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ICS > The Renal System > Flashcards

The Renal System Flashcards

1
Q

what similarities does the renal system share with the GI system?

A
  • excretion of waste
  • absorption of nutrients
  • secretes/influenced by hormones
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2
Q

What are the functional units of the kidney and where are they located?

A
  • Nephron

- renal cortex (outer layer of kidney) mainly

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3
Q

Which hormones act on the kidney to regulate its function?

A

ADH, aldosterone, ANP

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4
Q

what does ANP stand for?

A

atrial natriuretic peptide

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5
Q

difference between the ureter and the urethra?

A

ureter- carries urine from the kidney to the bladder

urethre- bladder to outside

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6
Q

where would you find the cortex in the kidney?

A

outside, around the pyramids

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7
Q

What encapsulates the kidney?

A

renal capsule, further surrounded by adipose

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8
Q

what 3 sections is the kidney broken down into?

A
  • Cortex- ouster layer
  • Medulla - inner layer
  • renal pelvis
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9
Q

what is contained within the cortex?

A

-glomeruli, proximal and distal convoluted tubules

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10
Q

renal corpuscles

A

small units including the glomeruli

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11
Q

how is the cortex of the kidney distinguished?

A

renal corpuscles, each of which consists of a glomerulus surrounded by bowman capsule.
(convoluted tubules are the bulk of the cortex)

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12
Q

in an image of the pyramids what would be the larger tubes/holes and what would be the smaller ones?

A

larger- collecting ducts

smaller-loops of henle

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13
Q

what would you find within the medulla

A

renal pyramids, containing the collecting ducts and loops of henle

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14
Q

What does the pelvis do?

A

major selecting duct for the products of renal filtration (urine)

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15
Q

what is the pelvis made up of?

A

major and minor calyx

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16
Q

what is the renal sinus?

A

the hollow space inside the kidney capsule

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17
Q

which tubule comes first… proximal or distal?

A

Proximal first

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18
Q

where would you find peritubular capillaries and what do they do?

A

surround the nephron tubule

reabsorption and secretion

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19
Q

does each nephron have its own blood supply?

A

yes

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20
Q

where do the nephrons descend from and to?

A

the cortex into the medulla

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21
Q

what are the 2 types of nephrons? and which are there more of?

A
  • cortical nephron (80%)

- juxtamedullary nephron

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22
Q

Cortical nephron

A

mostly in the renal cortex with just the tip in the renal medulla

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23
Q

juxtamedullary nephron

A

just the top in th renal cortex and the body of the loop of hence is in the renal medulla

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24
Q

does the sounding tissue around the loop of hence get more or less salty as you go down?

A

more salty

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25
Q

what are the 4 fundamental mechanisms that take place in the nephron?

A

filtration
reabsoption
secretion
excretion

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26
Q

does the afferent of the efferent arteriole go into the glomerulus?

A

the afferent

alphabetical

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27
Q

explain the glomerulus

A

located in the bowman capsule, uses ultra filtration to produce glomeruli filtrate

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28
Q

what percentage of blood is filtered through the filtration membrane?

A

20%

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29
Q

what parts make up the filtration membrane?

A
  • capillary endothelial fenestrations
  • gel-like basement membrane
  • slit diaphragms within filtration slits between the foot processes (pedicels) of podocytes
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30
Q

what makes up the glomerular filtrate?

A

water, urea, glucose and amino acids

similar to plasma

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31
Q

what percentage of the cardiac output do the kidneys receive?

A

25%

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32
Q

what is the GFR? (definition)

A

the amount of filtrate that forms in BOTH kidneys every minute

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33
Q

what are the average filtration rates?

A

females- 105ml/min (1 litre in 9-10 mins)

males - 125ml/min (1 litre in 8 mins)

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34
Q

what are the average daily volumes of GFR produced?

A

F-150L

M - 180L

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35
Q

how much GFR is reabsorbed

A

98-99%

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36
Q

what can GFR be used to assess?

A

renal function

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37
Q

what does GFR being too high indicate?

A

filtrate passes through the tubes too quickly and can’t be reabsorbed
-diabetes mellitus and diabetes insipidus

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38
Q

what does GFR too low indicate

A

chronic renal failure

waste products not excreted)

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39
Q

GFR can be measured by comparing the plasma and urine concentrations of a substance that is:

A

Freely filtered by the glomerulus
Is NOT reabsorbed nor secreted within the tubules
Is non-toxic and not metabolised by the body

40
Q

what is used (mainly) to measure GFR in humans)

A

insulin

41
Q

why is clearance of creatine less accurate at measuring GFR than insulin?

