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Renal W12 Flashcards

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1
Q

What are the kidney functions

A

Excretion…
* metabolic waste products
* foreign chemicals (including drugs)

Regulation…
* water balance
* electrolyte salt concentrations
* acid-base balance (bodypH)
* arterial blood pressure

Secretion, metabolism and excretion of hormones
Gluconeogenesis

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2
Q

Where are the kidney’s located*

A

by posterior muscular wall of the abdominal cavity
retroperitoneal

protected by ribs and muscles of back and surrounding adipose tissue

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3
Q

Label

A

Dont worry about what is circled

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4
Q

What is a nephron

A

Basic functional unit of the kidney
Filters blood and produces urine

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5
Q

What are the two parts of a nephron and there roles?

A

Renal corpuscle Filters blood - starting point for urine formation (red circle) <- includes glomerulus
Renal tubule Modifies filtrate prodcued by corpuscle -> urine

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6
Q

What are the two basic processes done by the renal tubule to modify the glomerular filtrate

A

Tubular reabsorption and tubular secretion

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7
Q

Describe the location/order of of… **
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Collecting duct
Using the diagram

A

Glomerulus
Proximal convoluted tubule: straight off the glomerulus
Loop of Henle: desending and ascending tubule
Distal convoluted tubule: follows loop of Henle
Collecting duct: final part of tubule

KNOW: glomerulus is always in cortext, some parts of tubule are in the medulla

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8
Q

What are the three processes performed by the nephron (Urine formation)

A
  1. Glomerular filtration - filtration of blood
  2. Tubular reabsorbption - reabsorb some filtered substances from tubules into blood (already absorbed in intestines) <- MOSTLY DETERMINES URINE
  3. Tubular secretion - secretion of substances from blood into tubules to be excreted ex. waste products, elecrtolytes, water
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9
Q

Describe the components of the Renal corpuscle

A

glomerulus
innermost, site of filtration.
ball of capillaries (with pores in their walls) that provide large surface area for filtration.
surrounded by…
glomerular capsule (bowmans capsule)
where filtrate from glomerulus ends up

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10
Q

Glomerular filtration has 3-layer filtration barrier. It is relatively impermeable to proteins and cellular elements of blood.

What is the barrier dependent on (2 things) and is the process selective or non-selective.?

A

Size selective and charge dependent barrier - fluid and solutes forced through a membrane by hydrostatic pressure.

Passive (does not require energy)
non-selective process (water, salts, nutrients, metabolic waste - all blood components minus blood cells and plasma proteins)

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11
Q

Why can’t plasma proteins get across the glomerular filtration barrier.

A

Too large and negative charge (repelled by negative glycoproteins on basement membrane)

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12
Q

Glomerular filtraion relies on pressure. What are the 3 forces that drive filtration across the membrane and effect glomerular filtration rate?

A
  1. Glomerular hydrostatic: pressure of blood in capillaries of glomerulus -> PROMOTES FILTRATION
  2. Capsular hydrostatic: pressure applied to the membrane by fluid in the capular space and tubule -> OPPOSE FILTRATION
  3. Blood colloid osmotic: pressure from proteins present in blood plasma -> OPPOSE FILTRATION

Net effect = filtration promoted

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13
Q

Kidneys average GFR is around 20% (120ml/min). Rapid filtering ensures quick removal of waste products and rapid correction of any changes in blood composition. What happens when this GFR is slow.

A

Kidney disease (15-60ml/min)
Kidney failure (under 15ml/min)

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14
Q

Most of our glomerular filtrate (99%) is reabsorbed as it passes through the renal tubule.
Is this process selective or non-selective?
What is always, likely and unlikely to be reabsorbed?

A

Highly Selective
Almost completely re-absorbed: glucose, aa’s
likely: salt and water (depending on body’s needs)
Poorly: waste (urea)

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15
Q

There are various transport mechanisms for reabsorbtion depending on the substance.
How is Na+ transported and what is it coupled to?

A

Na+/K+ pump - Active transport (moves solutes against concentration gradient - uses energy)

Coupled to glucose transport - Secondary active transport

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16
Q

What is the transport maximum for reabsorption, give an example?*

A

Limit to the rate at which a substance can be reabsorbed (transported) due to saturation of the transport system.

