Test 4- Anatomy 2 Renal Block Flashcards
Vocabulary/Abbreviations
- _____: in to something
- _____: out of something
- PCT: _____
- LOH: _____
- DCT: _____
- JGA: ______
- Afferent
- Efferent
- Proximal convoluted tubule
- Loop of Henle
- Distal convoluted tumble
- Juxtaglomerular apparatus
Functions of the kidneys
- Regulate blood ______
- Helps to regulate blood levels of ions like ______, ______, ______, ______, and ______
- Regulate blood ____
- Kidney excrete variable amount of ______ ions into urine and conserve ______ ions, bicarb is important buffer of ____
- Ionic composition
- Sodium/potassium/Calcium/Chloride/Phosphate
- pH
- Hydrogen/Bicarbonate/H+
Functions of the kidneys
- Regulate blood ______: adjust blood volume by conserving or eliminating water into the urine
- Regulate blood ______: kidneys excrete enzyme renin, The is activates renin-Angiotensin-aldosterone pathway; increased renin= increased blood pressure
- Maintain blood ______: separately regulates loss of water and loss of solutes in urine, kidney maintain relatively constant osmolarity close to 3000mOsm/liter
- Volume
- Pressure
- Osmolarity
Functions of the kidney
- Produce certain _____: kidneys produce the hormones calcitriol (active form of vitamin D) erythropoietin (stimulates production of RBC’s) and renin (hormone/enzyme)
- Regulate _____ levels: like the liver, the kidneys can use amino acid glutamine in gluconeogenesis, which can then release new glucose into the blood stream to help maintain Normal level
- Hormones
2. Blood glucose
Functions of the kidneys
- Excrete _________ substances: By forming urine, kidneys help body to get rid of ammonia and urea, Bilirubin, Creatinine, Uric acid. Drugs, environmental toxins
- Wastes and foreign substances
Anatomy of kidneys
- Located in ________ space: anatomically between last thoracic and 3rd lumbar vertebrae, partially protected by the 11th and 12th ribs. Right kidney is slightly lower than left
- The _______ face the spinal column
- Retroperitoneal space
2. Concave medial border (Hilum)
External Anatomy of the Kidney
Three external layers
- _____: outermost layer. Dense connective tissue anchors kidney to surrounding structure and retroperitoneal wall
- _____: Middle layer. Fatty tissue surrounding renal capsule, protection and holds kidney in place in cavity
- _____: Innermost layer. Smooth, transparent connective tissue covering that is continuous with ureters; helps maintain shape of kidney and offers protection
- Renal Fascia
- Adipose Capsule
- Renal capsule
Internal anatomy of the kidney
- ______ : contains all of the glomeruli and convoluted tubles of nephrons. Also makes columns that lay between pyramids
- _____: contains all of the loops of Henle and collecting ducts. Collection of all renal pyramids comprise the medulla
- _____: One portion of the medulla. 8-18 per kidney
- _____: narrow apex of the pyramid. Contains the papillary duct leading to minor calyx
- Cortex
- Medulla
- Pyramid
- Papilla
Internal anatomy of the kidney
- ______: space between renal pyramids. Is a portion of the renal cortex
- _____: a functional region within the kidney. Pyramid (medulla)+ overlying cortex + 1/2 each adjacent column (cortex)
- ______: small chambers that collect urine directly from papilla. 8-18 each kidney
- _____: larger chambers that collect urine from multiple minor calyces. 2-3 each kidney, extensions of ureters
- Columns
- Lobe
- Minor calyx
- Major calyx
Internal anatomy of the kidney
- ____: major calyces drain into one large chambers (pelvis). This mixes/collects all urine from entire kidney. Connects to the ureter outside of the kidney
- ____: The kidney is 3-dimensional, so in between the other structures there are spaces that house some adipose tissue, the blood vessels, and nerve supply
- ____: A region. Indentation of kidney where ureter emerges with blood and lymphatic vessels, and nerves
- Renal pelvis
- Renal sinuses
- Renal hilum
Blood supply
- Renal blood flow is ______ per minute
- _____ per kidney
- Total amount of blood in adult is _______
- Starts at ____ levels and then branches from there into smaller vessels
- This ______ allows for filtration, but not _______
- 1200ML
- 600mL
- 4500-5500mL
- Aortic
- Glomerulus/Reabsorption
Blood supply
1.-16.
