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AHP II > Renal > Flashcards

Renal Flashcards

1
Q

Are kidneys apart of the circulatory system

A

Yes. Because of blood pressure regulation and ionic homeostasis.

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2
Q

3 distinct capillary beds with 3 functional unit

A
  1. Glomerular capillaries. This is where filtration of blood occurs. Vasoconstriction and vasodilation of the afferent and efferent arterioles affect the glomerular filtration rate.
  2. Peritubular capillaries. Carry away reabsorbed substances from the filtrate. Returns to blood
  3. Vasa Recta. Supplies nutrients to the medulla without distrupting its osmolarity. Surrounds LOH. (Straight vessels that travel deep into the kidney).
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3
Q

Pathway of blood from the renal artery to the afferent arteriole

A 
Renal artery 
Segmental arteries
Interlobular arteries
Arcuate arteries
Interlobular arteries 
Afferent arteries
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4
Q

What four arteries/capillaries control what enters/exits the kidney?

A

Afferent arteriole
Glomerular capillaries
Efferent arterioles
Peritubular capillaries and or the vasa recta

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5
Q

Which capillary bed is the only one in the body that are fed and drained by an arteriole?

A

Glomerular capillaries fed and drained by afferent and efferent arteriole

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6
Q

Two types of nephrons

A
  1. Juxtamedullary. LONG loop of Henle. Involved in the concentration of urine. About 15% of nephrons make up this category. Main function is to keep water and salt for animals living in heat.
  2. Cortical. Short loops of Henle. Most nephrons are in this category.
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7
Q

The kidney has over ___ nephrons and they filter about ___ L/day

A

1 million

180 L

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8
Q

What is so special concerning the epithelial lining of the glomerulus?

A

Visceral and parietal double walled epithelial cup that collects filtrate. Specialized morphology.

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9
Q

Are more nephrons formed throughout life?

A

No. If they kidney expands, its because the individual nephrons are expanding. If injured, no replacement occurs.

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10
Q

Dysfunction of the kidney is not evident until function declines by

A

25% of normal.

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11
Q

Rate of excretion

A

(filtration + secretion) - reabsorption

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12
Q

Structures within the renal corpuscle

A
  1. Bowmans capsule: Outer pariteal layer (simple squamous) folds in on itself to form the visceral layer, which surrounds the capillary bed. The visceral layer is made of podocytes.
  2. Bowman’s space/Urinary space: The space between the capsule and glomerulus
  3. Glomerulus: capillary bed
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13
Q

What cells make up Bowman’s capsule? Parietal and visceral

A

Parietal- Outer layer made of simple squamous cells.

Visceral- Inner layer composed of podocytes that cover the capillary bed.

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14
Q

What are the three layers of the glomerulus that substances must pass through to reach the lumen of bowman’s capsule?

A
  1. Endothelial fenestrations. Pores of the glomerulus. This prevents filtration of cells, but allows all components of the blood plasma to pass through.
  2. Basal lamina of the glomerulus. Prevents filtration of larger proteins.
  3. Slit membrane between pedicles that form the visceral membrane of the glomerulus. Prevents filtration of medium sized proteins.
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15
Q

What do macula densa cells do and where are they located?

A

They are located at the apex between the distal tubule and ascending loop of henle. It monitors afferent and efferent arterioles (close by) and monitors Na+ and water

Have ability to increase renin release from JG cells if BP is too low or decrease resistance in afferent arteriole if BP is high.

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16
Q

Mesangial ells

A

Modified smooth muscle cells that can contract. They also phagocytize debris and provide support. Also can secrete immune system substances such as interleukin I.

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17
Q

Juxtaglomerular cells

A

Specialized smooth muscle cells in the afferent arterioles that synthesize and store renting. These cells respond to stretch receptors if they sense a drop in blood pressure and cause renin to be released.

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18
Q

The liver produces ____, which mixes with renin to produce

A

Angiotensinogen to produce angiotensin 1. Angiotension 1 is a precursor, inactive.

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19
Q

How is angiotensin I (inactive precursor) activated to angiotensin II?

A

By ACE. Angiotension converting enzyme. Any endothelium in the body can create this. Lungs create the most due to their large surface area.

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20
Q

What can angiotensin II do after it is activated by ACE?

