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Pathophysiology > Chapter 38 > Flashcards

Chapter 38 Flashcards

Structure and Function of the Renal/Urologic & Digestive System

1
Q

What are the primary functions of the Kidney’s?

A
  1. Maintain a stable internal environment for optimal cell and tissue metabolism.
  2. Balance solute and water transport.
  3. Excrete metabolic waste products.
  4. Conserve nutrients.
  5. Regulate acids and bases
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2
Q

What hormones do the kidneys secrete as their endocrine functions?

A
  1. Renin: Regulation of blood pressure
  2. Erythropoietin: Production of erythrocytes
  3. 1,25-dihydroxyvitamin D3: Metabolism of calcium
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3
Q

Synthesis of glucose from amino acids.

A

Gluconeogenesis

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4
Q

What substance forms in the kidneys and drains into the bladder?

A

Urine

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5
Q

Define the structure of the kidneys.

A

Paired organs located in the posterior region of the abdominal cavity behind the peritoneum (retroperitoneal).

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6
Q

What is a tightly adhering capsule that surrounds each kidney; each kidney is then embedded in a mass of fat.

A

Renal Capsule

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7
Q

What is the fibrous tissue that attaches each kidney to the posterior abdominal wall?

A

Renal Fascia

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8
Q

This is where the renal blood vessels, nerves, lymphatic vessels, and ureter enter and exit the kidneys.

A

Hilum

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9
Q

This is the outer layer of each kidney. It also contains all the glomeruli, most of the proximal tubules, and some segments of the distal tubule.

A

Renal Cortex

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10
Q

This is the inner part of each kidney that contains tubules and the collecting duct. It also consists of the regions called the pyramids.

A

Renal Medulla

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11
Q

Extends from the cortex down between the renal pyramids.

A

Renal Columns

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12
Q

Apexes of the pyramids that projects into a cup-shaped cavity that joins together to form a major calyx?

A

Minor Calyx

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13
Q

Joins to form the renal pelvis.

A

Major Calyx

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14
Q

Joins the proximal end of the ureter.

A

Renal Pelvis

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15
Q

What is the functional unit of the kidney? (Hint, each kidney contains 1.2 million)

A

Nephron

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16
Q

This makes up 85% of all nephrons, which extend partially into the medulla.

A

Superficial Cortical Nephrons

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17
Q

These have short or long loops.

A

Midcortical Nephrons

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18
Q

Lie close to and extend deep into the medulla and are important for the process of concentrating urine.

A

Juxtamedullary Nephrons

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19
Q

Three main components of the Renal Corpuscle.

A
  1. Glomerulus
  2. Bowman Glomerular Capsule
  3. Mesangial Cells
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20
Q

Tuff of capillaries

A

Glomerulus

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21
Q

Bowman space; Circular space between visceral and parietal epithelium

A

Bowman Glomerular Capsule

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22
Q
  1. Secrete mesangial matrix; lie between and support the glomerular capillaries. Some of these contracts like smooth muscle cells to regulate glomerular capillary blood flow.
    - Have phagocytic properties and release inflammatory cytokines and growth factors.
A

Mesangial Cells

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23
Q

Filters selected blood components through its three layers

A

Glomerulus

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24
Q

What are the three layers of the glomerular filtration membrane?

A
  1. Inner Capillary Endothelium
  2. Middle Glomerular Basement Membrane (GBM)
  3. Outer Layer: Visceral Epithelium that forms the inner layer of the Bowman’s capsule.
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25
Q
  1. Synthesize Nitric Oxide (a vasodilator)
  2. Synthesize Endothelin-1 (a vasoconstrictor)
  3. Regulate glomerular blood flow.
A

Glomerular endothelial cells

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26
Q
  1. What part of the Nephron: Is composed of cells bodies called podocytes, which are foot like projections?
  2. Form an elaborate network of intercellular clefts called filtration slits, modular filtration.
  3. Supplied by the afferent arteriole and drained by the efferent arteriole.
A

Visceral Epithelium of the Bowman’s Capsule

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27
Q

What are the two components of the Juxtaglomerular Apparatus?

A
  1. Juxtaglomerular Cells
  2. Macula Densa
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28
Q

These specialized cells are located around the afferent arteriole where the afferent arteriole enters the glomerulus.

A

Juxtaglomerular Cells

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29
Q

Between the afferent and efferent arterioles of the distal convoluted tubule; sodium-sensing cells.

A

Macula Densa

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30
Q

What three things are controlled by the Juxtaglomerular Apparatus (JGA) at this site?

