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kidney Flashcards

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1
Q

general parts of human urinary system

A

aorta
vena cava
renal artery
renal vein
kidney
ureter
bladder
urinary sphincter
urethra

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2
Q

human kidney parts

A

nephron
collection duct
cortex
medulla
fibrous capsule
pelvis
renal pyramids (w apex)
ureter
renal vein
renal artery

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3
Q

parts in diagram of nephron

A

branch of renal artery
branch of renal vein
afferent/efferent arteriole
glomerulus
Bowmans capsule
PCT
descending and ascending limb of loop of Henle
vasa recta
DCT
collecting duct

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4
Q

barriers between blood and glomerular filtrate

A

endothelial cells of blood capillary
basement membrane
podocytes (w filtration slits)

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5
Q

describe structure of the blood/nephron barrier

A
  1. numerous pores in endothelial cells of capillary walls allow blood to come into close contact
    with basement membrane
  2. basement membrane is a selective barrier. water-soluble substances with RMM <69,000 can cross
  3. podocytes are epithelial cells of the BC with long projections which attach to the basement membrane. filtrations occurs in the slits. allow blood components smaller than 100nm to pass into nephron
    presence of proteins in the blood means blood has low WP so some fluid retained by blood
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6
Q

3 functions of the kidney

A

ultrafiltration
selective reabsorption
secretion

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7
Q

define ultrafiltration

A

fluid part of the blood is filtered from the glomerulus into the renal tubule

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8
Q

define selective reabsorption in kidney

A

as fluid flows along tubules, useful substances are reabsorbed back into the blood in amounts required by the body

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9
Q

define secretion in kidney

A

unwanted substances are actively secreted in to the tubules

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10
Q

what does ultrafiltration require?

A

positive net filtration pressure
selectively permeable barrier

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11
Q

why does ultrafiltration require positive net filtration pressure?

A

to force fluid through the barrier

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12
Q

why does ultrafiltration require a selectively permeable barrier?

A

so rbc,wbc and plasma proteins retained bc remain in capillaries

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13
Q

how to work out net filtration pressure

A

HP in glomerulus - HP in BC
^^ subtract osmotic pressure in glomerulus

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14
Q

what is the glomerular filtration rate

A

measure of the volume of blood that can be filtered out by the kidneys every minute
can be used to measure kidney function -> the lower the GFR, the less effective the kidney function

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15
Q

average glomerular filtration rate

A

125cm3/min
declines with age

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16
Q

describe forces of ultrafiltration

A

blood enters the afferent arteriole/glomerulus from a branch of the renal artery at high pressure
this pressure forces small molecules into the Bowmans capsule (pressure filtration)
high HP generated by the difference in diameter between afferent and efferent arterioles
HP in BC is lower
oncotic pressure of proteins in blood in glomerulus

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17
Q

features of PCT epithelium

A

numerous microvilli (brush border)
basal infoldings
numerous mitochondria
good blood supply (close contact to capillaries)
co-transporter proteins and aquaporins
Na+/K+ pumps pump Na+ into blood

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18
Q

why does PCT epithelium have brush border (numerous microvilli)

A

increased surface area for reabsorption

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19
Q

why does PCT epithelium have basal inholdings

A

increased surface area for reabsorption into blood

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20
Q

why does PCT epithelium have numerous mitochondria

A

release ATP for active transport

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21
Q

why does PCT epithelium have good blood supply/ why’s it in close contact to capillaries

A

maintains steep concentration gradients
close to decrease diffusion distance

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22
Q

why does PCT epithelium have co-trasnporter proteins and aquaporins

A

transport Na+, glucose and amino acids
water transport

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23
Q

why does PCT epithelium have Na+/K+ pumps

A

maintains steep concentration gradient for Na+ and drives reabsorption of glucose, amino acids and water

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24
Q

what are the processes involved in selective reabsorption across the PCT membrane

A

active transport
secondary active transport
osmosis
facilitated diffusion

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25
Q

describe active transport in selective reabsorption across membrane of PCT

A

Na+/K+ pump actively removes Na+ from the PCT cell cytoplasm, causing it to enter the blood

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26
Q

describe secondary active transport in selective reabsorption across membrane of PCT

A

Na+ is transported into the PCT cell down its concentration gradient via a co-transporter protein which also carries glucose/amino acids at the same time (against their conc grad)

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27
Q

describe facilitated diffusion in selective reabsorption across membrane of PCT

A

amino acids and glucose diffuse into the blood

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28
Q

describe osmosis in selective reabsorption across membrane of PCT

A

water passively follows the salt movement and is reabsorbed by osmosis (via aquaporins)

