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Biomedicine (Semester II) > 11. Urinary System > Flashcards

11. Urinary System Flashcards

1
Q

Urinary system components

A

Two kidneys
Two ureters
One bladder
One urethra

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2
Q

Urinary system functions

A
  1. Filter/excretion of unwanted substances
  2. Water/electrolyte balance
  3. Body fluid pH regulation
  4. Hormone production (EPO, calcitriol)
  5. Regulation of red blood cell production
  6. Regulation of blood glucose levels
  7. Regulation of blood pressure, volume, osmolarity
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3
Q

Which substances are excreted by the urinary system?

A
  1. Metabolic wastes
  2. Ions
  3. Toxins
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4
Q

How is water balance controlled by the urinary system?

A

Mainly controlled by kidneys

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5
Q

What are electrolytes?

A

Electrolytes are charged atoms in solution (they conduct electricity)

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6
Q

What is the optimum blood pH balance?

A

Blood pH must remain between 7.35-7.45 (mildly acidic)

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7
Q

What is calcitriol?

A

Active form of vit D

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8
Q

What is erythropoietin?

A

Protein hormone that stimulates erythropoiesis in the red bone marrow

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9
Q

What is the normal blood glucose level?

A

4-7 mmol/L

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10
Q

How does the amount of urine excreted affect blood volume, pressure, concentration?

A

More water excreted = lower BP

Less water excreted (more conserved in blood) = increased BP

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11
Q

Kidney shape and location

A

Reddish, bean-shaped

Retroperitoneal (behind peritoneum)
Partially protected by 11th and 12th pairs of ribs between vertebral levels T11-L3

Right kidney is lower due to liver on same side

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12
Q

Kidney: external layers

A
  1. Renal capsule (deep layer)
  2. Adipose capsule (middle layer)
  3. Renal fascia (outer layer)
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13
Q

Kidney: internal regions

A
  1. Renal cortex
  2. Renal medulla

These make up the functional portion of the kidney

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14
Q

Kidney: internal regions

A
  1. Renal cortex: outer, light red area

2. Renal medulla: darker area composed of several cone-shaped structures (renal pyramids)

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15
Q

Minor calyces

A

These surround the renal papillae of each pyramid and collects urine from that pyramid

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16
Q

Major calyces

A

These are formed where several minor calyces converge. From here, the urine flows into the renal pelvis; and from there, it flows into the ureter

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17
Q

How is blood supplied to the kidneys?

A

Supplied through renal artery and vein

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18
Q

Nephron: definition

A

Functional unit of the kidney
More than 1 million per kidney
Single epithelial layer throughout

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19
Q

Nephron: regions

A
  1. Renal corpuscle

2. Renal tubule

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20
Q

Glomerulus

A

Network of capillaries that receives blood from an afferent arteriole (one coming in)
Very leaky

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21
Q

Bowman’s capsule

A

Double-walled epithelial cup that surrounds the glomerulus, receiving contents of filtered blood

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22
Q

Nephron: full composition/anatomy

A
  1. Glomerulus (renal corpuscle)
  2. Bowman’s capsule (renal corpuscle)
  3. Proximal convoluted tubule
  4. Loop of Henle
  5. Distal convoluted tubule
  6. Collecting duct
  7. Afferent arteriole
  8. Efferent arteriole
  9. Peritubular capillaries
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23
Q

Ureters: function and length

A

Two ureters transport urine from the renal pelvis to the bladder

Each ureter is around 25-30cm long and retroperitoneal

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24
Q

Ureters: layers

A
  1. Inner mucous membrane
  2. Muscularis
  3. Adventitia
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25
Q

Bladder: definition

A

Hollow, muscular organ held in place by folds of peritoneum
Acts as a reservoir for urine

Becomes spherical as it accumulates urine
Collapses when empty

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26
Q

Trigone

A

Small, triangular area on posterior floor of bladder

Bordered by two ureteral openings and the urethral opening

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27
Q

Bladder: layers

A
  1. Inner mucosa layer
  2. Muscularis (or detrusor muscle)
  3. Adventitia
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28
Q

