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Physiology 2nd Midterm > Urinary System > Flashcards

Urinary System Flashcards

1
Q

Functions of the kidneys
(Hint: 6 )

A
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2
Q

Structure of urinary system

A

Urine produced from the kidneys move from:

Kidney ➡️ renal pelvis ➡️ ureters ➡️ bladder ➡️ urethra

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3
Q

The kidney has two regions :

A

Cortex and Medulla

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4
Q

Arterial blood enters the kidney through which artery ?

A

Renal artery

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5
Q

The renal artery divides into ______________________ , then subdivides into numerous ____________________.

A

Interlobar arteries
Afferent arterioles

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6
Q

Which blood vessels deliver blood to the glomeruli

A

Afferent arterioles

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7
Q

What are glomeruli

A

Capillary networks that produce blood filtrate that enters the urinary tubules

(It filters the blood from the afferent arterioles, and that filtrate moves into the urinary tubules while the now filtered blood continues into the efferent arteriole.)

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8
Q

The blood remaining in the glomerulus leaves through an ________________________.

A

Efferent arteriole

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9
Q

The efferent arteriole delivers the blood to _________________.

A

Peritubular capillaries

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10
Q

Peritubular capillaries surround what structure ?

A

Renal tubules

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11
Q

Where does the blood from the Peritubular capillaries drain into

A

Veins and eventually leaves the kidney as a single RENAL VEIN

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12
Q

Renal circulation summary steps:

A
  1. Blood goes from Renal artery > interlobar arteries > afferent arteriole
  2. Afferent arterioles delivers blood into glomeruli
  3. Glomerulus filters the blood and the blood filtrate enters urinary tubules + the remaining filtered blood leaves through efferent arteriole
  4. The blood moves from efferent arteriole > peritubular capillaries > veins > renal vein
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13
Q

what is a nephron

A

Function unit of the kidney where urine is formed

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14
Q

How many nephrons in a kidney

A

About one million

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15
Q

Nephron blood circulation

A
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16
Q

Nephron filtrate flow in tubules

(After being filtered in the golmerulus , where does the filtrate go?)

A
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17
Q

Very important to know ALL these parts to understand the rest of the note

A

I know

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18
Q

3 main types of nephrons + how much each type makes up of total nephrons %

A
  1. Juxta-medullary (10%)
  2. Cortical nephrons (20%)
  3. Mid-cortical (70%)
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19
Q

Characteristics of juxta-medullary nephrons

A
  • deep glomeruli (in cortex near medulla)
  • long loops of Henle
  • their peritubular capillaries are modified into VASA RECTA
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20
Q

What is vasa recta

A

Long hair-pin shaped blood vessels that surround the loop of Henle

(Modified peritubular capillaries in juxta-medullary nephrons)

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21
Q

What feature of the juxta-medullary nephron plays a role in concentrating urine (more water absorption) ?

A

Long loop of henle

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22
Q

Juxta-medullary nephrons play an important role in :

A

Concentration of urine

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23
Q

Vasa recta are modified ___________________________ for juxta-medullary nephrons .

A

Peritubular capillaries

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24
Q

Characteristics of cortical nephrons

A
  • glomeruli in superficial cortex
  • short loops of Henle
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25
Q

Characteristics of mid-cortical nephrons

A
  • glomeruli in mid cortex
  • loops of Henle are of intermediate length
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26
Q

Sympathetic stimulation effect on the kidney

(Important and easy)

A
  1. Contracts smooth muscles of major branches of renal artery + afferent arterioles + efferent arterioles = VASOCONSTRICTION

(Vasoconstriction > less blood flow > less blood filtration > ⬇️GFR)

  1. Acts on β adrenergic receptors in the juxtaglomerular apparatus to cause the release of RENIN (enzyme)

(Angiotensinogen ➡️ ٍRenin ➡️ Angiotensin 1)
(Angiotensin 1 ➡️ ACE ➡️ Angiotensin 2)

AND ANGIOTENSIN 2 IS A VASOCONSTRICTOR (so also ⬇️ GFR)

NOTE:
Renin and ACE are enzymes

  1. Acts on α adrenergic receptors in the collecting ducts to increase Na+ reabsorption
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27
Q

What converts angiotensinogen to angiotensin 1

A

Renin

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28
Q

Where is angiotensinogen produced

A

Liver

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29
Q

What produces Renin

A

Kidney (specifically juxtaglomerular apparatus)