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29
Q

the cells lining the PCT use end/exocytosis in addition to AT and FD to move molecules across membranes
suggest why

A

to transport the few proteins that’s have been filtered out into the nephron (<69000 RMM)
endocytosis transports proteins from PCT lumen into cells in its walls
exocytosis transports proteins from cells in PCT wall into the tissue fluid and the blood

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30
Q

how much fluid enters PCT per minute

A

125cm3

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31
Q

how much fluid enters loop of Henle per minute

A

45cm3

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32
Q

what percentage of glomerular filtrate is reabsorbed in PCT

A

over 80%

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33
Q

proportion of glucose, amino acids, vitamins and hormones reabsorbed in PCT

A

ALL

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34
Q

proportion of Na+ reabsorbed in PCT

A

85-90% (ACTIVE)
Cl- follows

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35
Q

proportion of water reabsorbed in PCT

A

65%

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36
Q

proportion of urea that diffuses out of PCT

A

50% (PASSIVE)

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37
Q

proportion of uric acid and creatinine reabsorbed in PCT

A

NONE

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38
Q

what is an isotonic solution

A

solution that has the same solute concentration as a cell
no net movement of water particles
overall concentration on both sides of cell membrane remains constant

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39
Q

what is a hypertonic solution

A

a solution that has a higher solute concentration than a cell
water particles move out of the cell, causing crenation/plasmolysis as the cell shrivels

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40
Q

what is a hypotonic solution

A

a solution that has a lower solute concentration than a cell
water particles move into the cell causing the cell to expand and eventually lyse/become turgid

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41
Q

2 hormones which increase water and sodium reabsorption

A

ADH
aldosterone

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42
Q

how does aldosterone increase water and sodium reabsorption

A

causes nephron DCT to reabsorb more Na+ and water, which increases blood volume

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43
Q

how does ADH increase water and sodium reabsorption

A

mediates insertion of aquaporins into nephron collecting duct cells; so more water reabsorbed into blood
increases sodium reabsorption in medulla of the kidney

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44
Q

aldosterone type of hormone
site of release and production

A

steroid hormone
adrenal cortex

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45
Q

ADH type of hormone
production site
site of release

A

peptide hormone
hypothalamus
pituitary gland

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46
Q

what moves into blood from DCT

A

Na+, water and Cl-
(water and Cl- follow the Na+)

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47
Q

what moves into DCT lumen

A

K+ (opposite direction to Na+), H+, NH4+

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48
Q

describe aldosterone action on DCT

A

encourages water reabsorption by causing active reabsorption of Na+ so water follows

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49
Q

which part of DCT responds to ADH

A

second part
behaves like collecting duct

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50
Q

DCT blood pH description

A

involved in controlling blood pH via secretion of H+ and NH4+ from blood into urine
helps keep blood pH at 7.4

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51
Q

collecting duct role

A

LoH establishes a WP gradient going down medulla
WP of tissues surrounding CD is lower than the fluid inside of it
if ADH present, CD walls more permeable to water
water removed from the filtrate in CD by osmosis, concentrating the urine

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52
Q

what does the loop of Henle act as

A

a hairpin countercurrent multiplier

53
Q

describe loop of Henle structure/ccm

A

the 2 limbs of the LoH run parallel but the fluid inside them runs in opposite directions
this enables the max concentration to be built up both inside and outside the tubule at the bottom of the loop (v. negative WP so more water can be reabsorbed by CD)

54
Q

how is the LoH countercurrent multiplier effect Brough about

A
  1. bc of close proximity of the descending limb and ascending limb
  2. descending limb permeable to water but less permeable to ions
  3. ascending limb impermeable to water
  4. thin ascending limb highly permeable to Na+ and Cl-
  5. thick ascending limb has active transport mechanism for pumping Na+/Cl-
55
Q

step by step counter current mechanism in LoH

A
  1. Na+ and Cl- ions diffuse out of thin part of AL. water would follow by osmosis but can’t bc AL impermeable to water
    2.as filtrate flows up AL, becomes less concentrated. thick part of AL actively pumps out more of the Na+ and Cl-, decreasing conc of filtrate
    3.movement of ions out of AL results in conc of tissue fluid around DL increasing
    4.DL is permeable to water and (slightly) to Na+ and Cl-. as filtrate flows through DL, water lost by osmosis and this moves into vasa recta (in close contact w nephron). some Na+ and Cl- diffuse into tubule down their conc grad
    5.by the time filtrate has reached bottom of loop, contains much less water and ions than at top. longer loop= gets more conc
  2. as filtrate flows up AL, conc of ions so great it is relatively easy for Na+ and Cl- to be lost so filtrate becomes less conc
56
Q

