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Sap 3 > Urinary System > Flashcards

Urinary System Flashcards

0
Q

What is the condition where kidney fn is less than required to keep up with demands of body?

A

Renal failure

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1
Q

Name at least 3 factors that can lead to renal failure?

A

Chronic hypertension
Cardiovascular insufficiency
Lower UTIs

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2
Q

What level is kidney fn at with acute renal failure? What are 3 types?

A

50%
Pre renal failure
Intra renal failure
Post renal failure

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3
Q

What is the issue with pre renal failure?

A

Kidney works done but there is a reduced blood flow to it -ie hypotension

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4
Q

What is the issue with Intra renal failure?

A

Disease of kidney, ie bacterial infection like E. coli

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5
Q

What is the issue with post renal failure?

A

Reduction of fluid expulsion from kidney ie due to kidney stones or tumours

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6
Q

what is the urinary system made up of?

A

2 kidneys, 2 ureters, 1 urinary bladder, 1 urethra

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7
Q

What are some manifestations of chronic renal failure?

A 
Headaches
Restless leg syndrome
Easy bruising/ bleeding
Mm cramping 
reduced skin turgor
mm irritability/weakness
hypertension
peripheral edema
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8
Q

the kidneys regulate 5 things that are related to blood- name them. what other 2 functions does it serve?

A

regulates blood: pressure, volume, pH, ionic composition, glucose levels, osmolarity

  • waste excretion
  • hormone production
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9
Q

what are the most important ions the kidneys regulate?

A

sodium, potassium, calcium, phosphate

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10
Q

how do the kidneys regulate blood volume?

A

it either conserves or eliminates water in the urine

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11
Q

how do the kidneys regulate blood pressure?

A

secretes renin which stimulates RAA pathway» increased BP

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12
Q

what is blood osmolarity?

A

measure of total number of dissolved particles per litre

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13
Q

what two hormones does the kidney produce? what do they do?

A

calcitrol- active form of vit D

erythropoietin- stimulates production of red blood cells

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14
Q

where are the kidneys located?

A

high on posterior abdominal wall in abdominal cavity, retroperitoneal (post to peritoneum in abdominal cavity), between T12 and L3, protected by 11th and 12th ribs, right kidney lower (liver)

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15
Q

each kidney has a convex medial border that faces the verterbal colum, T/F?

A

false, it is concave medially

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16
Q

whats the renal hilum?

A

deep vertical fissure in which ureter, blood and lymph vessels go through

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17
Q

what are the layers surrounding the kidneys in order from deepest to most superficial? what are their functions?

A 
renal capsule (deepest-irregular tissue- barrier against trauma)
adipose tissue (middle layer, protects and anchors)
renal fascia- superficial (dense irregular connective tissue, anchors)
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18
Q

what are the names of the 2 regions the kidney is divided into?

A

renal cortex -superficial- divided into cortical zone and juxtamedullary zone
renal medulla- inner (pyramid shaped and apex face inwards)

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19
Q

what is between the renal pyramids?

A

renal columns (part of renal cortex)

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20
Q

what is the fn’l portion of a kidney called?

A

parenchyma

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21
Q

what is the basic functional unit of a kidney called?

A

nephron

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22
Q

what do papillary ducts do?

A

collect urine formed by nephrons

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23
Q

what do minor calyx/ calyces do? what is the major calyx?

A

minor=cup like, papillary ducts drain urine into them

major= recevies urine from several minor, drains into renal pelvis

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24
Q

what i s the renal pelvis?

A

single large basin that collects urine from major calyces

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25
Q

what is the renal sinus?

A

cavity that contains part of the renal pelvis, the calyces, renal BV and nn, as well as fat to hold the structures in place

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26
Q

show the pathway of urine

A

nephron> collecting duct> papillary duct in renal pyramid> minor calyx> major calyx> renal pelvis> ureter> urinary bladder> urethra> ext of body

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27
Q

show the flow of blood supply of kidneys (p 300)

A

renal artery> afferent arteriole> glomerulus> efferent arteriole> renal vein> renal venule> peritubular capillaries

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28
Q

what is the function of the ureters?

