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ESA3 > Urinary > Flashcards

Urinary Flashcards

1
Q

Where are the kidneys located?

A

Retroperitoneal at T11-12

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2
Q

What is different about the anatomical structure of the right kidney as compared to the left and why?

A

Right is lower because of the liver

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3
Q

What organ has highest blood flow per 100g

A

Kidneys

400ml/min/100g

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4
Q

List the main functions of the kidneys

A

Regulation of ECF ions/volume
Excretion of waste products
Endocrine - e.g. RAA, Erithropoeitin
Metabolism - Vit D activation

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5
Q

Where is the glomerulus

A

Cortex

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6
Q

After reabsorption at the PCT, where do the ions go?

A

Peritubular capillaries

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7
Q

What is the major site of reabsorption in the nephron?

A

Pct

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8
Q

Where in the nephron H+ actively secreted?

A

Dct

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9
Q

Where loop of henle

A

Medulla

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10
Q

What does loop of henle do?

A

Set up increasing osmolarity gradient in medulla (main)

Also further reabsorption of salts

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11
Q

Dct function

A

Variable reabsorption of electrolytes and water

ALSO ACTIVELY SECRETES H+

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12
Q

Collecting duct function

A

Passes through increased osmolarity of medulla!
Na+ recovery: RAA, hence affect ecf volume
Water recovery: ADH, hence affect ecf osmolarity

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13
Q

Watch this video

A

https://youtu.be/gNwWxpWZQJ8

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14
Q

Talk through briefly an overview of the journey through kidney without going into specifics.

A 
Blood in 
Renal corpuscle - ultrafiltrate
Tubule system
Medullary rays
Ducts of Bellini
Renal papillae
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15
Q

How is the renal corpuscle formed?

A

Primitive renal tubule envelopes growing glomerulus (capillary tuft pushes in it, and it is a blind ending tube so it envelopes it.

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16
Q

What is the primitive renal tubule a derivative of

A

Ureteric bud

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17
Q

Describe the structure of the filtration barrier at the renal corpuscle

A

Fenestrated capillaries, surrounded by the visceral layer of the bowman’s capsule

Visceral layer like meshwork. Has podocytes with foot processes that surround the capillaries, with gaps that act as filtration slits.

Parietal layer of bc forms funnel for ultrafiltrate

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18
Q

What are the two poles of the renal corpuscle?

A

Vascular

Urinary

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19
Q

I have windows but no door
I have feet but no hands
My windows and feet are separated by only a basement
What am I?

A

A renal corpuscle

Windows- fenestrations on capillary
Feet - podocytes
Basement - only one basement membrane shared between both

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20
Q

Histology of PCT

A

Simple cuboidal epithelium

pronounced brush border

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21
Q

Histology of thin descending limb of loop of Henle

A

(simp.squa@likeacapillary.com), no brush border

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22
Q

Histology of Thin ascending limb of loop of henle

A

Same as thin descending limb

(simp.squa@likeacapillary.com), no brush border

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23
Q

Histology of thick ascending limb of Loop of Henle

A 
Best seen in the medulla
– interspersed with thin limbs, vasa recta and collecting ducts
 • Simple cuboidal epithelium
– no brush border
 • Active transport
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24
Q

DCT histology

A 
Cortical
 • Makes contact with its “parent”
glomerulus
 • Contain numerous mitochondria
 • Compared to PCT
– No brush border – Larger lumen
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25
Q

What three groups of cells form the juxtaglomerular apparatus?

A

1) Macula densa
2) Juxtaglomerular cells (of afferent arteriole of glomerulus)
3) Extraglomerular mesangial cells (aka lacis cells)

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26
Q

Histology of collecting duct

A

Continuation of DCT via collecting tubule
• Similar appearance to the thick limbs of Henle’s loop
• But lumen is larger and tend to be more irregular rather than circular

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27
Q

Histology of ureter

A 
A muscular tube • 2 layers of smooth
muscle
– a third appears in the
lower 1/3 of the ureter
• Lined by specialised
epithelium
– transitional epithelium,
aka urinary epithelium
or urothelium
28
Q

Structure and histology of bladder

A

3 layers of muscle • Outer adventitia • Epithelium is transitional
Urothelium” • Stratified epithelium • “umbrella cells” on the surface layer which make
the epithelium impermeable

29
Q

What is average resting renal blood flow. What does renal plasma flow mean?

