water

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12
Q

What is the purpose of the nephron

A
  • filter blood plasma

- excrete waste products of metabolism in urine

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13
Q

What occurs at the renal corpuscle ?

A

Filtration/removal

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14
Q

What does the renal corpuscle consist of?

A

Glomerulus

Bowman’s capsule

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15
Q

What does the renal tubule do?

A

Reabsorption and secretion (conservation/ fine tuning)

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16
Q

What does the renal tubule consist of?

A

Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Collecting duct

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17
Q

What is the structure of the glomerulus?

A

A network of fine capillaries
single layer of endothelial cells resting on a basement membrane
fenestrated - many pores
which allows rapid filtration of blood plasma
surrounded by bowman’s capsule

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18
Q

What is the structure of Bowman’s capsule

A

Cuplike structure surrounded by glomerulus
Bowman’s space = space within double layer:
Parietal (outer) layer
Visceral (inner) layer - comprised of specialised epithelium - podocytes - wrap around glomerular capillaries

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19
Q

What forms a filtration barrier in the kidney?

A

Glomerular endothelium
basement membrane
pedicels of podocytes

Pedicels share basement membrane with fenestrated endothelium

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20
Q

What does the filtration barrier do

A

Movement of filtrate through filtration membrane
freely permeable to water and small molecules
not permeable to large proteins or cells
charge of filtration slits determine which molecules are filtered -vely charged

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21
Q

What occurs in glomerular filtration

A

It is the first step in blood processing

1) unfiltered blood arrives at the glomerulus via the afferent arteriole
2) blood components filtered through the filtration barrier
3) Filtered blood exits the glomerulus via efferent artieriole

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22
Q

In the glomerular, how is filtration faciliated

A

By a pressure gradient

  • glomerular hydrostatic pressure
  • Afferent is wider then efferent
  • blood arrives quicker then it leaves
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23
Q

In the glomerular filtration, what is filtered?

A

Water, glucose, AAs

Urea (protein waste), Creatine (muscle metabolism waste)

Electrolytes:
Na,Cl, Ca, K, PO, Bicarb

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24
Q

In glomerular filtration, what is not filtered?

