7.3 Urinary Flashcards

1
Q

what releases ADH? what does it cause

A

released by posterior pituitary gland in repsonse to high blood osmolarity

  • causes principal cells of collecting duct to insert inducible aquaporins in apical membranes, increasing water reabsorption
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2
Q

what does aldosterone do?

A

Main function: increase blood pressure/volune and decrease K+ levels

  • targets DCT and colelcting ducts to promote synthesis of apical Na+ and K+ channels and basolateral Na+, K+ ATPases for Na+ reabsorption

*net results Na reabs and K secretion

  • without alsosterone, daily loss of filtered Na would be 2%, incompatible with life

Main functions: increases blood pressure/volume and dec K+ levels

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3
Q

what is atrial natriuretic peptide?

what releases it and what does it do

A
  • released by cardia atrial cells in response to elevated bp/volume
  • reduces blood Na+ (decreased aldosterone)
  • causes vasodilation
  • decreases water intake

*net: decrease blood volume/pressure

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4
Q

what does parathyroid hormone do

A

acts on DCT to increase Ca2+ reabsorption

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5
Q

where does tubular secretion occur? what substances are invovled

A

*last of 3 major renal processes

  • occurs almsot completely in PCT
  • selected substances moved from peritubular capillaries, throuhg tubule out into filtrate

*K+. H+, NH4, creatine, organic acids and basis

* Substances synthesized in tubule cells are secreted (e.g. HCO3–)

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6
Q

what is tubular secretion important for

A

– Disposing of substances, such as drugs or metabolites

– Eliminating undesirable substances that were passively reabsorbed (example: urea and uric acid)

– Ridding body of excess K+ (aldosterone effect)

– Controlling blood pH by altering amounts of H+ or HCO3– in urine

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7
Q
A
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8
Q

what is osmolarity?

how many osmol in NaCl and MgCL2

A

Osmolality = number of solute particles in 1 L of H2O

  • 1 mole NaCl = 2 osmol (Na+ and Cl-)
  • 1 mole MgCl2 = 3 osmol (Mg2+ and two Cl-)

* body fluid osmotic conc maintained aroind 300mOsm

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9
Q

what are the two types of countercurrent mechanisms

A
  • countercurrent multiplier
    • creates a gradient through interaction of filtrate flow in ascending/descenign limb of nephron loops of Juxtamedullary nephrons
  • Countercurrent exchanger
    • preserves gradient using blood flow in ascening/descending limbs of asa recta

*work together to establish and maintian medullary osmotic gradietn from renal cort through medulla

  • gradient runs from 300 mOsm in crotex to 1200 mOsn at bottom of meducal

*Collecting ducts can then use gradient to vary urine concentration

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10
Q

what are the 3 key players that interact with the medullary osmotic gradient

A
  1. long nephron lops of juxtamedullar nephrons -> create gradient & act as countercurrent multipliers
  2. Vasa recta preserve the gradient. They act as countercurrent exchanges
  3. the collecting ducts of all nephrons use the gradient to adjust urine osmolarirty

*Juxtamedullary nephrons create as osmotic gradient w/ renal medulla. Allows kidney to produce urine of varying conc

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11
Q

how does countercurrent multiplier work in ascending vs descending limb

  • whats the main idea of it
A
  • limbs of nephron loop are not in deict contact but are close enough to influence exchanges with surrounding interstitial fluid
  • ascening limb of loop is impermeable to H2O and selectively permeable to solutes

*Na and Cl actively reabs in thick segment, some passive reabs in thin seg

  • Descening limb freely perable to H2O but impermeable to solutes

*H2) passes out filtrate causes remaining filtrate osmolarity to increase to 1200mOsm

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12
Q

describe the mechanism of countercurrent multiplier

A
  • the more NaCl the ascening limb actively transports out into interstitial fluid the more water diffuses out descenidng limb
  • more water that diffuses out descing that saltier the filtrate becomes
  • ascening limb uses the salty filtrate to further raise osmolarity of medulary interstital fluid

*constant diff of 200 mOsm exists btwn two limbs of nephron loop and between ascening limb and interstitial fluid

*difference is “multiplied” along length of loop

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13
Q

why is it called counter current multiplier

A

“Multiplier” refers to the ability of this countercurrent system to increase this small gradient into a much larger one

