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A&P 2: Renal Flashcards

1
Q

What are the 8 functions of the kidneys?

A 
Ionic composition
Blood pH
Blood volume
BP
Blood osmolarity
Hormones
Blood glucose
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2
Q

What ions does the kidney help regulate?

A 
Na
K
Ca2
Cl
HPO42
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3
Q

Kidney’s regulate blood pH by excreting __ ions and saving __ ions

A

Excrete- H

Saves- HCO3

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4
Q

Kidney’s maintain a relatively constant osmolarity close to ____

A

300 mOsm/L

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5
Q

What are three hormones the kidney excretes and their function?

A

Renin- inc Bp
Calcitriol- inactive Vit D
Erythropoietin- stims RBC production

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6
Q

What can the kidney use, similar to the liver, to help maintain blood glucose levels?

A

AA glutamine for gluconeogenesis

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7
Q

What are the 4 wastes the kidney excretes and where do the waste products come from?

A

Ammonia/urea- deamination of aa
Bilirubin- Hgb catabolism
Creatinine- breakdown of creatinine in muscles
uric acid- nucleic acid catabolism

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8
Q

Where are kidneys located within the body?

A

Retroperitoneal space
Between T12-L3
Protected by 11 and 12 rib

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9
Q

What are the 3 external layers of the kidney and what are their functions?

A

Renal fascia- dense CT that anchors in place
Adipose capsule- protects and holds in place, surrounds capsule
Renal capsule- protective smooth transparent CT, continuous w/ ureters, maintains kidney shape

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10
Q

What does the term Cortex encompass?

A

Contains all glomeruli and convoluted tubules of nephrons

Makes columns between pyramids

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11
Q

What does the term Medulla encompass ?

A

Contains LoH and collecting ducts

Collection of ALL renal pyramids

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12
Q

Pyramids belong to what part of the kidney?

How many are in each kidney?

A

Portion of medulla

8-18/kidney

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13
Q

What does the term Papilla encompass?

A

Narrow apex of pyramid

Contains papillary duct leading to minor calyx

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14
Q

What does the term Columns encompass?

A

Space between renal pyramids

Portion of renal cortex

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15
Q

Function of Lobe?

What structures make up a “lobe”?

A

Functional region of the kidney

Pyramid medulla + cortex + 1/2 of adjacent column (cortex)

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16
Q

Function of Minor Calyx?

How many are in each kidney?

A

Small urine collection chambers from papilla

8-18/kidney

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17
Q

Function of Major Calyx?

How many per kidney?

A

Larger chamber for collecting urine from minor calyces

2-3/kidney

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18
Q

Major Calyx are extensions of what structure?

A

Ureters

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19
Q

Function of Renal Pelvis?

A

Collection point from major calyces
Mixes all urine from entire kidney
Connects to ureter outside of kidney

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20
Q

What is the Renal Sinus?

A

Spaces of adipose tissue w/ blood and nerves

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21
Q

What structure meet the kidney at the Renal Hilum?

A

Ureter emerges
Blood/lymph vessels
Nerves

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22
Q

Renal blood flow is ______mL/min

A

1200

600mL/kidney

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23
Q

What is the total amount of blood in adults?

A

4500-5500mL

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24
Q

What is the specialized capillary inside of the kidneys and what is it’s function?

