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CPR Test 2 > Renal Anatomy and Histology > Flashcards

Renal Anatomy and Histology Flashcards

1
Q

what are the organs of the urinary system

A

kidneys, ureters, urinary bladder, and the urethra

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2
Q

Anterior aspect of the kidney

A

Retroeritoneal lying about T12-L3 level
-lower on the right due to the liver

Suprarenal gland above the zidney

size is about 10cm long, 5 cm wide, and 2 cm thick

Renal hilum: entrance to the renal sinus (area in kidney where BV, renal pelvis, and nerves, locafte

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3
Q

Posterior aspect of the kidney

A

Left hilum runs through the transpyloric plane (transverse plane)

Transpyloric plane runs through superior pole of right kidney
-2.5 cm lower than left

superior parts lie deep to 11th and 12th ribs

Inferior pole or right kidney is approximately index fingers breath superior to iliac crest

hilum of each kidney is about 5cm (2 in) from the midline

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4
Q

What are the two types of renal fat and what divides them

A

Perinephric fat: adjacent to the kidney capule and extends into renal hilum and pelvis

renal fascia: covers the fat enveloping kidney and suprarenal gland
-superiorly continuous with inferior diaphragmatic fascia

Paranephric fat: external to renal fascia

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5
Q

what composes the gross internal anatomy of the kidney (9 things)

A

Capsule: dense irregular CT on surface with inner layer of myofibroblasts

Renal cortex: outer portion containing renal corpuscles

Renal medulla: collection of renal pyramids and columns

renal pyramids: cone shaped masses in the medulla projecting into the calyx

renal columns: tissue lying between pyramids running from cortex to the calyx

renal lobes: single pyramids plus surrounding adjacent cortex

renal pelvis: collecting funnel for urine

renal calyxes: out pocketing of the renal pelvis
-major and minor

renal papillae: projections of medullary pyramids apices into calyxes

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6
Q

where does the ureter travel in regards to the arterial supply

A

water flows under the bridge

ureter is underneath the arterial bridge

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7
Q

order of flow of the renal arteries and veins

A 
Segmental
Interlobar
Arcuate
Interlobular
Afferent arteriole
Glomerulus
Efferent arteriole
Peritubular capillaries (Vasa recta)
Cortical radiate vein
Arcuate vein
interlobar vein
Renal vein
Inferior vena cava
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8
Q

where does the Ureter get its blood supply

A

bunch of different arteries as it descends

  • Renal branches
  • gonadal branches
  • Abdominal aorta branches
  • Iliac branches
  • Superior vesicular branches
  • Pelvic branches
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9
Q

NutCracker syndrome

A

Traction of the superior mesenteric artery compression on the left renal vein

leads to hematuria, proteinuria, flank pain, nausea, vomitting, and left sided variocele

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10
Q

what is the Renal nerve Plexus and where does it get its nerve supply from the Autonomic Nervous system

A

the nerve supply to the renal system

Sympathetic:

  • Lesser splanchnic (T10-11)
  • Least splanchnic (T12) both synapsing in the aorticorenal ganglia
  • lumbar splanchnic (L1-L2)

Parasympathetic:
Vagus N via the posterior vagal trunk

all nerves will follow arteries to get to specific location

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11
Q

what is the urine forming and carrying units made of

A

Nephron (urine forming unit)

  • consists of renal corpuscle and renal tubules)
  • juxtamedullary and cortical nephrons

Cortical and medullary collecting ducts
-final concentration of urine

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12
Q

what is the type of capillary bed for the Glomerulus

A

tuft of capillaries

  • Fenestrated endothelium
  • fed by afferent and drained by efferent arterioles
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13
Q

what is the peritubular capillaries composed of

A

Cortical: in the cortex

  • surround the proximal and distal convoluted tubules
  • Fenestrated endothelium

Long Medullary (vasa recta): In the medulla

  • surround the loop of henle
  • Ascending portion: Fenestrated endothelium
  • Descending portion: Continuous endothelium
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14
Q

why are some sections of peritubular capillaries fenestrated endothelium and others continuous

