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SUGAR > Renal > Flashcards

Renal Flashcards

1
Q

Which embryological layer are the kidneys derived from?

A

Mesoderm

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2
Q

At what vertebral level do the kidneys lie?

A

T12-L3

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3
Q

Right kidney is lower than the left kidney because…

A

It’s pushed down by the liver

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4
Q

At what vertebral level is the hilum of the right kidney?

A

L2

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5
Q

At what vertebral level is the hilum of the left kidney?

A

L1

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6
Q

How many layers does the kidney have?

A

3: the cortex, medulla and the renal pelvis

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7
Q

What does the cortex contain? (4)

A

Renal corpuscle (glomerulus and Bowman’s capsule)
PCT
DCT
Medullary ray (LoH and CD) –> gives the cortex its striated appearance

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8
Q

What does the medulla contain? (4 tubular structures)

A

CD
Thin descending limb of LoH
Thin and thick ascending limb of LoH
Blood vessels

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9
Q

What type of epithelium lines the renal pelvis?

A

Transitional epithelium/ urothelium

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10
Q

What is the renal pelvis continuous with proximally and distally?

A

Continuous proximally with the CDs

Continuous distally with the ureters

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11
Q

Describe the blood supply of the kidneys

A 
Renal arteries
Segmental arteries
Interlobar arteries
Arcuate arteries
Interlobular arteries
Afferent arteriole
Glomerular capillaries
Efferent arteriole
Peritubular capillaries (+ vasa recta)
Interlobular veins
Arcuate veins
Interlobar veins
Segmental veins
Renal veins
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12
Q

Are the kidneys extraperitoneal or retorperitoneal?

A

Retroperitoneal

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13
Q

What % of cardiac output do the kidneys receive?

A

20%

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14
Q

Total renal blood flow?

A

1L/min

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15
Q

Total urine flow?

A

1ml/min

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16
Q

What is the maximum filtration rate of the kidneys?

A

125ml/min

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17
Q

What does the renal corpuscle contain?

A

Glomerular tuft and Bowman’s capsule

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18
Q

What is the glomerular tuft?

A

Network of glomerular capillaries (w/ fenestrated walls) supported by mesangial cells

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19
Q

What do the mesangial cells do? (3)

A
  1. Produce extracellular matrix protein (structural support)
  2. Phagocytose glomerular unit breakdown products
  3. Contract to tighten capillaries + reduce GFR
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20
Q

What are the 3 layers of the filtration barrier?

A
  • Glomerular capillary endothelium
  • Basement membrane
  • Foot processes of the podocytes (epithelial cells)
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21
Q

What 2 components make the juxtaglomerular apparatus (JGA)?

A

Afferent arteriole

DCT

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22
Q

Location and function of GRANULAR CELLS.

A

Found in endothelium of afferent arteriole (in JGA).

Detect low bp and secrete renin in response.

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23
Q

Location and function of MACULA DENSA CELLS.

A

DCT contributes to it (in JGA).

Detect Na+ and regulates tubuloglomerular feedback (sends signals to granular cells to secrete renin).

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24
Q

In tubuloglomerular feedback, what happens when filtration is slow?
(check answer)

A

Filtration is slow –> More Na+ is absorbed –> Macula Densa send a signal to REDUCE afferent arteriole resistance –> this increases glomerular filtration

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25
Q

Cells in the PCT contain what and why? (3)

A

Microvilli on apical surface –> increase SA for reabsorption
Lots of mitochondria –> active transport of substances
Lysosomes (histology: black dots) –> break down proteins accidentally reabsorbed from urinary space

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26
Q

What moves out of the thin descending limb of the LoH?

A

Water (passively) flows out, concentrating the urine

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27
Q

What moves out of the ascending limb of the LoH?

A

Desired ions are actively pumped out and into the interstitium

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28
Q

How does the DCT regulate acid-base balance?

A

Secreting H+
Absorbing HCO3-
(via intracellular carbonic anhydrase)

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29
Q

How does DCT regulate Na+ and K+ concentration?

A

Exchanging urinary Na+ (reabsorption) for body K+ (excretion)

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30
Q

What hormone mediates Na+ reabsorption in the DCT?

A

Aldosterone

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31
Q

How is urine propelled down the ureters?

A

Peristalsis (contain two muscular layers: circular and longitudinal)

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32
Q

Which structures contain transitional epithelium?

A 
Renal Pelvis
Ureter
Bladder
In females: proximal urethra
In males: membranous urethra
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33
Q

How long is the urethra in females?

A

4-5cm

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34
Q

How long is the urethra in males?

A

20cm

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35
Q

Describe the urethra in males? (3)

A

Prostatic urethra
Membranous urethra
Penile urethra

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36
Q

What 2 cell types make up the collecting duct?

