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2.9 BRS Urology and Renal > Genitourinary System > Flashcards

Genitourinary System Flashcards

1
Q

What are the 4 functions of the kidneys?

A
  1. Excretion —> metabolic products: urea, uric acid,
    creatinine
    —> foreign substances: drugs
  2. Homeostasis —> body fluids
    —> electrolytes
    —> acid-base balance
  3. Regulate blood pressure
  4. Hormone secretion —> erythropoietin
    —> renin
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2
Q

What are the 7 main components of the kidneys?

A
  1. Cortex - outside
  2. Medulla - inside
  3. Major calyx - join to ureter
  4. Minor calyx - branches of major calyx
  5. Renal artery
  6. Renal vein
  7. Ureter
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3
Q

What is the pathway of blood through the kidneys?

A

In:
Renal artery
Segmental artery
Interlobar artery
Arcuate artery
Interlobular artery
Afferent arteriole
Glomerular capillaries

Out:
Efferent arteriole
Peritubular capillaries —> supply kidney
Interlobular vein
Arcuate vein
Interlobar vein
Renal vein

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4
Q

Which blood vessels supply the kidney?

A

Peritubular capillaries

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5
Q

What are the 5 parts of the bladder?

A
  1. Detrusor muscle
    • outside
      —> contraction for urination
  2. Trigone
    —> signals brain when bladder full (stretch)
  3. Internal sphincter
    • end of bladder
      —> involuntary control to prevent urination
  4. External sphincter
    • urogenital diaphragm
      —> voluntary control to prevent urination
  5. Bulbourethral glands
    • males only
    • urogenital diaphragm
      —> produce and secrete lubricant to semen for
      sperm survival
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6
Q

What are the 6 parts of a nephron?

A
  1. Glomerulus
  2. Bowman’s capsule
  3. Proximal convoluted tubule
  4. Loop of Henle - ascending and descending
  5. Distal convoluted tubule
  6. Collecting duct
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7
Q

Where is mitochondria found in high vs low densities in a nephron?

A

High —> active transport:
1. PCT
2. DCT
3. Thick ascending loop of Henle
4. Intercalated cells of collecting duct

Low —> passive transport:
1. Thin descending loop of Henle
2. Thin ascending loop of Henle
3. Principal cells of collecting duct

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8
Q

What are the 2 types of cells that make up the collecting duct?

A
  1. Principle cells —> Na+ reabsorption and K+
    secretion
  2. Intercalated cells —> maintain acid-base balance
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9
Q

What are the 2 types of nephron?

A
  1. Superficial
    • glomerulus in outer cortex
    • loop of Henle trough at inner-outer medulla
      border
  2. Juxtaglomerular
    • glomerulus near cortex-medullar border
    • loop of Henle trough deep in inner medulla

Nephron —> 10:1 (superficial : juxtaglomerular)

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10
Q

Why is the cortex granular and medulla striated?

A

Cortex —> contains many glomeruli (dots)
Medulla —> contains many tubules (lines)

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11
Q

What is the juxtaglomerular apparatus?

A

Where glomerulus is next to DCT
- Macula densa - cells of DCT that meet glomerulus
—> GFR regulation (tubulo-glomerular
feedback mechanism)
- Extraglomerular mesangial cells - between DCT and
efferent arteriole
- Juxtaglomerular cells - on afferent arteriole
—> secrete renin —> regulates
blood pressure

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12
Q

What are the 4 renal processes?

A
  1. Glomerular filtration
  2. Reabsorption
  3. Secretion
  4. Excretion
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13
Q

How does glomerular filtration occur?

A
  1. Blood plasma pushed through glomerular
    fenestrae
    • due to heart’s hydrostatic pressure
    • 70nm gaps in basement membrane —> sieve
  2. Through Bowman’s capsule space
  3. Through Bowman’s capsule membrane
    • -ve proteins in membrane —> repel proteins
  4. Through slit diaphragm
    • between epithelial podocytes
    • thin and porous —> sieve
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14
Q

Which 4 pressures affect glomerular filtration?

A

Push fluid out:
1. Blood hydrostatic pressure
2. Fluid oncotic pressure

Pull fluid in:
1. Blood oncotic pressure
2. Fluid hydrostatic pressure

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15
Q

What are the 4 equations for renal action?

