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Human Physiology > Renal > Flashcards

Renal Flashcards

1
Q

What is the main role of the kidneys?

A

Urinary system

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2
Q

Explain the function of the kidney

A

Excretion

Formation of urine (primary function)

Excrete end products of metabolism and excess

Inorganic substances from the diet

Homeostatic regulation

Blood pressure

Electrolyte homeostasis (concentration of Na+, K+ and HCO3- and other ions)

Water homeostasis regulation of ECF (plasma and interstitial fluid through formation of urine)

Acid-base balance (regulation of pH)

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3
Q

Name the main structures of the kidney

A

Capsule

Cortex

Medulla

Ureter

Renal artery, vein and pelvis

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4
Q

What is the kidney responsible for?

A

Processing blood and sifting out waste products and water

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5
Q

Explain the structure of the renal cortex and structure and function of the medulla

A

Renal Cortex

Contains many capillaries

Contains glomeruli

Medulla

Renal pyramids separated by renal columns

Renal pelvis collects urine

Transports urine to ureters

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6
Q

Explain the role of the glomerulaus

A

Filters small solutes from the blood

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7
Q

Explain the role of the proximal convoluted tubule (PCR)

A

Reabsorbs ions, water, and nutrient; removes toxins and adjust filtrate pH

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8
Q

Explain the role of the descending loop of henle

A

Contains aquaporins that allow water to pass from the filtrate into the interstitial fluid

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9
Q

Explain the role of the ascending loop of henle

A

Reabsorbs Na+ and Cl- ions from the filtrate into the interstitial fluid

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10
Q

Explain the role of the collecting duct

A

Reabsorbs solutes and water from the filtrate

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11
Q

Name the 3exchange processes that occur within the renal nephrons

A

Glomerular Filtration

Reabsorption

Secretion

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12
Q

Where does filtration take place?

A

Glomerulus

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13
Q

Where does reabsorption and secretion take place?

A

PCT

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14
Q

What percent of glomerular filtrate is reabsorbed in the PCT

A

60 - 70%

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15
Q
A
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16
Q

Explain how sodium is reabsorbed

A

Na+ ions enter cells by:

diffusion through sodium channels

Sodium-linked cotransport of glucose, and amino acids

Counter transport with H+, Na+ may then by extruded from cells by Na+/K+ pump

K+ diffuses back out of the cell through K+ channels

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17
Q

Explain the process of absorption that occurs at the descending limb and ascending limb of the loop of henle

A

Descending Limb

Permeable to water

No transport of Na+, Cl- or K+

Cells of the descending limb and initial cells of the ascending limb are flat with no microvilli and few mitochondria thus not specialised for transport

Ascending Limb

Impermeable to water

Active transport to water

Active transport of Na+, Cl-and K+

Cells Furter up the ascending limb are cuboidal with lots of mitochondria thus specialised for transport

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18
Q

Explain how Ions are reabsorbed in the ascending limb

A

Na+, K+ and Cl- are transported out of the tubular fluid

Involves active transport of Na+-K+ or 2 Cl- transporters

K+ and Cl- are pumped into peritubular fluid

Na+ is pumped out in exchange for K+ - Na+/K+ exchange pump

K+ diffuses back into the lumen of the tubule through K+ leak channels

Therefore Na+ and Cl- lost into peritubular fluid

19
Q

Name the 3 components of the distal tubule

A

Cuboidal epithelial cells

Fewer microvilli

Abundant mitochondria

20
Q

Explain the role in transport of ions in the distal tubule

A

Involved with reabsorption of water, Na+ and Ca2+ ions from the tubule fluid

Na+ and Cl= actively transported across DCT

Na+ also reabsorbed in exchange for K+ by pump

Ion pump is controlled by aldosterone

H+ secretion is increased at low blood pH

21
Q

Explain the role of aldosterone in the Distal tubule

A

Aldosterone stimulates synthesis and incorporation of pump into the membrane

Aldosterone favours reabsorption of filtered sodium

Prolonged aldosterone stimulation may result in Hypokalaemia

Ca2+ also reabsorbed in DCT - regulated by parathyroid hormone

22
Q

What are some of the signs of kidney failure

A

High blood pressure

High creatine levels in the blood plasma

Swelling feet, legs and fingers

Puffiness around eyes

Fatigue, icing, insomnia, irritability, nausea and vomiting

Urinary tract infection and trouble passing urine

Anaemia or bone disease

23
Q

What people are at risk of CKD (Chronic kidney disease)

A

Those with diabetes

Those with high blood pressure

People with cardiovascular disease

Obstructive tumour growth

Family history of kidney disease

24
Q

Explain some of the ways kidney disease can be avoided

A

Drinking plenty of fluids

Having your blood pressure checked regularly and keep in target

Controlling the salt intake

Work with your doctor to fight symptoms with antibiotics

Obstructive kidney disease

If you have diabetes, control your blood glucose level

Keep your cholesterol levels in the target range

Take medicines the way your provider teel you to

25
Q

Explain what a nephron is and how many of them there are per kidney

A

The functional unit of the kidney

Over a million per kidney

26
Q

Explain the role of the collecting duct

A

Consist of connecting tubules, which connect each nephron to a collecting duct, several collecting ducts empty into a large papillary duct

Participation in electrolytes and fluids balance through reabsorption and excretion processes regulated by the hormone aldosterone and vasopressin (antidiuretic hormone)

27
Q

Explain the role of aldosterone in the late distal tubule and collecting duct

A

Aldosterone is a hormone produced by the adrenal glands that acts on the cells of the distal tubule and collecting duct

It causes the conversion of sodium and excretion of potassium, thereby controlling water retention, blood volume, and therefore blood pressure

28
Q

Explain the Renin-Angiotensin-Aldosterone cycle I

A

When blood volume or sodium levels in the body decrease cells in the kidney detect and release renin

Renin converts circulating angiotensinogen produced in the liver to the hormone angiotensin I

An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolites angiotensin I to Angiotensin II

29
Q

Explain Renin-Angiotensin-Aldosterone cycle II

A

Angiotensin II stimulates the release of the hormone aldosterone in the adrenal glands, which causes the distal renal tubule and collecting duct to retain sodium and water and excrete potassium.

