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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
WHat are the 3 parts of the loop of henle? What epithelia does reach part have?
thin descending - squamous epithelia thin ascending - squamous epithelia Thick ascending - cuboidal epithelia
26
What is the JGA made up of?
macula densa of DCT Juxtaglomerular cells of afferent arteriole
27
How are organic cations secreted in the PCT?
Proton-OC exchanger linked to Na-H antiporter on luminal side Diffuses into cell from blood
28
What would you use to calculate renal plasma flow?
PAH actively secreted
29
How does the kidneys autoregulate GFR acutely?
NaCl sensed in the DCT. too much NaCl - adenosine (vasoconstricts) too little NaCl - prostaglandins (vasodilates)
30
How are calcium ions absorbed in the DCT?
Luminal: NCC transporter - Na and Cl symporter Calcium transporter Basolateral: Cl transporter NCX Na-k-ATPase
31
WHat are the 2 cell types of the late DCT and CD? WHat are their functions?
Intercalated - actively reabsorbs cl and secretes H+ or hco3 to make urine acidic or basic Principal - aquaporin
32
How is BP acutely regulated?
baroreceptor reflex
33
How do ANPs work?
Vasodilate renal blood vessels and inhibit Na reabsorption Stimulated by stretch receptors in atria
34
What senses plasma osmolarity and how is it regulated?
OVLT in hypothalamus senses plasma osmolarity High osmolarity stimulates ADH release from posterior pituitary, inserts AQP in late DCT and CD
35
What is the cellular mechanism by which AQP2 is inserted into the apical membrane of DCT and CD?
ADH --\> GPCR --\> Adenylyl cyclase --\> cAMP --\> PKA --\> AQP2
36
outline the process which occurs if serum calcium is low
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
How do kidney stones form?
urine supersaturated with calcium substances nucleation leads to calcium crystals
38
How does insulin stimulate K+ uptake into cells?
Increaes Na-K-ATPase
39
How does an increase in ECF osmolarity promote K+ shift out of cells?
Increase in osmolarity results in water leaving cells Cells become more concentrated therefore, K+ leaves cells.
40
What parts of nephron secrete K+? How?
DCT and CD Secreted via K+ channel on luminal side.
41
What tubular factors stimulate K+ secretion?
ECF K+ conc Aldosterone Alkalosis
42
What luminal factors affect K+ secretion?
tubular flow rate more na to DCT = more K lost
43
What clinical features are associated with hyperkalaemia?
Heart block GI muscular disturbances Acidosis
44
How do you treat hypokalaemia?
IV infusion of potassium Treat cause Potassium sparing diuretics
45
How is HCO3 reabsorbed in tubules?
Basolateral: Na-K-ATPase Luminal: Na-H antiporter
46
Give an example of an aldosterone antagonist drug
spironolactone
47
How do you treat pylonephritis?
co-amoxiclav 14 days
48
What type of diuretics lead to hypocalaemia? how?
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
What neurones control the storage phase of the bladder?
T10 to L2 - Hypogastric nerve
50
What neurones control the bladder voiding phase?
S2-S4
51
What receptors are found in the bladder?
M3 and Beta 3
52
What receptors are found in the urethra?
alpha 1
53
What receptors are found in the external sphincter?
nicotinic
54
What causes pre renal AKI? What is pre renal AKI?
hypoperfusion of the kidneys Caused by decrease in circulating volume
55
What happens in post renal AKI?
Blockage of uteret results in rise in pressure Dilatation of renal pelvis results in reduction of renal function
56
Give 2 clinical methods for defining AKI
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
Give 2 causes of post renal AKI wihtin the wall of the ureter
megaureter post TB stricture
58
Give 3 caues of post renal AKI due to pressure from outside
diverticulitis aortic aneurysm neoplasm
59
Define nephrotic syndrome
hyperlipidaemia hypoalbuminaemia oedema proteinurea
60
Define nephritic syndrome
haematuria low urine output small proteinuria mild hypertension
61
Give 2 secondary causes which result in nephrotic syndrome
amyloidosis DM
62
What is goodpasture syndrome?
autoantibody to collagen 4 of BM in glomerulus associated with deafness treated with immunosuppresants
63
give an example disase of subepithelial deposits in glomerulus. what happens?
membranous GN antigen on podocytes triggers IgG
64
give example of mesnagial deposits in glomerulus diease what happens?
IgA nephropathy circulating immune complex deposits in mesangium
65
How does osteomalacia osteitis fibrosa cystica result from reduced renal blood flow?
1. decreased GFR --\> decrease calcitriol 2. results in osteomalacia 3. increase in PTH --\> osteitis fibrosa cystica (bones replaced with cyst like brown tumours)
66
Give 3 causes of CKD
idiopathic, vascular, GN, hypertension
67
How can CKD result in CVD?
CKD results in hyperlipidaemia due to loss of albumin which results in increased albumin production and lipid production
68

ESA 3 - Recap (6 decks)

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