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BDS1 BAMS human systems > the kidney > Flashcards

the kidney Flashcards

1
Q

what type of organs are the kidneys?

A

excretory organs

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2
Q

what is the main function of the kidneys?

A

maintain internal homeostasis of fluid
(process blood and rid the body of waste products of metabolism via urine)

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3
Q

what do the kidneys regulate?

A
  • fluid volume/concentration
  • electrolytes
    (above two involved in blood pressure regulation)
  • acid/base
  • calcium/vit D metabolism
  • erythroprotein
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4
Q

how many kidneys are there?

A

two

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5
Q

what is the function of the ureters?

A

pass urine from kidneys to bladder

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6
Q

where is urine stored before entering the urethra?

A

bladder

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7
Q

what is the function of the urethra?

A

void urine

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8
Q

where do the kidneys sit in the body?

A

behind the peritoneal cavity

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9
Q

what are the three main parts of the kidney?

A
  • cortex
  • medulla
  • pelvis
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10
Q

what is the cortex?

A
  • outer part of kidney
  • contains 85% of all kidney tubules (nephrons)
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11
Q

what is the medulla?

A
  • middle ‘triangular’ part of kidney
  • where urine is concentrated
  • prevent excess water loss
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12
Q

what is the pelvis?

A
  • inner part of kidney
  • collection area where urine is funnelled into the ureter
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13
Q

what is the kidney encased in?

A

fibrous capsule (dense irregular)

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14
Q

describe the blood vessels of the kidney

A
  • highly vascular
  • renal artery delivers blood from abdominal artery
  • receives 1/5 of cardiac output
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15
Q

what is unique about the blood vessels of the kidney?

A
  • capillaries have a glomerulus (capillary bed) located between the afferent and efferent arteries
  • these then deliver blood to a secondary capillary bed (called the peritubular vasa recta) which passes to the interlobular veins
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16
Q

what is the basic functional unit of the kidney?

A

the nephron

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17
Q

where is the site of blood filtration?

A

glomerulus capillaries

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18
Q

what are the parts of the nephron?

A

bowmens caspule
proximal convoluted tubule
loop of henle
distal convuluted tubule

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19
Q

what are the two different types of nephrons?

A

cortical and juxtamedullary

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20
Q

what is unique about the juxtamedullary nephrons?

A

very long loop of henle which goes deep into the medulla

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21
Q

what is the renal corpuscle made up of?

A

glomerulus and bowman’s capsule (filter blood)

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22
Q

what forms the renal tube?

A
  • prox convoluted tubule
  • loop of henle
  • distal convoluted tubule
  • collecting duct
    (reabsorption and secretion_
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23
Q

what is the glomerulus?

A

a network of fine capillaries composed of a single layer of epithelial cells resting on a basement membrane

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24
Q

what does fenestrated mean?

A

poreous

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25
Q

what enables rapid filtration of blood plasma in the glomerulus?

A

the fenestrations

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26
Q

what is bowmans capsule?

A

a cuplike structure surrounding the glomerulus

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27
Q

how many layers are there in the bowmans capsule?

A

two:
- parietal outer (simple squamous)
- visceral inner (specialised epithelium called podocytes- long foot like processes)
bowmans space inbetween

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28
Q

what are the long branched processes which come from the podocytes called?

A

pedicels (wrap around the glomerular capillaries)

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29
Q

what forms the filtration barrier?

A

the glomerular endothelium, basement membrane and pedicels

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30
Q

what is the function of the filtration barrier?

A

barrier to large positively charged proteins

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31
Q

describe the steps in blood processing

A
  • unfiltered blood arrives at the glomerulus via the afferent arteriole
  • blood components filtered through the filtration barrier
  • filtered blood exits the glomerulus via the efferent arteriole
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32
Q

what is blood filtration facilitated by?

A

a pressure gradient (hydrostatic)

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33
Q

which arteriole has the thicker arteriole?