A
  • Increases sympathetic tone to increase blood pressure
  • NaCl reabsoption, K+ excretion

Also stimulates the adrenal glands which releases aldosterone and causes water reabsorption back into the body.

Also stimulates the posterior pituitary to release ADH, which causes the collecting duct to display aquaporins that will cause water to be reabsorbed into the body.

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21
Q

Which is a hormone and which is a peptide?

Angiotensinogen, angiotensin I and angiotensin II

A

Hormone- Angiotension II

Peptide- Angiotensinogen and Angiotension I

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22
Q

Another name for ADH

A

Vasopressin. Released from posterior pituitary and causes aquaporins to be inserted in the collecting duct so more water can be retained in the body and increase BP.

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23
Q

What causes glomerular filtration to occur?

A

It is a passive process in which hydrostatic pressure force the fluids and solute through a membrane.

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24
Q

Why is the glomeruli in the kidney a more efficient filter than other capillary beds in the body?

A

Large surface area and very permeable to water and solutes. Also, glomerular pressure is higher.

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25
Q

Which controls sodium levels? The JG cells or macula densa?

A

Macula Densa

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26
Q

How does each effect the GFR?

  1. Constrict afferent arteriole
  2. Constrict efferent arteriole
  3. Dilate efferent arteriole
  4. Dilate afferent arteriole
A
  1. Decrease GFR
  2. Increase GFR
  3. Decrease GFR
  4. Increase GFR
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27
Q

Which organ shuts the RAAS system down?

A

The heart.

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28
Q

Sensory innervation of these baroreceptors come from which CN?

Arch?
Carotid? (Lots of turbidity at this bifurcation. Important area to monitor BP. Can detect a wider range of BP than the arch since BP there is always high)

A

10, vagus

9, glossopharyngeal

29
Q

Average male GFR

Average female GFR

A

125 ml/min

105 ml/min

30
Q

Filtration stops if glomerular hydrostatic pressure drops below

A

45mmHg

31
Q

PCT lumen and cell characteristics?

A

The cells have a star shaped lumen and a brush border. Cell shape is indistinct and fuzzy. Non-distinct nuclei.

32
Q

DCT lumen and cell characteristics?

A

Lumen is more rounded and surface of cells are sharper. Distinct nuclei.

33
Q

What is the most abundant cation in the filtrate?

A

Sodium.

34
Q

Sodium reabsorption is almost always through what method?

A

Active transport. This creates an electrochemical gradient that allows other substances (glucose) via co-transporters to travel in the same direction.

35
Q

Tubular secretion is an important mechanism for

A

Disposing of drugs
Eliminating urea and uric acid.
Removing excess K+
Controlling blood pH

36
Q

2 methods of how drugs are disposed from body

A

Single pass- goes through once and is immediately removed

Double pass- Goes through twice. In body longer.

37
Q

The kidneys maintain plasma osmolarity at ___ mOsm. How do they do this?

A

300.

They do this by using the countercurrent exchange mechanism.

38
Q

What is permeable in the descending and ascending limb of the LOH?

A

descending: Water flows out by diffusion. Salts cannot exit.
Ascending: Water cannot exit. Only salts can flow out by active transport.

39
Q

Facillitated diffusion of urea is reabsorbed where?

A

Urea exits the collecting tubule and travels to the ascending LOH, where it can help create an even saltier environment.

40
Q

How does vasopressin (ADH) influence aquaporins?

A

Vasopressin binds to a g protein receptor on the collecting duct cells on the side near the interstitial fluid. Causes cascade for more aquaporins to be inserted onto the other side of the cell, which will connect the cell to the tubular lumen. Now, the lumen can travel through the cell and be reabsorbed back into the interstitial fluid and into the body.

41
Q

What types of aquaporins are found in the collecting duct cells? (interstitial side vs lumen side)

A

Lumen side: 2 (this is put on the membrane after vasopressin is released)
Interstitial side: 3 and 4

42
Q

Atrial Natriuetic Peptide

A

Released by the heart when there is increased distention of the atria. This shuts down the RAAS system when blood pressure is too high or is back to normal by decreasing plasma aldosterone. In turn, this causes more sodium to be excreted so water will follow. (RAAS works to increase BP when it is too low)

43
Q

What is the role of aldosterone and where is it released from?

