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
1
Q
Name at least 3 factors that can lead to renal failure?
A
Chronic hypertension
Cardiovascular insufficiency
Lower UTIs
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
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
4
Q
What is the issue with Intra renal failure?
A
Disease of kidney, ie bacterial infection like E. coli
5
Q
What is the issue with post renal failure?
A
Reduction of fluid expulsion from kidney ie due to kidney stones or tumours
6
Q
what is the urinary system made up of?
A
2 kidneys, 2 ureters, 1 urinary bladder, 1 urethra
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
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
9
Q
what are the most important ions the kidneys regulate?
A
sodium, potassium, calcium, phosphate
10
Q
how do the kidneys regulate blood volume?
A
it either conserves or eliminates water in the urine
11
Q
how do the kidneys regulate blood pressure?
A
secretes renin which stimulates RAA pathway» increased BP
12
Q
what is blood osmolarity?
A
measure of total number of dissolved particles per litre
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
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)
15
Q
each kidney has a convex medial border that faces the verterbal colum, T/F?
A
false, it is concave medially
16
Q
whats the renal hilum?
A
deep vertical fissure in which ureter, blood and lymph vessels go through
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)
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)
19
Q
what is between the renal pyramids?
A
renal columns (part of renal cortex)
20
Q
what is the fn’l portion of a kidney called?
A
parenchyma
21
Q
what is the basic functional unit of a kidney called?
A
nephron
22
Q
what do papillary ducts do?
A
collect urine formed by nephrons
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
24
what i s the renal pelvis?
single large basin that collects urine from major calyces
25
what is the renal sinus?
cavity that contains part of the renal pelvis, the calyces, renal BV and nn, as well as fat to hold the structures in place
26
show the pathway of urine
nephron> collecting duct> papillary duct in renal pyramid> minor calyx> major calyx> renal pelvis> ureter> urinary bladder> urethra> ext of body
27
show the flow of blood supply of kidneys (p 300)
renal artery> afferent arteriole> glomerulus> efferent arteriole> renal vein> renal venule> peritubular capillaries
28
what is the function of the ureters?
transport urine from renal pelvis of each kidney to urinary bladder by way of peristaltic smooth muscle waves
29
what are the 3 tissue layers of the ureters from deepest to superficial?
mucosa
muscularis- smooth mm
adventitia- areolar connective tissue, blends with surrounding tissue and anchors
30
where is the urinary bladder located?
in pelvic cavity
male- post to pubic symphysis and ant to rectum
female- ant to vagina and inferior to uterus
31
what structures are located in the bladder?
regae-increase surface area
folds of peritoneum hold it in place
shape determined by how much urine is in it
32
what are the 3 layers of tissue in the bladder?
same as in ureters
33
differentiate btwn internal urethral sphincter and external urethral sphincter
internal-around opening, smooth mmfor involuntary expulsion of urine from bladder
external- skeletal mm fibers, voluntary expulsion
34
what is the trigone?
small triangular are in floor of bladder, the two post corner contain the 2 urethral openings
35
what is micturition? what is it a combo of? where is this process initiated from?
the act of urinating, combo of voluntary and involuntary mm contractions
-cerebral cortex initiates or delays
36
what is the urethra and what is its fn?
terminal point of urinary system
37
how is the female urethra different that the male one?
length: M= 15-20cm, F= 4 cm
| passageway for= urine in both, semen in M
38
what are the 3 segments of the male urethra?
prostatic- goes thru prostate gland
membranous- shortest, thru urogenital diaphragm
spongy- longest, exits thru penis
39
the number of nephrons we have increases with age. T/F?
false. it is constant our whole lives. about 1 million.
40
what are the 2 parts of the nephron?
renal corpuscle= where blood plasma filtered
| renal tubule= filtured fluid passes through it
41
what happens to the kidney fn of body if one is removed?
the 2nd will grow in size (not number of nephrons) and work at about 80% capacity of 2 normal kidneys
42
what are the 3 parts to the renal tubule?
