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Anatomy 403 > Urinary System > Flashcards

Urinary System Flashcards

1
Q

Functions of the kidneys

A
  1. regulation of water, inorganic ion balance, and acid-base balance
  2. removal of metabolic waste products from the blood and their excretion in the urine
  3. removal of foreign chemicals from the blood and their excretion in the urine
  4. gluconeogenesis
  5. production of hormones / enzymes
    a. EPO (erythropoietin), which controls erythrocyte production
    b. renin, an enzyme that controls the formation of angiotensin and influences blood pressure and sodium balance
    c. PTH, which influences calcium balance
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2
Q

why is the right kidney lower than the left?

A

because of the liver

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3
Q

nephron

A

“functional unit”

~ 1 million / kidney –> can’t make more but can increase workload

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4
Q

renal cortex

A

outer layer

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5
Q

renal medulla

A

inner layer

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6
Q

series of tubules

A

capillaries

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7
Q

portal system

A

2 sets of arterioles + 2 sets of capillaries

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8
Q

types of nephrons

A
  1. juxtamedullary

2. cortical

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9
Q

juxtamedullary nephron

A
  • 15%
  • long nephron loop
  • generate gradient in medulla needed for water reabsorption from collecting duct
  • vasa recta
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10
Q

Cortical nephron

A
  • 85%
  • short nephron loop
  • majority of filtration
  • do not contribution to hypertonicity in medulla
  • peritubular capillaries
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11
Q

juxtaglomerular (JG) apparatus

A

macula densa + juxtaglomerular (JG) cells

- important in regulation filtration rate

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12
Q

macula densa

A
  • distal convoluted tubule (located)

- senses Na+ / Cl-

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13
Q

Juxtaglomerular (JG) cells

A
  • afferent arteriole

- secrete renin

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14
Q

basic regnal processes

A
  1. glomerular filtration
  2. tubular reabsorption / secretion
  3. water conservation
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15
Q

glomerular filtration

A

creates a plasma like filtrate of blood

–> renal corpuscle

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16
Q

tubular reabsorption

A

removes useful solutes from the filtrate, returns them to the blood
- in the PCT and DCT

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17
Q

tubular secretion

A

removes additional wastes from the blood, adds them to the filtrate
- in the PCT and DCT

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18
Q

water conservation

A

removes water from the urine and returns it to the blood; concentrates wastes
- in the PCT, collecting duct, and loop of nephron

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19
Q

what substances are filtered + secreted but not reabsorbed?

A

drugs / toxins

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20
Q

what substances are filters and some of it is reabsorbed?

A

Na+ / water

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21
Q

what substances are filtered and completely reabsorbed?

A

glucose

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22
Q

renal corpuscle

A

glomerular capillaries + glomerular capsule

glomerular capillaries + podocytes = glomerulus

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23
Q

layers of glomerular filtration

A
  • capillary endothelium
  • basement membrane
  • podocytes

LEAKY!!

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24
Q

glomerular filtration filters based on:

A
  1. size

2. charge

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25
Q

basement membrane

A

gel like negative charge: repels large, charged molecules

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26
Q

substances that are turned back during glomerular filtration

A
  • blood cells
  • plasma proteins
  • large anions
  • protein-bound minerals and hormones
  • most molecules >8 nm in diameter
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27
Q

substances passed through the filter during glomerular filtration

A
  • water
  • electrolytes
  • glucose
  • amino acids
  • fatty acids
  • vitamins
  • urea
  • uric acids
  • creatine
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28
Q

GFR

A

glomerular filtration rate

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29
Q

GFR average

A

125 mL/day

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30
Q

favoring filtration:

A
  • PGC (glomerular capillary blood pressure)
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31
Q

opposing filtration:

A
  • PBS (fluid pressure in Bowmen’s space)

- πGC (osmotic force due to proton in plasma)

