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Year 1 NME > The Kidney and Renal Function > Flashcards

The Kidney and Renal Function Flashcards

1
Q

What are the 2 main functions of the urinary system?

A

1 - urine excretion from kidneys

2 - urine elimination

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2
Q

What are the 2 organs in the body that control acid-base balance?

A

1 - kidneys

2 - lungs

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3
Q

How do the kidneys control water and electrolyte balance?

A
  • able to filter electrolytes (Na+, K+, Ca2+, Cl- and HCO3-)
  • H2O works on the basis of osmosis, especially Na+
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4
Q

What 2 main things do the kidneys excrete from the body?

A

1 - drugs and their metabolites

2 - endogenous waste products

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5
Q

The kidneys have an endocrine function, meaning they produce and secrete hormones. What do the following hormones conribute to in the body?

  • erythropoietin
  • renin
  • prostaglandins
  • active vitamin D
A
  • erythropoietin = RBCs production and maturation
  • renin = BP control
  • prostaglandins = BP and H2O concentration
  • active vitamin D = bone metabolism
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6
Q

The kidneys are important in regulation of water and electrolyte balance. If the kidneys do not function properly, what can happen?

A
  • body has inability to maintain salt and water balance
  • electrolyte abnormalities
  • water retention/fluid overload
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7
Q

The kidneys are important in regulation of acid-base balance. If the kidneys dont function properly, what can this cause?

A
  • acid-base imbalance
  • metabolic acidosis
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8
Q

The kidneys are important in excretion of drugs and their metabolites. If the kidneys dont function properly, what can this cause?

A
  • drug toxicity
  • dosing is very important in patients with kidney disease
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9
Q

The kidneys are important in the excretion of endogenous waste products. If the kidneys dont function properl what can this cause?

A
  • accumulation of toxins
  • uraemia = high urea and other nitrogenous compounds in blood, which can eventually kill patients
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10
Q

The kidneys are important in hormone production and secretion. If the kidneys dont function properl what can this cause?

A
  • anaemia due to renal disease (RBCs not produced)
  • BP problems due to renin secretion
  • vitamin D deficincies causing bone loss and fragile bones
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11
Q

What is end stage renal disease?

A
  • last stage of chronic kidney disease
  • can cause death
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12
Q

End stage kidney failure can present acutely or chronically. What is the definition of acute kidney injury?

A
  • days or weeks
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13
Q

End stage kidney failure can present acutely or chronically. What % of patients present with acute kidney injury?

A
  • 10%
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14
Q

End stage kidney failure can present acutely or chronically. What % of patients present with chronic kidney injury?

A
  • 90%
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15
Q

End stage kidney failure can present acutely or chronically. What is classified as chronic kidney injury?

A
  • months/years to develop
  • patients are often asymptomatic
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16
Q

End stage kidney failure can present acutely or chronically. In severe cases how is renal function supplemented?

A
  • dialysis
  • kidney transplant
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17
Q

What are the 2 layers of the kidney?

A

1 - cortex (outer layer)

2 - medulla (inner layer)

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18
Q

Where is the majority of work performed in the kidneys? Is it the cortex or medulla?

A
  • cortex
  • this is where the nephrons are
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19
Q

At what age does our kidney function begin to decline, what roughly how many nepherons a year do we lose?

A
  • _>_50
  • lose around 10,000/y
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20
Q

In the image below, there are the 5 main sections of the nepherons:

1 - glomerulus (Renal corpuscle)

2 - proximal tubule (PT)

3 - loop of Henle (LOH)

4 -distal tubule (DT)

5 - collecting duct (CD)

A

1 - glomerulus (Renal corpuscle) = B

2 - proximal tubule (PT) = A

3 - loop of Henle (LOH) = C

4 -distal tubule (DT) = D

5 - collecting duct (CD) = E

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21
Q

If babies are born prematurely, how can this affect the kidneys?

A
  • lower number of nepherons
  • more likely to develop kidney disease
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22
Q

Where is the proximal tubule of the kidneys located within the kidneys?

A
  • proximal = close to centre
  • wraps around glomerulus
  • located in the cortex
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23
Q

The proximal tubule of the kidneys wraps around glomerulus in the cortex and then continues onto what?

