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Anatomy Exam 3 > Lecture 5 : Clearance and Measures of Kidney Function > Flashcards

Lecture 5 : Clearance and Measures of Kidney Function Flashcards

1
Q

___ is specialized to transport urine to bladder

A

Ureter

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2
Q

Ureter has 3 layered wall:

A

Mucosa - Transitional epithelium and lamina propria

Muscularis - inner longitudinal, outer circular smooth muscle

Adventitia – outer CT layer holding ureter in place

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3
Q

Urine stretches muscularis layer – stimulates ____ of contraction which propels urine toward bladder

A

peristaltic waves

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4
Q

_____ is specialized for urine storage

A

Urinary bladder

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5
Q

Mucosa:

A

Transitional epithelium – stratified (barrier)
Lamina propria

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6
Q

Muscularis:

A

Detrusor Muscle – extensive smooth muscle layers; contract to void urine

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7
Q

Adventitia or serosa:

A

outer CT layer

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8
Q

Transitional epithelium creates barrier –

A

epithelium has ability to stretch or flatten, depending on “fullness” of bladder

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9
Q

The urinary bladder is very distensible

A

When empty, wall is thrown into folds called rugae; disappear when bladder is stretched full with urine

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10
Q

Detrusor Muscle

A

smooth muscle in wall stretches and thins allowing for increased storage without increasing internal pressure; under control of autonomic nervous system

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11
Q

urinary bladder capacity

A

500 – 1000 ml capacity

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12
Q

Trigone –

A

triangular region formed by openings of ureters and urethra; may be site of persistent infections

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13
Q

_____ carries urine out of the body

A

Urethra

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14
Q

The urethra is different in males and females:

A

Female: ~3-4 cm long
Male: ~20 cm long, 3 regions

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15
Q

Both males and females have urinary sphincters:

A

Internal urethral sphincter: smooth muscle controlled by ANS

External urethral sphincter:
skeletal muscle, voluntary - controlled by somatic NS

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16
Q

Micturition:

A

the act of emptying the urinary bladder

Micturition (urination, voiding) is a spinal reflex with CNS influence

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17
Q

______contracts detrusor muscle, relaxes internal urethral sphincter.

A

Parasympathetic nervous system

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18
Q

_______ is active during bladder filling : relaxes detrusor, and contracts internal urethral sphincter to prevent voiding.

A

Sympathetic nervous system

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19
Q

_____ Determine urine storage or emptying

A

CNS Centers

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20
Q

Urinary incontinence –

A

inability to control urination

weak pelvic floor muscles, pressure in pregnancy, stress, nervous system problems

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21
Q

Urinary retention -

A

bladder unable to expel urine

general anaesthesia, hypertrophy of prostate in men

may require catheterization

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22
Q

____ is the result of all the processes that take place in the kidney.

A

Urine output

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23
Q

____ the process of eliminating waste

A

Excretion:

Excretion = Filtration - Reabsorption + Secretion

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24
Q

Looking at the excretion rate of a substance tells us:

A

nothing about how the kidney handled the substance.