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30
Q

What two cell types are present in the Juxtaglomerular apparatus

A

Granular cells
Macula dense

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31
Q

What happens to GFR when the sympathetic nervous system is activated and why

A

⬇️ GFR

Why?
- vasoconstriction
- renin (angiotensin 2 is vasoconstrictor)

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32
Q

Sympathetic stimulation effect on β adrenergic receptors

A

Release of renin from juxtaglomerular apparatus

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33
Q

Sympathetic stimulation effect on α adrenergic receptors in collecting duct

A

Increase Na+ reabsorption

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34
Q

What is renal blood flow

A

Blood volume delivered to the kidneys per unit time 

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35
Q

Unit of renal blood flow RBF

A

ml / min
L / min

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36
Q

Renal blood flow is _____ % of cardiac output

A

20%

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37
Q

If cardiac output if 5 L/min, then what is renal blood flow?

A

RBF is 20% of cardiac output so⁣⁣⁣⁣⁣

20/100 x 5 = 1 L/min

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38
Q

What is renal plasma flow

A

Volume of plasma delivered to the kidneys every minute

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39
Q

Renal plasma flow depends on two things:

A
  1. Renal blood flow
  2. Hematocrit
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40
Q

Renal blood flow is regulated through three different ways:

A
  1. Autoregulation
  2. Neural regulation
  3. Humoral regulation
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41
Q

What is meant by renal autoregulation

A

Maintaining renal blood flow constant under changes in blood pressure in order to maintain constant GFR

(Meaning in order for the GFR to remain constant , the renal blood flow has to be constant as well , so that’s why we need autoregulation in case of changes in blood pressure) 

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42
Q

What is the blood flow formula

A
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43
Q

During autoregulation, which blood vessel is manipulated to control renal blood flow to kidneys?

A

Afferent arteriole

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44
Q

Describe what happens to the afferent arteriole during changes in blood pressure to keep the GFR constant !

A

BP ⬆️ = VASOCONSTRICTION = constant GFR

BP ⬇️ = VASODILATION = constant GFR

(We need to maintain blood flow to maintain constant GFR)

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45
Q

In autoregulation , increased blood pressure leads to ___________________ of afferent arteriole.

A

Vasoconstriction

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46
Q

In autoregulation , decreased blood pressure leads to ___________________ of afferent arteriole.

A

Vasodilation

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47
Q

In the absence of neural and hormonal factors, the kidney maintains renal blood flow and GFR ( through autoregulation) within what pressure range ?

A

80 to 200 mmHg

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48
Q

Neural regulation of renal blood flow is done by

A

Sympathetic noradrenergic (NE) nerve fibers

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49
Q

Humoral regulation of renal blood flow is done through

( you must know which causes vasoconstriction and vasodilation and which are involved in autoregulation)

A

Answer in the picture

Hints:
Vasoconstriction: AE

Vasodilation : NAP

Autoregulation: PEN

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50
Q

What is the first step in urine formation

A

Filtration

(Or glomerular filtration)

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51
Q

What occurs during filtration

A

Blood passes through the glomerulus and a fraction of it is filtered through the glomerular filtration barrier GFB

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52
Q

How much of plasma is filtered as blood passes through the glomerulus

A

20% of plasma

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53
Q

What is reabsorption

A

The retrieval of water and some solutes (NaCl, glucose, amino acids) from the tubule fluid back into the peritubular capillary blood

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54
Q

What is secretion

A

The addition of some substances from the peritubular capillary blood or from the tubule cells into the luminal fluid 

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55
Q

What is excretion

A

The solute and water eliminated in the urine are said to be excreted by the kidneys

56
Q

What are the processes that occur along the nephron

A

Filtration
Reabsorption
Secretion
Excretion

57
Q

How to calculate the amount excreted in the urine

A

Excreted = filtered - reabsorped + secreted

E = F - R + S

NOTE: NO BRACKETS IN THIS EQUATION

58
Q

Filtration is due to __________ pressure in the glomerular capillaries

A

High

59
Q

Difference between ultrafiltrate and plasma

A

They are similar BUT ultrafiltrate does NOT have:
- blood cells
- proteins

60
Q

What is glomerular filtration rate

A

The volume of filtrate produced by BOTH kidneys every minute

61
Q

Features of glomerular capillaries

A

Foot processes
Podocyte cell body
Pedicles

62
Q

Three layers of the glomerular filtration barrier

A
  1. Fenestrated capillary endothelial cells
  2. Basement membrane
  3. Slit diaphragm between podocyte foot processes
63
Q

