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Sem 4, case 7 (diabetic nephropathy) > an intro to the kidney (mini learning) > Flashcards

an intro to the kidney (mini learning) Flashcards

1
Q

Where in the kidney does blood filtration occur ?

A

Renal cortex

the boarder around the renal pyramids

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2
Q

In which layer of the kidney are renal pyramids found ?

A

medullary layer

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3
Q

Roughly how many renal pyramids does each kidney have ?

A

8-10 is average

could be 7-18

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4
Q

Where does the urine drain into from the renal pyramids ?

A

minor calyx

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5
Q

Where does urine drain into after the minor calyx ?

A

major calyx

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6
Q

Where does the urine accumulate after leaving the major calyx ?

A

renal pelvis

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7
Q

Where does the urine go after the renal pelvis ?

A

leaves the kidney, via the ureter, to be stored in the bladder

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8
Q

What are the main functions of the kidney ?

A
  • maintain ECFV (extracellular fluid volume)
  • maintaining acid-base balance
  • excretion of metabolic waste (urea, creatinine)
  • endocrine secretion
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9
Q

How does the kidney maintain ECFV ?

A

regulates Na in the blood, causing osmotic action to follow

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10
Q

Which endocrine systems does the kidney regulate ?

A
  • renin-angiotensin system
  • erythropoietin production
  • vitamin D activation
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11
Q

What effect does the number of nephrons in a persons kidney have on blood pressure ?

A

fewer nephrons = higher hypertension risk

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12
Q

Where does selective reabsorption of glomerular filtrate occur in the kidneys ?

A
  • Proximal convoluted tubule
  • Distal convoluted tubule
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13
Q

Where does ultrafiltration of glomerular filtrate occur in the kidneys ?

A

bowman’s capsule

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14
Q

Which arteriole of the glomerulus has a wider diameter ?

A

afferent in-coming arteriole

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15
Q

Which molecules are forced out of the glomerulus into the bowman’s capsule ?

A

small molecules

  • water
  • glucose
  • urea
  • ions
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16
Q

Which molecules do not leave the glomerulus in ultrafiltration ?

A
  • proteins
  • blood cells
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17
Q

What type of cells form the inner epithelial layer of the bowman’s capsule

A

podocytes

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18
Q

Where is 85% of glomerular filtrate reabsorbed ?

A

proximal convoluted tubule

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19
Q

What % of the glomerular filtrate is reabsorbed in the proximal convoluted tubule ?

A

85%

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20
Q

Does the PCT epithelium have microvilli or not ?

A

yes, there are microvilli

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21
Q

Name all the arterial divisions within the kidney from the renal artery to the afferent arteriole…

A
  • renal artery
  • segmental arteries
  • interlobar arteries
  • arcuate arteries
  • interlobular arteries
  • afferent arterioles
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22
Q

Which arteries travel between the medullary pyramids ?

A

interlobar arteries

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23
Q

Which arteries travel along the top of the medullary pyramids ?

A

arcuate arteries

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24
Q

Which arteries project into the renal cortex, alongside the nephrons ?

A

interlobular arteries

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25
Q

Which arteries give off the afferent arterioles ?

A

interlobular arteries

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26
Q

What is the capillary network called that surrounds the nephron ?

A

vasa recta

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27
Q

Does the vasa recta drain into the renal artery or vein system ?

A

vein system to return the reabsorbed nutrients back into general circulation

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28
Q

Roughly, how much blood per minute is supplied to the kidneys?

A

1 litre/min

about 20% of cardiac output

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29
Q

Compared to other organs in the body, how many times larger is renal blood supply ?

A

the kidneys receive 10-50 times more blood than other organs

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30
Q

What is the name of the smallest protein found in blood ?

A

albumin

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31
Q

In a healthy patient, is albumin filtered out the blood into the bowman’s capsule via ultrafiltration ?

A

Some is filtered out into the bowman’s capsule, as it is the smallest protein, but not large quantities

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32
Q

What type of cells make up the outer epithelium of the bowman’s capsule ?

A

parietal cells

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33
Q

Where does blood from the efferent arteriole go ?

A

into vasa recta to rejoin circulation

34
Q

What does ‘oncotic pressure’ mean ?

A

the osmotic pressure of plasma due to the presence of proteins, specifically albumin, that causes the pull of fluid back into capillaries

35
Q

Does oncotic pressure favour or oppose ultrafiltration in the golmerulus ?

A

opposes filtration

molecules leave the blood, increasing oncotic pressure due to the more concentrated protein cone creation, which acts to pull fluid back into the glomerulus

36
Q

Does glomerular capillary hydrostatic pressure favour or oppose ultrafiltration?

A

favours filtration

pressure in the glomerulus pushing out into the bowman’s capsule

37
Q

Does bowman’s capsule hydrostatic pressure favour or oppose ultrafiltration?

A

opposes filtration

pressure in the capsule pushing back against the filtrate leaving the glomerulus

38
Q

What are the 3 types of pressure used in the GFR (glomerular filtration rate) equation ?

A
  1. glomerular capillary hydrostatic pressure
  2. bowman’s capsule hydrostatic pressure
  3. glomerular capillary oncotic pressure
39
Q

What is the average glomerular hydrostatic pressure ?

40
Q

What is the average bowman’s hydrostatic pressure ?

41
Q

What is the average glomerular oncotic pressure ?

42
Q

Roughly how many litres of plasma gets filtered by the kidneys each day ?

43
Q

What is the process called that maintains a steady GFR and RBF regardless of blood pressure fluctuations?

A

auto regulation

44
Q

What are the mechanisms of auto regulation ?

A
  • myogenic tone
  • tubuloglomerular feedback
45
Q

What is myogenic tone ?

