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Urinary (Basics) Flashcards

1
Q

What is the main function of the renal cortex?

A

Filtration (to form urine)

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2
Q

What is the main function of the medulla?

A

Collection & excretion of urine

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3
Q

What happens in the renal papilla?

A

Medullary pyramids empty urine into major/minor calyces

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4
Q

Where are the glomeruli located in the kidney?

A

Cortex

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5
Q

what % of cardiac output may pass through the kidneys at any one time?

A

25%

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6
Q

Where is the capillary network found in the glomerulus?

A

Between TWO arterioles

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7
Q

What is the functional unit of the kidney?

A

The nephron

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8
Q

What are the 3 main section of the renal tubule?

A

PCT
Loop of Henle
DCT

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9
Q

What is the glomerulus?

A

Afferent arteriole divisions forming a capillary network at the Bowmans Capsule

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10
Q

Which type of nephron are present in dogs and cats? Clinical significance?

A

Juxtamedullary ONLY - urine very concentrated

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11
Q

Where do JM nephrons recieve their blood supply from?

A

Vasa Recta - runs parallel to LoH

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12
Q

What are the3 major functions of the kidney?

A

Regulates fluid/electrolyte balance
Extretes waste
Produces hormones

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13
Q

Which two hormones are produced in the kidney?

A

EPO

Renin

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14
Q

Describe how the peritubular capillaries promote reabsorption.

A

High oncotic pressure

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15
Q

What does the renal corpuscle consist of?

A

Bowmans Capsule

Glomerulus

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16
Q

What are the 3 major functions of the nephron?

A

Glomerular Filtration
Tubular reabsorption
Tubular secretion

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17
Q

What is the GFR?

A

Amount of filtrate formed in all renal corpuscles of both kidneys in each minute.

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18
Q

What is the aim of tubular reabsorption?

A

Returning important substances to the body FROM the filtrate

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19
Q

What is the aim of tubular secretion?

A

Movement of waste from body TO the filtrate

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20
Q

Where does filtration take place?

A

Glomerulus (Renal corpuscle)

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21
Q

Where does bulk, unregulated reabsorption take place?

A

PCT

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22
Q

Where does secretion take place?

A

PCT

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23
Q

How much filtrate doe shte kidney produce per day?

A

60x plasma volume

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24
Q

Which process in the nephron is indiscriminate?

A

Filtration

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25
Q

Which process in the nephron is extensive and selective?

A

Tubular reabsorption

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26
Q

Where does fluid filtered from the glomerulus enter?

A

Bowmans space (lumen of urinary tract)

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27
Q

Why is it important to maintain glomerular capillary BP?

A

GFR is directly related to CBP

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28
Q

what cannot be filtered at the glomerulus?

A

Proteins

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29
Q

What are the 3 factors affecting GFR?

A

capillary HSP
capillary flow rate
capillary SA

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30
Q

Desrcibe the link between vasoconstriction and GFR.

A

Vasoconstriction decreases GFR.

Vasodilation increases GFR

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31
Q

Which cells detect increases in GFR and where are they?

A

Macula Densa Cells
In JM apparatus.

AUTOREGULATE

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32
Q

A massive increase in sympathetic tone has what effect on GFR?

A

Vasoconstriction
Dec renal blood flow
Dec GFR

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33
Q

What effect does sympahtetic drive have on blood volume and how?

A

Conserves fluid via dec GFR and stimulation of renin

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34
Q

What effect does Ang II have on GFR?

A

Decreases

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35
Q

What effect does ANP have on GFR?

A

increases it

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36
Q

Why is ANP released?

A

stretching of atria

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37
Q

Where is angiotensinogen made?

A

Liver

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38
Q

Where is aldosterone secreted from?

A

Adrenal Cortex

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39
Q

Where is ADH secreted from?

A

Hypothalamus to Posterior Pituitary and blood

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40
Q

What are the two routes of tubular reabsorption?

A

PAracellular (passive)

Transcellular (active)

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41
Q

The asymmetrical distribution of which ion pump is key to tubular reabsorption?

