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ESA3 > Urinary 1 - Anatomy + GFR > Flashcards

Urinary 1 - Anatomy + GFR Flashcards

1
Q

Describe the position of the kidneys, in regards to vertebral levels:

A

T12 –> L2/3

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2
Q

What is the approx. length, width and thickness of a kidney?

A 
Length = 12 cm
Width = 6 cm
Thickness = 3 cm
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3
Q

What is the approx. weight of a kidney?

A

150g

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4
Q

Describe the relation of the uterus to the bladder:

A

Uterus lies superior and posterior to the bladder

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5
Q

What is the approx. length of the urethra?

A 
Males = 20 cm
Females = 4 cm
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6
Q

Describe the anatomical course of the ureter:

A
  • Descends down abdomen along anterior surface of psoas major
  • Cross pelvic brim into pelvic cavity, anteriorly crossing bifurcation of common iliac arteries
  • Down lateral pelvic walls, turning anteromedially at ischial spine level
  • Pierce bladder poster-laterally and obliquely
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7
Q

What is the approx. length of a ureter?

A

25 cm

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8
Q

What type of epithelium lines the ureters?

A

Transitional epithelium

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9
Q

What arteries supply the ureters? (divide into upper, middle and distal regions)

A

Upper - Renal artery, branches of Gonadal artery and Abdominal aorta
Middle - Common iliac artery and Gonadal artery
Distal - Branches of Common + Internal iliac arteries, and Uterine (Females) / Superior vesicle (Males)

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10
Q

Explain the saying ‘water under the bridge’, and its surgical significance:

A

Ureters run underneath the uterine arteries 2 cm superior to the ischial spine (Females only)
Must take care not to damage during hysterectomy

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11
Q

Which kidney lies slightly lower in the abdomen, and why?

A

Right kidney lies slightly lower, due to Liver pushing it down.

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12
Q

Describe the position of the bladder in regards to the pubic bone and pubic symphysis:

A

Lies posterior to pubic bone and pubic symphysis

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13
Q

What shape is the bladder when empty?

A

Tetrahedron

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14
Q

What shape is the bladder when full?

A

Spherical

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15
Q

What is the trigone of a bladder?

A

Area of smooth mucosa (no rugae) between the ureteric openings and the urethra.
Very sensitive to stretch - sends signals to brain when stretched to a certain degree.

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16
Q

What is the Median Umbilical Ligament, and what area of the bladder does it attach to?

A

Fibrous remnant of the Urachus and Fetal Allantois, located on the anterior abdominal wall.
Extends from APEX OF BLADDER to umbilicus.

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17
Q

What is the name of the ligament which attaches the apex of the bladder to the umbilicus?

A

Median umbilical ligament

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18
Q

What type of epithelial cells line the bladder?

A

Transitional epithelia

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19
Q

what are the layers of the detrusor muscle?

A 
Inner = longitudinal
Middle = circular
Outer = longitudinal
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20
Q

What is the main function of the transitional epithelia and rugae in the bladder?

A

Allow distension of the bladder without stretching the wall (therefore doesn’t send nerve signals for micturition as soon as urine deposited in the bladder)

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21
Q

What area of the bladder lining does not have rugae?

A

Trigone

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22
Q

What type of muscle is the detrusor muscle?

A

Smooth muscle

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23
Q

Name the region of the kidney which invaginates the medulla:

A

Cortex

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24
Q

What is a renal papilla?

A

Region of the medullary pyramid where urine empties into the minor calyx

25
Q

Name the 4 layers surrounding the kidney, from innermost to outermost:

A

1 - Thick fibrous capsule
2 - Perirenal fat
3 - Renal fascia (encircles kidney and adrenal glands)
4 - Pararenal fat

26
Q

Name the 3 physiological narrowings of the ureter:

A

1 - Ureteropelvic junction
2 - Crossing over iliac vessels
3 - Ureterovesical junction

27
Q

Name the 6 main functions of the Kidney:

A

1 - Regulate most ECF/plasma ions
2 - Maintain H20 balance
3 - Helps maintain body pH
4 - Excrete waste products and foreign components
5 - Produce Erythropoetin and Renin
6 - Convert vitamin D to Calcitriol (regulating plasma calcium and phosphate)

28
Q

Once the Renal arteries have entered the renal hilum, name the arteries they branch into:

A

Segmental arteries

29
Q

What is the name of the arteries which lie either side of every renal pyramid?