A

transport urine from renal pelvis of each kidney to urinary bladder by way of peristaltic smooth muscle waves

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29
Q

what are the 3 tissue layers of the ureters from deepest to superficial?

A

mucosa
muscularis- smooth mm
adventitia- areolar connective tissue, blends with surrounding tissue and anchors

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30
Q

where is the urinary bladder located?

A

in pelvic cavity
male- post to pubic symphysis and ant to rectum
female- ant to vagina and inferior to uterus

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31
Q

what structures are located in the bladder?

A

regae-increase surface area
folds of peritoneum hold it in place
shape determined by how much urine is in it

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32
Q

what are the 3 layers of tissue in the bladder?

A

same as in ureters

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33
Q

differentiate btwn internal urethral sphincter and external urethral sphincter

A

internal-around opening, smooth mmfor involuntary expulsion of urine from bladder
external- skeletal mm fibers, voluntary expulsion

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34
Q

what is the trigone?

A

small triangular are in floor of bladder, the two post corner contain the 2 urethral openings

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35
Q

what is micturition? what is it a combo of? where is this process initiated from?

A

the act of urinating, combo of voluntary and involuntary mm contractions
-cerebral cortex initiates or delays

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36
Q

what is the urethra and what is its fn?

A

terminal point of urinary system

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37
Q

how is the female urethra different that the male one?

A

length: M= 15-20cm, F= 4 cm

passageway for= urine in both, semen in M

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38
Q

what are the 3 segments of the male urethra?

A

prostatic- goes thru prostate gland
membranous- shortest, thru urogenital diaphragm
spongy- longest, exits thru penis

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39
Q

the number of nephrons we have increases with age. T/F?

A

false. it is constant our whole lives. about 1 million.

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40
Q

what are the 2 parts of the nephron?

A

renal corpuscle= where blood plasma filtered

renal tubule= filtured fluid passes through it

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41
Q

what happens to the kidney fn of body if one is removed?

A

the 2nd will grow in size (not number of nephrons) and work at about 80% capacity of 2 normal kidneys

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42
Q

what are the 3 parts to the renal tubule?

A

1) proximal convoluted tubule
2) loop of Henle (nephron loop) (descending/ascending limb)
3) distal convoluted tubule

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43
Q

what part of the urinary system do the collecting duct and papillary duct belong to?

A

renal tubule

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44
Q

what does the juxtaglomerular appartus do?

A

helps to regulate blood pressure within in the kidney

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45
Q

what does the juxtaglomerular appartus made up of?

A

macula densa- columnar tubule cells (p. 306 missing)

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46
Q

what are the 3 basic processes that occur to produce urine?

A

glomerular filtration- 1st step
tubular reabsorption
tubular secretion

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47
Q

where does glomerular filtration occur? what happens?

A

in glomerulus

-water and most solutes in blood plasma go from blood stream in glomerular capsule and into renal tubules

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48
Q

what is tubular reabsorption?

A

return of substances from the capsular space back into blood stream

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49
Q

what is tubular secretion?

A

moving of substances from blood stream back into collecting ducts (getting rid of what body doesnt need)

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50
Q

how do nephrons help to maintain homeostasis of blood volume and composition?

A

through filtering, reabsorping, and secreting

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51
Q

what is glomerulal filtrate?

A

fluid that enters capsular space

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52
Q

explain the mechanism for glomerular filtartion and the 3 types of cells you might find

A

there is a filtration membrane- “leaky barrier” that lets in what needs to go in and keeps proteins out
glomerular endothelial cells- leaky, everything but blood cells and platelets goes through
basal lamina- basement membrane
pedicels

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53
Q

filtration is driven by pressure (diffusion). T/F?

A

true

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54
Q

what is net filtration pressure?

