Final Review Flashcards
1
Q
Size of the kidney?
A
It’s a bar of soap
2
Q
Function of each of the components of the urinary system?
A
The ureters transport urine to the bladder, to be excreted by the bladder. The bladder stores the urine, the kidneys filter and make urine
3
Q
Level of the kidney
A
T12-L3
4
Q
Know the gross anatomy of the kidney?
A
- Its located Retroperitoneal
- The outside is called the Renal Fascia
- Fatty layer is the Adipose Capsule
- The innermost (surrounding kidney) is the Renal Capsule
- The inner in the Cortex
5
Q
What is the outside of the Kidney called?
A
Renal Fascia
6
Q
What is the Fatty Layer of the Kidney?
A
Adipose Capsule
7
Q
What is the Innermost (surrounding the kidney)?
A
Renal Capsule
8
Q
What is the inner of the Kidney?
A
Cortex
9
Q
What is the apex of the renal pyramid of the kidney?
A
Papilla
10
Q
Inside the kidney we have Major and Minor Calyces. What structure drains directly into the minor?
A
Papillary Ducts
11
Q
The renal cortex and the medulla combined are called the what?
A
Parenchima
12
Q
The efferent arterioles that leave the glomerulus, turn into what?
A
Peritubular Capillaries
13
Q
What is the order of the Nephron?
A
Glomerulous -> Bowman’s capsule -> Prox Convoluted Tubule -> Descending Limb of the Loop of Henle -> Ascending Limb of the Loop of Henle -> Distal Convoluted Tubule -> Collection Duct.
14
Q
What is the location of the Macula Densa Cells?
A
Thick Ascending Limb of Loop of Henle
15
Q
What is the function of principal cells found in the distal convoluted tubule as well as the collecting duct?
A
Receptors for antidiuretic hormone and aldosterone
16
Q
Know the order of the Blood Supply?
A
Renal Artery -> Segmental Arteries -> Interlobar Arteries -> Arcuate Arteries -> Interlobular Arteries -> Afferent Arterioles -> Glomerular Capillaries -> Efferent Arterioles -> Peritubular Capillaries -> Interlobular Veins -> Arcuate Veins -> Interlobular Veins -> Renal Vein
17
Q
What is the First step in urine production?
A
Glomerular Filtration
18
Q
Where does tubular reabsorption occur?
A
Renal Tubule
19
Q
Where does the Renal Tubule filter water into?
A
Back into the bloodstream
20
Q
What is the amount of urine excreted each day in the average adult?
A
1-2 L
21
Q
Glomerular endothelial cells are quite leaky because they have large pores called?
A
Fenestration
22
Q
Know what glomerular blood hydrostatic pressure (promotes)
A
The blood pressure of the glomerular capillaries forcing water and solutes in the blood plasma through filtration membrane.
23
Q
Know the average rate of GFR per minute
A
- Males: 125ml per min
- Females: 105ml per min
24
Q
What happens if the GFR rate is too high?
A
Substances will pass too quickly through, and won’t be filtered properly
25
What does hormone Angiotensin 2 do?
Reduces GFR
| -Potent vasoconstrictor of both afferent and efferent arterioles, reduces renal blood flow thus decreasing GFR.
26
Know what's secreted from each section of the nephron?
Proximal Convoluted Tubule
- Hydrogen
- Creatinine
- Urea
- Ammonium Ion
Distal Convoluted Tubule
- Potassium and Hydrogen
Nephron Loop
- Urea
27
What's the only sustenance that's secreted into the loop of henle?
Urea
28
What area is sodium reabsorbed?
All areas of the renal tubules
29
Where is Glucose reabsorbed?
Proximal Convuluted
30
Explain the Renal autoregulation Tubuloglomerular mechanism
- Macula densa in the renal tubules provides feedback to glomerulus. When BP is high, flow in tubules too fast, causing less reabsorption of Na, CL and water in the PCT and Loop of Henle.
- Macula densa in DCT detects increased amounts of Na, Cl and water and thus inhibits release of nitric oxide (NO) from cells in juxtaglomerular apparatus.
- A decrease of NO causes afferent arterioles to constrict, thus less blood flow in the capillaries and decreasing GFR. IF BP decreases the opposite occurs but to a lesser degree.
31
How much filtrate returns to the bloodstream after GFR occurs?
