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Test 4 Advanced Pathophysiology Dr. Gonzalez > Renal anatomy and physiology and renal blood flow > Flashcards

Renal anatomy and physiology and renal blood flow Flashcards

1
Q

Where are the kidneys located?

A

The kidneys lay in the retro peritoneal space of the abdominal cavity, one on each side of the spine.

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2
Q

The kidneys have 7 functions which include:

A
  1. excretion of metabolic waste products
  2. maintenance of water balance
  3. regulation of acid base balance
  4. blood pressure regulation
  5. secretion of erythropoietin
  6. activates vitamin D
  7. glucose regulation
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3
Q

The secretion of erythropoietin by the kidneys has what effect?

A

stimulates the growth of red blood cells

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4
Q

Disorders which affect the kidney can cause anemia due to?

A

a decrease in the production of erythropoietin resulting in anemia

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5
Q

What is the active form of vitamin D?

A

calcitriol

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6
Q

The kidneys activate which vitamin?

A

vitamin d - into calcitriol

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7
Q

Calcitriol has what function?

A

assists with the absorption of calcium in the intestines

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8
Q

Vitamin D steps to absorption (5)

A
  1. ingested in the food we eat (veg & meat)
  2. after absorption it is taken to the skin
  3. UV light changes it to a precursor of vit D
  4. transported to the kidneys
  5. converted into the active form of vit D - calcitriol
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9
Q

Calcitriol is reponsible for:

A
  1. assisting with the absorption of calcium in the intestines
  2. promoting the release of calcium from the bone (re-absorption)
  3. decreasing renal calcium excretion
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10
Q

The kidneys help maintain glucose balance by:

A
  1. completing gluconeogenesis from amino acids
  2. uptake of glucose from the circulation
  3. reabsorbing glucose from glomerular filtrate
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11
Q

The kidneys normally filter how much glucose per day by the glomeruli filter?

A

180 grams

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12
Q

After glucose is filtered by the kidneys, where is it absorbed?

A

in the proximal tubule

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13
Q

What absorbs the glucose in the proximal tubule?

A

the sodium-glucose co-transporter 2 (SGLT2) protein

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14
Q

Why does the sodium-glucose transporter 2 (SGLT2) protein absorb all the glucose in the proximal tubule?

A

this helps to ensure adequate glucose is available during periods of fasting

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15
Q

What happens when the serum glucose exceeds a threshold of 180?

A

the SGLT2 transporters become saturated and the excess glucose spills over into the urine

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16
Q

What is a diabetes drug class protein inhibitor?

A

SGLT2 inhibitors

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17
Q

What do SGLT2 inhibitors medications do?

A

This drug class inhibits this protein and allows for glucose to spill over into the urine thus decreasing serum glucose levels.

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18
Q

What is the outer most portion of the kidney and is made of fibrous tissue?

A

renal capsule

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19
Q

What is the fatty layer of tissue that adheres each kidney to the posterior wall of the abdomen?

A

renal fascia

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20
Q

What is directly below the renal capsule and extends between the medullary pyramids?

A

renal cortex

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21
Q

What houses the renal corpuscles and the proximal and distal tubules of the nephron?

A

renal cortex

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22
Q

What is pyramid-shaped in the kidney?

A

renal medulla

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23
Q

What is the inner darker portion of the kidney tissue consisting of renal pyramids?

A

renal medulla

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24
Q

What contains the secreting and collecting tubules?

A

renal pyramids

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25
Q

What extend from the medulla?

A

renal calyces

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26
Q

The renal calyces merge together to form?

A

the renal pelvis

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27
Q

What gives rise to the ureter which extends to the bladder?

A

renal pelvis

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28
Q

What is the functional unit of the kidney?

A

nephron

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29
Q

What are the two types of nephrons?

A

cortical nephron and juxtamedullary nephron

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30
Q

Where is the cortical nephron?

A

renal cortex

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31
Q

Where is the juxtamedullary nephron?

A

lays close to and extends into the medulla

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32
Q

What are the three main functional parts of the nephron?

A

glomerulus, bowman’s capsule, tubular system

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33
Q

What is a collection of capillaries which receives blood from the renal artery?

