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CPR Exam 2 > Renal Anatomy And Histology > Flashcards

Renal Anatomy And Histology Flashcards

1
Q

Where are the kidneys located?

A

Extend approximately T12-L3 with the right kidney slightly lower than the left due to its relationship with the liver

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2
Q

Where is the transpyloric plane and what is its relationship to the kidneys?

A

L1 (SP of T12)
Slightly superior to the left hilum
Runs through the superior pole of right kidney

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3
Q

The superior poles of both kidneys are deep to what structure?

A

11th and 12th ribs

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4
Q

The inferior pole of the right kidney is one index finger width superior to what structure?

A

The iliac crest

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5
Q

What structure do the ureters cross over on their way to the bladder?

A

Either the end of the common iliac or beginning of external iliac A

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6
Q

What are the points of constriction of the ureters?

A

At the uretopelvic junction, over the common/external iliac, at the uretovesical junction
Where kidney stones can become stuck

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7
Q

What provides sympathetic innervation to the kidneys?

A

Renal plexus

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8
Q

Describe the renal plexus

A

Lesser splanchnic N (T10-11) and Least splanchnic N (T12) which synapse in the aorticorenal ganglion
Lumbar splanchnic N (L1-2)

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9
Q

What provides parasympathetics to the kidneys?

A

Vagus nerve (CN X)

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10
Q

Describe the renal cortex

A

Contains renal corpuscles, convoluted tubules and straight tubules of the nephron and portions of CDs

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11
Q

Describe the renal medulla

A

Consists of renal columns and cone shaped masses called renal pyramids

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12
Q

What are cortical (medullary) rays?

A

Aggregation of CDs and straight tubules running between the renal corpuscles and convoluted tubules within the cortex
Axis of renal lobule

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13
Q

What do fibroblasts in the renal interstitium produce?

A

Erythropoietin depending on O2 levels

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14
Q

What is the cortical labyrinth?

A

Contains the renal corpuscles + convoluted tubules + collecting tubules
Located between medullary rays

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15
Q

What is the uriniferous tubule?

A

Nephron + collecting tubule (connected to CD in the medullary ray)

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16
Q

What are the two components of the urine carrying unit?

A

Nephron (urine forming unit) - consists of renal corpuscles and renal tubules
Cortical and medullary CDs - final concentration of urine

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17
Q

What is the renal corpuscle composed of?

A

Glomerular capillary tuft and Bowman’s capsule

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18
Q

What is the glomerular capillary tuft of the RC?

A

Fenestrated capillaries with truly open pores

Afferent and efferent arterioles

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19
Q

What is the parietal layer of Bowman’s capsule?

A

Simple squamous epithelium

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20
Q

What is present in the visceral layer of Bowman’s capsule?

A

Podocytes

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21
Q

What is present in the glomerular space in Bowman’s capsule?

A

Primary filtrate (also called ultrafiltrate)

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22
Q

Describe the glomerular endothelium

A

Fenestrated and no diaphragm
Contains AQP-1 water channels
Secrete NO and PGE2
Contain plasma membrane bound glycocalyx (negatively charged proteoglycans and glycoproteins that repel entrance of + proteins)

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23
Q

What are pedicels or foot processes of podocytes?

A

The extensions of secondary processes around capillaries from the podocytes
Interdigitates with neighboring podocytes to create filtration slits

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24
Q

Describe filtration slits

A

Covered by filtration slit diaphragm just above the GBM
Size selective filter
Nephrin is an important component of the diaphragm (has strong - charge which repels + proteins that shouldn’t enter)

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25
Q

Describe the glomerular basement membrane (GBM)

A

Both physical and ion selective filter
Type IV and XVIII (18) collagens, laminin, fibronectin, entactin, proteoglycans and glycosaminoglycans (heparin sulfate)
Restricts proteins larger than 70kD such as albumin and Hb
Negative charge also restricts movement of anionic particles
Protein that doesnt leak through is typically reabsorbed by the PCT

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26
Q

Albuminuria or hematuria indicate what?