A
  1. Net Ultrafiltration Pressure:
    Puf = HPgc - HPbw - πgc
  2. Glomerular Filtration Rate:
    GFR = Puf x Kf
  3. Renal Clearance:
    C = (U x V) / P
  4. Filtration Flow:
    FF = GFR / RPF
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16
Q

What is Puf and how is it calculated?

A

Net Ultrafiltration Pressure
- pressure exerted on blood to force fluid out at
glomerulus

Puf = HPgc - HPbw - πgc
- HPgc = hydrostatic pressure in glomerular capillaries
- HPgc = hydrostatic pressure in bowman’s capsule
- πgc = oncotic pressure of plasma proteins in
glomerular capillaries

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17
Q

What is GFR and how is it calculated?

A

Glomeruar Filtration Rate
- volume of fluid pushed filtered through the
glomeruli per unit time (indicative of renal failure)
- mL/min
- males —> 90-140
females —> 80-125

GFR = Puf x Kf
- Puf = net ultrafiltration pressure
- Kf = ultrafiltration coefficient
- depends on membrane permeability and surface
area

18
Q

What are the 2 mechanisms for GFR regulation?

A
  1. Myogenic mechanism:
    • arterial pressure inc —> afferent arteriole
      contracts —> blood flow dec
  2. Tubulo-glomerular feedback mechanism:
    • GFR inc —> inc NaCl in loop of Henle —> macula
      densa detects —> inc ATP and adenosine
      secreted —> afferent arteriole contricts
    • GFR dec —> dec NaCl in loop of Henle —> macula
      densa detects —> dec ATP and adenosine
      secreted —> afferent arteriole dilates
19
Q

What is C and how is it calculated?

A

Renal Clearance
- volume of plasma cleared of a specific substance via
the kidneys per unit time
- mL/min

C = (U x V) / P
- U = conc of substance in urine
- V = rate of urine production
- P = conc of substance in plasma

20
Q

Which 2 substances are used to determine GFR and why?

A
  1. Inulin - must be transfused from plants —> less use
  2. Creatine - muscle metabolism waste —> common
    - Freely filtered (no reabsorption or secretion)
    - Non-toxic
21
Q

What is FF and how is it calculated?

A

Filtration Factor
- proportion of filtered plasma fluid that reaches the
afferent arteriole
- 0.15-0.2 (15-20% filtered)
- use PAH to measure - all removed from plasma
through kidney

FF = GFR / RPF
- GFR = glomerular filtration rate
- RPF = renal plasma flow

22
Q

Which substance is used to calculate FF and why?

A

PAH = Para AminoHippurate
- all removed from plasma —> amount entering
kidney = amount excreted —> RPF = C

23
Q

What are the 5 transport mechanisms used in renal tubules?

A

Passive:
1. Diffusion
2. Osmosis
3. Electrochemical gradient

Active:
4. Primary —> Na+/K+ ATPase pump
—> endocytosis
5. Secondary (coupled) —> symport eg. Na+/glucose
—> antiport eg. Na+/H+

24
Q

What are the 2 transport pathways used in renal tubules?

A
  1. Transcellular —> across basolateral membrane
    cells via transport proteins
  2. Paracellular —> via tight junctions between
    basolateral membrane cells
25
Q

Which substances are reabsorbed and secreted in the early PCT?

A

Reabsorbed:
- Water —> 67%
- Na+ —> 67%
- Cl- —> 67%
- HCO3- —> 80%
- Urea —> 50%
- Glucose —> 100%
- Amino Acids —> 100%

Secreted:
- Drugs
- Ammonia
- Bile salts
- Prostaglandins
- Vitamins (B+C)

26
Q

How does Na+ and HCO3- reabsorption occur in the early PCT? (4)

A
  1. Na+/K+ ATPase pump (b) —> Na+ out, K+ in —> low
    Na+ in cells
  2. CO2 diffuses in —> react with water (CO2 + H2O —>
    HCO3- + H+) using carbonic anhydrase —> high H+
    in cells
  3. Na+/H+ antiporter (b) —> Na+ in, H+ out (regulated
    by angiotensin II)
  4. Na+/3 HCO3- symporter (b) —> Na+ out, 3 HCO3-
    out —> reabsorbed to blood
27
Q

How does glucose reabsorption occur in the early PCT? (3)

A
  1. Na+/K+ ATPase pump (b) —> Na+ out, K+ in —> low
    Na+ in cells
  2. SGLT2 (Na+/glucose symporter) (a) —> Na+ in,
    glucose in
  3. GLUT2 (b) —> glucose out —> reabsorbed to blood
28
Q

How is Na+ reabsorption regulated in the early PCT?