A

Glomerulus, tufted

Allow filtration, no reabsorption

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25
What is the sequence of blood flow from Aorta->kidney-> heart?
``` Aorta Renal Artery Segmental Artery Interlobar artery Arcuate Artery Interlobular arter Afferent Arteriole Glomerulus Vasa Recta (jux nephrons only) Interlobular Vein Arcuate Vein Interlobar Vein Renal Vein Inferior Vena Cava ARS IAI AGE PVI AIR I ```
26
Interlobular arteries are AKA ? | Interlobular veins are AKA ?
Radial arteries | Radial veins
27
How does blood enter and exit the kidney to be filtered?
Enters corpuscle, filtered in glomerulus, exits corpuscle into capillary system
28
When blood is in the ______ capillaries, it still has the same properties as blood in any other body location
Pertibular capillaries/vasa recta
29
The pressures in the pertibular capillaries/vasa recta allows for what mechanism?
Secondary filter
30
Where is filtrate first found? | Where does it flow to after?
``` Glomerular capsule (Bowmans's capsule) Tubule->collecting ducts ```
31
Filtrate is not called urine until it leaves what structure?
Collecting ducts
32
What has a larger diameter, Afferent or Efferent arteriole?
Afferent- larger | Efferent- smaller, forms back pressure
33
What is the functional unit of the kidney?
Nephron
34
What are the two parts of a nephron?
Renal Corpuscle | Renal Tubule
35
What are the two parts of the Renal Corpuscle?
Glomerulus | Glomerular Capsule
36
What are the three parts of the Renal Tubule?
PCT- attached to capsule LoH- middle DCT- distant from capsule, empties into collecting ducts
37
Corpuscle and both convoluted tubules reside in the ______
Cortex
38
Only the ____ extends into the renal medulla
LoH
39
What are the two types of nephrons?
Cortical nephron | Juxtamedullary nephron
40
What type of nephron is the majority?
Cortical- 85%
41
What are the subcomponents of the Cortical Nephron?
Renal corpuscles lie in outer portion of renal cortex Short LoH, barely dips into medulla before returning to renal medulla Peritubular capillaries only
42
What are the subcomponents of Juxtamedullary nephrons?
Renal corpuscles that lie deep in cortex Long LoH Peritubular capillaries that give rise to Vasa Recta
43
Justamedullary nephrons make up __% of total nephrons?
15%
44
What is the Vasa Recta of the Jux. Nephrons?
Capillary bed that extends into medulla surrounding the LoH
45
How do Cortical peritubular capillaries return back to systemic circulation?
After proximal/convoluted tubules, flow into interlobular veins, then to systemic circ.
46
What part of the kidney causes dilute or concentrated urine?
Juxtamedullary nephron long LoH
47
How do Juxtamedullary peritubular capillaries return to systemic circulation?
Vasa Recta- goes deep into renal medulla along LoH | Allows flow out of capillaries into filtrate and out of filtrate into capillaries
48
What kidney structure is extremely important for keeping a constant osmotic pressure gradient?
Juxtamedullary Vasa Recta
49
What are the characteristics of the Afferent Arteriole?
Arteriole into corpuscle/glomerulus | Wider lumen, thicker walls w/ greater capability to constrict/dilate
50
What are podocytes?
Modified simple squamous epitherlial cells w/ projections (pedicels) that wrap around glomerular capillaries
51
What is the ball of twine-like capillary structure that buds off an afferent arteriole?
Glomerulus
52
What are the characteristics of the Efferent Arteriole?
Arteriole leaving corpuscle/glomerulus Brings blood w/ larger solutes into peritubular capillaries and back into systemic circulation Have a smaller lumen and thinner walls which aids in back-pressure needed for filtration
53
A single layer of epithelial cells forms the entire wall of what three things?
Glomerular Capsule Renal Tubule Ducts
54
What is the histology of the PCT?
Sinple cuboidal w/ microvili on the apical surface (facing the lumen)
55
What is the histology of the LoH?
Think descending and ascending made of simple squamous Thick ascending- simple cuboidal to columnar
56
Histology of the DCT?
Most- simple cuboidal | Last part- Principal cells: receptors for ADH and aldosterone; Intercalated cells- role in blood pH
57
What is the histology of the Collecting Duct?
Simple cuboidal w/ principal and intercalated cells
58
What two places are Principal and Intercalated cells located?
Last part of DCT | Collecting Duct
59
What are the 3 functions nephrons and collecting ducts perform?
Glomerular filtration Tubular reabsorption Tubular secretion