A

Principal cells

Intercalated cells

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37
Q

What do PRINCIPAL CELL in the CD do?

A

Respond to aldosterone (Na+/ K+ exchange)

Respond to ADH: insert aquaporin channels into apical membrane to increase H20 reabsorption

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38
Q

What do INTERCALATED CELLS in the CD do?

A

Acid-base balance:
ALPHA - secrete ACID
BETA - secrete BICARBONATE

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39
Q

Name the determinants of what crosses the filtration barrier. (5)

A
  1. Pressure
  2. Size of moleucle
  3. Charge of molecule
  4. Rate of blood flow
  5. Binding to plasma proteins
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40
Q

What is the glomerular filtration rate (GFR)?

A

Volume of fluid filtered from the glomeruli into the Bowman’s space per unit time (min)

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41
Q

GFR (physiology)=

A

= Kf (PGC - PBS - pie.GC)

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42
Q

What is the only protein that should be found in urine?

A

Tamm Horsfall protein (produced by LoH)

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43
Q

What does constricting the afferent arteriole do to GFR?

A

Reduces PGC, reduces GFR.

44
Q

What does constricting the efferent arteriole do to GFR?

A

Increases PGC, increases GFR

45
Q

What does dilating the afferent arteriole do to GFR?

A

Increases PGC, increases GFR

46
Q

What does dilating the efferent arteriole do to GFR?

A

Reduces PGC, reduces GFR

47
Q

Formula for measurement of GFR (using substance M).

A

Pm x GFR = Um x urine flow rate

48
Q

Filtration fraction=

A

GFR / renal plasma flow

49
Q

Avg urine output?

A

0.5ml/kg/hr

50
Q

Define renal clearance.

A

The volume of plasma from which a substance is completely removed by the kidney per unit time

51
Q

If the renal clearance of substance M is 125ml/min, what does this mean?

A

After being freely filtered from glomerulus, substance M is neither reabsorbed or secreted.

52
Q

Clearance=

A

(urine conc x urine vol)/ plasma conc

53
Q

Describe the process of bulk reabsorption in the PCT (4)

A
  1. Basolateral Na-K ATPase maintains the Na+ concentration gradient from the lumen into the PT cell
  2. Na+ reabsorption drives the reabsorption of co-transported substances and the secretion of H+
  3. Water follows passively by osmosis
  4. Bicarbonate reabsorption (using H+ and carbonic anhydrase)
54
Q

Describe the countercurrent multiplier system (LoH) (3)

A
  1. Ascending limb pumps out NaCl into interstitium
  2. Medullary hypertonicity increases
  3. Water diffuses out of descending limb into interstitium
55
Q

How is urea involved in the countercurrent medullary interstitium?

A

Urea is an osmotically active molecule ==> increases medullary interstitial osmolarity

56
Q

Why doesn’t blood flow wash out the osmotic gradient? (4)

A
  • Vasa recta
  • Long capillaries extend deep into the medulla
  • Permeable to solute + H2O
  • Solute + H2O carried away by bulk flow
57
Q

Why is the amount of blood flow leaving the vasa recta 2x higher than the amount of blood entering it?

A

Because of the NaCl + H2O reabsorbed from the LoH and CD

58
Q

What takes place in the DCT? (3)

A

Fine regulation of Na, K, Ca and Pi
Separation of salt (Na) from H2O
Dilution of urine

59
Q

What takes place in the CD? (3)

A

Acid secretion (intercalated cells)
Regulated H2O reabsorption (principal cells)
Regulated Na absorption and K secretion (principal cells)

60
Q

What does aldosterone drive in the CD?

A

Na+ reabsorption and K+ excretion

61
Q

How much fluid is present in a 70kg man?

62
Q

How much of total body fluid is intracellular?

63
Q

How much of total body fluid is extracellular?

64
Q

How much of the extracellular fluid is plasma?

65
Q

What’s the range for normal plasma osmolality?

A

285-295mOsm

66
Q

Plasma osmolality=

A

2(Na + K) + glucose + urea

67
Q

How does the ingestion of excess water lead to the reduced release of vasopressin? (6)

A 
Increased H2O ingested
Decreased body fluid osmolarity
Decreased firing of hypothalamic osmoreceptors
Decreased vasopressin secretion
Decreased tubular permeability to H2O
More water is excreted
68
Q

How does loss of extracellular water lead to the increased release of vasopressin? (6)

A 
Water loss (diarrhoea/ haemorrhage)
Decreased cardiovascular pressure
Reduced firing by cardiovascular baroreceptors
Increased vasopressin release
Increased tubular permeability to H2O
Less water is excreted
69
Q

Na+ excreted=

A

Na+ filtered - Na+ reabsorbed

70
Q

How is GFR altered when total body Na+/ plasma volume decreases? (3 steps)

A

Reflex vasoconstriction of afferent arteriole
Decreases GFR
Increases Na + H2O reabsorption

71
Q

How is GFR altered when total body Na+/ plasma volume increases? (3 steps)

A

Reflex vasodilation of afferent arteriole
Increases GFR
Decreases Na + H2O reabsorption

72
Q

How is renin secretion initiated? (3)

A
  • Macula densa cells detect less NaCl
  • Sympathetic stimulation
  • Reduced arteriolar stretch
73
Q

What does renin do?

