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Urogenital > Kidneys > Flashcards

Kidneys Flashcards

1
Q

Function of kidneys

A

▪️excrete waste products of metabolism as urine
▪️controls water and electrolyte balance in the body- BP
▪️maintain blood composition
▪️regulate calcium levels

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2
Q

Position of kidneys

A

▪️high on posterior abdominal wall
▪️lies behind peritoneum (retroperitoneal)
▪️right kidney is lower than the left due to right lobe of the liver being bigger than the left
▪️right -rib 12 to L2
▪️left - ribs 11/12 to L1

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3
Q

Renal tubular system

A 
▪️collecting ducts
▪️minor calyx 
▪️major calyx
▪️renal pelvis
▪️ureter
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4
Q

Anterior relations of the kidneys

A

▪️superior-super-renal glands
-right
▪️upper part-liver (peritoneum)
▪️middle medial- descending part of duodenum (direct)
▪️middle lateral- right colic flexure (direct)
▪️lower part- small intestine (peritoneum)
-left
▪️upper medial- stomach (peritoneum)
▪️upper lateral- spleen (peritoneum)
▪️middle medial- pancreas (direct)
▪️middle lateral- left colic flexure (direct)
▪️lower lateral- descending colon (direct)
▪️lower medial- jejunum (peritoneum)

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5
Q

Artery branches

A 
▪️aorta
▪️renal artery 
▪️segmental artery 
▪️interlobar artery 
▪️arcuate artery 
▪️cortical radiate arteries 
▪️afferent arteriole 
▪️glomerulus
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6
Q

Vein branches

A 
▪️efferent arteriole 
▪️peritubular capillaries (around the tubules)
▪️cortical radiate vein 
▪️arcuate vein 
▪️interlobar vein
▪️renal vein 
▪️inferior vena cava
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7
Q

Urine formation

A

▪️filtration - 180litres of fluid per day (body has 5-6 so is recycled)
▪️reabsorption- 70% in PCT and LoH, DCT and CD influenced by ADH
▪️secretion- additional substances are secreted in tubular fluid, enhances kidneys ability to remove waste and toxins
▪️excretion- final composition of urine

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8
Q

Ureters position

A

▪️retroperitoneal
▪️start at renal pelvis to bladder
▪️descend inferior and medially along the lumbar transverse processes
▪️position leads to constricts in 3 places
▪️lower part is closely associated with the uterine artery which supplies uterus- common to damage one or the other during surgery

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9
Q

Ureters function

A

▪️muscular tubes that contract to aid movement of waste products
▪️delivers urine from kidneys to bladder

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10
Q

Ureter blood supply

A

▪️quite extensive-branches from different sources
-upper-renal
-middle-gonadal
-lower-internal iliac
▪️can sometimes get lumbar arteries branching from abdominal aorta

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11
Q

Ureteric constrictions

A

▪️pelviureteric junction- coming out of renal pelvis- gets narrower
▪️as it crosses pelvic brim- kink where kidney stones can become lodges
▪️as it enters the bladder-narrows

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12
Q

Histology of kidneys

A

▪️macular densa cells- thickening of DCT which regulates GFR as part of feedback loop.
▪️mesangial cells- middle of afferent and efferent arteries where they join glomerulus- modified smooth muscle cells- effect GFR
▪️podocytes- have feet like projections (pedicels) which weave together and leaves slits in between where filtrate flows through- stops large molecules from passing through.
▪️granular cells- juxtaglomerular cells- specialised smooth muscle cells-synthesise and store renin- walls of AA and EA

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13
Q

Histology of ureter

A

▪️similar to blood vessels- has layers of tissues
▪️adventitia- fibroelastic connective tissue - anchors to surrounding structure so it can move with other structures and not get damaged
▪️circular and longitudinal layer- thick muscular layers-peristalsis-active contraction
▪️epithelial layer- mucosal layer- protection

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14
Q

Embryology of kidneys

A

▪️3 successive stages- pronephros, mesonephros, metanephrons
▪️metanephros ascends from S1-S2 to T12-L3 which happens at Week 6-9
▪️as they rise, branches of vessels also rise with them
▪️rotate 90 deg as they rise to face medially

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15
Q

Congenital abnormalities of kidneys

A

▪️pelvic kidney -remains in pelvic location
▪️horseshoe kidneys-inferior poles fused together and gets stuck on inferior mesenteric artery
▪️unilateral double kidney-migration to one side
-not a functional issue, diagnostic issue
-different referred pain as in different position
-can be prone to strangulation by SI

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16
Q

Congenital abnormalities of ureters

A

▪️double pelvis
▪️bifold ureter- can join together or stay apart
▪️ectopic ureteric orifice-skip bladder into urethra- less control of urine
▪️megaloureter- bulgy and thick
▪️postcaval ureter- wraps around artery and veins

