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Session 1 Flashcards

(109 cards)

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1
Q

What is the broad function of the glomerulus

A

Filtration

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2
Q

What does the glomerulus filter

A

Water, sodium, chloride, potassium, bicarbonate, amino acids, glucose, creatinine, urea

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3
Q

What is reabsorbed at proximal convoluted tubule

A

Potassium, 67% sodium and chloride, 100% amino acids and glucose, 90% HCO3- and 65% water

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4
Q

What is secreted (cleared from body) at proximal convoluted tubule

A

Uric acid and organic acids

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5
Q

What happens at descending limb of loop of Henle

A

10% water reabsorbed

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6
Q

What happens at ascending limb of loop of Henle

A

Impermeable to water

25% Na+ and Cl- reabsorbed

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7
Q

What controls resorption of water and sodium at distal convoluted tubule

A

Aldosterone

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8
Q

What is secreted at distal convoluted tubule

A

K+ and H+

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9
Q

What controls resorption at collecting duct

A

ADH

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10
Q

What is reabsorbed at collecting duct

A

Urea, Na+, Cl-, water

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11
Q

What is excreted at end of nephron

A

Water, Na+, Cl-, HCO3-, Creatinine, Urea

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12
Q

Nephron gets blood supply from

A

Renal arteries

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13
Q

Why are kidneys vulnerable to ischeamic damage

A

They take about 20-25% of whole cardiac output

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14
Q

Big difference between cortical or juxtamedullary nephrons

A

Juxtamedullary have bigger loop of Henle

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15
Q

Broad nephron functions

A

Filters and cleans blood, enables site for secretion and resorption

Concentrates or diluted urine to control body fluid osmolality and fluid volume

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16
Q

How much that enters the glomerulus ends up filtered

A

20%

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17
Q

What is clearance

A

Rate at which glomerulus cleans blood

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18
Q

What is filtrate

A

What the substances are called once they leave the capillaries and end up being filtered into the Bowman’s capsule and tubule

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19
Q

What is GFR

A

Glomerular filtration rate= rate of solutes pushed out of blood into Bowman’s space

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20
Q

Excretion function of kidney and urinary tract

A

Excrete waste products and drugs

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21
Q

Regulation function of kidney and urinary tract

A

Body fluid volume and ionic compounds, major role in homeostasis and acid-base balance

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22
Q

Endocrine function of kidney and urinary tract

A

Synthesis of renin (bp and sodium balance), erythropoietin (erythrocyte production) and prostaglandins (involved in regulation of renal function)

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23
Q

Metabolism function of kidney and urinary tract

A

Vit D is metabolised to active form, metabolism of low molecular weight proteins e.g. insulin, parathyroid hormone, calcitonin