Urethra

A

Tube leading from the bladder to the exterior of the body

Between the internal urethral sphincter (involuntary) and the external urethral sphincter (voluntary)

Female urethra = 4cm
Male urethra = 20cm

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29
Q

Urethra: male

A

Around 20cm long

Divided into three sections:

  1. Prostatic
  2. Membranous
  3. Spongy

Passes through the prostate where it receives semen during ejaculation

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30
Q

Urine formation: processes

A
  1. Glomerular filtration
  2. Tubular reabsorption
  3. Tubular secretion
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31
Q

Golmerular filtration

A

Water and small molecules pass through pores in the golmerular capillaries into the Bowman’s capsule

Blood cells, plasma proteins and other large molecules cannot filter through because of the size of the pores (think of a sieve). They reside in the blood

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32
Q

Blood constituents that CAN pass into the glomerular filtrate

A 
Water
Mineral salts (electrolytes)
Amino acids
Glucose (but only if gone over the 9 mmol/L)
Ketoacids
Hormones
Creatinine
Urea
Uric acid
Toxins
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33
Q

Blood constituents that CAN’T pass into the glomerular filtrate

A

Erythrocytes
Leukocytes
Platelets
Plasma proteins

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34
Q

Renal capsule

A

Deep layer of outer region of kidney

Smooth, transparent sheet of connective tissue

Maintains kidney shape

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35
Q

Adipose capsule

A

Middle layer of outer region of kidney

Mass of fatty tissue

Provides protection and support

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36
Q

Renal fascia

A

Outer layer of outer region of kidney

Thin layer of connective tissue

Anchors kidneys to surrounding structures and keeps them in place

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37
Q

Renal cortex

A

Outer, light red area of the inner region of the kidney

Contains renal corpuscle (glomerulus and Bowman’s capsule) and proximal/distal convoluted tubules

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38
Q

Renal medulla

A

Darker area of the inner region of the kidney composed of several cone-shaped structures (renal pyramids) and Loop of Henle

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39
Q

What does the renal corpuscle consist of?

A

Consists of glomerulus and Bowman’s capsule

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40
Q

What does the renal tubule consist of?

A

Consists of:

a) proximal convoluted tubule (PCT)
b) Loop of Henle
c) distal convoluted tubule (DCT)

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41
Q

How does urine get from the kidneys to the bladder?

A

Peristaltic contractions of the ureters’ muscular walls propel urine towards bladder

Aided by gravity and pressure of urine

1-5 waves per min

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42
Q

Where do the ureters enter the bladder?

A

Through the posterior wall

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43
Q

What prevents the backflow of urine?

A

A physiological valve

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44
Q

Ureter: Inner mucous membrane

A

Transitional epithelium which is able to stretch

Also contains goblet cells which secrete mucous

Provides protection from urine

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45
Q

Ureter: Muscularis

A

Smooth muscle fibres

Produces peristaltic contractions

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46
Q

Ureter: Adventitia

A

Outer coat of connective tissue

Contains blood and lymph vessels, nerves

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47
Q

Bladder: Inner mucosa layer

A

Transitional epithelium supported by connective tissue

The mucosa folds to permit expansion of the bladder

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48
Q

Bladder: Muscularis (or detrusor muscle)

A

Middle layer of smooth muscle

At urethral opening, smooth muscle fibres accumulate and form the internal urethral sphincter (involuntary)

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49
Q

Bladder: Adventitia

A

Outer layer of connective tissue

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50
Q

How do the golmerular capillaries make filtration happen?

A
  1. The diameter of the efferent arteriole is less than that of the afferent arteriole
  2. Glomerular capillaries are c50x leakier than normal capillaries
  3. Glomerular capillaries have a large surface area
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51
Q

What is needed for golmerular filtration to happen?

A
  1. Blood pressure forces substances through the membrane
  2. Proteins present in blood plasma within the glomerular capillaries oppose filtration (colloid osmotic pressure)
  3. Back pressure of the fluid that’s already filtered opposes filtration (capsular hydrostatic pressure)
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52
Q

What is the glomerular filtration rate (GFR)?