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17
Q

Kidneys affect on Blood pressure

A

▪️maintains constant blood flow through and around nephrons

▪️regulates nephron blood pressure indecent of systemic one

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18
Q

Nephron function

A

▪️glomerulus- filters out substances- no large molecules
▪️bowman capsule- captures filtrate and directs to PCT
▪️PCT-reabsorbs 2/3 of Na+ therefore 2/3 water, glucose, organic nutrients
▪️loop of Henle- 20% of salt and water is absorbed here
▪️DL of loop- absorbs water as is only permeable to water
▪️AL of loop- absorbs Na+ and Cl- as is only permeable to them
▪️DCT- 10% is reabsorb here- only if needed- secretion of waste and toxins
▪️CD-influenced by ADH to absorb more water if needed

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19
Q

Types of nephron

A

▪️cortical nephron- 70%- short and majority in cortex of kidneys
▪️juxamedullary nephron- longer and majority in medulla of kidneys
-JMN are more in desert animals who conserve their water as it is scarce.

20
Q

Glomerulus

A

▪️3 layers make up filtration unit
▪️podocytes- modified epithelial feels, feet like process that weave together and stop large proteins from being filtration
▪️basement membrane- cell layer containing -ively charged glycoproteins, has pores to filter out different sized molecules
▪️capillary endothelium- flat and thin layer, sensory but not robust.
-afferent arteriole is larger than the efferent which increases pressure therefore GFR
Echoes

21
Q

Filtration of molecules

A

▪️uncharged molecules <30,000 daltons (measures proteins)
▪️salts, glucose, amino acids, water
▪️RBCs,WBCs, plasma protein- all stay in vessel- creates a colloid pull which tries to draw water back in
▪️not all the salts, water and glucose are taken out 2/3- as it keeps circulating

22
Q

Pressure in bowman capsule

A

▪️pressure created by AA being bigger than EA causes molecules to be forced out of filtration slits in to bow and capsule
▪️hydrostatic pressure- the pressure a liquid experts on something
-glomerular HP (HPg)- pressure of liquid being forever out =60mmHg (out)
-capsular HP (HPc)- pressure of capsule (rigid) pushing against liquid =18Hg (in)
-blood colloid osmotic pressure (OPg)- pressure of proteins trying to draw fluid back in to the vessel =32mmHg (in)
▪️net filtration pressure (NFP)- in a normal kidney the sure of OPg and HPc should be lower than HPg.
(60-(32+18))=10mmHg (out)

23
Q

How to determine GFR

A

▪️marker of kidney health in GFR
▪️compare a substance in the blood to urine- how long does it take for the substances to be passed out.
▪️substance needs to be:
-filtered freely- stays in blood (<30,000 daltons)
-not secreted or reabsorbed- more or less affects the time it would take
-not toxic
-not broken down- may not be recognised in urine

24
Q

GFR Calculation

A

▪️ GFR= solute conc in urine x vol of urine excreted per min / solute conc in plasma

▪️GFR= UV/P

25
Q

Substances used to determine GFR

A

▪️creatinine- cheap and easy, produced by muscles but also secreted in kidney epithelial cells in low amounts- over estimate GFR by 15%
▪️inulin- polysaccharide, but not made in body, continuous infusion to maintain steady rate, look to see when it appears in urine

-most people want C, if something looks wrong they will switch to I

26
Q

Inulin vs Glucose

A

▪️I is the standard- all that is infused in is excreted in urine (straight line- directly proportional)
▪️G is a bad marker- it is reabsorbed in the PCT
-however with hyperglycaemia there is not enough G transporters (fixed number become saturated) for the number of G molecules (transport maximum).
-this leads to G being excreted in the urine as it cannot be reabsorbed

27
Q

Clearance

A

▪️As all amounts of I infused= I in urine, for I clearance=GFR
▪️if a substance clearance is greater than I then it must have been secreted from somewhere therefore increasing the rate it got filtered.
▪️if the clearance is less than I then it must have been reabsorbed therefore decreasing the rate it got filtered.

28
Q

Myogenic mechanism of autoregulation to ⬆️ GFR

A

▪️intrinsic
▪️⬇️systemic blood pressure
▪️⬇️blood pressure in AA- less blood going in to glomerulus
▪️⬇️GFR
▪️⬇️stretch of smooth muscle in walls of AA- due to less blood vol due to low SBP- sensed by cells in AA
▪️ cause vasodialtion of AA- more pressure
▪️⬆️GFR

29
Q

Tubuloglomerular mechanism of autoregulation to ⬆️ GFR

A 
▪️intrinsic 
▪️⬇️SBP
▪️⬇️GFR
▪️⬇️filtrate flow
▪️⬇️NaCl in ascending limb of nephron loop 
▪️macular densa cells in juxtaglomerular complex of kidney sense low salt
▪️cause vasodilation of AA
▪️⬆️GFR
30
Q

