Renal Anatomy

Question 1

Potter Sequence

Answer 1

The fetus is compressed and unable to urinate in utero.

Develop pulmonary hypoplasia, oligohydramnios, twisted face and skin and extremity defects with in utero kidney failure.

Question 2

Horseshoe kidney

Answer 2

Inferior poles of both kidneys fuse as they ascend from the pelvis during fetal developement.

they are trapped under the INFERIOR MESENTARIC ARTERY.

Question 3

Why is the left kidney preferred during donor transplantations?

Answer 3

It has a longer renal vein.

Question 4

Describe the course of the ureters

Answer 4

pass under the uterine artery and under ductus deferens or uterine artery

“Water under the bridge”

Question 5

What is the 60-40-20 rule/

Answer 5

60 percent total body water
40 percent intracellular fluid
20 percent extracellular fluid

Question 6

What substance is used to measure extracellular volume?

Answer 6

inulin

Question 7

What makes up the layers of the glomerular filtration barrier?

Answer 7

Fenestrated capillary endothelium
Fused basement membrane (negatively charged lossed in nephrotic syndrome)
Epithelial layer of podicyte foot processes.

Question 8

Clearance equation

Answer 8

Urine concentration x Urine flow rate / Plasma oncentration

Question 9

What substance is used to measure effective renal plasma flow?

Answer 9

PAH (para-aminohippuric acid)
Used because it is both filtered and secreted in the proximal collectine tubule.

Results in near 100% excretion of all PAH entering the kidney.

Question 10

Which substance is best used to determine GFR?

Answer 10

Creatinine

Not perfect as some creatinine is secreted.

Question 11

At which plasma glucose level will glucosuria begin?

Answer 11

at 200 mg/dL

at 375 all transporters will be fully saturated.

Question 12

How are amino acids reabsorbed by the kidney?

Answer 12

Sodium dependent transporters in the PCT reabsorb amino acids.

In hartnup disease, there is a deficiency in the tryptophan transporters and thus you cannot convert tryptophan to niacin. Results in pallegra.

Question 13

What naturally produced hormone regulates the sodium/ H+ pump in the proximal convuluted tubule?

Answer 13

Angiotensin II it also promotes HCO3- reabsorption.

Acetazolamide counteracts the effects.

Question 14

What occurs in the thin descending loop of henle?

Answer 14

Passive water reabsorption

Known as the concentrating segment making urine hypertonic.

Question 15

What occurs in the thick ascending loop of henle?

Answer 15

Sodium
Potassium
Chloride absorbtion

indirect magnesium and cacium reabsorption through positive lumen potential generated by potassium backleak.

Impermiable to water here!!!!

Question 16

What occurs at the early distal convuluted tubule?

Answer 16

Reabsorption of sodium, chloride.

Makes the urine most dilute.

Question 17

Which segment of the kidney responds to PTH to cause reabsorption of calcium?

Answer 17

The early distal convuluted tubule.

Question 18

How do thiazides work?

Answer 18

Block the sodium/chloride channel in the early distal convuluted tubule.

Question 19

What occurs at the collecting tubule?

Answer 19

Reabsorbs sodium in exchange for secreting potassium and hydrogen.

Question 20

Which cells in the collecting duct does ADH interact with?

Answer 20

Principal cells via V2 receptor to increase aquaporin placement.

Question 21

Which cells in the collecting duct does aldosterone act on?

Answer 21

Alpha intercalated cells which serve to increase potassium conductance and ENAC channels leading to potassium loss and sodium absorption.

Question 22

FABulous Glittering LiquidS

Answer 22

Renal tubular defects in order of glomerular distance.
Fanconi syndrome - PCT
Barter Syndrome - Thick ascending
Gitelman syndrome - DCT
Liddle syndrome - Collecting tubule
Syndrome of apparent mineralcorticoid excess - Collecting tubule.

Question 23

Fanconi Syndrome

Answer 23

Generalized reabsorption disorder in PCT increased excretion of all amino acids, glucosee, HCO3- and PO4-.

Lead poisoning and wilsons disease can lead to this.

Question 24

Barter syndrome

Answer 24

Thick ascending limb Na/K+/Cl pump not working corrctly

Leads to hypokalemia and metabolic alkalosis with hypercalciuria.

Question 25

Gitelman Syndrome

Answer 25

Loss of NaCL absorption in the DCT.

Question 26

Liddle syndrome

Answer 26

Increased sodium reabsorption in the collecting tubules.

Treat with amiloride.