Renal System Flashcards

1
Q

What are the kidneys?

A

Humans have 2, one either side of the vertebral column. A tough renal capsule covers each one. It receives blood from the renal artery and returns it through a renal vein. The blood is filtered in the outer layer, the cortex, at the Bowmans capsule and the medulla contains the loop of Henle and the collecting ducts that carry the urine to the pelvis. The pelvis empties the urine into the ureter which goes to the bladder.

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2
Q

What is the calyx?

A

The first unit in the system of ducts in the kidney carrying urine from the renal pyramid of the medulla to the renal pelvis for excretion. There is the minor renal calyx with several others which drains into the major renal calyx which in turn joins other major calyces to form the pelvis.

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3
Q

What is the cortex?

A

Where small molecules are filtered from the blood and where most are returned to blood before leaving the kidney.

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4
Q

What is the medulla?

A

Helps in control of water content of blood. The renal pyramids are a part of the medulla in which urine drains into the pelvis. The pelvis is the white region at the top of the ureter that urine drains into. The ureter carries urine from kidneys to bladder.

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5
Q

What do the renal arteries and veins do?

A

Renal artery brings blood from the heart to the kidney. Renal vein carries blood from the kidney to the inferior vena cava.

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6
Q

What are the 2 main roles and 4 minor roles of the kidney?

A

Main: osmoregulation and excretion.
Minor: control of water balance, regulation of blood pressure, regulation of electrolyte balance and excretion of metabolic wastes like urea.

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7
Q

Where are the nephrons located?

A

They start in the cortex, loop down into the medulla and back into the cortex and join to form the ureter.

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8
Q

What is the bowmans capsule?

A

At the start of the nephron and Holds the glomerulus.

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9
Q

What is the glomerulus?

A

A network of blood capillaries, where blood enters at high pressure from the afferent arteriole from the renal artery.

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10
Q

Describe ultrafiltration.

A

In the glomerulus. Blood is at such high pressure that solutes and water are forced out through the fenestrae of capillaries, through the basement membrane and through filtration slits between pedicels into the cavity of the Bowmans capsule. The solutes and water that filter out constitute the glomerular filtrate and includes glucose, water, salts, urea and amino acids.

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11
Q

What happens at the proximal convoluted tubule?

A

Where most of the reabsorption happens. The solutes move from the filtrate to the blood and because this then lowers the water potential of the outside, water is followed by osmosis. Most of the water is reabsorbed.

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12
Q

What happens in the loop of Henle?

A

The ascending limb is impermeable to water, and ions actively transport out which reduces the water potential of the medulla. The descending limb is relatively permeable to water and because of the reduced water potential of the medulla due to the ascending limb, water moves out.

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13
Q

What happens at the distal convoluted tubule?

A

This is the area most affected by ADH. This controls the amount of water reabsorbed into the blood and therefore the concentration of the urine. This is osmoregulation.

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14
Q

What happens at the collecting duct?

A

The filtrate now has very little water, urea and salts/ions. It goes into the collecting duct, out of the renal pelvis, through the ureter and into the bladder.

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15
Q

Briefly describe urine production.

A

Blood enters glomerulus and water and solutes are forced out due to high BP - filtrate forms - reabsorption happens at the PCT - concentration increases at the loop of Henle - amount of water is modified to meet the bodies needs at DCT - some reabsorption occurs at the collecting duct - leaves through ureter.

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16
Q

Describe osmoregulation.

A

This is the control of water content in the blood, happening at the DCT. water levels are controlled by the hypothalamus and posterior pituitary gland in the brain and kidney. ADH is anti-diuretic hormone which changes the concentration of urine. When water level in the blood is too low or high, osmoregulation detect this and ADH is secreted or reduced.

17
Q

What happens if a person is dehydrated in terms of osmoregulation?

A

If they’re dehydrated, more ADH is released, acting on the DCT. the walls become more permeable, so more water is reabsorbed, so volume of urine decreases and concentration increases.

18
Q

What happens if a person is overhydrated in terms of osmoregulation?

A

Less ADH is released, so DCT walls become less permeable, less water is reabsorbed, volume of urine increases and concentration decreases.

19
Q

What is a kidney infection (leading to kidney failure)?

A

A kidney infection (pyelonephritis) is a painful illness caused by bacteria travelling from the bladder. If treated quickly it won’t cause harm but will make you feel unwell. Untreated it can lead to kidney failure.

20
Q

What are some symptoms of a kidney infection?

A
Pain and discomfort in side or lower back
High temperature
Shivering
Feeling weak or tired
Loss of appetite
Feeling or being sick
Pain during urination
Needing to urinate a lot
Blood in urine
21
Q

What are some effects of renal infections?

A

Reduced appetite meaning weight loss and mood swings
Generalised itching so avoidance of social situations
Expense from medications
Lethargy causing changes in sleeping
Possible time off work
Changes in relationships
Low mood
Side effects
Dialysis = risk of infection and time off work or school

22
Q

How can diabetes cause kidney infection/failure?