A

the amount of fluid filtered minus the amount that is returned to the bloodstream
(NFP= GBHP-CHP-BCOP)

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55
Q

name a pressure tha tpromotes filtration

A

GBHP- glomerular blood hystrostatic pressure= BP in G capillaries, it forces water and solutes from blood thru filtration membrane

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56
Q

name pressures that oppose filtration

A

CHP- capsular hydrostatic pressure (“back pressure”)

BCOP- blood colloid osmotic pressure

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57
Q

why does kidney disease lead to edema?

A

glomerular capillaries become damaged and permeable, BV decreaes, interstitial fluid volume decreases (p 310)

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58
Q

what is glomerular filtration rate? (GFR)

A

amount of filtrate formed in all of renal corpuscles of both kidneys each minute

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59
Q

how is GFR regulated?

A
  • by adjusting blood flow in and out of glomerulus (diameter of arterioles)
  • by altering glomerular capillary surface area available for filtration
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60
Q

what are the mechanisms that control GFR?

A

renal autoregulation
neural regulation
hormonal regulation

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61
Q

whast are the 2 mechanisms of renal autoregulation?

A

myogenic- stretching triggers contraction of smooth muscle cells in arterioles
tubulo-glomerular feedback- macula densa gives feedback

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62
Q

how does neural regulation of GFR work?

A

ANS releases epinephrine- causes constricton

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63
Q

how does hormonal regulation of GFR work?

A

angiostensin 2- vasoconstrictor

atrial natriuretic peptide-increases capillary surface area

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64
Q

what are the hormones that affect the extent of sodium, chloride and water reabsorption and potassium secretion?

A

RAA
Angiotensin 2
ADH/ vasopressin- regulates water reabsorption
ANP- minor role in inhibiting eltectrolye and water reapsorption
(p 312-313)

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65
Q

what are the most important regulators of electrolyte reabsorption and secretion?

A

angiotension 2 and aldosterone

66
Q

define diuretic

A

chemical that increases urine volume by decreasing water reabsorption (inhibts sodium)

67
Q

define diuresis

A

elevated urine flow rate which reduces BV (ANP)

68
Q

define natriuresis

A

loss of sodium in urine (ANP)

69
Q

what are the syndromes of the glomerular?

A 
nephrotic syndrome (glomerulonephrosis)
nephritic syndrome (glomerulonephritis)
70
Q

what are the symptoms of nephrotic syndrome?

A
  • loss of protein in urine (severe)
  • edema of sacrum/ankles
  • orthostatic hypotension
71
Q

what is the pathogenesis of nephrotic syndrome?

A

-kidney or systemic disease states may create increased permeability of the glomerular capillaries to protein

72
Q

what is nephtritic syndrome? what are its manifestations?

A

inflamm of glomerulus
acute- hematuria, moderate proteinuria, oliguria (reduced protein production)
chronic- acute renal failure, anuria (no urine production), fibrosis (glomerular crescents)

73
Q

What is the tx for nephritic syndrome?

A

Control hypertension
Correct electrolyte imbalances
Reduce edema
Prevent congestive heart failure

74
Q

What is pyelonephritis ?

A

Infection of kidney parenchyma and renal pelvis

75
Q

What is the etiology of acute pyelonephritis

A

Bacterial infection of upp urinary tract

E. coli infection

76
Q

What is the pathogenesis of pyelonephritis

A

Infection ascends from lower urinary tract often secondary to catherterization or vesicoureteral reflux, leads to bacterial spread and inflamm

77
Q

What is constant loin/flank pain and lower urinary tract symptoms a common symptom of?

A

Pyelonephritis

78
Q

What is the diff Btwn acute and chronic pyelonephritis

A

Scar tissue has formed and deformation of renal calyces

79
Q

What is tx for pyelonephritis

A

Antibiotics

80
Q

What is: injury to the tubular structures of nephron?

A

Acute tubular necrosis

81
Q

What is the etiology of acute tubular necrosis?

