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Pathophys II MHM - Exam 2 > Renal Module 1 > Flashcards

Renal Module 1 Flashcards

1
Q

What is the renal capsule?

A

Directly surrounds each kidney

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2
Q

What is the renal fascia?

A

Surrounds kidney and fatty mass

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3
Q

What does the renal cortex contain?

A
  • Glomeruli

- PCTs and DCTs

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4
Q

What does the renal medulla contain?

A

Straight segments of PCT and DCTs

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5
Q

What are renal pyramids?

A

Functional arrangement for collection

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6
Q

What are renal papilla and where do they drain into?

A
  • Apex of renal pyramid

- Drains into minor calyces

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7
Q

Function of minor calyces

A

Collect urine form renal pyramids

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8
Q

Function of major calyces

A

Collect urine from 2-3 minor calyces

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9
Q

What is renal pelvis and its function?

A
  • Funnel shaped duct that becomes continuous with ureter

- Collects urine from major calyces

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10
Q

What is the ureter and its function?

A
  • Smooth muscular tube 25-30 cm long

- Drains urine from renal pelvis and descends into bladder

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11
Q

What are the renal collecting system components (calyces, pelvis, ureters) composed of?

A

Smooth muscle

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12
Q

What regions have the most potential for kidney stones to lodge?

A
  1. Ureteropelvic junction
  2. Where ureter passes over pelvic brim
  3. As ureter enters bladder
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13
Q

Functional unit of the kidney?

A

Nephron

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14
Q

Types of nephrons

A
  1. Superficial cortical (85%, extend partially into medulla)
  2. Mid-cortical (short and long loops)
  3. Juxtamedullary (extend deep into medulla)
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15
Q

Which type of nephron is responsible for urine concentration?

A

Juxtamedullary

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16
Q

What is the site of renal filtration?

A

Renal corpuscle

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17
Q

What makes up the renal corpuscle and what is its function?

A
  • Glomerulus, Bowman’s capsule, Mesangial cells

- Site of filtration

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18
Q

What is the site of renal capillary filtration?

A

Glomerulus

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19
Q

How is the glomerulus composed?

A

Glomerular capillaries that extend into Bowman’s capsule

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20
Q

Layers of the glomerular filtration membrane

A
  1. Capillary endothelium (fenestrated wall)
  2. Basement membrane (negative charge which plays role in filtration)
  3. Capillary epithelium (podocytes)
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21
Q

What are podocytes?

A
  • Cells of the capillary epithelium of the glomerular filtration membrane
  • Foot like projections that form matrix of filtration slits
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22
Q

Glomerular blood flow through efferent arteriole:

A
  • Glomerulus capillaries drain into efferent arteriole
  • Blood then travels to peritubular capillaries
  • Allows for reabsorption and secretion along tubules of nephron
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23
Q

What is the juxtaglomerular apparatus composed of?

A

Juxtaglomerular cells + macula densa

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24
Q

Where are juxtaglomerular cells located?

A

Adjacent to afferent glomerular arteriole

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25
Q

What is the macula densa, where is it located, what is its function?

A
  • Part of JGA
  • Cells in DCT located adjacent to afferent and efferent arterioles
  • Function as NaCl receptors
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26
Q

What does the JGA regulate?

A
  • Renal blood flow
  • Glomerular filtration
  • Renin secretion
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27
Q

What are mesangial cells? Where are they located and what is their function?

A
  • Matrix of smooth muscle and phagocytic cells
  • Located b/w glomerular capillaries and Bowman’s capsule
  • Regulation of filtration
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28
Q

What is the function of Bowman’s space?

A

(space inside Bowman’s capsule)

-Collects filtrate from glomerular capillaries

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29
Q

What is the PCT?

A
  • Continuation from Bowman’s capsule

- 15 mm long single layer of cells along wall with microvilli (brush border)

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30
Q

Function of the PCT?

A

Major site of Na reabsorption as filtrate travels through tubules

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31
Q

What is the Loop of Henle composed of?