ADH vs aldosterone type of hormone

A

ADH= peptide
aldosterone= steroid

57
Q

ADH vs aldosterone synthesis and secretion site

A

ADH synthesised in hypothalamus and secreted from pituitary gland
aldosterone synthesised and secreted by adrenal cortex

58
Q

ADH vs aldosterone effect

A

ADH makes DCT and CD more permeable to water
aldosterone makes DCT and CD more permeable to sodium ions

59
Q

ADH vs aldosterone mechanism

A

ADH directly increases water reabsorption from tubules using aquaporins
aldosterone increases water reabsorption by creating an osmotic pressure

60
Q

ADH vs aldosterone effect on blood vessels

A

ADH increases Bp through vasoconstriction
aldosterone has no effect on blood vessels

61
Q

2 types on nephrons

A

cortical
juxtamedullary

62
Q

fraction of human nephrons that are juxtamedullary

A

1/3

63
Q

when do juxtamedullary nephrons perform their function

A

when water is in short supply

64
Q

effect of longer loop of Henle

A

longer loop= steeper WP concentration gradient in medulla
so more water reabsorbed in D
so more concentrated urine of smaller volume

65
Q

comparison of beaver, rabbit and kangaroo rat nephrons

A

beaver: cortical only bc aquatic habitat so less likely to become dehydrated (no need to conserve water)
rabbit: cortical and juxtamedullary bc terrestrial habitat so MAY need to avoid dehydration
kangaroo rat: juxtamedullary only bc desert habitat v dry so needs to preserve water

66
Q

describe changes in rate of flow through nephron

A

decreases across nephron due to reduction in fluid volume (less fluid to flow means less fluid passes a given point per unit time)

67
Q

describe rate of flow in PCT

A

flow rate is highest at beginning of PCT as fluid is entering
flow rate decreases as it flows along PCT as large percentage of fluid is reabsorbed so volume decreases

68
Q

describe rate of flow in LoH and DCT

A

flow rate continues to droop as reabsorption of water continues

69
Q

describe rate of flow in CD

A

rapid reduction in flow rate as high proportion of water reabsorbed

70
Q

describe changes in glucose conc through nephron

A

drops rapidly in PCT bc all glucose reabsorbed (Na+ AT into blood, glucose co-transported with Na+)

71
Q

describe change in urea conc through nephron

A

increases in PCT as, despite urea being reabsorbed, lots of water reabsorbed so the volume of water in which urea is dissolved decreases

72
Q

describe change in Na+ conc through nephron

A

PCT: conc remains constant, as despite Na+ reabsorption here, this is balanced by reabsorption of water
LOH: DL Na+ increases in con as water lost, in AL Na+ decreases as it is pumped out
DCT: Na+ increases (despite being actively pumped out) as lots of water reabsorbed here
CD: Na+ increases as water removed

73
Q

describe change in K+ conc through nephron

A

increases throughout DCT and CD as it is actively moved into the filtrate as sodium is reabsorbed

74
Q

what is osmoregulation

A

the control of water and salt content of the body by negative feedback
ensures total volume of blood plasma + concentration remains constant

75
Q

what is negative feedback

A

change away from a set point that leads to a reversal of the change to return to the set point

76
Q

control of water content of the body fluids is achieved by:

A
  1. osmoreceptors and thirst centres in hypothalamus
  2. hormone ADH
  3. angiotensin system
  4. aldosterone
77
Q

what is the angiotensin system

A

increases thirst
when BP drops, the angiotensin system acts on the adrenal gland (zona glomerulosa) causing release of aldosterone

78
Q

aldosterone effect

A

increases active reabsorption of Na+ in DCT and water follows

79
Q

role of osmoreceptors in stimulating thirst centres

A

osmoreceptors detect low blood water content and activate thirst centres in the hypothalamus of the brain
increased thirst
more water taken in
stops activation of thirst centres

80
Q

what does the hypothalamus contain

A

thermoregulatory and osmoregulatory centres

81
Q

ADH synthesising neurone role

A

make ADH in the cell body-> diffuses down axon in the synaptic bulb into vesicles, which are released directly into blood

82
Q

ADH structure
site of synthesis
where does it move and is stored

A

polypeptide of 9 amino acids
hormone made in cell body of neurosecretory cells in the hypothalamus
passes down axons to the posterior lobe of the pituitary gland where it can be stored