A 
Cells (RBC/WBC)
Large proteins (Haemoglobin)
Negatively charged protein (albumin)
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25
What is the Glomerular Filtration Rate?
The rate at which blood is filtered through the glomerulus in to the Bowman's capsule Driven by glomerular hydrostatic pressure (+ capsular osmotic pressure) counteracted by hydrostatic pressure in bowman's capsule + Glomerular osmotic pressure
26
GFR is influenced by hydrostatic and osmotic pressures. What else?
Systemic blood pressure Renin-angiotensin system Disease (inflammation - protein leaking across)
27
What is a health GFR
125ml/min 180l/day
28
How is kidney function to GFR
Kidney damage reduced GFR reduced GFR = inefficent blood clearance and waste removal Waste products accumulate in blood
29
How do you measure GFR
Serum creatinine (and urea)
30
What are the stages of chronic kidney disease
``` 1 kidney damage - normal function GFR 90 -100 2 mild loss of function GFR 60 - 89 3a Mild to moderate loss GFR 45 - 59 3b Moderate to severe GFR 30 - 44 4 Severe - dialysis GFR 15 - 29 5 Failure - transplant - GFR 0 - 15 ```
31
In the real corpuscle how much is filtered?
180l/day -> 99% reabsorbed
32
Discuss filtration from the proximal convoluted tubule
1) Primary Active transport: Against concentration gradient Na-K+ Pump = Basal-lateral side of cells - requires ATP to change configuration ->ADP 1 ATP to move 3 X Na+ out of cell, in exchange for 2 x K+ into cell - doesn't need ATP to bring K+ back - Drives Na against it's concentration gradient - facilitates 65 N+ reabsorbtion ``` 2) Secondary Active transport Against concentration gradient Across apical surface Na Co-transporter Transporting glucose + amino acid Against concentration gradient ``` 3) Passive diffusion From high concentration to low concentration Water Follows Na+ via Aquaporin (due to hydrophobic phosoplipid bilayer) Osmosis 4) Electrical gradient - High concentration -> low concentration Cl- and -ve ions follow Na+
33
What is not reabsorbed in the the proximal convoluted tubule
Creatinine 50% of Urea
34
What would occur, in the kidney, if only passive diffusion was used?
50% of filtrate would remain in the tubule to be excreted | 50% of filtrate would be reabsorbed into the blood
35
How much does the proximal convoluted tubule reabsorbs?
2/3 of filtrate
36
Describe the concentration gradients in the PCT and Peritubular capillary for Na+
PCT tubule lumen - High PCT tubule wall - Low Interstitial space - High Peritubular capillary - Low
37
Describe the concentration gradients in the PCT and Peritubular capillary for Na+
PCT tubule lumen - lower PCT tubule wall - highest Interstitial space - lower Peritubular capillary - lowest
38
What are the reabsorption rates in the PCT?
Na active transport faciliates: 100% nutrient reabsorption - glucose/ amino acids "hitch a ride" 65% Water reabsorption - water follows Na+ 65% negative ions follow electrical gradient no effect on waste removal - urea - 50% rebasorbed by passive diffusion -Creatinine - no reabsorption
39
After PCT, how much filtrate continues through to the Loop of Henle?
60l (started at 180l)
40
What does sodium handling do in respect to tubular function?
``` Sodium transport used for reabsorption : reabsorption of nutrients, water, ions 65% reabsorbed in PCT 25% reabsorbed in ascending loop of henle up to 8% reabsorbed in DCT - depending ``` 98% Na+ reabsorbed - 80% energy consumption used by kidney
41
Histology of proximal convoluted tubule
Simple cuboidal with microvilli brush border | increases surface area
42
Histology of distal convoluted tubule
Few/no microvilli
43
Histology of peritubular capillary
simple endothelium
44
Name the sections of the Loop of Henle
Thin descending limb Thin ascending limb Thick ascending limb
45
What properties does the thin descending limb have?
Contains aquaporin | freely permeable to water
46
What properties does the thick ascending limb contain
The site of active sodium reabsorption via Na/K pump on basal lateral side (????) Sodium reabsorption via NKCC2 on apical membrane
47
What properties does the thick and thin ascending limbs have
No not contain aquaporins | imperable to water
48
How does the counter current multiplication work in the Loop of Henle/Medulla
Thick ascending limb = site of active sodium reabsorption interstitium of medulla = salt Water entering Loop of Henle flows of of tubule via osmosis The concentration of filtrate as it descends the thin ascending limb increases (300->1200) The concentration of filtrate as it ascends the thick ascending limb decreases (1200->100) Counter current multiplication - water is pulled out of filtrate
49
In counter current multiplication, why does the concentration not equalise?
Vasa Recta Maintains concentration gradient of medulla -> structure
50
What does the Loop of Henle do?
Employs counter current multiplication to reabsorb water and concentrate urine Na - actively reabsorbed from thick ascending limb Creates and maintains high osmotic pressure within the medulla water reabsorbed from thin descending limb Vasa recta supports conc. grad. in medulla
51
What occurs at the distal convoluted tubule?
Fine tuning | site of fluid volume and electrolyte regulation
52
What hormone influence activity in the distal convoluted tubule and what do they do?
Na and water regulation ADH - increase water reabsorption Aldosterone - increase Na+ reabsorption Atrial Natriuretic hormone - Promotes Na secretion ADH + Aldosterone work together
53
Describe what happens in the DCT
Fluid that enters DCT is hypotonic with interstitium (less conc 100 vs 300) in absence of external hormonal regulation a large volume of urine is produced ADH, aldosterone, ANH acts on distal and collecting tubules ADH: inserts aquaporin allows water to be reabsorbed from filtrate small vol. con. urine produced AVPR2 (vasopressin receptor 2) on basal lateral membrane on epithelium on DCT Alderstone (steroid, can pass through membrane to nucleus): upregulates activity and insertion of Na+K+ pumps and channels small vol con. urine produced ANH inhibits action of ADH and aldosterone removes aqua porin and sodium pump large volume dilute urine produced
54
180 litres are filtered per day, how much is excreted?
1-2%
55
How does the change in blood pressure related to release of hormones in the DCT