A

Na/K

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42
Q

In which direction does Na move in reabsorption and how?

A

Active transport of Na OUT of tubular cells towards capillaries

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43
Q

How does Na reabsorption drive reapsorption of H20?

A

Anions follow electrochemical gradient made by Na+ active transport.
Water moves via osmosis following solute.

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44
Q

How is glucose reabsorbed?

A

secondary active transport - facilitated via Na symport.

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45
Q

How do other Cations become reabsorbed?

A

Follow water down diffusion gradient (passive)

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46
Q

What is transamination?

A

conversion of amino acid to glutamate

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47
Q

What is deamination?

A

conversion of glutamate to urea

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48
Q

How is urea transported?

A

Passively

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49
Q

How does the body get rid of urea?

A

continuous high GFR required to prevent high blood concentration

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50
Q

What are the 3 key principles of secretion in the PCT?

A

Always active
Non-selective
Substances must be ionised

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51
Q

What substances are secreted in the PCT?

A

Hormones
Drugs
Environmental Pollutants

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52
Q

How does the PCT affect acid-base balance?

A

Secretes H+

Reabsorbs HCO3

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53
Q

What is the key membrane transporter in the LoH?

A

Ka+-K+2Cl- symporter

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54
Q

What is the descending loop of henle permeable to?

A

water

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55
Q

What is the descending loop of henle NOT permeable to?

A

Na

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56
Q

What is the ascending loop of henle permeable to?

A

Na/K/Cl (active)

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57
Q

What is the ascending loop of henle NOT permeable to?

A

water

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58
Q

Was is the osmolarity of the water leaving the LoH?

A

Hyposmotic

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59
Q

How does ADH cause water retention in the kidney?

A

Insert aquaporins onto apical memberane to promote absorption

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60
Q

What 2 things cause ADH release?

A

Hypovolaemia

Hyperosmolarity

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61
Q

What is the role of the DCT?

A

Regulated reabsorption/secretion

62
Q

What are the two epithelial cell types in the DCT?

A

Principal Cells

Intercalated cells

63
Q

What pumps/channels do principal cells in the DCT contain?

A

Na/K pump on basolateral membrane

Na/K leak channels on apical membrane

64
Q

What is the role of intercalated cells in the DCT?

A

H+ secretion

65
Q

What is the role of H+ ATPase in the DCT?

A

Active pump of H+ into filtrate in DCT

66
Q

What is the role of H+ K+ ATPase in the DCT?

A

Active pump of H+ into urine in EXCHANGE for K+

67
Q

What is the role of Type A intercalated cells?

A

work in ACIDOSIS.

Secrete H+
Reabsorb HCO3

68
Q

What is the role of Type B intercalated cells?

A

work in ALKALOSIS.

Secrete HCO3
Reabsorb H+

69
Q

How does PTH stimulate the nephron?

A

Stimulates Ca reabsorption in DCT

70
Q

Which hormone inhibits Ca reabsorption in the DCT?

A

Calcitonin

71
Q

What is the role of aldosterone in the DCT?

A

stimulates principal cells to reabsorb more Na and Cl and secrete K

72
Q

What stimulates aldosterone secretion?

A

Hyperkalaemia

73
Q

What is the difference in H20/Na balance in the PCT vs DCT?

A

Separate regulation in DCT, water follows Na in PCT

74
Q

Which area reabsorbs the greatest volume of water ; PCT or DCT?

75
Q

what is the key principle of K reabsorption in PCT/LoH?

A

ALL K+ reabsorbed here regardless of body’s status.

76
Q

Which is more important for K+ regulation; absorption or secretion?

A

Secretion in DCT/collecting duct

77
Q

What stimulates the release of EPO?

78
Q

Where is EPO produced?

A

Peritubular capillaries in renal cortex

79
Q

What is the MOA of EPO?

A

Increases speed of maturation/release of RBCs at bone marrow

80
Q

What is the role of ANP?

