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Linganguliguliguli > Renal anat, physio > Flashcards

Renal anat, physio Flashcards

1
Q

What are the location of the kidneys

A

Lies against floating ribs 11,12
T12-L3

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2
Q

Which kidney is lower

A

Right kidney

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3
Q

What are the structures surrounding the kidneys

A

Superiorly = Suprarenal glands
Surrounding = Perinephric fat, Renal fascia, Paranephric fat

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4
Q

Describe the shape and orientation of renal pyramids

A

Wedge shaped
Point towards minor calyx

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5
Q

Compare the left renal vein to the right renal vein

A

Left renal vein is longer and crosses under the mesenteric artery

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6
Q

What is the arrangement of the kidney hilum

A

Anterior => Posterior
Vein Artery Nerve

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7
Q

What is the flow of fluid in the kidneys

A

Collecting duct => Minor calyces => Major calyces => Renal pelvis => Ureter => Bladder

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8
Q

Describe arterial blood supply to kidneys

A
  • Aorta => L/R renal arteries
    Segmental artery => Interlobar artery => Arcuate artery => Cortical radiate artery => Afferent arterioles
  • Glomerulus => Efferent arteriole => Peritubular capillaries
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9
Q

Describe venous drainage from kidneys

A

Cortical radiate vein => Arcuate vein => Interlobar vein => Renal vein => IVC

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10
Q

Where is the position of the ureters

A

Retriperitoneal, attached to posterior abdominal wall

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11
Q

How does urothelium change over time

A

Transitional epithelium => stratified squamous epithelium

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12
Q

What is the position of the bladder

A

Floor of pelvic cavity

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13
Q

How do the ureters run

A

Crosses sacroiliac joint before entering pelvic cavity

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14
Q

What are the 3 ureter constrictions

A

Ureteric junction
Pelvic inlet
Entrance to bladder

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15
Q

What is lined by urothelium

A

Renal pelvis, ureters, bladder, prox. urethra

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16
Q

What is the histology of urothelium

A

Transitional epithelium => Changes shape under stretch to accommodate liquid

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17
Q

Describe urethra epithelium

A

Membranous and spongy w pseudo stratified columnar epithelium

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18
Q

Describe distal urethra epithelium

A

Stratified squamous epithelium

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19
Q

What are the borders of the trigone area

A

Between both ureter openings and urethral orfice

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20
Q

What is the blood supply of the bladder

A

Vesical arteries
Branches of iliac artery

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21
Q

What does the trigone area originate from

A

Mesoderm

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22
Q

Describe the histology of the bladder

A

Mucosa
- Urinary epithelium
- Rugae = thick muscular folds that allow expansion

Submucosa
- Fibroelastic connective tissue

Detrusor SM
- Contracts to expel urine

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23
Q

Describe the muscular features and innervation of the sphincter muscles

A

Internal sphincter
- Smooth muscle
- Autonomic control

External sphincter
- Skeletal muscle
- Voluntary control via pudendal nerve

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24
Q

Describe coliquey pain

A

Ureters undergo peristalsis
Contract to move kidney stone but stone is stuck

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25
Describe the gross features of the glomerulus
Fenestrated capillary endothelium Basement membrane negatively charged Epithelial layer w podocyte foot processes
26
What are the cells of the nephron
Juxtaglomerular cells Macula densa Extraglomerular mesangial cells
27
Describe the function of juxtaglomerular cells