A

Cleaves angiotensinogen into angiotensin 1

Increases BP

74
Q

What converts angiotensin 1 into angiotensin 2?

75
Q

What does angiotensin 2 do? (4)

A
  • Stimulates release of ALDOSTERONE
  • Vasoconstricts efferent arteriole
  • Increases Na+ reabsorption in PCT
  • Increases VASOPRESSIN release
    All act to raise blood volume and thus pressure
76
Q

What does aldosterone do? (2)

A

Stimulates transcription of ENaC (on principal cells in CD) –> increases Na+ and H2O reabsorption.
Also, causes more K+ to leak out

77
Q

What does ANP (atrial natriuretic peptide) do? (3)

A
  • Blocks ENaC channels –> inhibits Na+ and H2O reabsorption
  • Directly inhibits aldosterone secretion
  • Vasodilates afferent arteriole –> increases GFR –> increases Na+ excretion
78
Q

What 2 main transporter channels does the PCT contain?

A

Na+ cotransporter channels (reabsorption of organic substances)
Na+/H+ countertransporter channels (bicarbonate reabsorption)

79
Q

What main transporter channel does the ascending limb of LoH contain?

A

NKCC2 (reabsorbs Na+, K+ and 2Cl-)

80
Q

What 2 main transporter channels does the DCT contain?

A

Na+/Cl- cotransporter

Ca2+ channel

81
Q

What main transporter channels does the CD contain?

A

Apical side: ENaC, K+ channels and aquaporins

Basolateral side: V2R

82
Q

Describe the relationship between osmoreceptors and vasopressin release.

A

Osmoreceptors act as the ACCELERATOR for vasopressin release.

83
Q

Describe the relationship between baroreceptors and vasopressin release.

A

Baroreceptors act as the BREAK for vasopressin release.

84
Q

What does parathyroid hormone do in the kidneys? (2)

A
  • Increases Ca2+ reabsorption

- Converts Vit D to its active form

85
Q

pH=

A

-log10[H+]

86
Q

Normal pH range of the blood?

A

7.35 -7.45

87
Q

Define a BASE

A

Proton acceptor

88
Q

Define an ACID

A

Proton donor

89
Q

Define base excess

A

Quantity of acid required to return plasma pH to normal

90
Q

Define standard base excess

A

Quantity of acid required to return ECF back to normal pH

91
Q

Define acidosis

A

Disorder causing blood to be more acidic than normal

92
Q

Define alkalosis

A

Disorder causing blood to be more alkaline than normal

93
Q

Define acidemia

A

Low blood pH

94
Q

Define alkalemia

A

High blood pH

95
Q

Anion gap=

A

[Na+] + [K+] -[Cl-] - [HCO3-]

96
Q

What is the average anion gap value?

97
Q

What does a wide anion gap suggest?

A

Increased acid in the body eg ingestion of acid, ketoacidosis, lactic acidosis

98
Q

What does a narrow anion gap suggest?

A

High Cl- so increased GI HCO3- loss, renal tubular acidosis

99
Q

What are the two main urinary buffers?

A

Phosphate buffer

Ammonium buffer

100
Q

Signs of respiratory acidosis

A

Decreased pH
Increased pCO2
Increased HCO3-

101
Q

Signs of respiratory alkalosis

A

Increased pH
Decreased pCO2
Decreased HCO3-

102
Q

Signs of metabolic acidosis

A

Decreased pH
Decreased HCO3-
Decreased pCO2

103
Q

Signs of metabolic alkalosis

A

Increased pH
Increased HCO3-
Increased pCO2

104
Q

Compensatory mechanism for resp acidosis

A

Increased renal HCO3- retention

Increased renal H+ secretion

105
Q

Compensatory mechanism for resp alkalosis

A

Decreased renal H+ secretion

Increased HCO3- secretion

106
Q

Compensatory mechanism for metabolic acidosis

A

Hyperventilation

107
Q

Compensatory mechanism for metabolic alkalosis

A

Hypoventilation

SUGAR (7 decks)

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