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CNM Biochemistry Workshop Responses > Urinary System I > Flashcards

Urinary System I Flashcards

1
Q

List FOUR functions of the urinary system

A
  1. Excretion of unwanted substances
  2. Production of hormones (erythropoetin & calcitriol)
  3. Maintenance of water and electrolyte balance
  4. Regulation of blood glucose levels
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2
Q

Name THREE metabolic wastes containing nitrogen excreted by the urinary system?

A

Urea
Uric Acid
Creatinine

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3
Q

Name ONE ion excreted by the urinary system

A

Hydrogen (H+)

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4
Q

State the minimum daily quantity of urine (ml) required to clear body waste

A

500ml / day

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5
Q

Name THREE electrolytes regulated by the kidneys

A

Sodium - NA+
Potassium - K+
Hydrogen - H+

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6
Q

Describe specifically how the kidney plays a role in pH balance?

A

Blood pH must be between 7.35-7.45.

  • The lungs excrete CO2
  • The kidneys excrete H+ into urine and produce the buffer HCO3 - bicarbonate
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7
Q

Describe the main role of calcitriol in relation to the kidney

A

Calcitriol - Active form of Vit D. UV light activates a vit D precursor in the skin. The Kidneys convert inactive Vit D into calcitriol. This increases calcium by stimulating calcium + magnesium uptake from the GIT and reducing calcium loss in kidneys.

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8
Q

Describe the main role of erythropoetin in relation to the kidneys

A

Erythtopoetin - A protein hormone that stimulates erythropoiesis in the red bone marrow. Secreted by kidney interstitial cells into blood. Released in response to hypoxia.

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9
Q

Explain why anaemia is common in renal failure

A

Kidneys fail to produce erythropoietin, meaning that erythropoiesis production drops. Can be measured on a blood test (EPO test)

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10
Q

State the normal renal threshold for glucose in mmol/L

A

9 mmol/L

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11
Q

Describe specifically how the kidney compensates for ‘low blood glucose’

A

The kidneys are able to make glucose from the amino acid glutamine to help elevate blood sugar levels when hypoglycaemic (gluconeogenesis)

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12
Q

Explain why the right kidney is lower than the left kidney

A

Because the liver is also on the right side, so the right kidney sits lower, below the liver

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13
Q

With regards to renal anatomy and tissue layers, complete the following table

A

Table responses

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14
Q

Explain what is meant by the hilum?

A

On the concave kidney border. The region where blood vessels, lymph vessels, nerves and ureters enter and exit the kidney

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15
Q

State the & cardiac output received by the kidney

A

20-25%. 1.2l per minute despite being only 0.5% of bodyweight

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16
Q

Name the location into which urine drains from the nephrons

A

The minor and major calyces of the renal medulla

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17
Q

State which of the following components are in the ‘renal tubule’ or ‘renal corpuscule’

a. Loop of Henle
b. Distal convoluted tubule
c. Bowmans capsule
d. Proximal convoluted tubule
e. Glomerulus

A

TUBULE

a. Loop of Henle
b. Distal convoluted tubule
d. Proximal convoluted tubule

CORPUSCULE

c. Bowmans capsule
e. Glomerulus

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18
Q

Name the specific location in a nephron where anti-diuretic hormone acts.

A

ADH acts on the distal convoluted tubule to reabsorb water

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19
Q

Explain how urine is transported from the renal pelvis to the urinary bladder

A

The two ureters transport urine from the renal pelvis to the urinary bladder. Each ureter is about 25-30cm long and is retroperitoneal

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20
Q

Describe the role of the muscularis in the ureter

A

Consists of smooth muscle fibres which produces peristaltic contractions.

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21
Q

State the volume of urine (ml) which when exceeded triggers a desire to urinate.

A

200ml

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22
Q

Name the small triangular area located on the posterior floor of the bladder

A

The trigone

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23
Q

Name the specific location of the ‘detrusor muscle’

A

In the bladder. At the urethral opening.

