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Anatomy > Renal W12 > Flashcards

Renal W12 Flashcards

1
Q

What are the kidney functions

A

Excretion…
* metabolic waste products
* foreign chemicals (including drugs)

Regulation…
* water balance
* electrolyte salt concentrations
* acid-base balance (bodypH)
* arterial blood pressure

Secretion, metabolism and excretion of hormones
Gluconeogenesis

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2
Q

Where are the kidney’s located*

A

by posterior muscular wall of the abdominal cavity
retroperitoneal

protected by ribs and muscles of back and surrounding adipose tissue

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3
Q

Label

A

Dont worry about what is circled

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4
Q

What is a nephron

A

Basic functional unit of the kidney
Filters blood and produces urine

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5
Q

What are the two parts of a nephron and there roles?

A

Renal corpuscle Filters blood - starting point for urine formation (red circle) <- includes glomerulus
Renal tubule Modifies filtrate prodcued by corpuscle -> urine

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6
Q

What are the two basic processes done by the renal tubule to modify the glomerular filtrate

A

Tubular reabsorption and tubular secretion

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7
Q

Describe the location/order of of… **
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Collecting duct
Using the diagram

A

Glomerulus
Proximal convoluted tubule: straight off the glomerulus
Loop of Henle: desending and ascending tubule
Distal convoluted tubule: follows loop of Henle
Collecting duct: final part of tubule

KNOW: glomerulus is always in cortext, some parts of tubule are in the medulla

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8
Q

What are the three processes performed by the nephron (Urine formation)

A
  1. Glomerular filtration - filtration of blood
  2. Tubular reabsorbption - reabsorb some filtered substances from tubules into blood (already absorbed in intestines) <- MOSTLY DETERMINES URINE
  3. Tubular secretion - secretion of substances from blood into tubules to be excreted ex. waste products, elecrtolytes, water
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9
Q

Describe the components of the Renal corpuscle

A

glomerulus
innermost, site of filtration.
ball of capillaries (with pores in their walls) that provide large surface area for filtration.
surrounded by…
glomerular capsule (bowmans capsule)
where filtrate from glomerulus ends up

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10
Q

Glomerular filtration has 3-layer filtration barrier. It is relatively impermeable to proteins and cellular elements of blood.

What is the barrier dependent on (2 things) and is the process selective or non-selective.?

A

Size selective and charge dependent barrier - fluid and solutes forced through a membrane by hydrostatic pressure.

Passive (does not require energy)
non-selective process (water, salts, nutrients, metabolic waste - all blood components minus blood cells and plasma proteins)

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11
Q

Why can’t plasma proteins get across the glomerular filtration barrier.

A

Too large and negative charge (repelled by negative glycoproteins on basement membrane)

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12
Q

Glomerular filtraion relies on pressure. What are the 3 forces that drive filtration across the membrane and effect glomerular filtration rate?

A
  1. Glomerular hydrostatic: pressure of blood in capillaries of glomerulus -> PROMOTES FILTRATION
  2. Capsular hydrostatic: pressure applied to the membrane by fluid in the capular space and tubule -> OPPOSE FILTRATION
  3. Blood colloid osmotic: pressure from proteins present in blood plasma -> OPPOSE FILTRATION

Net effect = filtration promoted

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13
Q

Kidneys average GFR is around 20% (120ml/min). Rapid filtering ensures quick removal of waste products and rapid correction of any changes in blood composition. What happens when this GFR is slow.

A

Kidney disease (15-60ml/min)
Kidney failure (under 15ml/min)

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14
Q

Most of our glomerular filtrate (99%) is reabsorbed as it passes through the renal tubule.
Is this process selective or non-selective?
What is always, likely and unlikely to be reabsorbed?

A

Highly Selective
Almost completely re-absorbed: glucose, aa’s
likely: salt and water (depending on body’s needs)
Poorly: waste (urea)

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15
Q

There are various transport mechanisms for reabsorbtion depending on the substance.
How is Na+ transported and what is it coupled to?

A

Na+/K+ pump - Active transport (moves solutes against concentration gradient - uses energy)

Coupled to glucose transport - Secondary active transport

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16
Q

What is the transport maximum for reabsorption, give an example?*

A

Limit to the rate at which a substance can be reabsorbed (transported) due to saturation of the transport system.

