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Midwifery 1201 > Renal System > Flashcards

Renal System Flashcards

1
Q

What makes up the renal System?

A

2 kidneys
2 ureters
urinary bladder
urethra

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2
Q

What are the function of the kidneys?

A

Maintaining homeostasis within the internal environment, by regulation of the volume and composition of body fluids

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3
Q

What is the definition fo homeostasis?

A

The ability or tendency of a living organism, cell or group to keep the conditions inside it the same despite any changes in the conditions around it, or this state of internal balance.

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4
Q

What are the key functions of the kidneys?

A

elimination, regulation and secretion

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5
Q

What other functions do the kidneys have?

A

Waste/ balance
Blood pressure
red blood cells
vitamin D

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6
Q

What is renin?

A

An important enzyme in the control of blood pressure

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7
Q

What is erythropoietin?

A

a hormone that stimulates the production of red blood cells

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8
Q

Where are the kidneys?

A

They are on the posterior wall of the abdominal cavity: one on each side of the vertebral column at the level of thoracic and lumbar vertebrae

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9
Q

How much of the cardiac output do the kidneys get?

A

25%

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10
Q

What sits on the top of each kidney?

A

an adrenal gland

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11
Q

How big is a kidney?

A

10cm long
6.5cm wide
3cm thick

weighs about 100-120g each

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12
Q

What is the structure of a kidney?

A

an outer fibrous capsule, surrounding the kidney
cortex
medulla
renal pelvis

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13
Q

Where do they kidneys get their blood supply?

A

The blood supply is from the aorta via the renal artery and returns to the vena cava via the renal vein

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14
Q

What are the two layers of the kidneys?

A

The outer reddish brown cortex which has a rich blood supply and the inner medulla where the functional units of the kidneys are found (the nephrons)

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15
Q

What is the hilum?

A

It’s an opening on the concave side (facing medially). The renal artery, renal vein, nerve supply and lymphatics enter and leave via the hilum,

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16
Q

What is the medulla?

A

The inner region of the kidney that is divided into approximately 12 pyramids, containing bundles of tubules.

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17
Q

Describe the tubules?

A

Tubules appear as lines ( medulla rays) each pyramid with overlying cortex’ forms a renal lobs

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18
Q

Where do the pyramids empty?

A

The tip of each pyramid empties into a calyx (singular), and calicies (plural) empty into the renal pelvis

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19
Q

How is urine carried?

A

Urine is carried from the renal pelvis to the urinary bladder via the ureter

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20
Q

What is a nephron?

A

It’s the basic functional unit of the kidney. More than 1 million nephrons per kidney.

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21
Q

Describe a nephron?

A

Approx 3cm long. A tubule that is closed at one end and open into a collecting duct at the other end. Starts as a knot of capillaries called glomerulus. Surrounded by the glomerular capsule which attaches to a tubule. the tubule has a winding twisted portion (proximal convoluted tubule), a loop (loop of Henle) and a distal convoluted tubule

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22
Q

Describe the blood supply to the nephron?

A

It has a blood supply from a branch of the renal artery, the afferent arteriole. Blood is collected from the efferent arteriole.

Goes in thorough the afferent arteriole and out through the efferent arteriole

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23
Q

How come there is pressure in the glomerulus?

A

The fact that the afferent arteriole has a wider bore than the efferent arteriole . This therefore forces out the filtrate of the capillaries into the capsule

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24
Q

What is the glomerular body?

A

the glomerulus and capsule

substances with small molecular size are filtered out into the cup surrounding the glomerulus

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25
Q

what is the juxtaglomerular apparatus?

A

A microscopic structure in the kidney that regulates the function of each nephron and secretion of renin

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26
Q

What is passive transport?

A

filtration: the process whereby fluids pass through a falter
Diffusion: ions or molecules from an area of higher concentration to an area of lower concentration
Osmosis: movement of fluid through a semipermeable membrane from a solution with a low solute concentration to a higher solute concentration

27
Q

What are the 3 stages of the renal system?

