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My Phase 2a > Renal > Flashcards

Renal Flashcards

1
Q

causes of incontinence

A
  • neurogenic detrusor overactivity
  • stress incontinence ( e.g. straining at the gym)
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2
Q

urge incontinance caused by

A
  • overactive bladder -
  • detrusor overactivity
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3
Q

define “overactive bladder”

A

OAB is defined as urgency with frequency, with or without nocturia, when appearing in the absence of local pathology

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4
Q

how is detrusor overactivity detected

A

using urodynamics

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5
Q

why are anticholinergics used to treat an overactive bladder

A

they inhibit the parasympathetic pathway which is responsible for bladder contraction → relaxation

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6
Q

why is mirabegron used in overactive bladder

A

it is a Beta3 agonist.

B3 receptors in the bladder trigger relaxation thus mirabegron promotes relaxation

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7
Q

effect of botox on the bladder

A

can cause urinary retention

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8
Q

how is neuromodulation used in overactive bladder

A

it works on the afferent feedback system to the brain

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9
Q

what are the spinal reflexes of the bladder

A
  1. reflex bladder contraction: parasympathetic: S3
  2. guarding reflex: rhabdosphincter tries to keep you dry by contracting: somatic innervation: brain control in Onulf’s nucleus.
  3. receptive relaxation: sympathetic nervous system: S3
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10
Q

what happens to bladder in a supra-spinal cord injury

A

coordination is lost and loss of completion of voiding

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11
Q

what is classed as an unsafe bladder

A

when the bladder puts the kidneys at risk due to:

  • high pressures in the bladder blocking the ureters preventing the kidneys from draining
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12
Q

sacral spinal cord injury

A

loss of:

  • reflex bladder contraction
  • guarding reflex
  • receptive relaxation → poor compliance → prolonged high pressure in the bladder that can put kidneys at risk.
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13
Q

features of sacral spinal cord injury

A
  • areflexic bladder
  • stress incontinance
  • risk of poor compliance → risk to kidneys.
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14
Q

how do brain conditions affect the bladder

A
  • they maintain a coordinated void but they may still be incontinent
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15
Q

what causes an unsafe bladder

A

prolonged high pressure

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16
Q

what’s the most common cause of autonomic dysreflexia

A

a full bladder - look for mechanism of this

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17
Q

where does the spinal cord end

A

L1

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18
Q

what are the main continence mechanisms

A
  1. internal sphincter
  2. external sprinter
  3. pelvic floor muscles
  4. prostate in men
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19
Q

describe the micturition reflex

A
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20
Q

why can’t babies control their wee

A
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21
Q

what surrounds the kidneys

A
  • layers after the kidney are:
    • renal capsule
    • perirenal fat
    • renal fascia
    • pararenal fat
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22
Q

the left kidney is slightly lower down than the right

T/F

A

False

the right is lower down due to being pushed by the kidney

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23
Q

what vertebral levels are the kidneys found at

A

T12 - L3

they are ~ 3 vertebrae in length

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24
Q

describe adrenal gland vasculature

A
  • arteries x3
    • superior artery = branch of the inferior phrenic artery
    • middle artery = branch of the abdominal aorta
    • inferior artery = branch of the renal artery
  • one vein drains the gland = the adrenal vein
    • the right adrenal vein drains directly into the IVC as its is in close proximity
    • the left adrenal vein drains into the left renal vein first
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25
Q

describe the anatomy of the adrenal glands

A
  • capsule
  • cortex
    • zona Glomerulosa
      • mineraolcorticoids synthesis
    • Zona Fascicularis
      • Glucocorticoids synthesis
    • Zona Reticularis
      • androgens synthesis
  • medulla
    • catecholamine synthesis
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26
Q

what doe the renal hilum contain

A
  • renal vein
  • renal artery
  • lymphatics
  • nerves
  • ureters
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27
Q

describe the renal vasculature

A
  • right and left renal arteries from the abdominal aorta
  • right and left renal veins that drain directly into the IVC
    • the right vein is shorter than the left
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28
Q

where do the right and left gonadal veins drain into

A

right drains directly into IVC

left drains into left renal vein first

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29
Q

Describe the anatomy of the internal kidney

A
  • cortex around the outside
  • medulla in the middle
    • arranged into pyramids
  • calyces
    • minor calyces → major calyces → renal pelvis → ureter
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30
Q

what is a nephron

A

a functional unit of the kidney

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31
Q

how is the nephron arranged within the kidney - where do the separate structure lie

A
  • the glomerulus, Bowman’s capsule, proximal and distal tubules and part of the collecting duct are in the cortex
  • the loop of henle and the rest of the collecting duct are in the renal pyramids
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32
Q

what is the renal papilla and what is its function

A

the apex of the medulla

it is the opening into a minor calyx for outflow of urine

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33
Q

explain the pathway of the ureter

A

it passes from the kidney to the bladder and travels behind the numerous arteries including the uterine and ovarian arteries.