Hormonal mechanism to ⬆️ GFR

A 
▪️extrinsic 
▪️⬇️SBP
▪️MD cells sense and talk to granular cells of JGC
▪️⬆️renin 
▪️⬆️angiotensin II
▪️⬆️aldosterone from adrenal cortex (or causes vasoconstriction of systemic arterioles)
▪️⬆️Na reabsorption
▪️⬆️water reabsorption follows 
▪️⬆️blood volume 
▪️⬆️ SBP , indirectly ⬆️GFR
31
Q

Neural control to ⬆️ GFR

A 
▪️⬇️SBP 
▪️inhibits baroreceptors in Bv of systemic circulations 
▪️activate sympathetic nervous system c
▪️causes vasoconstriction of arteriole 
▪️⬆️SBP
▪️⬆️GFR
32
Q

How does SBP ⬆️ GFR

A

▪️extrinsic
▪️causes distension of aorta
▪️atrial natriuretic peptide (ANP) is released which inhibits renin
▪️constricts of AA a little and constricts EA more
▪️⬆️ pressure in glomerulus
▪️⬆️GFR
▪️⬆️ tubular fluid and Na
▪️where as aldosterone allows reabsorption of Na and water, ANP does not- therefore in excreted in urine

33
Q

Transport in PCT

A

▪️Na is reabsorbed into PCT cells:
-co-transported with glucose/AA/Cl
-down it concentration gradient
-in the opposite direction to H+ions
▪️Na is transported into blood:
-co-transported down its conc gradient with K in other direction
▪️glucose/AA/Cl down its conc gradient into blood
▪️CO2 diffuses down conc gradient, combines with water and converts into H+ (goes back into TF)and HCO3- (reabsorbed with Na into blood)
▪️water follows Na into blood

34
Q

Factors affecting reabsorption

A

▪️rate of flow of filtrate - the faster the filtrate the less opportunity there is for molecules to be reabsorbed
▪️conc of molecules in filtrate- more molecules=more opportunity to bind to receptors and be reabsorbed
-however there is a fixed number of transporters so they can become saturated

35
Q

Na reabsorption

A

▪️PCT- 65%
▪️LoH- 25%
▪️DCT- 8%
▪️CD- 2%- only in the presence of aldosterone

36
Q

TAL reabsorption

A

▪️K+ and Na+ co-transported with 2Cl- into cells of TAL
▪️electrochemically neutral
▪️Cl is co-transported with K+ into interstitial space
▪️Na is co-transported into interstitial space, where as K+ is transported back in to cell and into filtrate
▪️always some K+ in interstitial space

37
Q

How does hyperglycaemia affect urine volume

A

▪️hyperglycaemia leads to not all glucose being reabsorbed in PCT as transporters are saturated
▪️glucose in filtrate stops water leaving in DL, this increases filtration vol
▪️due to filtration vol being high, filtrate rate is also high, harder for Na and Cl to be reabsorbed in AL therefore less water is reabsorbed
▪️higher vol of urine, with glucose

38
Q

Hyperglycaemia leading to protein in urine

A

▪️sustained hyperglycaemia makes large gaps in the glomerulus
▪️protein can enter the filtrate through gaps in podocytes
▪️protein in urine

39
Q

DCT reabsorption of Na

A

▪️macular densa cells in DCT senses low fluid flow or low Na conc
▪️juxtaglomerular cells secrete renin
▪️renin works on angiotensinogen to convert to A1
▪️A1-A2 by ACE in lungs
▪️A2 constricts AA a little and EA more (lowers pressure, therefore more volume vol into glomerulus therefore more Na)
▪️A2 stimulates aldosterone to be released
▪️aldosterone increase reabsorption of Na and more excretion of K

40
Q

Secretion into filtrate

A 
▪️PCT 
-NH4+ from plasma 
-urea
-creatinine 
-H+
▪️DCT
-K+
-H+
-NH4+- helps get rid of H+
41
Q

pH balance of ECF

A

▪️7.35-7.45
▪️below 7.35=acidemia
▪️above 7.45=alkalemia
-can result in coma, cardiac failure

42
Q

pH correction in kidneys

A

▪️reabsorption of filtered bicarbonate
▪️secretion of H+
▪️secretion of ammonium

43
Q

Bicarbonate reabsorption

A

▪️PCT (80-90%)
-bicarbonate and H, dissociate into CO2 and water
-CO2 enters cell where it’s converted back into bicarbonate and H.
-bicarbonate reabsorbed, H returned to TF
▪️DCT
-CO2 enters cell and is converted to bicarbonate and H
-bicarbonate reabsorbed, H returned to TF

44
Q

Urinary buffering

A

▪️process where secreted H+ are buffered in urine by combining with weak acids or with ammonia to be excreted
▪️ammonium chloride and Hydrochloric acid in TF
▪️sodium bicarbonate in blood

45
Q

Factors affecting blood pH

A

▪️diets rich in meat provide acids
▪️diets rich in fruits and vegetables provide bicarbonates
▪️exercising muscles produce lactic axis

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