1) proximal convoluted tubule
2) loop of Henle (nephron loop) (descending/ascending limb)
3) distal convoluted tubule
43
what part of the urinary system do the collecting duct and papillary duct belong to?
renal tubule
44
what does the juxtaglomerular appartus do?
helps to regulate blood pressure within in the kidney
45
what does the juxtaglomerular appartus made up of?
macula densa- columnar tubule cells (p. 306 missing)
46
what are the 3 basic processes that occur to produce urine?
glomerular filtration- 1st step
tubular reabsorption
tubular secretion
47
where does glomerular filtration occur? what happens?
in glomerulus
| -water and most solutes in blood plasma go from blood stream in glomerular capsule and into renal tubules
48
what is tubular reabsorption?
return of substances from the capsular space back into blood stream
49
what is tubular secretion?
moving of substances from blood stream back into collecting ducts (getting rid of what body doesnt need)
50
how do nephrons help to maintain homeostasis of blood volume and composition?
through filtering, reabsorping, and secreting
51
what is glomerulal filtrate?
fluid that enters capsular space
52
explain the mechanism for glomerular filtartion and the 3 types of cells you might find
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
53
filtration is driven by pressure (diffusion). T/F?
true
54
what is net filtration pressure?
the amount of fluid filtered minus the amount that is returned to the bloodstream
(NFP= GBHP-CHP-BCOP)
55
name a pressure tha tpromotes filtration
GBHP- glomerular blood hystrostatic pressure= BP in G capillaries, it forces water and solutes from blood thru filtration membrane
56
name pressures that oppose filtration
CHP- capsular hydrostatic pressure ("back pressure")
| BCOP- blood colloid osmotic pressure
57
why does kidney disease lead to edema?
glomerular capillaries become damaged and permeable, BV decreaes, interstitial fluid volume decreases (p 310)
58
what is glomerular filtration rate? (GFR)
amount of filtrate formed in all of renal corpuscles of both kidneys each minute
59
how is GFR regulated?
- by adjusting blood flow in and out of glomerulus (diameter of arterioles)
- by altering glomerular capillary surface area available for filtration
60
what are the mechanisms that control GFR?
renal autoregulation
neural regulation
hormonal regulation
61
whast are the 2 mechanisms of renal autoregulation?
myogenic- stretching triggers contraction of smooth muscle cells in arterioles
tubulo-glomerular feedback- macula densa gives feedback
62
how does neural regulation of GFR work?
ANS releases epinephrine- causes constricton
63
how does hormonal regulation of GFR work?
angiostensin 2- vasoconstrictor
| atrial natriuretic peptide-increases capillary surface area
64
what are the hormones that affect the extent of sodium, chloride and water reabsorption and potassium secretion?
RAA
Angiotensin 2
ADH/ vasopressin- regulates water reabsorption
ANP- minor role in inhibiting eltectrolye and water reapsorption
(p 312-313)
65
what are the most important regulators of electrolyte reabsorption and secretion?
angiotension 2 and aldosterone
66
define diuretic
chemical that increases urine volume by decreasing water reabsorption (inhibts sodium)
67
define diuresis
elevated urine flow rate which reduces BV (ANP)
68
define natriuresis
loss of sodium in urine (ANP)
69
what are the syndromes of the glomerular?
```
nephrotic syndrome (glomerulonephrosis)
nephritic syndrome (glomerulonephritis)
```
70
what are the symptoms of nephrotic syndrome?
- loss of protein in urine (severe)
- edema of sacrum/ankles
- orthostatic hypotension
71
what is the pathogenesis of nephrotic syndrome?
-kidney or systemic disease states may create increased permeability of the glomerular capillaries to protein
72
what is nephtritic syndrome? what are its manifestations?
inflamm of glomerulus
acute- hematuria, moderate proteinuria, oliguria (reduced protein production)
chronic- acute renal failure, anuria (no urine production), fibrosis (glomerular crescents)
73
What is the tx for nephritic syndrome?
Control hypertension
Correct electrolyte imbalances
Reduce edema
Prevent congestive heart failure
74
What is pyelonephritis ?
Infection of kidney parenchyma and renal pelvis
75
What is the etiology of acute pyelonephritis
Bacterial infection of upp urinary tract
| E. coli infection
76
What is the pathogenesis of pyelonephritis
Infection ascends from lower urinary tract often secondary to catherterization or vesicoureteral reflux, leads to bacterial spread and inflamm
77
What is constant loin/flank pain and lower urinary tract symptoms a common symptom of?
Pyelonephritis
78
What is the diff Btwn acute and chronic pyelonephritis
Scar tissue has formed and deformation of renal calyces
79
What is tx for pyelonephritis
Antibiotics
80
What is: injury to the tubular structures of nephron?
Acute tubular necrosis
81
What is the etiology of acute tubular necrosis?
Damage by toxic substances
| Which results in ischemia and destruction of tubular epithelial cells and suppression of renal fn
82
Explain oliguria and diuresis as clinical manifestations acute tubular necrosis
P 334
83
Primary hypertension results in serious renal dysfn. T-f?
True
84
Primary renal disease is almost always assoc with what?
