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Urinary > Session 1 > Flashcards

Session 1 Flashcards

1
Q

What is the broad function of the glomerulus

A

Filtration

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2
Q

What does the glomerulus filter

A

Water, sodium, chloride, potassium, bicarbonate, amino acids, glucose, creatinine, urea

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3
Q

What is reabsorbed at proximal convoluted tubule

A

Potassium, 67% sodium and chloride, 100% amino acids and glucose, 90% HCO3- and 65% water

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4
Q

What is secreted (cleared from body) at proximal convoluted tubule

A

Uric acid and organic acids

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5
Q

What happens at descending limb of loop of Henle

A

10% water reabsorbed

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6
Q

What happens at ascending limb of loop of Henle

A

Impermeable to water

25% Na+ and Cl- reabsorbed

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7
Q

What controls resorption of water and sodium at distal convoluted tubule

A

Aldosterone

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8
Q

What is secreted at distal convoluted tubule

A

K+ and H+

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9
Q

What controls resorption at collecting duct

A

ADH

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10
Q

What is reabsorbed at collecting duct

A

Urea, Na+, Cl-, water

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11
Q

What is excreted at end of nephron

A

Water, Na+, Cl-, HCO3-, Creatinine, Urea

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12
Q

Nephron gets blood supply from

A

Renal arteries

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13
Q

Why are kidneys vulnerable to ischeamic damage

A

They take about 20-25% of whole cardiac output

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14
Q

Big difference between cortical or juxtamedullary nephrons

A

Juxtamedullary have bigger loop of Henle

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15
Q

Broad nephron functions

A

Filters and cleans blood, enables site for secretion and resorption

Concentrates or diluted urine to control body fluid osmolality and fluid volume

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16
Q

How much that enters the glomerulus ends up filtered

A

20%

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17
Q

What is clearance

A

Rate at which glomerulus cleans blood

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18
Q

What is filtrate

A

What the substances are called once they leave the capillaries and end up being filtered into the Bowman’s capsule and tubule

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19
Q

What is GFR

A

Glomerular filtration rate= rate of solutes pushed out of blood into Bowman’s space

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20
Q

Excretion function of kidney and urinary tract

A

Excrete waste products and drugs

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21
Q

Regulation function of kidney and urinary tract

A

Body fluid volume and ionic compounds, major role in homeostasis and acid-base balance

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22
Q

Endocrine function of kidney and urinary tract

A

Synthesis of renin (bp and sodium balance), erythropoietin (erythrocyte production) and prostaglandins (involved in regulation of renal function)

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23
Q

Metabolism function of kidney and urinary tract

A

Vit D is metabolised to active form, metabolism of low molecular weight proteins e.g. insulin, parathyroid hormone, calcitonin

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24
Q

4 broad functions of kidney and urinary tract

A

Excretion, regulation, endocrine and metabolism

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25
Q

Anatomical location of kidney and urinary tract

A

Retroperitoneum on the posterior abdominal wall, either side of vertebral column, between T12 and L3, partially protected by ribs 11 and 12

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26
Q

Where is the hilum

A

L1

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27
Q

Why is right kidney lower

A

Liver pushed it down

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28
Q

What is yellow

A

Kidney

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29
Q

What is blue

A

Renal capsule

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30
Q

What is green

A

Perirenal fat

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31
Q

What is red

A

Renal fascia

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32
Q

What is pink

A

Pararenal fat

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33
Q

What do podocytes wrap around

A

Capillaries

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34
Q

What is the broad function of the Juxtaglomerular apparatus

A

Senses composition of contents

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35
Q

3 key cell types in juxtaglomerular apparatus

A

Macula densa cells, extraglomerular mesangial cells, granular cells

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36
Q

What do macula densa cells do

A

Sense salt, send signal to granular cells

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37
Q

What do granular cells control

A

Renin and constriction

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38
Q

What do extraglomerular mesangial cells do

A

Pass messages, secretes substances, hold skeleton

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39
Q

Order of blood flow from renal artery to efferent arteriole

A

Renal artery, segmental artery, interlobar artery, arcuate artery, interlobal artery, afferent arteriole, glomerulus, efferent arteriole

