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BHSC 2203 - Patho > Unit 11 - Renal Structure and Function > Flashcards

Unit 11 - Renal Structure and Function Flashcards

1
Q

Why is the right kidney slightly lower than the left?

A

B/c the liver is mostly on the right side

- give the liver more room

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2
Q

True or False:

Kidneys are not protected by the peritoneal membrane

A

True

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3
Q

What are the kidneys protected by?

A

Two fatty tissue layers

= “renal fat pad”

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4
Q

What are the two functions of the “renal fat pads”?

A
  1. Holds up the kidneys in the abdominal cavity (so they don’t drop and cut off blood vessels)
  2. Protection
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5
Q

What happens during anorexia nervosa?

A

Overall fat is reduced in the body - including the “renal fat pads”!
- Kidneys drop and blood supply can be cut off

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6
Q

Where will pain be felt if there is inflammation of the kidneys?

A

Flank pain

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7
Q

What percentage of body mass makes up the kidneys? What percentage of cardiac output do they receive?

A

0.4% of body mass
22% of cardiac output!
- this is 55x more blood then they are entitled to receive based on size and weight

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8
Q

Why do the kidneys receive so much blood (cardiac output)?

A

B/c their role is to filter blood ….

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9
Q

What happens if the cortex layer of the kidney become thin?

A

There will be less filtering

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10
Q

What is the main function of the kidneys?

A

Filters blood plasma, eliminates waste, and returns useful substances to the blood

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11
Q

What do the kidneys secrete to regulate the number of RBCs in circulation?

A

Erythropoietin

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12
Q

What do the kidneys secrete to regulate blood pressure and electrolyte balance?

A

Renin

- activates angiotensin II

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13
Q

What do the kidneys excrete (8)?

A
  • Urea
  • Metabolic wastes
  • Toxins
  • Drugs
  • Hormones
  • Salts
  • H+
  • Water
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14
Q

What does it mean if there is a high level of creatinine in blood circulation?

A

The kidneys aren’t functioning properly

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15
Q

What are the three main functions of the nephron?

A
  1. Filter
  2. Reabsorb
  3. Secretion
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16
Q

Why does the afferent arteriole have a wider diatmeter than the efferent arteriole?

A

Helps to maintain higher pressure in the renal corpuscle

- big input and small output (big artery, small vein)

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17
Q

What is important to note about the filtration at the renal corpuscle?

A

It is non-selective

- only BIG things won’t be filtered (proteins/lipids)

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18
Q

What are the three forces involved in creating filtration pressure in the renal corpuscle?

A
  1. Blood hydrostatic pressure
  2. Colloid osmotic pressure
  3. Capsular pressure
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19
Q

What is the average blood hydrostatic pressure normally?

A

60 mmHg (out)

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20
Q

What is the average colloid osmotic pressure normally?

A

32 mmHg (pushing back)

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21
Q

What is the average capsular pressure normally? Describe what this pressure is.

A 
18 mmHg (pushing back)
- fluid that has collected in the capsule
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22
Q

What is the overall net filtration pressure of the renal corpuscle (glomerus)

A

10 mmHg (out)

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23
Q

What are 5 things that can decrease blood hydrostatic pressure?

A
  1. Shock
  2. Reduced systemic blood pressure
  3. Reduced perfusion of the kidneys
  4. Hemorrhage (decreased blood volume)
  5. Atherosclerosis (obstruction of renal arteries by plaque)
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24
Q

What happens to urine production if colloid osmotic pressure decreases?

A

Increase in urine production

- there would be less force opposing blood hydrostatic pressure

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25
Q

What would cause the colloid osmotic pressure to decrease?

A

If the liver wasn’t functioning well

- fewer blood proteins = lower colloid osmotic pressure

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26
Q

What happens to urine production and capsular pressure if there is an obstruction in the collecting ducts?

A

Obstruction = MORE fluid is going to collect
- increase the (-) number of capsular pressure
- more pressure will oppose blood hydrostatic pressure
= LESS urine output

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27
Q

What is the GFR?