99%
32
What is the general homeostasis of the kidney
Bicarbonate system and stuff. So even though the kidneys intake can be highly variable, the volume in your blood stream remains the same and homeostasis of the body fluids depends largely on the kidneys to regulate the rate of water that is lost in your urine
33
Know what happens in your body when you have low/high levels of ADH
Absent or low ADH = dilute urine.
| Higher levels = more concentrated urine through increased water reabsorption
34
Have an understanding of the osmolarity of the loop of henle
Osmolarity of interstitial fluid of the renal medulla becomes progressively greater, more water is reabsorbed from tubular fluid along the descending limb toward the tip of the loop of Henle, therefore the remaining fluid in the lumen becomes more concentrated
35
Late distal convoluted tubules, and the collecting ducts, are regulated by what hormone that controls concentrated urine?
ADH
36
What is the normal mOsm/L for GRF?
300 mOsm/L
37
What is Countercurrent flow
The flow of fluid in opposite directions.
38
What is Countercurrent Multiplication
Process by which a progressively increasing osmotic gradient is formed as a result of countercurrent flow.
39
Know the 3 layers of tissue that comprise the ureter and their function:
1) Mucosa- Mucous membrane with transitional epithelium & underlying lamina propria (areolar connective tissue w/ collagen, elastic fibers and lymphatic tissue. Secreted mucus prevents cells from coming in contact with urine.
2) Muscularis- Composed of inner longitudinal & outer circular layers of smooth muscle. Distal 1/3rd aspect has an outer longitudinal layer. Peristalsis is the major function of the muscular layer.
3) Adventia- Areolar connective tissue w/ blood vessels and lymphatic vessels and nerves that serve muscularis and mucosa. Anchors the uterus in place.
40
What is the location of the urethra in both men and women?
Males – anterior to the rectum
| Females – anterior to the vagina and inferior to the uterus
41
What is Rugae?
Folds in tissue of the bladder within the mucosa layer
42
What spinal segment is referred to as the Micturition?
Sacral spinal cord segments at S2 and S3 and trigger the spinal reflex.
43
Superficial region of kidney extending from renal capsule to the bases of the renal pyramid and into the spaces between them. Divided into an outer cortical zone and inner juxtamedullary zone
Renal Cortex
44
Inner region of kidney, Consists of several pyramids.
Renal Medulla
45
Cone shaped, found in the medulla base points towards the cortex, Apex (Papilla) points towards the renal hilum
Renal Pyramids
46
The apex (narrow end) of renal pyramid which points towards the renal hilum
Renal Papilla
47
The portions of the renal cortex that extend between the renal pyramids
Renal Columns
48
Consists of a renal pyramid, its overlying area of renal cortex, and one-half of each adjacent renal column
Renal Lobe
49
Functional portion of the kidney, Made up of the renal cortex and renal pyramids
Parenchyma
50
The functional units of the kidney, Approximately 1 million microscopic structures
Nephrons
51
Extend through the papillae of the pyramids, Filtrate formed by the nephrons drain into these large ducts
Papillary ducts
52
Cup-like structures that the papillary ducts drain into
Minor & Major Calyces
53
Single large cavity that the major calyces drain into
Renal Pelvis
54
A cavity within the kidneys that the hilum expands into. Contains part of the renal pelvis, the calyces and branches of the renal blood vessels and nerves
Renal Sinus
55
Describe the anatomy, way the Bladder is positioned
At the base of the urinary bladder, the ureters curve medially and pass obliquely through the wall of the posterior aspect of the urinary bladder
56
Internal urethral sphincter
Involuntary
57
External urethral sphincter in deep muscles of the perineum
Voluntary
58
Muscularis (detrusor muscle)
Surrounding the mucosa, intermediate layer
59
What are the 3 layers of Smooth Muscle?
1) Inner Longitudinal
2) Middle Circular
3) Outer Longitudinal Layers
60
What are the 3 anatomical regions of the male urethra
1) Prostatic urethra (through prostate gland)
2) Intermediate urethra (through perineum)
3) Spongy urethra (through penis).
61
Path way of the female urethra
1 short tube.
