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Renal and Urology > Introduction to the Renal System > Flashcards

Introduction to the Renal System Flashcards

1
Q

six main functions of the kidney

A

filtration of blood
detoxification
regulation of blood pressure
regulation of blood pH
regulation of haematopoiesis
making vitamin D

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2
Q

what percentage of cardiac output is used by the kidneys?

A

20%

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3
Q

which kidney sits more superiorly

A

left

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4
Q

what size of molecules can pass through the glomerular filter

A

4nm is cut off
free flow below 1.8nm

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5
Q

how many layers make up the glomerular filter?

A

three

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6
Q

what is the coarsest layer of the glomerular filter

A

fenestrae in enthothelial cells

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7
Q

can blood cells pass through the the fenestrae in endothelial cells

A

no

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8
Q

how is the fenestrae in endothelial cells cleaned

A

mainly by bulk fluid flow

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9
Q

what is the second layer of the glomerular filter

A

glomerular basement membrane

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10
Q

what is the glomerular basement membrane made of

A

mesangial cells

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11
Q

how is the glomerular basement membrane cleaned?

A

by continuous replacement

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12
Q

what is the finest layer of the glomerular filter?

A

the slit diaphragm between podocyte processes (e.g. proteins like nephrin)

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13
Q

how is the finest layer of the glomerular filter cleaned

A

endocytosis of trapped proteins

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14
Q

what is the role of pressure in glomerular filtration

A

pressure is required to drive filtration against the colloid osmotic gradient back to the filtered plasma
pressure is also required to drive flow

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15
Q

how is pressure controlled through the glomerular filter

A

by how easily the blood is able to flow in and out which is controlled by afferent and efferent arteriole contraction

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16
Q

does higher pressure lead to more or less flow across the filter

A

more

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17
Q

what percentage of plasma is removed in the filtrate typically

A

20%

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18
Q

what type of substance is creatinine

A

nitrogenous waste

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19
Q

why is creatinine a good substance to use to estimate GFR

A

it is filtered from the plasma and is not subject to any transport mechanism thereafter/there is not recovery mechanism so everything filtered from plasma is excreted

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20
Q

why can urea not be used to estimate GFR

A

some can be reuptaken into the blood stream after initial filtration from the plasma

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21
Q

what is GFR

A

glomerular filtration rate

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22
Q

what is the equation for GFR

A

GFR = (urine flow rate x concentration of solute in urine)/concentration of solute in plasma

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23
Q

when can the concentration of creatinine rise in the plasma

A

with muscle use or muscle damage

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24
Q

what would you expect to happen to the plasma creatinine in someone who has just ran a marathon compared to before

A

it will rise a lot

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25
Q

give examples of types of reasons for the failure of the glomerular filter

A

congenital
damage by toxins
damage by immune attack

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26
Q

what happens in congenital Finnish nephrotic syndrome

A

protein leaks into the urine
glomerulosclerosis results

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27
Q

give example of congenital reasons for failure of glomerular filter

A

nephrin mutants

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28
Q

what is Goodpasture’s syndrome

A

autoimmune disease which attacks the collagen in the glomerular basement membrane leading to nephritic syndrome resulting in proteins and blood ending up in the urine

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29
Q

can glomeruli be replaced once it is lost

A

no

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30
Q

what is the cause of many glomerular pathologies

A

inappropriate behaviour of stem cells ‘trying’ to repair

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31
Q

what 10 molecules of the filtrate need to be recovered

A

water
sodium
potassium
calcium
chloride
bicarbonate
phosphate
glucose
amino acids
urea

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32
Q

why is some urea recovered from the filtrate

A

it is used to boost the hypertonicity of the medulla

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33
Q

how are molecules recovered from the filtrate

A
  1. cells use a primary active transporter (a basally located Na/K ATPase) to create a strong Na gradient across the apical membrane
  2. this gradient is used to power cotransport of other substances across the apical membrane
    to be continued…
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34
Q

what is the plasma creatinine level in healthy individuals

A

should be nearly 0 as cleared very quickly
however be aware of muscle damage or overuse causing a large rise

