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Human Systems > Renal system > Flashcards

Renal system Flashcards

1
Q

In 2017 how many deaths globally attributed to inflammation related diseases

A

73.4%

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2
Q

What are some inflammation related diseases

A

Cardiovascular diseases​

Cancer​

Metabolic disorders​

Chronic kidney diseases​

Autoimmune diseases​

Neurodegenerative disorder

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3
Q

What is the function of the kidneys

A

Maintain internal homeostasis of fluid
Kidneys are excretory organs
-process blood and rid the body of the waste products of metabolism via urine

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4
Q

What special roles do the kidneys undertake constantly

A

Get rid of or conserve fluid, regulate electrolytes in blood, so in turn play a role in regulating blood pressure

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5
Q

What is the anatomy of the urinary system

A

Kidneys - produce urine
Ureters - convey urine
Bladder - stores urine
Urethra - Void urine

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6
Q

Where are the kidneys positioned

A

Lie in retroperitoneal posistion, behind peritoneal cavity in renal fat pad

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7
Q

What are the parts of the kidney

A

Cortex

-contains 85% of all kidney tubules (nephrons)

Medulla

-the site where urine is concentrated​
-prevents excessive water loss

Pelvis

-collection area for urine which is funnelled into the ureter

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8
Q

What surrounds the kidneys

A

Dense irregular fibrous capsule

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9
Q

What supplies the kidneys

A

Renal arteries (from abdominal aorta)

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10
Q

How much blood do the kidneys process per minute

A

1.2 litres (1/5 cardiac output)

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11
Q

What drains the kidneys

A

Renal vein

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12
Q

Where is the site of blood filtration

A

Glomerular capillaries

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13
Q

What is the purpose of the vasa recta (peritubular capillaries)

A

Delivers oxygen and nutrients to the rest of the kidney, also plays a role in facilitating water reabsorption and concentrating urine

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14
Q

What are the types of nephrons

A

Cortical (cortex)
Juxtamedullary (next to medulla) - very long loops of henle

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15
Q

What is the function of the glomerulus and bowman’s capsule

A

Renal corpuscle - filtration (removal)

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16
Q

What is the function of the renal tubule (PCT, loop of henle etc)

A

Reabsorption and secretion (Conservation/finetuning)

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17
Q

What is the Bowman’s capsule

A

A cuplike structure surrounding the glomerulus
Bowman’s space
Parietal (outer) layer
Visceral (inner) layer comprised of specialised epithelium – podocytes
Together the glomerulus and Bowman’s capsule are known as the renal corpuscle

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17
Q

What is the glomerulus

A

Fine network of capillaries
Single layer of endothelial cells resting on a basement membrane
Fenestrated (leaky)
Enables rapid filtration of blood plasma
Surrounded by bowman’s capsule

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18
Q

What is the glomerulus and Bowman’s capsule known as

A

Renal corpuscle

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19
Q

What are podocytes

A

Epithelial cells with very long foot like processes which wrap around the glomerular capillaries

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20
Q

What is the specialised epithelium in the bowman’s capsule comprised of

A

Podocytes

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21
Q

What forms the filtration barrier

A

The glomerular endothelium, basement membrane and pedicels of podocytes form the filtration barrier

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22
Q

What can pass through the filtration barrier

A

Filtration barrier freely permeable to water and small molecules but NOT large proteins or cells

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23
Q

What do pedicels share a basement membrane with

A

The fenestrated endothelium

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24
Q

How does blood enter and exit the glomerulus

A

Arrive - afferent
Exit - efferent

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25
Q

What causes pressure gradient in renal corpuscle

A

Pressure in capillaries is slightly higher than surrounding tissues

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26
Q

What is filtered through the basement membrane

A

Sodium
Chloride
Calcium
Phosphate
Potassium
Bicarbonate
Urea
Creatinine
Water
Glucose
Amino acids

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27
Q

How can the arterioles increase renal corpuscle pressure

A

Afferent arteriole has a slighter greater diameter so more blood arriving than leaving increasing pressure

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28
Q

What is not filtered through the basement membrane

A

Negatively charged proteins
Cells
Large proteins

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29
Q

What impacts the rate of filtration through glomerulus

A

Glomerular hydrostatic pressure
Hydrostatic pressure in the bowman’s capsule
Glomerular osmotic pressure
Systemic blood pressure
Renin-angiotensin system
Disease

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30
Q

What equation determines the GFR

A

(Glomerular HP + Capsular OP)
-minus
(Glomerular OP + Capsular HP)

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31
Q

What is the normal healthy GFR

A

125ml/min

180 l/day

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32
Q

What does kidney damage result in

A

Kidney damage reduces GFR

Reduced GFR = inefficient blood clearance and waste removal

Waste products accumulate in blood

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33
Q

How can suspected kidney damage be confirmed

A

Measuring serum creatinine levels in blood

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34
Q

What would the GFR of someone with stage 4 kidney disease be

A

Between 29-15% (severe loss)