A

Na and H20 excretion

81
Q

Which ions are absorbed in the DCT?

A

Na, Cl, Ca

82
Q

Which ions are excreted in the DCT?

83
Q

Describe the ANS effects on bladder filling.

A

SYMPATHETIC
Relaxes detrusor
Contracts internal sphincter

84
Q

Describe the ANS effects on bladder emptying.

A

PARASYMP
Contracts detrusor
Relaxes internal sphincter

85
Q

Which receptors are responsible for detrusor relaxation?

86
Q

Which receptors are responsible for intrnal sphincter contraction?

87
Q

Which receptors are responsible for detrusor contraction?

A

Muscarinic

88
Q

Which receptors are responsible for internal sphincter relaxation?

A

Muscarinic

89
Q

What is the normal blood pH for a mammal?

90
Q

What are the 2 intracellular buffer systems?

A

Phosphate

Protein

91
Q

What are the 2 extracellular buffer systems?

A

Protein

Carbonic Acid

92
Q

How can you tell the difference between pre-renal and renal azotaemia?

A

Pre-renal CAN concentrate urine.

93
Q

Kidney dysfunction will increase what in the blood?

A

Urea
Creatinine
K+
H+

94
Q

What may be found in the urine during kidney dysfunction which is nor usually present?

A

Glucose

Protein

95
Q

What are the 3 drivers of ADH secretion?

A

increase osmolarity
hypotension
hypovolaemia

96
Q

What is a commonly used osmotic diuretic in veterinary practice & how is it given?

A

Mannitol (IV)

97
Q

How do osmotic diuretics work?

A

Filtered in kidney but NOT reabsorbed - maintain osmotic pressure in filtrate

98
Q

Which patients are CIed for use of mannitol?

A

Pulmonary Oedema
CHF
(may cause initial inc in ECF)

99
Q

Name two carbonic anhydrase inhibitors used in veterinary medicine.

A

Acteazolamide

Dichlofenamide

100
Q

What is the MOA for carbonic anhydrase inhibtors in the PCT?

A

Inhibit CI enzyme - reduced H+/HCO3 production so reduced Na/H+ exchange

101
Q

Which patients would be CIed for CA inhibitors?

A

Liver disease - NH4 in circulation would increase

102
Q

Name 2 loop diuretics used in vet med.

A

Furosemide

Torasemide

103
Q

what is the MOA of loop diuretics?

A

Inhibit NaKCl cotransporter to keep ions in UT

104
Q

What are loop diuretics used to treat?

A

Oedema
CHF
Hypercalcaemia

105
Q

what are CAIs used to treat?

A

Glaucoma

Metabolic Alkalosis

106
Q

What are osmotic diuretics used to treat?

A

Poisoning
Oliguric renal failure
cerebral oedema
Glaucoma

107
Q

What effect would a long/high dose of loop diuretics have?

A

Dehydration
Hypovolaemia
Weakness

108
Q

Name 3 thiazides used in vet med.

A

Chlorothiazide
Hydrochlorothiazide
Trichloromethiazide

109
Q

What are thiazides used to treat?

A

Oedema
Ca oxalate uroliths
nephrogenic diabetes insipidus

110
Q

What is the MOA for thiazides?

A

inhibit Na/Cl- co-transport before Na/K+ exchange

Inc Na/Cl/Mg/K excretion

111
Q

What side effects/CIs are associated with thiazides?

A

Hyperglycaemia

CI in renal failure

112
Q

Name 3 K+ sparing diuretics.

A

Spironolactone
Amiloride
Triamterine

113
Q

What is the MOA of spironolactone?

A

Aldosterone competitive inhibitor

114
Q

What is the MOA of Amiloride/Triamterine?

A

Inhibit Na/K+ATPase activity

115
Q

Which drugs may be used to directly stimulate the SYMP system for increased urethral sphincter activity?

A

Phenylpropanalamine

Ephedrine

116
Q

How does Phenylpropanalamine work?

A

Release of noradrenaline

Direct receptor activation (alpha)

117
Q

How does ephedrine work?

