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Anatomy and Physiology-DNP > Structure and Function of the Renal Urologic systems > Flashcards

Structure and Function of the Renal Urologic systems Flashcards

1
Q

Renal function

A
  • Maintain a stable internal environment for optimal cell and tissue metabolism
  • Balance solute and water transport
  • Excrete metabolic waste products
  • Conserve nutrients
  • Regulate acids and bases
  • Performs gluconeogenesis: synthesis of glucose from amino acids
  • Forms urine
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2
Q

Endocrine functions: Secrete hormones

A
  • Renin: regulation of BP
  • Erythropoietin: Production of erythrocytes
  • 1,25-dihydroxyvitamin D3: Metabolism of Ca
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3
Q

Forms urine

A
  • Filtration
  • Reabsorption
  • Secretion by the glomerii and tubules in the kidney
  • Storage of the urine in the bladder that it receives from the kidney by way of ureters
  • removal of the urine through the urethra
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4
Q

Structures of the kidney

A
  • Kidney
  • Renal capsule:Surrounds the kidney
  • Renal fascia: fibrous tissue
  • Hilium: place where the renal blood vessels, nerves, lymphatic vessels and ureters enter/exit the kidney
  • Renal cortex
  • Renal medulla
  • Renal columns
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5
Q

Renal cortex

A
  • outer layer of the kidney
  • Contains glomeruli
  • Most of proximal tubules
  • Part of the distal tubule
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6
Q

Renal Medulla

A
  • Forms the inner part of the kidney
  • Called pyramids
  • Contains the tubules and collection duct
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7
Q

Renal columns

A

-Extend from the cortex between the renal pyramids

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8
Q

Other structures of the kidney

A
  • Minor calyx
  • Major calyx
  • Renal pelvis
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9
Q

Nephron

A
  • functional unit of the kidney
  • Tubular structures w/ subunits that include the renal corpuscle, proximal convulated tubule, loop of henle, distal convoluted tubule, and collecting ducts
  • All those structures contribute to formation of urine
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10
Q

Three kinds of nephrons

A
  • Superficial cortical nephrons: make up 85% of nephrons
  • midcortical nephrons
  • Juxtamedullary nephrons: concentrating urine
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11
Q

Nephron renal corpuscle

A

-Contains glomerulus, Bowman glomerular capsule, mesangial cells

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12
Q

Mesangial cells

A

-Have phagocytic properties and release inflammatory cytokines and growth factors

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13
Q

Glomerulus

A

-Glomerular filtration membrane filters selected blood components through its

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14
Q

Glomerular endothelial cells

A
  • Synthesize nitric oxide (vasodilator)
  • Synthesize endothelin-(vasoconstrictor)
  • Regulate glomerular blood flow
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15
Q

Filtration of the glomerulus

A

-Plasma filtrate from glomerulus passes through the glomrular membrane into the bowman space to form the primary urine

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16
Q

Bowman capsule: podocytes

A
  • composed of cells: podocytes

- Form an elaborate network of intracellular clefts called filtration slits: modulate filtration

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17
Q

Glomerulus

A
  • Is supplied by the afferent arteriole and drained by the efferent arteriole
  • Juxtaglomerular apparatus: controls renal blood flow, glomerular filtration and renin secretion
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18
Q

Renal tubules

A
  • Substances are reabsorbed from the filtrate or secreted into the filtrate
  • Proximal convoluted tubule
  • Loop of henle
  • Distal convoluted tubule
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19
Q

Loop of Henle

A

-Hairpin-shaped loop composed of thick and thin portions of a descending segment that goes into the medulla

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20
Q

Collecting duct

A
  • Descends down the cortex through the renal pyramids of the inner and outer medulla, draining urine into the minor calyx
  • Consists of: principal cells, intercalated cells
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21
Q

Principal cells

A

-Reabsorb Na and water and secrete K

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22
Q

Intercalated cells

A

-Secrete hydrogen and reabsorb K

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23
Q

Blood vessels

A
  • Renal arteries: supply blood to kidneys-arise from abd aorta
  • Interlobar arteries
  • Arcuate arteries
  • Interlobular arteries
  • Afferent arterioles
  • Glomerular capillaries
  • Efferent arterioles
  • Peritubular capillaries
  • Vasa recta
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24
Q

Efferent arterioles

A
  • convey blood to the peritubular capillaries; an increase or decrease in resistance to the afferent or efferent arterioles
  • This will then increase or decrease in GFR
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25
Q

Ureters

A
  • long, interwining smooth muscle bundles
  • pass obliquely through the posterior aspect of the bladder
  • peristaltic activity propels urine to the bladder
  • Micturition compresses the lower end of the ureter to avoid urine refulx
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26
Q