A

Damage by toxic substances

Which results in ischemia and destruction of tubular epithelial cells and suppression of renal fn

82
Q

Explain oliguria and diuresis as clinical manifestations acute tubular necrosis

A

P 334

83
Q

Primary hypertension results in serious renal dysfn. T-f?

A

True

84
Q

Primary renal disease is almost always assoc with what?

A

Secondary hypertension

85
Q

What is benign essential hypertension?

A

Chronic condition

Occlusion of inter lobular arteries and affecting arterioles create anatomic changes in kidney which leads to atrophy

86
Q

Explain malignant hypertension

A

Bp rises quickly to high levels
Secondary to pre existing kidney condition
Patchy pathological lesions that progress rapidly

87
Q

What are s and s of malignant hypertension

A 
Rapidly increasing bp
Protein uria
Hematuria
Oliguria
Uremia
88
Q

Infantile kidney disease (of newborn)/ sponge kidney- explain pathogenesis and consequence

A

Cystic dilation in terminal branches of collecting tubules

Death shortly after birth

89
Q

What is adult poly cystic kidney disease?

A

Variable degree of change from single cysts to a mass of cysts
Defect is in branching of collecting tubules
Atrophy of normal nephrons by pressure
Chronic renal failure, uremia, hypertension

90
Q

What’s another name for Kidney stones?

A

Renal calculi- crystals that develop in renal pelvis

91
Q

What is the etiology of renal calculi?

A

Absence of fluid (dehydration, infection, etc)

92
Q

What are renal calculi made up of?

A

Calcium oxalate/phosphate
Uric acid stones
Struvite stones
Cystine stones

93
Q

What are manifestations of kidney stones

A

Flank pain
Severe abd pain
May be asymptomatic

94
Q

Differentiate Btwn upp urinary tract infection and lower

A

Upp- kidney and ureter

Lower- urinary bladder and urethra

95
Q

What are some manifestations of upp urinary tract/ pyelonephritis

A 
Burning sensation with peeing
Increased need to pee
Cloudy pee
Low back pain
Fatigue nausea vomiting
96
Q

What are the two Types of lower uti?

A

Cystitis- inflamm of urinary bladder

Urethritis- inflamm of urethra

97
Q

Why is lower UTIs more common in women?

A

Urethra is shorter and closer to anus and vagina

98
Q

What are some risk factors and manifestations of lower UTIs?

A

Rf- chronic urine retention, neurogenic bladder (incomplete emptying), diabetes mellitus (increased glucose)
Manifestations- blood tinged cloudy urine, pelvic abd and low back pain

99
Q

What is the greatest risk factor of urinary bladder cancer?

A

Smoking cigarettes

100
Q

What is the condition known as where the urinary bladder becomes smaller and inelastic?

A

Interstitial cystitis

101
Q

What is the pathogenesis of interstitial cystitis?

A

Breakdown of protective mucous membrane of bladder epithelium

102
Q

What is tubular reabsorption?

A

Returning of filtered water and filtered solutes to bloodstream and happens in collecting ducts of nephrons

103
Q

What is tubular secretion?

A

Transfer of materials from blood and tubule cells into tubular fluid , happens in collecting ducts - secreted substances eliminated from body in urine

104
Q

name the routes of reabsorption

A

paracellular- btwn adjacent tubule cells

transcellular- thru an individual tubule cell

105
Q

differentiate btwn passive transport and active transport in the tubules

A

passive- diffusion of a substance down its concentration gradient
primary active transport- energy from ATP hydrolysis to pump a substance against its concentration gradient
secondary active transport- energy stored in ions electrochemical gradient to push another substance across the membrane

106
Q

what is transport maximum and how is it measured?

A

upp limit to how fast a transporter can work

mg/min

107
Q

solute reabsorption drives water reasborption (all water reabsorption occurs by osmosis)- T/F?

A

true

108
Q

which segments of the nephron are always permeable to water and therefore are areas where obligatory water reabsorption occurs?

A

proximal convoluted tubule

descending loop of Henle

109
Q

what does facultative water reabsorption refer to?