``` Fall in BP ADH insert aquaporin Aldosterone insert sodium channels fluid reabsorption small volume con. urine raise in blood pressure ``` ``` Rise in BP ANP inhibits ADH + Aldosterone fluid excretion large volume dilute urine lower blood pressure ```
56
What factors are GFR influenced by?
``` G hydrostatic pressure BC hydrostatic pressure G Osmotic pressure Systemic blood pressure - determine rate/force of afferent filtration RAAS Disease ```
57
How do the kidneys measure systemic blood pressure?
They use GFR as a proxy
58
Discuss how the GFR effects systemic blood pressure
If GFR increases, fluid flows faster through the tubules, there is less time to reabsorb Na = higher Na conc in DCT If GFR lower, flow is lower, more time to reabsorb, Na conc lower in DCT.
59
What is the equation for excretion from the kidney?
Excretion = (filtration - reabsorption) + secretion
60
Describe secretion in the nephron
GFR = 100% into PCT PCT na + water = 65% reabsorpted glucose + aa = 100% Urea = 50% Look of henle Na (+K + Cl) = 25% DCT water = < 8% GFR = 1% leaving collecting ducts
61
What the is Juxta-glomerular apparatus?
Connects the distal convoluted tubule with the glomerulus (afferent)
62
What does the juxta-glomerular apparatus measure and do?
Measures and responses to changes in Na+ conc of the filtrate - as a proxy for blood volume/pressure
63
What are the sections of the juxta-glomerular apparatus?
1) Macula densa Epith cells near/on DCT detect Na+ conc in filtrate as flows through 2) Juxtaglomerular cells - modified smooth muscle Adjust diameter of the afferent arteriole vasodilate/constrict talk directly to macula densa 3) Mesangial cells supporting cells extra and intra cells
64
How is homeostatic blood pressure maintained?
glomerular hydrostatic pressure maintained via: Blood pressure drives Glomerular hydrostatic pressure which determines GFR which determines Na+ conc of filtrate as enters DCT (which is in homeostatic limits) this is detected by: Macula densa No further signal to juxtaglomerular cells in homeostasis: JGcell = large diameter of afferent arteriole maintained (compared to efferent)
65
What happens when blood pressure increases?
Tubuloglomerular Feedback 1) increased blood pressure drives increase Glomerular hydrostatic pressure which drives increased GFR causing increase Na+ cons of filtrate entering DCT Na flows out to Macula densa + water follows Macula densa expands and swells + releases adenosine Adenosine signals to Juxtaglomerular cells Causes constriction of afferent arteriole This protects glomerular capillaries from fluctuation in BP glomerular hydrostatic pressure decrease The knock on effect is: decreased GFR Na+ filtrate decreases Macula densa detects and stops signal to JG cell diameter of JG cells = normal (large diameter of afferent arteriol maintained) Glomerular hydrostatic return to homeostasis. 2) Decreased blood pressure causes decreased glomerular hydrostatic pressure decreased GFR less Na+ concentrate in filtrate going in to DCT Na+ flows out of cell, water follows, cells shrivel Macula densa releases prostaglandin Tells Juxtaglomerular cells to vasodilate - but they are already vasodilated Renin is secreted in response - activates RAAS system
66
Where does tubuloglomerular feedback occur?
High blood pressure: Local to the kidney no effect to systemic elevated blood pressure function: to protect glomerular capillaries from fluctuations in kidneys Low blood pressure: activates RAAS
67
What does tubuloglomerular feedback regulate?
systemic blood pressure
68
Discuss RAAS
Renin angiotensinogen-system restores blood pressure via angiotensin II It restores blood volume via increased fluid and salt retention. 1) Angiotensin produced in liver constantly + always present. Released into circulation 2) Low Na+ causes release of renin. Renin cleaves angiotensinogen into angiotensin I 3) Angiotensin converting enzyme produced in vascular endothelium of lungs - converts angiotensin iI into Angiotensin II. Angiotensin II = vascoconstrictor. Binds to receptors in arterioles. Increases blood pressure short term measure
69
How is blood volume restores
RAAS: | restores blood volume via increased fluid and salt retention
70
Where does Angiotensin II target receptors and what do they do?
1) Arterioles - constriction 2) Hypothalamus - thirst (take on more fluid) 3) Pituitary Gland - release of ADH (epithelium in DCT = aquaporins = water reabsorbed) 4) Adrenal Medulla - release of aldosterone (DCT insert Na+ - Na+ reabsorb = more water in association with ADH) restores blood and volume via increased fluid and salt retention
71
What are the consequences of chronic kidney disease?
Inadequate removal of fluid and waste products of metabolism Inappropriate activation of RAAS (increase fluid and water retention)
72
what are the links between CKD and CVD
Diabetes | Hypertension
73
What are the causes of CKD
``` Hypertension diabetes High cholesterol kidney infections glomerulonephritis - oral bacteria polycystic kidney disease - hereditary kidney stones - waste crystals, blocks kidney long term use of NSAIDs - ibuprofen ```
74
What are the systems of CKD
``` hypertension nausea oedema - ankles, hands, feet, lungs blood/protein in urine anaemia weak/painful bones ```
75
How do you regulate hypertension?
Diet (reduce salt)/ weight loss combination of anti hypertensive treatments diuretics (furosemide) ACE inhibitors/angiotensin receptor blockers (ARBS) Aldosterone agonists (nuclear receptors or Na channels)
76
What does Furosemide target?
NKCC2 | Na reabsorption is via NKCC2 on apical membrane
77
what is kidney failure?
Stage 5 end stage renal disease less then 15% kidney function dialysis and/or kidney transplant required
78
What is dialysis?
Artificial removal of waste, solutes, water and toxins from blood two types - Haemodialysis - Periotoneal dialysis
79
How does ANP counteract RAAS?
RAAS increases BP Baroreceptors detect rise in BP Atrial Natriuretic peptide, released by epithelium cells in atria. this inhibits effect of ADH, Aldosterone and Renin in RAAS causes excretion of excess fluid causes BP to return to homeostatic levels.
80
Juxtaglomerular detects and responds to changes in Na+ concentrate in filtrate. Give a summary
1) High Na+ -> adenosine -> vasoconstriction -> tubuloglomerular feedback 2) Low Na+ -> Prostaglandins -> renin -> RAAS - > high BP via antiotensin II - > high blood volume via aldosterone and ADH 3) ANP counteracts Aldosterone, ADH, Renin to remove excess fluid and lower BP

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