Final Flashcards
What are the functions of the kidney?
- Regulate total water volume
- Regulating ECF ion concentration’s – extracellular fluid
- ensuring long term acid-base balance
- removal of metabolic wastes and toxins
- Produces hormones
- activation of vitamin D
Which hormones does the kidneys produce
- erythropoietin – red blood cell synthesis
- renin- blood pressure regulation
Renal artery
Carries blood to the kidneys
Renal hilum
Entry point for the renal artery and renal vein
Renal vein
Carries blood away from the kidneys
Ureter
Carries waste products from the kidneys to the urinary bladder
Where are the kiddies located
Retroperitoneal and held in place from Renal fascia and masses of adipose tissue
What is the outermost layer of the kidneys
Renal/ fibrous capsule
What is the second layer of the kidneys from the outside in?
The cortex
Cortex of the kidney
Has blood vessels that serve the nephrons and extensions into the renal sinuses called renal columns
Renal columns
Extensions of the cortex into the renal sinuses
Renal medulla
Known as the Reno Peerman used to concentrate urine and to collect urine for disposal
What is the innermost layer of the kidney
The renal pelvis
Renal pelvis
Resides in the renal sinus – a network of tubes connecting Ceperley to the Ureter
Ureter
Connects kidneys to the urinary bladder
Major calyx
Branches from the renal pelvis
Minor calyx
Branches from the major calyx
Renal papilla
The area at the end of the pyramid and beginning of the calyx resembles a funnel
What is the functional part of the kidney
The nephron which is located in the renal Pyramid
Trace a drop of blood going through the kidneys starting in the abdominal aorta and ending and the inferior vena cava.
Abdominal aorta – renal artery – segmental artery – interlobar artery – arcuate artery (base of cortex)– Cortical radiate artery- afferent arterial - glomerulus (filtration)- Efferent arterial- Peritubular capillaries- vasa recta- Peritubular capillaries- cortical radiate vein- arcuate vein- segmental vein- inferior vena cava
What is the renal capsule made out of?
Glomerular capsule and glomerulus
List the parts of the nephron in order from left to right
- Renal corpuscle
-glomerular capsule
-glomerulus - Proximal tubule
Nephron loop - Descending loop
- ascending loop
- Distal tubule
- Collecting duct
What are the two types of nephrons.
Cortical nephron
Juxtamedullary nephron
Cortical nephron
- 80%
- used primarily to remove waste
Juxtamedullary nephron
- 20%
- used to reabsorb water concentrates in urine
Glomerulus
Blood capillaries
Glomerular capsule
Made up of two layers the visceral layer and the parietal layer
Visceral layer of the glomerular capsule
Covers the glomerulus with special epithelial cells – podocytes – that act as a filtration barrier
Parietal layer of the glomerular capsule
Outer layer of the capsule not directly under visceral because there is a large space between the two
What is the juxtaglomerular apparatus anatomy?
-macula densa cells, granular cells, extraglomerular mesangial cells
Macula densa cells
And the ascending loop – they have chemo receptors to detect changes in sodium concentration
Granular cells
In the a Farrant arterial
- Baroreceptors – to detect changes in blood pressure
- secretory granules- to release renin
Extraglomerular mesangial cells
- Transfer signals between macula densa and granular cells
- activated when there is a decrease in sodium in blood pressure – which activates the Renin-angiotensin system
What are the three processes needed for urine formation
- glomerular filtration
- tubular reabsorption
- tubular secretion
Glomerular filtration
Filters Water and other small dissolved molecules and ions out of the glomerular capillaries plasma and into the glomerular capsule
What type of capillaries are in the glomerulus
Fenestrated to allow filtration
Glomerularnephritis
Homeostasis Imbalance
-inflammation caused by type three hypersensitivity where immature complex formed with in streptococcus prevents glomerular filtration
- can happen within a month of having strep throat
What are the contents of glomerular filtrate
Water, glucose, amino acids, urea, uric acid, creating, creatinine, sodium, chloride, potassium, calcium, bicarbonate, phosphate,Sulfur
What other fluid in the body is glomerular filtrate similar to?
Blood cells and plasma proteins are only in tissue fluid
What is the main force that moves substances by Phil Traciann through the glomerular capillaries?