60
Define Glomerular Filtration
Water and solutes in blood moves across glomerulus wall into Bowmans capsule and into tubules
61
Define Tubular Reabsorption
Water and solutes in tubule system can be reabsorbed
62
How much of filtrate is reabsorbed and where does it happen?
99% in tubular reabsorption
63
Define Tubular Secretion?
Peritubular capillaries and vasa recta give final chance for wastes to be transferred into filtrate
64
Adults make ___ L of filtrate per day compared to a normal urine output of ___ L
150-180L/day of filtrate | 1-2L of urine
65
What form the leaky barrier in the capsule? | What is it's function?
Glomerular capillaries and podocytes Allows water/solutes to pass into capsular space Prevents- proteins, RBCs, platelets from getting into capsular space
66
What are the 3 layers of the filtration membrane?
Fenestrations of endothelial cells- prevents blood from passing Basement membrane/Basal lamina- prevents large proteins from passing Slit membranes between pedicels- prevents filtration of most other proteins
67
What are Mesangial Cells and what are their function?
Glomerular capillaries Regulate surface area for filtration Relaxed= max SA Contracted= reduced SA
68
Define GBHP
Glomerular blood hydrostatic pressure- pressure in glomerulus pushing outward into capsular space
69
Define CHP
Capsular hydrostatic pressure- pressure by fluid in capsular space pushing inward on visceral glomerular membrane, "back pressure" Opposing filtration pressure
70
Define BCOP
Blood colloid osmotic pressure- pressure due to proteins (albumin) in blood plasma Pulls on fluid to keep them in glomerulus Opposes filtration
71
Define NFP and the equation
``` Net Filtration Pressure NFP= GBHP-CHP-BCOP NFP pressure is supposed to promote filtration + = filtration - = no filtration ```
72
Normal NFP is the pressure that causes a normal amount of ____ to filter from ____->______
blood plasma glomerulus capsular space
73
What is the average GFR for an adult? What happens if it's too fast? Too slow?
125mL/min amount of blood filtered by kidney's glomeruli into capsular space per time Fast= filtrate passes too quickly, substances not reabsorbed Slow= all filtrate reabsorbed and wastes no excreted efficiently
74
How is GFR calculated?
Estimation | Serum creatinine levels plus age, race, weight, gender
75
How is a creatinine clearance test conducted? | What if it's low?
With 24 hour urine collection sample | Low urine level= kidney's not filtering creatinine correctly, kidney damage
76
What patient population has a higher serum creatinine level?
Afro-Caribbean due to increased muscle mass and higher rates of muscle breakdown 21% higher than normal level for non-black PTs
77
GFR is directly related to what?
Pressures that determine net filtration pressure
78
If GBHP drops by even 10mmHg, what happens to filtration?
Filtration in glomerulus stops
79
What are mechanisms that regulate GFR?
Renal auto regulation- innate w/in kidney Neural regulation- SNS input/lack of Hormonal- Angiotensin II, ANP
80
Kidneys help regulate their own GFR through what two mechanisms?
Myogenic mechanism- increased BP causes afferent stretching, smooth muscle contraction of afferent arteriole, reduced renal blood flow, reduced GFR (inc BP=myogenic constriction=compensating vasodilation) Tubuloglomerular feedback- Juxtaglomerular apparatus. GFR inc=rate through tubules increased Reduced Na, Cl and water Macula densa sense increased levels of ions in filtrate, inhibits release of NO, afferent arterioles constrict, lowers GFR, lowers GFR rate through tubules
81
What kidney regulation process helps preserve nephron integrity from a sudden/abrupt increase of BP?
Myogenic mechanism
82
Define Juxtaglomerular Apparatus | What does it contain?
Ability to affect systemic BP through auto regulation of tubuloglomerular feedback Contains: one JGA per nephron in walls of afferent arteriole Macula densa cells- walls of DCT Lacis cells, located between a/efferent arterioles and DCT
83
Define Lacis cells
Modified mesangial cells
84
What are the two functions of the JGA?
Detect low BP (lack of stretch in afferent wall) | Synthesize, store and secrete renin
85
Where are macula densa cells located?
DCT
86
What are the two functions of macula densa?
Detect increase in NaCl in FILTRATE | Release ATP, adenosine that contract afferent arteriole, reduces GFR
87
What are the 3 components of the Justaglomerular apparatus? | These components together make up what concept?