A
  • loop of henle
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24
Q

Where is the loop of henle in the kidney and what are the 2 parts called?

A
  • connects to proximal tubules
  • has descending and ascending regions
  • located in the medulla
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25
Q

What does the ascending loop of henle attach to in the kidneys?

A
  • the distale conveluted tubules
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26
Q

Where is the distale conveluted tubule in the kidney?

A
  • connects to the ascending loop of henle and runs close to the glomerulus
  • then connects to the collecting ducts
  • this connects and drains into the medulla
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27
Q

What is the glomerella filtration rate?

A
  • how much filtrate is made per minute
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28
Q

What are the 2 types of nepheron, and which is more abundant?

A
  • cortical = 70-80% of all nepherons
  • juxtaglomerular
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29
Q

There are 2 types of nepheron, the cortical and the juxtaglomerular. Where are these located in the kidney?

A
  • cortical = deep cortex
  • juxtaglomerular = close to medulla
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30
Q

There are 2 types of nepheron, the cortical, which is in the deep cortex and the juxtaglomerular, which is in the cortex, but close to medulla. What is major structural differenc between the nepherons?

A
  • cortical = short loop of henle and smaller glomerulus
  • juxtaglomerular = long loop of henle and larger glomerulus
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31
Q

The filtrate that leaves the collecting ducts at the tips of the renal pyramids enters whats?

A
  • renal papilla
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32
Q

The filtrate that leaves the collecting ducts at the tips of the renal pyramids enters the renal papilla. Why is this site important in relation to drugs?

A
  • common site of drug-induced nephrotoxicity
  • called renal papillary necrosis
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33
Q

What is the main blood supply to the kidneys?

A
  • renal artery
34
Q

As the kidneys are highly vascularised they recieve 20-25% of cardiac output. How much of this is used in the renal cortex for maintaining the highly active tubular cells?

A
  • 90%
35
Q

Once the renal artery enters the kidneys, what do they divide into?

A
  • segmental arteries
36
Q

Once the renal artery enters the kidneys, they divide into segmental arteries. What do these then divide into?

A
  • into the interlobar arteries
  • these run either side of the renal pyramids
37
Q

Once the renal artery enters the kidneys, they divide into segmental arteries, and then into the interlobar arteries which run either side of the renal pyramids. What do these then form?

A
  • arcuate arteries
  • located at border or medulla and cortex
38
Q

Once the renal artery enters the kidneys, they divide into segmental arteries, and then into the interlobar arteries which run either side of the renal pyramids. They then form arcuate arteries which transcend lthe border or medulla and cortex. What do the arteries then divide into?

A
  • interlobular ateries
  • ends just inside the capsule
39
Q

Once the renal artery enters the kidneys, they divide into segmental arteries, and then into the interlobar arteries which run either side of the renal pyramids. They then form arcuate arteries which transcend lthe border or medulla and cortex. The arteries then divide into the interlobular ateries, which end just inside the capsule. On their route to the capsule what comes off the interlobular arteries?

A
  • afferent arterioles
  • these filter blood into the glomerulus
40
Q

Onc the blood has been filtered by the glomerulus and has passed around the nepheron, what drains the blood that ultimately ends up in the inferior vena cava?

A
  • interlobular vein
  • blood follows same route as the arteries
41
Q

The cortical nepherons, which have a short loop of henle have blood enter the glomerulus via afferent arterioles, which then leave the glomerulus via efferent arterioles. What then happens to this blood before it is collected by interlobular veins?

A
  • enters the peritubular capillaries
  • tiny blood vessels that wrap around the tubules
  • this is where absorption and secretion occur
42
Q

The juxtaglomerular nepherons, which have a long loop of henle and a much larger glomerulus have blood enter the glomerulus via afferent arterioles, which then leave the glomerulus via efferent arterioles. To accomadate the longer loop of henle, what runs alongside the juxtaglomerular nepherons?

A
  • vasa recta
43
Q

There are 2 types of nepheron in the body, the cortical and the juxtaglomerular nepherons. What is the primary role of each of these nepherons?

A
  • cortical = regulatory and excretory function
  • juxtaglomerular = concentrate or dilute urine
44
Q

How does the sympatheitc nervous system inervate the kidneys?