A

Glomerular filtration rate

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28
Q

What is the average GFR for a male?

A

125 mL/min

= 180 L/day

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29
Q

What is the average GFR for a female?

A

105 mL/min

= 150 L/day

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30
Q

What happens to urine output if there is an increase in GFR? What could it result in?

A

Urine output rises

- could result in dehydration and electrolyte depletion

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31
Q

What happens if there is a decrease in GFR?

A

Wastes accumulate

- Azotemia is possible

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32
Q

What is Azotemia?

A

Excess ammonia levels in blood

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33
Q

What are the three mechanisms that regulate GFR?

A
  1. Autoregulation
  2. Sympathetic control
  3. Hormonal mechanism
34
Q

Where are juxtaglomerular cells located?

A

Around the afferent arteriole

35
Q

What is the role of juxtaglomerular cells?

A

Monitors the level of stretch in the afferent arteriole

- sensitive to vasomotor changes (vasomotion)

36
Q

What are the two types of cells in the kidneys that play a role in autoregulation?

A
  1. Juxtaglomerular cells

2. Macula densa cells

37
Q

How do the kidneys respond if there if an increase in blood pressure?

A

Increase in BP = increase in GFR
- therefore, the kidneys will constrict the afferent arteriole and dilate the efferent arteriole
= results in decrease in GFR

38
Q

How do the kidneys respond if there is a decrease in blood pressure?

A

Decrease in BP = decrease in GFR
- therefore, the kidneys will dilate the afferent arteriole and constrict the efferent arteriole
= results in an increase in GFR

39
Q

What happens to electrolytes if there is an increase in BP or GFR?

A

Increase loss of electrolytes

- this is why the kidneys will try to decrease the GFR

40
Q

What happens to wastes if there is an decrease in BP or GFR?

A

Wastes accumulate

- this is why the kidneys will try to increase the GFR (to increase the amount of waste being excreted)

41
Q

At what blood pressure range will the kidneys stop auto-regulating?

A

< 80 mmHg
> 170 mmHg
- they cannot compensate for extreme blood pressure

42
Q

What do macula densa cells detect?

A

Amount of sodium being excreted

43
Q

True or False:
When high levels of sodium are being excreted and detected by macula densa cells, there will be a constriction of the afferent arterioles

A

True

  • means that GFR is too high
  • too much is being lost in the urine
  • kidneys will reduce GFR to reduce loss of electrolytes
44
Q

Describe the steps involved in the hormonal control of GFR?

A
  1. Blood loss
  2. Drop in BP
  3. Kidneys release renin
  4. Renin acts on angiotensinogen
  5. Forms angiotensin I
  6. Converted to angiotensin II in the lungs by ACE
  7. Angiotension II is a vasoconstrictor - increases blood pressure
45
Q

Angiotensin II ONLY acts on which arteriole in the kidneys? Why?

A

EFFERENT arteriole

  • to increase GFR
  • increase filtration of wastes
46
Q

Since angiotensin II is a vasoconstrictor (increase GFR = increase urine production), how does this increase blood pressure?
[Since angiotensin II is released b/c of a DROP in blood pressure]

A

Remember that angiotensin II also causes the adrenal cortex to release aldosterone
- aldosterone causes the kidneys to retain sodium + water
= INCREASE in blood pressure

47
Q

Why does angiotensin II only affect the efferent and not the afferent arterioles?

A

Receptors are present on the efferent but NOT on the afferent arterioles

48
Q

What are the effects of angiotensin II on the kidneys?

A
  1. Causes constriction of efferent arteriole
  2. Increases GFR and filtration
  3. Tubular reabsorption increases
  4. Urine volume is LESS but the concentration of urine is HIGH
49
Q

How do the kidneys control water loss when the patient is dehydrated?

A

Dehydration triggers ADH secretion (from posterior pituitary)

50
Q

What effect does ADH (anti-diuretic hormone) have on the kidneys?