Hydrostatic pressure of the blood inside
How is glomerular filtration pressure created
From outward pressure from the glomerulus and counteracting forces creating N-word pressure
- colloid osmotic pressure from plasma proteins
- hydrostatic pressure from glomerular capsule
What are the three factors in glomerular filtration
- hydrostatic pressure – glomerulus
- Inward pressure created by osmotic pressure in the glomerular capsule
- And would pressure created by hydrostatic pressure in the glomerular capsule
Outward hydrostatic pressure
Created by moving blood into the glomerulus from the afferent arterial and increased by the narrowed efferent arterial as compared to the afferent
Osmotic pressure control
Inward pressure from glomerular capsule – created by blood cells and plasma protein (albumin)
Hydrostatic pressure from the glomerular capsule
- inWord pressure
- created from a large volume of fluid moving into the glomerular capsule from the glomerulus
What is the average filtration rate and 24 hours
180L/ 24 hrs
How does the average filtration rate compare to the average urine output
Average filter ration is 180 L where as urine output is .6–2.5 L/ 24 hours
What other factors can affect the glomerular filtration rate
- Vasomotor center
- Obstruction in urinary nephron
- Renin – angiotensin system
Vasomotor center
Of them medulla oblongata using sympathetic nervous system. constricts blood vessels (afferent and efferent) which will increase glomerular filtration rate.
Obstruction in urinary nephron
Well increase inward pressure so that the glomerular filtration rate will become zero if obstruction is big enough.
Renin- angiotensin system
Used to increase blood pressure which will increase glomerular filtration rate
What is the rent and angiotensin system activated by
- Sympathetic nervous system
- Baroreceptors
- Chemoreceptors
How is the renin-angiotensin system activated by sympathetic nervous system
Sending signals to granular cells to secrete renin
How is the renin- angiotensin system activated by baroreceptors
When the baroreceptor in the granular cells detect low blood pressure and thus makes the cell secrete renin
How is the rain and angiotensin system activated by chemoreceptors
Activated chemoreceptors when macula densa cells detect low sodium thus activating the extra glomerular messangeal cells to activate the glomerular cells to secrete renin
Of the items filtrated by glomerular filtration what is not reabsorbed?
Erythrocytes, leukocytes, proteins
Tubular reabsorption
The process by which substances are transported out of the tubular fluid through the epithelium of the renal tubule and into the interstitial fluid
What percentage of ribs or chicken happens in the proximal tubule
85%
What factors affect tubular reabsorption
Perry tubular capillaries and epithelium of the proximal tubule
How do peritubular capillaries affect tubular rehab sorption
Hi colloid osmotic pressure due to the presence of cells and protein
- Low hydrostatic pressure equals slow movement
- cell membrane is Fenestrated
How does epithelium of the proximal tubule affect tubular reabsorption
High hydrostatic pressure from glomerular filtrate
- increased surface area from convution in the tubule
- has carrier proteins for active transport of electrolytes, glucose and amino acid
How do you keep blood glucose at a normal level
There are a limited numbers of glucose transports so that normal blood glucose will be reabsorbed. Any extra glucose will be passed in the urine
What does the present of glucose in urine indicate
Diabetes
How is water brought from the personal tubular to the peritubular capillaries
Sodium is actively passed from the. Proximal tubule to the peritubular capillaries and water is passably transported from the proximal tubule to Peritubular capillary
Where is the juxtaglomerular apparatus located and what does it consist of?
Between afferent and you efferent arterials
- macula densa cells – in the ascending loop – have chemo receptors to detect changes in sodium
- granular cells – in the afferent arterial, baroreceptors to detect changes in blood pressure and signals to release renin
- extraglomerular mesangial cells- transfer sales between macula densa and granular cells-activated when there is a decrease in sodium and blood pressure
What is the second step in urine information
Tubular reabsorption
Tubular reabsorption
The process by which substances are transported out of the tubular fluid through the epithelium of the renal tubule into the interstitial fluid
What is the process of sodium and water reabsorption
- sodium ions are reabsorbed by active transport
- Negatively charged ions are attracted to positively charged ions – create salt
- As concentration of ions increases and plasma, osmotic pressure increases
- Water moves from proximal tubule to capillary by osmosis.
