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Fundamentals Of Science > Kidney Physiology And Function > Flashcards

Kidney Physiology And Function Flashcards

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1
Q

What are the three main functions of the renal system?

A

Excretion
Elimination
Regulation of other body systems

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2
Q

What is elimination via the renal route?

A

Removal of waste products from the body via the ureter, bladder and urethra.

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3
Q

What does regulation via the kidneys entail?

A

Homeostatic regulation of volume and blood plasma concentration.

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4
Q

State the 3 main regions of the kidney?

A

Renal cortex
Renal medulla
Renal pelvis

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5
Q

Where are nephrons primarily located?

A

In the renal cortex

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6
Q

Where is the blood pressure the highest in the kidneys?

A

In the glomerulus

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7
Q

Which nervous system is in control of the kidneys?

A

The sympathetic nervous system.

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8
Q

Where are the renal sensory nerves found?

A

In the renal pelvic wall

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9
Q

What is the importance of the adrenal glands?

A

They are important for the production of hormones which can regulate renal function.

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10
Q

What are adrenal glans comprised of?

A

Adrenal cortex

Adrenal medulla

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11
Q

State which hormone is released by the adrenal cortex.

A

Aldosterone is released through hormonal stimulation

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12
Q

What does the adrenal medulla release?

A

Adrenaline and noradrenaline through sympathetic NS stimulation.

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13
Q

What are the two main types of nephrons?

A

Cortical nephrons = 85%

Juxtamedullary nephrons = 15%

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14
Q

What is the function of a nephron?

A

The basic structural and functional unit of the kidneys.

It regulates water and soluble substances in the body by filtering blood and reabsorbing/ excreting urine.

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15
Q

What is the structure of a Nephron?

A

Renal corpuscle
Renal tubule
Collecting systems

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16
Q

What is the renal corpuscle made up of?

A

Bowman’s capsule

Glomerulus

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17
Q

What is the renal tubule made up of?

A

Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule

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18
Q

What is the collecting system made up of?

A

Collecting duct

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19
Q

How is the blood supplied to the nephron?

A

Blood arrives at the nephron through the afferent arteriolar
Enters into the glomerular capillaries
Exits through the efferent arteriole

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20
Q

What are the renal lobes made up of?

A

Renal pyramids and the outer renal cortex

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21
Q

What does excretion via the kidneys entail?

A

Removal of waste materials from the body (kidneys). Urine is formed in the kidneys.

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22
Q

What is elimination?

A

Urine is removed from the body via the ureter > bladder > urethra

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23
Q

What is the importance of renal regulation?

A

It is important in the regulation of other body systems.

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24
Q

What do renal nerves do?

A

The renal nerves follow arterial supply to reach individual nephrons.

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25
Q

Where is the highest blood pressure in the kidneys?

A

The glomerulus

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26
Q

How is blood supplied around the kidneys?

A

Blood arrives to the nephron through the afferent arteriole.
It then flows through the glomerular capillaries
The blood exits via the efferent arteriole.

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27
Q

What are the 3 main functions of the nephron?

A

Filtration
Reabsorption
Secretion

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28
Q

Where does filtration occur?

A

Within the corpuscle

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29
Q

Where does reabsorption occur?

A

Along the renal tubule;
PCT
Loop of henle
Duct

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30
Q

What is filtration?

A

This occurs in the glomerulus.
Blood pressure forces water through membrane pores in glomerular capillaries.
It filters out all plasma proteins

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31
Q

What is the glomerular filtration rate? (GFR)

A

The amount of filtrate produced per minute.

This is sensitive to changes in blood pressure.

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32
Q

How can the GFR be calculated?

A

It can be estimated with a creatinine clearance test.

Creatinine is a natural waste product formed from metabolism of muscle. This is usually excreted in the urine and not reabsorbed into the tubules.

33
Q

What is reabsorption?

A

A combination of diffusion, osmosis and carrier mediated transport.
Solutes such as glucose and ions are reabsorbed, water follows by osmosis.

34
Q

What happens along the proximal convoluted tubule?

A

Glucose, amino acids and ions are actively reabsorbed

Largest site of water reabsorption (60-70% by osmosis)

35
Q

Why is the PCT an important site of action for therapeutic benefit?