It lies posterior to pubic symphysis and has a length of 4 cm (1.5 inches). The opening is located between the clitoris and the vaginal opening
62
Bind excess hydrogen ions thereby preventing an increase in the acidity of body fluids. Have a limited capacity eventually the H+ must be eliminated from the body by excretion
Body Buffers
63
provides pickup and delivery for the transport of wastes
Blood
64
The primary site for metabolic recycling, amino acid into glucose or glucose into fatty acids. Also converts toxic substances into less toxic ones, ammonia into urea
Liver
65
With each exhalation the ? excrete CO2 and expel heat and a little water vapor
Lungs
66
Help eliminate excess heat, water, and CO2 plus small quantities of salt and urea as well
Sweat Glands
67
Through defecation, excretes solid, undigested foods, wastes, some CO2, water, salts and heat
Gastrointestinal tract
68
What is the difference between and acid and a base?
Acid: Molecule that can release Hydrogen (removes it)
Base: Ion/molecule that can accept or combine with Hydrogen
69
How does the body try to return itself to homeostasis?
Kidneys will slow the excretion of bicarbonate to help decrease the acid of the blood. Lungs hyperventilate to increase CO2
70
Causes of metabolic acidosis?
1) Excess Metabolic Acids
- Excessive production of metabolic acids.
Lactic acidosis- too much acid, e.g. due to strenuous
exercise
Diabetic ketoacidosis- occurs when body has no insulin
- Alcoholic ketoacidosis- acute metabolic acidosis seen in binge drinking and alcoholics
- Fasting and starvation- leading to ketoacidosis
- Poisoning
2) Impaired Elimination of Metabolic Acids
- Kidney Failure or Dysfunction
3) Excessive Bicarbonate Loss
- Loss of intestinal secretions
>Diarrhea
>Intestinal suction (pumping out)
>Intestinal or biliary fistula (hole in intestinal tract)
- Increased renal losses
>Renal tubular acidosis
>Treatment with carbonic anhydrase inhibitors
>Hypoaldosteronism- low serum levels of aldosterone
- Increased Chloride Levels
>Excessive reabsorption of chloride by the kidney
>Sodium chloride infusions
>Treatment with ammonium chloride
>Parenteral hyperalimentation (tube feeding)
71
Manifestations of Metabolic Acidosis?
1) Increased extracellular H+ ion concentration,
2) Decrease in pH (<7.35)
3) Decrease in HCO3- levels
4) Anorexia
5) Nausea and vomiting
6) Abdominal pain
7) Weakness
8) Lethargy
9) General malaise
10) Confusion
11) Coma
12) Decreased heart rate
13) Cardiac arrhythmias
14) Warm and flushed skin
15) Bone disease
16) Increased rate & depth of respiration
17) Acidic urine
18) Increased ammonia in urine
72
Manifestations of Respiratory Acidosis
1) pH decreased
2) Increased PCO2
3) Then HCO3- due to compensation of high acidic level (increase secondarily)
4) Skin is warm and flushed
5) Signs of compensation is acid in the urine
Neural Function :
6) Dilation of cerebral vessels and depression of neural function
7) Headache
8) Weakness
9) Behavior changes:
10) Confusion
11) Depression
12) Paranoia
13) Hallucinations
14) Tremors
15) Paralysis
16) Stupor and Coma
73
Causes of Respiratory Acidosis
1) Depression of Respiratory Center
- Drug overdose
- Head injury
2) Lung Disease
- Bronchial asthma
- Emphysema
3) Chronic Bronchitis
- Pneumonia
- Pulmonary edema
- Respiratory distress syndrome
4) Airway obstruction, Disorders of the chest wall and respiratory muscles
- Paralysis of respiratory muscles
- Chest injuries
- Kyphoscoliosis
- Extreme Obesity
- Treatment with paralytic drugs
= Breathing Air with high CO2 content
74
What are the possible causes of metabolic acidosis
Excessive loss of Bicarbonate
Increased Metabolic Acids
Impaired elimination of metabolic acids
75
Causes of Respiratory Alkalosis
1) Excessive ventilation
2) Anxiety and psychogenic hyperventilation
3) Hypoxia and reflex stimulation of ventilation
4) Lung disease that reflexively stimulates ventilation
5) Stimulation of respiratory center
6) Elevated blood ammonia level
7) Salicylate toxicity
8) Encephalitis
9) Fever
10) Mechanical ventilation
76
Manifestations of Respiratory Alkalosis
1) Decrease in PCO2 (primary issue)
2) Decrease in HCO3 to compensate for decreased PCO2
pH increased
3) Cardiovascular function
4) Cardiac dysrhythmias
5) Neural function
6) Constriction of cerebral vessels and increased neuronal excitability
7) Dizziness, panic, lightheadedness
8) Tetany- involuntary contractions (spasms)
9) Numbness and tingling of the fingers and toes
10) Positive Chvostek and Trousseau signs
11) Seizures
77
Small and shrunken kidneys are causes of what type of kidney disease?