A
  1. Renal Blood Flow (RBF)
  2. Glomerular Filtration
  3. Renin Secretion
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31
Q

This is where substances are reabsorbed from the filtrate or secreted into the filtrate.

A

Renal Tubules

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32
Q

Is the only surface inside the nephron covered with microvilli?

A

Proximal Convoluted Tubule

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33
Q

Is a hairpin-shaped loop composed of thick and thin portions of a descending segment that goes into the medulla.

A

Loop of Henle

34
Q

Extends from macula densa to collecting duct.

A

Distal Convoluted Tubule

35
Q

Descends down the cortex, through the renal pyramids of the inner and outer medullae, draining urine into the minor calyx.

A

Collecting Duct

36
Q

Reabsorbs sodium and water and secretes potassium.

A

Principle Cells

37
Q

Secretes hydrogen and reabsorb potassium.

A

Intercalated Cells

38
Q

Supplies blood to the kidneys.

A

Renal Arteries

39
Q

Travel down the renal columns and between the pyramids.

A

Interlobar Arteries

40
Q
  1. Arch over the base of the pyramids and run parallel to the surface of the kidneys.
  2. Interlobular arteries extend through the cortex toward the periphery of the kidneys and supply the afferent glomerular arterioles.
A

Arcuate Arteries

41
Q
  1. Feed into the efferent Arteriole
  2. Afferent arterioles subdivide into a fist like structure of four to eight glomerular capillaries.
  3. Efferent arterioles convoy blood to a second capillary bed
A

Glomerular Capillaries

42
Q

Surround the proximal and distal convoluted tubules and loop of Henle.

A

Peritubular Capillaries

43
Q

Is a network of capillaries that forms loops and follow loops of Henlel

A

Vasa Recta

44
Q

Follow arterial path in reverse direction and have the same names as corresponding arteries, empty into inferior vena cava.

A

Renal Veins

45
Q
  1. Are 30 cm long
  2. Are long, intertwining smooth muscle Bundles.
  3. Pass obliquely through the posterior aspect of the bladder
  4. Peristaltic activity moves urine to the bladder
  5. Micturition compresses the lower end of this ureter to prevent further urine reflux.
A

Ureters

46
Q

Bladder
Detrusor muscle
Transitional epithelium
Trigon

A

Transitional epithelium

47
Q
  1. Internal Urethral Sphincter
    *Smooth muscle located at junction of bladder and urethra.
  2. External Urethral Sphincters
    *Striated skeletal muscle under voluntary control.
  3. Between 3 and 4 cm long in females
  4. Between 18 and 20 cm long in males
A

Urethra

48
Q
  1. Parasympathetic Fibers
    Bladder and internal urethral sphincter
  2. Skeletal motor Neurons in the pudenda nerve
    External Urethral Sphincter
A

Innervation

49
Q

Kidneys receive 1000-1200 mL of blood per minute.

A

Renal Blood Flow

50
Q

600-700 mL as plasma

A

Renal Plasma Flow (RPF)

51
Q
  1. Filtration of Plasma into the Bowman space.
  2. 20% of the RPF (120-140 mL/ minute)
  3. Directly related to the perfusion pressure in the glomerular capillaries.
  4. If mean arterial pressure decreases or vascular resistance increases then the RBF decreases.
A

Glomerular Filtration Rate (GFR)

52
Q
  1. Strict maintenance of 80-180 mmHg provides constant GFR.
  2. As the systemic blood pressure increases, afferent arterioles constrict, preventing an increase in filtration pressure.
  3. Prevents wide fluctuations in the systemic arterial pressure from being transmitted to the Glomerular Capillaries.
    - Solute and water excretion is constantly maintained, despite arterial pressure changes.
  4. Myogenic Mechanism (stretch)
    - As arterial pressure declines, glomerular perfusion
    increases.
    - Stretch on the afferent arteriolar smooth
    muscle decreases, and the arteriolar relaxes.
    - An increase in arteriolar pressure decreases
    glomerular perfusion.
    - Causes the arteriole smooth muscle to
    contract.
  5. Tubuloglomerular feedback (sodium chloride NaCl content)
    - When sodium filtration increases, GFR decreases.
    - Macula densa cells stimulate afferent arteriolar
    vasoconstriction.
    - When sodium filtration decreases, the opposite
    occurs - GFR increases.
A

Autoregulation

53
Q
  1. Sympathetic nervous system.
    - Vasoconstriction diminishes RBF and GFR
    - Increases renal tubular sodium and water
    reabsorption.
    - Increases blood pressure.
  2. Decreased afferent renal sympathetic nerve activity produces opposite effects.
  3. Renalase: Promotes Metabolism of catecholamines
  4. Hormonal regulation of renal blood flow.
A