A

1.1L

Plasma flow is amount of plasma in blood (taking out haematocrits which are 45% of blood)

30
Q

List the blood supply to the nephron starting at the renal artery and ending at the renal vein.

A

Renal artery->segmental artery->interlobar artery->arcuate artery->interlobular artery->afferent arteriole->efferent arteriole->peritubular capillaries->venules->interlobular veins->arcuate veins-> interlobar veins->segmental veins->renal vein.

31
Q

Why is it difficult for anions to pass through the filtration barrier at the renal corpuscle?

A

The basement membrane between the endothelium and visceral layer of the bowman’s capsule is an acellular, gelatinous layer which has glycoproteins.

These are negatively charged, hence repel anything else with a negative charge. Hence anions are less likely to pass through the barrier.

32
Q

What three forces are involved in driving plasma into BC?

A

1) Hydrostatic force of glomerular capillary (forces plasma IN)
2) Hydrostatic force of Bowman’s capsule (forces plasma OUT)
3) Oncotic pressure of proteins in glom cap (sucks plasma back OUT)

33
Q

How are short term changes in blood pressure dealt with to keep GFR stable?

A

Myogenic autoregulation: afferent arteriole responds by changing tone

Tubular-Glomerular feedback:
Macula densa cells in DCT
Sense changes in (Na)Cl concentration
Send chemical signals to vasodilate either arteriole (depending on whether GFR is increased or reduced).

Adenosine to vasodilate EA.
Prostaglandins to vasodilate AA.

34
Q

What is/are the key Na transporter(s) in the PCT?

A

Na/H antiporter

Na/glucose symporter

35
Q

What is/are the key Na transporter(s) in the Loop of Henle?

A

Na/K/2Cl Symporter

NKCCT

36
Q

What is/are the key Na transporter(s) in the early DCT?

A

Na/Cl symporter

37
Q

What is/are the key Na transporter(s) in the late DCT and collecting duct?

A

ENaC

38
Q

ROMK

A

Renal Outer Medullary Potassium channels

39
Q

In urinary, what is Tm?

A

Transport maximum - maximum concentration of a substance after which it will spill into urine

(Maximum reabsorption is taking place in nephron, so any more will be left in tubules and pass out)

Hence why diabetics may have glycosuria when hyperglycaemic

40
Q

A patient was given morphine after surgery.
Morphine is an organic cation.
Describe the process of excretion of organic cations in the kidney at a celullar level.

A

Two important exchangers on apical membrane that work together with Na+/K ATPase (which is at the basolateral membrane)

  • Na+/H+ exchanger
  • H+/OC+ exchanger

At basolateral membrane, 3Na+/2K+ ATPase sets up favourable gradient

OC+ enters cell by carrier-mediated diffusion across bl membrane
Low Na inside cells favours Na/H exchange at apical membrane, resulting in low H+ in cell
This in turn favours H+/OC exchange at apical membrane

41
Q

Examples of cations

A

Dopamine, adrenaline, morphine

42
Q

Examples of anions

A

Bile salts, fatty acids, penicillin

43
Q

What percentage of Na+ is reabsorbed at each part of the nephron?

A

67% PCT
25% Ascending LoH
5% DCT
3% CD

44
Q

Effectors of Na reabsorption in kidney

A

Change in osmotic/hydrostatic pressure in peritubular capillaries (pressure natriuresis and diureses)

RAAS - Na reabso in PCT
Aldosterone - Priniciple cells DCT / CD

45
Q

Briefly outline the segments of the PCT

A

S1 - glucose, aa main reabsorbed

S2 - cl- reabsorbed,

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46
Q

What is glomerotubular balance?

