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CPRI - Final > Renal Anatomy & Histology > Flashcards

Renal Anatomy & Histology Flashcards

1
Q

Describe renal gross anatomy

A

retroperitoneal organs in posterior of abdomen, extend from T12-L3, surparenal glands atop each, renal hilum entrance of blood vessels, renal pelvis, nerves

posteriorly, transpyloric plane at L1, superior poles deep to 11th and 12th ribs

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2
Q

What are the points of constriction for the ureters?

A

uretopelvic junction, over the common/external iliac, and uretovesical junction

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3
Q

What is the renal blood supply starting at the aorta and ending at the inferior vena cava?

A 
Aorta
 •Renal artery (branches in the renal sinus and sends...)
•Segmental artery
•Interlobar arteries (between pyramids to the cortex, then turn to the base of the pyramids between medulla and cortex as...)
•Arcuate arteries
•Interlobular arteries ascend in the cortex, give off...
•Afferent arterioles
•Glomerular capillaries
•Efferent arteriole
•Peritubular capillaries/vasa recta
•Interlobular veins 
•Arcuate veins
•Interlobar veins
•Renal vein 
Inferior vena cava
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4
Q

What is the renal nerve supplu?

A

Sympathetic: Renal plexus - lesser splanchnic (T10-T1), least splanchnic (T12), Lumbar splanchnic (L1-L2)

Parasympathetic: Vagus nerve

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5
Q

Cortex contains…

A

renal corpuscles, convoluted and straight tubules of the nephron, and portions of collecting ducts

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6
Q

The medulla contains…

A

renal columns and cone-shaped masses called renal pyramids

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7
Q

What are cortical medullary rays?

A

aggregation of collecting ducts and straight tubules running between the renal corpuscles and convoluted tubules within the cortex (arrows in image); axis of renal lobule

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8
Q

What is made in the fibroblasts of the renal interstitium?

A

erythropoietin

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9
Q

Cortical labyrinth =

A

between the medullary rays; contains the RC + convoluted tubules + collecting tubules

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10
Q

Urine carrying unit made of:

A
  • Nephron (urine forming unit) - consists of renal corpuscle and renal tubules (>1-2 million/kidney)
  • Cortical and medullary collecting ducts – final concentration of urine
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11
Q

List the renal tubular structures starting at the glomerulus

A 
Bowman’s capsule 
Proximal convoluted tubule 
Proximal straight tubule 
Thin loop of Henle 
Thick ascending loop of Henle 
Macula densa location 
Distal convoluted tubule 
Collecting tubule 
Collecting duct-cortical 
Collecting duct-medullary 
Papillary duct
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12
Q

What constitutes the renal corpuscle?

A

glomerular capillary tuft: fenestrated with truly open pores; afferent and efferent arteriole

bowman’s capsule: parietal layer (simple squamous), visceral layer (podocytes), glomerular space (ultrafiltrate)

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13
Q

What is special about the glomerular endothelium?

A

Fenestrated, no diaphragm, AQP-1 water channels, secretes NO and PGE2, glycocalyx

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14
Q

Describe the function of podocytes.

A

Located in visceral layer of Bowman’s capsule, extend secondary processes around capillaries called pedicels which interdigitate to create filtration slits that act as a size selective barrier

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15
Q

Describe the Glomerular Basement Membrane

A

both a physical and ion selective barrier

Type IV and XVIII collagens, laminin, fibronectin, entactin, proteoglycans and glycosaminoglycans (heparin sulfate)

Restricts proteins larger than 70kD such as albumin and hemoglobin
•Albuminuria or hematuria indicate physical or
functional damage to the GBM

Negative charge also restricts movement of anionic particles

Protein that does leak through is typically reabsorbed by the proximal convoluted tubule

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16
Q

What are the three components of the renal corpuscular filtration apparatus?

A
  1. glomerular endothelium
  2. GBM
  3. visceral layer of bowman’s capsule
17
Q

What is bowman’s 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
18
Q

Where are mesangial cells located and what is their function?