A

Increases noradrenaline activity at alpha and beta receptors

118
Q

Which drugs may be used to INDIRECTLY stimulate the SYMP system for increased urethral sphincter activity?

A

Estriol - estrogen increases alpha adrenoreceptor sensitivity

119
Q

Which drug may be used to decrease the detrusor activity?

A

Propantheline (antimuscarinic)

120
Q

which drug increases detrusor activity via parasymp stimulation?

A

Bethanecol - Muscarinic Agonist

121
Q

which drugs decrease urinary sphincter activity?

A

Alpha antagonists - phenolxybenzamine or prazosin

122
Q

How can we inhibit the voluntary sphincter from maintaining urinary retention?

A

Central inhibition - diazepam

Peripheral inhibition - dantrolene

123
Q

what is the MOA of dantrolene with regard to urine retention?

A

Prevents Ca release form SR - uncouples muscle contraction (NOT SMOOTH)

124
Q

What are the 4 types of urolith commonly found?

A

Struvite
Ca Oxalate
Urate
Cystine

125
Q

How would you cure a struvite urolith?

A

Acidify urine

Low Mg/P in diet

126
Q

How would you prevent a struvite urolith?

A

Alkalinise urine

127
Q

How would you prevent a urate urolith?

A

low protein diet

alkalinise urine

128
Q

Which drug can be given to aid urate urolithiasis?

A

Allopurinol (dec uric acid production)

129
Q

Which drug can be given to aid cystine urolithiasis?

A

Penicillamine - binds to cystine to make soluble complex

130
Q

Name 2 drugs used to decrease the pH of urine

A

Methionine

Ammonium Chloride/sulphate

131
Q

Name 2 drugs to increase the pH of urine

A

NaHCO3

Na/K citrate

132
Q

What class of drugs may be used in UTIs as an alternative to antibiotics?

A

Urinary Antiseptics i.e. Methanamine

133
Q

Whatis the range for isosthenuria?

A

1.008-1.012

134
Q

What does isosthenuria mean?

A

SG of plasma = SG urine

135
Q

What is the normal urine conc of a cat?

136
Q

What is the normal urine conc of a dog?

137
Q

What does hyperphosphataemia lead to?

A

hyperP inhibits VitD –> NO neg feedback on PTH –> unabated PTH release

138
Q

What are 5 potential causes for increased urea?

A 
High protein diet
Recent meal
Catabolism (fever)
GI haemorrhage
Dehydration
139
Q

What are 3 potential causes for decreased urea?

A

Severe Liver Dz
Low protein diet
Aggressive IVFT

140
Q

Which solute can be used to measure GFR?

A

Creatinine - reliable mesaure of kidney fct

141
Q

Name 2 causes of AKI

A

Acute poisoning

Infection

142
Q

What effect may AKI have on urine output?

A

Anuria OR

Oliguria

143
Q

What may you notice on biochem of an AKI patient?

A

Azotaemia
Inc P & K
Metabolic Acidosis

144
Q

How is AKI treated?

A

IVFT

Supportive Therapy

145
Q

What may you notice on biochem of an CKD patient?

A 
Azotaemia
Inc P
Metabolic acidosis
BUT...
Inc OR dec K!!
146
Q

Common Cx of CKD include….

A 
PUPD
Anorexia
Hypertension
Anaemia
Hyperphosphataemia
147
Q

How does renal Dz cause bottle jaw?

A

Secodary hyperparathyrodism –> inc PTH & demineralisation of bone

148
Q

HOw should CKD be managed?

A

fluids
low protein & P diet
Drugs: EPO and dec BP

149
Q

Name 3 different phosphate binders.

A

Calcium Acetate
Lanthanum Carbonate Octahydrate
Sevelamer

150
Q

Which drugs are used to reduce systemic BP in CKD cats?

A

Ace inhibitors

151
Q

Which drug is used to reduce glomerular BP in CKD cats?

A

Telmisartan

Veterinary Medicine (68 decks)

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