A
  • through the sympatheitc trunk and coeliac ganglia
45
Q

The sympatheitc nervous system inervate the kidneys through the sympatheitc trunk and coeliac ganglia. What parts of the kidneys are innervated and what generally occurs when stiumulated?

A
  • supplies arteries, afferent and efferent arterioles and granular cells
  • reduces blood flow during fight or flight
46
Q

How does the para-sympatheitc nervous system inervate the kidneys?

A
  • via the vagus nerve
  • ganglion located in the hilum
47
Q

The para-sympatheitc nervous system inervate the kidneys through the vagus nerve and the ganglion in the hilum. What does this innervate in the kidneys, and what is the result of innervation?

A
  • efferent arterioles
  • modify glomerular filtration rate (GFR) and renal blood flow (RBF)
48
Q

The afferent arterioles enter the glomeruls and form what inside?

A
  • around 40 loops
49
Q

The afferent arterioles enter the glomeruls and form around 40 loops. This is contained within what?

A
  • bowmans capsule
50
Q

Around the capillaries in the glomerulus is the bowmans capsule. Surrounding the capillaires is interstial space. Why is this interstitial space important?

A
  • site of production for hormones
  • erythropoetin and prostaglandin produced here
51
Q

Around the capillaries in the glomerulus is the bowmans capsule. Surrounding the capillaires is the interstial space, which is where hormones including erythropoetin and prostaglandin are produced and secreted. There is another type of cell here that secretes renin, what is this cell called?

A
  • juxtaglomerular cells
52
Q

The afferent arterioles enter the glomerulus and and are filtered. What type of capillary facilitates this filtration?

A
  • fenestrated capillaries
53
Q

Fenestrates capillaires faciltate filtration at a blood vessel level. What is the next layer that facilitates filtration?

A
  • glomerula basement membrane
  • made of collagen and glycoproteins
54
Q

Fenestrates capillaires faciltate filtration at a blood vessel level. Beyond this there is a epithelial cells, which secretes collagen and glycoproteins called the glomerula basement membrane. Beyond this is a specialised epithelial cell type, what is this called?

A
  • podocytes
55
Q

Fenestrates capillaires faciltate filtration at a blood vessel level. Beyond this there is a epithelial cells, which secretes collagen and glycoproteins called the glomerula basement membrane. There is s a specialised epithelial cell type, called podocytes that wrap around the the glomerules basement membrane. This only allows filtration of what size molecules?

A
  • <60KDa
56
Q

There are 3 layers that failiate filtration of the capillaries in the glomerules, what are they?

A

1 - fenestrates capillaires

2 - epithelial cells, secreting collagen and glycoproteins

3 - specialised epithelial cell type, called podocytes

57
Q

There are 3 layers that failiate filtration of the capillaries in the glomerules, including

1 - fenestrates capillaires

2 - epithelial cells, secreting collagen and glycoproteins

3 - specialised epithelial cell type, called podocytes

This facilitates electrolytes and H2O to flow through, but are proteins able to pass through?

A
  • almost none
58
Q

The are 3 layers that failiate filtration of the capillaries in the glomerules, including

1 - fenestrates capillaires

2 - epithelial cells, secreting collagen and glycoproteins

3 - specialised epithelial cell type, called podocytes

In addition there is a specialised cells that is important, what is this called and what is its function?

A
  • mesangial cells in centre of glomerulus
  • posses phagocytic capabilities
  • clearing antigen-anrtibody complexes
59
Q

Mesangial cells are located in the centre of glomerulus in the capillary loops. These cells posses phagocytic capabilities and are able to clear antigen-anrtibody complexes. If they are stiumlated by the release of sngiotensin II and anti-diuretichormone, what does this cause?

A
  • mesangial cells contract
  • GFR is reducing due to reduced filtration surface area
60
Q

What is diffusion?

A
  • solvent or solutes moves based on concentration gradient
  • only move if semi-permeable membrane (SPM) permits this
  • in the kidney thr SPM is the glomerulus
61
Q

What is osmosis?