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35
Q

how does dialysis work

A

dialysate is full of the ‘wanted’ molecules so that there is no net movement of these molecules out of the blood into the dialysate
and the dialysate has not of the waste products so that these move out of the blood into the dialysate

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36
Q

which type of tubules have microvili - distal or proximal

A

proximal

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37
Q

what type of junctions are between epithelial cells of the glomerulus and what is special about these in the PCT

A

tight and adhaerens junctions
leaky in PCT

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38
Q

what is the function of tight junctions

A

stops fluid moving freely

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39
Q

what is the function of adhaerens junctions

A

sticks cells together

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40
Q

what type of cells make up the PCT and DCT

A

simple (single layer) epithelial

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41
Q

what cell organelle is very abundant in kidney cells and why

A

mitochondria
lots of energy is required for active transport

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42
Q

what is the role of ROMK channels

A

regulated leakage of potassium

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43
Q

what is controls transport of sodium and phosphate by SLC34A1 transporters

A

parathyroid hormones

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44
Q

what is a characteristic of the filtrate leaving the PCT

A

it is iso-osmotic with tissue

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45
Q

how is water drawn out of the descending limb of LoH

A

the membrane is permeable to water but not to salt
the membrane of the ascending limb is almost impermeable to water but is permeable to salt so salt is dumped into interstitial space
this makes the medulla very salty so water is drawn out of the descending limb

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46
Q

how does the concentration of urine change from the end of the PCT to the start of the DCT

A

water drawn out in descending limb - more concentrated
salt drawn out in ascending limb - less concentrated than when it started
less concentrated at start of DCT than PCT

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47
Q

where is the collecting duct found and what sort of environment is this

A

medulla
very salty

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48
Q

what three things happen in the collecting duct and how is this controlled

A
  1. urine is concentrated because water leaves by aquaporin channels into the very salty medulla
    this is controlled by vasopressin
  2. the urine receives K+ and H+ to control acid-base balance
  3. urine loses some urea which contributes to the hypertonic zone in the medulla
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49
Q

what is the vasa recta

A

capillary networks which supply the medulla/LoH

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50
Q

what are vasa recta permeable to

A

very permeable to salt and water

51
Q

how does blood flow compare to urine flow in the LoH

A

they move in opposite directions
efferent arteriole moves down the ascending limb of LoH and returns towards the renal vein up the descending limb of LoH

52
Q

what structures are found within the renal cortex

A

renal corpuscles
PCT
DCT

53
Q

what structures are found within the renal medulla

A

LoH
collecting duct

54
Q

is GFR independent or dependent of systemic blood pressure

A

relatively independent

55
Q

where is the juxtaglomerular apparatus found

A

the afferent and efferent arteriole cells which are in contact with the macula densa cells of the DCT

56
Q

where is the macula densa

A

on the DCT where it in contact with the afferent and efferent arterioles

57
Q

how does feedback and regulation work between the macula densa and juxtaglomerular apparatus

A
  1. macula densa cells pump NaCl from the filtrate at a rate limited by its concentration in the filtrate
  2. the JG cells respond to high NaCl by making adenosine (NaCl will be high when the filtrate is flowing too fast for proper recovery)
  3. adenosine constricts the afferent arteriole
  4. this reduces glomerular blood pressure which therefore reduces GFR
58
Q

what would be a problem that would arise from relying only on the local feedback mechanisms of the macula densa and JG apparatus

A

if DCT NaCl was high because someone had eaten a lot of salt, reducing GFR would be bad as the excess salt needs to be cleared

59
Q

what three systems control GFR

A

macula densa and JG apparatus
renin-angiotensin system
atrial natruietic peptide (ANP)

60
Q

what is the role of ANP

A

blocks the Na+ re-uptake channel collecting ducts and causes more sodium loss

61
Q

where in the renal tubule is K+ regualted

A

the collecting duct
elsewhere its movement is just driven by the Na+ gradients

62
Q

what two processes control K+ regulation in collecting duct

A
  1. potassium reabsorbed in exchange for hydrogen excretion
  2. collecting duct principle cells secrete potassium in proportion to K+ in tissue
63
Q

what happens to K+/H+ exchangers in collecting duct when body is in acute acidosis