A

PCT always tries to maintain 67% Na reabsorption to minimise downstream effects

47
Q

If hypoxia, what part of nephron one of first affected?

A

LoH because TAL vv active

48
Q

ADME

A

Absorption
Distribution

Metabolism
Excretion

49
Q

What is the meaning of xenobiotic

A

Body sees (substance) as foreign

50
Q

Define clearance

A

Rate of removal of drug by liver and kidney

51
Q

What factors affect renal clearance?

A

How well the kidneys ‘see’ the drug i.e. Amount in plasma

Hence:

Lipophilicity - enters tissues, partitions to fats, ‘hidden’ vs hydrophilicity

Binding to plasma proteins - won’t pass filtration barrier

Binding to tissue proteins - again, hidden

52
Q

What is apparent volume of distribution?

A

Assuming all tissue and fluid is one compartment for convenience, used to work out renal plasma flow
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53
Q

Samuel was given penicillin for an infection. Penicillin is an anion. What effect will a drop in his urine pH have on the renal clearance of penicillin from his plasma?

A

The anion will become protonated

It will become electrically neutral hence more lipophilic

Can be reabsorbed in the nephron

Hence reduce clearance

54
Q

What

A

Answer

55
Q

Mineralocorticoid deficiency and excess symptoms

A

Deficiency: low sodium, dehydration, high potassium

Excess: high sodium, hypertension, low potassium

56
Q

Glucocorticoid deficiency and excess features

A

Deficiency: low glucose, weight loss, nausea, hypotension, underweight

Excess: high glucose, weight gain, increased appetite, hypertension, cushingoid

57
Q

Acth is released as…

A

Pomc -> acth and msh

58
Q

Major cause of hyperthyroidism and its ttmt

A

Graves
Autoimmune activation of TSH receptors
Carbimazole

59
Q

Major cause of hypothyroidism and its ttmt

A

Hashimotos
Autoimmune destruction of thyroid follicles and blocking of TSH receptors

Give oral T4 - measure TSH level, it will become normal when correct T4 dosage given

60
Q

Plasma pH must be maintained within a tight range. Give values.

A

7.35-7.45

61
Q

Why alkalaemia bad?

A

Alkalaemia lowers free calcium by causing Ca2+ ions to come
out of solution
Increases neuronal excitability
Parasthesia then Tetatany

62
Q

Why acidaemia bad?

A

Increases plasma potassium ion concentration. Affects cardiac muscle - arrythmias.

Also, H+ denatures proteins

63
Q

How can an change in ventilation cause a change in blood pH?

A

Hypervent = hypocapnia = low pCO2 - pH 👆( resp. Alkalaemia)

Hypovent = hypercap = high pCO2 - pH 👇(resp. Acidaemia)

64
Q

Outline RAAS in control of bp

A

Low NaCl delivery to macula densa cells of DCT, low renal pressure, or sympathetic stimulation causes kidney to release renin.

Renin converts angiotensinogen into angiotensin 1
Angiotension 1 is converted to angiotensin 2 by ACE

Angiotensin 2 stimulates the adrenal glands to make aldosterone
It also vasoconstricts
AND ALSO INCREASES NA+ REABSORPTION IN PCT

65
Q

Why do ACE inhibitors work?

A

Firstly, they stop angiotensin 1 from being converted to angiotensin 2 by inhibiting the ACE enzyme. This prevents the effects of AG2 such as Na+ reabsorption, vasoconstriction and stimulation of aldosterone production.

It also promotes vasodilation by increasing bradykinin, a local vasodilator, which is normally broken down by ACE. inhibiting ace thus results in more bradykinin, hence even less vasoconstriction.

66
Q

Natriuresis = loss of Na+

Explain how the heart can be involved in promoting natriuresis

A 
Atrial natriuretic peptide
Released when cardiac myocytes stretched
Increases Na loss
Decreases circulating volume
Eventual decrease in ANP

ESA3 (7 decks)

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