Kidneys, Ureter and Bladder

Question 1

Which renal artery is longer?

Answer 1

Right

Question 2

Which renal vein is longer?

Answer 2

Left

Question 3

What sits atop the kidney? Is it a part of the kidney?

Answer 3

Adrenal gland, no

Question 4

What happens when we lose too much fat?

• What is ptosis
• What will happen to the ureters?
• What is hydronephrosis?

Answer 4

Changes positions
Drop
Kink
Fluid in the kidneys

Question 5

What controls the release of urine? What is the blood supply?

Answer 5

Pyramids

Renal artery too-> Renal vein drains

Question 6

Glomerular FIltration

Answer 6

Passive filtration
High pressure rate -55 mmHg
Small molecules pass freely
Glomerular filtration rate
-Intrinsic controls
  -Smooth muscle is the arterioles will change shape
  -Low concentration or decrease in flow may be sensed in the juxtaglomerular cells and increase BP with renin-angiotensin
-Extrinsic controls
  -Sympathetic control

Question 7

Renin-Angiotensin

Answer 7

Renin is released from the kidneys
Promotes angiotensin to turn into angiotensin II
Promote
-Vasoconstriction
-Reabsorption of Na+ and therefore water
-ADH release
-Thirst receptors in the hypothalamus
-Release of aldosterone from the adrenal cortex

Question 8

Tubular Reabsorption

Answer 8

Total blood filters every 45 minutes
Different areas absorb different substances
-Na+, water is reabsorbed at all areas
-Other proteins, cations, anions, etc are absorbed in various areas…
-Glucose is usually only reabsorbed in the PCT

Non reabsorbed or poorly reabsorbed substances = Urea, creatinine, and uric acid

Question 9

Tubular Secretion

Answer 9

Helps balance acidity alkalinity in the body
Acid
-H+ is secreted
-HC03- and K+ is retained
Alkalinic
-Cl- is reabsorbed instead of HC03- and bicarbonate is dumped in the urine

Question 10

The concentration of Solution in Kidneys

Answer 10

Water leaves the descending limb, NaCl leaves the ascending limb. Urea leaves the collecting ducts.

Question 11

Dilute Urine vs Concentrated Urine

Answer 11

Dilute urine secretes all the water as it travels into the ascending limb (NaCl leaves, diluting the urine)
Concentrated urine occurs when ADH is secreted, and water is removed from the collecting ducts
-ADH opens pores with aquaporin (aqua is pourin in) in the collecting ducts allowing water to travel through

Question 12

Diuretics

Answer 12

Stop reabsorption of Na+ at the DCT, Na+ is dumped into the ducts and water goes with it

Question 13

Glomerular Disorders

Answer 13

Several names such as acute, chronic, diffuse, or focal etc… but they are all glomerulonephritis
Pathogenesis usually due to immune-mediated destruction of the glomerulus (from infections) or specific antibodies that destroy the basement membrane of the glomerulus. This can cause scar tissue, and also microthrombi
The results are damage to the ability of the glomerulus to filter substances

Question 14

Nephrotic vs Nephritic Syndrome

Answer 14

Nephrotic Syndrome (damage to the basement membrane or the foot processes)

• Proteinuria
• Hypoalbuminemia- leading to systemic edema
• HLD- due to decease plasma proteins

Question 15

Nephrotic vs Nephritic Syndrome

Answer 15

Nephrotic Syndrome (damage to the basement membrane or the foot processes)

• Proteinuria
• Hypoalbuminemia- leading to systemic edema
• HLD- due to decease plasma proteins

Nephritic syndrome

• Inflammatory changes (from immune complexes) swell and restrict glomerular filtration and allows RBCs escape to the urine (hematuria)
• Decrease urinary output (oliguria) and build up of nitrogenous wastes in blood (azotemia)
• Less demands on tubule cells which atrophy and eventually scar
• HTN due to the decreased filtration in the glomerulus

Question 16

Tubulointerstitial Disorders

Answer 16

Renal medulla in the loop of Henle, collecting ducts, peritubular capillaries and the interstitial tissues.
Usually water and sodium loss and retention of acid
Pylonephritis
-Interstitium, calyces and pelvis
-Usually bacteria
-Desceinding is caused by hematogenous bacteria infecting the cortex which then descends to the kidneys and urinary tract
-Ascending pylonephritis is much more common with infection spreading from the external urethral meatus (usually E. Coli) and more common in females
-Causes kidney stones, prostate enlargement, pregnancy, PID, tumors
Interstitial nephritis
-Toxic damage (drugs, gout, polycythemia) causes swelling in the interstital spaces
-Can cause eosinophilia and possibly hematuria or proteinuria (not as common)

Question 17

Renal Vascular Disorders

Answer 17

Vascular damage from atherosclerosis of the aorta or renal arteries, circulatory shock, diabetic damage to glomerular capillaries will change perfusion to the kidneys

Nephrosclerosis

• Hardening of the arterioles due to systemic HTN
• Loss of lumen causes ischemia
• Renin-angiotensin kicks in increasing already high systemic blood pressure

Microangiopathic hemolytic anemia
-When the RBCs travel in the hardened blood vessels, they are damaged causing a decrease in RBCs in the body
The RBCs cannot be replaced quickly enough causing anemia