A

afferent

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34
Q

what does the diameter of arterioles help with?

A

pressure gradients

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35
Q

what is filtered in the filtration barrier?

A

water
glucose
aa
urea
creatinine
sodium
chlorine
calcium
phosphate
bicarbonate

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36
Q

what is not filtered in the filtration barrier?

A

cells and large proteins eg haemoglobin
negatively charged proteins eg albumin

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37
Q

what is glomerular filtration rate?

A

the rate at which blood is filtered through the glomerulus into bowmans capsule

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38
Q

what is filtration primarily driven by?

A

glomular hydrostatic pressure

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39
Q

what is filtration counteracted by?

A

hydrostatic pressure in the bowmans capsule and glomerular osmotic pressure

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40
Q

what are factors which can influence glomerular filtration rate?

A
  • hydrostatic pressure
  • osmotic pressure
  • systemic bp
  • renin-angiotensin system
  • disease
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41
Q

what is the normal value for glomerular filtration rate?

A

125ml/min

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42
Q

what happens to GFR if the kidneys are damaged?

A

decreases so inefficient blood clearance and waste removal so waste accumulates in the blood

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43
Q

what are measurements used to estimate GFR?

A

serum creatinine and urea

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44
Q

what if glomerular filtration rate equivalent to?

A

kidney function (stage 1-5 of chronic kidney disease)

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45
Q

what if glomerular filtration rate equivalent to?

A

kidney function (stage 1-5 of chronic kidney disease)

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46
Q

what % of filtered substance is reabsorbed?

A

99%

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47
Q

how many litres of filtrate does a healthy individual produce each day?

A

180 litres/day

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48
Q

what is the function of the renal corpsule?

A

filtration

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49
Q

what is the function of the renal tubule?

A

reabsorption and secretion (conservation and fine tuning)

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50
Q

what makes up the renal tubule?

A
  • proximal convoluted tubule
  • loop of henle
  • distal convoluted tubule
51
Q

what is the main site of reabsorption in the kidney?

A

proximal convoluted tubule

52
Q

what makes the proximal convoluted tubule ideal for reabsorption?

A
  • very long
  • convoluted to max. surface area
  • lining epithelial cells have microvilli on apical surface
53
Q

what is another name for the peritubular capillaries?

A

vasa recta

54
Q

where does reabsorption occur from?

A

tubule lumen filtrate to peritubular capillary blood

55
Q

where does secretion occur from?

A

peritubular capillary blood to tubule lumen filtrate

56
Q

what is reabsorbed?

A
  • water
  • glucose
  • amino acids
  • urea
  • sodium
  • chloride
  • calcium
  • phosphate
  • potassium
  • bicarbonate
57
Q

what is the only substance not reabsorbed in the renal corpsule?

A

creatinine

58
Q

what is the concentration gradient in the convoluted tubule?

A

high to low
tubule to capillary

59
Q

in the convoluted tubule how much filtrate remain in the tubule lumen after passive diffusion?

A

50%

60
Q

how does the convoluted tubule transport the other 16% of filtrate into the capillaries after passive diffusion?

A

sodium potassium pump
- 1 ATP moves 3 sodium out and 2 potassium in
- everything else follows sodium eg water, glucose, amino acids, chloride and negative ions

61
Q

how much sodium in reabsorbed by the sodium potassium pump?

A

65%

62
Q

how much of the 180l is reabsorbed immediately by the proximal convuluted tubule?

A

120l

63
Q

how much nutrient reabsorption does Na+ transport facilitate?

A

100%

64
Q

where does the remaining 60l of filtrate go from the proximal convoluted tubule?

A

loop of henle

65
Q

what participates in counter-current multiplication?

A

juxtamedllary nephrons

66
Q

what are the different sections of the loop of henle?

A
  • thin descending limb
  • thin ascending limb
  • think ascending limb
67
Q

what does the thin descending limp of the loop of henle contain?

A

aquaporins

68
Q

do the ascending limps of loop of henle contain aquaporins?