Ex. Glucose (more glucose than transport max, it remains in filtrate and therefore urine) uncontrolled diabetes symptom!

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17
Q

What are some common secreted products?*

A

K+ and H+ <- pH regulation

Organic acids and bases - bile salts, oxalate - end products of metabolism that must be removed rapidly.

Drugs or toxins - rapid clearing from the blood.

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18
Q

What is the primary site for reabsorption*

A

Proximal convoluted tubule

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19
Q

What is ‘reabsorption’ in simple terms*

A

Removal of useful substances from glomerular filtrate to return to blood.
Generally couples to H2O reaborption

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20
Q

What is ‘secretion’ in simple terms*

A

Transfer of unwanted substances from blood and tubule cells into tubular fluid

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21
Q

What is the primary site for secretion*

A

Proximal convoluted tubule

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22
Q

(2 systems)

Constant volume and stable compostion of body fluids is essential for homestasis. Why?

A

Cardiovascular function increased extracellular fluid -> increased B.V -> increased B.P
Excitable tissues nerve and muscle cells sensitive to changes in electrolyte composition ex. cardiac muscle

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23
Q

What structure and hormone is involved in the regulation of urine volume and osmolarity?

A
  • Loop of Henle
  • ADH
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24
Q

How is urine osmolarity regulated? - Which ion is ALWAYS reabsorbed

A

Osmolarity is a measure of solute and water ratio. High and low volumes of osmolarity and urine concentration/dilution is altered in the Loop of Henle - by ADH.

Active reabsorption of Na+ in proximal tubules and ascending limb of the loop of Henle - 80% ALWAYS reabsorbed. Therefore, filtrate that leaves loop of Henle has low concentration of salt and urine.
= high solute concentration in medulla, low solute in filtrate (GRADIENT SET UP for reabsorption of water)

Can also reabsorb more Na from distal tubule controlled by aldosterone = dilute urine.