Macula Densa Juxtaglomerular cells Lacis cells Tubuloglomerular feedback
88
What does tubuloglomerular feedback regulate?
BP within kidneys and eventually, systemic BP
89
Kidney blood vessels are only supplied by what NS?
Sympathetic At rest- low Exercise/fight: Constriction of afferent, decreased flow to glomerulus, decreased GFR
90
What two processes protect the nephrons from sudden BP increases?
Myogenic mechanism | GFR neural regulation
91
What are the two hormones that control regulation of GFR?
Angiotensin II- reduces GFR | ANP- increases GFR
92
How does Angiotensin II create its effect on GFR?
Potent vasoconstrictor Acts on efferent arteriole Reduces renal flow
93
How does ANP create its effect on GFR?
Secreted by atria in response to increased volume | Vasodilates afferent and efferent, increases GFR
94
When does passive movement occur?
Pressure gradients allow flow from high->low w/out ATP (glomerular filtration)
95
When does active movement occur?
Moving solutes against a gradient w/ help of ATP expenditure (Na/K pump)
96
What three structures can reabsorb filtrate? | Where does the majority occur?
Renal Tubule Renal Ducts PCT- reabsorbs the most
97
What are solutes that are actively and passively reabsorbed?
``` Glucose AA Urea Na K Ca Cl Ma Bicarb Phosphates ```
98
What distal structures "fine tune" the reabsorption process?
LoH DCT Collecting duct
99
If small protein and peptides are passed through the glomerular filter, how are they usually reabsorbed?
Pinocytosis
100
Tubular reabsorption occurs through what two processes?
Paracellular- PASSIVE movement between adjacent tubule cells, 50% of reabsorption Transcellular- PASSIVE and ACTIVE movement through the tubule cell itself
101
Define Apical Membrane
Lumen side of the cell
102
Define Basolateral Membrane?
Interstitial side of the cell
103
Define Obligatory Water Reabsorption and where does it occur?
90% of water reabsorption by kidneys occurs through the reabsorption of Na, Cl and glucose Occurs in PCT and descending LoH
104
What drives obligatory water reabsorption?
Solute reabsorption via osmosis
105
What areas of the kidney are ALWAYS permeable to water?
PCT | Descending LoH
106
Obligatory water reabsorption accounts for 90% of reabsorbed fluid, what happens to the other 10%?
Facultative water reabsorption
107
What regulates Facultative Water Reabsorption and where does it occur?
Regulated by ADH | Occurs in late DCT and Collecting Ducts
108
Tubular secretion gives the final chance to secrete what substances?
``` H K Ammonium Creatinine Drugs like penicilin ```
109
If antibiotics/drugs were to be secreted into filtrate, where would the transfer occur?
Tubular secretion, from capillaries (peritubular/vasa recta), interstitial and tubule cells to filtrate
110
What happens to most of the ammonia made in the body?
Converted to urea in liver
111
What is urea's beneficial component to the body?
Significant in creating/maintaining osmotic gradient in renal medulla
112
Where is the majority of bicarbonate reabsorbed?
PCT
113
Since Bicarbonate can't be reabsorbed in tit's complete form, what steps have to happen first?
H + HCO3= H2CO3 Carbonic Acid H2CO3 disassociates into CO2 and water CO2 diffuses into tubule cells and joins with H2O forming H2CO3 in tubule cells where it dissociates into H and HcO3
114
For every H+ secreted into tubular lumen, how many bicarb and Na are reabsorbed?
One and One
115
The largest amount of solute and water reabsorption from filtered fluid occurs where? What are the solute %s that are reabsorbed?
PCT 100% of glucose, aa and vitamins 80-90% of Bicarb 65% Na, K and water 50% Cl and urea
116
How is Na moved out of tubules and into interstitial fluids?
Actively with Glucose and AA co-transported w/ Na
117
How does urea and Cl ions move from filtrate into interstitial fluid?
Passively
118
What happens when Na and Cl move into interstitium?
Osmotic imbalance, causing water to be obligated to move out of filtrate into interstitium by osmosis which often brings K and Ca
119
Why are cells in PCT and descending LoH especially permeable to water?
Aquaporin 1 channels- protein water channels that increase rates of water movement
120
Define Solvent Drag
Osmosis of water bringing K and Ca with it in the PCT
121
What effects does PTH have on the kidneys and reabsorption?
Stimulates PCT to secrete phosphate Stimulates calcitriol (Vit D) to be made in PCT and absorbed in blood Stimulates cells in DCT to absorb more calcium
122
How does calcitriol exert it's effect on Ca absorption?