A

located in the renal corpuscle; mesangial cells + ECM = mesangium; like pericytes; function in phagocytosis and endocytosis, structural support, secretion of IL-1, PGE2, PDGF, and modulation of glomerular distention (contraction)

*clinical note: proliferation of mesangium is pathognomonic for certain kidney diseases

19
Q

Describe the PCT

A

Found only in renal cortex, receives ultrafiltrate from Bowman’s space (180 L/day)
•65% reabsorbed (120/Lday)

Simple cuboidal to columnar epithelium with apical brush border/microvilli and mitochondria

Na/K/ATPase pumps actively reabsorb Na+ , Cl- passively diffuses, H2O follows via AQP-1

Reabsorbs amino acids, sugars (sGLT2), polypeptides

Proteins and large peptides are endocytosed

20
Q

Describe the PROXIMAL STRAIGHT TUBULE/ Thick descending limb

A
  • Shorter than the PCT
  • Less well-developed brush border
  • Contain high-affinity sodium-glucose co-transporters (sGLT1)
21
Q

What is the function of the thin segment of the loop of henle?

A

structurally: Juxtamedullary nephrons – long; cortical nephrons – short
•Simple squamous epithelium without brush border
•Some nuclei bulge into lumen

Functionally: 
Thin descending limb:
  •Highly permeable to water, less permeable to NaCl, 
    urea
  •Water diffuses out

Thin ascending limb:
•Highly permeable to NaCl
•NaCl diffuses into interstitium
•Impermeable to water

22
Q

Describe the function of the thick ascending loop of henle (aka distal straight tubule).

A

Simple cuboidal epithelium with microvilli but no visible brush border

•Cortical and medullary (latter in the medullary ray)

  • Na, K, and Cl- diffuse out of filtrate into interstitium
  • No movement of water
  • Nucleus in apical section, cells bulge into the lumen
23
Q

Describe the function of the distal convoluted tubule.

A
  • Simple cuboidal epithelium without brush border (smoother lumen)
  • Shorter than PCT cells = relatively larger lumen
  • Reabsorb: •Na+ and HCO3-
  • Secrete:•K+ and NH4+

•DCT exchanges Na for K under aldosterone (which is released under stimulation from angiotensin II) regulation

24
Q

Describe the Collecting tubules/ducts and the two distinct cell types found here.

A

– simple squamous to cuboidal epithelium

•Medullary collecting ducts – simple cuboidal to columnar epithelium

  • Light cells (principal cells):
    • single cilium
    • Target of ADH-regulated AQP2 channels
  • Dark cells (intercalated cells):
    • alpha-intercalated – secrete H+
    • β-intercalated – secrete HCO3-
  • CD primary function is water reabsorption via aldosterone regulation
  • CD will eventually join to form larger papillary ducts that drain into a minor calyx
25
Q

What is the significance of peritubular capillaries?

A

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

26
Q

What is the vasa recta?

A
  • Surrounds the LOH, also from efferent arterioles •countercurrent exchange/concentrating
  • Descending is continuous endothelium, but ascending has fenestrations
27
Q

What is the juxtaglomerular apparatus?

A

Located near vascular pole of renal corpuscle and terminal portion of distal straight tubule (TAL of LOH)

  • Regulates BP – activates RAAS at times of low sodium/blood volume
  • Macula densa cells are chemoreceptors that “sensa” low sodium
  • Trigger release of renin from JG cells that leads to downstream activation of the entire RAAS to increase sodium retention, blood volume and ultimately BP
28
Q

What is urothelium?

A

transitional epithelium that lines the calyces, ureters, bladder, initial segment of the urethra. Stratified, impermeable to salts and water

•”umbrella” or “dome-shaped” apical surface in empty bladder. Accommodate to distention and flatten

Modified areas of plasma membrane called 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

29
Q

Ureters have how many layers of smooth muscle?

A

Inner longitudinal, middle circular, outer longitudinal at distal end; Embedded in adipose tissue with which the vessels and nerves form the adventitia

Clinical note:
•Reflux prevented in 3 ways:
•Bladder distends = compresses ureters
•Contraction of smooth muscle of bladder wall = compresses ureters
•Ureters enter the bladder obliquely

CPRI - Final (17 decks)

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