A

Filtration
Reabsorption
Secretion

28
Q

Describe filtration?

A

A passive process which takes place in the semipermeable walls of the glomerulus. Water and small molecules are forced out of the glomerular capillaries, through the filter and into the Bowman’s capsule to form ‘glomerular filtrate’

29
Q

What happens to larger molecules during filtration?

A

Blood components which are large molecules (blood cells, platelets and plasma proteins) are usually retained in the blood (they are too large to get out). The kidneys form about 180 litres of dilute filtrate per day. Most os selectively reabsorbed, producing a final urine volume of approx 1.5 litres per day

30
Q

Describe selective reabsorption?

A

The glomerular filtrate in reabsorbed from the rest of the nephron into the surrounding capillaries. The body reabsorbs what it needs (water, salt and glucose).

31
Q

How is reabsorption of water controlled ?

A

by antidiuretic hormones (ADH), produced by the posterior pituitary gland.

32
Q

What is the pituitary gland?

A

A small structure at the base of the brain which releases a wide variety of hormones that control the activity of the body’s other hormone glands

33
Q

Describe the proximal convoluted tubule?

A

It is the widest and longest part of the nephron. the cells lining it contain lots of energy producing mitochondria, which facilitate active transport, as most of the reabsorption takes place here

34
Q

Why are glucose and amino acids not common in urine?

A

These substances are completely reabsorbed

35
Q

Describe secretion

A

This is active transport of some waste products into the tubules from the surrounding blood capillaries. These products include hydrogen ions (H=) and potassium (K=), creatinine ( a nitrogenous compound produced during body metabolism) as well as toxins and drugs

36
Q

Endocrine activity:

A

Erythropoietin and renin are produced by the kidneys. Erythropoietin stimulates read blood cell production in the bone marrow. Renin regulates blood pressure.

37
Q

What is the action of erythropoietin?

A

More red blood cells = increased oxygen carrying capacity of the blood

38
Q

What is Renin?

A

Renin is secreted from the juxtaglomerular apparatus when the renal blood supple is reduced and in response to lowered sodium levels. Renin stimulates the production of angiotensin 1. This is converted in the lungs to angiotens 2, which would cause vascoconstriction.

39
Q

Describe the ureters?

A

Three layers: a lining, a muscle layers and an outer coat. Each tube is about 3mm in diameter and between 25 and 30 cm in length. The ureters are outside and behinds the peritoneum. the ureters transport urine to the bladder by peristalsis.

40
Q

What is the structure of the bladder?

A

It is composed of epithelium, it folds to allow for distension. Three coats of smooth muscle called the detrusor muscle, which contracts to expel urine during micturition. Around the internal meatus (a body opening or passage) the muscle is thickened, forming the internal sphincter.

41
Q

What is the trigone?

A

A smooth, triangular region of the internal urinary bladder formed by two ureteral orifices and the internal urethral orifice

42
Q

what happens to the bladder when it fills with urine?

A

The walls distend and it becomes a globular shape. Its capacity is approx 500-600mls although can hold more. It expands upwards and outwards when full and into the abdomen.

43
Q

Describe the female urethra.

A

It’s a narrow tube approx 4cm long. It passes from internal meatus of bladder to vestibule, where it opens externally. It is embedded on the lower half of the anterior vaginal wall. The internal sphincter surrounds it as it leaves the bladder. External sphincter is under voluntary control.

44
Q

What lies anterior to the bladder?

A

Anterior- pubic bone separated by a space filled with fatty tissue

45
Q

What lies posterior to the bladder?

A

Posterior- cervix and ureters

46
Q

What lies lateral to the bladder?

A

lateral- lateral ligaments of the bladder and side walls of the pelvis

47
Q

What lies superior to the bladder?

A

superior- body of uterus and intestines

48
Q

What lies inferior to the bladder?