- Aorta
- Renal artery
- Segmental artery
- Interlobar artery
- Arcutate artery
- Interlobular artery
- Afferent arterioles
- Glomerulus
- Efferent arterioles
- Peritubular capillaries
- Vasa recta (juxtameduallary nephrons only)
- Interlobular vein
- Arcuate vein
- Interlobar vein
- Renal Vein
- Inferior vena Cavae
Blood
- Blood flows into the ____ to get filtered
- It enters each _____, gets filtered through the ______, and exits the corpuscle to flow into a ______ system
- Blood is filtered in the glomerulus, where things can be _____ only
- When in the ____ capillaries/_____, blood will still act like it does in any other capillary in the body. Stuff will move in and out of the capillaries depending on _______
- This capillary action acts as a ________ filter
- Depending on the body’s needs, it can ______/______ more water/______ as needed
- Kidneys
- Corpuscle/Glomerulus/Capillary
- Removed
- Peritubular/Vasa recta/Pressure
- Secondary filter
- Reabsorb/Secrete/Solutes
Filtrate
Blood flows into the kidneys to get filtered
- As blood flows through, certain substances are removed from blood and placed into the urinary tubular system. This is known as ______
- Filtrate is first found in the _______ capsule
- From there it flows through the _____ and then into _______ ducts
- While in these ducts, things can still be _____ or ______
- Once the filtrate leaves the collecting duct, it is then called _____
- Filtrate
- Glomerular capsule (Bowmans capsule)
- Tubules/Collecting ducts
- Added/Removed
- Urine
The Nephron
- Function unit of the kidney- approximately _____ in each kidney
Nephron consist of two parts:
- ______: where blood is filtered. Glomerulus/Glomerular capsule (aka Bowman’s capsule)
- ______: Filtered contents (from blood; three parts). Proximal convoluted tubule attached to capsule. Loop of Henle (nephron loop)- middle section. Distal convoluted Tubule- distant from capsule, empty into collecting duct
- Corpuscle and both convoluted tubules reside in _____
- Only loop of Henle extends into the renal _____
- One million
- Renal corpuscle
- Renal Tubule
- Cortex
- Medulla
Nephrons
Two different types of nephrons
- ______: 85% of nephrons
- Renal corpuscles lie in ______ of renal cortex
- ____ loops of Henle
- ______ capillaries only
- ______: 15% of nephrons
- Renal corpuscles lie ______ in the renal cortex
- _____ loops of Henle
- Peritubular capillaries that give rise to the _______
- ______: capillary bed that extends into medulla surrounding the Loop of Henle
- Cortical Nephron
- Outer portion
- Short
- Peritubular
- Juxtamedullary nephron
- Deep
- Long
- Vasa Recta
- Vasa recta
Cortical Nephrons
- ______ nephrons
- _____ lie in the outermost portion of the cortex
- ______ limb of loop of Henle barely dips into he renal medulla
- After a hairpin turn, the ______ limb of the loop of Henle returns to the cortex
- Peritubular capillaries: arise from the ______ arterioles. Intermingle throughout the _____ and ______ tubules. These then flow into ________ veins and eventually back into _______ circulation
- Short
- Renal corpuscles
- Descending
- Ascending
- Efferent/Proxmial/Convoluted/Interlobular/Systemic
Juxtamedullary Nephrons
- Long nephrons: Renal corpuscles lie in the _____. ______ limb of loop of Henle dives deep into the renal medulla. Anatomy lends to very ____ and _______ urine. After a hairpin turn, the ascending limb of loop of Henle climbs back to the _____
- Peritubular capillaries: arise from the ______ arteriole. Intermingle throughout the ______ and ______ tubules. In the ________ nephrons only, a specialized capillary system exists coming off of these pretubular capillaries
- Cortex/Descending/Dilute/Concentrated/Cortex
2. Efferent/Proximal/Convoluted/Juxtamedullary
Juxtamedullary Nephrons
Vasa Recta
- Coming from the _____ capillaries, this type of capillary System dives deep into renal medulla
Flows Side by side each of the loops of Henle so that things can
- _____ of the capillaries and into the _____ as well
- ______ of the Filtrate and into the ______
- The design with the use of vasa recta is extremely important for keeping a constant ______ gradient so that things can flow in and out
- Peritubular
- Flow out/Filtrate
- Out of/Capillaries
- Osmotic pressure
Blood flow-Nephron
Afferent arteriole
- The arteriole coming into the _____/_______. Brings blood in for _______
- Wider lumen, thicker walls. Has much more capability to ____ or ____ when compared to ______ arteriole
Glomerulus
- Ball of twine like capillary structure that buds off of the ______ arteriole