A

property of vascular smooth muscle that means it responds to stretch by vasoconstricting

46
Q

What is tubuloglomerular feedback ?

A

the flow through the DCT (distal convoluted tubule) regulates vasoconstriction/dilation as necessary

47
Q

What is glomerulotubular balance ?

A

an increased/decreased flow through the PCT (proximal convoluted tubule) increases/decreases reabsorption in the PCT and loop of Henle, respectively, which has the opposite feedback effect on the system

48
Q

Which neurotransmitter is released onto the afferent arterioles to cause constriction when increased flow is detected in the distal convoluted tubule ?

49
Q

How does tubuloglomerular feedback cause vasoconstriction to regulate GFR in the event of increased arterial pressure ?

A
  • increased pressure = increased GFR
  • increased GFR = increased filtration
  • increased filtration = increased oncotic pressure
    - increased oncotic pressure negatively feedbacks to decrease GFR
  • increased GFR = increased flow through PCT
  • increased PCT flow = increased reabsorption
    - increased reabsorption negatively feedbacks to decrease GFR via glomerulotubular balance
  • increased PCT flow = increased DCT flow
  • increased DCT flow = transmitter (adenosine) released from macula densa
  • adenosine release = vasoconstriction of afferent arteriole
  • afferent constriction = decreased GFR
50
Q

Which cells detect the flow rate within the distal convoluted tubule ?

A

macula densa cells

51
Q

Which transmitter does the macula densa cells release in response to increased flow through the DCT ?

A

increased GFR = adenosine = constriction of afferent arteriole

52
Q

What receptors on the afferent arteriole does adenosine interact with to cause vasoconstriction?

A

a1 receptors

53
Q

Which transmitter does the macula densa cells release in response to decreased flow through the DCT ?

A

decreased GFR = prostaglandin E2 = constriction of efferent arteriole

54
Q

What stimulates
RAAS (renin-angiotensin system) ?

A

drop in BP

55
Q

What renal transmitter stimulates
RAAS (renin-angiotensin system) ?

A

prostaglandin E2

56
Q

Which arteriole does RAAS act to constrict ?

A

constricts efferent arteriole to raise pressure within glomerulus

57
Q

What is renal clearance ?

A

the removal of substance from the blood via the glomerulus

= the amount of a substance in a given volume of plasma that passes the kidneys and ends up in urine

58
Q

Which 2 markers are used to measure renal clearance/GFR ?

A
  • inulin gold standard (not inSulin!!)
  • creatinine
59
Q

Why are creatinine and inulin good markers of real clearance/GFR?

A
  • freely filtered by glomerulus
  • not reabsorbed in nephron
  • not secreted into DCT at later stage of process
  • excreted in urine
60
Q

Why might creatinine not be the best marker of renal clearance/GFR ?

A

affected by:
- age
- ethnicity
- gender
- diet

61
Q

what is the downside to inulin as a marker for GFR ?

A

it isn’t endogenous

it comes from a plant so to use it, it has to be infused into the blood until you reach a constant plasma conc.

62
Q

What is the substance currently being tested as a good marker for measuring GFR ?

A

Cystatin C

63
Q

What marker is primarily used in clinical settings to measure GFR?

A

creatinine

64
Q

What marker is considered the gold standard for measuring GFR?

65
Q

What happens to efferent arteriole resistance as renal arterial pressure increases ?

A

efferent arteriole resistance decreases

66
Q

What is the average plasma sodium concentration of blood ?

A

140 mmol/L

67
Q

Roughly how much sodium is filtered out the blood per day ?

A

25,200 mmol/day

1.5 kg salt per day - most is reabsorbed

68
Q

Roughly how much salt is found in urine per day ?

A

9g salt per day

69
Q

Why is it important to regulate Na in the blood?

A

Na levels determine…
- extracellular fluid volume
- arterial BP

70
Q

What kind of sodium reabsorption occurs in the proximal convoluted tubule ?

A

bulk reabsorption

= unregulated

71
Q

What kind of sodium reabsorption occurs in the distal convoluted tubule ?

A

fine tuning

72
Q

What % of sodium is reabsorbed in the proximal convoluted tubule ?

A

67%

two thirds of Na

73
Q

What % of sodium is reabsorbed in the loop of Henlé ?

74
Q

What % of sodium is reabsorbed in the distal convoluted tubule ?

75
Q

What % of sodium is lost in the urine ?

76
Q

Describe how Na is absorbed into the cells of the late proximal convoluted tubule …

A
  • Na actively pumped out basolateral membrane, K pumped into cell = sets the Na gradient
  • Na diffuses in from lumen via NHE-3 receptor in exchange for Hydrogen

On basolateral membrane…
- Na-K pump sets Na gradient
- Na moves into cell via NHE-1 in exchange for H out cell
- Cl moves through channel out cell

On apical membrane…
- Na moves into cell via NHE-3 in exchange for H out
- Bicarbonate leaves cell in exchange for Cl in

77
Q

What is the name of the receptor involved in bulk reabsorption in the proximal convoluted tubule ?

A

NHE-3

SLC9A3 is another name for it

78
Q

Where does ‘fine tuning’ reabsorption occur in the nephron ?

A

late distal convoluted tubule/collecting ducts

79
Q

Is ‘fine tuning’ reabsorption of Na under
a) ionic gradient control ?
b) osmotic potential control ?
c) hormonal control ?

A

hormonal control

80
Q

Which hormone controls ‘fine tuning’ reabsorption of Na in the nephron ?

A

Aldosterone

steroid hormone

81
Q

Where is Aldosterone produced ?

A

adrenal cortex

82
Q

What causes/stimulates the release of aldosterone ?

A
  • angiotensin 2
  • plasma potassium conc

Sem 4, case 7 (diabetic nephropathy) (3 decks)

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