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BAMS > Renal system > Flashcards

Renal system Flashcards

1
Q

What is the function of the kidneys?

A

Excretery organs - process blood and rid the body of the waste products of metabolism via urine

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2
Q

What do the kidneys maintain homeostasis of?

A 
Fluid
Electrolytes (sodium/potassium)
Acid/base
Blood pressure
Calcium/vitamin D
Erythropoietin
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3
Q

What are the components of the urinary system?

A

Two kidneys (produce urine)
Ureters (Convey urine)
Bladder (stored)
Urethra (void urine)

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4
Q

What are the three distinct parts of the kidney?

A
  • Cortex - 85% of nephrons
  • Medulla - urine is concentrated, prevents excessive water loss
  • Pelvis - collection area for urine which is funneled into ureter
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5
Q

What are the blood vessels of the kidney?

A

Renal artery delivers blood from abdominal aorta

Renal artery
Segmental arteries
Lobar arteries
Interlobar arteries
Arcuate arteries
Interlobular arteries
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6
Q

How does blood move from the interlobular arteries to the interlobular veins?

A

Blood travels through afferent arterioles to the glomerular capillaries and then out via efferent arterioles to peritubular capillaries and finally interlobular veins

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7
Q

What are the veins of the kidney?

A 
Interlobular veins
Arcuate veins
Lobar veins
Segmental veins
Renal vein
Inferior vena cava
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8
Q

What is a nephron?

A

A structure optimally evolved to filter blood plasma

and excrete waste products of metabolism in urine

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9
Q

What are the two types of nephrons?

A

Cortical

Juxtamedullary

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10
Q

What is the renal corpuscle?

A

The blood filtering component of the nephron

Consists of:
Glomerulus
Bowmans capsule

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11
Q

What is the renal tubule?

A

The renal tubule is the part of the nephron involved in reabsorption and secretion.

It consist of:

  • PCT
  • Loop of Henle
  • DCT

After passing through the renal tubule, the filtrate continues to the collecting duct system.

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12
Q

What is the glomerulus?

A

A network of fine capillaries

Single layer of endothelial cells surrounded by basement membrane

Enables rapid filtration of blood plasma

Surrounded by bowmans capsule

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13
Q

What is the bowmans capsule?

A

A cuplike structure surrounding the glomerulus

Parietal (outer) layer
Visceral (inner) layer comprised of specialised epithelium - Podocytes

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14
Q

What forms the filtration barrier in the renal corpuscle?

A

The glomerular endothelium, basement membrane and pedicels of the podocytes

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

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15
Q

How is filtration controlled in the filtration membrane?

A

Filtration is facilitated by a pressure gradient - hydrostatic pressure

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16
Q

What is filtered from the plasma?

A 
Sodium
Chloride
Calcium
Phosphate
Potassium
Bicarbonate
Water 
Glucose
Amino acids
Urea
Creatinine
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17
Q

What is not filtered in glomerulus?

A 
Cells
Large proteins (haemoglobin)
Negatively charged proteins (albumin)
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18
Q

What is the glomerular filtration rate?

A

The rate at which blood is filtered through the glomerulus into the Bowmans capsule

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19
Q

What drives GFR?

A

Glomerular hydrostatic pressure

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20
Q

What counteracts GFR?

A

Hydrostatic pressure in bowmans capsule or glomerular osmotic pressure

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21
Q

What factors can influence GFR?

A
  • Hydrostatic pressure
  • Osmotic pressure
  • Systemic blood pressure
  • Renin-angiotensin system
  • Disease

Normal healthy GFR = 125ml/min

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22
Q

What does a reduced GFR result in?

A

Inefficient blood clearance and waste removal

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23
Q

What can be used to estimate GFR?

A

Serum creatinine (and urea) measurements

24
Q

What GFR is indicative of kidney failure?

A

Less than 15%

25
Q

What facilitates reasborption?

A

Sodium transport facilitates reabsorption of nutrients, water and ions

26
Q

What facilitates secretion?

A

Sodium transport facilitates secretion of H_ (and waste)

27
Q

Where does reabsorption occur?

A

Within the renal tubule
65% in PCT
25% in ascending LofH
8% reabsorbed in DCT

28
Q

How much sodium is reabsorbed?

A

98%

29
Q

How does water move?

A

Via aquaporins

30
Q

How do glucose and amino acids move?

A

Via sodium cotransporters

31
Q

How does reabsorption occur in the PCT?

A 
Sodium/potassium pump 
3 na out/2 k in 
Na moves against conc gradient 
Everything (almost) follows Na
- Water
- Glucose and amino acids co-transported with Na
- Chloride

Remaining filtrate continues to LofH

32
Q

What features of the nephron lie in the cortex?