A

Interlobar arteries

30
Q

Segmental arteries in the kidneys branch into what arteries?

A

Interlobar arteries

31
Q

Describe the position of Interlobar arteries:

A

Situated either side of every renal pyramid

32
Q

Interlobar arteries branch into which arteries?

A

Arcuate arteries

33
Q

Arcuate arteries branch into which arteries?

A

Interlobular arteries

34
Q

What is the name of the arteries which pass through the cortex, and divide to form afferent arterioles in the kidneys?

A

Interlobular arteries

35
Q

Which renal vein is longer than the other and why?

A

Left renal vein is longer than the right.

  • As IVC lies to the right of the abdominal aorta
  • Allows other veins to drain into it ie Adrenal/Gonadal
36
Q

What is the average renal blood flow / min?

A

1.1 L/min

37
Q

What percentage of blood from the renal artery is filtered at the glomerulus?

A

20%

38
Q

Is the Macula densa located closer to the afferent or efferent arteriole?

A

Afferent arteriole

39
Q

What causes the capillary endothelium to become leaky inside the glomerulus?

A

Podocytes on the visceral layer of the Bowmans capsule make filtration slits

40
Q

Name the 3 filtration barriers in the glomerulus:

A

1 - Capillary endothelium
2 - Basement membrane
3 - Podocyte layer

41
Q

What is the capillary endothelium (within the glomerulus) permeable to?

A
  • Water
  • Salts
  • Glucose
  • Filtrate (via filtration slits)
42
Q

What filtration barrier of the glomerulus prevent anion and protein filtration? How?

A

Basement membrane

- Contains negatively charged glycoproteins which repel anions and proteins

43
Q

What is the maximum radius of a particle which can be filtered at the glomerulus?

A

1.48 nm (Inulin)

44
Q

What forces in the glomerulus contribute to filtration pressure?

A

1 - Hydrostatic pressure in the capillary
2 - Hydrostatic pressure in the Bowmans capsule
3 - Oncotic pressure difference

45
Q

What is the net filtration pressure in the glomerulus?

A

10 mmHg

46
Q

What are the 2 types of autoregulation to maintain GFR?

A

1 - Myogenic response

2 - Tubular-Glomerular feedback

47
Q

How does the myogenic response maintain GFR?

A

If high bp = increase resistance in afferent arteriole

If low bp = increase resistance in efferent arteriole

48
Q

How does Tubular-Glomerular Feedback maintain GFR?

A

Juxtaglomerular apparatus:

  • Macula densa cells detect [NaCl] in distal convoluted tubule
  • -> If too high = stimulates juxtaglomerular cells to secrete Adenosine into efferent arteriole = vasodilation
  • -> If too low =
    1) stimulates juxtaglomerular cells to secrete prostaglandins into afferent arteriole = vasodilation
    2) stimulates juxtaglomerular cells to secrete Renin
49
Q

Where are Macula densa cells located?

A

In the wall of the distal convoluted tubule

50
Q

Where are the juxtaglomerular cells located?

A

In the afferent and efferent arteioles

51
Q

Why would juxtaglomerular cells secrete Adenosine into the efferent arteriole?

A

To cause vasodilation of the efferent arteriole, to decrease GFR

52
Q

Why would juxtaglomerular cells secrete Prostaglandins into the afferent arteriole?

A

To cause vasodilation of the afferent arteriole, to increase GFR

53
Q

What would cause the juxtaglomerular cells to secrete Adenosine into the efferent arteriole?

A

Macula densa cells would stimulate them, after detecting increased [NaCl] in the distal convoluted tubule.

54
Q

What would cause the juxtaglomerular cells to secrete Prostaglandins into the afferent arteriole?

A

Macula densa cells would stimulate them, after detecting a decrease in [NaCl] in the distal convoluted tubule

55
Q

What cells release Renin?

A

Juxtaglomerular cells

56
Q

How is GFR / Renal clearance calculated?

A

([substance in urine] x flow rate of urine) / [substance in plasma]

57
Q

Name an intrinsic and extrinsic substance that may be used to calculate GFR:

A 
Intrinsic = Creatinine
Extrinsic = Inulin
58
Q

What is the normal GFR range?

A 
Males = 115 - 125 ml/min
Females = 90-100 ml/min
59
Q

How is eGFR calculated?

A

{(140-age) x mass x constant (M = 1.23, F = 1.04)} / serum Creatinine

ESA3 (48 decks)

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