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ESA 3 - Recap > Urinary > Flashcards

Urinary Flashcards

1
Q

State the sodium channels found in:

  1. PCT
  2. Loop of Henle
  3. Early DCT
  4. Late DCT and CD
A
  1. Na-Glucose symporter, Na-H Antiporter
  2. Na-K-2Cl symporter
  3. Na-Cl symporter
  4. ENaC
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2
Q

Where is renin released from? State the 3 factors that affect renin release

A

Released from granular cells of JGA.

3 factors affect release:

1) Reduced NaCL delivery to distal tubule - due to reduced circulating volume
2) Reduced blood flow to kidneys, sensed by baroreceptors in afferent arterioles
3) Sympathetic stimulation to JGA

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3
Q

What is the function of renin?

A

Cleaves angiotensinogen to angiotensin 1

  1. Angiotensin 1 –> Ag2 by ACE
  2. Ag2 vasoconstricts afferent and efferent arterioles, reducing GFR
  3. Ag2 stimulates thirst sensation and aldosterone release from adrenal cortex.
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4
Q

How does aldosterone increase circulating volume?

A

Increases expression of ENaC (in CD and late DCT), apical K channels and Na-K-ATPase.

This results in increase of water reabsorption in the kidneys

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5
Q

State the intracellular and extracellular concentration of:

a) sodium
b) potassium
c) calcium
d) chloride

A

a) i - 15 e - 140
b) i - 140 e - 5
c) i - 0.0001 e - 2.5
d) i - 5 e - 100

mM units

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6
Q

What type of nephrons generate the medullary gradient? Explain how the medullary gradient is generated.

A

Juxtamedullary nephrons. Contain Vasa recta.

  1. Thick ascending loop of Henle removes ions from tubule
  2. This generates a concentration gradient with the vasa reta capillaries absorbing the ions as it descends, making it hypertonic
  3. Hypertonicity used to absorb water from interstitial fluid.
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7
Q

How does ADH concentrate urine?

A
  1. Inserts aquaporin into the late DCT and CD
  2. Increases Urea recycling
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8
Q

How does Urea recycling act to aid the medullary gradient?

A

Urea is reabsorbed from the CD into the interstitial fluid.

Here, urea acts as an osmole and attracts more water from tubules.

Moves back into the ascending limb.

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9
Q

Give the normal pH range of plasma

A

7.38-7.42

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10
Q

Give an example of an aldosterone antagonist diuretic.

A

Spironolactone

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11
Q

Give example carbonic anhydrase inhibitor

A

Acetazolamide

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12
Q

Give the 3 main categories of direct action diuretics and an example in each category

A
  1. Loop diuretics - bumetanide
  2. Thiazide Diuretics - metalozone
  3. K+ sparing diuretics - amiloride
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13
Q

What type of diuretic would you use for glaucoma?

A

Carbonic anhydrase inhibitor

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14
Q

What type of diuretic would you use for cerebral oedema?

A

osmotic diuretic

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15
Q

What type of diuretic would you use for hyeprcalcaemia?

A

Loop diuretic

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16
Q

Give 3 primary causes which result in nephrotic syndrome

A
  1. Minimal change glomerulonephritis
  2. Focal Segmental Glomerulosclerosis
  3. Membranous Glomerulonephritis
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17
Q

Give 3 primary causes which result in nephritic syndrome

A
  1. Crescentic glomerulonephritis
  2. IgA nephropathy
  3. Membranoproliferative glomerulonephritis
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18
Q

WHat spinal level do the ureters arise form?

A

L2

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19
Q

What is reabsorbed at the PCT?

A

70% of water and sodium. 90% of potassium and bicarobs. 100% of AAs and glucose

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20
Q

Label

A
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21
Q

Where does the urinary system originate from?

A

intermediate mesoderm

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22
Q

What areas of the kidney fo the corticle renal corpuscle occupy?

A

PCT and DCT in renal cortext.

Loop in outer zone of medulla

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23
Q

What areas of the kidney do the juxtamedullary renal corpuscle occupy?

A

PCT and DCT in the renal cortex

Loop in the inner zone of the medulla.

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24
Q

What epithelia do PCT have?

A

cuboidal with microvilli

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25
Q

WHat are the 3 parts of the loop of henle? What epithelia does reach part have?

A

thin descending - squamous epithelia

thin ascending - squamous epithelia

Thick ascending - cuboidal epithelia

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26
Q

What is the JGA made up of?

A

macula densa of DCT

Juxtaglomerular cells of afferent arteriole

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27
Q

How are organic cations secreted in the PCT?

A

Proton-OC exchanger linked to Na-H antiporter on luminal side

Diffuses into cell from blood

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28
Q

What would you use to calculate renal plasma flow?

A

PAH

actively secreted

29
Q

How does the kidneys autoregulate GFR acutely?

A

NaCl sensed in the DCT.

too much NaCl - adenosine (vasoconstricts)

too little NaCl - prostaglandins (vasodilates)

30
Q

How are calcium ions absorbed in the DCT?

A

Luminal:

NCC transporter - Na and Cl symporter

Calcium transporter

Basolateral:

Cl transporter

NCX

Na-k-ATPase

31
Q

WHat are the 2 cell types of the late DCT and CD? WHat are their functions?