A

as it is secreted and reabsorbed

42
Q

what id the equation for working out GFR (ml/min)

A

(Conc. of insulin (mg/ml) in urine) X using flow per unit time (ml/min)
/
Conc. of Insulin (mg/ml) in arterial plasma

43
Q

When is ANP released from the atrial wall of the heart?

A

in response to increased blood volume

released during hypertension to help promote increased excretion of water and salts in urine

44
Q

What happens if GFR system in the kidneys fails?

A
  • waste products accumulate in blood (urea, creatine)
  • pH [H+] and electrolyte balance (Na+, K+) jeopardised
  • blood volume control impaired (hypertension, oedema)
45
Q

what is the main control systems for GFR regulation?

A
  • Myogenic autoregulation
  • tubuloglomerular feedback
  • neuronal regulation
46
Q

what does myogenic auto regulation control?

A

constriction/dilation of afferent arteriole in response to changes in blood pressure

-vasodilation in afferent arteriole, increased blood flow, inc. pressure in glom. capillaries, increased GFR

47
Q

what does tubulogglomerular feedback control?

A
  • macula dense cells (specialised cells) in the distal tubule monitor filtered Na+ (flow rate)
  • If filtered Na+/flow rate increases, GFR is decreased
48
Q

what does neuronal regulation control with GFR?

A

sympathetic mediated constriction of afferent arteriole -> decreased GFR

49
Q

does the parasympathetic NS have an effect on the kidneys?

A

no, the parasympathetic NS has no effect on the kidneys (does affect the GI system)

50
Q

What is absorbed within the proximal convoluted tubule?

A
  • essential nutrients reabsorbed back into the blood from the filtrate
  • water (65%), glucose, AAs and electrolytes
51
Q

what does reabsorption of nutrients in the proximal convoluted tubule rely on?

A

secondary active transport of Na+

powered by basolateral Na+/K+ ATPase pumps

52
Q

what secretions take place in the proximal convoluted tubule?

A

H+ and organic ions (acid base balance and waste)

-variable H+ secretion depending on the acid-base balance of the body

53
Q

how is water reabsorbed in the loop of henley? and where

A

passively in the descending part f the loop

54
Q

where is Na+ reabsorbed in the loop of henley and how?

A
  • in the ascending loop

- actively reabsorbed by K+/Na+/2Cl- cotransporters (powered by basolateral Na+/K+ ATPase pumps)

55
Q

How does water being absorbed in the descending and Na+ being absorbed in the ascending loop affect the filtrate leaving the loop of hence?

A

-means that there is a smaller volume of hypotonic filtrate leaving the loop of henle and entering the distal tubule

56
Q

what sort of system gets the maximum amount of fluid moved out of the loop of henle?

A

counter current multiplier system

57
Q

the descending loop of henle

A

Descending limb permeable to water, but not to solutes

Water exits descending limb by osmosis

58
Q

the ascending loop of henle

A

Ascending limb impermeable to water but not to solutes

Na+ (and Cl-) exit ascending limb by active transport

59
Q

which hormone controls further reabsorption of water in the collecting duct?

A

ADH

anti diuretic hormone

60
Q

what do the long loops of henle in the juxtamedullary nephron establish? and why is this important?

A

-vertical osmotic gradient in the renal medulla
-counter current multiplication system
-Permits variable water reabsorption from collecting ducts under control of anti-diuretic hormone (ADH)
(Concentrated urine)

61
Q

where is ADH secreted from?

A

posterior pituitary

62
Q

what does ADH do?

A

increases the permeability of collecting ducts to water by promoting insertion of aquaporins… therefore less urine
-water conservation

63
Q

what is ADH secreted in response to?

A
  • An increase in body fluid osmolality (via osmoreceptors in hypothalamus)
  • A decrease in blood volume/BP (via baroreceptor reflexes)
64
Q

Over hydration… what happens

A
  • Diuresis
  • large volume of dilute urine
  • No water conservation required
  • No ADH released from posterior pituitary
65
Q

Dehydration what happens?

A
  • Water conservation required
  • ADH released from posterior pituitary
  • antidiuresis
  • small volume of concentrated urine produced
66
Q

what is the juxtaglomerular apparatus?

A

A cluster of renal cells located within the walls of the distal convoluted tubule and the afferent arteriole (“next to the glomerulus”)

macula dense cells, juxtaglomerular cells

67
Q

what do macula densa cells decrease GFR in response to?

A

Increased Na+ levels in tubule

Increased sympathetic nervous activity

68
Q

What do Juxtaglomerular cells release renin in response to?

