C31 - Kidney Functions and Malfunctions Flashcards

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1
Q

What’s the gross structure of the kidney?

A

Vertebrates have 2 kidneys, located just below the ribs on either side of the spine.
Each receives and removes blood from the renal artery and renal vein.

Urine produced passes through a tube called the ureter into the bladder, where it’s stored.

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2
Q

What are the components of a kidney?

A
Pelvis of kidney
Medulla
Cortex
Renal artery
Renal vein
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3
Q

What are the organs/components of the excretory system?

A

Vena cava

Aorta

Renal artery

Renal vein

Kidney

Ureter

Bladder

Urethra

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4
Q

What are the 3 regions of the kidney?

A

Cortex (outer region)

Medulla (inner region, consisting of renal pyramids, which are composed of sections of nephrons)

Renal pelvis (most central region which leads into the ureter)

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5
Q

What’s excretion?

A

Removal of waste products of metabolism.

E.g. CO2 and water from the lungs or water and salts in sweat from skin.

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6
Q

What does the ultrastructure of the nephron consist of?

A

The nephron begins in the kidney’s cortex.
It has a cup-shaped structure called the Bowman’s capsule which surrounds a dense network of capillaries known as the glomerulus.

The nephron is then divided into four sections:

  • proximal convoluted tubule
  • loop of Henle
  • distal convoluted tubule
  • collecting duct
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7
Q

What’s the Bowman’s capsule?

A

Cup shaped structure in nephrons surrounding the glomerulus.

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8
Q

What’s the glomerulus?

A

A dense network of capillaries in the Bowman’s capsule of nephrons.

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9
Q

Where does deamination mainly occur?

A

Liver cells

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10
Q

How is ammonia removed from the body?

A

As urea

Ammonia is formed when excess amino acids are deaminated.

Ammonia is then combined with CO2 in the Ornithine cycle and converted into urea.
Urea is less toxic than ammonia but must be removed via excretion by the kidneys.

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11
Q

What happens in the glomerulus?

A

Blood pressure is very high, which causes water, ions, urea, glucose and amino acids to be forced from the blood and filtered into the nephron.

This is known as ultrafiltration.

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12
Q

What’s selective reabsorption?

A

A process in nephrons where useful substances, e.g. glucose, most water and some ions, are reabsorbed back into the tissue fluid and blood capillaries.

Unwanted substances travel to the collecting duct.

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13
Q

What is the waste fluid from nephrons, which reaches the end of the collecting duct, called?

A

Urine.
This moves through the renal pelvis, down the urethra and into the bladder.

Urine is excreted from the bladder via a tube called the urethra.

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14
Q

From where is urine excreted?

A

From the bladder via a tube called the urethra.

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15
Q

What’s ultrafiltration?

A

Filtration of molecules in the glomerulus of the kidney nephrons.
Large molecules remain in the blood meanwhile smaller molecules pass into the Bowman’s capsule.

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16
Q

What occurs in ultrafiltration?

A

Hydrostatic pressure in the capillaries of the glomerulus is greater than the pressure in the Bowman’s capsule.

Blood is brought into the glomerulus by the afferent arterioles and leaves via the efferent arteriole.
The smaller diameter of the efferent arteriole causes the build-up of hydrostatic pressure.

This causes water and small molecules (ions, amino acids, glucose) to be forced into the Bowman’s capsule.

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17
Q

How does the structure of capillaries in the glomerulus and Bowman’s capsule act as a filter?

A

Endothelium cell’s in capillaries are separated by narrow gaps called fenestrations, which prevents blood from escaping.

The basement membrane of capillaries is composed of a fine mesh of collagen and glycoprotein. This prevents large proteins from being filtered out of the plasma.

Epithelial cells of the capsule have finger-shaped projections to create small gaps between cells. These cells are called podocytes and the gaps are known as filtration slits.

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18
Q

Where does selective reabsorption occur?

A

In the proximal convoluted tubule (PCT) of nephrons.

All glucose is reabsorbed here, as well as acids and some ions.

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19
Q

How are cells lining the proximal convoluted tubule (of nephrons) specialised for reabsorption?