Synthesise renin
28
Describe the features and functions of macula densa cells
Tall cuboidal cells Monitors NaCl conc
29
Describe the function of extraglomerular mesangial cells
Autoregulation of blood flow to kidney
30
How is GFR calculated
Urine creatinine/ Serum creatinine x Urine flow rate
31
What does clearance > GFR suggests
Net secretion
32
What does clearance < GFR suggests
Net reabsorption
33
What does clearance = GFR suggests
No net movement
34
What is a precaution of using creatine clearance to calculate GFR
Creatinine is moderately secreted by renal tubules => Slight overestimation of GFR
35
What are some causes of decreased GFR and what are their effects on renal plasma flow and filtration fraction
Afferent arteriole contraction/ narrowing - Decreased RPF only Severe dehydration - Decreased RPF - Increased FF Glomerulonephritis - Decreased RPF only
36
What is filtration fraction
GFR/ RPF
37
What are some causes of increased GFR and what are their effects on renal plasma flow and filtration fraction
Efferent arteriole constriction - Decreased RPF - Increased FF Decreased plasma proteins - Increase FF only
38
How is filtration regulated
- Myogenic response => Increased stretch of arterial wall - Tubuglomerular feedback = Macula dense release vasoactive substances - Hormones => afferent arteriole vasoconstriction
39
What are the reabsorbed substances at the proximal convoluted tube
Glucose & AA - 100% H2O, HCO3-, NaCl - 66%
40
How is Na+ reabsorbed in the PCT
- Enters cell down electrochemical gradient via membrane protein - Pumped out basolateral side via Na+/K+ ATPase
41
How is glucose reabsorbed at the PCT
Enters via SGLT with Na+ Exits cell via GLUT
42
How are organic metabolites and ions absorbed at PCT
Absorbed by Na+ dependant co-transport
42
How are proteins reabsorbed at PCT
- Enter cell via apical endocytosis => digested into AA, reabsorbed via transcytosis - Basal exocytosis/ diffusion into plasma
42
How is water reabsorbed at PCT
Osmosis following solute reabsorption
42
What substances are absorbed throughout the loop of henle
Thin descending limb = Absorb H2O Thick ascending limb = Absorbs Na+, K+, Cl-, Mg2+, Ca2+
42
What are the transporters at the PCT and their functions
Na+/K+ ATPase = maintains Na+ gradient NHE3 = Na+ (in), H+ (out) SGLT1,2 = Na+ w glucose reabsorption Na+/AA co-transporters Aquaporin-1 = Facilitates osmosis NBC1 = HCO3- reabsorption
42
How is urea reabsorbed at PCT
Initially no urea conc gradient => Na+ & H2O reabsorption creates gradient => Urea diffuses across epithelium down gradient
42
What are the transporters in the loop of henle
Descending - Aquaporin-1 = Facilitates osmosis Ascending - NKCC2 = Na+, K+, Cl- reabsorption - Na+/K+ ATPase = maintains Na+ gradient - ROMK = Recirculates K+ into lumen - CLC-kb = Pumps Cl- basolaterally
43
Which part of the nephron do loop diuretics act on
Loop of henle
43
What are the substances secreted and absorbed at the distal convoluted tubule
K+, H+, HCO3- secretion Na+ (aldosterone) Ca2+ reabsorption
43
What are the transporters at the distal convoluted tubule
NCC = Na+ & Cl- co-transport TRPV5 = Ca2+ channel for reabsorption Na+/K+ ATPase = maintain Na+ gradient NCX1 = Ca2+ into blood, Na+ into tubule
43
What is the process of secretion at the DCT
Accumulation of Na+ & AKG- from urine => Na+ pumped into interstitial fluid increase AKG- accumulation in cell => Increases organic anion into cell via OAT => OA changed for random anion from urine
43
How is excretion calculated
Filtration - reabsorption + secretion
43
Describe the osmolarities throughout the nephron
Cortex = isosmotic Desc limb = High osmolarity Bottom of loop = Highest osmolarity Asc limb = Low osmolarity Collecting duct = Variable on hormones
44
Compare osmolarity and tonicity
Osmolarity = solutes/L; depends on solutes Tonicity = How a solution affects cell V; depends on non-penetrating solutes
45
Describe the countercurrent exchange system
Vasa recta and loop of henle run parallel but opposite directions Vasa recta A. limb absorbs H2O reabsorbed by Henle D. limb Vasa recta D. limb absorbs solutes reabsorbed by Henle A. limb =>Maintains high medullary osmolarity and gradient between medulla and tubules
45
What is the stimulus of Vasopressin and where is its origin
Decreased BP (main drive) and Increased Osmolarity Synthesise in hypothalamus, released by posterior pituary
45
What is the MOA of Vasopressin