How much is remaining after tubular rehab sorption and where is it absorbed
15% and it occurs in the distal tubule and nephron loop
What two factors helps to absorb the remaining 15%
Antidiuretic hormone, countercurrent mechanisms
What is the role of antidiuretic hormone
- Stimulus – blood volume decreases
- Receptor – osmoreceptors in the hypothalamus
- Control center – posterior pituitary gland will release antidiuretic hormone
- Effector – distal tubule of the nephron to increase water absorption using Aquaporins.
- Response – water will move into the peritubular capillaries and urine becomes concentrated
Aquaporins
Channel proteins to passively transport water
Countercurrent mechanism
The countercurrent mechanism ensures that the medullary interstitial fluid becomes hypertonic. This occurs in the nephron loop of the Juxtamedullary nephrons.
What are the factors that contribute to the countercurrent mechanism
- countercurrent multiplier
2. countercurrent exchanger
Countercurrent multiplier
Interaction of filtrate flow and ascending/descending limb of the nephron loop of Juxtamedullary nephrons
Countercurrent exchanger
Blood flow in the a sending/descending lambs of the vast director – peritubular capillaries surrounding the nephron loop
What three properties of the nephron loop are dependent on to establish the osmotic gradient
- Fluid flows in the opposite direction – countercurrent – through 2 adjacent parallel sections of the nephron loop
- The descending limb is permeable to water but not to salt.
- The ascending limb is in permeable to water and pumps out salt
What is the result of the countercurrent multiplier
Establishes a positive feedback cycle that increases salt in the medulla to enhance osmosis of water into medulla
What is special about the ascending limb of the nephron loop?
Makes the medulla hypertonic
What are the steps of the countercurrent exchanger – vasa recta
- Blood flows down into the descending vasa recta.
- NaCl moves into vasa recta by diffusion from the medulla
- In a sending vasa recta NaCl diffuses into medulla
- This preserves gradient
Why is there no osmosis along with NaCl diffusion?
Because water is attracted to the high colloid osmotic pressure in the vasa recta
Why is the water attracted to the Vasa recta
Because of the plasma protein and cells that attract it there
What is step three in urine formation
Tubular secretion
Tubular secretion
- Disposes of substances down to plasma proteins – drugs
- eliminates undesirable substances passively reabsorbed – urea and uric acid
- read the body of access potassium – aldosterone affect
- Controls blood pH by altering amounts of hydrogen or HCO3 in urine
What type of process is tubular secretion
An active process and requires ATP
Diuretics
These drugs counteract tubular reabsorption
What with diuretics be used to treat
Hypertension to lower blood volume to prevent tubular reabsorption
What chemicals enhance urinary output
- ADH inhibitors-alcohol
- Na reabsorption inhibitors-caffeine, drugs for hypertension or Edema
- Loop diuretics – inhibit medullary gradient formation. Disrupts countercurrent multiplier
- Osmotic diuretics – seven cents not ribs award so water remains in urine high glucose of diabetic patients – glucose is attracted to water
What are the common components in urine?
- 95% water
- The rest is urea, uric acid, amino acids, and electrolytes
How would you and production indicate kidney failure
If lower than normal
Normal is 56 mL per hour, 30 mL per hour indicates can you failure
1/3 cup equals kidney failure, 1/2 cup equals normal
What items are not usually found in urine
Glucose, proteins, pus, red blood cells, hemoglobin, bile pigment
What would glucose in your urine indicate
Glycosuria-diabetes Mellitus
What would proteins in your urine indicate
Proteinurea-pregnancy, hypertension, glomerulonephritis
What would pus in your urine indicate
Pyuria- urinary tract infection
What would red blood cells in your urine indicate
Hematuria- trauma, infection, kidney stones
What would hemoglobin in your urine indicate
Hemoglobinuria- transfusion reaction, Hemolytic anemia
What would bile pigments in your urine indicate
Bilirubinuria-liver disease
What are common signs and symptoms of urinary disease?