A

PCT
DCT
Renal corpuscle

33
Q

What features of the nephron lie in the medulla?

A

Loop of Henle

collecting duct too but not part of nephron technically

34
Q

Is the descending limb of the LofH thin or thick?

A

Thin - freely permeable to water

35
Q

Is the ascending limb of the LofH thin or thick?

A

Both - has two sections

Thin part impermeable to water but permeable to ions

Thick part impermeable to water
Actively pumps na, cl, and k into interstitium
Interstitium becomes ‘salty’
Generates osmotic gradient
Facilitates water reabsorption from thin ascending limb

36
Q

What is the vasa recta?

A

It maintains the concentration gradient of the medulla

37
Q

What is the concentration of solutes in the plasma?

A

Approx 300 mosm/kg

38
Q

How is the 200 mOsm/L difference between interstitual fluid and the ascending limb created?

A

Movement of sodium ions out

39
Q

Does the osmolarity increase or decrease due to a loss in sodium?

A

Decreases

40
Q

What happens after sodium is pumped out of the thick ascending limb?

A

After 200 mOsm/L gradient established, water moves passively out of the thin descending limb until equilibrium reached between interstitial fluid and filtate.

Water moving out descending limb doesn’t affect ISF osmolarity but lowers the filtrate osmolarity.

41
Q

What is the maximum osmolarity?

A

1200 mOsm/L

42
Q

Tubule fluid entering the distal convoluted tubule is?

A

Hypotonic with the interstitium

43
Q

What is the purpose of distal convoluted tubule?

A

Fine-tuning - site of fluid volume and electrolyte regulation

Sodium and water reasbsorption hormonally regulated

  • ADH - increases water reasborption
  • Aldosterone - Increases Na reabsorption
  • Atrial natiuretic hormone (ANH) - Promotes Na secretion
44
Q

What are the juxta-glomerular apparatus and what is their function?

A

Macula densa - detects sodium conc

Juxtaglomerular cells - adjust the diameter of the afferent arteriole

45
Q

What occurs in normal homeostatic blood pressure?

A

GFR in normal limits as is sodium conc
Macula dens detects this and does not pass signal to juxtaglomerular cells thus large diameter of afferent arteriole and thus GFR is maintained

46
Q

What occurs from elevated BP in tubuloglomerular feedback?

A

Elevated systemic BP leads to elevated glomerular hydrostatic pressure increasing GFR and sodium conc in DCT, detected by macula densa which signals to juxtaglomerular cells to constrict via release of adenosine - lowers GFR by reducing blood flow

47
Q

What occurs from decreased BP in tubuloglomerular feedback?

A

Macula densa detects drop in sodium conc and releases prostaglandins which act on juxtaglomerular cells to cause dilation of afferent arterioles, only has marginal effect

Main response - release of RENIN from juxtaglomerular cells in response to prostaglandins

48
Q

How does the renin angiotensinogen-system work?

A

Angiotensinogen released into circulation
Renin converts angiotensinogen to Angiotensin 1
Angiotensinogen coverting enzyme converts angiotensin 1 into angiotensin 2
Angiotensin 2 is a potent vasoconstrictor - rapidly increases blood pressure

49
Q

What is Angiontensin 2 detected by?

A

Adrenal medulla- release of aldosterone

Hypothalamus - release of ADH

50
Q

What does Atrial Natriueretic peptide do?

A

Helps to return an elevated blood pressure to homeostasis by inhibiting the action of renin, aldosterone and ADH.

Promotes water and sodium excretion

51
Q

How does RAAS raise blood pressure?

A

Via Angiotensin II

52
Q

How does RAAS raise blood volume?

A

Via aldosterone and ADH

53
Q

What are the symptoms of chronic kidney disease?

A 
Nausea
Oedema
Blood/protein in urine
Anaemia
Weak/painful bones
54
Q

What are the causes of CDK?

A

Hypertension
Diabetes
High cholesterol
Long term use of NSAIDs

55
Q

How do you regulate hypertension?

A

Diet
Diuretics
ACE inhbitors inhibit angiontensin II
Beta-blockers block SNS by stress hormones

56
Q

What receptor facilitates sodium reabsoprtion of apical membrane?

A

NKCC2

57
Q

What is dialysis and what are the two types?

A

Dialysis is the artifical removal of wastes, solutes, water and toxins from blood

Haemodialysis
Peritoneal dialysis

Required in stage 5 (kidney failure)

BAMS (14 decks)

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