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24
Q

List two differences between the female and male uretehras

A

Male’s is longer at 20mm. Womens is 4mm. The males passes through the prostate.

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25
Q

List THREE processes involved in urine formation

A
  1. Glomerular filtration
    2 Tubular reabsorption
    3 Tubular secretion
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26
Q

Describe specifically how the glomerulus is adapted for filtration

A
  • The diameter of the efferent arteriole is less than the afferent arteriole.
  • Glomerular capillaries are 50x more leaky than normal capillaries.
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27
Q

Name FOUR blood constituents that pass into glomerular filtrate

A

Hormones
Urea
Toxins
Uric Acid

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28
Q

Name TWO blood constituents that remain in glomerular capillaries

A

Leukocytes
Erythrocytes
Platelets
Plasma Proteins

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29
Q

Define the Glomerular Filtration Rate (GFR)

A

The amount of filtrate formed int he renal corpuscules of both kidneys each minute.

30
Q

State how GFR is measured

A

Ml/min. Normal should be over 90ml/min

31
Q

State the normal adult GFR range

A

Over 90ml/min

32
Q

Describe specifically how ‘colloid osmotic pressure’ develops

A

Damage to the glomerular capillaries can lead to plasma protein loss into urine

Albumin leaks into the filtrate leading to albuminuria

Blood volume decreases and interstitial fluid volume increases causing oedema

33
Q

Name THREE substances/molecules which are

a) reabsorbed via tubular reabsorption
b) secreted into tubular fluid

A

a) Water, amino acids, electrolytes

b) waste products like creatinine, excess ions like H+ (ph regulation), certain drugs e.g. penicillin

34
Q

Name the area of the renal tubule where most reabsorption occurs

A

In the PCT

35
Q

Describe how the RAAS works to increase blood pressure

A

If BP is low, the afferent arteriole walls are stretched less, causing

  1. The enzyme Renin released by the kidney into the blood
  2. Coverts angiotensinogen to angiotensin I (in liver)
  3. Angiotensin I is converted to angiotensin II by Angiotensin Converting Enzyme (ACE) in the lungs.
  4. Angiotensin II causes release of Aldosterone from the adrenal cortex
36
Q

Describe the role of ACE

A

Converts Angiotensin I to angiotensin II

37
Q

Identify where ACE is released in the body

A

in the lungs

38
Q

Describe how Angiotensin II acts upon the

a) pituitary gland
b) blood vessels

A

a) triggers it to release ADH

b) triggers vasoconstriction, increases blood pressure

39
Q

Explain how aldosterone affects sodium and water reabsorption

A

It increases it

40
Q

List one trigger for anti-diuretic hormone (ADH)

A

Angiotensin II

41
Q

Explain how ADH can rebalance osmotic pressure

A

ADH increases permeability of the distal convoluted tubules, thus increasing water reabsorption in the kidneys, thereby aiding in rebalancing the osmotic pressure

42
Q

Describe the role of the atrial natriuretic peptide (ANP)

A

LOWERS BLOOD PRESSURE

Inhibits reabsorption of Na+ and water in the renal tubules.

Suppresses the release of ADH and aldosterone.

43
Q

Define micturition

A

Discharge of urine from the bladder.

44
Q

Describe the difference between micturition in infants and in adults

A

Adults have learned to initiate and stop micturition via control of the external urethral sphincter and pelvic floor muscles.