A

The amount of filtrate formed in the renal corpuscles of both kidneys each minute

Normal GFR should be over 90ml/min

GFR males = 125ml/min
GFR females = 105ml/min

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53
Q

How is GFR calculated?

A

Through a blood test

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54
Q

What can the GFR test result determine?

A

The severity of kidney disease

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55
Q

What can affect the GFR?

A

Anything affecting the 3 filtration processes e.g. severe blood loss

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56
Q

What is colloid osmotic pressure?

A

A form of osmotic pressure exerted by plasma proteins e.g. albumin

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57
Q

What can affect colloid osmotic pressure?

A

Damage to the glomerular capillaries can lead to plasma protein loss into urine

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58
Q

What happens when albumin leaks from blood into the filtrate (urine)?

A

Blood volume decreases and interstitial fluid volume increases causing oedema (there are other causes of oedema)

59
Q

Albuminuria

A

Albumin in urine

60
Q

Where does most tubular reabsorption happen?

A

In the renal tubules and collecting ducts but mostly in the PCT

61
Q

What substances are reabsorbed during tubular reabsorption?

A

Water (65% in PCT)
Amino acids
Glucose
Electrolytes

62
Q

Which mode of transport is used when substances are reabsorbed during tubular reabsorption?

A

Active and passive

They pass into nearby blood vessels and return to general circulation

63
Q

What substances are secreted into the urine during tubular secretion?

A

Waste products - creatinine, ammonium ions, urea
Certain drugs e.g. penicillin
Excess ions e.g. H+ for pH regulation

64
Q

Which hormones are involved in kidney reabsorption?

A 
Angiotensin II
Aldosterone
Antidiuretic hormone
Atrial natriuretic peptide
Parathyroid hormone
65
Q

What is the Renin-Angiotensin-Aldosterone System (RAAS)?

A

A system of hormones that work together to increase blood pressure

66
Q

What triggers the RAAS?

A

A systolic BP below 100mmHg

67
Q

What happens when the RAAS is triggered?

A
  1. The enzyme renin is released by the kidneys into the blood
  2. Angiotensinogen (inactive) gets converted to angiotensin I in the liver
  3. Angiotensin I is converted to angiotensin II by the angiotensin-converting enzyme (ACE) in the lungs
  4. Angiotensin II causes release of aldosterone from the adrenal cortex
68
Q

Angiotensin II

A
  1. Triggers vasoconstriction which increases blood pressure
  2. Triggers the pituitary gland to release ADH
  3. Stimulates the adrenal cortex to produce aldosterone
69
Q

Aldosterone

A

Increases renal sodium and water reabsorption which increases BP

70
Q

Antidiuretic Hormone (ADH)

A

Increases the permeability of the DCT, increasing water reabsorption in the kidneys

71
Q

What stimulates the secretion of ADH?

A

Reduced water concentration in the blood, and lowered blood volume, causes increased blood osmotic pressure

Osmoreceptors in the hypothalamus stimulate the posterior pituitary gland to secrete ADH

72
Q

Atrial Natriuretic Peptide (ANP)

A

Inhibits the reabsorption of sodium and water in the renal tubules

Increases urine output and lowers BP

73
Q

What stimulates the secretion of ANP?

A

A large increase in blood volume promotes the release of ANP from the heart

It’s released from the myocardium in response to atrial stretch

74
Q

Which hormones does ANP suppress?

A

ADH

Aldosterone

75
Q

Parathyroid Hormone (PTH)

A

Released by the parathyroid gland in response to low blood calcium levels

Increases blood calcium levels by:

  1. Stimulating renal reabsorption of calcium and magnesium
  2. Increasing osteoclast activity
  3. Stimulating release of calcitriol (increases gut calcium absorption)
76
Q

Urine flow

A

Nephrons - papillary ducts of renal pyramids - minor/major calyces - renal pelvis - ureters - bladder

77
Q

Urine composition

A 
Water (96%)
Urea (2%), uric acid, creatinine
Ammonia
Sodium, Potassium, Phosphorus, Sulphur
Hormones
Oxalates (rhubarb, spinach, beetroot)
78
Q

