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HUBS192 > Renal > Flashcards

Renal Flashcards

1
Q

What are the major functions of the kidney

A

Endocrine, metabolic, pH regulation, water homeostasis, salt/ion homeostasis, reabsorption of nutrients, excretion of medications, toxins and metabolites (waste products)

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2
Q

What percentage of our bodies is water

A

55% (females), 60% (males)

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3
Q

How much of our total body water is ECF and ICF

A

1/3 ECF and 2/3 ICF

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4
Q

What substances would be found in normal urine

A

Water, salts, urea, metabolites, hormones, small proteins

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5
Q

Where are the kidneys located (rib level)

A

T12-L3

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6
Q

How many lobes per kidney

A

5-11

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7
Q

What are the kidneys surrounded with for support

A

Renal fat pad (adipose tissue)

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8
Q

Where does filtration occur in the kidney

A

Cortex

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9
Q

Where do peritubular capillaries drain to

A

Cortical radiate vein, renal vein, inferior vena cava

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10
Q

How are the kidneys innervated

A

A network of autonomic nerves and ganglia called the renal plexus
(sympathetic nerves act to adjust diameter of renal arterioles and thus regulate bloodflow)

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11
Q

What are the two types of nephrons

A

Cortical and juxtamedullary

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12
Q

What percentage of nephrons are cortical

A

85%

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13
Q

What percentage of nephrons are juxtamedullary

A

15%

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14
Q

What forms the filtration barrier

A

Fenestrated capillary endothelial cells, fused basement membrane, podocytes

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15
Q

What are peritubular capillaries specialised for

A

Absorption

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16
Q

What are vasa recta

A

Extensions of capillaries that follow nephron loops deep into the medulla (only found with juxtamedullary nephrons)

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17
Q

What is the outer layer of the glomerular capsule made of

A

Parietal simple squamous cells

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18
Q

What is the inner layer of the glomerular capsule made of

A

Inner visceral podocytes

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19
Q

What are podocytes

A

Specialised epithelium with many branches and intertwining foot processes called pedicels

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20
Q

What are filtration slits

A

Gaps between pedicels

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21
Q

What does the filtration barrier mostly filter based on

A

Size

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22
Q

Urine = (in terms of filtrate)

A

Filtered - reabsorbed + secreted

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23
Q

What type of epithelium is the proximal convoluted tubule

A

Cuboidal (leaky)

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24
Q

How is the basolateral membrane of PCT cells described

A

Highly folded

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25
Q

How is the luminal membrane of PCT cells described

A

Dense microvilli brush border

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26
Q

What organelle is prominent in PCT epithelial cells

A

Mitochondria for active transport

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27
Q

What type of epithelium is present in the thin descending limb

A

Simple squamous

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28
Q

What type of epithelium is present in the thin ascending limb

A

Simple squamous

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29
Q

What is the purpose of the PCT

A

Bulk reabsorption

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30
Q

What is the purpose of the DCT

A

Fine tuning reabsorption

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31
Q

What type of epithelium is found in the DCT

A

Cuboidal, but thinner than PCT

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32
Q

What is the structure of epithelial cells in the DCT (same as collecting duct)

A

Few microvilli: no brush border, fewer mitochondria

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33
Q

What hormone does the kidney secrete and when

A

EPO, when blood oxygen levels are low. Stimulates bone marrow to produce more red blood cells

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34
Q

How do the kidneys undergo gluconeogenesis

A

During fasting kidneys make glucose from lactate

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35
Q

What is the blood pH range

A

7.35-7.45

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36
Q

What blood pH is known as alkalosis

A

> 7.45

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37
Q

What blood pH is known as acidosis

A

<7.35

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38
Q

What are the two main sources of acid in the body

A

Acids coming from metabolism, food and drink, and carbon dioxide from metabolism

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39
Q

How is pH of the blood controlled

A

Lungs (exhalation of CO2), kidneys (reabsorption and secretion of bicarbonate and hydrogen ions)

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40
Q

What do kidneys secrete to maintain salt/ion homeostasis

A

K+

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41
Q

What medications do the kidneys secrete

A

Lidocaine (common local anaesthetic excreted after metabolism due to its lipophilic nature), aspirin (common pain killer excreted directly due to its hydrophilic nature)