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32
Q

average of PCG

A

60

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33
Q

net glomerular filtration pressure equation

A

PGC - PBS - πGC

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34
Q

PGC > PBS + πGC means

A

movement of fluid into capsule

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35
Q

vasomotion __

A

of the afferent and efferent arteriole alters PGC to change GFR

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36
Q

constrict afferent arterioles means

A
  • decreased PGC

- decreased GFR

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37
Q

dilate efferent arterioles means

A
  • decreased PGC

- decreased GFR

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38
Q

constrict efferent arterioles means

A
  • increased PGC

- increased GFR

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39
Q

dilate afferent arterioles means

A
  • increased PGC

- increased GFR

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40
Q

renal auto regulation (intrinsic control)

A

ability of nephrons to adjust blood flow in order to maintain GFR despite changes in blood pressure —> ordinary daily changes

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41
Q

intrinsic controls on regulation of GFR

A
  1. myogenic mechanism

2. tubuloglomerular feedback

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42
Q

myogenic mechanism

A
  • smooth muscle contracts when stretched
  • increased BP = increased stretch of afferent arteriole = increased vasoconstriction = decreased PGC = maintain GFR despite increased BP
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43
Q

tubuloglomerular feedback

A
  • high GFR
  • rapid flow of filtrate in renal tubules
  • sensed by maculae densa via Na+ / Cl-
  • paracine secretion –> adenosine
  • constriction of afferent arteriole –> decreased PGC
  • reduced GFR
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44
Q

effects of autoregulation

A
  • when BP changes rapidly, GFR does not change much (maintains fluid/electrolyte balance)
  • if no renal auto regulation:
    MAP: 100 –> 125 mmHg
    urine output would go from 1-2 L/day to 45 L/day
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45
Q

extrinsic control on regulation of GFR

A
  • sympathetic nervous system
  • when BP change is dramatic / persistent (strenuous exercise / shock)
  • SNS = vasoconstrict afferent arteriole (also help redirect blood flow to heart, brain, muscles) = decreased PGC = decreased GFR
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46
Q

tubular reabsorption

A
  • filtered loads are huge
  • reabsorption of water, ions, nutrients, etc. is almost complete
  • –> water and ions are regulated
  • –> nutrients are NOT regulated
  • reabsorption of wastes is incomplete –> excreted
  • most reabsorption occurs in PCT (65%)
  • 99% of filtrate is reabsorbed
  • occurs by diffusion and thru transporters
  • –> not regulated in the PCT
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47
Q

transport maximum

A
  • substances needing protein carriers have a “transport maximum”
  • if all transporters are occupied some solute won’t be reabsorbed and will appear in urine
  • only occurs in a diseased state
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48
Q

tubular secretion

A
  • to dispose of substances at higher rate than filtered load
  • foreign chemicals (drugs) and toxins
  • –> 80% of penicillin lost in 3-4 hours
  • metabolic wastes (urea, uric acid, creatinine)
  • H+ / K+
  • via active transport (usually coupled to sodium)
  • –> can also have transport maximum, foreign chemicals compete for same transporters
  • most secretion is into proximal tubules (not regulated)
  • -> except K+ and H+ are in the distal (regulated)
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49
Q

Na+ is regulated by ______ and ______ in the ______ during tubular _______

A

aldosterone and ANP in the DCT during tubular reabsorption

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50
Q

K+ is regulated by _____ in the ____ during tubular ____

A

aldosterone in the DCT during tubular secretion

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51
Q

water is regulated by _____ in the _____ during _____

A

ADH in the collecting duct during tubular reabsorption

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52
Q

water follows solute via _____

A

osmosis

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53
Q

Na+ determines amount of water in the extracellular fluid means

A

increased Na+ = increased water = increased blood volume = increased blood pressure