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24
Q

4 broad functions of kidney and urinary tract

A

Excretion, regulation, endocrine and metabolism

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25
Anatomical location of kidney and urinary tract
Retroperitoneum on the posterior abdominal wall, either side of vertebral column, between T12 and L3, partially protected by ribs 11 and 12
26
Where is the hilum
L1
27
Why is right kidney lower
Liver pushed it down
28
What is yellow
Kidney
29
What is blue
Renal capsule
30
What is green
Perirenal fat
31
What is red
Renal fascia
32
What is pink
Pararenal fat
33
What do podocytes wrap around
Capillaries
34
What is the broad function of the Juxtaglomerular apparatus
Senses composition of contents
35
3 key cell types in juxtaglomerular apparatus
Macula densa cells, extraglomerular mesangial cells, granular cells
36
What do macula densa cells do
Sense salt, send signal to granular cells
37
What do granular cells control
Renin and constriction
38
What do extraglomerular mesangial cells do
Pass messages, secretes substances, hold skeleton
39
Order of blood flow from renal artery to efferent arteriole
Renal artery, segmental artery, interlobar artery, arcuate artery, interlobal artery, afferent arteriole, glomerulus, efferent arteriole
40
Blood flow from efferent arteriole to renal vein
Splits into 2- peritubular capillaries (associated with convoluted tubules), Vasa recta (associated with loop of Henle), interlobular vein, arcuate vein, interlobar vein, renal vein
41
What is the ureter made from and where is it
Smooth muscle fibres that propel urine (peristaltic waves) to urinary bladder Retroperitoneal, lateral to tips of transverse processes of lumbar vertebrae
42
Ureter beyond the pelviureteric junction PUJ divided into
Proximal (abdominal), Middle (pelvic), Distal part (intramural)
43
Most common area of uteretic injury?
Near pelvic brim
44
Bony landmarks to approximate course of ureter (Hilium to bladder)
L1- hilium Tip of lumbar transverse processes Crosses sacrum at S1 Ischial spine- ureter kink towards bladder Run around pelvis and enter bladder posteriorly
45
What is the detrusor muscle
1 massive bladder muscle- weakens and goes wrong = incompetence
46
What acts instead of a sphincter in the bladder
Vesicoureteral junction- oblique angle
47
Bladder surface
Muscular folds called rugae- contract and expand Lined with transitional epithelium- urothelium
48
When empty the bladder rests on
Symphysis pubis in front of rectum (and vagina and uterus in women)
49
Bladder can hold on average
750ml
50
Lumen or ureter is coated in
Urothelium
51
urothelium is
Continuous lining of the bladder, ureter and pelvis of kidneys
52
Why do women get more UTIs
Shorter distance from opening
53
Urethral divisions female
Ureteric openings, internal urethral sphincter, urogenital diaphragm, urethra
54
Urethral divisions made
Prostatic urethra, Urogenital diaphragm, membranous urethra, Bulbous urethra, penile/spongy urethra, navicular fossa, external urethral meatus
55
What does euvolemic mean
In fluid balance
56
What is osmolality
Solute per kg of solvent
57
What is osmolarity
Number of osmoles of solute per unit
58
A large volume of what type of plasma comes out as filtrate
Protein free
59
Plasma contains
Proteins, electrolytes, amino acids, glucose
60
Give an example of protein too large to fit through holes
Albumin- has charge which helps osmotic force
61
What is RBF
Renal blood flow- amount of blood that flows through glomeruli per minute Litres/minute
62
What is RPF
Renal plasma flow- amount of plasma in ml/minute
63
Renal plasma flow =
Renal blood flow x (1-Hct) Hct= haematocrit = 40/45% usually
64
Average GFR
125 ml/min
65
FF = (Filtration fraction)
GFR/RPF Usually around 20%
66
What does FF represent
Proportion of fluid reaching the kidneys that passes into the renal tubules
67
Glomerular filtrate usually contains
No blood cells or platelets, virtually no proteins Mostly organic solutes with a low molecular weight, and inorganic ions
68
The end product of filtration is identical to
Plasma without the large proteins and cells
69
What do podocytes help with
Forming a barrier as negatively charged - closely associated with capillary membrane. In Bowman’s capsule epithelium
70
What is proteinuria
Negative charge on filtration barrier lost so proteins more readily filtered hence in urine
71
The amount of filtrate is determined by the product of
The average filtration of each nephron in each kidney
72
A decrease in GFR means
Kidney function has worsened- less nephrons or lower GFR within nephrons
73
When kidney function declines slowly, what process may happen
Individual nephrons may hypertrophy, so actual kidney function may not fall significantly until kidney damage has occured
74
What is the issue with GFR
Can’t measure actual GFR so need surrogate marker- renal clearance
75
What is C
Clearance- volume of plasma that is cleared of a substance in a unit time
76
Clearance of y =
Urine conc of y x urine flow rate / plasma conc of y
77
When is renal clearance not accurate
If substance does not stay with filtrate and is altered by kidney (reabsorbed, secreted, synthesised or metabolised)
78
Why is clearance an imaginary concept
Describes a volume of plasma completely cleared of solute
79
Formula for filtration rate
Plasma conc x urine flow rate
80
Formula for excretion ate
Urine conc x flow rate
81
How does being a baby affect GFR
Premature and LBW infants often have lower nephron numbers Fetal excretion predominantly via placenta Normal GFR by 18 months
82
Nephron development is finished by
35th-36th week of fetal development
83
GFR starts declining when, features
30 years old, 6-7ml/min per decade, loss of functioning nephrons, some compensatory hypertrophy
84
Pregnancy and GFR
GFR increases by about 50%, 130-180ml per minute Kidney size increases by about 1cm (increased fluid volume vascular and interstitial) Nephron number same Back to pre pregnancy levels 6 months postpartum
85
If used to measure kidney clearance a substance should
Be produced at constant rate, be freely filtered across glomerulus, not be reabsorbed in nephron and not be secreted into nephron
86
Inulin is a
Plant polysaccharide, ingested, freely filtered, not reabsorbed and not secreted
87
Why dont we use inulin
Required continuous IV to maintain steady state, required catheter and timed urine collections
88
What do we use to measure clearance hence GFR
51 Cr-EDTA
89
Why uses 51 Cr-EDTA
Radioactive labelled marker Cleared exclusively by renal filtration Timed injection with blood samples taken 2,3,4 hours after Approx 10% lower clearance than insulin
90
When is 51 Cr-EDTA used clinically
In children, where indication of renal function required e.g. transplant or donation
91
What is creatinine
Endogenous, end product of muscle breakdown
92
Creatinine is measured by
Urine creatinine over 24 hours, serum creatinine
93
Disadvantages of measuring creatinine
Cumbersome- carrying bottle of urine, frequently inaccurate Over estimated GFR by 10-20% due to creatinine secretion (more with more severe renal impairment)
94
When is measuring creatinine used
In pregnancy
95
Things that affect creatinine levels in an individual
Intake, muscle mass, renal filtration, renal secretion, renal secretion
96
Renal secretion makes up proportionately more of total renal excretion as
GFR declines
97
Things which increase serum creatinine
Large muscle bulk, young, male, creatine supplements, high intake of meat, certain drugs e.GFR. Trimethoprim
98
Things which reduce serum creatinine
Reduced muscle mass, old, female, vegetarian
99
What is eGFR
Estimated GFR
100
Problems with eGFR
Inaccurate in mild kidney disease,
101
Why is eGFR not reliable in mild kidney disease
reduction in GFR causes increase in blood flow Reduced nephron number leads to hypertrophy so no change in GFR Reduced filtration of creatinine due to reduced GFR results in increased serum creatinine and increased secretion into the tubule
102
How long is urethra in male vs female
Female 4cm, male 15-20cm
103
What is the area of the bladder compromising of steric openings and internal urethral meatus
Trigone
104
Which urethral sphincter is under voluntary control
External urethral sphincter
105
Segmental artery splits to become the
Interlobar artery
106
Kidneys generally located between
T12-L3
107
Ureter is narrowest at the
Vesicoureteral junction, the point where it enters bladder
108
Which arteriole has reduced volume with age
Efferent
109
Which fluid can escape during collecting duct injury
Urine

Urinary (20 decks)

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