A

more H+ is excreted so more K+ is reabsorbed

64
Q

what happens to K+/H+ exchangers in collecting duct when body is in acute alkalosis

A

less H+ is excreted so less K+ is reabsorbed

65
Q

what happens to collecting duct principle cells in response to chronic hypokalaemia

A

tyrosine phosphorylation of channels occurs
the channels are then withdrawn from the membrane
so phosphorylation excretion decreases
the opposite happens in chronic hyperkalaemia

66
Q

what problems can arise due to loop diuretic use

A

K+ reabsorption in the TAL of LoH gets messed up
high calcium in urine can cause stones

67
Q

why are diuretics useful in hypertension treatment

A

the dilute urine in the macula densa fools the tubuloglomerular feedback system into thinking blood pressure is too high
so renin release is stopped
this helps reduce BP

68
Q

why does fluid loss caused by diuretics not lower high blood pressure

A

because the fluid loss will be replaced by drinking

69
Q

MoA of carbonic anhydrase inhibitors

A

inhibit bicarbonate uptake in PCT so keep the lumen contents more osmotic
this inhibits water uptake later in the tubule (e.g. in the collecting duct)

70
Q

why do diabetics pee more

A

glucose can only be reabsorbed in the PCT
if there is too much glucose for it all the be reabsorbed it will remain in the filtrate
therefore the filtrate will be more concentrated and less water will be able to be reabsorbed into the body
so more will be peed out

71
Q

what is bilateral agenesis
how common is it
prognosis

A

no kidneys forming
rare
fatal after birth

72
Q

what is unilateral agenesis
how common is it
prognosis

A

only one kidney forms
1 in 500
fine as long as kidney stays healthy

73
Q

what are congenital cystic diseases
how common is it

A

overgrowth of the collecting ducts and/or fluid pumps are orientated the wrong way round
common

74
Q

what is Wilms’ tumour

A

‘islands’ of kidney remain in the primitive state and make a tumour very similar to normal developing kidney

75
Q

what are supernumerary ureters

A

many ureters
one enters trigone normally but other often ends up elsewhere on the uregenital sinus and therefore empties somewhere else (e.g. vagina or gut)

76
Q

how does a pelvic kidney form

A

kidney gets caught in aortic bifurcation and fails to ascend

77
Q

what is a horseshoe kidney and how is it formed

A

2 kidneys fuse
often occurs when two pelvic kidneys are forced together

78
Q

what is a urachial fistula

A

the passage to allantois should have closed but does not

79
Q

what is a urachial cyst

A

the passage to allantois closes at the body wall end, parts remain between there and the bladder

80
Q

what is a urethral valve

A

the ureter opens too low so that the prostate balloons under pressure and traps urine, causing more pressure

81
Q

how do rectovaginal, rectoprostatic and rectocloacal canals occur

A

as a result of failure of the folds to separate the cloaca

82
Q

what is hypospadias

A

the urethral orifice fails to migrate to the end of the penis

83
Q

what drug type does Bartter’s syndrome mimic

A

loop diuretics

84
Q

clinical effect of Bartter’s syndrome

A

loss of Na+
loss of K+
loss of Ca+
loss of lots of water

85
Q

what drug type does Gitelman’s syndrome mimic

A

thiazide diuretic

86
Q

clinincal effect of Giltelan’s syndrome

A

loss of Na+
loss of K+
loss of some water

87
Q

what is the clinical effect of Liddle’s syndrome

A

body volume expansion and hypertension

88
Q

treatment of Liddle’s syndrome

A

amiloride - potassium sparing diuretic

89
Q

cliniclal effects of pseudohypoaldosteronism

A

Na+ loss and K+ retention
symptoms mimic low aldosterone
but actually have high aldosterone as trying to correct the problem but can’t because of inactive ASC channels