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54
Q

sodium reabsorption

A
  • most Na+ is reabsorbed in the PCT (not regulated)
  • Na+ reabsorption is regulated in DCT
  • aldosterone builds Na+ channels and Na+/K+ pumps
  • ANP inhibits Na+ channel activity
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55
Q

effects of angiotensin II

A
  1. widespread vasoconstriction (increase TPR)
  2. increased aldosterone = increase Na+ reabsorption in DCT
  3. increased ADH = increased water reabsorption in collecting duct
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56
Q

result of angiotensin II

A

when plasma volume drops, an increase in RAA reduces Na+ and water loss to increase BP

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57
Q

atrial natriuretic peptide (ANP)

A

increased BP/BV = stretch in right atria = increase ANP =

  1. afferent dilation & efferent constriction = increase GFR
  2. decreased aldosterone
  3. decreased ADH
  4. decreased Na+ reabsorption
    - -> increase Na+ and water excretion
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58
Q

ANP result

A

when plasma volume increases, ANP increases Na+ and water loss to decrease BP

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59
Q

water reabsorption

A
  • proximal tubule; water follows Na+ –> osmotic drage
  • not regulated
  • osmosis is ALWAYS the driving force for water
  • regulation of water reabsorption in the distal nephron requires an osmotic gradient in the medulla
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60
Q

countercurrent multiplier

A

in loop of nephron = creates gradient in vasa recta

  • effect is “multiplied” as move deep into medulla”
  • urea from collecting duct contributes to increased osmolarity of ECF
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61
Q

countercurrent exchanger

A

maintains gradient

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62
Q

ascending limb (countercurrent multiplier)

A
  • active transport of salt –> into medulla (ECF)
  • impermeable to water
  • water does not follow
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63
Q

descending limb (countercurrent multiplier)

A
  • impermeable to salt
  • permeable to water
  • water moves out until concentration in/out are equal
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64
Q

higher protein diet leads to

A

increased urea = increase ability to concentrate urine

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65
Q

renal regulation of water

A
  • osmotic gradient is used in collecting duct to concentrate urine
  • –> gives water a reason to move
  • presence of water channels in collecting duct is regulated by ADH
66
Q

when is ADH secreted?

A

when blood osmolarity is high (dehydrated)

67
Q

+ADH

A

increased number of Aquaporins in collecting duct = increased water reabsorption

68
Q
  • ADH
A

decreased number of Aquaporins in collecting duct = increased excretion (collecting duct is relatively impermeable to water)

69
Q

what gland secreted ADH?

A

posterior pituitary

70
Q

main function of ADH

A

regulate plasma osmolarity

71
Q

renal regulation of potassium

A
  • potassium is the main intracellular ion
  • small changes in [K+] of ECF can cause lethal malfunction of excitable tissues
  • K+ is absorbed in the PCT by diffusion
  • excess K+ is secreted in the DCT (regulated by low)
72
Q

norokalemia

A
  • K+ concentrations in equilibrium
  • equal diffusion into and out of cell
  • normal resting membrane potential (RMP)
73
Q

hypokalemia

A
  • reduced extracellular K+ concentration
  • greater diffusion of K+ out of cell
  • reduced RMP (cells hyper polarized)
  • cells less excitable
74
Q

hyperkalemia

A
  • elevated extracellular K+ concentration
  • less diffusion of K+ out of cell
  • elevated RMP (cells partially depolarized)
  • cells more excitable
75
Q

aldosterone

A
  • regulates the secretion of K+ in the distal nephron by building pumps and channels
  • cells are directly sensitive to K+ levels (no renin involved)
76
Q

H+ gain

A
  • generation of H+ from CO2
  • production of acids from metabolism of proteins and other organic molecules
  • gain H+ due to loss of bicarbonate in diarrhea or other non gastric GI fluids
  • gain of H+ due to loss of bicarbonate in the urine
77
Q