The pituitary gland in the brain releases ADH (Vasopressin) which causes blood vessels to constrict and acts on the renal tubules.

Together, ADH and aldosterone work to raise blood volume, blood pressure, and sodium levels in the blood to restore the balance of sodium, potassium, and fluids. If the renin-angiotensin system becomes overactive, consistently it results in high blood pressure.

30
Q

Explain how the kidney controls pH

A

The kidneys maintain homeostasis through the excretion of waste products.

Carbonic anhydrase catalyzes the reaction.

Slower than the lungs

Acidosis causes more bicarbonate to be reabsorbed from proximal tubular fluid while collecting ducts secrete more hydrogen ions.

Alkalosis causes the kidney to excrete more bicarbonate and retain the hydrogen ions.

31
Q

Explain what Erythropoiesis (EPO) is

A

Erythropoietin (EPO) is the hormone released by the kidneys when the oxygen level in the blood is low

32
Q

Explain some of the role of the kidney

A

Controls the excretion and retention of calcium

The kidney is the most important organ involved in the elimination of drugs and their metabolites

Some drugs can be nephrotoxic and concentrated in the kidneys causing damage

33
Q

Explain what happens during acute kidney failure (renal)

A

Sudden loss of renal function (in a matter of hours or days)

Causes:

In patients in intensive care due to Multi-organ failure

Nephrotoxin poisons

Inflammation pr construction

Can be reversible with promo treatment

Treatment relies on the identification and removal of the cause

Intensive care to stabilize

Dialysis to filter blood waste

IV Fluids or diuretics

Medications to control potassium and calcium levels

34
Q

Explain what happens during chronic kidney disease, its cause and treatment

A

Nephron damage that occurs over a sustained period (not necessarily severe)

Due to:

High blood pressure

Diabetes

Obesity

Inflammation/ Autoimmune Kidney disease

Long-term use of Lithium or Nonsteroid anti-inflammatory drugs

Inherited genetic component

Treatment:

Careful management with GP, renal unit, and dietitian

35
Q

Name the 3 renal function tests

A

Blood plasma levels

Urine levels

Glomerular filtration rate

36
Q

Explain how blood tests can detect renal function

A

Blood urea nitrogen (BUN) provides a rough measurement of the glomerular filtration rate. Can be elevated in other conditions.

Creatinine levels in the serum give a good indication of nephron function because it is excreted by the kidney

37
Q

Explain what proteinuria is used for

A

The presence of protein in the urine indicates stress in the glomerular filtration

Protein in the urine can be detected and measured quickly
using the dipstick in the urine

The resulting color indicator can be compared to the chart on the pot.

38
Q

Explain the test for Glomerular filtration rate (GFR)

A

The test is used clinically to assess the degree of renal impairment

The test measures how many milliliters (ml) of waste fluid the kidneys can filter from the blood in a minute measured in ml/min.

The average GFR is approximately 125ml/min in the average-sized 70kg healthy male healthy pair of kidneys should be able to filter more than 90ml/min.

The result is similar to the percentage of normal kidney function. For example, an eGFR of 50ml/min equates to 50% kidney function.

39
Q

Explain the function of the Juxtaglomerular apparatus

A

Maintain blood pressure and GFR

The Distal tubule of each nephron loops back to form the apparatus

40
Q

Explain what macula dense cells and juxtaglomerular cells are

A

Macula densa cells - Chemoreceptor cells respond to changes in sodium and chlorine levels in the filtrates that travel through the distal convoluted tubule and to oxygen levels in the blood passing to the glomerulus; this sensory information is conveyed to the juxtaglomerular cells which will adjust their output of renin accordingly

Juxtaglomerular cells - Soecilialized smooth muscle cells that act as mechanoreceptors that stretch in response to an increase in the blood pressure of the afferent arterioles; they also synthesize and secret the enzyme renin

41
Q

Give the equation and explain how glomerular filtration rate (EGFR) is estimated

A

eGFR = (Urine concentration x Uirne flow) / plasma concentration

The GFR can be determined by injecting insulin into the blood plasma

Insulin is not reabsorbed nor secreted by kidneys after glomerular filtration; their rate of excretion is directly proportional to the rate of filtration of water and solutes across the glomerular filter

42
Q

Explain the uses of creatinine clearance

A

Creatinine clearance is usually used instead of insulin

creatinine waste product of muscle metabolism

Urine is collected over 24 24-hour period and the concentration of the creatine in urine is calculated

Divided by the plasma concentration of creatinine

Not as good as insulin because creatinine also excreted by the tubules

43
Q

Explain the 5 stages of CKD

A

Stage 1:

eGFR greater than 90 mls/min, with some sign of kidney damage on other tests. Control of blood pressure and

Stage 2:

eGFR 60-90 with some sign of kidney damage- Control of blood pressure and other risk factors.

Stage 3

eGFR 30-59 ml/min, a moderate reduction in kidney function, Control of blood pressure clinical assessment, medication review imaging tests.

Stage 4

eGFR 15-29 ml/min, a severe reduction in kidney function

Stage 5

eGFR less than 15 ml/min, established kidney failure, when dialysis or a kidney transplant may be needed

Human Physiology (9 decks)

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