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The Renal System > Gross structure and function of the renal system > Flashcards

Gross structure and function of the renal system Flashcards

1
Q

What structures make up the renal system

A

two kidneys
two ureters
one urethra
bladder

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2
Q

What are the key functions of the renal system

A

excretion
elimination
homeostatic regulation

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3
Q

What are the homeostatic functions of the kidney

A

Regulating blood volume and blood pressure
Regulating plasma ion concentrations
Stabilising blood pH
Conserving valuable nutrients and excreting waste products
Detoxify poisons

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4
Q

What does each nephron consist of

A 
Renal corpuscle (consisting of the glomerulus and the Bowman's capsule and the 
renal tubule)
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5
Q

What is the renal tubule divided into

A

Proximal convoluted tubule
loop of Henle
Distal convoluted tubule

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6
Q

What processes does the nephron undertake in the formation of urine

A

Filtration
Reabsorption
Secretion

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7
Q

What does the Bowman’s capsule of epithelial cells act as

A

A filter of the blood entering through the afferent arteriole

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8
Q

What is the juxtaglomerular apparatus situated in the renal corpuscle important for

A

Regulation of fluid and electrolyte balance

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9
Q

What does the proximal convoluted tubule consist of

A

fused cuboidal epithelial cells

mitochondria

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10
Q

What happens in the PCT

A

all the nutrients (glucose and amino acids) and most of the electrolytes (sodium, chloride and bicarbonate) are reabsorbed here with water

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11
Q

What are the cells of the descending limb like

A

thin and permeable

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12
Q

What does the LOH create through the medulla

A

An osmotic gradient

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13
Q

What does the thick section of the ascending loop of Henle do

A

Moves sodium from the filtrate into the interstitial fluid by active transport using ATP

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14
Q

What hormone increases the permeability of the collecting duct

A

ADH

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15
Q

What system regulates the amount of ions reabsorbed from the distal tubule

A

The RAAS

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16
Q

What does aldosterone do

A

stimulates the reabsorption of sodium into the interstitial fluid and secretion of potassium into the tubular filtrate

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17
Q

what do intercalated cells in the distal convoluted tubule do

A

reabsorb the bicarbonate remaining in the filtrate after the reabsorption in the proximal tubule. this leads to excretion of acid urine.

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18
Q

Where does the filtrate move through

A

the collecting ducts via the calyces into the pelvis of the kidney and then ureter

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19
Q

what three processes form urine

A

filtration, selective reabsorption and secretion

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20
Q

what does glomerular filtrate consist of

A

water, sodium, glucose and waste products

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21
Q

what is the GFR

A

the rate at which the filtrate is formed (ml/minute)

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22
Q

What substances do you examine in excretion of urine to determine GFR

A

Insulin or creatinine clearance

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23
Q

What does the filtrate consist of

A

electrolytes (sodium and potassium), urea, uric acid and creatinine but not protein or cells

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24
Q

What is selective reabsorption

A

The movement of fluid and solutes from the tubular system into the peritubular capillaries

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25
Q

what three processes does reabsorption occur via

A

osmosis, diffusion and active transport

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26
Q

What is secretion

A

The removal of waste products and substances not required by the body that are extracted from the blood, passed into the convoluted tubules and collecting ducts and excreted from the body in urine

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27
Q

What substances are secreted

A

waste products of metabolism (urea, creatinine, ammonium ions), foreign materials such as drugs, H+ ions or bicarbonate ions

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28
Q

What % of substances make up urine

A

95% water

5% dissolved liquids and gases

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29
Q

What is the pH of urine

A

4.5-8.0 (average 6.0)

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30
Q

What is the normal composition of urine

A

Water, urea, uric acid, creatinine, ammonia, sodium, potassium, chloride, bicarbonate, calcium, magnesium and phosphate

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31
Q

What should urine not normally contain

A

Protein, glucose, blood, ketones, white blood cells and casts

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32
Q

what do the ureters do

A

collect urine from the calyces of the kidneys and drain it into the bladder by peristalsis

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33
Q

When does Vesicoureteral reflux occur and what can it cause and why

A

When the oblique entry of the ureter into the bladder is straightened and back flow of urine from the bladder into the ureter occurs. Can cause infection because it enables bacteria to ascend from bladder to kidneys.

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34
Q

What is the area at which the ureters enter the bladder

A

The trigone

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35
Q

What initiates the need to micturate

A

The stretching of receptors in the trigone of the bladder

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36
Q

What is the main muscle of the bladder

A

The detrusor

37
Q

What is the bladder lining formed of

A

Transitional epithelium

38
Q

When empty, what do the bladder walls fold into

A

Rugae

39
Q

What volume of urine can be held in the bladder and at what point does micturition occur

A

600-800ml

150-300ml

40
Q

what is the role of the urethra

A

carries urine from the bladder to the external urinary meatus to remove excess fluid from the body

41
Q

How long is the female urethra

A

4.8-5.1cm

42
Q

Where does the female urethra exit the body

A

through the external meatus of striated voluntary muscle between clitoris and vagina

43
Q

What are the 3 layers of the urethra

A

Muscular, erectile and mucosal

44
Q

Which nerves control the external urethral sphincter

A

The pudendal nerves

45
Q

How long is the male urethra

A

15-29cm

46
Q

What are the 4 parts of the urethra in males

A

pre-prostatic
prostatic
membranous
spongy (or penile)

47
Q

What higher brain centres are responsible for the voluntary control of the micturition reflex

A

The pons of the hindbrain and the cerebrum

48
Q

What happens during the storage stage of bladder activity

A

Distension of the bladder occurs as urine collects and when 150ml has collected, stretching provides stimulus to the sympathetic nervous supply to the bladder. This inhibits contraction of the detrusor and constricts the internal urethral sphincter around the neck of the urethra, preventing micturition. When urine volume reaches 400ml, desire to pass urine occurs and is prevented by voluntary contraction of the external urethral sphincter through the pudendal nerves.

