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HSF > HSF 4 - Unit 1 Physiology: Organization of the Urinary System > Flashcards

HSF 4 - Unit 1 Physiology: Organization of the Urinary System Flashcards

1
Q

what are the major functions of the kidney?

A

homeostatic, excretory, and endocrine

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2
Q

what are the homeostatic functions of the kidney?

A

regulation of ECF blood pressure by volume control
regulation of ECF electrolyte composition by osmolality control
regulation of ECF acid-base balance

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3
Q

what are the excretory functions of the kidney?

A

metabolic waste products like urea and creatinine

foreign substances and toxins like drugs and pesticides

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4
Q

what are the endocrine functions of the kidney?

A

regulation of blood pressure with renin
EPO for RBC production
Vitamin D activity and gluconeogenesis (50%)

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5
Q

what are the 2 types of nephrons? what are the differences?

A

cortical (7/8) shorter loops, juxtamedullary (1/8) longer loops and bigger glomeruli so can concentrate urine more

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6
Q

what are the parts of the early nephron? what are the functions of each part?

A

glomerulus (filtration), PT (reabsorption of salts and drug secretion) LOH (DL, reabsorption of water)

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7
Q

what happens if you lose nephrons? what is considered the ‘point of no return’?

A

they adapt to compensate, but if you lose over 50% you are pushed towards kidney failure/uremia

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8
Q

what happens to nephrons as you age?

A

<10% lost per decade after 40 years of age, by age 80 are left with about 480k-720k

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9
Q

how many nephrons do we have?

A

800k-1.2 mil per kidney

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10
Q

what are the parts of the mid to late nephron? what are the functions of each part?

A

LOH (AL, NaCl reabsorption and adjusting salts)

DCT (adjusting salts), CD (adjusting water)

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11
Q

what is the flow of fluid in nephrons to the rest of the kidney? how does it get moved into the rest of the urinary tract and what control is it under?

A

fluid from nephrons dumps into collecting ducts, connected to calyces that have a stretch induced pacemaker myogenic activity, which induces peristaltic contractions from calyces to the renal pelvis to the ureters; the lower ureter peristalsis pumps the fluid into the bladder; parasympathetic control increases peristalsis where sympathetic inhibits peristalsis

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12
Q

what muscles control micturition?

A

detrusor (smooth muscle around the bladder), internal sphincter, external sphincter, ureter

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13
Q

how does the detrusor muscle control micturition?

A

micturition reflex via gap junctions, contractions +40-60 cm H2O; deltaP = urination

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14
Q

how does the internal sphincter muscle control micturition? what is is composed of?

A

involuntary tonic contraction; detrusor muscle + elastic tissue

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15
Q

how does the external sphincter muscle control micturition?

A

voluntary skeletal muscle that the higher brain centers control to prevent urination

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16
Q

how does the ureter control micturition?

A

high intraluminal pressure pushes on ureter to reduce reflux like a valve

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17
Q

what is the micturition reflex?

A

an autonomic spinal cord reflex using self-regenerating contractions to raise bladder pressures

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18
Q

what is the stretch reflex of the bladder?

A

it is initiated by sensory stretch receptors in the bladder wall, stretch is sent to the CNS via sensory afferent pelvic nerve fibers and comes back to bladder via efferent parasympathetic pelvic nerve fibers

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19
Q

what nerves control the bladder?

A

hypogastric, pelvic, pudendal

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20
Q

how does the hypogastric nerve control the bladder?

A

sympathetic, B3R on the bladder that is relaxed with NE, a1R on the internal sphincter that contracts with NE

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21
Q

how does the pelvic nerve control the bladder?

A

parasympathetic, M3R on the bladder, contraction with Ach; cGMP on the internal sphincter that relaxes with NO

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22
Q

how does the pudendal nerve control the bladder?

A

somatic, external sphincter has Nicotinic R that contracts with Ach

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23
Q

what does a decrease in sympathetic activity cause?

A

relaxation of internal urethral sphincter

24
Q

what does an increase in parasympathetic activity cause?

A

contraction of the detrusor muscle

25
Q

what does a decrease in somatic motor neuron activity cause?

A

relaxation of external urethral sphincter

26
Q

what does an increased volume of fluid in the bladder cause?

A

expansion of the wall and activation of the stretch receptors, which cause variable effects on the spinal cord

27
Q

why does the kidney get ____% of the cardiac output?