Ex. Glucose (more glucose than transport max, it remains in filtrate and therefore urine) uncontrolled diabetes symptom!

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17
Q

What are some common secreted products?*

A

K+ and H+ <- pH regulation

Organic acids and bases - bile salts, oxalate - end products of metabolism that must be removed rapidly.

Drugs or toxins - rapid clearing from the blood.

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18
Q

What is the primary site for reabsorption*

A

Proximal convoluted tubule

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19
Q

What is ‘reabsorption’ in simple terms*

A

Removal of useful substances from glomerular filtrate to return to blood.
Generally couples to H2O reaborption

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20
Q

What is ‘secretion’ in simple terms*

A

Transfer of unwanted substances from blood and tubule cells into tubular fluid

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21
Q

What is the primary site for secretion*

A

Proximal convoluted tubule

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22
Q

(2 systems)

Constant volume and stable compostion of body fluids is essential for homestasis. Why?

A

Cardiovascular function increased extracellular fluid -> increased B.V -> increased B.P
Excitable tissues nerve and muscle cells sensitive to changes in electrolyte composition ex. cardiac muscle

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23
Q

What structure and hormone is involved in the regulation of urine volume and osmolarity?

A
  • Loop of Henle
  • ADH
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24
Q

How is urine osmolarity regulated? - Which ion is ALWAYS reabsorbed

A

Osmolarity is a measure of solute and water ratio. High and low volumes of osmolarity and urine concentration/dilution is altered in the Loop of Henle - by ADH.

Active reabsorption of Na+ in proximal tubules and ascending limb of the loop of Henle - 80% ALWAYS reabsorbed. Therefore, filtrate that leaves loop of Henle has low concentration of salt and urine.
= high solute concentration in medulla, low solute in filtrate (GRADIENT SET UP for reabsorption of water)

Can also reabsorb more Na from distal tubule controlled by aldosterone = dilute urine.

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25
Q

What is the hormone Aldosterone’s role in the regulation of urine osmolarity?

A

Na+ reabsorption in the distal tubule (for concentrated urine)

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26
Q

What happens with low levels of ADH*

A

In ascending loop, tubular fluid dilute
In distal tubules and collecting ducts, tubular fluid is further diluted due to reabsorption of NaCl but no reabsorption of water (low ADH)
= Large volume of dilute urine

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27
Q

Describe the mechanism of action of ADH*

A

Normally distal tubules and collecting ducts impermeable to water
ADH release = aquaporins = distal tubules and collecting ducts permeable to water
+
high salt concentration in medulla (hyperosmolar) = water reabsorption

= small volume of concentrated urine

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28
Q

Reabsorption/secretion of salt in the distal tubules is under the control of which hormone?

A

Aldosterone

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29
Q

What ion movement is controlled by aldosterone?

A

Controls excretion of Na+ and K+

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30
Q

What does high aldosterone levels result in?

A

Reabsorption of Na+ in exchange for secretion of K+

31
Q

What does low aldosterone levels result in?

A

Secretion of Na+ in exchange for reabsoption of K+

32
Q

Describe the order to structures urine passes through in the kidneys to be excreted

A

Collecting ducts fuse to form papillary ducts as they approach the renal pelvis.
Papillary ducts –> minor calyces
stretch of calyces iniciates peristaltic conctration
Minor calyces –> Major calyces –> Renal pelvis –> Ureter –> Bladder

33
Q

Slender tubes that convey the urine from the kidneys to the bladder are called…

A

Ureters (2)
continuations of the renal pelvis, descending behind the peritoneum to the posterior wall of the bladder

34
Q

Why does urine not backflow from the bladder back to the kidneys?

A

As the bladder fills and the pressure increases the bladder compresses and closes the distal ends of the ureters

35
Q

Smooth, collpasible muscular sack on the pelvic floor for the temporary storage of urine = ____

A

Urinary Bladder

36
Q

What is the trigone?

A

Triangular region at the base of the bladder outlined by the 3 openings for the (2) ureters and the urethra forming

37
Q

Describe the three layers of the bladder wall

A
  1. Transitional epithelium (urothelium)
  2. Thick smooth muscular layer (detrusor muscle)
  3. Fibrous adventitia
38
Q

When empty the bladder collapses into ____ shape. When urine accumulates it becomes a ____ shape and rises towards the abdominal cavity.