83
Q

where are osmoreceptors

A

hypothalamus

84
Q

what triggers osmoreceptors

A

a difference in WP of the blood and WP of the osmoreceptors can cause water to enter or leave the osmoreceptor by osmosis

85
Q

what happens when WP of blood is low

A

osmoreceptors lose water, shrink and their volume decreases
this triggers stimulation of neurosecretory cells in the hypothalamus
AP passes along the axon to the nerve endings in the posterior lobe, causing release of ADH which is secreted directly into blood (endocrine gland)

86
Q

ADH pathway from posterior lobe

A

travels in blood to kidney

87
Q

ADH affect on kidney

A

increases permeability of DCT and CD to water
more water is reabsorbed and therefore th volume of urine produced decreases but the concentration of urine incerases

88
Q

mechanism of ADH

A

binds to receptors in cell surface membrane of cells lining CD and DCT
activates G protein, which activates adenyl cyclase which converts ATP to 2nd messenger cAMP
cAMP activates protein kinases A causing vesicles containing aquaporins to move to the cell surface membrane
vesicles fuse w cell surface and insert aquaporins
water can now move freely through membrane down its WP gradient then into tissue fluid and then into the blood
NEGATIVE FEEDBACK

89
Q

why do CD cells not respond immediately to the stopping of ADH secretion by the posterior pituitary gland

A

bc it takes some time for the ADH already in the blood to be broken down
however, once ADH stops arriving at the CD cells, it takes only 10-15 minutes for the aquaporins to be removed from the cell surface membrane and taken back to cytoplasm for storage

90
Q

describe activation of aldosterone

A

dehydration causes blood pressure to decrease, and this leads to aldosterone release from the adrenal cortex

91
Q

aldosterone type of hormone
where does it act

A

steroid hromone
acts on intracellular receptor in cytoplasm and leads to an increase in ion channels in the membrane of the DCT cells

92
Q

aldosterone effect

A

induces Na+ reabsorption and K+ secretion
also leads to Cl- reabsorption and water reabsorption by osmosis
salt and water reabsorption increases BP

93
Q

what is diabetes insipidus

A

lack of ADH
make lots of dilute urine

94
Q

factors contributing to/causing kidney failure temporarily/permanently

A

bacterial infection
external mechanical injury
high BP
diabetes type 1 or 2
polycystic kidney disease
side effects of some medications
kidney stone/blockage preventing kidney drainage

95
Q

indicators/signs of kidney failure

A

blood and protein in urine (making it cloudy)
oedema (swelling)
anaemia and tiredness
lower GFR
creatinine in blood
rashes and nausea
retention of urea

96
Q

why is oedema a symptom of kidney failure

A

accumulation of salt and water (tissue fluid) in tissues due to blood protein loss in urine also due to high HP

97
Q

why is anaemia and tiredness a symptom of kidney failure

A

kidneys stop producing erythropoietin which is a hormone which promotes red blood cell production in the bone marrow

98
Q

lower GFR due to kidney failure

A

normally 125cm2/min
cut by half

99
Q

why is creatinine in blood a symptom of kidney failure

A

blood can be analysed for waste creatinine
this increases in blood as disease progresses as kidneys fail to remove waste

100
Q

why are rashes and nausea a symptom of kidney failure

A

buildup of toxins

101
Q

why is retention of urea a symptom of kidney failure

A

cause blood pH to drop and in untreated renal failure can be fatal for this reason

102
Q

types of treatment for kidney failure

A

haemodialysis
peritoneal dialysis
kidney transplant

103
Q

describe haemodialysis

A

artificial kidney machine
patients blood passes along numerous tubes made of partially permeable dialysis membrane
the tubes are immersed in the dialysis fluid

104
Q

how is haemodialysis efficiency improved

A

blood flows in opposite direction to dialysis fluid
COUNTERCURRENT
maintains steep conc gradient

105
Q

features of haemodialysis: blood vessels used?

A

efficient dialysis requires a high rate of blood flow through machine (200-300cm3/min)
arteries r the only blood vessel which will deliver blood at the necessary pressure but are deeper and narrower than veins so piercing an artery each time has high risk
therefore, blood can be taken from a vein and fed through a pump, or an artery can be joined to this nearby vein creating an arteriovenous fistula

106
Q

how often is dialysis fluid replaced and why (haemodialysis)

A

frequently
ensures steep concentration gradient is maintained for removal of unwanted substances from the blood

107
Q

temperature of dialysis fluid

A

warmed to ensure same as body temp so blood temp remains constant

108
Q

what does haemodialysis fluid contain

A

glucose
ions (Na+, Cl-)
water
prevents diffusion of these into the dialysis fluid

109
Q

haemodialysis frequency of treatment

A

2-3 times a week for several hours
affects lifestyle

110
Q

any restrictions between haemodilaysis treatment?