A

Physical or functional damage to the GBM

27
Q

What is the filtration apparatus of the kidney?

A

Glomerular endothelium
GBM
Visceral layer of Bowman’s capsule
(All contained within the renal corpuscle)

28
Q

Describe Bowman’s (urinary) space

A

Space between the visceral and parietal layers of Bowman’s capsule
Receptacle for glomerular ultrafiltrate (primary filtrate/urine)
Continuous with the proximal convoluted tubule at the urinary pole of renal corpuscle

29
Q

What is the mesangium?

A

Mesangial cells + ECM

30
Q

Describe mesangial cells

A

Located in the renal corpuscle and are most obvious near the vascular stalk of the glomerulus
Like pericytes and enclosed by the GBM
Those that are not in the RC make up the juxtaglomerular apparatus

31
Q

What are the functions of the mesangial cells?

A

Phagocytosis and endocytosis (clean debris)
Structural support
Secretion of IL-1, PGE2 and PDGF
Modulation of glomerular distention (are contractile)

32
Q

Proliferation of the mesangium is pathognomonic for what?

A

Certain kidney diseases

33
Q

Describe the proximal convoluted tubule

A

Found only in the renal cortex
Receives ultrafiltrate from Bowman’s space
Simple cuboidal to columnar epithelium with apical brush border/microvilli and mitochondria
Na/K/ATPase pumps actively reabsorbs Na, Cl passively diffuses and H2O follows
Also has AQP1
Reabsorbs amino acids, sugars (SGLT2) and polypeptides
Proteins and large peptides are endocytosed

34
Q

Describe the proximal straight tubule

A

I.e. thick descending limb of the loop of Henle
Shorter than the PCT
Less well developed brush border
Contain high affinity Na glucose cotransporters (SGLT1)

35
Q

Describe the thin segment of the loop of Henle

A

Juxtamedullary nephrons - long; cortical nephrons - short

Simple squamous epithelium without brush border (some nuclei bulge into lumen)

36
Q

Describe the thin descending limb of the loop of Henle

A

Highly permeable to water and less permeable to NaCl and urea
Water diffuses out

37
Q

Describe the thin ascending limb of the loop of Henle

A

Highly permeable to NaCl
NaCl diffuses out into the interstitium
Impermeable to water

38
Q

Describe the distal straight tubule

A

I.e. thick ascending limb of the loop of Henle
Simple cuboidal epithelium with microvilli but no visible brush border
Cortical and medullary (latter in the medullary ray)
Na, K and Cl diffuse out into interstitium w/out movement of water
Nucleus in apical section, cells bulge into the lumen

39
Q

Describe the distal convoluted tubule

A

Simple cuboidal epithelium without brush border (smoother lumen)
Shorter than PCT cells with relatively larger lumen
Reabsorbs Na and HCO3 and secretes K and NH4

40
Q

The distal convoluted tubule exchanges Na for K under the regulation of which hormone?

A

Aldosterone (which is released under stimulation from angiotensin II)

41
Q

Describe the collecting tubules/ducts

A

Cortical CDs: Simple squamous to cuboidal epithelium
Medullary CDs: simple cuboidal to columnar epithelium
Distinguished from proximal and distal tubules by their distinct cell boundaries
Will eventually join to form larger papillary ducts that drain into a minor calyx

42
Q

What are the two distinct cell types in the CDs?

A

Light cells (principal cells) and dark cells (intercalated cells)

43
Q

Describe light (principal) cells

A

Single cilium

Target of ADH regulated AQP2 channels

44
Q

Describe dark (intercalated) cells

A

Alpha intercalated secrete H

Beta intercalated secrete HCO3

45
Q

What is the primary function of the CDs?

A

Water reabsorption via aldosterone regulation

46
Q

What vasculature surrounds the uriniferous tubules?