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35
Q

When is kidney disease usually symptomatic and diagnosed

A

Stage 3

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36
Q

What is stage 5 Kidney disease

A

Less than 15% kidney function
-Kidney failure

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37
Q

What is the functional unite of the kidney

A

Nephrons

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38
Q

What is the function of the PCT

A

Reabsorption and secretion

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39
Q

Where is most Na+ reabsorbed

A

PCT - 65%

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40
Q

What percentage of Na+ is reabsorbed

A

98%

41
Q

What percenatge of Na+ is reabsorbed in the loop of henlé

A

25%

42
Q

How is the PCT adapted for reabsorption and secretion

A

Long and convuluted, mqaximise SA
Epithelial lining cells possess microvilli

43
Q

Why does the PCT stain darker than the DCT with masson trichrome stain

A

Due to a greater density of organelles as it is has more highly metabolically active cells present

44
Q

Where are substances being reabsorbed from

A

Tubules back into the blood

45
Q

What is the only substance not reabsorbed

A

Creatine

46
Q

What is passive diffusion

A

movement of molecules from high to low concentration until equilibrium is reached

47
Q

How is filtrate reabsorbed

A

Passive diffusion
-High conc of molecules and water etc in the tubules and very low conc in capillaries

48
Q

What facillitates water movement

A

Aquaporins
-protein pores in phospholipid bilayer

49
Q

How do glucose and amino acids get reabsorbed

A

Via sodium co-transporters
-carrier proteins

50
Q

How much filtrate is reabsorbed by passive diffusion

A

50%

51
Q

For every 3 Na+ ions pumped out of a cell how many K+ ions move in

A

2

52
Q

How is 2/3 of the filtrate reabsorbed in the PCT when only 50% moves via passive diffusion

A

Sodium potassium pumps

53
Q

How does the presence of sodium potassium pumps impact the reabsorption of other molecules/substances

A

Water follows Na+ - osmosis
Glucose and amino acids are co-transported with Na+
Chloride and negative ions follow Na+ to balance the charge

54
Q

How much filtrate remains after passing through the PCT

A

60 litres

55
Q

What does Na+ active transport facillitate

A

100% nutrient reabsorption - Glucose and amino acids ‘hitch a ride’

65% Water reabsorption – water follows Na+

65% Negative ions follow electrical gradient

No effect on waste removal​
-Urea – 50% reabsorbed by passive diffusion​
-Creatinine – no reabsorption

56
Q

What are the features of the thin descending limb of the LOH

A

Contains aquaporins
Freely permeable to water
Does not contain active sodium pumps

57
Q

What limb is IMPERMEABLE to water

A

Both ascending limbs

58
Q

What section of the LOH is the site of active Na+ reabsorption

A

Thick ascending limb

59
Q

How is a conc formed in the medulla to promote water reabsorption in the descending limb and collecting ducts

A

Na+ actively transported out of ascending limb which is impermeable to water preventing it following the Na+ creating a conc grad

60
Q

What conditions are created in the medulla as sodium is actively reabsorbed from the filtrate?

A

Medulla becomes salty due to increased Na+ conc

61
Q

What portion of the capillaries extends into the medulla

A

Vasa recta

62
Q

What is furosemide

A

Drug which binds to and inhibits NKCC2 pump in LOH

63
Q

What happens to the water in the filtrate as it enters the loop of henlé

A

Moves out of the descending limb from high conc to low conc

64
Q

What happens to the concentration of the filtrate as it descends the thin ascending limb?

A

Conc of the filtrate increases due to loss of water
300mosm/l - 1200mosm/l

65
Q

What happens to the concentration of the filtrate as it ascends the thick ascending limb?

A

Na+ is now pumped out into medulla decreasing the conc
1200 - 100

66
Q

Where does the reabsorbed water and salt from the LOH go

A

Go back into blood via vasa recta

67
Q

Why is it called counter current multiplication

A

Filtrate flows in 2 different directions
Conc multiplied

68
Q

What does counter current multiplication achieve

A

Reabsorption of water and salt

69
Q

Why does the blood in vasa recta not destroy medulla conc grad

A

Slow blood flow, capillaries are freely permeable to ions and water so they become equal with the conc of the medulla
Some of the salt and water is carried away but not alot to ensure process not distrupted

70
Q

What occurs in the DCT

A

Fine-tuning - site of fluid volume and electrolyte regulation

Sodium and water reabsorption hormonally regulated
-Anti-diuretic hormone (ADH) – Increases water reabsorption
-Aldosterone – Increases Na+ reabsorption​
-Atrial natriuretic hormone (ANH) – Promotes Na+ secretion

71
Q

Why is the tubule fluid hypotonic with the interstitium of the cortex as it leaves the LOH