A

Increases permeability of aquaporin channels

  • increases water permeability of collecting ducts
  • MORE water is REABSORBED
  • urine is more concentrated
51
Q

What does alcohol do to ADH?

A

Interferes with secretion and action of ADH

- therefore, you will pee more

52
Q

What happens if a patient is over-hydrated?

A
  • inhibition of ADH secretion
  • reduced water re-absorption by collecting ducts
  • water remains in urine
    (more volume, less concentrated)
53
Q

What gives urine it’s colouring?

A

Bilirubin (urochrome)

- breakdown product of RBC destruction

54
Q

What happens the odor of urine, if there is urine stasis?

A

Bacteria degrade urea to ammonia

= therefore, strong ammonia smell

55
Q

What could cause a patient to have a higher density of urine (3)?

A
  • dehydrated
  • too much albumin in urine
  • too much glucose in urine
56
Q

What is the normal range for urine density?

A

1.001 - 1.028

57
Q

What is the range of urine osmolarity?

A

50 mOsm/L - 1200 mOsm/L (dehydrated)

58
Q

What is the normal pH of urine?

A
  1. 5 - 8.2

- normally 6

59
Q

What are two common tests run on the kidneys to determine proper functioning?

A
  1. Creatinine

2. BUN (blood urea nitrogen)

60
Q

What is the normal volume of urine excreted in a day?

A

1 - 2 litres

61
Q

What is the urine volume excreted if the patient has polyuria?

A

> 2 litres/day

62
Q

What is the urine volume excreted if the patient has oliguria?

A

< 500 mL/day

63
Q

What is the urine volume excreted if the patient has anuria?

A

0 - 100 mL/day

64
Q

What is the main cause of concern in patient that have oliguria and anuria?

A

Don’t have sufficient excretion of wastes

65
Q

What is the effect of diuretics (2)?

A
  1. Increase urine output

2. Decrease blood volume

66
Q

What are diuretics used for (2)?

A
  1. Hypertension

2. Congestive heart failure

67
Q

What are the two mechanisms of action of diuretics?

A
  1. Increase GFR

2. Decrease tubular reaborption

68
Q

What is the function of the ureters?

A

Pass urine from kidneys to bladder

69
Q

What is the capacity of the bladder?

A

Moderately full = 500 mL

Max = 800 mL (approx)

70
Q

Describe the differences in the two urinary sphincters.

A
  1. Internal = smooth muscle and involuntary

2. External = skeletal muscle and voluntary

71
Q

At what volume of urine do we feel the urge to urinate?

A

Approx 200 mL

72
Q

Why is the female bladder more prone to infection than the male bladder?

A

Females have shorter urethras

- shorter distance for bacteria to travel

73
Q

How long is the female urethra?

74
Q

How long is the male urethra?

75
Q

What are the three regions of the male urethra?

A
  1. Prostatic
  2. Membranous
  3. Spongy
76
Q

Describe the micturition reflex

A
  1. 200 mL of urine in bladder
  2. Stretch receptors send signals to spinal cord
  3. Parasympathetic reflex arc from spinal cord stimulates contraction of detrusor muscle
  4. Relaxation of internal urethral sphincter
77
Q

What does the valsalva maneuver aid in?

A

Expulsion of urine by increasing pressure on the bladder

78
Q

What are the effects of aging on the renal system (4)?

A
  1. Declining number of functional nephrons
  2. Reduced glomerular filtration
  3. Reduced sensitivity to ADH
  4. Problems with micturition reflex (retention or incontinence)
79
Q

What happens to an aging patient if they have a declining number of functional nephrons?

A
  • less ability to filter
  • less ability to reabsorb
  • less ability to regulate the concentration of blood
    = HIGH risk of TOXICITY
80
Q

What happens to an aging patient if they have a reduced sensitivity to ADH?

A

Less capable of reabsorbing water

- urine volume will be increased

BHSC 2203 - Patho (13 decks)

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