A
  • They have microvilli (which increase SA)
  • There are co-transporter proteins present. These allow facilitated diffusion of glucose or amino acids, in association with Na+ ions, from tubule fluid. They can then diffuse into blood capillaries.
  • Na/K pumps in the membrane next to PCT cells, adjacent to capillaries. They pump Na+ out of the PCT and into tissue fluid.
    This results in a low Na+ concentration in PCT cells which allows co-transport of glucose or amino acids.
  • High concentration of mitochondria, which provide energy for active transport.
20
Q

What remains in the nephron filtrate after selective reabsorption?

A

Toxic compounds (urea), excess water and some ions, which will be excreted as urine.

21
Q

In what order does fluid move around parts of the nephron?

A

1) Glomerulus
2) Bowman’s capsule
3) Proximal convoluted tubule (PCT)
4) Descending and ascending loop of Henle
5) Distal tubule
6) Collecting duct

22
Q

What does the loop of Henle consist of?

A

A descending and ascending limp, arranged as a hairpin countercurrent multiplier.
This means that a fluid passing in opposite directions close to each other enables exchange of substances between the 2 limbs.

23
Q

How are ions and water transferred in the loop of Henle (within nephrons)?

A

Fluid enters the descending limb from the proximal convoluted tubule.

Water diffuses out the descending limb by osmosis and is reabsorbed by capillaries.

At the bottom of the loop, ion concentration is very high and water potential is very low.
Na+ and Cl- diffuse out of the nephron at the base of the ascending limb and into the tissue fluid in the medulla.

Water is unable to leave the ascending limb as its wall is impermeable to water.

The filtrate leaves the ascending limb and travels to the distal convoluted tubule. The filtrate has high water potential (and low solute concentration).

A low water potential has been created in the medulla, through which the collecting ducts pass.

24
Q

What happens in the collecting duct (of nephrons)?

A

Fluid reaches the collecting duct via the distal convoluted tubule (DCT).

The fluid has a high water potential, meanwhile the surrounding medulla tissue has low water potential. Thus water will move out the duct and into the medulla and capillaries via osmosis.

However, permeability of the collecting duct can be altered to control how much water gets reabsorbed.

25
Q

What hormone changes the permeability of the collecting duct walls to water (in nephrons).

A

ADH (antidiuretic hormone).

26
Q

How does ADH affect water reabsorption?

A

When the body needs to reabsorption extra water, more ADH is produced and released.
This increases permeability of the collecting duct walls, resulting in an increase in urine concentration and decrease in volume.

Lower levels of ADH reduce the permeability of collecting duct walls, meaning less water is reabsorbed and urine is dilute.

27
Q

What happens if there is a decrease in blood water potential below the set point?

A

Osmoreceptors in the hypothalamus detect low water potential.

Neurosecretory cells (specialised nerve cells) in the hypothalamus are stimulated to release ADH from the posterior pituitary gland.

ADH travels from the blood to the kidneys.

ADH binds to receptors on the cell surface membrane of cells in the collecting duct.

The concentration of cyclic AMP (cAMP) in these cells is increased.

cAMP acts as a second messenger and causes aquaporins to be inserted into the membrane of cells in the collecting duct walls.
Aquaporins are membrane-spanning channel proteins that increase permeability of the collecting duct wall. They allow water to diffuse through but prevent passage of ions.

More water is reabsorbed from the collecting duct by osmosis.

Urine with a high solute concentration is produced and water potential of the blood in increased.

28
Q

What functions do kidneys have other than osmoregulation?

A

Endocrine functions.

They take part in homoeostatic mechanisms such as producing erythropoietin or renin.

29
Q

What’s renin?

A

An enzyme (angiotensinogenase).

It is secreted by the kidneys in response to low blood volume and catalyses the conversion of angiotensinogen into the hormone angiotensin.

Angiotensin increases blood pressure by constricting blood vessels, stimulating more ADH to be produced, and activating the thirst reflex in the hypothalamus.

30
Q

What are the causes of acute kidney failure?

A

Bacterial infection (e.g. E.coli)

Kidney stones (or problem resulting in a blockage)

Medication side effects

31
Q

What are causes of chronic kidney failure?