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25
What is the hormone Aldosterone's role in the regulation of urine osmolarity?
Na+ reabsorption in the **distal tubule** (for concentrated urine)
26
What happens with low levels of ADH*
In ascending loop, tubular fluid dilute In distal tubules and collecting ducts, tubular fluid is further diluted due to reabsorption of NaCl but no reabsorption of water (low ADH) = **Large volume of dilute urine**
27
Describe the mechanism of action of ADH*
Normally distal tubules and collecting ducts impermeable to water ADH release = aquaporins = distal tubules and collecting ducts permeable to water + high salt concentration in medulla (hyperosmolar) = water reabsorption = **small volume of concentrated urine**
28
Reabsorption/secretion of salt in the **distal tubules** is under the control of which hormone?
Aldosterone
29
What ion movement is controlled by aldosterone?
Controls excretion of Na+ and K+
30
What does high aldosterone levels result in?
Reabsorption of Na+ in exchange for secretion of K+
31
What does low aldosterone levels result in?
Secretion of Na+ in exchange for reabsoption of K+
32
Describe the order to structures urine passes through in the kidneys to be excreted
**Collecting ducts** fuse to form **papillary ducts** as they approach the renal pelvis. **Papillary ducts** --> **minor calyces** *stretch of calyces iniciates peristaltic conctration* **Minor calyces** --> **Major calyces** --> **Renal pelvis** --> **Ureter** --> **Bladder**
33
Slender **tubes** that convey the **urine from the kidneys to the bladder** are called...
Ureters (2) *continuations of the renal pelvis, descending behind the peritoneum to the posterior wall of the bladder*
34
Why does urine not backflow from the bladder back to the kidneys?
As the bladder fills and the pressure increases the bladder compresses and **closes the distal ends of the ureters**
35
Smooth, collpasible muscular sack on the pelvic floor for the temporary storage of urine = ____
Urinary Bladder
36
What is the **trigone**?
Triangular region at the base of the bladder outlined by the 3 openings for the (2) ureters and the urethra forming
37
Describe the three layers of the bladder wall
1. Transitional epithelium (urothelium) 2. Thick smooth muscular layer (detrusor muscle) 3. Fibrous adventitia
38
When empty the bladder collapses into ____ shape. When urine accumulates it becomes a ____ shape and rises towards the abdominal cavity.
Empty : Pyramindal shape --> Full: Pear shape
39
Thin-walled muscular tube that drains urine from the bladder to the outside = ____
Urethra
40
Why are women more prone to urinary tract infections
Men have a long urethra Women have a short urethra - closer to the outside
41
Where is the **internal urethral sphincter** located and what does it do?
Thickening of the detrusor muscle at the bladder-urethra junction Involuntary control = Prevents leakage between voiding
42
Where is the **external urethral sphincter** located and what does it do?
Surrounds the urethra as it passs through the urogenital diaphragm Voluntary controlled (by skeletal muscle)
43
What **other function** does the **urethra** hold in **males**?
**Carries semen **(& urine) *early part of urethra runs within the prostate gland*
44
What is **Micturition**
Act of emptying the bladder *Under involuntary and voluntary control*
45
Describe the **initial relaxation** of the bladder during the **process of micturition***
1. **Urine accumulates** in the bladder (1ml/min) --> distension of bladder wall = **activates stretch receptors** 2. **Impulses transmitted** (via visceral sensory fibres - afferent) to the **sacral region of the spinal cord** = **spinal reflex** **Spinal reflex** * Initiates increased sympathetic outflow = inhibits (relaxes) detrusor muscle * Simulates contraction of the external urethral sphincter via motor nerve fibres (pudendal nerve)
46
Why does the **first part of the spinal relfex** include the **relaxation of the detrusor muscle**?
Need the bladder to **relax to allow filling** initially
47
Describe what happens when the bladder contains the following ml's of urine * 200ml * 400ml * 600-800ml
* **200ml**: impulses transmitted to brain = small transient contraction waves * **400ml**: desire to micturate begins *Either decide to void **or** voluntarily overide (bladder contractions subside, external sphincter closed, urine continues to accumulate)* * **600-800ml**: reflex begins again, try to surpress until voiding is irresistible and micturation occurs
48
What happens when you **decide to void**?*
Conscious, positive decison is made by cerebral cortex Afferent impulses activate the **micturition centre** in the pons - "on/off" switch for micturition => signals the parasympathetic neurons to **stimulate conctraction** of the **detrusor muscle** & **relaxation** of both internal and external **sphincter** = urine flows through urethra and exrternal trethral orifice
49
What is the role of the Renin-Angiotensin system
Regulates blood volume and vascular resistance
50
What is the response to decreased arterial pressure **short-term vs long-term**
Short-term: baroreceptor reflex Long -term: renin angiotensin system
51
What are the **three major components** of the Renin-Angiotensin system
* Renin * Angiotensin 2 * Aldosterone *act together to elevate arterial pressure*
52
What are the **three stimuli** for the Renin-Angiotensin system
* Decreased renal blood pressure * Decreased salt delivery to the distal tubule * Beta agonism
53
What is the **overall result** of the Renin-Angiotensin system
* Elevated blood volume * increased sodium reabsorption * increased potassium secretion * increased water reabsorption * increased vascular tone = **prolonged** elevated blood pressure