A

Corresponds with what molecules are being reabsorbed or secreted in that section of the nephron

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15
Q

what makes up the renal corpuscle

A

Glomerulus
-capillary system, fenestrated endothelium

and the Glomerular capsule (Bowmans)

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16
Q

what makes up the layers of the Glomerular (bowmans) capsule

A

Visceral layer: consist of podocytes

Glomerular space: contains primary filtrate (early urine)

Parietal layer: simple squamous epithelium

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17
Q

what are the poles of the renal corpuscles

A

Vascular pole: vessels are Endothelium (not continuous with outside world)

  • Afferent arteriole
  • Efferent arteriole

Urinary pole or Tubular pole: tubules with epithelium (continuous with external environment. i.e GI tract)
-Origin of proximal convoluted tubule

18
Q

what are Mesangial cells

A

structural support cells for glomerular loops and the extracellular matrix of the podocytes

also are phagocytic cells

prevents glomerular distension (contraction) due to high glomerular blood pressure

secrete growth factors and cytokines in response to injury

19
Q

what are the layers of the Glomerulus endotheilum

A

Open fenestrations

Thick luminal glycocalyx

Posses large number of aquaporin water channels

can generate nitric oxide and PGE2 for vasodilation

20
Q

what is the significance of the Glomerular Basement membrane

A

contains type IV and XVIII collagens, laminin, entactin, and proteoglycans

restricts particles larger than 70kD which would be blood cells

chemical barrier is strong and anti-anionic (repels negative charge)
-good since proteins are negative (albumin)

21
Q

what is the significance of the Podocytes

A

makes up the visceral layer of the bowmans capsule (glomerular capsule)

helps make the filtration barrier

has feet like connections that serve as filtration like slits that are critical in regulating size, patency, and selectivity of filtration

22
Q

what is the significance of the Filtration membrane

A

Lies between the blood and capsular space
composed of:
-Fenestrated endothelium, basement membrane, and podocytes

restricts passage of blood cells, Ig, and large proteins

allows passage of water, ions, glucose, amino acids, and urea
-makes urine

23
Q

what kind of cells make up the parietal layer of the Bowmans Capsule

A

Simple squamous empithelium

24
Q

Functions and locations of the Proximal Convoluted Tubule

A

Only found in the renal cortex

It is the most active tubule in resorption and secretion

  • simple cuboidal to columnar epithelium
  • abundant microvilli
  • abundant mitochondria
  • basal and lateral cell membranes are highly folded to increase surface area
  • lumen is star shaped and jagged

contains lots of transporters

  • Na,K-ATPase
  • aquaporins
  • glucose transporters sGLT2
  • amino acid transporters

end is the proximal straight tubule:

  • not as tall as PCT with less developed brush border
  • equipped with high affinity sodium glucose co-transporters (sGLT1)
25
Q

function and parts of the Loop of Henle

A

Loops down into the medulla and then back up into the cortex and terminates near the vascular pole

Thin limb segment: thin permeable simple squamous epithelial lacking a brush border

Thick ascending segment: simple cuboidal epithelium with numerous microvilli but no visible brush border

sets up the hyperosmotic gradient

26
Q

Function and location of the Distal convoluted tubule

A

only found in the cortex

Lined with simple cuboidal epithelium with sparse microvilli, luminal surface is much smoother and open compared to PCT

Segment begins a variable distance from the Macula Densa of the thick ascending loop of henle portion

Angiotensin II influences Na+ resorption here!

27
Q

what is the function of the juxtaglomerular apparatus and how does the Macula densa interact with it?