Medullary cystic disease
78
Simple renal cysts present with?
Flank pain
Blood in the urine (hematuria)
Infection
Hypertension.
79
Causes of urinary tract obstruction?
1) Developmental defects
2) Calculi (stones)
3) Pregnancy
4) Benign prostatic hyperplasia (increase prostate size)
5) Scar tissue resulting from infection and inflammation
6) Tumors
7) Neurologic disorders such as spinal cord injury.
80
Types of treatment of kidney stones
Preventive:
1) Dietary restriction
2) Calcium salt supplementation
3) Thiazide diuretics
4) Cellulose phosphate
5) Antibiotic for Infection
81
3 ways to removing Kidney stones
1) Ureteroscopic removal
2) Percutaneous removal
3) Extracorporeal lithotripsy
82
Ways for Diagnosis for Kidney Stones?
1) Urinalysis
2) Radiography
3) Intravenous pyelography
4) Ultrasonography
83
Wash out phenomenon?
Ureters assist by moving urine out of the renal pelvis into the bladder. Bacteria then becomes washed out of the ureters and bladder to help protect against UTI
If washout didn't occur and there was backflow this is when a UTI would occur
84
Causes of UTIS stasis of the urine
Anatomic obstructions:
- Urinary tract stones
- Prostatic hyperplasia
- Pregnancy
- Malformations of the ureterovesical junction
Increased pressure resulting in reflux
Functional obstructions:
- Neurogenic bladder
- Infrequent voiding
- Detrusor (bladder) muscle instability
- Constipation
85
Frequency of urination (as often as every 20 minutes) Lower abdominal or back discomfort Burning and pain on urination (dysuria) Cloudy and foul-smelling urine on occasion Symptoms usually disappear after 48 hours of medical treatment.
Cystitis- UTI in the bladder
86
Affects the parenchyma and pelvis of kidney Less common- related primarily to those with Urinary Tract Obstructions, or other predisposing conditions like diabetes. Symptoms most often include fever and lateral low back (flank) tenderness. May also include nausea, burning with urination and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure
Pyelonephritis- UTI in the kidney
87
Diseases that provoke a proliferative inflammatory response of the endothelial, mesangial, or epithelial cells of the glomeruli
Glomerulonephritis
88
What is the inflammatory process of Glomerulonephritis?
Damages the capillary wall Permits red blood cells to escape into the urine Produces hemodynamic changes that decrease the GFR *nephrotic= loss of proteins VS *nephritic= loss of blood
89
Renal failure Prerenal and post renal causes?
Pre-Renal Causes of Acute Renal Failure
- Hypovolemia
- Decreased vascular filling
- Heart failure and cardiogenic shock o Decreased renal perfusion due to vasoactive mediators, drugs, diagnostic agents
Post-Renal Causes of Acute Renal Failure
- Bilateral ureteral obstruction
- Bladder outlet obstruction
90
Common causes of chronic kidney disease
1) Hypertension
2) Diabetes mellitus
3) Polycystic kidney disease
4) Obstructions of the urinary tract
5) Glomerulonephritis
6) Cancers
7) Autoimmune disorders
8) Diseases of the heart or lungs
9) Chronic use of pain medication
91
How many stages there for Chronic Kidney Disease?
1. Damage with normal or increased GFR
2. Mild reduction of GFR to 60–89 mL/min/1.73 m2
3. Moderate reduction of GFR to 30–59 mL/min/1.73 m2
4. Severe reduction in GFR to 15–29 mL/min/1.73 m2
5. Kidney failure with a GFR < 15 mL/min/1.73 m2, with a need for renal replacement therapy
92
When it comes to renal failure, know the types of treatments used
1) Medical management
2) Dialysis
3) Hemodialysis
4) Peritoneal dialysis
5) Transplantation
93
When it comes to chronic kidney failure what are the clinical manifestations?