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14
Q

what is the countercurrent exchanger

A
  • preserved medullary gradient by
  • > prevenign rapid removal of salt from interstital space
  • > removing reabsorbed water
  • water in ascending vasa recta comes from descening vasa recta or is reabs from nephron loop and colelcting duct
    result: volume of blood at en fo vasa recta > than at beginning
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15
Q

formation of urine durign dehydration or overhydration

A

* edullary osmoti gradient used to form dilute or conc urine

  • Dehydration
    • produces small volume of conc urine
    • at maximal ADG ~1200 mOsm
    • severe dehydration: 99% of water is reabs
  • Overhydration:
    • products large vol of dilute urine
      • ADH decreases: urine ~100 mOsm
      • Alsosterone: can cause more ions to be removed causing urien to reach ~50 mOsm
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16
Q

how does urea help form the medulalry Osmotic Gradient

A
  1. Urea enters fitrate in descending limb and ascending thin limb of nephron loop by facilitated diffusion
  2. cortical colelcting duct reabs water, leading uea behind
  3. in deep medulalry region, now have highly conc yrea
    • leaves colelcting duct and enters interstitial fluid of medulla
    • urea moves back into ascening thin limb
    • contributes to high osmolality in medulla (called urea recycling)
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17
Q

what is diruesis

what diff substances are diuretics

A

homeostatic process in which urine production is increased

*many common sub are diruetics, but can have diff MOA

  • Alcohol: inhibst ADH
  • Na+ reabs inhibtors (reduced H2O reabs) like caffeine or drugs for hypertension or edema
  • loop diruetics interfere w/ formation of medullary osmotic gradietn
  • osmotic diuretics not reabs, so water remains in urine
18
Q

what is renal clearance

A

volume of plasma kidneys can clear of a particular substance in a given time

  • to determine renal clearance: both blood and urine are required

*can help detect glomerular damage and follow progress of renal disease

C = V* (U/P)

– C = renal clearance rate (ml/min)

– U = concentration (mg/ml) of substance in urine

– V = flow rate of urine formation (ml/min)

– P = concentration (mg/ml) of same substance in plasma

19
Q

what does it mean if

C= 125mL/min

C < 125mL/min

C= 0

C > 125mL/min

A

C= 125mL/minL no net reabs or secteion (ex: inulin a plant by prpduct)

C < 125mL/min, substance reabsorbed

C= 0, substance completely reabsorebd or not filtered

C > 125mL/min, substance was secreted (most drug metabolines)

20
Q

what can you use renal clearance tests to determine

A

GFR

21
Q

what is chornic renal disease

A

defined as a GFR < 60 ml/min for 3 months

  • filtrate formation decreases, nitrogenous wastes accumulate in blood, pH becomes acidic
  • seen in daibetes mellitus and hypertension
22
Q

what is renal failure

A

– Causes uremia: ionic and hormonal imbalances, metabolic abnormalities, toxic molecule accumulation

– Symptoms: fatigue, anorexia, nausea, mental changes, cramps

– Treatment: hemodialysis or transplant

23
Q

what is the chemical composition of urine?

what nitrogenous wastes are present?

what other solutes present?

A

chemical comp: 95% water, 5% solutes

nitrogenous wastes: urea (largest solute comp), ruic acid, creatine

also Na+, K+, PO43–, and SO42–, Ca2+, Mg2+ and HCO3–

* Abnormally high concentrations of any constituent, or abnormal components such as blood proteins, WBCs, and bile pigments, may indicate pathology

24
Q

describe olour/transparecy of urine

and odor

A
  • colour/transparence
    • clear, cloudy can indicate UTI
    • pale to keep yellow from urochrome (pigment from hemoglobin breakdown)
    • absnoraml colour (pink, brown, smoky)
      • can be caused by food, bile pigments, blood or drugs
  • Odor
    • slghilty aromatic when fresh
    • ammonia odor upon standing bc bacteria metabolize urea
    • may be altered by some drugs/veg
    • disease may alter small
25
Q

describe pH ans specific gravity of urine

A
  • pH
    • urine is slightly acidic (pH ~6, ranges from 4.5-8)
    • acidic diet (protein, whole wheat) can cause drop in pH
    • Alkaline diet (vegetarian), rpologned vomiting, or UT can use inc pH
  • Specific gravity
    • raito of mass of substance to mass of equal vol of water
    • ranges from 1.001 (more filute) to 1.035 (mroe salty)
26
Q