A

Juxtagomerular cells:
-Mechanosensory cells in afferent arterioles and they secrete renin if BP is too low

Macula densa:

  • tight nuclei at distal end of thick ascending loop of henle
  • signals release of renin (from juxtaglomerular cells) if low Na+
28
Q

cell types found in the Collecting tubules/ducts

A

Final urine osmolality is determined by reabsorbing water

Target of both ADH and aldosterone therby increasing Na+ reabsorption and water retention

Two basic mechanosensory cell types:

  • Principal cells (light cells), target of aldosterone
  • Intercalated cells (dark cells) - involved in H+ and bicarbonate transport
29
Q

Function of the collecting ducts

A

Lined with simple cuboidal epithelium but are simple columnar at their ends

Primary function is water reabsorption

runs straight through cortex into deep medulla

several join together to form larger papillary ducts that then drain into renal minor calyx

30
Q

what are the cortical medullary rays

A

aggregation of collecting ducts and straight tubules running between the renal corpuscles and convoluted tubules within the cortex

31
Q

what does the renal interstitum do?

A

special fibroblasts that produce erythropoietin depending on O2 levels

32
Q

where is transitional epithelium located?

A

aka Urothelium

found in Calyces, ureters, bladder and portions of the urethra

this epithelium has a relaxed and stretched state

33
Q

what are the three layers that make up the transitional epithelium

A

deepest single layer of basal cells on basement membrane

Intermediate region of cuboidal/columnar cells in several layers (sliding layer)

Superficial: binucleated umbrella cells (where the stretch and relax happens)
-Urothelial plaques form impermeable barrier on membrane. this is made with Uroplakin proteins that protect the cells from urine when stretched and then stored when not needed in fusiform vesicles

34
Q

What are the three layers of the Ureters

A

Transitional epithelium

Muscularis

  • three distinct layers
  • moves with waves of peristalsis
  • folds form when empty
  • enters bladder obliquely to prevent retrograde flow

Adventitia
-typical connective tissue

35
Q

Significance of the bladder

A

Detrusor muscle is a smooth muscular sac that encloses the bladder

can hold up to a liter of urine but normally 400-600ml

anterior to the uterus and rectum and sits within the pelvis so that when really full can expand up in the abdomen

Pregnant women can run into problems with this

36
Q

what are the components of the Urinary bladder

A

Trigone

  • location where the ureters and urethra open
  • inferior/posterior wall of bladder

Bladder wall

  • urothelium
  • 3 layers of smooth muuscle tissue (detrusor m)
  • Fibrous adventitia
37
Q

Components of the Female Urethra and how does the epithelium change through the urethra

A

the length of the female urethra is only 3-5 cm long so it is at high risk for UTI

connects bladder to the external urethral orifice

Epithelium changes through the urethra:

  • Transitional near the bladder
  • Majority of urethra is pseudostratified columnar
  • distal end stratified squamous epithelium

Membranous urethra through the urogenital diaphragm

Internal urethral sphincter: involuntary smooth muscle

External urethral sphincter: skeletal muscle so control is voluntary

38
Q

Components of the Male urethra and how does the epithelium change through the urethra

A

20 cm in length

Epithelium changes through the urethra:

  • transitional near the bladder
  • Majority of urethra: pseudostratified columnar
  • distal end: stratified squamous epithelium

Three named regions

  • prostatic urethra
  • Membranous urethra (through the urogenital diaphragm)
  • spongy (penile) urethra

Internal sphincter: involuntary smooth muscle

external sphincter: skeletal muscle and is voluntary

39
Q

Polycystic Kidney Disease

A

Autosomal Dominant
-appears in 4th decade

PKD1 or PKD2 mutations

  • cysts form that crush tissue that impede drainage
  • leads to kidney failure

hypertension, renal hemorrhage, calculi or UTI

Dialysis and kidney transplant is the treatment

40
Q

Urinary Incontinence

A

can be a lot of different causes, and types but affects more females than males

41
Q

Urinary tract infections

A

Women at higher risk

normally E.coli

catheters are a risk to cause these

dysuria, pelvic pain, fever

lead to pyelonephritis, cystitis, urethritis

treat with antibiotics

42
Q

Schistosoma Hematobium

A

Parasitic blood flukes

GU tract disease

passed via a snail species

Chronic infection can cause fibrosis and calcification of the bladder

risk of bladder cancer

CPR Test 2 (25 decks)

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