A

Kidney damage develops in about 20% of people w Type 1 and type 2 diabetes. It is because glucose can damage the filters in the kidney, affecting the kidneys ability to filter out waste products and fluid. Diabetes means glucose isn’t being removed from the blood due to insulin so there is more glucose to damage the kidneys.

23
Q

How can infection cause kidney failure?

A

Pyelonephritis is painful but harmless if treated. Infection usually occurs because bacteria, typically E Coli accidentally gets into the urethra and travels up through the bladder into the kidneys.

24
Q

How does raised blood pressure cause kidney damage?

A

Damage to the capillaries in the glomerulus prevents ultrafiltration.

25
Q

How do lifestyle factors cause kidney damage?

A

Long term regular use of NSAIDs including aspirin and ibuprofen can damage the kidneys. Any crushing injuries can cause kidney failure.

26
Q

How can disease cause kidney damage?

A

Auto immune disease is where the individuals immune system destroys their own tissues.

27
Q

How can an ultrasound diagnose kidney damage?

A

Good for determining the size of the kidneys and detecting cysts, solid masses that may be benign or malignant tumours and kidney stones. Also can help estimate the scarring in the kidney and whether there is a blockage of urine flow.

28
Q

How can IVP diagnose kidney damage?

A

Intravenous pyelogram. Uses traditional x rays to produce pictures of the kidneys, ureters and bladder. A contrast dye is injected into a vein and circulated through the blood stream, being processed and excreted by kidneys. This technique produces 2D black and white imagines and can give detailed info on the size and shape of kidneys as well as kidney stones, cysts or tumours. If kidney function is reduced this isn’t used because the kidneys won’t process the cue as well and there is a risk of renal failure.

29
Q

How can CT scans diagnose kidney damage?

A

Also use x rays to produce pictures of the kidneys but from a different angle. They also show kidney stones, cysts and masses

30
Q

How can MRI scans diagnose kidney damage?

A

Create images based on the magnetic field. It produces high quality images but can’t be used on people with metal in their body such as a pacemaker.

31
Q

How can blood tests diagnose kidney damage?

A

Blood tests for urea and creatinine are used. These two substances are normal waste products excreted by the kidneys. Urea is a by product of protein break down and creatinine is a by product of normal muscle functioning. In kidney disease these substances aren’t excreted normally so accumulate.

32
Q

How can urine dipstick/urine analysis diagnose kidney damage?

A

In many types of kidney diseases the tiny glomerular filtrates are damaged and this allows proteins and red blood cells to spill into the urine where they can be detected. A urine dipstick is a small flat plastic stick containing several rows of chemically treated square papers which is dipped into urine. The squares turn different colours and are compared to a colour chart to see if the urine contains proteins, blood, glucose (diabetes), and white blood cells (infection).

33
Q

How can urethroscopy diagnose kidney damage?

A

A slim endoscope can be used to look into the interior of the urethra. A cystoscope can be used to visualise the bladder. Both can be used to remove obstructions like polyps, prostatic enlargement and benign cancers

34
Q

How can medication cure kidney damage?

A

If it was because of an infection, antibiotics can be given to treat it lasting 7-14 days.

35
Q

What is haemodialysis?

A

Blood is taken from an artery usually in the arm, and is run through thousands of long, narrow fibres made of selectively permeable dialysis tubing. The fibres are surrounded by dialysis fluid. The pores let molecules in solution out into the machine in opposite directions, enhancing diffusion out of the blood by counter current flow. The blood is returned to a vein and heparin is injected to prevent clotting. A sensor in the fluid detects haemoglobin that would diffuse through if red blood cells were damaged. This occurs in several hours, several days a week.

36
Q

What is CAPD?

A

Continuous ambulatory peritoneal dialysis. They can walk around. The patient drains a 1-3dm3 bag of dialysis fluid through a catheter into the abdomen. The peritoneum is the membrane lining the abdomen and has a rich supply of capillaries, acting as a dialysis membrane and materials are removed from blood in capillaries into dialysis fluid. After about 40 mins the fluid is drained out. It is repeated 4 times a day.

37
Q

What are the negative effects of CAPD?

A

Retention of liquid and potassium ions accumulate in blood so patients are advised to drink little and avoid potassium rich foods. Bleeding may occur from the access point, hypotension, infections, fatigue, low BP, muscle cramps and itchy skin are other side effects.

38
Q

How can a transplant treat kidney failure?

A

Donors may be living or suffered brain stem or circulatory death. A kidney from a live donor works immediately and lasts longer whereas a transplant from a deceased owner may take a few days or weeks to work and dialysis is used in the meantime. Most of them fail at some stage. The donor and recipient must be compatible in their blood type and the HLA (human leukocyte antigens). The transplanted kidney is placed in the lower abdomen and the renal artery and vein are connected to the iliac artery and vein. The circulation is restored and when urine is seen emerging from the ureter it is joined to the bladder.

39
Q

What are the negatives of kidney transplants?

A

Immunosuppressants must be taken but even so, rejection can occur. With a suppressed immune system individuals are more at risk of infection especially of the urinary tract, which can eventually lead to a damaged kidney. Long term low dose antibiotics may be used. Immunosuppressants also increase the risk of cancer.