A

Angiotensin II —> inc Na+/H+ antiporters

29
Q

What happens at the loop of Henle? (4)

A
  1. No aquaporins in ascending limb —> no water out
  2. Na+ and Cl- out ascending limb —> passive in thin
    —> active in thick
  3. Outside loop —> v. low water potential (salty)
  4. Water out descending passively
    No Na+ or Cl- transporters —> no ions out
30
Q

How does Na+ and Cl- reabsorption occur in the thick ascending limb of the loop of Henle? (3)

A
  1. Na+/K+ ATPase pump (b) —> Na+ out, K+ in —> low
    Na+ in cells
  2. K+/Cl- symporter and channels (b) —> K+ out, Cl-
    out —> low Cl- in cells
  3. Na+/K+/2 Cl- symporter (a) —> Na+ in, K+ in, Cl- in
    —> out via transporters above —> reabsorbed
31
Q

Which substances are reabsorbed in the loop of Henle?

A
  • Na+ —> 25%
  • Cl- —> 25%
  • Water —> 15%
32
Q

How does Na+ and Cl- reabsorption occur in the early DCT? (4)

A
  1. Na+/K+ ATPase pump (b) —> Na+ out, K+ in —> Na+
    reabsorbed
  2. No aquaporins (a) —> no water in
  3. Na+/Cl- symporter (b) —> Na+ in, Cl- in
  4. K+/Cl- symporter + Cl- channels (b) —> K+ out, 3 Cl-
    out —> Cl- reabsorbed
33
Q

How does Ca2+ reabsorption occur in the early DCT? (3)

A
  1. Na+/K+ ATPase pump (b) —> Na+ out, K+ in —> low
    Na+ in cells
  2. Ca2+ channels (a) —> Ca2+ in —> high Ca2+ in cells
  3. Na+/Ca2+ antiporter + Ca2+ ATPase pump (b) —>
    Na+ in, Ca2+ out —> Ca2+ reabsorbed into blood
34
Q

How does Na+ reabsorption and K+ secretion occur in the distal DCT and collecting duct? (4)

A

Principle cells:
1. Na+ channels (a) —> Na+ in
2. K+ channels (a+b) —> K+ out
3. Na+/K+ ATPase pump (b) —> Na+ out, K+ in —> Na+
reabsorbed and K+ secreted
4. Aquporins (a+b)—> water in —> out —> water
reabsorbed

35
Q

How is blood and urine pH maintained by the collecting duct? (3x2)

A

Acidosis —> α-intercalated cells (urine too alkaline):
1. Cl- channels (b) —> Cl- out —> low Cl- in cells
2. Cl-/HCO3- antiporter (b) —> Cl- in, HCO3- out —>
HCO3- reabsorbed
3. H+ ATPase pump (a) —> H+ out —> H+ secreted

Alkalosis —> β-intercalated cells (urine too acidic:
1. Cl- channels (b) —> Cl- out —> low Cl- in cells
2. H+ ATPase pump (b) —> H+ out —> H+ reabsorbed
3. Cl-/HCO3- antiporter (a) —> Cl- in, HCO3- out —>
HCO3- secreted

36
Q

How is Na+ reabsorption in the distal DCT and collecting duct regulated?

A

Aldosterone —> inc apical Na+ channels
—> inc basolateral Na+/K+ ATPase pump
- inc Na+ reabsorption —> dec Na+ loss

37
Q

How is water reabsorption in the distal DCT and collecting duct regulated?

A

ADH —> inc apical aquaporins
- inc water reabsorption —> dec water loss

38
Q

What occurs at the early PCT? (2)

A
  1. Na+ and HCO3- reabsorption
  2. Glucose reabsorption
39
Q

What occurs at the early DCT? (2)

A
  1. Na+ and Cl- reabsorption
  2. Ca2+ reabsorption
40
Q

What occurs at the distal DCT and collecting duct? (2)

A
  1. Na+ reabsorption and K+ secretion
  2. Maintaining acid-base balance

2.9 BRS Urology and Renal (4 decks)

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