Calcitriol circulates in intestines to cause more Ca from digestive system to be absorbed
123
Where is solute and water reabsorption independently regulated?
Entire LoH | NOT in PCT
124
Where is filtrate diluted or concentrated?
Descending- mostly water reabsorption and solute secretion, concentrates Ascending- no water absorption, solute absorption, dilutes
125
What happens in the thin portion of the Ascending LoH?
Passively permeable to small solutes, impermeable to water | Solutes move out of tubule, water remains causing first dilution of filtrate
126
After the end of the first dilution process in the Ascending LoH, is the filtrate hyper or hypoosmotic?
Hypo
127
What happens in the thick portion of the Ascending LoH?
Active reabsorption of K, Na, Cl but region is IMPERMEABLE to water Filtrate moves up ascending limb and dilutes even more
128
What events occur in the late portion of the DCT?
90-95% of filtered solutes/water have been reabsorbed and returned to circulation
129
Amount of reabsorption of solutes/water in the DCT is dependent on what?
Body feedback Hormonal Osmoreceptor
130
How are the DCT and PCT similar in regards to Na reabsorption? How is the DCT different?
Completed by active transport Cells impermeable so water doesn't follow Na by osmosis ADH can cause principal cells in DCT and collecting ducts to become permeable
131
How does ADH trigger Principal cells and Collecting Ducts to reabsorb water?
ADH causes cells to generate Aquaporin 2 channels in apical membrane of cells lining the tubule
132
With ADH present, what is the concentration of urine? | Where does the presence of ADH cause an osmotic imbalance?
ADH present, small quantity of highly concentrated urine | DCDuct
133
What cascade occurs when ADH is present and causes an osmotic imbalance?
Forces urea reabsorption | Urea assists with increasing high osmolarity in interstitial fluid
134
Where does Urea Recycling occur?
Reabsorbed in Distal Collecting Duct | Secreted in descending LoH
135
If ADH is at max secretion levels, how much urine output will there be?
400-500mL very concentrated urine
136
When blood pressure/volume stabilizes, what occurs with ADH?
Decline, removing Aquaporin-2 molecules from Principal cells
137
What happens to Principal Cells when aldosterone is present?
Na reabsorption | K secretion
138
What causes aldosterone to be released?
Hyperkalemia | Angiotensin II- low BP
139
Principal cells are responsible for secretion of __ and reabsorption of __?
K | Na
140
What stimulates the two different Intercalated cells?
Osmoreceptor readings in reference to pH and K levels
141
What are the two types of intercalated discs and what are their functions?
Type A: Secrete H Reabsorb Bicarb and K Type B: Reabsorb of H Secrete Bicarb Secrete K
142
Where does ANP have its effect? | How does it carry out this effect?
DCT Collecting Ducts Inhibits reabsorption of Na and water (inc urine output) Inhibits RAAS
143
RAAS is activated when low BP/volume is sense where?
Afferent arteriole
144
What is the cascade of events when the RAAS is activated?
Low pressure sensed at afferent arteriole Juxtaglomerular cells release renin Hepatocytes release angiotensiogen Renin cleaved 10 aa peptides off of angiotensinogen making Angiotensin-1 which goes to lungs Converted to Angiotensin-2 by ACE and is now ACTIVE
145
Angiotensin II affects renal physiology in what 3 ways?
Decreases GFR by constricting afferent arteriole Enhances Cl, Na and water reabsorption in PCT by Principal cells Stimulates release of aldosterone from adrenal cortex
146
Regulation of plasma osmolarity and volume are the responsibility of what areas in the kidneys?
LoH: Descending= permeable, concentration of urine, concentrating filtrate Ascending= diluting urine, impermeable DCT and Collecting ducts= final dilution/concentration
147
Absence of ADH= _____ urine | Presence of ADH= _____ urine
``` Absent= diluted Present= concentrated ```
148
What is normal color for urine?
Yellow or amber
149
What is urine turbidity?
Transparent when voided, become cloudy with time
150
What is urine's odor?
Mildly aromatic, become ammonia like with time (bacteria turning urea->ammonia)
151
What is normal urine pH range?
4.6-8.0 w/ 6.0 being average
152
What are some dietary factors that can alter urine pH?
High protein increases acidity | Vegetarian increases alkalinity
153
What is normal urines specific gravity?
1.001-1.035 lower=hydrated higher the solute, higher the SpecG. value
154