Neural Regulation

54
Q
  1. Increases systemic arterial pressure and increases
    sodium reabsorption.
  2. Renin: Enzyme is formed and stored in the afferent
    arterioles of the juxtaglomerular apparatus.
  3. Renin helps form angiotensin I (physiologically
    inactive).
  4. In the presence of angiotensin-converting enzyme
    (ACE), angiotensin I is converted to angiotensin II
  5. Angiotensin II
    - Stimulates the secretion of aldosterone by the
    - adrenal cortex.
    - Is a potent vasoconstrictor.
    - Stimulates antidiuretic hormone (ADH) secretion
    and thirst.
A
  1. Renin-Angiotensin-Aldosterone System (RAAS)
55
Q
  1. Atrial natriuretic peptide (ANP) is secreted from myocardial cells in the atria.
  2. Brain natriuretic peptide (BNP) is secreted from myocardial cells in the ventricles.
  3. ANP and BNP
    - Inhibit sodium and water absorption by kidney
    tubules.
    - Inhibit secretion of renin and aldosterone.
    - Vasodilate the afferent arterioles, constrict the
    efferent arterioles.
    - Increase urine formation, leading to decreased
    blood volume and pressure.
A

Natriuretic Peptides

56
Q
  1. Is secreted from vascular endothelium and in the
    nephron.
  2. Causes vasodilation.
A

C-type Natriuretic Peptide

57
Q
  1. Is secreted by the distal convoluted tubules and the collecting ducts.
  2. Causes vasodilation, increases renal blood flow, and diuretic effects.
A

Urodilatin

58
Q

Influences RBF

A

Hormones and Mediators

59
Q
  1. Filters the plasma at the glomerulus.
  2. Reabsorbs and secretes different substances at
    various parts of its tubular structure.
  3. Forms a filtrate of protein-free plasma, called
    ultrafiltration.
  4. Regulates filtrate to maintain body fluid volume,
    electrolyte composition, and pH with narrow limits.
    - Requires tubular reabsorption and tubular
    secretion.
A

Nephron Functions

60
Q

Movement of protein-free plasma across the glomerular membrane (hydrostatic pressure)

A

Filtration

61
Q

Movement of fluid and solutes from tubular lumen to the peritubular capillaries.

A

Tubular Reabsorption

62
Q

Transfer of substances from the peritubular capillaries to the tubular lumen.

A

Tubular Secretion

63
Q

Elimination of substances in the final urine

A

Excretion

64
Q
  1. Glomerulus is freely permeable to water and
    relatively impermeable to large colloids such as
    plasma proteins.
    - Size and electrical charge are important factors
    that affect permeability.
    - Positive-Charged particles permeate the
    membrane more readily that neutral- or
    negative-charged particles.
    - Capillary pressure
    - Hydrostatic pressure
    - Determined by systemic arterial pressure and
    resistance to blood flow in the afferent and
    efferent arterioles.
A

Glomerular Filtration

65
Q
  1. Is the combined effect of forces favoring and forces opposing filtration.
    - Favoring forces: Capillary hydrostatic pressure
    - Opposing forces: Oncotic pressure in the capillary
    and hydrostatic pressure in Bowman’s capsule
  2. Includes glomerular hydrostatic pressure, capsular
    hydrostatic pressure, and blood oncotic pressure.
A

Net Filtration Pressure

66
Q
  1. Total volume of fluid filtered by the glomeruli
    averages 180 L/day or approximately 120 mL/minute.
  2. Filtration of plasma per unit of time is directly related
    to the perfusion pressure of the RBF.
  3. 99% of the filtrate is reabsorbed into the peritubular
    capillaries and returned to the blood.
A

Filtration Rate

67
Q

In some molecules, active transport is limited as carrier molecules become saturated: Transport maximum

A

Active Transport

68
Q
  1. Approximately 60% to 70% of filtered sodium and
    water and approximately 50% of urea have been
    reabsorbed, along with 90% or more of potassium,
    glucose, bicarbonate, calcium, phosphate, amino
    acids, and uric acid.
  2. Chloride, water, and urea are passively reabsorbed.
A

Tubular Transport

69
Q
  1. Function: Active reabsorption of sodium.
    - Promotes the passive diffusion of water.
    - Reabsorption of water leaves an increased
    concentration of urea.
    - Hydrogen ions are actively exchanged for sodium
    ions.
    - Bicarbonate combines with hydrogen in the tubular
    cell and is eventually reabsorbed as carbon dioxide
    (CO2) and water.
    - Glomerulotubular balance (GTB)
  2. Damaged renal tubules: Metabolic byproducts and
    drugs may accumulate, causing toxic levels.
A