45
Q

List FOUR signs/symptoms which may indicate a urinary pathology

A
  • Frequent and painful urination
  • Low or no urine volume
  • Nausea and vomiting
  • Exhaustion
46
Q

With regards to ‘signs’ indicating a possible renal disease, explain why each of the following occur

a Pallor
b Frothy urine
c Oedema
d Itchy skin

A

a Pallor - due to anaemia
b Frothy urine - due to proteinuria
c Oedema - protein loss
d Itchy skin - due to uraemia

47
Q 
Identify one pathology for each of the following urinalysis parameters
a Protein 
b Bacteria 
c Glucose
d Casts
A

a - Kidney disease
b - UTI
c - Diabetes mellitus
d - Nephron disease

48
Q

With regards to urinary terminology, complete the following table

A
49
Q

Explain why cystitis is more common in women

A

Because they have a shorter urethra closer to the anus

50
Q

Name the main cause of cystitis

A

75% caused by E.coli

51
Q

List THREE signs/symptoms of cystitis

A

Dysuria
Oliguria (small amounts)
Dark smelly and cloudy urine
Pain in abdomen

52
Q

With regards to the diagnosis of cystitis, describe what the following tests reveal

a. dipstick test
b urine microscopy

A

a. Nitrares, leucocytes, erythrocytes

b. Significant bacteria

53
Q

Using definitions, compare ‘pyelonephritis’ and ‘cystitis’

A

Pyelonephritis is a microbial infection of the renal pelvis and medulla. Cyctitis is an infection of the bladder

54
Q

Name TWO signs / symptoms more suggestive of pyelonephritis

A

Loin pain and tenderness (often unilateral)

Haematuria

55
Q

Name TWO causes (not infection) of pyelonephritis

A

Immunocompromised patients
Pregnancy
Obstructed flow of urine

56
Q

With regards to the diagnosis of pyelonephritis, describe what the following should reveal’
a Dipstick test
b Urine microscopy
c Blood test

A

a - nitrates, erythrocytes, leukocytes, protein
b - bacteria, urinary casts, blood cells, protein
c - inflammatory markers (WBC’s)

57
Q

List two complications of pyelonephritis

A

Septicemia
Secondary hypertension
Chronic kidney disease and renal failure

58
Q

Describe specifically the pathopsyiology of glomerulonephritis

A

Autoimmune reaction (type III hypersensitivity) - whereby antigen-antibody immune complexes are formed in response to infection.

These immune complexes are deposited in the glomeruli where they trigger an immune response, which leads to leaky capillaries and leukocyte proliferation, allowing proteins and erythrocytes to escape into uring

59
Q

List one secondary cause of glomerulonephritis

A

bacterial infection

60
Q

Name one trigger of an autoimmune reaction in glomerulonephritis

A

Bacterial infection (often from upper respiratory tract)

61
Q

Explain how hypertension can develop in glomerulonephritis

A

Due to glomerulosclerosis (scarring and fibrosis of the glomerular capillaries reduces renal blood flow and GFR resulting in an increase in renin

62
Q

Name two urinalysis parameters that you would expect to find in glomerulonephritis

A

Erythrocytes and protein

63
Q

Describe how oedema develops in nephrotic syndrome

A

the loss of plasma proteins leads to low plasma osmotic pressure, so fluid moves out of capillaries and into tissues = oedema

64
Q

List TWO infectious causes of nephrotic syndrome

A

HIV, malaria, hepatitis

65
Q

List one common medicine that can cause nephrotic syndrome

A

NSAIDS

66
Q

Describe the pathophysiology of diabetic nephropathy

A

Diabetes elevates blood pressure. Glomerulosclerosis occurs as a result of the increased intra glomerular pressure. Kidneys often enlarged. Gleomeruli become damaged and proteins leak

67
Q

Name one mineral that is commonly implicated in renal calculi (kidney stones)

A

calcium oxolate and phosphate

uric acid stones and magnesium stones

68
Q

Explain how the position of kidney stones affects signs and symptoms experienced

A

Stones may stay in position (can obstruct urine outflow) or can migrate down the urinary tract, producing symptoms on route

69
Q

List TWO causes of renal calculi

A

Dehydration

Gout

70
Q

Describe the pain associated with renal calculi

A

Severe loin pain, radiating to the groin (ureteric colic)

71
Q

Describe the key difference between haemodialysis and peritoneal dialysis

A

Peritoneal dialysis uses the peritoneums structure

CNM Biochemistry Workshop Responses (3 decks)

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