- Modified simple squamous epithelial cells called ______
- Podocytes have fingerlike projections that wrap around the _______ capillaries
- Corpuscle/Glomerulus
- Constrict/Dilate/Efferent
- Afferent
- Podocytes
- Glomerular
Blood Flow- Nephron
Efferent arteriole
- The arteriole _______ the corpuscle/glomerulus
- Brings blood with larger solutes into the _______ capillaries and then back into ______ circulation
- Smaller lumen size, thinner walls. Smaller lumen size aids in ______ sometimes needed for _______ filtration
- Leaving
- Peritubular/Systemic
- Back pressure/Glomerular
Tubule Histology
- A single layer of ______ cells forms the entire wall of the glomerular capsule, renal tubule, and ducts
- Each section of cells has _____ differences that allow for ______ functions
- Epithelial
2. Minor/Different
Rena Tubule Histology
PCT-Proximal convoluted tubule
- ________ cells with prominent microvilli brush border facing lumen (apical surfaces)
- ______ increase surface area for absorption and secretion
- ______ (thin descending and thin ascending limb portions). _____ epithelial cells
- Loop of Henle (thick ascending limb portion): _______ to low columnar epithelial cells
- Simple cuboidal epithelial
- Microvilli
- Loop of Henle/Simple squamous
- Simple cuboidal
Renal Tubule Histology
DCT- distal convoluted tubule
- Most of DCT- _______ epithelial cells
Last part of DCT- simple cuboidal epithelial cells that contain:
- ______-receptors for ADH and aldosterone
- ______- help play a role in blood pH
Collecting Duct
- _______ epithelial cells that also contain:
- _______- receptors for ADH and aldosterone
- ______- help play a role in blood pH
- Simple cuboidal
- Principal cells
- Intercalated cells
- Simple cuboidal
- Principal cells
- Intercalated cells
Terminology- Renal
Blood/Serum
- The fluid that enters the ______ arteriole and into the _____
- The fluid that gets ______ in glomerulus
- The leftover blood/serum and components not filtered into the glomerular capsule. Leaves the _____ via the _______ arteriole
Filtrate
- The fluid that were filtered out of blood at the ______
- The fluid that enters the _____ system at the glomerular capsule
- Fluid can still be _____/_____ over and over again
Urine
- Once the filtrate leaves the ______ ducts, it is now called Urine
- Afferent/Glomerulus
- Filtered
- Corpuscle/Efferent
- Glomerulus
- Renal tubular
- Reabsorbed/Secreted
- Collecting
Terminology
- _______: water and many solutes found in blood move across the wall of the glomerulus, into the glomerular capsule (Bowmans capsule) and into tubules
- _______: Water and solutes that are now flowing through the tubule system can get reabsorbed (99% of filtrate is reabsorbed back into bloodstream)
- _______: due to the peritubular capillaries and vasa rect, there is still the chance to dump unwanted materials into filtrate such as wastes, drugs, excess ions
- ______: once out of the collecting duct, there is no more opportunity for exchange; expelling wast matter
- Glomerular filtration
- Tubular reabsorption
- Tubular secretion
- Excretion
Urine Production- Analogy
Recycling center
- Garbage trucks dump smaller garbage (potential recyclables) into a mechanism that can sort out recyclables called _________
- Large items such as proteins/RBC’s that cannot make it through the filtration membrane are still in blood, exits glomerulus via _______
- Glomerular Filtration
2. Efferent arteriole
Urine Production- Analogy
- ______ of useful products (while in tubule system)
- Wastes are secreted back into the ______ (filtrate) to be made into _____ and ______
- Reabsorption
2. Ducts/Urine/Excreted
Glomerular Filtration
The amount that makes it into the glomerular capsule space and tubule system
- Adults create ______ of filtrate a day
- _____ is usually reabsorbed and returned to circulation
- Leaving only ______ of urine produced a day
- 150-180 liters
- 99%
- 1-2L
Filtration Membrane
- Glomerular capillaries and podocytes form a _____ barrier in the capsule
- ______: allows water and certain solutes to pass into capsular space
- Prevents _____ plasma proteins, blood cells, platelets from getting into capsular space
- Leaky
- Loosely packed
- Most
Filtration Membrane
Consists of three layers of filtration
- _______: prevents blood cells from passing, but allows all other components of blood plasma through
- ________: prevents large proteins from passing through
- _______: Prevents filtration of most other proteins
- Fenestrations of endothelial cells
- Basement membrane/Basal lamina
- Slit membranes between pedicels
Mesangial cells and filtration membrane