Bladder

A
  • Components: detrusor muscle, trigone
  • Transitional epithelium: allows expansion as the bladder fills; serves and transduces info about the luminal pressure and urine composition
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27
Q

Urethra

A
  • Extends outside the body
  • Internal and external sphincters
  • Shorter in females
  • Innervation: parasympathetic fibers, skeletal motor neurons in the pudendal nerve
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28
Q

Bladder and Urethra

A

Reflex arc is required for micturition-stimulated by mechanoreceptors from stretching-bladder fullness is sensed; impulses sent to sacral level of spinal cord

  • When bladder accumulates 250-300mL of urine-contracts and the internal urethral sphincter relaxes from activation of the spinal reflex arc (micturition reflex)
  • Urge to void is felt
29
Q

Renal blood flow

A
  • Kidneys receive 1-1.2L//min of blood
  • GFR
  • If MAP decreases or vascular resistance increases, then RBF decreases
30
Q

GFR

A
  • Filtration of plasma into the Bowman space
  • 20% of the RPF is filtered here
  • directly related to the perfusion pressure in the glomerular capillaries
31
Q

Autoregulation

A
  • Strict maintenance of 80-180 mm Hg provides constant GFR
  • As systemic BP increases, afferent arterioles constrict, preventing an increase in filtration pressure
  • Prevents wide fluctuations in the systemic arterial pressure from being transmitted to the glomerular capillaries
  • Solute and water excretion is constantly maintained, despite arterial pressure changes
32
Q

Autoregulation: Myogenic mechanism (stretch)

A
  • As arterial pressure declines, glomerular perfusion increases
  • An increase in arterial pressure decreases glomerular perfusion
33
Q

Autoregulation: Tubuloglomerular feedback

A
  • Sodium chloride content
  • When Na filtration increases, GFR decreases
  • When Na filtration decreases, the opposite occurs-GFR increases
34
Q

Renal blood flow: Neural regulation

A
  • Sympathetic nervous system
  • Baroreceptor reflex
  • Exercise and change of body position
  • Severe hypoxia
35
Q

Sympathetic nervous system and RBF

A
  • Vasoconstriction occurs (diminishes GFR)

- Causes arteriolar vasoconstriction to reduce renal blood flow

36
Q

Baroreceptors reflex

A
  • Vasoconstriction of afferent arterioles w/ activation of a1-adrenoreceptors
  • Decreases glomerular perfusion and GFR
37
Q

Exercise and change of body position

A

-Activate renal sympathetic neurons, causes mild vasoconstriction

38
Q

Severe hypoxia

A
  • Stimulates chemoreceptors (from pulmonary system)

- Decreases RBF by means of sympathetic stimulation

39
Q

Hormones-RAAS

A
  • Increases systemic arterial pressure, and increases Na reabsorption
  • Hormones and other mediators can alter the resistance of renal vasculature by stimulating vasodilation and vasoconstriction
  • -In the precence of angiotensin-converting enzyme (ACE), angio 1 is converted to angiotensin 2
40
Q

Renin

A
  • Enzyme is formed and stored in afferent arterioles of the juxtaglomerular apparatus
  • Helps form angiotensin 1
  • Released in response to decreased BP, decreased Na concentrations in the distal convulated tubules, and release of prostaglandins, and hypovolemia
41
Q

Angiotensin 2

A
  • Stimulates the secretion of aldosterone by the adrenal cortex
  • Potent vasoconsctrictor
  • Stimulates antidiuretic hormone (ADH) secretion and thirst
42
Q

ACE inhibitors

A

-Anti-Htn meds which inhibit the formation of angiotensin 2, to help reduce BP

43
Q

System of RAAS

A

-Liver hepatocytes release angiotensinogen-then release of renin-forms angio 1-then ACE forms-angio 2-increases plasma volume and BP-negative feedback loop

44
Q

Hormones: Natiuretic peptides

A
  • Artial natiuretic peptide (ANP)-secreted from myocardial cells in atria
  • Brain natiuretic peptides (BNP)-secreted from myocardial cells in the ventricle
  • Both: Inhibit Na and water asborption by kidney tubules
  • Inhibit secretion of renin and aldosterone
  • Vasodilate the afferent arterioles; constrict the efferent artioles
  • Increase urine formation leading to decreased blood volume and BP, promote Na and water loss
  • Promotes diuresis
45
Q

Hormones

A
  • C type natiuretic peptide: secreted from vascular endothelium and in the nephron
  • Urodilatin: secreted by distal convulated tubules and the collecting ducts
  • Causes vasodilation
  • Other hormones: adenosine, bradykinin, dopamine, endothelin, histamine, nitric oxide, and prostaglandins
46
Q