A

Descending and ascending loops

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32
Q

Describe Loop of Henle in juxtamedullary nephrons

A
  • Extends deep into medulla

- Plays critical role in concentrating urine

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33
Q

Describe Loop of Henle in superficial cortical and mid-cortical nephrons

A
  • Short, only partially extend into medulla

- Do NOT play role in concentrating urine

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34
Q

Where does the DCT begin and end?

A
  • Begins at macula densa

- Ends at connection to collecting duct

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35
Q

Functions of early and late DCT?

A
  • Early DCT: continues to dilute filtrate as reabsorbs Na

- Late DCT: begins to concentrate the fluid as it enters collecting duct

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36
Q

What drains into a single collecting duct?

A

DCTs from many nephrons

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37
Q

Location of collecting duct

A
  • Descends to renal papilla

- Drains into minor calyces

38
Q

Function of collecting duct

A

Final concentration of urine

39
Q

Pathway of blood to kidney

A

Descending aorta to renal arteries, branches form afferent glomerular arterioles to glomerular capillary beds

40
Q

What is unique about the renal circulation?

A

2 successive capillary networks

41
Q

Describe peritubular capillary beds of nephrons - location, function

A
  • Past the efferent arteriole
  • Surround PCT, DCT and some of short loop of Henle
  • Secretion and reabsorption of filtrate throughout the tubules of the nephron
42
Q

Describe vasa recta of medullary nephrons - location, function

A
  • Run parallel to long loops of Henle

- Concentration of urine and regulation of concentration gradients along loop of Henle

43
Q

Pressure in glomerular capillary beds is:

A

HIGH

  • To encourage filtration
  • Starts at 45 mm Hg, drops 1-3 by the end
44
Q

Pressure in peritubular capillaries is:

A

LOW

  • To encourage exchange
  • Starts at 8 mm Hg, drops to 4
45
Q

What is renal blood flow (RBF) defined as and what is its approximate value?

A
  • Volume of blood that flows through the glomerular capillaries of both kidneys per minute
  • 1.2 L/min (approx 20-25% resting CO)
46
Q

What is renal plasma flow (RPF) defined as and what is its approximate value?

A
  • Volume of plasma that flows through the glomerular capillaries of both kidneys per minute
  • 600-700 mL/min
47
Q

How can RPF be calculated?

A

RBF x (1 - hematocrit)

48
Q

What is glomerular filtration rate (GFR) and what is its approximate value?

A
  • Volume of plasma that is filtered into Bowman’s capsule per unit of time
  • 120 mL/min
49
Q

How can GFR be calculated?

50
Q

Approximately how much RPF will filter into Bowman’s capsule?

A

20% of RPF

51
Q

If approximately 20% of RPF is filtered into Bowman’s capsule, where does the remaining 80% go?

A

Travels to peritubular capillaries/vasa recta

52
Q

How much glomerular filtrate is reabsorbed back into the blood stream?

A

99% is reabsorbed into peritubular capillaries

53
Q

How much glomerular filtrate remains in the nephron to form urine?

A

Around 1% remains in the tubules and is excreted as urine through collecting duct

54
Q

How is urine output calculated?

A

GFR x 1.5%

55
Q

What is the filtration fraction?

A

Ratio of GFP to RPF

-Tells us how much plasma is filtered into Bowman’s out of total plasma flow

56
Q

Average urine output per day?

57
Q

How is GFR related to RBF?

58
Q

How is RBF/GFR regulated?

A
  1. Autoregulation
  2. Neuroregulation
  3. Hormonal feedback mechanisms
    * The net result of all 3 mechanisms determines “actual” RBF/GFR
59
Q

How does autoregulation maintain constant GFR?

A
  • If systemic pressures INCREASE: afferent arteriole constricts to decrease RBF which prevents an increase in GFR
  • If systemic pressures DECREASE: afferent arteriole dilates to increase RBF which prevents a decrease in GFR
60
Q

What are the mechanisms of autoregulation in the kidneys?

A
  • Myogenic mechanism (stretch feedback)

- Tubuloglomerular feedback

61
Q

What is the myogenic mechanism of GFR?

A
  • Autoregulation
  • “Stretch” feedback
  • Smooth muscle of afferent arteriole wall is sensitive to stretch
  • If systemic pressures cause stretch then muscle constricts which limits RBF
62
Q

What is the tubuloglomerular feedback mechanism of GFR?