Water accounts for _% of urine Solutes account for _% What are the solutes?
95% 5% Urea, creatinine, uric acid, urobionogen Fatty acids, pigments, enzymes, hormones
155
Where does uric acid and urobilinogen come from to get into urine?
Uric acid- break down of nucelic acids | Urobilinogen- breakdown of Hgb
156
What are the two blood tests for testing urine function?
Blood Urea Nitrogen- BUN increases when GFR severely reduces | Plasma creatinine- no use for creatinine in f body
157
What are normal levels for BUN and plasma creatinine?
BUN= 7-20mg/dL | 1.6mg/dL
158
Define Renal Plasma Clearance
Volume of plasma in mL that can be completely cleared of a substance per time unit
159
What is a great measure of true GFR? | What is a good estimate for GFR?
Insulin- plant polysaccharide | Creatinine clearance
160
What is the sequence of urine flow from kidney to elimination?
``` Collecting ducts Papilla Papillary ducts Minor calyces Major calyces Renal pelvis Ureter Bladder Urethra ```
161
Where do ureters meet with kidneys?
Pass obliquely into posterior/inferior aspect of bladder
162
Define anti-reflux mechanism
When bladder is full, it pulls down which closes valves to ureters
163
What are the 3 layers of ureters?
Adventitia- anchors ureters to tissues and contains blood/lymph vessels and nerves Muscularis- provides paristalsis Mucosa- transition epithelium w/ goblet cells to protect mucosa from acidity
164
What is the bladders shape when empty and full?
Collapsed | Pear shaped
165
What is the bladders anatomical location?
``` Posterior pubic symphisis Anterior rectum (males) Anterior vagina Inferior uterus Held by peritoneal folds ```
166
What are the 3 layers of the bladder?
1: Serosa- visceral peritoneum 2: Adventitia- covers post/inferior surface and continuous w/ ureter Muscularis- detrusor muscle 3: Mucosa- uroepitheroium, rugae, transitional epitherlium,
167
What are the 3 layers of the detrusor muscle?
Inner longitudinal Middle circular Outer longitudinal
168
What happens when detrusor muscle is relaxed and contracted?
``` Relaxed= bladder filling Contracted= forced emptying ```
169
What part of the renal system is a huge sight for development of cancer cells?
Transitional epithelium of bladder
170
Define trigone
Smooth triangular bladder floor w/ ureteral openings in posterior corners and urethral opening in the anterior corner
171
Define the Internal Urethral Sphincter
Inferior aspect of the bladder Extension of detrusor muscle w/ involuntary control by parasymp. NS Located just above prostate in males
172
Define External Urethral Sphincter
Skeletal muscles of deep perineal muscles and pelvic floor Below prostate in males Opening of external urethra in females
173
What are the 3 parts of the male urethra?
Prostatic Membranous Spongy
174
What are the characteristics of the Prostatic urethra?
Smooth muscle forming internal urethral sphincter | Contains openings for prostatic fluids and sperm
175
What are the characteristics of the Membranous Urethra?
Shortest region Passes through urogenital diaphragm Skeletal muscle forms external urethral sphincter
176
What are the characteristics of the Spongy Urethra?
Longest region | Contains bulbourethral openings- Cowpers glands, delivers alkaline fluid to neutralize urethra acidity
177
What does the mucosa of the female urethra consist of?
Epithelium and lamina propria Transitional epithelium near bladder Middler section is pseudo/stratified columnar External urethra is non-keratinized stratified squamous
178
What initiates the mechanism for urination? | What is the sequence of events?
Parasympathetic Involuntary contraction on detrusor muscle Internal urethral sphincter opens, urine moves from bladder to urethra Sensation to urinate is sent/received Voluntary contraction of external urethra sphincter prevents urination until appropriate time Voluntary relaxation of external sphincter allows for urination
179
Why do humans wear diapers as babies and geriatrics?
Learned control to contract/relax external urethra sphincter and pelvic muscles to over ride weak spinal muscles which are normally contracted No conscious thought as infant Weak muscles as a geriatric
180
What effects does nephron deterioration cause with age?
Kidney shrinkage | Decreased renal flow/GFR
181
Why does increased incidence of calculi occur with age?
Decreased thirst sensation
182
What influences can cause polyuria and nocturia?
BPH Prostate cancer Hematuria Dysuria

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