ALL three layers of the GFB barrier are ________________ charged

A

Negatively

64
Q

Effect of the nagetively charged GFB on different types of ions and neutral molecules

A
  • ⬇️ filtration of anionic molecules (ex: albumin)
  • ⬆️facilitates filtration of cationic molecules
  • little impact on neutral molecules

NOTE:
Anion means negative ion
Cation means positive ion

65
Q

True or false
The ultrafiltrate has very low amounts of plasma proteins 

A

True

66
Q

Why does the ultrafiltrate have very low amounts of plasma proteins

A
  • proteins are large in size
    ( GFB has small pore sizes)
  • proteins are negatively charged
    (GFB is also negatively charged so they resell each other)
67
Q

Effect of the GFB’s negative charge on small solutes (Na+, Ca2+, Cl-, HCO3-)

A

No effect at all (no repelling occurs)

They are freely filtered because they are verrry small

68
Q

Filtration of solutes depend on

A
  1. Size
  2. Charge
69
Q

The filtrate is formed under pressure called

A

Net filtration pressure

70
Q

What are the different pressures involved in net filtration pressure

A
  1. PGC = hydrostatic pressure
  2. πGC = oncotic pressure
  3. PBS = hydrostatic pressure
  4. πBS = oncotic pressure

NOTE:
GC - glomerular capillary
BS - Bowman’s space

71
Q

Which pressure favors filtration

A

PCG

72
Q

Which pressures are against/oppose filtration

A

πGC
PBS

73
Q

Which filtration pressure remains 0 in both afferent end and efferent end ? Why?

A

πBS

Because in normal conditions, there is no protein in the Bowman’s space that will pull the fluid and contribute to filtration.

74
Q

What is glomerular hydrostatic pressure PCG

A

Pressure due to circulating blood in the capillary

This pressure FAVORS filtration 

75
Q

What is glomerular oncotic pressure πGC

A

Pressure due to the presence of plasma proteins in the glomerular capillaries

This pressure is AGAINST filtration

76
Q

What is interstitial hydrostatic pressure PBS

A

The pressure inside Bowman’s space

This pressure is AGAINST filtration

77
Q

What is interstitial oncotic pressure πBS

A

Pressure due to the presence of proteins in Bowman’s space

USUALLY ZERO, because proteins are not filtered

78
Q

Regulation of glomerular filtration rate GFR

A
  1. Constriction of afferent arteriole
    (symmetric stimulation، Endothelin)

= ⬇️ renal blood flow = ⬇️ PCG = ⬇️GFR

  1. Dilation of efferent arteriole
    ( NO, ANP, Prostaglandins)

= ⬆️ renal blood flow = ⬆️ PCG = ⬆️ GFR

79
Q

Understand how this mechanism works (easy)

A
  1. Low BP/Fight or flight/ Exercise = sympathetic stimulation
  2. Sympathetic stimulation causes:
    - increased CO
    - vasoconstriction of afferent
    - increase in TPR (due to vasoconstriction)
  3. Vasoconstriction of afferent causes :
    low GFR = low urine production = high blood volume
  4. Blood pressure is restored

ALSO NOTE:

high blood pressure ALSO causes sympathetic stimulation = vasoconstriction = to maintain constant GFR (autoregulation)

80
Q

What is renal plasma clearance

A

The ability of the kidneys to remove molecules from the blood by excreting them into the urine

81
Q

What is plasma clearance of a substance

A

The volume of plasma that was completely cleared of that substance per unit time

(Unit: ml/min)

82
Q

Formula for clearance

A

NOTE: also know how to calculate excretion rate which is (Ux x V)

83
Q

Effect of filtration, reabsorption, and secretion on clearance

A

Filtration = ⬆️ clearance
Reabsorption = ⬇️ clearance
Secretion = ⬆️ clearance

84
Q

What is Inulin

A
  • polymer of fructose
  • exogenous (not produced by body)
  • used to measure GFR
85
Q

How is inulin clearance used to measure GFR

A
  • inulin is administered intravenously
  • inulin is ONLY filtered (not secreted or reabsorbed)

So⁣⁣⁣⁣⁣
Amount filtered = Amount excreted
GFR = clearance of inulin

86
Q

How to measure amount of inulin filtered (filtered load)?

How to measure amount of inulin excreted (excretion rate)?