- dysuria
- nocturia
- oliguria
- anuria
- frequency
- urgency
- uremia
Dysuria
Difficulty or painful urination
Nocturia
Increased urination at night
Oliguria
Decreased urine output
Anuria
No urine output
Frequency
Urinating frequently
Urgency
Need to urinate immediately
Uremia
Hi levels of urea in blood
Renal clearance
The rate at which a particular chemical is removed from the plasma and indicates kidney efficiency
What tests are real parents to type with Marial or damage or monitor possession of renal disease
- Insulin clearance test
- Creatinine clearance text
- Para-aminohippuric acid
What other organs are in the urinary system?
Ureters
Urinary Bladder
Urethra
Ureters
- 25 cm long
- extend the rain I’ll tell this down where the bladder where is connected on the posterior side area
- functions and moving urine from the kidneys to the urinary bladder using Peristalsis
Three layers of the uterus
1- innermost layer- Thick layer of transitional epithelium
2- middle layer- muscular coat- smooth muscle fibers in circular and longitudinal bundles
3- fibrous coat – outer coat – connective tissue
How is backflow of urine from the bladder into the ureter prevented?
And mucus flap/valve separates the ureter from the bladder
Insulin Clarence test
- insulin is a polysaccharide from plant roots. Goes in blood but once in urine stains in urine
- filtered by glomerular filtrate ocean but not reabsorbed into peritubular capillaries
- this measures glomerular filtration rate
Creatinine clearance test
Creatinine is produced during muscle metabolism, and as a byproduct of the breakdown of Creatine and phosphate.
- creatinine is filtered through Camaros and not reabsorbed
- creatinine level should be consistent and blood, therefore the amount present indicates glomerular filtration rate
- creatine increased in the blood means that the GFR is affected
Para-aminohippuric acid
BA H is an acid that is filtered by glomerular filtrate Chin, but is reabsorbed into Perry tubular capillaries and secreted into the distal tubule
-we can use this test to determine total blood flow versus glomerular filtration rate
Homeostasis in balance of the ureter
Renal calculi- kidney stones
Kidney stones
Will form an obstruction
- cause severe radiating pain in the abdomen and lower limbs
- 60% of the time there pass spontaneously
- 40% of the time they will require ESWL or surgery
What is a kidney stone made of
Calcium, phosphate, uric acid
ESWL
Extracorporeal shock wave lithotripsy
-shockwave sent through a waterbath into the body to fragment the stones for passage
Urinary bladder
- behind peritoneum, lower pelvis
- muscular sac for temporary storage of urine
- Male – prostate inferior to bladder neck
- female – anterior to vagina and uterus
What is the difference between male and female urinary systems
Female – 4 cm long, one part, one passage of urine to the outside of body, UTI is more common due to the short length the of urethra and the urethra is closer to the anus
Mel – 19.5 cm, three parts/prosthetic urethra and prostate, membranes us urethra, Penal urethra, there are two functions one is the passage of urine and two is the transport of semen
Urinary bladder
Three layers of bladder wall
- Mucosa – transitional epithelium mucosa
- Thick detrusor- three layers of smooth muscle
- Trigone- smooth triangular area outline but openings for uterus and urethra infections 10 to persist in this region – commonplace for UTI
What are the three layers of the urethra
Mucosa – actively secretes mucus
Muscular layer – smooth longitudinal muscles for Peristalsis
Fibrous coat – for protection
What are the eight steps to micturition
- urinary bladder decisions as it fills with urine, urinary bladder can hold up to 600 mL.
- stretcher scepters in the bladder wall are stimulated and I signal to the micturition center in the brain and spinal cord.
- Parasympathetic nerve impulses travel to the detrusor muscle (in bladder) from the spinal cord, which response by contracting rhythmically as long as sympathetic nerve impulses are not activated by the spinal cord.
- The need to urinate is urgent – this signal can start as early as 150 mL and sensation get stronger as filling continues.
- Voluntary contraction of the external urethral sphincter and inhibition of the maturation reflex by impulses from the pontine maturation Center and the cerebral cortex prevent urination-no bathroom
- Following the decision to urinate the external urethral sphincter is relaxed by inhibiting somatic nerve activity and impulses from the pontine micturition and the cerebral cortex facilitate the micturition reflex.
- The detrusor muscle contracts and the internal urethral sphincter relaxes and the urine is expelled/released through the urethra
- The micturition reflex subsides, the detrusor muscle relaxes and the internal urethral sphincter contracts and the bladder begins to fill with urine again
What is an electrolyte? Where do they come from?