A

Contains more water and less solutes than surrounding interstitium

72
Q

What can alter the absorption of water in the DCT and collecting ducts

A

ADH

73
Q

Why is ADH needed to promote water reabsorption in the DCT

A

As there are no aquaporins in the DCT to prevent water reabsorption

74
Q

What does increased ADH production mean for urine production

A

Smaller more conc urine vol

75
Q

What receptors are used in the insertion of aquaporins by ADH

A

AVPR2 (vasopressin receptor 2)

76
Q

What affect does aldosterone have on DCT

A

Release of aldosterone signals for an upregulation and insertion of sodium channels in the membrane increasing levels of Na+ leaving tubules in turn increasing the levels of water reabsorption to increase internal volume of water

77
Q

Why does aldosterone not need a receptor

A

It’s a steroid hormone so it can diffuse directly across the phospholipid bilayer and into the nucleus

78
Q

What does NAP do

A

Released when there is an increase in BP indicating too much fluid volume so atrial naturetic hormone conteracts effects of aldosterone and ADH by removing aquaporins and Na+ pumps to increase the vol of dilute urine produced

79
Q

How much of the Kidney’s energy requirements are dedicated to moving and reabsorbing Na+

A

80%

80
Q

How many litres are filtered per day

A

180 litres

81
Q

How much filtrate is excreted

A

1-2% (99% reabsorbed)

82
Q

How much sodium is reabsorbed in the DCT

A

<8%

83
Q

What is the Juxta-glomerular apparatus

A

Connects the distal comvoluted tubule with the glomerulus

84
Q

What is the purpose of the Juxta-glomerular apparatus

A

Measures the amount of sodium and responds by regulating fluid and electrolyte reabsorption to regulate BP

85
Q

What are the structure and function of juxta-glomerular cells

A

Modified smooth muscle cells
Adjust the diameter of the afferent arteriole to regulate juta-glomerular filtration rate

86
Q

What is the purpose of mesangial cells

A

Supporting cells

87
Q

What does the macula densa do

A

Detect sodium conc

88
Q

How does an increased BP affect the juta-glomerular cells

A

Increase BP leads to an increased HP which increases filtration and sodium conc
Mecule densa releases adenosine
Causing constriction of juxtaglomerular cells to constrict the afferent arteriole
HP is ultimately decreased

89
Q

How can the tubuloglomerular feedback regulte systemic BP

A

Macula densa secretes prostaglandins in response to decreased sodium filtrate conc which stimulates the secretion of renin which activates the renin-angiotensin system the restore BP

90
Q

What process increases BP

A

Angiotensinogen released into circulation​

Renin converts angiotensinogen into Angiotensin I​

Angiotensinogen converting enzyme coverts angiotensin I into angiotensin II​

Angiotensin II potent vasoconstrictor – rapidly increases blood pressure

91
Q

How does Angiotensin II increase BP

A

Angiotensin II binds target receptors on:

Arterioles - constriction​
Hypothalamus- thirst​
Pituitary gland – release of ADH​
Adrenal medulla- release of aldosterone

Restores blood volume via increased fluid and salt retention​

92
Q

How is High blood pressure resolved

A

Baroreceptors detect the rise and stimulate the release of ANP which counteracts aldosterone and ADH to remove ecess fluid

93
Q

What happens to BP as kidney disease progresses

A

Kidney recognises low filtration rates as a low BP which is untrue hence raising BP unnecessarily and patients with kidney disease most likely already have high BP due to strain on kidneys

94
Q

What are the consequences of chronic kidney disease in the renal system

A

Reduced GFR leading to:
-Inadequate removal of fluid and waste products of metabolism
-Inappropriate activation of RAAS

95
Q

What diseases are commonly diagnosed with CKD

A

Hypertension
Cardiovascular disease
Diabetes

96
Q

What causes CKD (chronic kidney disease)

A

Hypertension​

Diabetes​

High Cholesterol​

Kidney Infections​

Glomerulonephritis​

Polycystic kidney disease​

Kidney stones​

Long-term use of NSAIDS

97
Q

What are the symptoms of CKD

A

Hypertension​

Nausea​

Oedema​
-ankles, hands or feet​
-lungs​

Blood/protein in urine​

Anaemia​

Weak/painful bones​

98
Q

How can hypertension be regulated

A

Diet (reduce to salt intake)/weight loss​

Often a combination of anti-hypertensive treatments required​

Diuretics (furosemide)​

ACE inhibitors/angiotensin receptor blockers (ARBs)​

Aldosterone agonists (nuclear receptors or sodium channels)

99
Q

What is dialysis

A

Artificial removal of waste, solutes, water and toxins from blood

100
Q

What are the 2 types of dialysis

A

Haemodialysis
Peritoneal dialysis

101
Q

What effect does furosemide have on.. ​

The reabsorption of sodium and water from the filtrate?​

Fluid and electrolyte balance of blood?​

Symptoms of hypertension

A

Inhibits Na+ cotransport inthe ascending loop of henle hence more ions remain in the urine and less water is reabsorbed due to a lesser conc grad
Water may move into the urine to combat conc grad reducing blood pressure and hypertension

Human Systems (34 decks)

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