90
Q

where is the molecular defect in nephrogenic diabetes insipidus

A

aquaporins

91
Q

symptoms of nephrogenic diabetes insipidus

A

polyuria
polydispia

92
Q

what is addisions disease

A

destruction of the adrenal glands

93
Q

what is the clinical effect of addisons disease

A

loss of Na+
retention of K+
loss of water - hypovolaemia

all due to the effects of low aldosterone

94
Q

clinical effects of psychogenic polydipsia

A

whole body hypo-osmolarity

95
Q

where do kidneys first develop in humans and what is the earliest form of kidney called

A

in thoracic region
mesonephros

96
Q

cloaca meaning

A

a common cavity at the end of the digestive tract for the release of both excretory and genital products in vertebrates (except most mammals) and certain invertebrates

97
Q

where does the mesonephros drain

A

via its mesonephric draining duct to the cloaca

98
Q

what happens to the mesonephros in females

A

it regresses

99
Q

what develops next to the mesonephros in males

A

testes

100
Q

where are the rete testis and epididymis formed

A

in ‘hijacked’ mesonephric tubules

101
Q

what three structures arise from the mesonephric duct

A

vas deferens and ejaculatory duct and seminal vesicles

102
Q

what pulls the testis into the scrotum

A

gubernaculum

103
Q

what type of kidney is used by adults mammals

A

metanephric

104
Q

how is the collecting duct system of the metanephric kidneys and ureters formed from the nephric duct

A

a side branch forms from the nephric duct close to where is empties into the cloaca
this is the ureteric bud which gives rise to the ureters
the end of the ureteric bud/ureters undergoes repeated branching
this forms the collecting duct system of the metanephric kidneys

105
Q

how are nephrons formed

A

cells surrounding the branching ureteric bud multiply and groups of cell condense in response to signals from the ureteric bud

106
Q

what impact does a low protein maternal diet have on kidney formation in a rodent fetus

A

less nephrons are formed

107
Q

how do the DCT and JG apparatus of the same nephron stay in contact with each other

A

the nephron begins as a curved tube and middle extends down into the medulla so the ends stay together

108
Q

at what stage of development do kidney ascend

A

week 10
don’t really ascend but rest of body elongates past them

109
Q

what three folds subdivide the cloaca into the anorectal canal and urogenital sinus

A

Tourneaux fold
r and l Rathke folds

110
Q

what structure does the bladder form from

A

the upper part of the urogenital sinus

111
Q

what structure runs roughly next to the nephric ducts

A

mullerian ducts

112
Q

what happens to mullerian ducts in males

A

regress because of secretion of anti mullerian hormone

113
Q

how is the fallopian tubes and uterus and vagina formed

A

the ends of the mullerian ducts fuse and contact the urogenital sinus
the unfused parts are fallopian tubes
the fused parts are the uterus and top of the vagina
the lower vagina is formed from the urogenital sinus itself

114
Q

where does the prostate form from

A

urethra in early foetal life

115
Q

where does the urogenital sinus open to the body wall and what structure is ventral to this

A

ventral to the anorectal canal
genital tubercle

116
Q

what happens to the genital tubercle in development

A

same in both sexes (initailly at least)
it grows and extends
the tip becomes the glans
the sides become the shaft of a developing phallus

117
Q

what are the swellings at the side of the genital tubercle called

A

labioscrotal swelling

118
Q

what happens to the enlargement of the phallus in females

A

stops enlarging early on and becomes the clitoris

119
Q

what happens to the labioscrotal swelling in females

A

become labia major which engulf the whole of the vulva area

120
Q

what happens to the urethral folds in females

A

form labia minora which encircles the urogenital sinus which forms the opening of the urethra and vagina

121
Q

what happens to the enlargement of the phallus and urethral fold in males

A

continues to enlarge and incorporates the urethral fold on its lower surface
the urethra migrates along this fold towards the tip of the penis and the urethral fold zips up

122
Q

what process and structures are responsible for penile erection

A

corpora spongiosa and cavernosa
when engorged with blood become hard

123
Q

what drives the difference in male and female sexual development

A

testosterone

Renal and Urology (16 decks)

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