A

no therefore they are impermeble to water

69
Q

what part of the loop of henle is permeable to water?

A

permeable

70
Q

where are sodium potassium pumps present in the loop of henle?

A

ascending limbs, water is prevented to follow due to absence of aquaporins

71
Q

what is sodium reabsorption done via?

A

NKCC2 pump on the apical membrane

72
Q

what happens to the conc of sodium in the medulla due to the pump?

A

becomes more salty, which draws water out of the descending limb into the medulla

73
Q

what happens to the water conc in the descending loop on henle?

A

decreases as you descend

74
Q

what happens to the conc of the filtrate in the ascending loop of henle?

A

decreases as you go up

75
Q

where does the reabsorbed water and salt from the loop of henle go?

A

back into the blood stream via the vasa recta

76
Q

what helps maintain the conc gradient of the medulla?

A

counter current exchange in the vasa recta

77
Q

what occurs in the distal convoluted tubule?

A
  • fine-tuning of sodium and water reabsorption
78
Q

what hormones regulate sodium and water reabsorption in the distal convoluted tubule?

A
  • anti-diuretic hormone
  • aldosterone
  • atrial natriuretic hormone
79
Q

what is the function of ADH in the distal convoluted tubule?

A

increases water reabsorption

79
Q

what is the function of ADH in the distal convoluted tubule?

A

increases water reabsorption

80
Q

what is the function of aldosterone in the distal convoluted tubule?

A

promotes Na+ reabsorption

81
Q

what is the function of ANH in the distal convoluted tubule?

A

promotes Na+ secretion

82
Q

what is the concentration of the filtrate when leaving the loop of henle?

A

100 mosm/l (low compared to body- 300)
- therefore filtrate is hypotonic

83
Q

why does water want move out of the distal convoluted tubule?

A

down concentration gradient

84
Q

why can water not move out the distal convoluted tubule?

A

no aquaporins

85
Q

how does ADH increase water reabsorption?

A

it signals to the epithelial cells lining the distal convoluted tubule which respond by adding aquaporins so water can leave

86
Q

what is AVPR2?

A

vasopressin receptor 2
- found on tubule wall

87
Q

how does aldosterone act?

A

on distal and collecting tubules
- upregulates activity and insertion of sodium-potassium pumps and channels

88
Q

what do the functions of ADH and aldosterone both lead to?

A

a small conc urine produced.

89
Q

what is the function of ANP?

A

acts on distal and collecting tubules
- counteracts ADH and aldosteone
- large volume of dilute urine produced

90
Q

how much sodium is reabsorbed in the distal convoluted tubule?

A

8%

91
Q

what is the function of both ADH and aldosterone together?

A

Fluid reabsorption

92
Q

What are the signals which initiate the hormones in the kidney?

A

Changes in blood pressure

93
Q

What are the factors which influence glomerular filtration rate?

A

-glomerular hydrostatic pressure
-capsular hydrostatic pressure
-glomerular osmotic pressure
-systemic blood pressure
-renin-angiotensin-aldosterone system
-disease

94
Q

how is excretion calculated?

A

(filtration - reabsorption) + secretion

95
Q

What is the juxta-glomerular apparatus?

A

The ball of cells which connects the distal convoluted tubule with the glomerulus which measures and responds to changes in sodium ion concentration of the filtrate

96
Q

what are the macula dense?

A
  • found where the distal convoluted tubule interacts with the glomerus and afferent arteriolar
  • small group of specialised epitheliul cells
  • measure and respond to changes in sodium concentration
97
Q

what are the juxtaglomerular cells?

A
  • modified smooth muscle cells
  • can adjust diameter of afferent arteriolar by vasoconstriction or vasodilation
  • talk directly to macula densa cells
98
Q

what are the mesangial cells?

A
  • extra or intro
  • supporting cells
99
Q

what do the macula densa cells do when Na+ is in homeostasis ?