“water under the bridge”

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34
Q

urine is transported in the ureters by peristalsis

T/F

A

True

they have muscular walls

35
Q

describe the passage of blood in the kidneys starting from the abdominal aorta

A

Abdominal aorta → renal artery → segmental arteries → interlobular arteries → arcuate arteries → afferent arteriole → Glomerulus → efferent arteriole → peritubular capillaries → interlobular veins → Arcuate vein → interlobular vein → renal vein → IVC

36
Q

What are the functions of the kidney

A

A WET BED

  • Acid/base balance
  • Water removal
  • Erythropoietin
  • Toxins
  • Blood Pressure
  • Electrolyte
  • D - vitamin D activation
37
Q

how much of the cardiac output goes to the kidneys

A

20%

38
Q

what is glomerular filtration rate

A

The volume of fluid filtered through the from the glomerulus to the bowman’s space

Glomerulus = the collection of capillaries carrying blood to filtered

bowman’s capsule = the space into which filtrate is captured

39
Q

why is there no oncotic pressure of the Bowmas capsule

A

there are no proteins in bowmans space

40
Q

why is creatinine used as a marker substance

A
  • it’s freely filtered
  • not secreted or reabsorbed
  • not metabolised
41
Q

what factors affect GFR

A
  1. Pressure
  2. Size of the molecule
  3. Charge of the molecule
  4. Blood flow
  5. Binding to plasma proteins
42
Q

describe the physiology of glomerular filtration and urine production

A
  1. the glomerular capillaries are fenestrated, meaning they have gaps to allow molecules in the blood to be filtered out, everything except RBCs.
    • the endothelial cells have glycocaelyx - proteins - which are -vely charged to repel the passage of proteins [also -vely charged] through.
  2. the afferent arteriole dilates while the efferent one constricts which raises the hydrostatic pressure exerted on the blood in the glomerulus → ultrafiltration.
  3. the filtrate passes into Bowman’s capsule and is basically protein free plasma.
  4. as the filtrate moves through the tubules, certain substances are reabsorbed either by diffusion or by mediated transport[ATP]
  5. whats left enters the collecting duct into the calyces to form the urine
43
Q

how is GFR controlled

A
  • To increase GFR;
    • Constrict the efferent arteriole (build up pressure before)•Dilate the afferent arteriole (builds up pressure after)
  • To decrease GFR;
    • Constrict the afferent arteriole (reduce blow flow)•Dilate the efferent arteriole (allows blood to escape easier)
44
Q

what is the glomerular filter layers made of

A
  1. fenestrated endothelial cells
  2. basement membrane
    • made from fusion of capillary and podocyte basement membrane.
  3. podocytes
45
Q

what are the mechanisms of autoregulation within the glomerulus

A
  • Myogenic; smooth muscle contraction in response to external stretching force, occurs in capillary walls, passive mechanism
  • Tubuloglomerular feedback;
    • constriction of afferent arteriole to increased sodium chloride concentration.
    • Dilation in response to decreased concentration.
    • Fast response via GFR and slow via RAAS
46
Q

explain tubuloglomerular feedback

A
  1. GFR of individual nephron regulated by the rate at which filtered fluid reaches the distal tubule
  2. Cells of macula densa (distal tubule) detect NaCl arrival
  3. Macular densa cells release prostaglandins in response to reduced NaCl delivery.
  4. This acts on granular cells, triggering renin release, activating the renin-angiotensin system
47
Q

protein is never found in the urine

T/F

A

False

  • The only protein that is normally found in urine is Tamm– Horsfall protein (uromodulin) which is produced by the thick ascending limb
  • otherwise other proteins shouldnt be present in the urine and indicate leaky nephrons
48
Q

what is the filtration fraction

A
  • Filtration Fraction = GFR / Renal Plasma Flow
  • i.e. the proportion that gets filtered.
49
Q

what is renal clearance

A

renal clearance is the volume of plasma completely cleared of a substance by the kidneys per unit time.

50
Q

main function of the proximal tubule

A
  • bulk reabsorption of essentials:
    • Na+
    • Cl-
    • water
    • glucose
    • bicarbonate
    • amino acids
    • phosphate
    • lactate
  • ⅔ of all filtrate reabsorbed here
51
Q

how is glucose reabsorbed in the PCT

A
  • via SGLT1 and SGLT2 transporters
    • these a co transporters that carry Na+ and glucose into the cell
    • SGLT1= 2Na+ and 1glucose
    • SGLT2=1Na+ and 1glucose
  • glucose reenters the blood passively via GLUT channels
52
Q

what is autoregulation in the kidneys and why is it important

A

Pressure within afferent arteriole rises → stretches vessel wall → triggers contraction of smooth muscle → arteriolar constriction