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40
Q

Blood flow from efferent arteriole to renal vein

A

Splits into 2- peritubular capillaries (associated with convoluted tubules), Vasa recta (associated with loop of Henle), interlobular vein, arcuate vein, interlobar vein, renal vein

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41
Q

What is the ureter made from and where is it

A

Smooth muscle fibres that propel urine (peristaltic waves) to urinary bladder

Retroperitoneal, lateral to tips of transverse processes of lumbar vertebrae

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42
Q

Ureter beyond the pelviureteric junction PUJ divided into

A

Proximal (abdominal), Middle (pelvic), Distal part (intramural)

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43
Q

Most common area of uteretic injury?

A

Near pelvic brim

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44
Q

Bony landmarks to approximate course of ureter (Hilium to bladder)

A

L1- hilium
Tip of lumbar transverse processes
Crosses sacrum at S1
Ischial spine- ureter kink towards bladder
Run around pelvis and enter bladder posteriorly

45
Q

What is the detrusor muscle

A

1 massive bladder muscle- weakens and goes wrong = incompetence

46
Q

What acts instead of a sphincter in the bladder

A

Vesicoureteral junction- oblique angle

47
Q

Bladder surface

A

Muscular folds called rugae- contract and expand

Lined with transitional epithelium- urothelium

48
Q

When empty the bladder rests on

A

Symphysis pubis in front of rectum (and vagina and uterus in women)

49
Q

Bladder can hold on average

A

750ml

50
Q

Lumen or ureter is coated in

A

Urothelium

51
Q

urothelium is

A

Continuous lining of the bladder, ureter and pelvis of kidneys

52
Q

Why do women get more UTIs

A

Shorter distance from opening

53
Q

Urethral divisions female

A

Ureteric openings, internal urethral sphincter, urogenital diaphragm, urethra

54
Q

Urethral divisions made

A

Prostatic urethra, Urogenital diaphragm, membranous urethra, Bulbous urethra, penile/spongy urethra, navicular fossa, external urethral meatus

55
Q

What does euvolemic mean

A

In fluid balance

56
Q

What is osmolality

A

Solute per kg of solvent

57
Q

What is osmolarity

A

Number of osmoles of solute per unit

58
Q

A large volume of what type of plasma comes out as filtrate

A

Protein free

59
Q

Plasma contains

A

Proteins, electrolytes, amino acids, glucose

60
Q

Give an example of protein too large to fit through holes

A

Albumin- has charge which helps osmotic force

61
Q

What is RBF

A

Renal blood flow- amount of blood that flows through glomeruli per minute Litres/minute

62
Q

What is RPF

A

Renal plasma flow- amount of plasma in ml/minute

63
Q

Renal plasma flow =

A

Renal blood flow x (1-Hct)

Hct= haematocrit = 40/45% usually

64
Q

Average GFR

A

125 ml/min

65
Q

FF =

(Filtration fraction)

A

GFR/RPF

Usually around 20%

66
Q

What does FF represent

A

Proportion of fluid reaching the kidneys that passes into the renal tubules

67
Q

Glomerular filtrate usually contains

A

No blood cells or platelets, virtually no proteins

Mostly organic solutes with a low molecular weight, and inorganic ions

68
Q

The end product of filtration is identical to

A

Plasma without the large proteins and cells

69
Q

What do podocytes help with

A

Forming a barrier as negatively charged - closely associated with capillary membrane. In Bowman’s capsule epithelium

70
Q

What is proteinuria

A

Negative charge on filtration barrier lost so proteins more readily filtered hence in urine

71
Q

The amount of filtrate is determined by the product of

A

The average filtration of each nephron in each kidney

72
Q

A decrease in GFR means

A

Kidney function has worsened- less nephrons or lower GFR within nephrons

73
Q

When kidney function declines slowly, what process may happen

A

Individual nephrons may hypertrophy, so actual kidney function may not fall significantly until kidney damage has occured