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25
Excretion rate of a substance depends on:
The filtration rate of the substance Whether the substance is reabsorbed, secreted, or both
26
If it is filtered at glomerulus:
it ends up in tubule and if we leave it there (don’t reabsorb it), it will be excreted.
27
If we leave it in the tubule, and secrete more of it into the tubule:
even more of it will be excreted.
28
Proximal Convoluted Tubule (PCT)
Reabsorption of all nutrients, many electrolytes, most Na+ and water (obligatory water reabsorption)
29
Descending limb of nephron loop
Reabsorption of water only through aquaporins
30
Ascending limb of nephron loop
ion of solutes (Na+, K+, Cl-)
31
Distal Convoluted Tubule (DCT) and/or Collecting Duct :
Regulated Reabsorption/Secretion
32
___________ stimulates aquaporin synthesis increasing water reabsorption (regulated water reabsorption)
Antidiuretic hormone
33
__________ stimulates synthesis of Na+ channels (apical) and Na+/K+ ATPase (basolateral) increasing Na+ reabsorption
Aldosterone
34
___________ inhibits Na+ reabsorption (so opposes effect of aldosterone)
Atrial natriuretic peptide (ANP)
35
_________ increases Ca2+ reabsorption
Parathyroid hormone
36
Tubular secretion moves substances that we don’t want from the _________ through the tubule cells into the filtrate
peritubular capillaries
37
Things that are secreted during tubular secretion:
Drugs and drug metabolites Urea, uric acid, nitrogenous wastes Creatinine (muscle metabolism) Excess K+ (driven by aldosterone) Excess H+ is secreted when blood is too acidic
38
Most secretion happens in ______, but aldosterone driven K+ secretion and some secretion for acid-base balance occurs in _______ and ________.
proximal convoluted tubule distal tubule collecting duct
39
Urinalysis
analysis of urine, can be used to diagnose disease or detect illegal substances
40
Characteristics of Urine: Color - pH - smell - turbidity - Constituents -
Color: indicator of hydration, blood in urine pH: affected by diet (high protein – acidic urine; vegetarian – alkaline) Smell: diabetics may have sweet smelling urine Turbidity: normal is clear; increased turbidity due to suspended particles – due to cells, urinary tract infections Constituents: water, urea, salts, pigments
41
Normal Urine composition:
95% water, 5% solutes
42
Nitrogenous wastes: (in urine)
Urea – derived from normal breakdown of amino acids Uric acid – end product of nucleic acid metabolism Creatinine – breakdown product of creatine phosphate
43
Normal solutes in urine (in order of decreasing concentration):
Urea, Na+, K+, PO43-, SO42-, creatinine, uric acid less: Ca2+, Mg2+, HCO3-
44
Abnormal Urine composition:
Plasma proteins, RBCs, WBCs, bile pigments may indicate pathology
45
______ is the main mechanism for eliminating drugs from your body
Renal Clearance
46
Renal Clearance (C)
is the volume of plasma from which the kidneys clear (completely remove) a particular substance in one minute Renal Clearance tells us how quickly a substance is removed from plasma, but is also an indicator of kidney function
47
Any compound that is completely cleared by the kidneys can be used to estimate _____
GFR
48
To measure Renal Clearance of a substance (ml/min):
compare the amount of substance in the plasma (mg/ml) to the amount of that same substance that ends up in the urine (mg/min)
49
clearance =
excretion rate in substance / concentration rate of substance in plasma
50
____ is plant compound that is freely filtered, and is not secreted or reabsorbed
Inulin
51
Inulin
the rate at which inulin shows up in urine is the same as glomerular filtration rate (GFR) clearance of inulin can be used to accurately determine GFR (the “gold standard”).
52
It is ____ and ____ to test everyone with inulin to determine GFR.
expensive impractical
53
_____ is a natural body substance (breakdown product of muscle creatine phosphate)
Creatinine
54
Creatinine
Produced at constant rate, little is reabsorbed, a small amount is secreted
55
Creatinine clearance is used clinically as an estimate of GFR -
but not as accurate as using inulin
56
The renal clearance of a substance tells us how that substance is handled by the kidneys:
whether it is reabsorbed from the filtrate, or whether it is secreted into the filtrate, and therefore excreted in the urine
57
The renal clearance of specific substances can be used as an indicator of glomerular filtration rate or GFR –
monitoring GFR over time allows us to detect glomerular damage or follow the progress of kidney disease
58
Understanding renal clearance of drugs can help determine :
dosage levels and dosing frequencies for medications
59
The clearance value of a substance tells us about the net handling of a substance by the kidneys :
If inulin clearance is used to measure GFR, it can be used to compare handling of other substances
60
If clearance value is equal to that of inulin:
the substance is filtered but neither reabsorbed or secreted (the amount that is filtered at glomerulus is excreted in the urine)
61
A clearance value less than inulin:
(meaning there is less in the urine) suggests that the substance is filtered but at least some is reabsorbed by tubule cells eg. Glucose: Cglucose = 0, as it is completely reabsorbed in the PCT
62
A clearance value greater than inulin:
(meaning there is more in the urine) suggests that the substance is filtered but also being secreted by the tubule cells and added to the filtrate eg. Creatinine, drugs and metabolites
63
Renal function can be assessed by:
Monitoring urine output (volume) Measuring levels of nitrogenous wastes in blood (to make sure they aren’t accumulating) Monitoring appearance of nitrogenous wastes in urine Measure glomerular filtration rate
64
Glomerular Filtration Rate (GFR) –
volume of filtrate formed each minute by all glomeruli Can be used to indicate how well kidneys are functioning
65
Normal GFR:
~ 125 ml/min (range 90 – 125 ml/min) (result ~180 liters filtrate per day)
66
GFR ___ with advancing kidney disease
decreases
67
Chronic renal disease:
GFR<60 ml/min Filtrate formation decreases gradually, nitrogenous wastes accumulate in blood, blood pH becomes more acidic Causes: diabetes mellitus, hypertension, kidney infections, trauma, heavy metal poisoning
68
Renal Failure:
GFR < 15 ml/min Filtrate formation decreases or stops completely Patients require hemodialysis or kidney transplant
69
Nephrons ___ with increasing age
die
70
The threshold for chronic kidney disease is reached sooner with ____
more disease conditions
71
____ performs the role of failing kidneys
Dialysis
72
Hemodialysis –
patient’s blood passed through membrane tubing that removes wastes, excess ions and replaces beneficial substances such as pH buffers or glucose
73
Using Imaging to Assess the Urinary System
Dye is injected and x-ray is taken kidney, bladder, ureter Pyleogram kidney, renal pelvis, ureter
74
Kidney stones
(renal calculi) very common Solutes in urine precipitate during concentration process

Anatomy Exam 3 (11 decks)

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