49
Q

What happens during the voiding stage of bladder activity

A

Neurons in the micturition centre send maximum impulses to the sacral centre and the parasympathetic fibres stimulate contraction of the bladder and relaxation of the internal urethral sphincter. The external urethral sphincter is consciously relaxed enabling micturition to occur.

50
Q

What is urinary incontinence

A

a condition in which involuntary loss of urine is a social or hygienic problem

51
Q

What are the different types of incontinence

A 
stress UI 
urge UI 
Mixed UI 
Overflow UI 
Reflex UI 
Enuresis (involuntary loss of urine) 
nocturnal enuresis 
Functional UI
52
Q

What cells are inside the epithelium of the nephron

A

Podocytes (filtration slits)

53
Q

What are the three types of cells in the juxtaglomerular region of the nephron

A

macula dense
extraglomerular mesangial
juxtaglomerular cells

54
Q

What do the macula densa cells do

A

sense when levels of sodium and chloride are low e.g. hypovolemia and hypotension

55
Q

what do the extraglomerular mesangial cells do

A

help with signalling between macular densa and juxtaglomerular cells

56
Q

what do juxtaglomerular cells do

A

recieve signals from the macula densa cells and sense low blood pressure. secrete renin that increases sodium reabsorption - raises blood volume and increases constriction of blood vessels, which raises BP.

57
Q

What forces water and small solutes across the glomerulus membrane

A

The hydrostatic pressure

58
Q

Why does the osmotic concentration in the fluid around the descending limb increase

A

the descending limb is permeable to water and relatively impermeable to solutes

59
Q

What is stress incontinence

A

Incontinence due to coughing/sneezing/laughing

60
Q

what is urge incontinence

A

Abrupt and intense urge to urinate

61
Q

What is overflow incontinence

A

overflow of urine due to blockage of urethra causing overfilling

62
Q

what is functional incontinence

A

due to impaired functioning of the nervous system

63
Q

what does ADH (antidiuretic) control

A

blood volume

controls volume of urine produced by controlling the amount of water present within urine

64
Q

what does the RAAS control

A

blood pressure

65
Q

what structure produces ADH

A

the pituitary gland

66
Q

What is the pathway of activity when the hypothalamus detects too little water in blood

A

pituitary gland releases ADH
ADH acts on the kidneys to reabsorb water back into the blood
less water is lost in urine (urine more concentrated)
blood water level returns to normal

67
Q

describe the pathway of the RAAS when blood pressure or fluid volume drops

A

renin released from kidney
angiotensin released from liver
renin acts on angiotensinogen to form angiotensin 1
ACE released from lungs and acts on angiotensin 1 to form angiotensin 2
angiotensin 2 acts on blood vessels stimulating vasoconstriction and decreasing GFR
angiotensin 2 acts on adrenal gland to stimulate release of aldosterone
aldosterone acts on kidneys to stimulate reabsorption of salt and water

68
Q

why would you carry out urinalysis

A

screening
diagnosis
management and planning

69
Q

what should not be present in urine

A 
proteinuria 
red blood cells 
white blood cells 
microorganisms 
glucose 
ketones
70
Q

what would proteinuria indicate

A

breakdown of basement membrane in Bowman’s capsule due to injury, high blood pressure, toxins or pre-eclampsia

71
Q

what would red blood cells in urine indicate

A

injury, infection, kidney stones

72
Q

what would white blood cells or microorganisms in the urine indicate

A

infection or inflammation

73
Q

what could glucose in the urine indicate

A

diabetes mellitus or pregnancy

74
Q

what would ketones in the urine indicate

A

excessive fat breakdown e.g., starvation, uncontrolled type 1 diabetes, diabetic ketoacidosis

75
Q

why are UTI’s more common in females

A

they have a shorter urethra so more bacteria can enter and less distance for them to travel

76
Q

what is the main bacteria that causes UTI’s

A

E-coli

77
Q

what 3 structures does the kidney develop from fetally

A

pronephros, mesonephros, metanephros (functional kidney)

78
Q

how are waste products cleared from the blood during pregnancy

A

through the placenta

79
Q

what happens to nephrons with maturation

A

the number does not grow but they do grow in weight and function

80
Q

before what age should bladder control be accomplished

A

5

81
Q

which area of the spinal column controls bowel and bladder

A

sacral area

82
Q

what is cystitis

A

infection of the bladder

83
Q

what is pyelonephritis or glomerulonephritis

A

infection of the kidney (inflammation of the glomerulus or nephron)

84
Q

symptoms of kidney infection

A

fever, shivery, sick, pain in back or side, symptoms of UTI

85
Q

what is renal agenesis

A

when a baby is born without kidneys

86
Q

what is vesicoureteral reflux and what does it cause

A

abnormal development of the ureteric and bladder junction

causes backflow of urine up the ureter meaning the bladder does not empty properly

87
Q

what is hypospadias

A

a condition where the urethral meatus is located on the under surface of the penis

88
Q

what is epispadias

A

a condition where the urethral opening is located on the upper surface of the penis

The Renal System (2 decks)

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