A

Inulin filtered :
GFR x P(in)

Inulin excreted:
U(in) x V

87
Q

Inulin was infused intravenously and the concentration in plasma was maintained at 0.5 mg/mL. Urine was collected and the following data were obtained.. 

Rate of urine formation is 2 ml/min
Concentration of inulin in urine was 30 mg/ml

Calculate GFR

A

Px = 0.5
Ux = 30
V = 2

GFR = (30 x 2) / 0.5 = 120 ml/min

Since this is inulin : GFR = clearance (that’s why we can use this formula)

88
Q

Clearance of urea

A

Urea is both FILTERED and REABSORBED
It is filtered like inulin but 50% is reabsorption in proximal tubule

So….

Urea Clearance < GFR

89
Q

Where is urea reabsorbed

A

Proximal tubule

90
Q

Clearance of PAH

A

PAH is FILTERED and SECRETED
It is filtered like inulin and completely secreted in proximal tubule
So…⁣⁣⁣⁣⁣

PAH clearance > GFR

91
Q

What is PAH secretion used for ?

A

To estimate renal plasma flow RPF

92
Q

Clearance of glucose

A

Glucose is FREELY FILTERED and COMPLETELY REABSORBED in proximal tubule

Glucose is reabsorbed by SGLT ( Na+ - glucose co-transport)

SGLTs are saturable so there is a maximum load of filtered glucose it can handle
This maximum load is called TRANSPORT MAXIMUM TM
TM = 375 mg/min

Glucose filtered load is = GFR x P(g)

BUT glucose excretion is NORMALLY = 0 (zero) !!
So plasma clearance = 0

93
Q

What is responsible for the reabsorption of glucose in proximal tubule

A

SGLT

94
Q

The maximum load SGLT can handle is called

A

Transport maximum

(Or tubular maximum)

95
Q

How much is transport maximum for glucose

A

TM = 375 mg/min

96
Q

Normally, how much is glucose excretion ?

A

ZERO

(Because normally for people with healthy diet , ALL of the glucose is reabsorbed back by SGLT so none is excreted)

97
Q

If filtered glucose is higher than the TM, this condition is called

A

Hyperglycemia

(High amount of glucose in blood)

98
Q

What is glucosuria

A

Excretion of glucose into the urine. This happens when the filtered glucose exceeds the transport maximum of SGLT

Excretion rate of glucose > zero
Clearance of glucose > zero

99
Q

Plasma glucose concentration = 1 mg/mL
GFR = 120 ml/min
What is the filtered load of glucose

A

GFR x P(g) = 120 x 1 = 120 mg/min

Since 120 < 375 (TM)
Then ALL of the glucose is reabsorbed and none is excreted (zero)

100
Q

If plasma glucose concentration = 4 mg/mL.
GFR = 120 mL/min

What is filtered load of glucose?

A

GFR x P(g) = 120 x 4 = 480

Since 480 > 375
Only 375 will be absorbed and the rest of the 480 will be excreted

Excreted glucose = 480 - 375 = 105 mg/min

101
Q

_____% of filtrate is reabsorbed and _____% is excreted

A

99% reabsorbed
1% excreted

102
Q

If 180 L is filtered a day, how many was excreted ?

A

180 x 1/100 = 1.8 L

Because only 1% of the filtrate is excreted , the rest of the 99% are reabsorbed

103
Q

The minimum volume of water needed to excrete waste materials by the kidneys is called

A

Obligatory water loss (400 ml)

104
Q

Where does water reabsorption occur and how does it happen

A

In PROXIMAL tubule by OSMOSIS

105
Q

The proximal tubule reabsorbs _______% of the filtered Na+, water, and K+

A

67%

106
Q

Normally, _______% of the glucose and amino acids and proteins filtered by the glomerulus are reabsorbed in the proximal tubule

A

100%

107
Q

Two ways exchange of solutes between tubule and capillary can occur

A
  1. Paracellular pathway ( BETWEEN CELLS)
  2. Transcellular pathway (THROUGH CELLS)
108
Q

Solute such as Na+ and Cl- are freely filtered, therefore there osmolarity of ultrafiltrate is similar to plasma which is about

A

300 mOsm/L

109
Q

True or false
Osmolarity of ultrafiltrate is similar to plasma

A

True

110
Q

Where is sodium reabsorbed

A

67% by proximal tubule

25% by thick ascending loop of Henle (TALH)