H+ loss

A
  • utilization of H+ in the metabolism of various organic anions
  • loss of H+ in vomit
  • loss of H+ (primarily in the form of H2PO4- and NH4+) in urine
  • hyperventilation
78
Q

urine is usually ____

A

acidic

- except for strict vegetarians

79
Q

buffers

A
  • first line of defense
  • short-term
  • msec-sec
80
Q

buffers buffering capacity

A

low

81
Q

buffers response time

A

fast

82
Q

respiratory

A
  • via changes in CO2
  • intermediate
  • sec - min
83
Q

respiratory buffering capacity

A

intermediate

84
Q

respiratory response time

A

intermediate

85
Q

renal

A
  • via bicarbonate / H+ excretion
  • long-term
  • hours - days
86
Q

renal buffering capacity

A

high

87
Q

renal response time

A

slow

88
Q

buffer systems ICF

A
  • phosphates

- proteins

89
Q

buffer systems ECF

A
  • bicarbonate

- proteins

90
Q

what happens when there is too much acid/base in the buffer system?

A

shift equilibrium = release or accept H+

91
Q

respiratory system

A

CO2 + H2O –>

92
Q

what happens when there is too much acid in the respiratory system?

A

hyperventilate to decrease CO2 = decrease H+

93
Q

what happens when there is too much base in the respiratory system?

A

hyperventilate to increase CO2 = increase H+

94
Q

renal regulation of pH

A

kidneys filter bicarbonate but CANT reabsorb it directly

95
Q

renal regulation: when pH is balanced

A

filtered bicarbonate is recovered and “recycled” into new bicarbonate ion

96
Q

what if blood is alkalotic?

A

bicarbonate ions that are filtered run out of H+ to recombine with = excreted

  • more bicarbonate than H+
  • not regulated = no active response = it just happens
97
Q

Renal regulation: Excess H+

A
  • after all filtered bicarbonate is gone, secreted H+ combines with phosphates and is excreted
  • net gain of bicarbonate
  • H+ excretion bound to HPO4-2
98
Q

renal regulation: excess H+ w/ glutamine

A
  • secrete H+ with ammonium
  • net gain of bicarbonate
  • H+ excretion bound to NH3-
  • urine pH can be as low as 4.5 then transporters stop working
99
Q

acidosis

A
  • pH < 7.35
  • decrease CNS function (confusion, disorientation, coma)
  • pH < 7.0 quickly fatal
100
Q

alkalosis

A
  • pH >7.45
  • increase muscle contraction (spasms, convulsions, paralysis)
  • pH > 8.0 quickly fatal
101
Q

respiratory

A

change in pH caused by change in CO2

102
Q

metabolic

A

change in pH not caused by change in CO2

103
Q

respiratory acidosis problem

A

increased CO2

104
Q

respiratory acidosis causes

A
  • hypoventilation

- emphysema

105
Q

respiratory acidosis respiratory compensation

A

increase ventilation

106
Q

respiratory acidosis renal compensation

A

increase H+ excretion

- bound to H2PO4- or NH4+

107
Q

respiratory alkalosis problem

A

decreased CO2

108
Q

respiratory alkalosis cause

A

hyperventilation

109
Q

respiratory alkalosis respiratory compensation

A

decrease ventilation

110
Q

respiratory alkalosis renal compensation

A

increase bicarbonate excretion

- nothing to bind to

111
Q

metabolic acidosis problem

A

increased H+ or decreased bicarbonate

112
Q

metabolic acidosis causes

A
  • diarrhea
  • diabetes
  • exercise
113
Q

metabolic acidosis respiratory compensation

A

increase ventilation

114
Q

metabolic acidosis renal compensation

A

increase H+ excretion

- bound to H2PO4- or NH4+

115
Q

metabolic alkalosis problem

A

decreased H+ or increased bicarbonate

116
Q

metabolic alkalosis causes

A
  • vomiting
  • increased aldosterone
  • exchange K+ for Na+ first then will use H+
117
Q

metabolic alkalosis respiratory compensation

A

decrease ventilation

118
Q

metabolic alkalosis renal compensation

A

increase bicarbonate excretion

- nothing to bind to

119
Q

renal clearance

A
  • the volume of plasma from which all of a substance is removed (cleared by the kidney per minute
  • also a measure of efficiency of kidneys
120
Q

equation of renal clearance

A

C = [U] x V / [P]

121
Q

clearance is used to determine

A
  • GFR
  • renal plasma flow
  • handling of new substances
122
Q

inulin

A

polymer of fructose from plants

  • must infuse at a constant rate
  • is used to measure GFR with renal clearance
123
Q

what is used for a more practical way for renal clearance?