A
  • capable of adapting to a need

- regulated by ADH, occurs in collecting ducts as “fine tuning”

110
Q

what do you call the appearance of glucose in the urine?

A

glucosuria

111
Q

when does glucosuria usually occur?

A

when blood levels of glucose become excessive, such as with diabetus mellitus

112
Q

what helps to maintaim homeostasis of body’s fluid volume and controls whether urine is large in volume and dilute or small in volume and concentrated?

A

presence (concentrated) /absence of ADH (dilute)

113
Q

what maintains the osmotic gradient?

A

the counter-current mechanism
-fluid in the loop of Henle becomes more concentrated and gains more osmolarity as you go down the tube, and the reverse happens as you ascend the tube

114
Q

what do you call substances that slow the renal absorption of water? what do they cause as a result?

A 
diruetics
cause diuresis ( elevation in urine flow rate, reduces BV)
115
Q

give examples of some natural diuretics? what do they inhibit the secretion of?

A

caffeine and alcohol

inhibit secretion of ADH

116
Q

what are other organs that contribute to “waste management” program in the body?

A

body buffers (prevent increased acidity in body)
blood (pick up and delivery system)
liver (metabolic recylcing)
lungs (excretes CO2)
sweat/ sudoriferous glands- eliminate excess
GI tract- excretes wastes and etc

117
Q

how much fluid makes up the body of a lean male/female?

A

55-60%

118
Q

what are the 2 compartments fluids are present in?

A

intracellular fluid/cytosol- 2/3
extracellular- 1/3
short form= ECF/ ICF

119
Q

of the extracellular fluid, what compartments does it become broken up into?

A

interstitial fluid- 80%, in spaces btwn tissue cells (lymph, CSF, pericardial, etc)
plasma- liquid portion of blood, 20%

120
Q

what are the barriers that seperate the fluids of cells from each other?

A

plasma membrane- seperates intracellular fluid from interstitial fluid
blood vessel walls- seperate interstitial fluid from blood plasma

121
Q

when is the only time that exchange of water and solutes btwn plasma and interstitial fluid happens?

A

in cappillaries bc the walls are thin and leaky

122
Q

what is fluid balance?

A

when the body has reached balance btwn rewuired amounts of water and solutes

123
Q

*what is fluid balance?

A

when the body has reached balance btwn rewuired amounts of water and solutes

124
Q

what determines the direction of water movement btwn intracellular and interstitial fluid?

A

the concentration of solutes (bc osmosis)

125
Q

the volume of fluid in each compartment remains relatively stable. T/F?

A

true

126
Q

what are electrolytes?

A

inorganic compounds that dissociate into ions

127
Q

what does fluid balance depend on?

A

electrolye balance

  • excess water excreted by diluting urine
  • excess electrolytes excreted by producing concentrated urine
128
Q

what are sources of water gain?

A

drinking/ingesting liquids (most common)
eating moist foods
“metabolic water” produced thru metabolic reactions

129
Q

what are sources of water loss?

A

sweat -skin
urine-kidney
feces-GI tract
exhalation-lungs

130
Q

what does regulating water gain depend on?

A

regulating the volume of fluid intake

131
Q

what is the formation of metabolic water linked to?

A

ATP production- aerobic cellular respiration

132
Q

where is the thirst centre located that controls our urge to drink?

A

hypothalamus

133
Q

when there is dehydration, what is stimulated and how?

A

the hypothalamus:
decreased saliva- neurons in mouth
increased blood osmolarity- osmoreceptors in hypothalamus
decreased BV and pressure- renin relase, angiotensin 2
result= THIRST

134
Q

what is the main factor that determines body fluid volume?

A

extent of urinary salt loss bc water follows solutes

135
Q

what is that main factor that determines the osmolarity of body fluids?