A

inferior- upper half of anterior vaginal wall and levator ani muscles

49
Q

What is the make up of urine?

A

96% water
2% urea
2% other solutes
usually acidic

50
Q

What factors inhibit urine production?

A

sleep and muscular activity

51
Q

What characteristics should urine have?

A

colour- amber
this is due to the bile pigment urobilin
Fresh urine has a smell but not an unpleasant smell
Should not normally contain glucose, ketones, blood cells or bacteria

52
Q

What causes the structural and functional changes in the renal system?

A

the effects of progesterone on smooth muscle
the pressure of enlarging uterus
cardiovascular changes

53
Q

What are the structural changes that happen in the kidneys?

A

The kidneys enlarge and increase in length by 1.5cm due to increased blood flow and vascular volume
Glomerular size increases but no change in the number of cells

54
Q

What are the changes to the renal system?

A

Dilatation of the renal calyces, renal pelvis and ureters. It begins in the first trimester and is maximal by the middle if the 2nd trimester. the ureters are dilated to 2cm (3mm in non pregnant women). Mainly seen in the portion of the ureters above the pelvic brim brim

55
Q

Describe physilogical hydroureter and hydronephrosis.

A

The cause is not understood. The main factor is that the uterus rises out of the pelvis it rests on the ureters laterally displacing and compressing them at the pelvic brim. During the last half of pregancy the upper portion of the ureters above the pelvic brim is elongated and becomes tortuous (full of twists), this increases urinary stasis. dilation is more marked on the right side, due to the cushioning effect of the sigmoid colon on the left fie to the uterine tendency to dextrorotation (turned to the right)

56
Q

Describe the physiological changes in the bladder.

A

As the uterus enlarges, the urinary bladder is displaced upward and fattened in the anterior- posterior position. Bladder vascularity increases and muscle tone decreases increasing capacity up to 1000 mls. Trigone elevation occurs with the increase of vascular tortuousity. The muscosa also becomes oedematous and is more vulnerable to trauma and infection. The decrease in bladder tone leads to incompetence of the junction between ureter and bladder, and there may be reflux or urine from bladder to ureters or kidneys.

57
Q

What does pressure on the presenting part do?

A

impairs drainage of blood and lymph from the base of the bladder which may cause the area to become oedematous, easily traumatised and more susceptible to infection

58
Q

What hormone is involved in the relaxation of bladder smooth muscle?

A

progesterone

59
Q

What is renal haemodynamic?

A

flow of blood within the kidneys

60
Q

How much does renal blood flow increase during pregnancy?

A

It increases by 35-60% by the end of the first trimester, which then decreases slightly until term. Due to the increased blood volume and cardiac output.

61
Q

What are the changes to the renal system during pregnancy?

A

Decreased renal vascular resistance brought on by the relaxing effects of progesterone

Vasodilation of the afferent and efferent glomerular capillaries

62
Q

What happens to the Glomerular filtration rate (GFR) during pregnancy?

A

GFR increases by 40-50% in pregnancy, the rise beginning soon after conception and peaking at 9-16 weeks. GFR may reach more than 150 ml/min. The volume of urine produced in 24 hr is 25% higher during pregnancy.

63
Q

What are some of the maternal changes during pregnancy?

A

Increased renal blood flow. Haemodilution also increases GFR. Other hormones such as prostaglandins may cause the renal vasodilation of pregnancy. Proteinuria excretion during pregnancy and if more than 300 mg/ 24 hours is lost, a disease process should be suspected.

64
Q

Describe postpartum changes?

A

Rapid and sustained loss of sodium and major diuresis during postpartum period (typically between 2nd and 5th day)
Women should pass urine 6-8 hours after birth
Urine output rises to up to 3000ml, with 500-1000 mls voided at any micturition. By the end of 1st week, urinary excretion of calcium, phosphate, vitamins, glucose return to normal.
Structural changes may take up to three months to disappear, although for most women, these are complete by 6-8 weeks

Midwifery 1201 (23 decks)

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