What stimulates the micturition process

A

When the volume in the bladder exceeds 200-400ml, stretch receptors in the bladder wall transmit nerve impulses to the spinal cord (S2 and S3)

79
Q

Micturition process: infants

A

Increase in bladder volume generates a micturition reflex leading to contraction of the detrusor muscle and relaxation of the internal AND external urethral sphincters

80
Q

Micturition process: adults

A

Nervous system matures and consciously inhibits the reflex contraction of the bladder and relaxation of the internal urethral sphincter

Adults can control the external urethral sphincter and pelvis floor muscles

81
Q

When do we learn to initiate and stop micturition voluntarily?

A

In early childhood

82
Q

How much urine do we produce a day?

A

1-2 litres

83
Q

What colour should urine be?

A

Yellow/amber coloured

84
Q

What is the odour of urine?

A

Slightly aromatic

Sweeter in diabetics

85
Q

What is the pH of urine?

A

4.5-8 pH

Average 6

86
Q

Homeostasis: Skin

A

Kidneys convert vit D precursor made in the skin into its active form, calcitriol

87
Q

Homeostasis: Skeletal

A

The kidneys help adjust blood levels of calcium and phosphate

88
Q

Homeostasis: Muscular

A

Kidneys help to adjust blood calcium levels, required for muscle contraction

89
Q

Homeostasis: Nervous System

A

Kidneys can perform gluconeogenesis to provide glucose for neurons, especially during fasting or starvation

90
Q

Homeostasis: Endocrine

A

Kidneys produce calcitriol and EPO

91
Q

Homeostasis: Lymphatic

A

Adjustment of water reabsorption affects the volume of interstitial fluid and lymph
Urine flushes out microbes

92
Q

Homeostasis: Respiratory

A

Lungs and kidneys help adjust pH of body fluids

93
Q

Homeostasis: Digestive

A

Calcitriol increases absorption of dietary calcium

94
Q

Homeostasis: Reproductive

A

In males, the urethra is the passageway for urine and semen

95
Q

Homeostasis: Cardiovascular

A

Kidneys can alter blood volume and pressure by adjusting water reabsorption (renin)

96
Q

Signs/symptoms of urinary tract pathology

A
  1. Frequent, urgent and painful urination
  2. Red urine (blood or beetroot?)
  3. Pain in loin (lower back)
  4. High urine volume with great thirst
  5. Low or no urine volume
  6. Nausea and vomiting
  7. Oedema (loss of albumin)
  8. Exhaustion (anaemia, blood loss into urine)
97
Q

Signs/symptoms of renal disease

A
  1. Pallor (due to anaemia)
  2. Frothy urine (due to proteinuria)
  3. Oedema (due to plasma protein loss)
  4. Itchy skin (due to uraemia)
  5. Altered mental state (common with UTIs)
  6. Puffy face/bags under eyes
  7. Dehydration
  8. Flapping tremor
98
Q

Urinalysis: what can the dipstick test?

A 
Leukocytes
Ketones
Nitrites
Urobilinogen
pH
Erythrocytes
Protein
Glucose
Specific gravity
99
Q

Urinalysis: what can urine microscopy test?

A 
Volume
Colour
Odour
pH
Leukocytes
Erythrocytes
Casts (clumps formed in nephrons)
Bacteria
Specific gravity
Microalbuminuria
100
Q

What can leukocytes indicate in urinalysis?

A

UTI

101
Q

What can ketones indicate in urinalysis?

A

Ketoacidosis (complication of diabetes mellitus) or ketone diet

102
Q

What can nitrites indicate in urinalysis?

A

Bacteria

UTI

103
Q

What can urobilinogen indicate in urinalysis?

A

Liver pathology

104
Q

What can erythrocytes indicate in urinalysis?

A

UTI
Tumour
Kidney stones

105
Q

What can protein indicate in urinalysis?

A

Kidney disease

106
Q

What can glucose indicate in urinalysis?

A

Diabetes mellitus

107
Q

What can specific gravity indicate in urinalysis?