74
Q

What is the issue with GFR

A

Can’t measure actual GFR so need surrogate marker- renal clearance

75
Q

What is C

A

Clearance- volume of plasma that is cleared of a substance in a unit time

76
Q

Clearance of y =

A

Urine conc of y
x
urine flow rate

/

plasma conc of y

77
Q

When is renal clearance not accurate

A

If substance does not stay with filtrate and is altered by kidney (reabsorbed, secreted, synthesised or metabolised)

78
Q

Why is clearance an imaginary concept

A

Describes a volume of plasma completely cleared of solute

79
Q

Formula for filtration rate

A

Plasma conc x urine flow rate

80
Q

Formula for excretion ate

A

Urine conc x flow rate

81
Q

How does being a baby affect GFR

A

Premature and LBW infants often have lower nephron numbers

Fetal excretion predominantly via placenta

Normal GFR by 18 months

82
Q

Nephron development is finished by

A

35th-36th week of fetal development

83
Q

GFR starts declining when, features

A

30 years old, 6-7ml/min per decade, loss of functioning nephrons, some compensatory hypertrophy

84
Q

Pregnancy and GFR

A

GFR increases by about 50%, 130-180ml per minute

Kidney size increases by about 1cm (increased fluid volume vascular and interstitial)

Nephron number same

Back to pre pregnancy levels 6 months postpartum

85
Q

If used to measure kidney clearance a substance should

A

Be produced at constant rate, be freely filtered across glomerulus, not be reabsorbed in nephron and not be secreted into nephron

86
Q

Inulin is a

A

Plant polysaccharide, ingested, freely filtered, not reabsorbed and not secreted

87
Q

Why dont we use inulin

A

Required continuous IV to maintain steady state, required catheter and timed urine collections

88
Q

What do we use to measure clearance hence GFR

A

51 Cr-EDTA

89
Q

Why uses 51 Cr-EDTA

A

Radioactive labelled marker
Cleared exclusively by renal filtration
Timed injection with blood samples taken 2,3,4 hours after
Approx 10% lower clearance than insulin

90
Q

When is 51 Cr-EDTA used clinically

A

In children, where indication of renal function required e.g. transplant or donation

91
Q

What is creatinine

A

Endogenous, end product of muscle breakdown

92
Q

Creatinine is measured by

A

Urine creatinine over 24 hours, serum creatinine

93
Q

Disadvantages of measuring creatinine

A

Cumbersome- carrying bottle of urine, frequently inaccurate

Over estimated GFR by 10-20% due to creatinine secretion (more with more severe renal impairment)

94
Q

When is measuring creatinine used

A

In pregnancy

95
Q

Things that affect creatinine levels in an individual

A

Intake, muscle mass, renal filtration, renal secretion, renal secretion

96
Q

Renal secretion makes up proportionately more of total renal excretion as

A

GFR declines

97
Q

Things which increase serum creatinine

A

Large muscle bulk, young, male, creatine supplements, high intake of meat, certain drugs e.GFR. Trimethoprim

98
Q

Things which reduce serum creatinine

A

Reduced muscle mass, old, female, vegetarian

99
Q

What is eGFR

A

Estimated GFR

100
Q

Problems with eGFR

A

Inaccurate in mild kidney disease,

101
Q

Why is eGFR not reliable in mild kidney disease

A

reduction in GFR causes increase in blood flow

Reduced nephron number leads to hypertrophy so no change in GFR

Reduced filtration of creatinine due to reduced GFR results in increased serum creatinine and increased secretion into the tubule

102
Q

How long is urethra in male vs female

A

Female 4cm, male 15-20cm

103
Q

What is the area of the bladder compromising of steric openings and internal urethral meatus

A

Trigone

104
Q

Which urethral sphincter is under voluntary control

A

External urethral sphincter

105
Q

Segmental artery splits to become the

A

Interlobar artery

106
Q

Kidneys generally located between

A

T12-L3

107
Q

Ureter is narrowest at the

A

Vesicoureteral junction, the point where it enters bladder

108
Q

Which arteriole has reduced volume with age

A

Efferent

109
Q

Which fluid can escape during collecting duct injury

A

Urine

Urinary (20 decks)

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