  • important because it prevents a rise in systemic arterial pressure reaching the capillaries in the nephron THUS it prevents damage and maintains constant level of filtration
  • revers happens in low pressure to maintain a constant rate of filtration
53
Q

main function of the loop of Henle

A
  • Descending limb = H20 reabsorption
  • ascending limb = Na, Cl and K reabsorption
54
Q

function of the distal convoluted tubule

A
  • “fine tuning” of sodium reabsorption, potassium and acid-base balance
  • impermeable to water
  • Macula densa located in juxtaglomerular apparatus which is in the DCT-
    • detects [Na+] and can activate RAAS.
55
Q

function os the collecting duct

A
  • Collecting duct mediates water reabsorption and maintains acid base homeostasis
  • Principal cells - Na and water reabsorption and K excretion
    • site of ADH action
  • Intercalated cells (alfa and beta) – secrete H or HCO3
    • •Essential for acid base homeostasis
56
Q

what is the normal pH range for blood

A
  • 7.35-7.45
  • Acidosis: pH<7.35
  • Alkalosis: pH>7.45
57
Q

where is the juxtaglomerular apparatus located

and what is it composed of

A

located in the distal convoluted tubule next to the glomerulus

  • macula densa cells
  • granular cells
  • afferent arteriole
  • distal convoluted tubule
58
Q

where are juxtaglomerular cells located

A

in the walls of the afferent arteriole

59
Q

what is RAAS

A

The Renin-Angiotensin-Aldosterone System (RAAS) is a hormone system within the body that is essential for the regulation of blood pressure and fluid balance

60
Q

what stimulates the RAAS

A
  • decreased blood pressure
    • detected by little or no arteriolar stretch (from low blood volume due to low Na+ and thus H2O).
  • decreased NaCl detected in the macula densa cells
  • sympathetic innervation

when any of these happens, then renin is released by the juxtaglomerular cells in the afferent arterioles

61
Q

what is renin and what does it do

A

an enzyme

cleaves angiotensinogen → angiotensin1

62
Q

where is angiotensinogen produced

A

the liver

63
Q

where is ACE produced

A

in the pulmonary and renal endothelium

64
Q

what are the effects of angiotensin 2

A
  1. stimulates the adrenal gland → aldosterone secretion
    • increases reabsotption of salt and water
    • increases K+ excretion
  2. stimulates the posterior pituitary gland → ADH secretion → more conc. urine
  3. stimulates vasoconstriction of systemic arteries and arterioles
  4. stimulates thirst in the hypothalamus
  5. increases total peripheral resistance thus raises BP
  6. stimulates sympathetic nervous system to increase release of noradrenaline
    • Increase in cardiac output.
    • Vasoconstriction of arterioles.
    • Release of renin.
65
Q

where is ADH produced

A

hypothalamus

66
Q

which cells does ADH take effect in

A

principal cells of the collecting duct

67
Q

what effect does ADH have

A
  1. it binds to the V2R receptors of the principal cells →
  2. upregulation of aquaporin channels in the collecting tubule walls →
  3. increased H2O reabsorption and less urine produced
68
Q

where is erythropoietin produced

what is its function

A

in the kidneys

increases production of RBCs in the bone marrow

69
Q

what hormones are produced in the adrenal glands

A
  1. Aldosterone
  2. cortisol
  3. corticosterone
  4. DHEA
  5. androstenedione

1= glomerulosa

2+3=fasciculata

4+5 = reticularis

70
Q

what is the role of the adrenal medulla

A
  • part of the autonomic nervous system
  • production of catecholamines
    • adrenaline 80% and noradrenaline20%
    • main site for adrenaline synthesis
  • production of catecholamines is dependent on cortisol levels [permissive effect]
71
Q

what is the role of the adrenal medulla

A
  • part of the autonomic nervous system
  • production of catecholamines
    • adrenaline 80% and noradrenaline20%
    • main site for adrenaline synthesis
  • production of catecholamines is dependent on cortisol levels [permissive effect]
72
Q

TRUE or FALSE

creatinine production is equivalent to creatinine excretion

A

True - this makes it a good marker of renal function

73
Q

what factors reduce GFR

A
74
Q

where do thiazide diuretics act

give an example

A
  • proximal convoluted tubule
  • bendroflumathiazide
75
Q

where do potassium sparing diuretics act

give an example

A
  • distal convoluted tubule
  • spironolactone [mineralocorticoid antagonist also]
  • amiloride
76
Q

where do loop diuretics act

give an example

A
  • loop of Henle
  • furosemide + bumetanide
77
Q

causes of hypokalaemia

A
  • insulin
  • hyperaldosteronism: Conn’s + Cushings
  • beta2 antagonists
  • alkalosis
78
Q

causes of hyperkalaemia

A
  • insulin deficiency
  • aldosterone deficiency - Addison’s
  • beta2 antagonists
  • exercise
  • acidosis
  • cell lysis
  • diet - lots of bananas
79
Q

how do NSAIDs → AKI

A

they reduce blood flow to the kidney by causing constriction of the afferent arteriole → reduced oxygen and cell death.

80
Q

causes of painful haematuria

A
81
Q

causes of painless haematuria

A
82
Q

triad of symptoms of nephrotic syndrome

A
  • proteinuria
  • oedema - eye sockets, genital region + peripheral limbs
  • hypoalbuminaemia
83
Q

difference between nephrotic and nephritic syndrome

A
84
Q

What cellular and structural changes in the glomerulus are responsible for nephrotic syndrome

A

podocyte damage → widened gaps between them which allows the easy passage of substances through them such as proteins.

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