A

Dehydration
Glucosuria
Proteinuria

108
Q

What can casts indicate in urinalysis?

A

Nephron disease

109
Q

What can microalbuminuria indicate in urinalysis?

A

Kidney disease

110
Q

Urinary system blood test parameters

A 
Glomerular filtration rate (GFR)
Urea
Creatinine
Electrolytes
Inflammatory markers (ESR/CRP)
Leukocytes
111
Q

Urinary system medical examinations

A 
Ultrasound
Renal arteriography
X-rays
CT (ureteric obstruction)
MRI (malignancy)
Cystoscopy (bladder camera)
112
Q

Dysuria

A

Painful, burning urination

113
Q

Polyuria

A

Large quantity of urine

114
Q

Oliguria

A

Little urine (<400ml/day)

115
Q

Anuria

A

No urine

116
Q

Proteinuria

A

Protein in urine

117
Q

Bacteriuria

A

Bacteria in urine

118
Q

Nocturia

A

Night-time urination

119
Q

Haematuria

A

Blood in urine

120
Q

Which metabolic wastes are excreted by the urinary system?

A

Urea,
Uric acid
Creatinine

(All contain nitrogen)

121
Q

Which ion is excreted by the urinary system?

A

Hydrogen (H+)

122
Q

How are toxins excreted by the urinary system?

A

Medications and toxins are mostly detoxified in the liver and then excreted via the kidneys

123
Q

Which electrolytes are regulated by the kidneys?

A

Sodium
Potassium
Hydrogen

124
Q

What can electrolytes form to regulate changes in pH?

A

Buffer substances

125
Q

How much urine does a person need to pass a day to clear body waste

A

500ml/day

126
Q

What can alter the water balance feedback mechanism?

A

Pathologies e.g. untreated diabetes mellitus

127
Q

What are the two primary pH control systems?

A
  1. Lungs: excrete CO2

2. Kidneys: excrete H+ into urine and produce bicarbonate buffer

128
Q

How is vit D synthesised?

A

UV light activates a vit D precursor in the skin

The kidneys convert inactive vit D into its active form

129
Q

What functions does calcitriol play?

A

Increases bone formation by increasing blood calcium levels

130
Q

How is calcium uptake increased by calcitriol?

A
  1. Stimulates calcium and magnesium uptake from GIT

2. Reduces calcium loss in kidneys (along with PTH)

131
Q

What can a vit D deficiency cause?

A

Rickets

Osteomalacia

132
Q

How is EPO secreted and under what conditions?

A

Secreted by kidney interstitial cells into the blood

Released in response to hypoxia (negative feedback)

133
Q

What happens to EPO production in renal failure?

A

EPO production is inadequate and results in anaemia

134
Q

How is EPO measured?

A

On blood EPO test

135
Q

What is the renal threshold for glucose?

A

9 mmol/L

136
Q

What happens if blood levels go above the renal threshold?

A

Glucose can’t be reabsorbed from the nephrons into the blood when passing through the kidney tubules

137
Q

What is hyperglycaemia an indication of?

A

A pathology e.g. diabetes mellitus

138
Q

How do kidneys elevate blood sugar levels when a person is hypoglycaemic?

A

Kidneys make glucose from glutamine (an amino acid)

Process is called gluconeogenesis

139
Q

How is blood volume/pressure/concentration regulated by the kidneys?

A
  1. Conserving or eliminating water in urine
  2. Regulating loss of solute in the urine which helps to maintain a constant blood concentration/osmolality
  3. Regulating blood pressure by secreting the enzyme renin. This activates the Renin-Angiotensin-Aldosterone pathway (increased renin causes an increase in blood pressure)
140
Q

What percentage of the cardiac output (blood) does the kidney receive?

A

20-25% (1.2L blood per min)

141
Q

What role does the renal tubules play?

A

Involved in reabsorption and secretion of various solutes

142
Q

How much fluid is in the bladder when the desire to urinate occurs?

A

200ml

143
Q

What is the total capacity of the bladder?

A

600-700ml

Biomedicine (Semester II) (20 decks)

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