5-7% by distal tubule

3% By connecting segment and collecting duct

111
Q

Where is water reabsorbed

A

67% by proximal tubule ✅

15% by thin descending loop of Henle ✅

0% NONE BY THE ASCENDING LOOP OR EARLY DISTAL TUBULE ❌

8-17% IN THE PRESENCE OF ADH ONLLLY⚠️

112
Q

What is ADH

A

Antidiuretic hormone that is synthesized by the hypothalamus and stored in the posterior pituitary

113
Q

Which part of the nephron is impermeable to water (does NOT reabsorb water)

A

Ascending loop of Henle AND early distal tubule

114
Q

Water and solutes reabsorption in the proximal tubule

A

Water:
- passive transport : diffuses through tubular cells via aquaporin all the way into the capillary

Na+ :
- secondary active transport (when entering tubule) via SGLT2
- primary active transport (when leaving tubule into capillary) via ATPase

Glucose:
- secondary active transport (when entering tubule) via SGLT2
- passive (facilitated) diffusion (when leaving tubule into capillary) via GLUT2

115
Q

Reabsorption of water is dependent on ______________

A

Solute reabsorption

Why?
Reabsorption of solutes creates osmotic pressure which causes water movement by osmosis from the lumen into the blood

116
Q

Just like Na+, K+ is also reabsorbed in the _______________ and _______.


A

Proximal tubule and TALH

117
Q

True or false
In a normal diet. potassium is secreted

A

True

118
Q

Where is K+ secreted

A

Connecting segment and collecting duct

119
Q

K+ is _____________ in a normal or high K+ diet.

K+ is ______________ in a low K+ diet

A

Secreted
Reabsorbed

120
Q

Sodium reabsorption is regulated by:

A
  1. Angiotensin 2:
    INCREASES NaCl reabsorption in proximal tubule
  2. Aldosterone:
    INCREASES NaCl reabsorption in connecting segment and collecting duct
  3. ANP:
    DECREASES Na+ and water reabsorption in collecting duct
    INCREASES Na+ excretion (Natriuresis)
121
Q

Effects of angiotensin 2 on sodium reabsorption

A

Increases NaCl reabsorption in proximal tubule 

122
Q

Effect of aldosterone on sodium reabsorption

A

-Increases NaCl reabsorption in the connecting segment and collecting duct

  • increases K+ secretion
123
Q

True or false
aldosterone increases K+ secretion

A

True

124
Q

Effect of ANP on sodium reabsorption

A

Decreases Na+ and water reabsorption
Increases Na+ excretion

125
Q

What is natriuresis

A

Excretion of Na+ in urine

126
Q

What regulates water reabsorption

A
  1. ADH
    - increases water reabsorption in DISTAL tubule by increasing permeability of the collecting ducts to water ONLY
  2. ⬆️ NaCl reabsorption = ⬆️ water reabsorption in PROXIMAL tubule
127
Q

Which part of the nephron does ADH increase water reabsorption in

A

DISTAL tubule

128
Q

True or false
ADH increases water and sodium reabsorption by increasing the permeability of collecting duct

A

False

ONLY water reabsorption (NOT sodium)

129
Q

Easy summary diagram

A

Explanation:
1.Low sodium (either due to less intake or drinking too much water and diluting sodium) will lead to low sodium in the blood. This will trigger the hypothalamus and pituitary gland to decrease ADH to decrease water reabsorption.

  1. Decreasing water reabsorption will increase urine volume and lower blood volume.
  2. Low blood volume will stimulate the juxtaglomerular apparatus to secrete renin in order to increase angiotensin 2
  3. Angiotensin 2 will cause vasoconstriction to lower GFR AND to stimulate adrenal medulla to create more aldosterone
  4. Aldosterone will keep in sodium by increasing its reabsorption
  5. Sodium levels return to normal
130
Q

Easy summary

A

Low water intake requires high ADH to increase water reabsorption and decrease urine secretion

High water intake requires low ADH to decrease water reabsorption and increase urine secretion

131
Q

Renal function tests: What is an indicator of GFR

A

Inulin clearance

132
Q

Renal function tests: what is an indicator of renal plasma/blood flow

A

PAH clearance

133
Q

Renal function tests: what is an index of renal function

A

Plasma creatinine

(Creatinine is filtered and slightly secreted)

134
Q

What is microalbuminuria

A

Increase in urine albumin meaning proteins are being filtered and excreted in the urine which normally shouldn’t happen because proteins are large and negative

135
Q

List some kidney diseases

A

Acute renal failure
Glomerulonephritis
Renal insufficiency

Physiology 2nd Midterm (7 decks)

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