Proximal Convoluted Tubules

70
Q
  1. Provides the kidney with the ability to concentrate
    urine and conserve water for the body.
  2. Fluid leaving the ascending limb of the loop is
    hypoosmotic and is more diluted than the fluid that
    entered.
  3. Reabsorb more solute than water into the
    interstitium.
  4. Primary function is to establish a hyperosmotic sate
    within the medullary interstitial fluid.
  5. Thin, descending segment: Is highly permeable to
    water and moderately permeable to sodium, urea,
    and other solutes.
  6. Thin, ascending segment: Is highly permeable to
    water and moderately permeable to sodium, urea,
    and other solutes.
  7. Thick portion of the ascending segment: Is highly
    permeable to sodium, potassium, and chloride and
    significantly less permeable to water and urea.
A

Loop of Henle

71
Q
  1. Performs the final adjustments in urine composition.
  2. Convoluted portion of the distal tubule: Is limitedly
    permeable to water but readily absorbs ions and
    contributes to the dilution of the tubular fluid.
  3. Straight segment of the distal tubule and the
    collecting duct: Is permeable to water as controlled
    by ADH.
  4. Tamm-Horsfall Glycoprotein (uromodulin)
    - Is formed on the epithelial surface of the thick
    ascending segment and is the first segment of the
    distal tubules.
    - Is the most abundant urinary protein.
    - Protects against bacterial adhesion and urolithiasis.
    Is a renal ligand for lymphokines.
  5. Sodium is readily absorbed by the latter segment of
    the distal tubule and collecting duct under the
    regulation of aldosterone.
  6. Potassium is actively secreted by the principal cells
    and is reabsorbed in lesser amounts by intercalated
    cells in these segments; is controlled by aldosterone
    and other factors related to the concentration of
    potassium in body fluids.
  7. Hydrogen is secreted by the distal tubule; it
    combines with non-bicarbonate buffers (ammonium
    and phosphate) for the elimination of excess acids in
    the urine.
  8. Contribute to the regulation of acid-base balance by
    excreting hydrogen ions into the urine and by adding
    new bicarbonate to the plasma.
A

Distal Convoluted Tubules and Collecting Duct

72
Q
  1. When GFR spontaneously decreases or increases.
    - Renal tubules and, primarily the proximal tubules,
    automatically adjust their rate of reabsorption of
    sodium and water to balance the change in GFR.
    - Constant fraction of filtered sodium and water is
    reabsorbed from the proximal tubule.
A

Glomerulotubular balance

73
Q
  1. Are initiated in the thick ascending limb of the loop
    of Henle with active transport of chloride and sodium
    into the medullary interstitium.
  2. Hyperosmotic interstitium causes water to move out
    of descending limb; the remaining fluid becomes
    increasingly concentrated.
  3. As fluid enters the ascending limb, sodium and
    chloride are removed and water is retained.
  4. Fluid becomes more and more dilute as it enters the
    distal tubule.
A

Water, Sodium, and Chloride

74
Q
  1. Is the end product of protein metabolism and the
    major constituent of urine.
  2. Approximately 50% of urea is excreted in the urine,
    and 50% is recycled in the kidneys.
A

Urea

75
Q
  1. Promote afferent arteriolar vasoconstriction and decrease GFR and RBF.
  2. Renalase: Is the hormone produced by the kidney that promotes the metabolism of catecholamines and regulates blood pressure.
A

Catecholamines

76
Q
  1. Controls the concentration of final urine.
  2. Increases water permeability in the last segment of
    the distal tubule and along the entire length of the
    collecting ducts.
  3. In the presence of ADH, water reabsorption is high,
    causing less urine volume.
A

ADH

77
Q

Promotes diuresis

A

Natriuretic peptides

78
Q

Are the agents that enhance the flow and excretion of urine.

A

Diuretic Drugs

79
Q
  1. Calcitriol (1,25-dihydroxyvitamin D3)
    - Is necessary for the absorption of calcium and
    phosphate by the small intestine.
  2. Can be obtained in the diet or synthesized by action
    of ultraviolet radiation on cholesterol in the skin.
  3. Decreased phosphate levels stimulate calcitriol.
A

Vitamin D

80
Q
  1. Is produced in fetal liver and the adult kidney; is
    essential for erythropoiesis.
  2. Chronic renal failure: Causes anemia from reduced
    erythropoietin secretion.
A

Erythropoietin

Pathophysiology (8 decks)

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