- Interspersed throughout the _____ capillaries
Regulate surface area available for filtration
- When relaxed, surface area is ______
- When contracted, _____ area available
- Glomerular
- Maximal
- Reduced
Glomerular Filtration Pressure
- Although still capillaries, pressure is ______ in these than in any other capillaries in the body
- _____ surface area
- Larger ______ for easier filtration
- Efferent arteriole is _____ than the afferent
- This then requires more pressure to get plasma ______ of the glomerulus through the ______ arteriole
- This pressure builds _____ into the glomerulus increasing filter pressure (______)
- Higher
- Larger
- Fenestrations
- Smaller
- Out/Efferent
- Backwards/Positive pressure
Net Filtration Pressure
Glomerular blood hydrostatic pressure
- Pressure in glomerulus pushing ______ into capsular space
- Usually ______
Capsular hydrostatic pressure
- Hydrostatic pressure exerted by the fluid in capsular space that pushes _______ on the visceral glomerular membrane
- Known as ______
- Usually ______
- Outward
- 55mmHg
- Inward
- Back pressure
- 15mmHg
Net filtration pressure
Blood colloid osmotic pressure
- Pressure due to _____ in blood plasma (mainly albumin)
- Opposes filtration: ______ on fluid/solutes to keep them in the _____ if possible
- Usually ______
- Proteins
- Pulls/Glomerulus
- 30mmHg
Net filtration Pressure
- NFP is the pressure that is supposed to _______ filtration
- ______=GBHP-CHP-BCOP
- _______- Normal NFP in healthy kidneys
- As long as the NFP is a positive number, filtration will _____
- If NFP calculates into a negative number ______ is occurring
- Promoting filtration eventually leads to ______ production
- Promote
- NFP
- 10mmHg
- Occur
- No filtration
- Urine
Glomerular Filtration Rate
- GFR= the amount of blood filtered by the _____ glomeruli into capsular space per unit time. _____ in average adult
- If GFR too fast- filtrate may pass too ______ and required substances may not be _______
- If GFR too slow- nearly all filtrate may be ______ and certain wastes may not be _______ efficiently
- Kidneys/125mL/min
- Quickly/Reabsorbed
- Reabsorbed/Excreted
Calculating GFR
- An estimated rate only as it involves calculations and not actual ______
- Calculated using the serum creatinine levels and some or all of the following: _______, ______, ______, ______
- Measurements
2. Age/Race/Weight/Gender
Calculating GFR
- ______: waste from the breakdown of muscle (normal
- As blood is filtered through the nephrons the kidney neither ______ or ________ this substance
- Should freely pass through the ______ membrane and be ______ out
In a normal healthy adult, the serum level should be near at the same level of the urine creatine clearance. (24hr urine collection)
- If the urine level is low this means the kidneys are not filtering the serum _______ properly (kidney damage)
- Usually means that the serum level will be _______
- Creatinine
- Reabsorbs/Metabolizes
- Filtration/Urinate
- Creatine
- Elevated
GFR: Black vs Non Black
- In calculating the estimated GFR African American population had a much higher serum ______ level
- Generally have increased _____ mass
- Generally have higher rates of muscle ______
- When accounting for this shift of normal levels, it shows that the average African American patient will have a _________ GFR
- ______ above the normal levels for non black patients
- Creatinine
- Muscle
- Breakdown
- Higher normal
- 21%
Glomerular Filtration Rte
- GFR directly related to ______ that determine net filtration pressure
- If GBHP drops by even 10mmHg, filtration in the glomerulus _______
- Pressure
2. Stops
Glomerular Filtration Rate
Mechanisms that regulate GFR
- _____: innate actions that occur within the kidney
- _____: sympathetic nervous system input (or reduction of input)
- ______: Angiotensin II, Atrial natriuretic peptide (ANP)
- Renal autoregulation
- Neural regulation
- Hormonal regulation
GFR- Renal Autoregulation
Kidneys help maintain their own GFR by two mechanisms
- _______: Increased BP (as in exercise) causes stretching of afferent arteriole, this causes smooth muscle contraction of afferent arteriole, reduces renal blood flow, which reduces GFR
- This helps to preserve nephron integrity with increased _________
- When threat of increased BP is reduced, _______ arteriole May vasodilator to increase GFR to balance out the system
- Myogenic mechanism
- Blood pressure
- Afferent
Myogenic mechanism
- Immediate increase in BP causes _________
- Myogenic vasoconstriction can cause _________
- Myogenic Vasoconstriction
2. Compensatory vasodilation