A

Intercalated - actively reabsorbs cl and secretes H+ or hco3 to make urine acidic or basic

Principal - aquaporin

32
Q

How is BP acutely regulated?

A

baroreceptor reflex

33
Q

How do ANPs work?

A

Vasodilate renal blood vessels and inhibit Na reabsorption

Stimulated by stretch receptors in atria

34
Q

What senses plasma osmolarity and how is it regulated?

A

OVLT in hypothalamus senses plasma osmolarity

High osmolarity stimulates ADH release from posterior pituitary, inserts AQP in late DCT and CD

35
Q

What is the cellular mechanism by which AQP2 is inserted into the apical membrane of DCT and CD?

A

ADH –> GPCR –> Adenylyl cyclase –> cAMP –> PKA –> AQP2

36
Q

outline the process which occurs if serum calcium is low

A

PTH stimulated from parathyroid.

PTH breaks bone down to release calcium and phosphate

PTH stimulates calcifediol to calcitriol conversion by kidneys

calcitriol increases absorption of calcium in the GI by acting on calcium ATPase

37
Q

How do kidney stones form?

A

urine supersaturated with calcium substances

nucleation leads to calcium crystals

38
Q

How does insulin stimulate K+ uptake into cells?

A

Increaes Na-K-ATPase

39
Q

How does an increase in ECF osmolarity promote K+ shift out of cells?

A

Increase in osmolarity results in water leaving cells

Cells become more concentrated therefore, K+ leaves cells.

40
Q

What parts of nephron secrete K+? How?

A

DCT and CD

Secreted via K+ channel on luminal side.

41
Q

What tubular factors stimulate K+ secretion?

A

ECF K+ conc

Aldosterone

Alkalosis

42
Q

What luminal factors affect K+ secretion?

A

tubular flow rate

more na to DCT = more K lost

43
Q

What clinical features are associated with hyperkalaemia?

A

Heart block

GI muscular disturbances

Acidosis

44
Q

How do you treat hypokalaemia?

A

IV infusion of potassium

Treat cause

Potassium sparing diuretics

45
Q

How is HCO3 reabsorbed in tubules?

A

Basolateral:

Na-K-ATPase

Luminal:

Na-H antiporter

46
Q

Give an example of an aldosterone antagonist drug

A

spironolactone

47
Q

How do you treat pylonephritis?

A

co-amoxiclav 14 days

48
Q

What type of diuretics lead to hypocalaemia? how?

A

loop and thiazide diuretics

Faster flow rate to the DCT.

also decrease circulating volume which activates RAAS system and aldosterone which results in more K+ secretion

49
Q

What neurones control the storage phase of the bladder?

A

T10 to L2 - Hypogastric nerve

50
Q

What neurones control the bladder voiding phase?

A

S2-S4

51
Q

What receptors are found in the bladder?

A

M3 and Beta 3

52
Q

What receptors are found in the urethra?

A

alpha 1

53
Q

What receptors are found in the external sphincter?

A

nicotinic

54
Q

What causes pre renal AKI? What is pre renal AKI?

A

hypoperfusion of the kidneys

Caused by decrease in circulating volume

55
Q

What happens in post renal AKI?

A

Blockage of uteret results in rise in pressure

Dilatation of renal pelvis

results in reduction of renal function

56
Q

Give 2 clinical methods for defining AKI

A

increase above 1.5 times baseline creatine in 7 days

less than 0.5 ml per kg per hour urine production for 6 hours

57
Q

Give 2 causes of post renal AKI wihtin the wall of the ureter

A

megaureter

post TB stricture

58
Q

Give 3 caues of post renal AKI due to pressure from outside

A

diverticulitis

aortic aneurysm

neoplasm

59
Q

Define nephrotic syndrome

A

hyperlipidaemia

hypoalbuminaemia

oedema

proteinurea

60
Q

Define nephritic syndrome

A

haematuria

low urine output

small proteinuria

mild hypertension

61
Q

Give 2 secondary causes which result in nephrotic syndrome

A

amyloidosis

DM

62
Q

What is goodpasture syndrome?

A

autoantibody to collagen 4 of BM in glomerulus

associated with deafness

treated with immunosuppresants

63
Q

give an example disase of subepithelial deposits in glomerulus. what happens?

A

membranous GN

antigen on podocytes triggers IgG

64
Q

give example of mesnagial deposits in glomerulus diease what happens?

A

IgA nephropathy

circulating immune complex deposits in mesangium

65
Q

How does osteomalacia osteitis fibrosa cystica result from reduced renal blood flow?

A
  1. decreased GFR –> decrease calcitriol
  2. results in osteomalacia
  3. increase in PTH –> osteitis fibrosa cystica (bones replaced with cyst like brown tumours)
66
Q

Give 3 causes of CKD

A

idiopathic, vascular, GN, hypertension

67
Q

How can CKD result in CVD?

A

CKD results in hyperlipidaemia due to loss of albumin which results in increased albumin production and lipid production

68
Q
A

ESA 3 - Recap (6 decks)

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