A

Uncontrolled diabetes mellitus (type 1 or 2)

Hypertension (high blood pressure)

Certain inherited diseases e.g. polycystic kidney disease.

32
Q

What are signs of kidney failure?

A

Reduction in urine volume

Bloody or cloudy urine

Oedema (accumulation of fluid in tissues. Feet, hands and area around eyes appear puffy)

33
Q

How’s kidney failure diagnosed?

A

By analysing composition of blood or urine samples in labs, e.g. for erythrocytes, leucocyte and protein concentrations.

Blood samples with a high concentration of creatinine are indicative of kidney failure. (Creatinine is a waste substance which is normally filtered from the blood by kidneys.)

Structural abnormalities and blockages can be identified by ultrasound and CT scan.

34
Q

What are the consequences of kidney failure?

A
  • It prevents excess water and waste from being removed from the blood, leading to accumulation of toxins and ultimately death if untreated.
    (Acute can eventually return to normal. Chronic is often irreversible).
  • A diseased kidney often produces more renin, in response to low blood pressure in the glomerulus. The kidney responds by secreting more renin into blood plasma which can lead to hypertension.
  • EPO production may be increased in kidneys with cancer or cysts. However, usually, diseased kidneys produce less EPO, which leads to anaemia. (RhEPO can be given).
  • Kidney disease can trigger cardiovascular disease. This is because blood pressure rises due to increased renin production, which causes hypertension and damage to endothelium in arteries.
35
Q

What are the two types of treatment for kidney failure?

A

Dialysis

Transplant surgery

36
Q

What are the 2 types of dialysis for kidney failure treatment?

A

Haemodialysis

Peritoneal dialysis

37
Q

What’s dialysis?

What happens in (general) dialysis?

A

A process that artificially filters a patients blood.
A partially permeable membrane separates the patient’s blood from dialysis fluid. The fluid matches the composition of their body fluids.
The dialysis membrane allows exchange of substances between blood and dialysis fluid.

Molecules in the blood in excess diffuse into the dialysis fluid, and substances lacking diffuse into the blood.

38
Q

What is haemodialysis?

A

A form of dialysis where blood is passed from the patient’s vein into a dialysis machine, where exchange occurs across a partially permeable membrane.

Heparin is added to prevent blood clotting.

This is usually carried out 3 times per week at a clinic.

39
Q

How often is haemodialysis carried out?

A

Around 3 times per week (usually at hospital although it can be done at home).

40
Q

What’s peritoneal dialysis?

A

A form of dialysis where the patient’s own abdominal membrane (peritoneum) acts as the dialysis membrane.
A tube is implanted into the patient’s abdomen, which enables dialysis fluid to be pumped into the patient’s body cavity, and exchange can occur across their peritoneal membrane.

This must be done several times a day.

41
Q

How often must peritoneal dialysis be done?

A

Several times a day

42
Q

What are the advantages and disadvantages of haemodialysis?

A

+ There are trained professionals available at hospitals

+ Daily dialysis not required

  • Patients must travel if they’re receiving treatment at hospital
  • Patient should be on strict diet
43
Q

What are the advantages and disadvantages of peritoneal dialysis?

A

+ Can be done at home

+ Patients’ diet can contain more fluids and salts than the diet recommended for haemodialysis

  • Self-administered dialysis requires training and attention to hygiene during exchanges
  • High risk of infection
  • Requires daily dialysis
44
Q

What are the advantages and disadvantages of transplant surgery for treating kidney failure?

A

+ Can be done using live (or deceased) donors

+ Provides a long term cure

+ Patient will no longer require dialysis

  • Patient will be on immunosuppressant drugs for the rest of their life
  • Requires (HLA) antigen matching (based on their blood cells and their haplotype)
45
Q

How could rejection of future transplanted kidneys be prevented?

A

By using kidneys grown from the patient’s own stem cells.

This can be done using:
iPSC (induced pluripotent stem cells) which are stem cells that have been reset from differentiated adult stem cells

Embryonic stem cells to clone organs

Therapeutic (non-reproductive) cloning

46
Q

What are iPSC?

A

Induced pluripotent stem cells, which are stem cells that have been reset from differentiated adult stem cells.