A

A drop in BP within afferent arteriole

Renin activates the renin-angiotensin-aldosterone system to increase BP back to normal

69
Q

how does the JGA monitor and responds to a fall in blood pressure and GFR

A

by activating the renin-angiotensin-aldosterone system (RAAS)

70
Q

macula densa cells

A

regulate GFR in the short-term via tubuloglomerular feedback
Modified epithelial cells
Distal tubule
Monitor filtered Na+ within distal tubule

71
Q

juxtaglomerular cell

A

Modified smooth muscle cells
Afferent arteriole
Secrete renin

72
Q

Renin-Angiotensin-Aldosterone System(RAAS)

A
  • renin released from juxtaglomerular cells in kidney in response to low BP
  • renin act on angiotensinogen which is secreted from the liver
  • angitensinogen is converted to angiotensin I
  • angiotensin I is converted to angiotensin II by angiotensin converting enzyme
  • Angiotensin II is a potent vasoconstrictor and causes release of aldosterone
  • aaldosterone released from the adrenal gland which increases reabsorption of Na+ in the nephron
  • osmosis, increase H2O reabsorption, larger Blood vol. and hence higher BP
73
Q

What other hormone is released by the kidney in response to blood loss?

A

EPO

Erythropoietin

74
Q

what do ADH and RAAS both do?

A

lead to the conservation of water in the body.

75
Q

ADH is a short-tem effector in response to dehydration

A

Increase in plasma osmolarity
Increased body loss of water (sweating during exercise)
Reduced intake of water (thirst centre in hypothalamus)

76
Q

RAAS is a long-term response to decreased ‘Body fluid volume

A

Loss of both water and salt resulting in no change in osmolarity
Injury (blood loss) or illness (prolonged diarrhoea)

77
Q

Atrial natriuretic peptide (ANP)

A

– opposes action of aldosterone and ADH increase excretion of water & Na+ (natriuresis

78
Q

Aldosterone

A

water + Na+ reabsorption; K+ secretion)

79
Q

Parathyroid hormone (PTH)

A

Ca2+ reabsorption)

80
Q

ADH

A

water reabsorption

81
Q

what are the 3 main functions of the urinary system?

A

-regulation, excretion and production

82
Q

what does the urinary system produce?

A

Gluconeogenesis (production of glucose from non carbohydrate sources, i.e. protein)

Production of hormones (i.e. Erythropoietin, renin)

83
Q

what does the urinary system excrete?

A

Removal of metabolic wastes (from the blood, which is excreted into the urine)
Removal of foreign chemicals from the body (pesticides, drugs and food additives)

84
Q

what does the urinary system regulate?

A

water and inorganic ion balance (acid/base)

85
Q

electrolyte imbalance leads to disease

A

K+ conc – reduced by 1/3 of K+ - paralysis – nerves unable to generate AP
Ca2+ conc – reduced by 1/2 - tetanic skeletal muscle contractions

86
Q

where is Na+ largely located?

A

Largely located extracellularly – primary determinant of extracellular fluid volume
Disorders of sodium – think water content!

87
Q

what is hypernatramia?

A
  • Much rarer than hypo

- Always associated with increased plasma osmolarity – potent stimulator of thirst

88
Q

what is Hyponatramia?

A

low levels of sodium in the blood, range of causes that are present with varying blood volumes

89
Q

where is K+ mainly located?

A

Largely located intracellularly – primary determinant of extracellular fluid volume

90
Q

what is hypokalaemia?

A

low levels of K+ in the blood

91
Q

what does hypokalaemia cause?

A

Causes: diuretics, diarrhoea/vomiting, hyperaldosteronism
Majority of deficit is intracellular
Leads to intracellular hyperpolarization (intracellular loss extracellular)
RMP further from threshold potential (muscle weakness)

92
Q

Reason for hyperpolarisation with hypokalaemia-

A

low K outside, creates greater conc gradient with inside, natural leaky K channels are likely to leak ‘more’, thus more K leaves the cell, causing the hyperpolarisation. From researching a little, there appears to be more going on than just this, but was leading me more and more into electrophysiology.

93
Q

Hyperkalaemia

A

high K+ in the blood

94
Q

what does Hyperkalaemia

cause

A

Renal failure, tissue damage, acidosis, aldosterone impairment (spironolactone)
Clinical features – ECG changes, Kussmaul breathing (hyperventilation)
Depolarisation of excitable cells

95
Q

acidosis

A
  • both K+ and H+ compete to be secreted into the urine. When acidosis is present more H+ makes it out and K+ is left behind to contribute to the rise in extracellular K+
96
Q

The depolarisation as a result of hyperkalaemia-

A

high K outside causes an increase in voltage gated Na channel opening in the first instance, which depolarises the cell, then these channels are inactivated once it reaches a certain voltage leading to overall inhibition of the cell.

97
Q

what are the 2 specialised cells determining final K+ secretion? location?

A

principle cells and intercalated cells

-both located in the late DCT and cortical CD

ICS (11 decks)

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