A

glomerulus

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34
Q

What is the function of the glomerulus?

A

It is responsible for filtering the blood

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35
Q

What partially encases the glomerulus and extends to form the tubule system?

A

bowman’s capsule

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36
Q

Together the glomerulus and bowman’s capsule are termed?

A

renal corpuscle

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37
Q

A collection of tubules which originate from the bowman’s capsule

A

the tubule system

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38
Q

The proximal tubule comes directly off the?

A

bowman’s capsule

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39
Q

What is the recipient of the filtrate?

A

the proximal tubule

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40
Q

The filtrate flows from the glomerulus into the bowman’s capsule and then into?

A

the proximal tubule

41
Q

What reabsorbs all the glucose?

A

the proximal tubule

42
Q

The proximal tubule reabsorbs glucose and?

A

amino acids, HCO3, Na, Cl, phosphate, potassium, and water

43
Q

A serum glucose above 180 mg/dL will exceed the renal threshold for glucose and result in?

A

glucosuria

44
Q

What causes damage associated with diabetes mellitus?

A

glucosuria

45
Q

What is stimulated by the parathyroid hormone will excrete phosphate?

A

the proximal tubule

46
Q

What is the site of action for angiotensin II which stimulates Na, water, and bicarbonate reabsorption?

A

the proximal tubule

47
Q

What extends from the proximal tubule?

A

the descending loop of Henle

48
Q

What is impermeable to Na, passively reabsorbs water, and concentrates urine?

A

the descending loop of Henle

49
Q

What extends from the descending loop of Henle?

A

the ascending loop of Henle

50
Q

What actively reabsorbs sodium, potassium, and chloride?

A

the ascending loop of Henle

51
Q

What induces the reabsorption of magnesium, calcium, and it is impermeable to water (making the urine more dilute)?

A

the ascending loop of Henle

52
Q

What extends from the ascending loop of Henle?

A

the distal convoluted tubule

53
Q

What actively reabsorbs sodium, is impermeable to water, and causes urine to be more dilute?

A

the distal convoluted tubule

54
Q

Where does the parathyroid hormone increase calcium reabsorption?

A

the distal convoluted tubule

55
Q

What extends from the distal convoluted tubule?

A

the collecting tubule

56
Q

What connects with the renal pyramids?

A

the collecting tubule

57
Q

What reabsorbs sodium in exchange for potassium and hydrogen?

A

the collecting tubule

58
Q

What hormone regulates the process in the collecting tubule of sodium reabsorption in exchange for potassium and hydrogen?

A

aldosterone

59
Q

Where is the site of action for anti-diuretic hormone?

A

the collecting tubule

60
Q

What are epithelial cells in the bowman’s capsule which wrap around the capillaries of the glomeruli?

A

podocytes

61
Q

Podocytes form long processes (foot projections) called?

A

pedicels

62
Q

What wraps around the glomerular capillaries and leave slits between them?

A

pedicels formed by podocytes

63
Q

What is filtered between the slits (pedicels)?

A

blood

64
Q

What is located in the area just proximal to the renal corpuscle, between the afferent and efferent arterioles, and where the distal tubule loops up and makes contact with the afferent arteriole?

A

the juxtaglomerular apparatus (JGA)

65
Q

The JGA is a collection of cells consisting of?

A

juxtaglomerular cells, the macula densa, and the mesangial cells

66
Q

Where are the juxtaglomerular cells located?

A

in the wall of the afferent arterioles

67
Q

What is the function of the juxtaglomerular cells?

A

they monitor renal pressure and help to maintain normal GFR through the release of renin

68
Q

What happens when renal perfusion is decreased?

A

the juxtaglomerular cells are responsible for releasing renin to help increase GFR

69
Q

The end result of renin?

A

the release of angiotensin II which constricts the efferent arteriole thereby increasing pressure to the glomerulus

70
Q

A group of epithelial cells located in the distal convoluted tubule that are in close contact with afferent and efferent arterioles. They help regulate GFR.

A

macula densa

71
Q

Located in the section between the afferent and efferent arterioles and among the glomerular capillaries.