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42
Q

What percentage of ECF is plasma

A

20%

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43
Q

What percentage of ECF is interstitial fluid

A

80%

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44
Q

What is the normal osmolarity of the ECF

A

275-300 mosmol/L

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45
Q

What is the normal osmolarity of the ICF

A

275-300 mosmol/L

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46
Q

What does hyposmotic mean

A

Increase in water, decrease in concentration

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47
Q

What does hyperosmotic mean

A

Decrease in water, increase in concentration

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48
Q

What does a loss of water from the ECF result in

A

Loss of water from both regions, cells shrink

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49
Q

What does a gain of water to the ECF result in

A

Gain of water to both regions, cells swell

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50
Q

What does a loss of isosmotic fluid from the ECF result in

A

No net water movement, decrease in ECF volume only

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51
Q

What does a gain of isosmotic fluid from the ECF result in

A

No net water movement, increase in ECF volume only

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52
Q

What is filtration

A

Movement of solutes from the blood to the plasma like filtrate

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53
Q

What is secretion

A

Movement of solutes from the peritubular capillaries into the tubular fluid

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54
Q

What is reabsorption

A

Movement of solutes from the tubular fluid (nephron) into the peritubular capillaries

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55
Q

What reabsorption occurs in the PCT

A

Bulk reabsorption of ions, water and nutrients (glucose)

56
Q

What reabsorption occurs in the nephron loop

A

Bulk reabsorption of ions, water

57
Q

What reabsorption occurs in the distal tubule and collecting duct

A

Fine tuning reabsorption of ions and water

58
Q

Where does secretion occur

A

PCT

59
Q

What does regulated reabsorption refer to

A

Regulated by hormones

60
Q

Is sodium secreted

A

No

61
Q

Where is sodium mostly reabsorbed

A

Most parts of the nephron

62
Q

How much sodium is secreted in the urine

A

Small amount

63
Q

Is glucose secreted

A

No

64
Q

Where is glucose fully reabsorbed

A

PCT

65
Q

How much glucose is secreted in the urine

A

None

66
Q

Are medications and toxins secreted (e.g PAH)

A

Yes, entirely

67
Q

Are medications and toxins reabsorbed (e.g PAH)

A

No

68
Q

How much PAH is excreted in the urine

A

All IN BLOOD will be excreted

69
Q

Are creatinine and inulin secreted

A

No

70
Q

Are creatinine and inulin reabsorbed

A

No

71
Q

How much creatinine and inulin are excreted in the urine

A

All filtered will be excreted

72
Q

What is the renal blood flow

A

20% of CO (~1100-1200ml/min)

73
Q

What is the magnitude of glomerular hydrostatic pressure

A

50 mmHg

74
Q

What is the magnitude of blood colloid osmotic pressure

A
  • 25 mmHg
75
Q

What is the magnitude of capsular hydrostatic pressure

A
  • 15 mmHg
76
Q

What is the magnitude of net filtration pressure

A

10 mmHg

77
Q

What is filtration fraction (definition)

A

The proportion of kidney plasma flow which actually gets filtered

78
Q

What is filtration fraction (equation)

A

CO*1/5 * 0.55 * 1/5
(1/5 of plasma entering the kidneys is filtered)

79
Q

What is the GFR (definition)

A

How much plasma is filtered per minute

80
Q

How are RPF and GFR calculated

A

By measuring the clearance of specific substances

81
Q

What is the GFR (equation)

A

RPF * FF

82
Q

What is renal filtered load (definition)

A

How much of a substance in the plasma is filtered per minute

83
Q

What is renal filtered load (equation)

A

GFR * solute plasma concentration

84
Q

What is renal clearance

A

How much plasma is cleared of a substance per minute

85
Q

The clearance of which substances is used to estimate GFR

A

Inulin and creatinine

86
Q

The clearance of which substance is used to estimate RPF

A

PAH

87
Q

How much plasma is cleared of glucose per minute

A

None

88
Q

How much plasma is cleared of sodium per minute

A

A very small volume

89
Q

What is the equation for renal clearance

A

UV / P

90
Q

What is an average value for GFR

A

125ml/min, 180L/day

91
Q

What GFR indicates kidney failure

A

<15ml/min

92
Q

What percentage of water filtered load is reabsorbed in the PCT

A

67% (water follows sodium)

