Kidney Function 1 Flashcards

1
Q

Functions of the kidney

A
  • Control of the body fluid- REGULATION
    Volume Regulation- therefore regulate the interstitial flood and therefore intracellular composition
    Osmoregulation
    pH regulation by secreting and excreting H+ and reabsorbing HCO3-
- Excretion of Metabolites
  Urea- protein catabolism 
  Uric Acid- nucleic acid breakdown 
  Creatine- muscle creatine breakdown 
  End products of Hb Breakdown
  Metabolites of hormones 
  Foreign chemicals  eg. drugs 
  • EndocrineHormones that act on the kidney:
    ADH, aldosterone, natriuretic peptides, parathyroid hormone, fibroblast growth factor 23Hormones produced by the kidney:
    Rennin, vitamin D, erthpoietin, prostaglandins
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2
Q

Gross structure of the kidney

A

Kidneys positioned either side of the vertebral column between T12- L3. Back of the abdominal cavity, outside of the peritoneum

Concave surface-face each other
Convex surface faces the abdominal wall

Ureter- originates from the the concave surface
Moves urine from the kidney to the bladder by peristalsis.

Urine is stored int he bladder until it is expelled

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3
Q

Renal Corpuscle- Structure

A

Initial filtering mechanism of the nephron
Consists of glomerulus and bowman’s capsule
Golumerulus consists of a compact loops of interpolated capillary loops

Filtered through the filtering interface enters the bowman’s capsule

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4
Q

Filtering interface

A

Fenestrated capillarity endothelium- LEAKY

Basement membrane- fixed polyanions-

i) lamina densa
ii) lamina interera
iii) lamina externa

Podacytes- tubular epithelium- speciliased

central body and very long foot processes- these interdigitate and form filtration slits for which fluid can move.

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5
Q

Tubule

A

Proximal convuluted tubule
proximal straight tubule

descending thin limb of Henle’s loop
Ascending thin limb of Henle’s loop
Ascending thick limb of Henle’s loop

Distal Convoluted loop

Cortical collecting duct

Medullary collecting duct

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6
Q

nephron types-

A

cortical- outer 2/3 of cortex- short loop of Henle

Juxtamedullary- inner 1/3 cortex- long loop of Henle- concentrated urine- more water conserved

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7
Q

Juxtaglomerular apparatus

A

Juxtaglomerular cells- secrete renin

Macula densa in the wall of the ascending loop of Henle

Mesangial cells also present

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8
Q

The nephrons blood supply

A

2 sets of arterioles- afferent and efferent

2sets of capillary beds in series- glomerulus and peritubular- near the tubules forming vasa recta

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9
Q

Basic Renal Processes

A

Glomerular Filtration- ultrafiltration- the movement of fluid and solutes. GLOMERULR CAPILLARIES - BOWMANS’S SPACE

Tubular Secretion- the secretion of solutes from the peritubular capillaries to the tubules

Tubular reabsorbtion- the movement of materials from the filtrate in the tubules into peritubular capillaries

Metabolism- glutamine

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10
Q

Amount excreted in urine=

A

Amount filtered + Amount secreted - Amount reabsorbed

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11
Q

1) PAH

A

filtered and secreted

NOT reabsorbed

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12
Q

2) Water and electrolytes

A

Filtered

Some reabsorbed

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13
Q

3) glucose

A

filtered

Completely reabsorbed

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14
Q

What gets through the glomerular filtration barrier

A

Depends on size, shape and charge

Most plasma constituents are freely filtered except proteins

[Filtered] / [Plasma] =1
This is called free passage

Anionic molecules will have a ratio less than one due to repulsion due to fixed polyanions

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15
Q

Composition of ultra filtrate

A

it is similar to that plasma except for the fact that there are differences in certain molecules- proteins

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16
Q

Infection + Damage to the glomerulus + High BP

A

PROTEIN IN URINE - proteinuria
HB IN URINE -haemoglobinuria
RBC IN URINE - haematuria

17
Q

GFR

A

Volume of fluid filtered from the glomerulus per minute

18
Q

What is GFR dependant on?

A

Starling forces - hydrostatic forces vs Osmotic forces
Surface area of filtration interface
Hydraulic permeability of capillaries

regulated by neural and hormonal input

19
Q

Changing pressure gradient in relation to GFR

A

Constricting AA - decreasing GFR

Constricting EA - increasing GFR

20
Q

Changing SA in relation to GFR

A

Mesangial cells- contain actin and innervated by sympathetic NS

Symapathetic NS activated due to the Low BP
The SA of the interface decreases due to actin contracting
Decrease in glomerular filtrate rate

21
Q

Reabsorption

A

Occurs in the proximal tubule

Na+ coupled transporter- glucose amino acids, phosphate

Passive reabsorption - urea, chloride, potassium and chloride

22
Q

Secretion in PCT

A

Organic acids- anions:
Endogenous molecules- bile salts, fatty acids, prostaglandins
Drugs
Diagnostic agents- PAH

Organic bases- cations
Endogenous molecules- creatine, dopamine, choline, guandine, histamine
Drugs- atropine, cimetidine, morphine

23
Q

How are organic anions secreted in PCT

A

OA- enters the cell in exchange for DC-

DC-accumialtes in cells by metabolism and Na+ coupled co transport

OA- enters tubule lumen via ATP dependant transporters

24
Q

How are organic cations secreted in PCT

A

Enter cell via facilitated organic cation transporters

Enter tubule lumen via multi drug and toxin extrusion proteins anti porter in exchange for H+