A

Don’t send any signals to the juxtaglomerular cells

100
Q

Describe the sequence of steps which occur after an increase in blood pressure (tubuloglomerular feedback)

A
  • increase in glomerular hydrostatic pressure
  • increase in glomerular filtration rate
  • increase in sodium ion filtrate concentration
  • sodium and water flow into macula densa cells which expand
  • this release adenosine from macula densa cells
  • adenosine tells the juxtaglomerular cells to vasoconstrict the afferent arteriolar
  • this helps protect glomerular capillaries from blood pressure fluctuations
  • glomerular hydrostatic pressure decreases
  • return to homeostasis
101
Q

What do the macula densa cells release after a decrease in blood pressure?

A

prostaglandins

102
Q

what do the juxtaglomerular cells release on affect of prostaglandins?

A

renin

103
Q

describe the renin-angiotensin system’s function to restore blood pressure

A
  • angiotensin is released into circulation by the liver
  • renin converts angiotensin into angiotensin 1
  • angiotensin converting enzyme converts angiotensin 1 into angiotensin 2
    -angiotensin 2 is a potent vasoconstriction which increases blood pressure
104
Q

where is angiotensin produced and released?

A

the liver

105
Q

what is the problem with the renin-angiotensin system?

A

it’s only short term as not enough blood fluid volume

106
Q

what is the solution to the short term renin-angiotensin system?

A

renin angiotensin-aldosterone system

107
Q

describe the renin angiotensin-aldosterone system

A

-angiotensin 2 binds target receptors o:
arterioles causing constriction
hypothalamus causing thirst
pituitary gland causing ADH release
adrenal medulla causing aldosterone release
- blood volume is restored via increased fluid and salt retention

108
Q

What does the atrial natriuretic peptide hormone counteract?

A

The renin antidioretic aldosterone system

109
Q

Now does ANP counteract RAAS?

A
  • ANP released from heart from decrepit on of increased blood pressure in baroreceptors
110
Q

What is the anti- diuretic hormone also known as?

A

Vasopressin

111
Q

What is the overall goal of hormones; anti-diuretic hormone, aldosterone and atrial naturetic peptide ?

A

Homeostatic regulation of blood pressure and volume

112
Q

What happens to glomerular filtration rate as kidney disease increases?

A

Decreases

113
Q

What are the consequences of chronic kidney disease?

A
  • inadequate removal of fluid and waste products of metabolism
  • inappropriate activation of RAAS
114
Q

why does kidney disease lead to activation of RAAS?

A
  • the low glomerular filtration is mistaken as being due to low blood pressure
  • RAAS pathway activated inappropriately
  • leads to hypertension
  • leads to cardiovascular disease
115
Q

What is a significant risk factor for kidney disease and cardiovascular disease?

A

Diabetes

116
Q

What are causes of chronic kidney disease?

A

X hypertension
- diabetes
- high cholesterol
- kidney infection
- glomerulophritis
- polycystic kidney disease
- kidney stones
- long term use of NSAIDS

117
Q

what are symptoms of chronic kidney disease?

A
  • hypertension
  • nausea
  • oedema in ankles hands and lungs
  • blood/protein in urine
  • amaemia
  • weak/painful bones
118
Q

How can hypertension be regulated?

A
  • diet reduced salt
  • anti-hypertensive treatment combinations
  • diuretics
  • ACE inhibitors / angiotensin receptor blockers
  • aldosterone agonists
119
Q

What does furosemide target?

A

NKCC2 (sodium reabsorption )

120
Q

What is the function of kidney dialysis?

A
  • artificial removal of waste, solutes, water and toxins from blood
121
Q

What are the two types of dialysis?

A

Haemodialysis
Peritoneal dialysis

122
Q

Describe haemodialysis?

A

Removing blood to cleaning blood and returning it back to the body

123
Q

Describe peritoneal dialysis

A

In peritoneal cavity of abdomen
(Can be done at home)

BDS1 BAMS human systems (47 decks)

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