Nephron functions

A
  • Filters the plasma at the glomerulus
  • Reabsorbs and secretes substances at various parts of its tubular structure
  • Forms filtrate of protein-free plasma (ultrafiltration)
  • Regulates filtrate to maintain body fluid volume, electrolyte composition, and pH w/in narrow limits
  • Glomerulus w/in bowmans capusle (filtration)-Proximal tubule-Loop of Henle-Distal Tubule-Collecting duct
47
Q

Proximal tubule

A
  • reabsorption: Na, glucose, K, amino acids, HC03, Po, UREA, h20
  • Secretion of: H+, foreign substances
48
Q

Loop of Henle

A
  • Concentration of urine
  • Descending loop: water reabsorption, Na diffuses in
  • Ascending loop: Na reabsorption, water stays in
  • Urea secretion in thin segment
49
Q

Distal tubule

A
  • Reabsorption: Na, H20 (adh required), HCO3

- Secretion: K, urea, some drugs

50
Q

Collecting duct

A
  • Reasborption: H20 (adh required)
  • reabsorption or secretion: Na, K,
  • Final concentration
51
Q

Glomerular Filtration

A
  • freely permeable to water and relatively impermeable to large colloids such as plasma proteins
  • Contains electrolytes (Na, K, glucose, chloride, creatinine, urea)
52
Q

Filtration rate

A
  • Total volume of fluid filtered by the glomeruli averages 180L/day
  • Filtration of plasma per unit of time is directly related to the perfusion pressure of RBF
53
Q

GFR increase

A

-If vasoconstriction of efferent arteriole-filtration pressure increases-GFR increases

54
Q

GFR decrease

A
  • Vasocontriction of one of the two arterioles produces opposite effects on the glomerular pressure: if afferent arteriole vasoconstricts-decrease in blood flow-drop in glomerular pressure-decrease in GFR and retention of body fluids
  • Excessive protein-free fluid loss from vomit, diarrhea, diuretics or sweating can decrease GFR
  • Renal tubules and primarily proximal tubules automatically adjust their rate of reasborption of Na and water to balance the change in GFR
55
Q

Proximal Convulated tubules

A
  • Active reabsorption of Na
  • Promotes passive diffusion of water
  • Damaged renal tubules: metabolic by products and drugs may accumulate
  • Water and electrolytes are cotransported w/ Na
56
Q

Loop of Henle

A

-provides the kidney w/ ability to concentrate urine and conserve water for the body

57
Q

Uromodulin

A
  • Formed on the epithelial surface of thick ascending segment and is first segment of distal tubule
  • most abundant urinary protein
  • protects against bacterial adhesion and urolithiasis
58
Q

Distal convulated tubules and collecting duct

A
  • performs final adjustments in urine composition

- Fluids become more diluted as is reaches the distal tubules

59
Q

Urea

A
  • End product of protein metabolism and the major constituent urine
  • 50% of urea is excreted in urine and other 50% recycled by kidneys
60
Q

Catecholamines

A
  • Norepi and epi promote afferent arioterolar vasoconstriction and decrease GFR and RBF
  • Renalase: hormone produced by the kidney that degrades catecholamines and regulates BP
61
Q

ADH

A
  • controls final concentration of urine
  • in presence of ADH water reabsorption is high, causing less urine volume
  • Secreted in the posterior pituitary
  • Excessive ADH is cause of oliguria; SIADH occurs when posterior pituitary hypersecretes ADH, resulting in excess water reasborption and water excess in the plasma
  • Inadequate secretion occurs w/ DI-water excreted in large amounts
62
Q

Vitamin D

A
  • Calcitriol: active form of Vitamin D3
  • Necessary for aborption of Ca and Phosphate in small intestine
  • decreased Phos stimulate calcitrol
  • Patients w/ renal disease typically have low calcitrol and manifest sx of Ca and phosphate balance
63
Q

Erythropoietin

A

Produced by adult kidney-essential for erythropoiesis

64
Q

Creatinine clearance

A

Creatinine clearance and GFR provide the best estimate for functioning renal tissue.
-damage to the glomerular membrane and loss of nephrons decreases the GFR

65
Q

Creatinine

A
  • produced by muscles
  • valuable for monitoring progress in chronic rather than acute renal disease
  • decrease in GFR see increase in creatinine
66
Q

Plasma cyst atin concentration

A

Measures progressive Rena dysfunction

67
Q

BUN

A

Blood urea nitrogen
Varies as a result of altered protein intake and protein catabolism
Better indication for hydration status
Increase in dehydration and kidney failure
10-20mg/dL

68
Q

Aging and renal function

A 
Decreased kidney size 
Decreased RBF and GFR 
Decreased number of nephrons from renal vascular and perfusion changes 
Decreased tubular transport 
Decreased elimination of drugs

Anatomy and Physiology-DNP (18 decks)

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