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Semester 4 (NME) > Kidneys 2 > Flashcards

Kidneys 2 Flashcards

1
Q

What are the functional units of the kidney and what do they consist of?

A

Nephrons (consisting of:)
1- Bowmans capsule (with glomerulus etc) +
2- Renal tubule

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2
Q

Where does filtration take place in the kidney?

A

The renal corpuscle (bowmans capsule + glomerulus)

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3
Q

What processes occur in the renal tubule?

A

Nutrient reabsorption
Water reabsorbtion (90% reabsorbed)
Secretion of waste products not already filtered

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4
Q

Where does the ureter originate from and what course does it take?

A

From the pelvis of each kidney, descending over the top of psoas minor and in-front of the common iliac artery, into the R/L sides of the bladder

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5
Q

Where does the renal artery leave the abdominal aorta?

A

L2

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6
Q

What are the 4 layers which surround each kidney?

A 
Pararenal fat (post/ posteriolat only)
Perirenal fat (around whole kidney)
Renal fascia 
Renal capsule (fibrous)
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7
Q

What is the renal sinus?

A

Cavity within the kidney which is occupied by the renal pelvis/ renal calyx BV’s/ nerves and fat

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8
Q

What is the renal pelvis?

A

Dilation of ureter at kidney hilum

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9
Q

What are renal calyces (single: calyx)? What are the two types?

A

Chambers through which urine passes
Minor: At the apex of each pyramid
Major: Lead to renal pelvis

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10
Q

How does the kidney endothelium repel proteins such as albumin? How is the affected in diabetes?

A

Has a negative charge so repels proteins

Charge lost in diabetes so = proteinuria

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11
Q

What is the main function of the PCT?

A

Reabsorb ions and organic nutrients

Reabsorbs water

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12
Q

What is the main function of the loop of henle (both limbs)?

A

Descending limb: Reabsorbs water

Ascending limb: Reabsorbes Na+/Cl-

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13
Q

What is the main function of the DCT?

A

Secretion of ions/acids/drugs/toxins

Variable water/ion re-absorption - this is fine tuned by hormones

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14
Q

Where is urea re-absorbed from tubular fluid?

A

Collecting ducts

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15
Q

Where does the tubular fluid go once it has left the DCT?

A

Many DCT’s feed into 1 collecting duct

Collecting duct feeds to minor calyx (now as urine)

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16
Q

What is counter-current multipilication?

A

Na+/Cl-/K+ re-absorption in the ascending loop of Henle by active transport creates an osmotic gradient with passively draws out water from the descending loop of Henle

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17
Q

What happens to substances reabsorbed in the nephron?

A

Go into peritubular capillaries

These all drain eventually to the efferent arteriole

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18
Q

What type of epithelium lines the PCT?

A

Cuboidal cells with microvilli

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19
Q

What type of epithelium lines the Loop of Henle?

A

Squamous/ low cuboidal cells

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20
Q

What type of epithelium lines the DCT?

A

Cuboidal cells w/o microvilli

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21
Q

What type of epithelium lines the collecting ducts?

A

Cuboidal cells w/o microvilli

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22
Q

What type of epithelium lines the papillary ducts?

A

Columnar cells

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23
Q

What are the two types of nephrons?

A

Cortical (85%) - Stay in cortex- their peritubular capilaries drain to cortical radiate veins
Juxtamedullary (15%)- Peritubular capilaries drain to vasa recta

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24
Q

What are the two layers of epithelium in the renal corpuscle?

A

Outer: Simple squamous
Visceral: Has podocytes with filtration slits between them

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25
Q

What are mesangial cells?

A

Support cells between capillaries, they can contract to dilate or constrict vessels

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26
Q

What substances act on mesangial cells?

A

Angiotensin II, ADH, histamine

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27
Q

What are the two main glucose transporters in the kidney?