A

Drugs which prevent glucose uptake here act as diuretics
= useful to pass more urine
Can be used for conditions such diabetes (inhibits uptake of glucose)
When excess fluid needs to be removed from the body.

36
Q

What are the main differences between the juxtamedullary and cortical nephron?

A

Juxtamedullary nephron has a long loop of henle, allows even more water to be reabsorbed (useful in dehydration)

Cortical has a short loop of henle

37
Q

Where does the majority of water reabsorption occur?

A

In the PCT and the descending limb of the loop of henle.

38
Q

What occurs in the loop of henle? (Reabsorption)

A

Filtration becomes more concentrated (down the descending limb). Permeable to water and impermeable to solutes.

Ascending limb is impermeable to water = permeable to solutes.
Na, K, Cl are pumped out to be preserved
Concentration decreases.

39
Q

What transporters facilitate the movement of ions in the loop of henle?

A

An/K/2Cl transporter (NKCC) carries one Na, one K and 2Cl ions out of the filtrate.

40
Q

What are the therapeutic benefits of the reabsorption (loop of henle) ?

A

Site of action for loop diuretics ie. water tablets.

Site of action is the Na/K/2Cl transporter.

41
Q

Explain the process of reabsorption at the distal convoluted tubule.

A

NaCl is actively reabsorbed.

The NCC ca(Na/2Cl transporter) carries out 1 Na, 2Cl ions out of the filtrate.

42
Q

What is the therapeutic benefit of reabsorption in the DCT?

A

Thiazide diuretics.

43
Q

Explain the process of secretion

A

This mainly occurs at the PCT and DCT.
K+ and H+ are secreted in exchange for the reabsorption of Na+
H+ secretion is important in blood and pH regulation.

44
Q

Why is hydrogen ion secretion important?

A

It’s important for blood pH regulation.

When this goes wrong acidosis and alkalosis can occur.

45
Q

What happens if the GFR decreases?

A

Renin is released.
Renin stimulates the conversion of angiotensin to angiotensin 1
Ace stimulates cinversion of angiotensin 1 to 2
Angiotensin 2 is increased when GFR decreases

This has affects on adrenal glands, kidneys and CNS
Aldosterone is released from the adrenal glands
This causes an increase of the GFR until it reaches a normal level.

46
Q

What is the renin-angiotensin aldosterone system?

A

Renin is released
Causing the release of angiotensin 2
This has affects on the adrenal glands, kidneys and the CNS
Aldosterone is released from the adrenal glands

47
Q

What are anti diuretic hormones?

A

(ADH, Vasopressin)
Released from the CNS in response to dehydration.
It increases water reabsorption in the DCT and the collecting duct
It also acts to constrict renal arteries = reducing the GFR

Decreases diuresis.

48
Q

What are natriuretic peptides?

A

They are released from the heart in response to stretch
Opposite effect to ADH
Increases diuresis
It relax renal arteries hence increasing the GFR

(More blood is flowing through into the kidneys so more filtrate is being formed)

49
Q

What is the neurotransmitter involved in the sympathetic nervous control of kidneys?
What affect does this have on blood vessels and adrenal glands?

A

Noradrenaline

This binds to alpha adrenal receptors and causes contractions through Gq coupled mechanisms… causing an increase in phospholipids C.
This increases intracellular calcium in blood vessels.
This activates the calcium calmodulin pathway and produces contraction.

50
Q

What is the urinary system responsible for regulating?

A

It regulates blood volume and pressure
Regulates electrolyte concentration in blood
Regulation of blood pH
Removal of metabolic waste products and chemicals from blood.

51
Q

What is the relationship between renal function and blood pressure?

A

They are closely linked. Things that affect blood pressure affect kidney function.
When volume of blood decreases, BP decreases
When volume of blood increases, BP increases

52
Q

What is the importance of Na+ as a body electrolytes?

A

Control of plasma levels, important for regulation of blood volume and pressure
Hypo/ hypernatremia

53
Q

What is the importance of K+ as a body electrolytes?

A

Important for the regulation of excitable cells

Hypo/ hyperkalemia

54
Q

What is the importance of pH balance?

A

The kidneys remove H+ and makes HCO3-( bicarbonate ions)

Alkalosis and acidosis.

55
Q

In drug excretion where do drugs cross freely?