And I Amber has disassociated in water and is capable of conducting electricity
-from salts acids and bases
What is the role of water in electrolyte formation?
What uses hydrogen bonding to dissociate sources of ions
What is the relationship between water and electrolytes
Water loves salt or sources of electrolytes and follows them using osmosis
Who has more water men or women?
Males have 63% wait by water where women have 52% weight by water because women have more fat
What are the two major compartments in which water in the body with its dissolved electrolytes distributed into?
intracellular fluid- Two thirds of water resides inside the cells
Interstitial fluid – one third of water reside outside of the cells.
- also found in the eyes, joints, central spinal fluid
How much of an infants weight is made up by water
73%
What is the most abundant electrolyte an intracellular fluid
Potassium
What is the most abundant electrolyte in extracellular fluid?
Biocarbonate
What are the two major factors regulating the movement of water and electrolytes from one fluid compartment to another?
Hydrostatic pressure and osmotic pressure
Hydrostatic pressure
Fluid moving fluid through vessels that decrease in diameter for passive transportation through filtration
Osmotic pressure
Created by movement of water from a high concentration to low concentration and presence of an in permeable solut- water love salt, Na is impermeable solute
Hypotonic
lower solute concentration on the outside of the cell that on the inside of the cell
Hypertonic
Higher salute concentration on the outside of the cell than that on the inside of the cell
Isotonic
A solution that has the same salt concentration on the inside of the cell as on the outside of the cell
Crenation
Cell shrinks – hypertonic
Hydrolysis
Swelling of a cell – hypotonic
Water balance
Regulates intake by creating thirst sensation
What are the major sources of water intake
Metabolism, foods, beverages
What are the major sources of water output
Feces, sweat, insensible losses be a skin and lungs, urine
What is the most modified water output
Urine
Where is the thirst center located?
?
What is the process of regulation of water intake/creation of thirst sensation
- Osmotic pressure and extracellular fluid increases volume of water decreases and salute concentration increases.
- stimulates Osmoreceptors in the hypothalamus
- triggered when total body water is decreased by 1%.
- If blood plasma decreases 5 to 10% blood pressure will decrease which will detect and granular cells of the kidney to start the renin-angiotensin system.
- activation of their sitter will cause mouth to become dry and encourage drinking
When does thirst stop
When fluid does sends the stomach and plasma volume and extracellular fluid pressure returns to normal
How is water output regulated during dehydration
By concentrating urine
How is the output of urine regulated during dehydration
Stimulated by increase in extracellular fluid osmotic pressure, an increase of Na in extracellular fluid and a decrease in plasma volume
-I smell receptors and hypothalamus will stimulate the posterior pituitary gland to release ADH
Where is ADH released from
Posterior pituitary gland
Dehydration
Extracellular fluid water loss due to hemorrhage, severe burns, prolonged vomiting or diarrhea, perfuse sweating, water deprivation, diuretic abuse, endocrine disturbances
What are signs and symptoms of water dehydration
Cottony mouth, thirst, dry flush skin, oliguria
-May lead to weight loss, fever, mental computing, hypovolemic shock, and lots of electrolytes
What are the consequences of dehydration
Cell crenation – excess loss of H2O from extracellular fluid – extracellular fluid osmotic pressure rises – cell loses H2O to extracellular fluid by osmosis and the cell shrinks
Water intoxication
Cellular overhydration – occurs with renal insufficiency he or rapid access water ingestion
What is water intoxication treated with
Hypertonic saline
What are the consequences of hypotonic hydration
Hydrolysis of the cell – excess water enters the extracellular fluid – extracellular fluid asthmatic pressure falls Dash water moves into the cell by osmosis and the cell swells
Edema
And abnormal accumulation of extracellular fluid and the extracellular spaces – and her schedule fluid
What are the four causes of edema
- Low plasma protein-liver or kidney disease
- obstruction of lymph vessels-surgery or infection
- increased venous pressure -Venous obstruction
- inflammation-tissue damage, mosquito bites or wounds
Electrolyte regulation