A

extent of urinary water loss (if water leaves, solutes do not follow)

136
Q

what hormones regulate the reapsorbtion of salt? (sodium and chloride)

A 
angiotensin 2 (enhances reasborption in PCT)
aldosterone (enhances reabsprtion in collecting duct)
atrial natriuretic peptide (enhances excretion)
137
Q

what hormone regulates water loss?

A

ADH aka vasopressin
released by post pituitary when osmolarity of body fluids increases
osmoreceptors in hypothalamus detect
-increases permeabilty of principal cells in collecting duct to water
-increases facultative water reabsorption

138
Q

why is it that cells (normally) do not shrink or swell?

A

bc intracellular and interstitial fluids have same osmolarity

139
Q

what happens when osmolarity of interstitial fluid increases or decreases?

A

increases- when consume lots of salt> draws water out

decreases -when drink lots of water> cells swell

140
Q

what is water intoxication? what are the consequences of such?

A

when water is consumed faster than kidneys excrete it

-cells swell> coma, convulsions, possible death

141
Q

what are ions?

A

they start out as electrolytes (salts) that dissolve in water and dissociate

142
Q

what are the functions of electrolytes?

A
  • assist in metabolic processes
  • control osmosis
  • carry electrical current
  • act as co-factors in enzyme reactions
143
Q

name some important ions:

A 
sodium
chloride
potassium
bicarbonate
calcium
144
Q

what does sodium do? what controls its levels?

A
  • most abundant ECF ion
  • voltage gated channels, actions potentials, depolarization
  • controlled by aldosterone, ADH and ANP
145
Q

what does chloride do?

A

follows sodium bc its attracted to it

most prevalent anion in ECF

146
Q

what does potassium do?

A

most prevalent cation in ICF

-repolarization phase of action potentials

147
Q

what is bicarbonate?

A

a buffer for acids

148
Q

what is bicarbonate?

A

a buffer for acids

-maintains ph of blood

149
Q

what does calcium do?

A

bone health
triggers action potentials, neurotransmitter
mm contracting and mm tone
blood clotting

150
Q

what is the consequence of having electrolyte imbalances?

A

hormone imbalances

illnesses of various sorts

151
Q

what mechanisms does the removal of H from body fluids depend on?

A

buffer systems
exhalation of CO2
kidney excretion of H

152
Q

how does a buffer system work?

A
  • consists of weak acid and salt of acid (base)

- makes a strong solution weaker which ionize less and don’t alter pH so much

153
Q

name examples of other buffer systems in body

A

protein BS
phosphate BS
carbonic acid bicarbonate BS

154
Q

why is carbonic acid called a volatile acid?

A

bc it dissociates into carbon dioxide and water and the CO2 is elimnatedfrom body via exhalation

155
Q

how does breathing affect pH of blood?

A

increased breathing rate> more CO2 exhaled> reduction of H> rise in blood pH (more alkaline)
reverse with decreased breathing rate
-negative feedback loop regulates blood pH

156
Q

how do we excrete non-volatile acids (ie sulphuric acid)?

A

they must be excreted in urine

157
Q

differentiate btwn acidosis/acidemia and alkalosis/alkalemia

A

normal is 7.35>7.45
acidosis is below 7.35
alkalosis is above 7.45

158
Q

what is the result of acidosis?

A

pH too low-depression of CNS, coma and possible death

159
Q

what is the result of alkalosis?

A

pH too high- increased excitability of CNS so resulting in nervousness, mm spasms, convulsions, possible death

160
Q

how does body compensate to return pH to normal?

A

hyper/hypoventilation to change CO2 levels (hours for mac effect)
renal compensation-changes in secretion of H and reabsorption of HCO3 (days for max effect)

161
Q

what is metabolic acidosis?

A

decrease in blood Ph from excess H or insufficient HCO3
cause: renal dysfn, diarrhead, ketosis
tx= hyperventilation, IV of bicarbonate

162
Q

what is metabolic alkalosis?

A

increase in blood pH due to reduction of H or too much HCO3
causes: vomiting, dehydration
tx= hypoventilation, fluid solutions

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