A

Most drugs cross the glomerular membrane freely,except warfarin and penicillin
These bind strongly to proteins which aren’t free to cross this membrane

56
Q

In drug excretion, where are drugs secreted into?

A

Many drugs are actively renal tubule for example penicillin

57
Q

Given an example of a drug that is predominantly excreted via the kidneys:

A

Digoxin

Important to know kidney function when prescribing it.

58
Q

What is the best description of hormonal regulation of kidney function?

A

it involves integration of multiple organ systems

Several hormones - natriuretic peptides, ADH as well as the renin angiotensin aldosterone system - are involved in the regulation. These hormones coordinate responses throughout the body - in particular the CNS, cardiovascular system.

59
Q

Specific transporters are located in the renal tubule and facilitate the reabsorption of water and solutes. What is the best description of transporters in the renal tubule?

A

Apical localisation of transporters allow the uptake of solutes from the filtrate

The apical membrane is the membrane of the epithelial cells which is in contact with the filtrate. Solutes would cross over the basolateral membrane to reach the blood stream.

60
Q

What class of drugs prevent the uptake of glucose in the nephron?

A

Diuretics

61
Q

What are the water channels that enable reabsorption?

A

Aquaporins

62
Q

What are the differences in the descending limb and ascending limb of the loop of henle?

A

The ascending limb is thick whereas the descending limb is thin.
The descending limb is permeable to water and impermeable to solutes whereas the ascending limb is impermeable to water and permeable to solutes

63
Q

What is the mechanism of action of thiazide diuretics?

A

Inhibit the reabsorption of Na and Cl ions in the DCT.
(Block the symporter)
Increase the Ca reabsorption

64
Q

Outline the steps that occur in the nephron.

A

-Filtration at the glomerular capillaries in the renal corpuscle
-Active removal of ions, glucose and amino acids in the PCT
-Water reabsorption in the PCT and descending limb of the loop of Henle. Increases filtrate concentration
-Active transport of Na, Cl from the ascending limb
_reabsorption and secretion in the DCT
-Final reabsorption of H20 in collecting duct.

65
Q

Where is renin secreted from?

A

Juxtaglomerular apparatus

66
Q

What is the renin-angiotensin aldosterone system?

A

A feedback mechanism that regulates the body’s blood pressure. Its stimulated when cardiac output is decreased. (LOW BP AND DROP IN FLUID VOLUME)

67
Q

What is the role of aldosterone?

A

Acts on the kidneys to stimulate reabsorption of NaCl and H2O.

68
Q

Explain the role of renin.

A

Renin is secreted by the juxtaglomerular apparatus and acts on angiotensin to form angiotensin I

69
Q

Explain the effect that angiotensin II has.

A

Acts directly on blood vessels stimulating vasoconstriction.

Acts on the adrenal glands to stimulate the release of aldosterone.

70
Q

How is angiotensin I converted into angiotensin II?

A

By the action of ACE enzyme. (Angiotensin converting enzyme)
ACE is released from the lungs.

71
Q

Where are and when are natriuretic peptides released?

A

Released from cardiomyocytes in response to stretch

72
Q

What are the two natriuretic peptides?

A

ANP - atrial natriuretic peptide

BNP - brain natriuretic peptide

73
Q

What do natriuretic peptides do?

A

The opposite affect to ADH

They promote diuresis by causing vasodilatation and increasing renal perfusion to increase the GFR

They act of Na epithelial channels (ENaC) to prevent sodium reabsorption

74
Q

How do natriuretic peptides cause an effect?

A

They initiate a signalling pathway - activate cyclic GMP - activates protein kinase G

75
Q

What is the effect of BP when the volume of blood decreases?

A

Blood pressure decreases

76
Q

What is the effect of BP when the volume of blood increases?

A

Blood pressure increases

77
Q

How does aldosterone produce an effect? (mechanism of action)

A

Act on mineralocorticoid receptors (nuclear).
They alter protein expression when activated.
This increases the expression of ENaC (in collecting duct)

78
Q

How does vasopresin (ADH) produce an effect?

A

Increases the expression of aquaporins (in collecting duct).

This constricts blood vessels and stimulates the sensitisation of thirst.

79
Q

Where is the site of action for thiazide diuretics?

A

Distal convoluted tubule

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