A

20; because it filters the blood even though it is a fairly small organ

28
Q

what is the path of blood flow through the kidney?

A

arcuate a., interlobular a., afferent arteriole, glomerulus, efferent arteriole, peritubular capillaries, vasa recta, interlobular v., arcuate v.

29
Q

what is special about the afferent arteriole?

A

high pressure where hydrostatic pressure > oncotic pressure to drive filtration (water pushed out blood vessel)

30
Q

what is special about efferent arteriole and peritubular capillaries?

A

lower pressure as flows out in this direction with oncotic > hydrostatic (high concentration of unfiltered blood proteins) to allow reabsorption of fluid

31
Q

what is special about the vasa recta?

A

continuations of efferent arterioles that run parallel to the collecting tubules and the loops of henle to provide a counter-current, altered osmotic gradient for exchange

32
Q

what is TGF?

A

tubuloglomerular feedback; nephrons’ intrinsic ability to increase GFR (during low Na+ delivery) or decrease it during high Na+ by dilating or constricting the afferent arterioles

33
Q

what composes the JGA?

A

macula densa cells, juxtaglomerular cells, extracellular mesangial cells

34
Q

what do macula densa cells do?

A

NaCl sensors, release adenosine to constrict AAs, located in the distal tubular region

35
Q

what do juxtaglomerular cells do?

A

aka granular cells, SMCs of the afferent arteriole and secrete renin due to low pressure, input from macula densa or sympathetic input

36
Q

what do extracellular mesangial cells do?

A

unclear function but could help transmit signals for TGF or alter glomerular flow by contraction

37
Q

what are the 4 mechanisms the kidney filters the blood, regulates the ECF, and produces urine?

A

filtration (glomerular capillary to bowman’s space), tubular reabsorption (tubular lumen to peritubular capillary plasma), tubular secretion (peritubular plasma to tubular lumen), excretion (excreted urine = filtration - reabsorption +secretion)

38
Q

how does the kidney handle protein?

A

all stays in the vasculature

39
Q

how does the kidney handle inulin?

A

a portion moves through vasculature while some goes through the nephron for excretion

40
Q

how does the kidney handle K, Na, and urea?

A

a portion through vasculature, some through the nephron, some of this portion gets reabsorbed into vasculature

41
Q

how does the kidney handle glucose and bicarb?

A

some through vasculature and others through nephron but reabsorbed into vasculature

42
Q

how does the kidney handle PAH?

A

some through the vasculature and this gets secreted to nephron, other straight through nephron

43
Q

how does the kidney handle creatinine?

A

some through vasculature, some through nephron, of vasculature some secreted

44
Q

what are the aspects of the glomerular filtration barrier?

A

fenestrated capillary endothelium, glomerular basement membrane, podocyte with filtration slit diaphragm

45
Q

why is the charge of the basement membrane important?

A

negative, stops proteins from entering; if lost lose oncotic pressure so less force keeping water out of interstitial space and end up with edema

46
Q

what do the endothelial cells contribute to the barrier?

A

fenestrations that are size selective, 70 nm holes (RBCs, WBCs, no platelets)

47
Q

what do the podocyte cells contribute to the barrier?

A

visceral epithelial cells with foot processes (pedicels), overlie the BM, size selective with 40 nm slit pores

48
Q

what would mutations in the podocyte cause?

A

proteinuria/nephrotic syndrome

49
Q

what substances are freely filterable? which ones are not?

A

water, Na, glucose, inulin; myoglobin, albumin (very little for albumin); positive charged easier

50
Q

what is NFP?

A

(Pgc - Pbs) - (Pigc - Pibs)

51
Q

what is the major factor in filtration?

A

Pgc/glomerular capillary hydrostatic pressure; is proportional to filtration

52
Q

what is the difference between plasma and filtrate?

A

way more protein in the plasma

53
Q

what happens with LPS?

A

severe inflammatory signal that causes gut permeability

54
Q

what happens with EC swelling?

A

inhibits movement across the membrane

55
Q

what happens with diabetes?

A

thickening of the BM,, inhibition of movement across membrane

56
Q

what happens with minimal change disease?

A

proteinuria, protein molecules spill into the urine because of abnormalities in the capillary wall

57
Q

what happens with glomerulonephritis?

A

any renal disease where the immune cells destroy the glomerular barrier causing proteinuria

HSF (23 decks)

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