pathway or urine

A
  • kidneys form urine continuously, transported by ureters to bladder for storage
  • *ureters = slender retroperitoneal tubes taht convery urine from kidney to blasser (begin at L2 as continuation of revel pelvis)
  • ureters enter base of bladder through posterior wall
  • as blodder pressure inc, distal ends or ureters close -> prevents backflow or urine
  • release of urien from blassers thoruhg urethra = microturition
27
Q

what are teh 3 layers or the ureter wall

A
  1. Mucosa: transitional epithelium
  2. Muscularis: smooth muscle sheets contract in repsonse to stretch and propels urine itno bladder (gravity alone is not enough -> must be pushed by peristalitc wave action of smooth muscle)
  3. Adventitia (outer fibrous connective tissue
28
Q

what is renal caliculi

A
  • kisney stones in renal pelvis (crystalized calcium, magnesium or uric acid salts)
  • large stones block ureter, causes pressure and pain
  • may be due to: chornic bacterial ifnection, ruine retention, inc Ca in blood, inc pH or urine

shock wave lithotripsy: non invsive producure invovling shcok waves to shallter caliculi

29
Q

strucutre of urinary bladder

males vs femlaes

A
  • retroperitonal on pelvic floor
  • rugae disappear as bladder stretches

Males: prostate inferior to bladder neck

females: anterior to vagina and uterus

30
Q

what is the trigone

A
  • 3 openings in lader forming a ttriangular area (two for ureters, one fro urethra)

*Clinically important because infections tend to persist here

31
Q

what are the layers of the bladder wall

A
  • Mucosa: transitional epithelial mucosa
  • Muscular layer: thick Detrusor muscle (3 layers of smooth muscle, inner and outer longitudinal layres w/ circular middle layer)
  • fibrous adventitia: all but superior surface here it is covered by peritonium
32
Q

storange capcity of bladder

A
  • collapses wen empty and rugae appear
  • exands and rises superiorly during filling without significant rise in internal pressure
  • moderately ull bladder is ~12cm long and can hold 500 mL

*can hold twice that amount if necessary but can burst if overdistended

33
Q

hat is the urethra? waht type of tissues does it have

A
  • Muscular tube that drains urinary bladder
  • mostly pseudostratified columnar epithelium except:
  • > transition epithelium near bladder
  • > stratified squamous epithelium: near external urethral orifice
34
Q

descirbe the sphincters of the urethra

A
  • internal urethral sphincter: involuntary (smooth) muscle at bladder-rethra jucntion (contracts to oepn)
  • external urethral sphincter: Voluntary (skeletal) muscle surroudnign urethra as it passes trhu pelvic floor
35
Q

compoennet sof male urethra

A
  • carries semen and urien
  • prostatis urethra (2.5cm) : in prostate
  • intermediate part of urethra (2c): passes thru urogenital diaphragm from prostate to beginnign of penis
  • spongy urethra (15cm): passes thru penis; opena via external orifice
36
Q

what is micturition

A

*urination or voiding: ahs 3 simultaneous events

  1. contraction of dextrusor by ANS (squeezes bladder)
  2. Opening of external urethral sphincter (contraction) by AND
  3. opening of external urethral sphincter (relaxation) by somatic NS
37
Q

what is reflexive urination

A

*urination in infants

  • distension of bladder catives stretch receptors
  • causes excitation of parasympathetic neurons in reflex center in sacral region of spinal cord
  • leasd to contraction of dextursor and opening (contraction) of internal sphincter)

- inhibition of somatic pathways to external sphincter allow its relaxation and opening

38
Q

how coes pontine micturition contorl centers inhiibt and promtoe micturition

A
  • Inhibits micturtion
    • inhibits parasympathetic pathways
    • excited sympathetic and somatic efferent pathways
  • Promotes micrurition
    • excites parasympathetic
    • inhibitc sympathetic and somatic efferent pathways
39
Q
A
40
Q

describe urinary incontinence

A
  • in adults its usually caused by weakended pelvic muscles
  • Stress incontinence
    • increased intraabdominal pressure forces urine through external sphincter
    • laughing, coughing, or sneezing can cause incontinence
  • Overflow incontinence
    • urine dribbed when bladder overfilles