And electrolyte balance exist with the quantities of electrolytes that the body gain equal those that is lost
What do you think are important electrolytes and the body based on the previous lecture
Calcium, sodium, potassium
What are the major sources of intake for electrolyte balance
Food, fluids, metabolic reactions
What are the major sources of output for electrolyte balance
Respiration, feces, urine
What electrolyzer pound of innercellular fluid
Potassium
What electrolytes are found in the extracellular fluid
Sodium, chloride, calcium, bicarbonate
Sodium
Important for impulse conduction along an axon and membrane permeability
- nerve cells
- needed for contraction of the skeletal and cardiac muscle
Potassium
Important for maintaining resting potential of nerve and cardiac muscle cells – repolarization
Calcium
Important for neurotransmitter release in neurons and important for all muscle contractions
- important for both cardiac and skeletal muscle
Skeletal muscle – inhibits contraction
cardiac muscle – stimulates contraction
Regulation of sodium
Sodium regulation -low sodium is controlled by the hormone aldosterone
Hypernatremia
High sodium
Hyponatremia
Low-sodium
What is hypernatremia caused by
-dehydration, fever, Cushing syndrome
Cushing syndrome
Over active adrenal cortex, absorbing a lot of sodium causes bloating
What are the effects of hypernatremia
Adema, thirst, lethargic, agitation, increase blood pressure
How is hypernatremia regulated
There are no receptors to detect high sodium – the use of Osmo receptors because of high sodium correlates with high osmotic pressure in the extracellular fluid
What is hyponatremia caused by
Prolonged water electrolyte loss by perspiration
- water intoxication – extreme exercise or renal failure
- excessive diarrhea and vomiting
- addison’s disease – adrenal cortex isn’t working means we are not producing aldosterone
What are the effects of hyponatremia
Fatigue due to muscle weakness, confusion, seizure, cramping and nausea
How is hyponatremia regulated
Detected by chemo receptors in the macula densa cells in the ascending loop of the nephron as part of the juxtaglomerular apparatus
sends a signal to the extraglomerular mesingeal cells
- which send the signal to the granular cells in the afferent arterial to release renin to start the renin-angiotensin system
- so that the adrenal gland releases aldosterone to reabsorb sodium in the distal tubule of the nephron in the kidney
What does aldosterone do
Regulate sodium and potassium
Where is aldosterone released from
Adrenal gland
What triggers the release of aldosterone
The start of the renin – angiotensin system
Regulation of potassium
Is controlled by the hormone aldosterone
Hypokalemia
Low potassium
Hyperkalemia
High potassium
How is sodium and potassium related
When sodium decreases potassium increases
What is hypokalemia caused by
Diuretic drugs and kidney disease
What does hypokalemia effect on the body
Causes paralysis – muscles are contracted also known as tetany
Respiratory difficulty – severe cardiac dysrhythmia – speeds up the heart
How is hypokalemia regulated
No not receptors for potassium and low levels – no regulation by body
What is hyperkalemia caused by
Renal disease, certain drugs, Addison’s disease because aldosterone is not produced
What affects on the body does hyperkalemia cause
Paralysis, fatigue, nausea, cardiac dysrhythmia, slows the heart rate
How is hyper kalemia regulated by the body
-increase in potassium concentration and extracellular fluid equals decreased sodium content which triggers renin release increasing angiotensin two
- stimulates the adrenal cortex
- adrenal cortex releases aldosterone
- aldosterone targets the kidney tubules
- The kidney tubules increase sodium bring absorption and increase potassium secretion
- which restores homeostatic plasma levels of sodium and potassium
What is the difference between Addison’s disease and Cushing’s disease
Cushing’s disease has an overactive adrenal cortex which causes absorbency of a loan sodium where as Addison’s disease the adrenal cortex is not working which means you’re not producing aldosterone
Regulation of calcium
Controlled by the hormone parathyroid hormone
Where in the body does most of the calcium reside
99% of calcium is in the bones the other 1% is in the extracellular fluid
What is calcium and extracellular fluid important for
Blood clotting, cell membrane permeability, sensory activities, neuromuscular excitability – most important
Hypocalcemia
Less than enough calcium
What is hypocalcemia caused by
Reduce parathyroid function, low absorption of vitamin D, gastrointestinal diseases, kidney disease