54
What **systems** are involved in the Renin-Angiotensin system
* Kidneys * Lungs * Systemic vascularture * Brain
55
What components make up the **Juxtaglomerular apparatus** and what is its **function**?
Juxtaglomerular apparatus initiates/stimulates the Renin-Angiotensin system * Macula densa * Juxtaglomerular (Granular) cells * Mesangium-extra glomerular cells
56
Describe the **role and location** of the **Juxtaglomerular (Granular) cells**
* In **afferent arteriole wall** of the glomerulus * **Smooth muscle cells** that contain **secretory granules containing renin** * Act as **mechanoreceptors** - detect changes in BP in afferent arteriole
57
Describe the **role and location** of the **Macula densa cells**
* Tall, densely packed **distal tubule** cells - adjacent to JG cells * Act as **osmoreceptors** -respond to changes in solute content in filtrate in renal tubule
58
What **4 stimuli trigger the release of renin from the JG cells**?
* **Reduced stretch** of the JG cells - *drop in systemic BP (and afferent arteriole BP) - below 80mmHg* * **Stimulation by Macula densa cells** in response to rapid filtrate flow or decreased Na+ in distal tubule * **Stimulation by renal sympathetic nerves** (B1 adrenergic receptors) * **Stimulation by angiotensin 2**
59
Describe the **mechanism of action** of the Renin-Angiotensin system
1. Renin is released from the JC cells 2. Renin cleaves angiotensinogen into angiotensin 1 3. Angiotensin 1 --> angiotensin 2 by ACE enzyme
60
Describe the **3 major actions of Angiotensin 2** to increase BP
1. Stimulates **Na+/H+ exchange in proximal tubule** *Short term effect* 2. Stimulates adrenal glands to release **aldosterone** *Long term effect* 3. **Acts on** the **brain** to... * Bind to hypothalamus to stimulate thirst and increase H2O intake * Stimulates release of ADH * Decrease sensitivity of the baroreceptor reflex - diminished response to increasing BP
61
What is the action of **Aldosterone**
* Stimulates **reabsorption of the NaCl and H2O** in the distal tubule and collecting duct * Acts as a **vasoconstrictor** = Increase in BP
62
What is the **role of aldosterone**
Regulates Na+ levels in extracellular fluid through **reabsorption** of **remaining Na** (NaCl) in **distal tubules and collecting ducts** *Water will be reabsorbed only if ADH is also released*
63
What is the main and secondary **trigger for aldosterone release**?
Main trigger: **Renin-Angiotensin system** Secondary trigger: **Increase** in level of **extracellular K+** *because Na+ reabsoption in exchange for K+ secretion by Na+/K+ pump*
64
Is the renal system and hypertension linked, how?
* The kidneys play a role in the development of hypertension & renal diseases can cause hypertension * Hypertension can lead to renal disease - constriction and narrow of B.V's -> damage/weakness of B.V's through whole body (in kidneys) -> reduced B.F and dysfunction of B.V's -> waste and excess water not removed = more hypertension | BV and therefore P is dependent on Na+ levels - controlled by kidneys
65
What are UTI's?
Urinary tract infections *Presence of microorganisms in the urinary tract (bladder, postate, collecting systems and kidneys*
66
What is a **serious complication of a common UTI's** and the associated **symtoms**?
**Pyelonephritis** Effects bladder, kidneys and nephrons (collecting systems) Symptoms: flank pain, fever, chills, dysuria (painful urination), constant urgency/freq
67
What factors play a role in **chronic pyelonephritis**
**Bacterial infection** + **Vesicoureteral reflux** (closing of ureter doesnt function properly = backflow of bacteria further up) or **obstruction**
68
What is **Glomerulonephritis** and how is it **diagnosed** and what is the **cause**?
**Inflam** of the **glomeruli** leading to **damage** -> acute or chronic **Asymptomatic** - diagnosed by **protein or blood in urine** in absense of infection. Cause - **strep throat or absessed teeth** -> immune overreaction
69
What can be done to **slow the progression** of **Glomerulonephritis**
Management of **hypertension** -> ACE inhibitors
70
What is **Acute renal failure** *ARF* and the associated symptoms?
Sudden reduction in renal function accompanied by accumulation of waste products in the blood *decrease in urine output/ceasation*
71
Describe the **three classifications of Acute Renal failure**
* **Pre-renal failure**: impaired renal BF (*to kidneys*), *easily reversed* Ex. hypotension, renal artery blockage. * **Intra-renal failure**: nephron itself damaged, recovery slow or progression to chronic renal failure* Injury, infection, autoimmune reaction, hypertension * **Post-renal failure**: obstruction within urinary collecting systems distal to kidneys -> back pressure - impedes glomerular filtration. *easily reversed*
72
What is **Chronic renal failure**
Progressive loss of renal function over months-years -> end stage renal disease *Irreversible*
73
# Correspond to degree of nephron loss Describe the **three stages of Chronic Renal failure**
1. **Decreased renal reserve** - 50% loss of kidneys nephrons. *no signs or sympt, hyperfunct. of remaining* 2. **Renal insufficiency** - 75% nephrons damaged. *ability to concentrate urine impaired = increased output* 3. **End stage renal disease** - >90% nephrons damaged. *renal failure* *Causes: hypertension, diabetes mellitus, glomerulonephritis, pyelonephritis*
74
What are the two 'treatments' for **End stage renal disease**
* Dialysis - machiene replaces kidney function * Kidney translant - limiting factor is avaibility of organs

Anatomy (13 decks)

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