A

Empty : Pyramindal shape –> Full: Pear shape

39
Q

Thin-walled muscular tube that drains urine from the bladder to the outside = ____

A

Urethra

40
Q

Why are women more prone to urinary tract infections

A

Men have a long urethra
Women have a short urethra - closer to the outside

41
Q

Where is the internal urethral sphincter located and what does it do?

A

Thickening of the detrusor muscle at the bladder-urethra junction
Involuntary control = Prevents leakage between voiding

42
Q

Where is the external urethral sphincter located and what does it do?

A

Surrounds the urethra as it passs through the urogenital diaphragm
Voluntary controlled (by skeletal muscle)

43
Q

What other function does the urethra hold in males?

A

**Carries semen **(& urine)
early part of urethra runs within the prostate gland

44
Q

What is Micturition

A

Act of emptying the bladder
Under involuntary and voluntary control

45
Q

Describe the initial relaxation of the bladder during the process of micturition*

A
  1. Urine accumulates in the bladder (1ml/min) –> distension of bladder wall = activates stretch receptors
  2. Impulses transmitted (via visceral sensory fibres - afferent) to the sacral region of the spinal cord = spinal reflex

Spinal reflex
* Initiates increased sympathetic outflow = inhibits (relaxes) detrusor muscle
* Simulates contraction of the external urethral sphincter via motor nerve fibres (pudendal nerve)

46
Q

Why does the first part of the spinal relfex include the relaxation of the detrusor muscle?

A

Need the bladder to relax to allow filling initially

47
Q

Describe what happens when the bladder contains the following ml’s of urine
* 200ml
* 400ml
* 600-800ml

A
  • 200ml: impulses transmitted to brain = small transient contraction waves
  • 400ml: desire to micturate begins
    Either decide to void or voluntarily overide (bladder contractions subside, external sphincter closed, urine continues to accumulate)
  • 600-800ml: reflex begins again, try to surpress until voiding is irresistible and micturation occurs
48
Q

What happens when you decide to void?*

A

Conscious, positive decison is made by cerebral cortex
Afferent impulses activate the micturition centre in the pons - “on/off” switch for micturition => signals the parasympathetic neurons to stimulate conctraction of the detrusor muscle & relaxation of both internal and external sphincter = urine flows through urethra and exrternal trethral orifice

49
Q

What is the role of the Renin-Angiotensin system

A

Regulates blood volume and vascular resistance

50
Q

What is the response to decreased arterial pressure short-term vs long-term

A

Short-term: baroreceptor reflex
Long -term: renin angiotensin system

51
Q

What are the three major components of the Renin-Angiotensin system

A
  • Renin
  • Angiotensin 2
  • Aldosterone
    act together to elevate arterial pressure
52
Q

What are the three stimuli for the Renin-Angiotensin system

A
  • Decreased renal blood pressure
  • Decreased salt delivery to the distal tubule
  • Beta agonism
53
Q

What is the overall result of the Renin-Angiotensin system

A
  • Elevated blood volume
  • increased sodium reabsorption
  • increased potassium secretion
  • increased water reabsorption
  • increased vascular tone
    = prolonged elevated blood pressure
54
Q

What systems are involved in the Renin-Angiotensin system

A
  • Kidneys
  • Lungs
  • Systemic vascularture
  • Brain
55
Q

What components make up the Juxtaglomerular apparatus and what is its function?

A

Juxtaglomerular apparatus initiates/stimulates the Renin-Angiotensin system

  • Macula densa
  • Juxtaglomerular (Granular) cells
  • Mesangium-extra glomerular cells
56
Q

Describe the role and location of the Juxtaglomerular (Granular) cells

A
  • In afferent arteriole wall of the glomerulus
  • Smooth muscle cells that contain secretory granules containing renin
  • Act as mechanoreceptors - detect changes in BP in afferent arteriole
57
Q

Describe the role and location of the Macula densa cells

A
  • Tall, densely packed distal tubule cells - adjacent to JG cells
  • Act as osmoreceptors -respond to changes in solute content in filtrate in renal tubule
58
Q

What 4 stimuli trigger the release of renin from the JG cells?