Triggers G-Protein signalling => Increased aquaporin2 expression at collecting ducts => Increase collecting duct permeability to H2O and reabsorption
46
What are some ADH disorders and how do they affect urine osmolarity
Diabetes insipidus = Hypothalamic damage => Decreased ADH synthesis => Increase H2O loss => Polyuria and decrease urine osmolarity SIADH = Excessive ADH synthesis and release => Excessive H2O retention => Oliguria, Oedema and increase urine osmolarity
46
What is the body's response to severe dehydration
Osmoreceptors (hypothalamus) & Baroreceptors (atrial, aortic, carotid) => Hypothalamus - Increase thirst - Increase ADH => Increase Na+ reabsorption w water at collecting duct => Increase BV and BP Baroreceptors => CVS =>Parasympathetic inactivation & Symptoms activation =>Increase HR & contractility, vasoconstriction & PR => Increase CO and BP Baroreceptors & Decrease GFR (macula densa) => Renal => Increase renin release => Ang II - Aldosterone synthesis and release - Peripheral vasoconstriction & PR - Na+/H2O retention => Increase BP
46
What is the effect of vasopressin on urine osmolarity
Increased urine osmolarity
46
What stimulates/inhibits aldosterone release
Hyperkalaemia, Hypotension, Decrease osmolarity increase release Natriuretic peptides inhibit release
47
Describe the RAAS pathway and its effects
Renin - Increased by hypotension, hyponatremia, Sympathetic activity - Decreased by Ang II, Aldosterone, Increased BP Angiotensinogen (liver) => Ang I (Renin) = > Ang II (ACE) Ang II - Peripheral vasoconstriction (afterload) - Increase thirst (CNS) and ADH synthesis and release (Hypothalamus & Posterior pituitary ) - Increase aldosterone synthesis and release (adrenal cortex) - Increase H2O, Na+ reabsorption at PCT (preload) Aldosterone - Increase Na+ reabsorption (w water) and K+ excretion at collecting duct (Preload) => Increase BP and BV
47
What stimulates ANP, BNP release
Increase blood volume & pressure
48
What is the MOA of aldosterone
Diffuses into collecting duct principal cells => Cytoplasmic receptors => Increase expression/activity of protein channels (ENAC, ROMK) & pumps (Na+/K+ ATPase) => Increase Na+ reabsorption w water and K+ secretion
49
What is the MOA of ANP & BNP
Kidneys => vasodilation => increase GFR => decrease renin => Na+/H2O secretion Inhibits ADH and aldosterone release=> decrease Na+, H2O reabsorption Medulla oblongata => decrease symp output => decrease PR => decrease BP
50
What are the complications of hyperkalaemia and the body's response
Causes arrhythmias and increased neuronal excitability Response => increase aldosterone and K+ secretion
51
What are the complications of hypokalaemia and the body's response
Causes muscle weakness => cardiac/respi muscle failure Response => No K+ secretion in collecting ducts
52
What can cause hypokalaemia
Kidney disease Diarrhoea Loop diuretics
53
What are the normal values of Respi rate, Pulse rate, BP, and SaO2
RR = 10-15/min PR = 60-100 bpm BP = 120/80 mmHg SaO2 = 95-100%
54
Describe the change in pH, pCO2, HCO3- and responses to different acid-base disturbances
Metabolic acidosis => Hyperventilation => decrease pCO2 => decrease pH and HCO3- Respi acidosis => Kidneys retain HCO3- => Increase HCO3- => Increase pCO2 and decrease pH Metabolic alkalosis => Hypoventilation => Increase pCO2 => Increase pH and HCO3- Respi alkalosis => Kidneys secrete HCO3- => Decrease HCO3- => Decrease CO2 and increase pH
54
What are the normal values of blood pH, pCO2, pO2, HCO3-, and anion gap
pH = 7.35-7.45 pO2 = 80-100mmHg pCO2 = 35-45mmHg HCO3- = 22-28mEq/L Anion gap = 14-18mM/L
55
What are the calculations for the compensatory responses for metabolic acidosis
Anion gap = Na+ - (Cl- + HCO3-) Expected pCO2 = 1.5 x HCO3- + 8 +/-2
55
What can cause metabolic acidosis
Diabetic Ketoacidosis
56
What can cause metabolic alkalosis
Hypovolemia
56
What are the calculations for the compensatory responses for metabolic alkalosis
Change in pCO2 = (0.7 x change in HCO3-)
57
What causes respi acidosis
Acute = pneumonia Chronic = COPD
58
What are the calculations for the compensatory responses for respi acidosis
Acute = Expected HCO3- = 24 + (0.1 x (pCO2 - 40)) Chronic = Expected HCO3- = 24 + (0.35 x (pCO2 - 40))
59
What causes respi alkalosis
Hypoxemia
60
What are the calculations for the compensatory responses for respi alkalosis
Acute = Expected HCO3- = 24 - (0.2 x (40 - pCO2)) Chronic = Expected HCO3- = 24 - (0.40 x (40 - pCO2))

Linganguliguliguli (7 decks)

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