A
  • water moves by concentration gradient
  • only move if semi-permeable membrane (SPM) permits this
  • in the kidney thr SPM is the glomerulus
62
Q

What is ultrafiltration?

A
  • solution moves by pressure gradients
  • only move if semi-permeable membrane (SPM) permits this
  • in the kidney thr SPM is the glomerulus
63
Q

What are the 3 major functions of the nepheron?

A

1 - filtration = blood is filtered creating a filtrate

2 - resabsorption of H2O, ions and organic nutrients from filtrate

3 - secretion of waste products into tubular fluid

64
Q

In the tubules of the kidney, there can be transcellular and paracellular transport. What is transcellular transport?

A
  • transport through channels can be passive or active
  • many passive processes are secondary to active transport processes and require ATP
65
Q

In the tubules of the kidney, there can be transcellular and paracellular transport. What is paracellular transport?

A
  • para = to the side
  • movement of solute or solvents between tight junctions between cells
  • movement driven by concentration (osmotic or electrical gradients)
66
Q

Filtration of blood into urine begins in the glomerular. There is a good blood flow and pressure so small molecules less than 60kDa can be filtered. What is generally filtered at the glomerular?

A
  • electrolytes
  • amino acids
  • glucose
  • metabolic waste
  • some drugs, metabolites
67
Q

Filtration of blood into urine begins in the glomerular. There is a good blood flow and pressure so small molecules less than 60kDa can be filtered. What molecules that are larger than 60kDa are unable to be filtered at the glomerular?

A
  • RBCs
  • lipids
  • proteins
  • most drugs, metabolites
68
Q

What 2 things is filtration in the capillaries of the glomeral dependent on?

A

1 - blood pressure at capillary level

2 - renal blood flow

69
Q

Filtration in the capillaries of the glomeral is dependent on blood pressure in the afferent capillaires and renal blood flow. But even if these are optimal what 3 things must the filtrate pass through?

A

1 - pores in the fenestrated capillaires

2 - glomerula basement membrane of Bowman’s capsule (includes contractile mesangial cells)

3 - specialised epithelial cells of Bowman’s capsule called Podocytes

70
Q

What is the normal filtration pressure in the bowmans capsule?

A
  • 10mmHg
71
Q

Glomerular Filtration Rate (GFR) is the rate at which the glomerulas filter blood per minute. What is the normal GFR and what is it used for?

A
  • 125 mL/min which is equal to 180 L/day
  • measusre or renal function
  • used to identify renal function in disease
72
Q

The normal GRF is 125 mL/min which equals 180 L/day. Does this change, even when you have drastic changes in blood pressure?

A
  • no
73
Q

Following filtration by the glomerulas, the tubules of the nepherons are responsible for reabsorption. What % of electrolytes, H2O and nutrients is reabsorbed by the renal tubules?

A
  • 99%
74
Q

How can electrolytes be reabsorbed into the tubules of the kidneys?

A
  • concentration gradients
  • chemical gradients
75
Q

In addition to electrolytes being reabsorbed into the tubules of the kidneys by concentration and chemical gradients, how else can they be reabsorbed?

A
  • active and passive transport
  • such as glucose with Na+
76
Q

How is H2O reabsorbed into the tubules?

A
  • passively along the osmotic gradient created by solute (Na+)
  • re-uptake is via aquaporins
77
Q

Glucose is reabsorbed into the tubules in the kidneys. Where in the tubules does the majority of this take place?

A
  • proximal conveluted tubules
78
Q

Some solutes require ATP to be reabsorbed. What is an example of one of the most commonly used channels?

A
  • Na+ / K+ ATPase pump
79
Q

Some endogenous substances and drugs cannot be filtered at the glomerulus due to size or protein binding. Therefore they are secreted into the tubules using what, and where does this commonly happen?

A
  • pumps
  • proximal conveluted tubule
80
Q

Some endogenous substances and drugs cannot be filtered at the glomerulus due to size or protein binding. Therefore they are secreted into the tubules using what pumps generally in the proximal conveluted tubules. What are the 2 types of pumps used?

A
  • organic acids or drugs (e.g. uric acid, diuretics, antibiotics – e.g. penicillin)
  • organic bases or drugs (e.g. creatinine, procainamide)

Year 1 NME (61 decks)

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