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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
Q

Excretion rate of a substance depends on:

A

The filtration rate of the substance

Whether the substance is reabsorbed, secreted, or both

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26
Q

If it is filtered at glomerulus:

A

it ends up in tubule and if we leave it there (don’t reabsorb it), it will be excreted.

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27
Q

If we leave it in the tubule, and secrete more of it into the tubule:

A

even more of it will be excreted.

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28
Q

Proximal Convoluted Tubule (PCT)

A

Reabsorption of all nutrients, many electrolytes, most Na+ and water (obligatory water reabsorption)

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29
Q

Descending limb of nephron loop

A

Reabsorption of water only through aquaporins

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30
Q

Ascending limb of nephron loop

A

ion of solutes (Na+, K+, Cl-)

31
Q

Distal Convoluted Tubule (DCT) and/or Collecting Duct :

A

Regulated Reabsorption/Secretion

32
Q

___________ stimulates aquaporin synthesis increasing water reabsorption (regulated water reabsorption)

A

Antidiuretic hormone

33
Q

__________ stimulates synthesis of Na+ channels (apical) and Na+/K+ ATPase (basolateral) increasing Na+ reabsorption

A

Aldosterone

34
Q

___________ inhibits Na+ reabsorption (so opposes effect of aldosterone)

A

Atrial natriuretic peptide (ANP)

35
Q

_________ increases Ca2+ reabsorption

A

Parathyroid hormone

36
Q

Tubular secretion moves substances that we don’t want from the _________ through the tubule cells into the filtrate

A

peritubular capillaries

37
Q

Things that are secreted during tubular secretion:

A

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
Q

Most secretion happens in ______, but aldosterone driven K+ secretion and some secretion for acid-base balance occurs in _______ and ________.

A

proximal convoluted tubule

distal tubule

collecting duct

39
Q

Urinalysis

A

analysis of urine, can be used to diagnose disease or detect illegal substances

40
Q

Characteristics of Urine:
Color -

pH -

smell -

turbidity -

Constituents -

A

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
Q

Normal Urine composition:

A

95% water, 5% solutes

42
Q

Nitrogenous wastes:
(in urine)

A

Urea – derived from normal breakdown of amino acids

Uric acid – end product of nucleic acid metabolism

Creatinine – breakdown product of creatine phosphate

43
Q

Normal solutes in urine (in order of decreasing concentration):

A

Urea, Na+, K+, PO43-, SO42-, creatinine, uric acid

less: Ca2+, Mg2+, HCO3-

44
Q

Abnormal Urine composition:

A

Plasma proteins, RBCs, WBCs, bile pigments may indicate pathology

45
Q

______ is the main mechanism for eliminating drugs from your body

A

Renal Clearance

46
Q

Renal Clearance (C)

A

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
Q

Any compound that is completely cleared by the kidneys can be used to estimate _____

A

GFR

48
Q

To measure Renal Clearance of a substance (ml/min):

A

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
Q

clearance =

A

excretion rate in substance / concentration rate of substance in plasma

50
Q

____ is plant compound that is freely filtered, and is not secreted or reabsorbed

A

Inulin

51
Q

Inulin

A

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
Q

It is ____ and ____ to test everyone with inulin to determine GFR.

A

expensive

impractical

53
Q

_____ is a natural body substance (breakdown product of muscle creatine phosphate)

A

Creatinine

54
Q

Creatinine

A

Produced at constant rate, little is reabsorbed, a small amount is secreted

55
Q

Creatinine clearance is used clinically as an estimate of GFR -

A

but not as accurate as using inulin

56
Q

The renal clearance of a substance tells us how that substance is handled by the kidneys:

A

whether it is reabsorbed from the filtrate, or whether it is secreted into the filtrate, and therefore excreted in the urine

57
Q

The renal clearance of specific substances can be used as an indicator of glomerular filtration rate or GFR –

A

monitoring GFR over time allows us to detect glomerular damage or follow the progress of kidney disease

58
Q

Understanding renal clearance of drugs can help determine :

A

dosage levels and dosing frequencies for medications

59
Q

The clearance value of a substance tells us about the net handling of a substance by the kidneys :

A

If inulin clearance is used to measure GFR, it can be used to compare handling of other substances

60
Q

If clearance value is equal to that of inulin:

A

the substance is filtered but neither reabsorbed or secreted

(the amount that is filtered at glomerulus is excreted in the urine)

61
Q

A clearance value less than inulin:

A

(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
Q

A clearance value greater than inulin:

A

(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
Q

Renal function can be assessed by:

A

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
Q

Glomerular Filtration Rate (GFR) –

A

volume of filtrate formed each minute by all glomeruli

Can be used to indicate how well kidneys are functioning

65
Q

Normal GFR:

A

~ 125 ml/min (range 90 – 125 ml/min)
(result ~180 liters filtrate per day)

66
Q

GFR ___ with advancing kidney disease

A

decreases

67
Q

Chronic renal disease:

A

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
Q

Renal Failure:

A

GFR < 15 ml/min

Filtrate formation decreases or stops completely

Patients require hemodialysis or kidney transplant

69
Q

Nephrons ___ with increasing age

A

die

70
Q

The threshold for chronic kidney disease is reached sooner with ____

A

more disease conditions

71
Q

____ performs the role of failing kidneys

A

Dialysis

72
Q

Hemodialysis –

A

patient’s blood passed through membrane tubing that removes wastes, excess ions and replaces beneficial substances such as pH buffers or glucose

73
Q

Using Imaging to Assess the Urinary System

A

Dye is injected and x-ray is taken
kidney, bladder, ureter

Pyleogram
kidney, renal pelvis, ureter

74
Q

Kidney stones

A

(renal calculi)

very common

Solutes in urine precipitate during concentration process

Anatomy Exam 3 (11 decks)

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