93
Q

What percentage of water filtered load is reabsorbed in the descending limb of the nephron loop

A

25% (DESCENDING: water flows downhill)

94
Q

What percentage of water filtered load is reabsorbed in the CD

A

2-8%

95
Q

What percentage of water filtered load is excreted

A

<1-6%

96
Q

What percentage of water absorption is bulk (obligatory), and where does this occur

A

92%, occurs in the PCT and descending limb of the nephron loop

97
Q

What percentage of water absorption is regulated (facultative), and where does this occur

A

2-8%, CD

98
Q

How does water cross the PCT

A

Trans and paracellular pathways

99
Q

How does water cross the CD

A

Transcellular pathway

100
Q

What is regulated water reabsorption regulated by

A

ADH

101
Q

What percentage of sodium filtered load is reabsorbed in the PCT

A

67% (water follows sodium)

102
Q

What percentage of sodium filtered load is reabsorbed in the ascending loop

A

25% (ASCENDING!)

103
Q

What percentage of sodium filtered load is reabsorbed in the DCT

A

5%

104
Q

What percentage of sodium filtered load is reabsorbed in the CD

A

2-3%

105
Q

What percentage of sodium filtered load is excreted

A

<1%

106
Q

What percentage of sodium reabsorption is accounted for by bulk sodium reabsorption

A

92%

107
Q

What percentage of sodium reabsorption is accounted for by regulated sodium reabsorption

A

7-8%

108
Q

What is regulated sodium absorption regulated by

A

Aldosterone (RAAS)

109
Q

What creates the HOMG

A

Different permeabilities of descending and ascending juxtamedullary nephron loops

110
Q

Where are TBW changes and hence changes in ECF osmolarity detected

A

Osmoreceptors in the hypothalamus

111
Q

Where is ADH secreted from

A

Posterior pituitary

112
Q

What does the release of ADH result in

A

Insertion of aquaporins into apical membrane of CD cells

113
Q

What does an increase in ECF volume result in the secretion of (isosmotic fluid)

A

ANP (N)

114
Q

What does a decrease in ECF volume result in the secretion of (isosmotic fluid)

A

Aldosterone (D)

115
Q

What does the release of aldosterone result in

A

Insertion of sodium channels in apical membrane of DCT and CD

116
Q

Where does creatinine come from

A

Muscle metabolism

117
Q

Describe transitional epithelium

A

Stratified, rounded cells, flatten when stretched for protection

118
Q

Are ureters intra or retroperitoneal

A

Retroperitoneal

119
Q

Describe the muscularis of the ureters

A

Inner longitudinal, outer circular

120
Q

What improves the protection of transitional epithelium

A

Protein plaques on its surface

121
Q

Where do the ureters insert into the bladder

A

Posterolateral corners

122
Q

Why does the ureter enter the bladder at an oblique angle

A

So that filling of urine doesn’t go back up, compressed by increased bladder pressure

123
Q

What are the rugae of the bladder

A

Folds that allow the bladder to expand without great increase in pressure

124
Q

What is the region between the two ureters and urethra called

A

Trigone

125
Q

Where does the bladder expand

A

Superiorly

126
Q

Where is the male bladder located

A

Anterior to rectum, superior to prostate

127
Q

Where is the female bladder located

A

Anterior to vagina and uterus

128
Q

Describe the detrusor muscle

A

Smooth muscle layer made of oblique, circular and longitudinal muscle fibres

129
Q

How does the epithelium change down the urethra

A

Transitional near bladder, then columnar, then stratified squamous near external opening

130
Q

What is the opening of the urethra called

A

External meatus/orifice

131
Q

What are the three regions of the male urethra

A

Prostatic, membranous, spongy/penile

132
Q

What muscle layer does the membranous urethra pass through

A

Urogenital diaphragm

133
Q

What is the internal urethral sphincter

A

Continuation of detrusor muscle, involuntary control

134
Q

What is the external urethral sphincter

A

Skeletal muscle, voluntary control

135
Q

What signals to the brain that you need to urinate

A

APs from stretch receptors in the bladder

HUBS192 (6 decks)

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