Secondary hypertension
85
What is benign essential hypertension?
Chronic condition
| Occlusion of inter lobular arteries and affecting arterioles create anatomic changes in kidney which leads to atrophy
86
Explain malignant hypertension
Bp rises quickly to high levels
Secondary to pre existing kidney condition
Patchy pathological lesions that progress rapidly
87
What are s and s of malignant hypertension
```
Rapidly increasing bp
Protein uria
Hematuria
Oliguria
Uremia
```
88
Infantile kidney disease (of newborn)/ sponge kidney- explain pathogenesis and consequence
Cystic dilation in terminal branches of collecting tubules
| Death shortly after birth
89
What is adult poly cystic kidney disease?
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
What's another name for Kidney stones?
Renal calculi- crystals that develop in renal pelvis
91
What is the etiology of renal calculi?
Absence of fluid (dehydration, infection, etc)
92
What are renal calculi made up of?
Calcium oxalate/phosphate
Uric acid stones
Struvite stones
Cystine stones
93
What are manifestations of kidney stones
Flank pain
Severe abd pain
May be asymptomatic
94
Differentiate Btwn upp urinary tract infection and lower
Upp- kidney and ureter
| Lower- urinary bladder and urethra
95
What are some manifestations of upp urinary tract/ pyelonephritis
```
Burning sensation with peeing
Increased need to pee
Cloudy pee
Low back pain
Fatigue nausea vomiting
```
96
What are the two Types of lower uti?
Cystitis- inflamm of urinary bladder
| Urethritis- inflamm of urethra
97
Why is lower UTIs more common in women?
Urethra is shorter and closer to anus and vagina
98
What are some risk factors and manifestations of lower UTIs?
Rf- chronic urine retention, neurogenic bladder (incomplete emptying), diabetes mellitus (increased glucose)
Manifestations- blood tinged cloudy urine, pelvic abd and low back pain
99
What is the greatest risk factor of urinary bladder cancer?
Smoking cigarettes
100
What is the condition known as where the urinary bladder becomes smaller and inelastic?
Interstitial cystitis
101
What is the pathogenesis of interstitial cystitis?
Breakdown of protective mucous membrane of bladder epithelium
102
What is tubular reabsorption?
Returning of filtered water and filtered solutes to bloodstream and happens in collecting ducts of nephrons
103
What is tubular secretion?
Transfer of materials from blood and tubule cells into tubular fluid , happens in collecting ducts - secreted substances eliminated from body in urine
104
name the routes of reabsorption
paracellular- btwn adjacent tubule cells
| transcellular- thru an individual tubule cell
105
differentiate btwn passive transport and active transport in the tubules
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
what is transport maximum and how is it measured?
upp limit to how fast a transporter can work
| mg/min
107
solute reabsorption drives water reasborption (all water reabsorption occurs by osmosis)- T/F?
true
108
which segments of the nephron are always permeable to water and therefore are areas where obligatory water reabsorption occurs?
proximal convoluted tubule
| descending loop of Henle
109
what does facultative water reabsorption refer to?
- capable of adapting to a need
| - regulated by ADH, occurs in collecting ducts as "fine tuning"
110
what do you call the appearance of glucose in the urine?
glucosuria
111
when does glucosuria usually occur?
when blood levels of glucose become excessive, such as with diabetus mellitus
112
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?
presence (concentrated) /absence of ADH (dilute)
113
what maintains the osmotic gradient?
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
what do you call substances that slow the renal absorption of water? what do they cause as a result?
```
diruetics
cause diuresis ( elevation in urine flow rate, reduces BV)
```
115
give examples of some natural diuretics? what do they inhibit the secretion of?
caffeine and alcohol
| inhibit secretion of ADH
116
what are other organs that contribute to "waste management" program in the body?
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
how much fluid makes up the body of a lean male/female?
55-60%
118
what are the 2 compartments fluids are present in?
intracellular fluid/cytosol- 2/3
extracellular- 1/3
short form= ECF/ ICF
119
of the extracellular fluid, what compartments does it become broken up into?
interstitial fluid- 80%, in spaces btwn tissue cells (lymph, CSF, pericardial, etc)
plasma- liquid portion of blood, 20%
120
what are the barriers that seperate the fluids of cells from each other?
plasma membrane- seperates intracellular fluid from interstitial fluid
blood vessel walls- seperate interstitial fluid from blood plasma
121
when is the only time that exchange of water and solutes btwn plasma and interstitial fluid happens?
in cappillaries bc the walls are thin and leaky
122
what is fluid balance?
