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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
Describe the glomerular basement membrane (GBM)
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
26
Albuminuria or hematuria indicate what?
Physical or functional damage to the GBM
27
What is the filtration apparatus of the kidney?
Glomerular endothelium GBM Visceral layer of Bowman’s capsule (All contained within the renal corpuscle)
28
Describe Bowman’s (urinary) space
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
What is the mesangium?
Mesangial cells + ECM
30
Describe mesangial cells
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
What are the functions of the mesangial cells?
Phagocytosis and endocytosis (clean debris) Structural support Secretion of IL-1, PGE2 and PDGF Modulation of glomerular distention (are contractile)
32
Proliferation of the mesangium is pathognomonic for what?
Certain kidney diseases
33
Describe the proximal convoluted tubule
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
Describe the proximal straight tubule
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
Describe the thin segment of the loop of Henle
Juxtamedullary nephrons - long; cortical nephrons - short | Simple squamous epithelium without brush border (some nuclei bulge into lumen)
36
Describe the thin descending limb of the loop of Henle
Highly permeable to water and less permeable to NaCl and urea Water diffuses out
37
Describe the thin ascending limb of the loop of Henle
Highly permeable to NaCl NaCl diffuses out into the interstitium Impermeable to water
38
Describe the distal straight tubule
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
Describe the distal convoluted tubule
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
The distal convoluted tubule exchanges Na for K under the regulation of which hormone?
Aldosterone (which is released under stimulation from angiotensin II)
41
Describe the collecting tubules/ducts
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
What are the two distinct cell types in the CDs?
Light cells (principal cells) and dark cells (intercalated cells)
43
Describe light (principal) cells
Single cilium | Target of ADH regulated AQP2 channels
44
Describe dark (intercalated) cells
Alpha intercalated secrete H | Beta intercalated secrete HCO3
45
What is the primary function of the CDs?
Water reabsorption via aldosterone regulation
46
What vasculature surrounds the uriniferous tubules?
Glomerulus, peritubular capillaries and vasa recta
47
Describe peritubular capillaries
From efferent arterioles Surrounded convoluted tubules Fenestrated endothelium Re-uptake water and salt
48
Describe the vasa recta
Surrounds the loop of Henle and is also from efferent arterioles Countercurrent exchange/concentrating Descending is continuous endothelium but ascending has fenestrations
49
Describe the juxtaglomerular apparatus
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
What are macula densa cells?
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
Describe transitional epithelium (urothelium)
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
What are the three layers of transitional epithelium?
Superficial (stretch/relax) Intermediate (sliding) Basal (stem cells)
53
What are the modified areas of plasma membrane of transitional epithelium?
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
Describe the ureters
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
How is reflux in the ureters prevented?
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
Describe the urinary bladder
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
What are the 3 openings of the bladder?
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
Describe the urethra
Fibromuscular tube conveying urine from the urinary bladder to exterior through the external urethral sphincter (voluntary control)
59
Describe how the epithelium of the urethra changes based on location
Transitional epithelium near origin Pseudostratified columnar for majority Stratified squamous epithelium at distal end
60
Describe the female urethra
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
Describe the male urethra
Terminal duct for urinary + genital systems | 20cm long with 3 distinct segments including prostatic, membranous and penile/spongy urethra
62
Describe the prostatic urethra
Transitional epithelium 3-4cm from neck of bladder through prostate gland Ejaculatory ducts enter posteriorly along with many small prostatic ducts
63
Describe the membranous urethra
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
Describe the penile/spongy urethra
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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