A

GLUT 1 (2Na+ to 1 glucose) - High affinity/ low capacitity
- Found in the late proximal tubule
GLUT 2 (1Na+ to 1glucose) - Low affinity/ high capacity
- Found in the early proximal tubule

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28
Q

What is the capacity of the glucose transporters in the kidney, what impact could this have clinically?

A

1.25mmol/min

So if plasma glucose is greater than 10mmol/L you will start to get glucosuria

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29
Q

Where do gluconeogenesis and glycolysis happen in the kidney?

A

Roughly 20% of bodies gluconeogenesis happens in the cortex of the kidney
Glycolysis happens in the medulla

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30
Q

To increase filtration rate what must happen to the afferent and efferent arterioles?

A

Afferent must dilate

Efferent must constrict

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31
Q

What is GFR?

A

Rate of filtration per unit time

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32
Q

How do you calculate GFR?

A 
                              Plasma conc (x)
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33
Q

An increase in glomerular capillary hydostatic pressure will have what effect on GFR?

A

Increase it

34
Q

An increase in bowmans capsule hydostatic pressure will have what effect on GFR?

A

Decrease it

35
Q

An increase in glomerular capillary oncotic pressure will have what effect on GFR?

A

Decrease it

36
Q

What three waste substances must be removed by the kidneys and why?

A

Need to be dissolved in water
Urea (from AA breakdown)
Creatinine (from creatinine phosphate in muscle)
Uric acid (from recycling nitrogen bases in RNA)

37
Q

What is the anatomy of the juxtaglomerular complex?

A

Juxtaglomerular complex = (Epithelium of DCT near renal corpuscle - ka macula densa) + (smooth muscle cells in afferent arteriole - ka juxtaglomerular cells)

38
Q

What two things are secreted by the juxtaglomerular complex?

A

Renin and EPO

39
Q

What stimuli cause the JG complex to release renin?

A

Decreased BP in glomerulus
When stimulated by SNS
Low osmotic conc of tubular fluid

40
Q

What is ANP?

A

A powerful vasodilator molecule released by the atria

It causes dilation of afferent arterioles and constriction of efferent arterioles thus increasing GFR

41
Q

What is BNP?

A

A powerful vasodilator molecule released by the ventricles

It causes dilation of afferent arterioles and constriction of efferent arterioles thus increasing GFR

42
Q

What is the function of renin?

A

Converts angiotensinogen (from liver) to Angiotensin I

43
Q

What converted Angiotensin I to Angiotensin II?

A

ACE in epithelial cells

Mainly in lungs

44
Q

What are the effects of angiotensin II?

A

SM vasoconstriction / renal water retention (Increase BP)
Pituitary releases ADH
Zona glomerulosa releases aldosterone
Increased thirst and cardiac output

45
Q

How do changes in blood volume regulated GFR?

A

Increased blood volume = increased GFR

This promotes fluid loss

46
Q

What does sympathetic stimulation do to GFR? How?

A

Powerfully decreases GFR

By constricting afferent arteriole

47
Q

Raised urea indicates what?

Raised urea and raised creatinine indicates what?

A

Inc urea: Renal failure OR high protein load (starvation or exercise)
Inc urea + creatinine: Renal failure only

48
Q

What can chronic raised levels of cortisol do to glucose levels?

A

Caused chronic hyperglycemia

lead to diabetes

49
Q

What is the key feature of cushings syndrome?

A 
Chronically elevated cortisol
Central obesity (face) with limb sparing
50
Q

How does cortisol affect insulin levels?

A

Cortisol acts to INHIBIT insulin

51
Q

What is the role of carbonic anhydrase?

A

Converts H2O + CO2 === H+ and HCO3-

52
Q

Where are carbonic anhydrase enzymes commonly found and what are the two subtypes?

A

Found in lung and kidney
CAII (type2)- Soluble in cytoplasm
CAIV (type4)- Extra-cellular (linked to membrane by GP1)

53
Q

What is the main area of acid secretion in the nephron?

A

PCT

54
Q

Gluatamine metabolism produces what?