A

Role is to increase water reabsorption back into the body to raise blood pressure levels. Apart of the RAAS system. Angiotension II stimulates the adrenal gland to release.

44
Q

How do aldosterone and K+ levels influence each other?

A

Increased K+ levels in the body will cause an increase in aldosterone release. This will cause an increase in sodium and water reabsorption into the body and excretion of K+.

In order for Na+ to exit the tubule, K+ enters as part of a paired transporter.

45
Q

Calcium reabsorption is increased by which hormone?

A

Parathyroid

46
Q

Phosphate reabsorption is decreased by which hormone?

A

Parathyroid

47
Q

How does parathyroid hormone influence calcium and phosphate reabsorption back into the body?

A

Will increase calcium reabsorption and decrease phosphate reabsorption.

48
Q

Diuretis

A

Substances that promote the loss of Na+ and water. Ex: alcohol inhibits the release of vasopressin.

49
Q

How does H+ ions affect pH?

A

Increase of H+ will bring the pH down.

50
Q

What ways will result in the gain of H+ ions, thereby decreasing pH?

A

Generation of H+ from CO2

Gain of H+ due to loss of bicarbonate in urine or diarrhea.

51
Q

What ways will result in the loss of H+ ions, thereby increasing pH?

A

Loss of H+ in urine or vomit.

Hyperventilation.

52
Q

Percentage of water reabsorbed
Sodium?
Glucose?
Urea?

A

Water- 99%
Sodium- 99.5%
Glucose- 100%. Glucose should not be in urine.
Urea- 44%. Will have urea in urine.

53
Q

Which two systems work together to regulate hydrogen ion concentrations?

A

Kidney and respiratory

54
Q

Renal respinse to acidosis

A

H+ is secreted to reabsorb all the filters bicarbonate.

55
Q

Convergence of the collecting ducts leads to the formation of the largest excretory ducts, called the

A

Papillary ducts.

56
Q

Histological features of collecting ducts and papillary ducts.

A

Cuboidal columnar cells with sharp intercellular boundaries.

57
Q

Kidney stones

A

More common in men 4:1
Vary in size
Can use shock waves to break apart if they are too large

58
Q

Polycystic disorder

A

Kidney is filled with fluid filled cysts in kidney. Genetic.

59
Q

All excretory passages except the lower part of the urethra are lined by

A

Transitional epithelium. Also called urothelium.

60
Q

Female and male epithelium at end of urethra

A

Female: SSNK
Male: Pseudostratified as it passes through prostate then SSNK

61
Q

Where can you found muscularis? in the ureter or in the urinary passages?

A

Only ureter. Inner longitudinal, middle circular, and outer longitudinal.

62
Q

Three muscles of the bladder and which system controls them?

A

Detrusor. Smooth muscle. Regulated by parasympathetic system. Inhibited during filling and stimulated during urination.

Internal urethral sphincter. Smooth muscle. Regulated by the sympathetic nervous system. Stimulating while filling and relaxed/inhibited while urination.

External urethral sphincter. Skeletal muscle that is voluntary, somatic. Stimulated to contract during filling and is inhibited/relaxed while urinating.

63
Q

How full is the bladder when the stretch receptors are activated?

A

200-300ml of storage. Stimulation will exponentially increase from there. If pons/parasympathetic system isn’t fully suppressed, you will urinate.

64
Q

Stress incontinence

A

Undesired urination due to sneezing, coughing, exercise. More common in women, especially after childbirth. In women, the pelvic muscles weaken with age, causing the uterus to push on bladder.

65
Q

Urge Incontinence

A

In males in females. Any irritation to the bladder or urethra (due to bacterial infection) can cause this.

66
Q

BPH in males

A

Benign Prostatic hypertrophy. Loss of ability to urinate due to prostate gland enlarging and pinching off the urethra. Causes urine to not be voiced as well. Medication: Flomax.

67
Q

Other urinary complications

  1. UTI, kidney infection
  2. Hemolytic uremic syndrome due to E coli
  3. Sickle cell
A
  1. 50% of females have had a UTI. Cause more cognitive complications in older women.
  2. Body attacks RBCs.
  3. Fragmented RBCs get stuck in nephron.
68
Q

ESRD (End stage regnal disease)

A

Domino effect. Begins when GFR is reduced. Causes edema, pulmonary disfunction and heart failure due to edema.

AHP II (11 decks)

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