A
  • Autoregulation via JGA
  • Macula densa located in DCT sensitive to flow rate and Na levels
  • Changes in Na and flow rates will signal constriction or dilation of afferent arterioles
  • Increased NaCl = afferent constricts, RBF slows which decreases GFR
63
Q

Describe neuroregulation of GFR

A
  • Sympathetic nervous system if systemic BP DECREASES

- Stimulates arterioles to constrict, limiting RBF which either maintains or decreases GFR

64
Q

How is GFR affected by exercise? What regulates this?

A
  • Decrease in GFR (and RBF)

- Controlled by sympathetic mechanism

65
Q

Why does the sympathetic nervous system mechanism aim to decrease GFR?

A
  • It is activated upon decreased systemic pressure

- Decreased GFR means less Na/water is excreted (water is retained) which increases BV and BP

66
Q

How does hemorrhage affect GFR?

A
  • Sympathetic mechanism is stimulated

- Decreased RBF/GFR to promote increased BV and BP

67
Q

What are the major hormone mechanisms regulating GFR?

A
  • RAAS

- Natriuretic peptides

68
Q

How does RAAS affect GFR?

A
  • Decreases GFR

* This causes increased BV and BP

69
Q

How do natriuretic peptides affect GFR?

A
  • Increases GFR

* This causes increased fluid excretion so lower BP

70
Q

Liver’s role in RAAS?

A

Produces pre-angiotensin

71
Q

Kidney’s role in RAAS?

A

Releases renin

72
Q

Where is renin synthesized and released?

A
  • Juxtaglomerular cells of JGA

- Released into afferent glomerular arteriole

73
Q

Renin in the blood stream’s role in RAAS?

A

Converts pre-angiotensin to angiotensin I

74
Q

Lungs role in RAAS?

A

Produce ACE

75
Q

Function of ACE in RAAS?

A

Converts AT I to AT II

76
Q

Stimulus of renin release and the goal of RAAS

A
  • Stimulus: decreased BV/BP, sympathetic activity, decreased NaCl flow through macula densa
  • Goal: increase BV/BP
77
Q

Actions of AT II

A
  • Vasoconstriction
  • Stimulate thirst centers in brainstem
  • Enhances sympathetic function by promoting release of NE
  • Stimulate adrenal cortex to release aldosterone
  • Stimulate posterior pituitary to release ADH
78
Q

Action of aldosterone in distal nephron?

A

Increases Na/Cl reabsorption

79
Q

Action of ADH in distal nephron?

A

Increases water/fluid reabsorption

80
Q

How does AT II affect peritubular capillary hydrostatic pressure?

A

Decreases (promotes fluid reabsorption)

81
Q

How does AT II affect mesangial cells?

A

Stimulates contraction of mesangial cells (resulting in decreased GFR)

82
Q

What is the long term action of AT II?

A

Stimulates vascular hypertrophy

83
Q

Net result of RAAS?

A

Increased BV/BP

84
Q

What inhibits renin release?

A
  • Increased GFR or Na/Cl flow
  • Increased systemic/glomerular BP
  • Negative feedback of increased AT II and ADH
85
Q

Goal of natriuretic peptides?

A

Counteract RAAS

86
Q

What are the natriuretic peptides?

A
  • ANP
  • BNP
  • CNP
  • Renal natriuretic peptide (urodilatin)
87
Q

Where is CNP produced/secreted from?

A

Vascular endothelium and heart

88
Q

Where is renal natriuretic peptide (urodilatin) secreted from?

A

DCT/collecting ducts

89
Q

Where is BNP produced and secreted from?

A

-Right ventricle

and brain where it was originally identified

90
Q

Functions of ANP/BNP:

A
  • Promote Na/water excretion (increase GFR)
  • Inhibit secretion of renin and aldosterone
  • Inhibit Na/water reabsorption
91
Q

Function of CNP?

A

Promotes vasodilation of blood vessels

92
Q

Function of renal natriuretic peptide?

A

Promotes Na/water excretion in DCT/collecting ducts

Pathophys II MHM - Exam 2 (4 decks)

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