A

Creatinine

124
Q

Creatinine

A
  • produced by muscles at a constant rate
  • freely filtered
  • not reabsorbed
  • only slightly secreted
  • measuring creating clearance gives a 10% overestimate of GFR
125
Q

PAH

A

para-amino hippuric acid

126
Q

clearance of PAH

A
  • infused like inulin
  • PAH is completely secreted and all removed in one pass
  • so clearance of PAH is about renal plasma flow
  • decrease C PAH = decrease renal plasma flow = blockage of renal artery
127
Q

urine

A
  • shade of yellow

- clear

128
Q

specific gravity range

A
  1. 002 - 1.030

- used to estimate osmolarity

129
Q

osmolarity range

A

about 80 - 1200 mOsm/L

130
Q

pH range

A

4.5 - 8.2

131
Q

urine volume range

A

1-2 L/day

132
Q

what shouldn’t be in urine

A
  • protein
  • blood
  • ketones
  • glucose
  • bilirubin
  • urobilinogen
  • nitrites
  • leukocytes
133
Q

protein

A
  • trace amounts okay

- kidney disease

134
Q

blood

A
  • kidney stones

- infection

135
Q

ketones

A
  • product of fat metabolism

- fasting, keto diet, increased diabetes

136
Q

glucose

A

hyperglycemia, increased diabetes

137
Q

bilirubin

A
  • increase in liver disease

- metabolite of Hb degradation, normally lier puts in bile

138
Q

urobilinogen

A

from eating fatty foods/meals

139
Q

nitrites

A
  • increased infection

- metabolite of bacteria

140
Q

leukocytes

A
  • increased infection

- WBC’s

141
Q

UTI

A
  • increased WBC’s
  • bacteria
  • +/- nitrites
142
Q

glomerular nephritis

A
  • increased WBC’s
  • increased protein
  • pus
143
Q

bilirubin formation and excretion

A
  • normally removed by liver and put in bile
  • small amounts are normal in urine
  • increased by GI tract during fatty meals
144
Q

diuresis

A

> 2L urine / day

145
Q

diuretic

A

any chemical that increases urine volume

146
Q

diuretic: caffeine

A

dilates afferent arteriole = increased GFR

147
Q

diuretic: alcohol

A

inhibits ADH = increased water excretion

148
Q

diuretic: nicotine

A

antidiuretic = increase ADH release

149
Q

diabetes mellitus (osmotic diuresis)

A
  • failure to reabsorb glucose –> Tm
  • more water is excreted with glucose
  • water follows glucose into urine
150
Q

diabetes insipidus (water Diuresis)

A
  • failure of posterior pituitary to release ADH or failure of kidney to respond to ADH
  • water permeability in collecting duct is low
  • increased water loss
  • 25 L / day
151
Q

what type of muscle is the detrusor

A

smooth muscle

152
Q

detrusor innervation type

A

PSNS causes contraction

153
Q

detrusor during filling

A

inhibited

154
Q

detrusor during micturition

A

stimulated

155
Q

what type of muscle is the internal urethral sphincter

A

smooth muscle

156
Q

internal urethral sphincter innervation type

A

SNS causes contration

157
Q

internal urethral sphincter during filling

A

stimulated

158
Q

internal urethral sphincter during micturition

A

inhibited

159
Q

what type of muscle is the external urethral sphincter

A

skeletal muscle

160
Q

external urethral sphincter innervation type

A

somatic motor causes contraction

161
Q

external urethral sphincter during filling

A

stimulated

162
Q

external urethral sphincter during micturition

A

inhibited

Anatomy 403 (13 decks)

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