A

Glomerulus, peritubular capillaries and vasa recta

47
Q

Describe peritubular capillaries

A

From efferent arterioles
Surrounded convoluted tubules
Fenestrated endothelium
Re-uptake water and salt

48
Q

Describe the vasa recta

A

Surrounds the loop of Henle and is also from efferent arterioles
Countercurrent exchange/concentrating
Descending is continuous endothelium but ascending has fenestrations

49
Q

Describe the juxtaglomerular apparatus

A

Located near vascular pole of renal corpuscle and terminal portion of distal straight tubule
Regulates BP by activating RAAS when Na/BP is low
Contains macula densa cells

50
Q

What are macula densa cells?

A

Chemoreceptors that “sensa” low Na
Trigger release of renin from JG cells that leads to downstream activation of RAAS to increase Na retention, blood volume and BP

51
Q

Describe transitional epithelium (urothelium)

A

Lines calyces, ureters, bladder, initial segment of the urethra
Stratified and impermeable to salts and water
Umbrella or dome shaped apical surface in empty bladder
Accommodate to distention and flatten (when full)

52
Q

What are the three layers of transitional epithelium?

A

Superficial (stretch/relax)
Intermediate (sliding)
Basal (stem cells)

53
Q

What are the modified areas of plasma membrane of transitional epithelium?

A

Plaques - uroplakin proteins
More rigid/thicker
Prevent diffusion of urine into the cells
Give cells scalloped contour and appear to fold inward on themselves
Appear as a series of fusiform vesicles

54
Q

Describe the ureters

A

Luminal layer of transitional epithelium
Smooth muscle arranges in 3 layers (inner longitudinal, middle circular, and outer longitudinal which is only present at the distal end)
Embedded in adipose tissue with which the vessels and nerves form the adventitia

55
Q

How is reflux in the ureters prevented?

A

Bladder distends which compresses the ureters
Contraction of SM of bladder wall which compresses returns
Ureters enter the bladder at an oblique angle which prevents reflux

56
Q

Describe the urinary bladder

A

Dispensable reservoir for urine posterior to pubic symphysis
Lined by transitional epithelium
SM of wall forms detrusor muscle (contraction compresses bladder and forces urine into urethra)
Fibrous adventitia
Internal urethral sphincter around the internal urethral orifice (involuntary control)

57
Q

What are the 3 openings of the bladder?

A

2 ureteric orifices and 1 internal urethral orifice
The triangular region defined by these 3 is called the trigone which is smooth compared to thick and folded empty bladder wall

58
Q

Describe the urethra

A

Fibromuscular tube conveying urine from the urinary bladder to exterior through the external urethral sphincter (voluntary control)

59
Q

Describe how the epithelium of the urethra changes based on location

A

Transitional epithelium near origin
Pseudostratified columnar for majority
Stratified squamous epithelium at distal end

60
Q

Describe the female urethra

A

Shorter than the male urethra (3-5cm long)
Terminates just posterior to the clitoris
Membranous part of the urethra penetrates the urogenital diaphragm (striated muscle of this structure forms the external urethral sphincter [voluntary])

61
Q

Describe the male urethra

A

Terminal duct for urinary + genital systems

20cm long with 3 distinct segments including prostatic, membranous and penile/spongy urethra

62
Q

Describe the prostatic urethra

A

Transitional epithelium
3-4cm from neck of bladder through prostate gland
Ejaculatory ducts enter posteriorly along with many small prostatic ducts

63
Q

Describe the membranous urethra

A

Urothelium ends here, mostly pseudostratified columnar
Extends 1cm from prostate gland to bulb of penis
Passes through deep perineal pouch (skeletal muscle of the pouch forms the external urethral sphincter [voluntary])

64
Q

Describe the penile/spongy urethra

A

15cm through length of penis and opens at the glans penis
Surrounded by corpus spongiosum (erectile tissue) and lined with pseudostratified columnar until the end where it transitions to stratified squamous epithelium
Cowper’s glands and urethral glands empty in spongy urethra

CPR Exam 2 (18 decks)

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