when the body has reached balance btwn rewuired amounts of water and solutes
123
*what is fluid balance?
when the body has reached balance btwn rewuired amounts of water and solutes
124
what determines the direction of water movement btwn intracellular and interstitial fluid?
the concentration of solutes (bc osmosis)
125
the volume of fluid in each compartment remains relatively stable. T/F?
true
126
what are electrolytes?
inorganic compounds that dissociate into ions
127
what does fluid balance depend on?
electrolye balance
- excess water excreted by diluting urine
- excess electrolytes excreted by producing concentrated urine
128
what are sources of water gain?
drinking/ingesting liquids (most common)
eating moist foods
"metabolic water" produced thru metabolic reactions
129
what are sources of water loss?
sweat -skin
urine-kidney
feces-GI tract
exhalation-lungs
130
what does regulating water gain depend on?
regulating the volume of fluid intake
131
what is the formation of metabolic water linked to?
ATP production- aerobic cellular respiration
132
where is the thirst centre located that controls our urge to drink?
hypothalamus
133
when there is dehydration, what is stimulated and how?
the hypothalamus:
decreased saliva- neurons in mouth
increased blood osmolarity- osmoreceptors in hypothalamus
decreased BV and pressure- renin relase, angiotensin 2
result= THIRST
134
what is the main factor that determines body fluid volume?
extent of urinary salt loss bc water follows solutes
135
what is that main factor that determines the osmolarity of body fluids?
extent of urinary water loss (if water leaves, solutes do not follow)
136
what hormones regulate the reapsorbtion of salt? (sodium and chloride)
```
angiotensin 2 (enhances reasborption in PCT)
aldosterone (enhances reabsprtion in collecting duct)
atrial natriuretic peptide (enhances excretion)
```
137
what hormone regulates water loss?
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
why is it that cells (normally) do not shrink or swell?
bc intracellular and interstitial fluids have same osmolarity
139
what happens when osmolarity of interstitial fluid increases or decreases?
increases- when consume lots of salt> draws water out
| decreases -when drink lots of water> cells swell
140
what is water intoxication? what are the consequences of such?
when water is consumed faster than kidneys excrete it
| -cells swell> coma, convulsions, possible death
141
what are ions?
they start out as electrolytes (salts) that dissolve in water and dissociate
142
what are the functions of electrolytes?
- assist in metabolic processes
- control osmosis
- carry electrical current
- act as co-factors in enzyme reactions
143
name some important ions:
```
sodium
chloride
potassium
bicarbonate
calcium
```
144
what does sodium do? what controls its levels?
- most abundant ECF ion
- voltage gated channels, actions potentials, depolarization
- controlled by aldosterone, ADH and ANP
145
what does chloride do?
follows sodium bc its attracted to it
| most prevalent anion in ECF
146
what does potassium do?
most prevalent cation in ICF
| -repolarization phase of action potentials
147
what is bicarbonate?
a buffer for acids
148
what is bicarbonate?
a buffer for acids
| -maintains ph of blood
149
what does calcium do?
bone health
triggers action potentials, neurotransmitter
mm contracting and mm tone
blood clotting
150
what is the consequence of having electrolyte imbalances?
hormone imbalances
| illnesses of various sorts
151
what mechanisms does the removal of H from body fluids depend on?
buffer systems
exhalation of CO2
kidney excretion of H
152
how does a buffer system work?
- 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
name examples of other buffer systems in body
protein BS
phosphate BS
carbonic acid bicarbonate BS
154
why is carbonic acid called a volatile acid?
bc it dissociates into carbon dioxide and water and the CO2 is elimnatedfrom body via exhalation
155
how does breathing affect pH of blood?
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
how do we excrete non-volatile acids (ie sulphuric acid)?
they must be excreted in urine
157
differentiate btwn acidosis/acidemia and alkalosis/alkalemia
normal is 7.35>7.45
acidosis is below 7.35
alkalosis is above 7.45
158
what is the result of acidosis?
pH too low-depression of CNS, coma and possible death
159
what is the result of alkalosis?
pH too high- increased excitability of CNS so resulting in nervousness, mm spasms, convulsions, possible death
160
how does body compensate to return pH to normal?
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
what is metabolic acidosis?
decrease in blood Ph from excess H or insufficient HCO3
cause: renal dysfn, diarrhead, ketosis
tx= hyperventilation, IV of bicarbonate
162
what is metabolic alkalosis?
increase in blood pH due to reduction of H or too much HCO3
causes: vomiting, dehydration
tx= hypoventilation, fluid solutions