A
  • Reduced stretch of the JG cells - drop in systemic BP (and afferent arteriole BP) - below 80mmHg
  • Stimulation by Macula densa cells in response to rapid filtrate flow or decreased Na+ in distal tubule
  • Stimulation by renal sympathetic nerves (B1 adrenergic receptors)
  • Stimulation by angiotensin 2
59
Q

Describe the mechanism of action of the Renin-Angiotensin system

A
  1. Renin is released from the JC cells
  2. Renin cleaves angiotensinogen into angiotensin 1
  3. Angiotensin 1 –> angiotensin 2 by ACE enzyme
60
Q

Describe the 3 major actions of Angiotensin 2 to increase BP

A
  1. Stimulates Na+/H+ exchange in proximal tubule
    Short term effect
  2. Stimulates adrenal glands to release aldosterone
    Long term effect
  3. Acts on the brain to…
    * Bind to hypothalamus to stimulate thirst and increase H2O intake
    * Stimulates release of ADH
    * Decrease sensitivity of the baroreceptor reflex - diminished response to increasing BP
61
Q

What is the action of Aldosterone

A
  • Stimulates reabsorption of the NaCl and H2O in the distal tubule and collecting duct
  • Acts as a vasoconstrictor
    = Increase in BP
62
Q

What is the role of aldosterone

A

Regulates Na+ levels in extracellular fluid through reabsorption of remaining Na (NaCl) in distal tubules and collecting ducts
Water will be reabsorbed only if ADH is also released

63
Q

What is the main and secondary trigger for aldosterone release?

A

Main trigger: Renin-Angiotensin system
Secondary trigger: Increase in level of extracellular K+
because Na+ reabsoption in exchange for K+ secretion by Na+/K+ pump

64
Q

Is the renal system and hypertension linked, how?

A
  • The kidneys play a role in the development of hypertension & renal diseases can cause hypertension
  • Hypertension can lead to renal disease - constriction and narrow of B.V’s -> damage/weakness of B.V’s through whole body (in kidneys) -> reduced B.F and dysfunction of B.V’s -> waste and excess water not removed = more hypertension

BV and therefore P is dependent on Na+ levels - controlled by kidneys

65
Q

What are UTI’s?

A

Urinary tract infections
Presence of microorganisms in the urinary tract (bladder, postate, collecting systems and kidneys

66
Q

What is a serious complication of a common UTI’s and the associated symtoms?

A

Pyelonephritis
Effects bladder, kidneys and nephrons (collecting systems)
Symptoms: flank pain, fever, chills, dysuria (painful urination), constant urgency/freq

67
Q

What factors play a role in chronic pyelonephritis

A

Bacterial infection + Vesicoureteral reflux (closing of ureter doesnt function properly = backflow of bacteria further up) or obstruction

68
Q

What is Glomerulonephritis and how is it diagnosed and what is the cause?

A

Inflam of the glomeruli leading to damage -> acute or chronic

Asymptomatic - diagnosed by protein or blood in urine in absense of infection.
Cause - strep throat or absessed teeth -> immune overreaction

69
Q

What can be done to slow the progression of Glomerulonephritis

A

Management of hypertension -> ACE inhibitors

70
Q

What is Acute renal failure ARF and the associated symptoms?

A

Sudden reduction in renal function accompanied by accumulation of waste products in the blood
decrease in urine output/ceasation

71
Q

Describe the three classifications of Acute Renal failure

A
  • Pre-renal failure: impaired renal BF (to kidneys), easily reversed
    Ex. hypotension, renal artery blockage.
  • Intra-renal failure: nephron itself damaged, recovery slow or progression to chronic renal failure*
    Injury, infection, autoimmune reaction, hypertension
  • Post-renal failure: obstruction within urinary collecting systems distal to kidneys -> back pressure - impedes glomerular filtration. easily reversed
72
Q

What is Chronic renal failure

A

Progressive loss of renal function over months-years -> end stage renal disease Irreversible

73
Q

Correspond to degree of nephron loss

Describe the three stages of Chronic Renal failure

A
  1. Decreased renal reserve - 50% loss of kidneys nephrons. no signs or sympt, hyperfunct. of remaining
  2. Renal insufficiency - 75% nephrons damaged. ability to concentrate urine impaired = increased output
  3. End stage renal disease - >90% nephrons damaged. renal failure
    Causes: hypertension, diabetes mellitus, glomerulonephritis, pyelonephritis
74
Q

What are the two ‘treatments’ for End stage renal disease

A
  • Dialysis - machiene replaces kidney function
  • Kidney translant - limiting factor is avaibility of organs

Anatomy (13 decks)

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