1) Accumulation of nitrogenous wastes
2) Alterations in water, electrolyte, and acid-base balance
3) Mineral and skeletal disorders
4) Anemia and coagulation disorders
5) Hypertension and alterations in cardiovascular function,
6) Gastrointestinal disorders
7) Neurologic complications
8) Disorders of skin integrity
9) Immunologic disorders
94
How does chronic disease in children manifests
- Severe growth impairment
- Developmental delay
- Delay in sexual maturation
- Bone abnormalities
- Development of psychosocial problems.
95
What are the types of Kidney Stones?
1) Calcium stones (increased calcium):
2) Oxalate or phosphate.
3) Magnesium ammonium phosphate stones
4) Uric acid stones
5) Cystine stones (childhood)
96
Know how to Label Kidney and Nephron? Bonus maybe?
| Know Blood Flow Chart - Maybe matching or Bonus?
97
What are contributing solutes in high Osmolarity in renal medulla
Sodium
Chlorine
Urea
98
What does the urinary system consist of?
Kidneys (2)
Ureters (2)
Urinary Bladder
Urethra
99
What are the 4 functions of the Urinary System
1) Kidneys regulate blood volume and composition
2) Ureters transport urine from kidney to urinary bladder
3) Urinary bladder stores urine and expels into Urethra
4) Urethra expels urine from body
100
What 2 hormones do the Kidneys produce?
Calcitriol
| Erythropoietin
101
What do the Kidneys do?
1) Regulate blood volume and composition
2) Regulate blood pressure, PH, Glucose
3) Excrete waste in urine
4) Produce 2 hormomes
102
How does Urine drain from nephron
Papillary duct -> Minor Calyce -> Major Calyce -> Renal Pelvis -> Ureter -> Urinary Bladder
103
How much blood flows through the kidneys ?
1200ml per minute
104
What are the 2 parts of the Nephron
1) Renal Corpuscle: Filters blood plasma
- Glomerulus, Glomerular Capsule
2) Renal Tubule : Receives filtered fluid
- PCT, Loop of a Henle, DCT
105
Helps regulate blood pressure in the kidney
Juxtamerular Apparatus
106
Cells found in Afferent alongside Macula Densa cells
Juxtaglomerular Cells
107
These cells have a role in blood pH homeostasis
Intercalated Cells
108
receptors for ADH and Aldosterone
Principal Cells
109
Modified simple squamous epithelial cells
Podocytes
110
What are 3 processes of Nephron and Collecting Ducts to produce urine
1) Glomerular Filtration
2) Tubular Reabsorption
3) Tubular Secretion
111
Contractile cells help regulate filtration
Mesangial Cells
112
Why is volume of fluid filtered by Renal Capsule much larger than other Blood capillaries
1) Large surface area of Glomerular capillaries b/c they are long and extensive
2) Filtration membrane is thin and very porous b/c large fenstration
3) Glomerular capillary blood pressure is higher than elsewhere b/c diameter of efferent is smaller than afferent
113
What is Net Filtration Pressure
Total pressure that promotes filtration
| NFP = GBHP - CHP - BCOP
114
What are 3 pressures that control Glomerular filtration
1) Glomerular blood hydrostatic pressure (GBHP)
2) Capsular hydrostatic pressure (CHP)
3) Blood colloid osmotic pressure (BCOP)
115
3 mechanisms control GFR
1) Renal Auto-regulation
2) Neural Regulation
3) Hormonal Regulation
116
Which solutes are reabsorbed by active/passive process
Glucose
Amino Acids
Urea
Ions
117
Transfer of material from blood into Glomerular filtrate
Secretion
118
Where is the largest amount of solute and water Reabsorption occur?
PCT
119
Concentration of a solution in terms of osmoses of solutes per litre of solution
Osmolarity
120
What are the 3 points of Dilute Urine
1) Osmolarity of fluid increases as it goes down the descending loop of Henle
2) Osmolarity decreases as it goes up the ascending limb
3) Osmolarity decreases still more as it flows through the rest of the nephron and collecting duct
121
What is the average capacity of urine in the bladder
700-800ml (smaller in females because of uterus)
122
Discharge of urine from the bladder
Micturition