GFR- Renal Autoregulation
Kidneys help maintain their own GFR by two mechanisms
- _________: The juxtaglomerular apparatus
- When GFR increases, rate through Tubules ______
- Reabsorption of ______, ______ and ______ reduce due to rate of flow
- _______ cells sense the increased levels of these in filtrate
- These levels inhibit the release of ________ (NO; Vasodilator)
- If NO inhibited, afferent arterioles _______, lowers _____
- Lowered GFR _____ rate through tubules
- Tubuloglomerular Feedback
- Increase
- Na+, Cl-/Water
- Macula Densa
- Nitric Oxide
- Constrict/GFR
- Slows
Juxtaglomerular Apparatus (JGA)
- A complex structure that has the ability to affect ______ through autoregulation of ________ feedback
- Their is ______ JGA for every nephron
Contains
- _______: Found in the walls of the afferent arteriole
- _______: found in the walls of the distal convoluted tubule
- _______ (modified mesangial cells): Located between afferent arteriole, Efferent arteriole, and DCT
- Systemic blood pressure/Tubuloglomerular
- One
- Juxtaglomerular cells
- Macula densa cells
- Lacis cells
Juxtaglomerular Apparatus (JGA)
- The _____ contain Juxtaglomerular cells
Modified smooth muscle cells that have two functions
- Detect when blood pressure is ______ (by sensing the lack of stretch of the afferent arteriole wall)
- They synthesize, store, the secrete _______, _______
- Renin causes a cascade of events that helps to ______ blood pressure when needed
- Afferent arterioles
- Too low
- Hormone/enzyme renin
- Increase
Juxtaglomerular Apparatus (JGA)
- The distal convoluted tubule (where it meets the afferent arteriole) contains ______ cells
Closely packed specialized cells that have two functions
- Detect increase in ______ concentrations in the _____
- In response to this concentration check, these cells release _____ in various concentrations which act locally
- These trigger ______ of afferent arteriole
- This causes GFR to ______ which _____ the rate tubule flow
- Macula Densa
- NaCl/Filtrate
- ATP, adenosine
- Contraction
- Reduce/Reduces
Juxtaglomerular Apparatus (JGA)
- _________: located in between the afferent, Efferent and distal convoluted tubule junction
- _____ or _____ to make small regulatory changes in response to the signals that the other JGA cells are sending
- Together the macula densa, juxtaglomerular cells, and lacis cells make the ___________
- This is _________ feedback
- Helps regulate _______ within the kidneys
- Lacis cells (modified Mesangial cells)
- Contract/Relax
- Juxtaglomerular Apparatus
- Tubuloglomerular
- Blood pressure
GFR- Neural Regulation
- Blood vessels of the kidney are supplied by ________ fibers only
- At rest sympathetic stimulation is _____
- ______ and _______ arterioles are dilated
- Blood flow ____ and _____ of the glomerulus is relatively equal
With greater sympathetic stimulation (exercise, Flight/Fight)
- ______ of the afferent arteriole occurs
- Blood flow _______ into glomerulus
- _____ decrease- This also protects the nephrons from the rapid rise in blood pressure
- Sympathetic nervous system
- Low
- Afferent/Efferent
- Into/out
- Vasoconstriction
- Decreases
- GFR
GFR- Hormonal Regulation
Two hormones control regulation of GFR
- _______: reduces GFR
- Very potent ______
- Mostly acts on ______ arterioles
- Reduces _____ blood flow
- _______: increases GFR
- Secreted by the ______
- Usually secreted in response to _______ in volume
- Markedly vasodilates ______ and _______ arterioles
- GFR _______
- Angiotensin II
- Vasoconstrictor
- Efferent
- Renal
- Atrial natriuretic peptide (ANP)
- Atria (heart)
- Increase Afferent/Efferent
- Increases
Active vs. Passive Movement
- _______ occurs when pressure gradients allow flow of something from high concentration to a low concentration; it does not require ______ to occur
Example: Glomerular filtration occurs from pressures alone, not from ATP expenditure
- _______ occurs usually against the concentration gradient and with the help of _______ expenditure
Example: Sodium/Potassium pumps (Na+/K+) expend energy converting ATP to ADP
- Passive movements/ATP energy
2. Active movement/ATP
Tubular Reabsorption
- Normally ____ of filtrate is Reabsorbed
- Epithelial cells along the ______ and ______ reabsorb, but the PCT cells make the _______ contribution to Reabsorption
- Solutes that are both actively and passively Reabsorbed include: ______, ______, _____, _____, _____, _____, _____, ______, _____ and _____
- 99%
- Renal tubule/Ducts/Largest
- Glucose/amino acids/urea/sodium/potassium/calcium/chloride/magnesium/bicarbonate/phosphates