A

mesangial cells

72
Q

Function as macrophages and are able to contract to regulate blood flow of the glomerular capillaries

A

mesangial cells

73
Q

The kidneys receive approximately how much blood per minute which is a sizable portion of the cardiac output?

A

1000-1200mL

74
Q

As the blood enters the ____, ____% of this plasma is filtered out of the capillaries and enters the ____?

A

glomerulus
20%
bowman’s capsule

75
Q

the filtrate then enters the _____ at a rate of approximately ____mL per minute. This is known as the _____.

A

proximal tubule
125mL
glomerular filtration rate (GFR)

76
Q

The remaining ____% of plasma is not filtered into the bowman’s capsule but instead flows out of the glomerular space and into the ______.

A

80%

efferent arterioles

77
Q

the efferent arterioles then divide into millions of capillaries that surround the tubules and are called

A

peritubular capillaries

78
Q

the network of capillaries in conjunction with epithelial cells of the tubules is responsible for

A

solute exchange and water regulation

79
Q

___ branch off the abdominal aorta, go into the kidneys and become the _____ of the glomerulus and form the ______

A

renal arteries
afferent arteriole
glomerular arterioles

80
Q

Renal blood flow….

A 
abdominal aorta
renal arteries
into the kidneys
afferent arterioles of 
     glomerulus
glomerular arterioles
efferent arteriole
peritubular capillaries
connect with the venous 
     system
inferior vena cava
81
Q

In normal physiology what assist with the dilation of the afferent arterioles

A

prostaglandins

82
Q

The dilation of the afferent arterioles results in increased blood flow to the glomeruli and ___

A

increase GFR

83
Q

Some prostaglandins produced by the arachidonic pathway are

A

renal protective

84
Q

NSAIDS block the production of renal protective prostaglandins and can cause __

A

AKI
sodium retention
and edema

85
Q

Angiotensin II constricts mainly?

A

the efferent arterioles in the glomeruli

86
Q

Angiotensin II causes?

A

increase in GFR and glomerular pressure

87
Q

ACE inhibitors block the action of

A

angiotensin II

88
Q

ACE inhibitors block the action of angiotensin II on the ___

A

efferent arterioles

89
Q

ACE inhibitors block the action of angiotensin II on the efferent arterioles and therefore

A

have a renal protective quality in diabetics because it decreases the pressure within the glomeruli - but this could also result in AKI particularly in someone with renal artery stenosis

90
Q

Renal blood flow is regulated by

A

a variety of auto regulatory processes

91
Q

The regulatory systems affect

A

the amount of blood which flows to the kidneys and also the rate of filtration

92
Q

What is EABV?

A

effective arterial blood volume

93
Q

A decrease in the arterial blood pressure or a decrease in the EABV causes?

A

a decrease in renal perfusion

94
Q

A decrease in renal perfusion causes

A

the filling pressure of the glomerular arterioles to decrease which in turn decreases the GFR

95
Q

A decrease in GFR leads to

A

a decrease in the fluid and sodium in the distal tubule

96
Q

A decrease in the fluid and sodium in the distal tubule is sensed by the JGA which then does 2 things?

A

1 - it sends signals to the afferent arterioles to relax which increases the flow of blood to the glomeruli
2 - the JGA releases more renin

97
Q

What does renin do related to the kidneys?

A

1 - converts the plasma protein angiotensinogen to angiotensin I
2 - angiotensin I passes through the lungs and stimulates the release of (ACE) angiotensin converting enzyme
3 - ACE then converts angiotensin I to angiotensin II
4 - which stimulates vasoconstriction of efferent arterioles
5 - this helps increase glomerular back pressure
6 - this increases GFR

98
Q

What does angiotensin II responsible for besides vasoconstriction?

A

it is also responsible for stimulating the release of aldosterone.

99
Q

What does aldosterone do related to the kidneys?

A

is the hormone of sodium regulation and signals to the collecting ducts in the nephron to reabsorb Na. The increase in sodium load leads to an increase in water retention and ultimately an increase in blood volume, blood pressure, and GFR.

Test 4 Advanced Pathophysiology Dr. Gonzalez (4 decks)

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