A

monitor and restrict parts of diet e.g. no excess protein, regulate salt and water to regulate BP

111
Q

why must blood flwo continuously through dialysis machine

A

so no clots form

112
Q

describe peritoneal dialysis

A

dialysis fluid introduced into the abdominal cavity using a catheter
abdominal cavity and all the organs are lined w a peritoneal membrane (covers area of 10m2 and has its own extensive blood supply)
while fluid is in cavity, equilibrium takes place between the fluid and surrounding blood and since fluid is changed regularly, toxic substances are lost from blood

113
Q

peritoneal dialysis fluid replacement

A

fluid is left in 24 hours a day and replaced 3-5x a day

114
Q

freedom w peritoneal dialysis

A

a person can move around freely and take control of their own dialysis

115
Q

haemodialysis vs peritoneal dialysis: membrane

A

H: artificial membrane- cannot do AT/FD so relies on simple diffusion
P: peritoneum: peritoneal wall is made up of living cells so can perform AT and FD

116
Q

haemodialysis vs peritoneal dialysis: counter current?

A

H: uses countercurrent flow to maintain steep conc grad
P: doesn’t use countercurrent flow and conc grad is lower/ reaches equilibrium with the blood

117
Q

haemodialysis vs peritoneal dialysis: fluid change

A

H: fluid constantly refreshed/changed
P: fluid drained then changed every 4-6 hours

118
Q

haemodialysis vs peritoneal dialysis: how often

A

H: only need treatment 3 times a week
P: needs to be carried out every day

119
Q

disadvantages of kidney transplants

A

not enough donor organs to go around
risk of rejection and need to take immunosuppressant drugs
kidney must come from a healthy person w a tissue match close to the patient
involves major surgery under anaesthetic so risky
only about 50% of people eligible

120
Q

advantages of kidney transplants

A

best life-extending treatment
freedom from repeated and time consuming dialysis
feel physically better almost immediately and diet less limited
improved life quality able to travel whiteout disruption
improve self-image: no longer feeling chronically ill

121
Q

what can urine testing help to detect

A

blood in urine: indicates bladder or kidney cancer
urine cytology can detect cancer cells in the urine under a microscope
glucose test using biosensor to diagnose diabetes
detect recreational drug use (gas chromatography)
detect anabolic steroids days/weeks after last dose
pregnancy testing

122
Q

what are anabolic steroids

A

drugs which mimic the action of steroid hormones that increase muscle growth by increasing protein synthesis in cells

123
Q

anabolic steroids effects

A

athletes can train for longer and ave increased endurance as well as decreased recovery time

124
Q

side effects of anabolic steroids

A

liver damage
infertility in men bc sperm production affected
menstrual cycle affected

125
Q

how is urine used for pregnancy testing

A

once the embryo has implanted into the uterine lining, the embryo starts secreting a pregnancy hormone called hCG
found in urine as early as 6 days after conception
test for presence of hCG in urine

126
Q

hCG structure

A

small glycoprotein
RMM of 36700 so can pass into Bowmans capsule and is therefore found in urine

127
Q

describe old pregnancy testing using mice

A

hCG antigens injected
mouse detects foreign antigen
plasma cells produced are fused with myeloma cells (cancer cells) to produce hybridoma cells
this produced a monoclonal antibody which can bind to hCG antigen

128
Q

describe modern pregnancy test mechanism

A

urine applied to stick (urine contains hCG) these molecules are carried up the strip in the urine by capillary action
in the 1st region of the stick there are mobile, dye-labelled monoclonal antibodies which recognise and attach to the hCG only
these antibodies are carried to the test window. at the test site, fixed monoclonal antibodies are anchored. these only bind to the hCG-antibody complex, and when they do, the dye/coloured beads make a blue/red line. antibodies which have no hCG attach don’t bind so do not form a blue/red line
2nd window is a control site where 2nd set of fixed antibodies capture labelled antibodies on their own (this is a positive control to prove the test is working as antibodies will attach here whether they have bound to the hCG or not) it proves antibodies have moved to the top of the test strip

129
Q

explain the role of the Loop of Henle in the production of urine

A

LOH causes decrease in WP going down medulla
Na+ and Cl- AT out of AL
DL walls permeable to H2O so water removed
WP surrounding CD lower so water removed from CD when ADH present

biology (27 decks)

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