A

HCO3- and NH3

NH3 joins H+ to make NH4+ and is secreted in PCT

55
Q

What happens to the H+ and HCO3- produced by carbonic anhydrase?

A

H+ is secreted into tubular fluid (where it often combines to be buffered by phosphate H2PO4-)
HCO3- is often re-absorbed into blood (although this costs ATP)

56
Q

Foamy urine is a sign of what?

A

Proteinuria

57
Q

What are microabuminuria and proteinuria signs off?

A

Kidney damage (leaking proteins)

58
Q

Why do diabetic patients sometimes experience oedema?

A

Due to protein loss in kidney lowering blood oncotic pressure

59
Q

What do patients with diabetic nephropathy experience hyperlipidemia?

A

Lowered triglyceride clearance in the kidney

Lowered lipoprotein lipase activity

60
Q

Why do patients with diabetes experience raised BP?

A

Due to a decreased GFR (renal impairment)

61
Q

Why are patients with diabetic nephropathy asked to keep to a low protein diet?

A

So less metabolites of protein are released into the blood (toxicity)

62
Q

What is the clinical definition of CKD?

A

End stage, advanced kidney disease

eGFR less than 60ml/min for greater than 3months

63
Q

Name 5 signs of CKD:

A

Anorexia / pruitus / peripheral oedema / weakness / fatigue / nocturia

64
Q

Which AB’s should be avoided in Px with CKD?

A

Penacillins/ cephalosporins

65
Q

What does NICE recommend as treatment for CKD?

A

Start with ACEI
> Diuretics
> Dialysis

66
Q

How is peritoneal dialysis conducted?

A

Incision made just below navel and permenant ‘tenckhoff’ catheter inserted
Dialysate fluid is pumped in, catheter is sealed, fluid left for a while then removed again (with waste)

67
Q

What are the two types of peritoneal dialysis?

A

CAPD (continous ambulatory)- Done at home with wheelchair stand to hang bags from, 4 times daily
APD (automated PD)- Done by a machine overnight, fluid left in during day and removed next night

68
Q

What is haemodialysis?

A

Arteriovenous fistula created in wrist/ upper arm
Two needles inserted into fistula and connected to a machine
Done 3x/week for ~4hrs at a time

69
Q

What lifestyle changes must Px on haemodialysis undergo?

A

Limited to 1L of fluid per day (so to not overload kidney)

Px cuts down on high Na+/K+ foods

70
Q

90% of pancreas transplants are of what type?

A

SPK (simultaneous pancreas-kidney)

71
Q

What causes acidosis in CKD?

A

Not enough acid secretion
HCO3- is lowered as it tries to mop up H+
Px hyperventilates and pCO2 is low (resp compensation)

72
Q

Why is K+ raised during acidosis?

A

Because excess H+ in blood is pumped into cells and swapped for K+
(Also in CKD there is less K+ excretion)

73
Q

Why do patients with CKD experience a swollen face and increased body weight?

A

Due to increased cortisol (as less is excreted)

74
Q

What is an anion gap and what does a raised anion gap indicate?

A

Difference between Na+/K+ and HCO3-/ Cl-

Raised anion gap can indicate metabolic acidosis

75
Q

What is the NET result of each H+ leaving a tubular cell in the kidney?

A

A HCO3- leaves on the basolateral side into serum

76
Q

Where does 90% of the bicarbonate reabsorption (and H+ secretion occur)?

A

Proximal convoluted tubule

77
Q

How does the body remove H+ in the late distal tubules and collecting ducts?

A

H+ secreted by primary active transport (usually with Cl-)

78
Q

What is the pH of urine and which buffer system is this closest to?

A

6.8

Closest to phosphate buffer system

79
Q

Where does the ammonia buffer system originate from?

A

Glutamine is metabolised in liver to two NH4+ and two HCO3-

80
Q

Why are nephrotic patients vulnerable to infection, which infections are they particually vulnerable to?

A

Staphylococcal and pneumococcal

Due to loss of immunoglobulins through the leaky renal filtration membranes

Semester 4 (NME) (24 decks)

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