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SYSTEMIC PATHOLOGY 3 > Urinary System I > Flashcards

Urinary System I Flashcards

1
Q

Kidney macroscopic structure

A
  • Cortex and medulla
    o 1:2 or 1:3 (1:5 for animals who need to conserve water=camels)
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2
Q

Cortex structure

A
  • Dark red or brown
  • Radial streaks on cross section
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3
Q

Medulla structure

A
  • Light red or grey
  • Pyramids or lobes
  • Apex of each lobe=renal papilla
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4
Q

What is the only animal with a unipyramidal kidney?

A
  • Cats
    o One lobe during embryo stage and after birth
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5
Q

What are the animals with a unipyramidal kidney?

A
  • Dogs
  • Cats
  • Horses
  • Sheep and goats
  • *all but cats, are actually multipyramidal in the embryo stage
  • *renal pyramids and papilla fuse together in late development=renal crest
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6
Q

What are the animals with a multipyramidal kidney?

A
  • Bovine
  • Porcine
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7
Q

Bovine kidney

A
  • Multipyramidal
  • External lobation
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8
Q

Pig kidney

A
  • Multipyramidal
  • NO external lobation
  • Dorso-ventally flattened
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9
Q

Cat kidney

A
  • Unipyramidal
  • **Yellow cortex
    o Lots of fat stored within renal tubules normally (ex. obese cat)
  • Prominent subscapular veins
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10
Q

Granulomatous inflammation=white nodules (DDx: neoplasia, likely lymphoma) on a cat kidney, LOCATION

A
  • If nodules along capsular vesicles=FIP
  • If not along=neoplastic
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11
Q

Dog, sheep and goat kidney

A
  • Unipyramidal with renal crest
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12
Q

Horse kidney

A
  • unipyramidal
  • Right=heart shaped
  • Left=bean shaped
  • *urine of horses appears turbid due to lots of calcium carbonate=NORMAL
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13
Q

What are the 4 microscopic structures of the kidney?

A
  • Vessels
  • Glomeruli
  • Tubules
  • Interstitium
  • **INTERDEPENDENT=if damage one part=damage ALL parts
    o Why in chronic conditions kidney will grossly look the same no matter the primary cause
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14
Q

Vascular supply of the kidney

A
  • Receive 20-25% of CO (weights less than 1% of the body)
    o Good place to culture if suspecting septicaemia
  • *major regulator of systemic and renal blood pressure
  • Supplied by end arterioles (ex. no anastomosis)
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15
Q

Where is the number place to culture if suspecting septicemia?

A
  • Spleen
  • Kidney is good second choice
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16
Q

What can happen to BP if kidney failure?

A
  • Get hypertension
  • But hypertension can also cause kidney failure
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17
Q

Why is the kidney prone to infraction (necrosis secondary to loss of blood supply)?

A
  • End arterial blood supply with LIMITED collateral circulation=PRONE
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18
Q

What is the ‘pathway’ of the vascular supply to the kidney?

A
  1. Renal artery
  2. Interlobar artery
  3. Arcs and courses into cortico-medullary junction= arcuate artery
  4. Branches into multiple interlobular arteries
  5. Each branches to multiple afferent arterioles
  6. Each leads to a glomerulus
  7. Efferent arteriole leading to vascular plexus of small capillaries surrounding the tubules (vasa recta)
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19
Q

What kind of blood is the blood supply after the glomerulus?

A
  • Still arterial
  • *if damage glomerulus=decreasing blood supply to tubules causing tubular damage
20
Q

What 2 receptors does the kidney have to regulate the flow of blood?

A
  • BP
  • Na
  • *release 3 molecules ADH, Ang-II and aldosterone
  • **2 receptors do 3 things
21
Q

What is a part of the juxtaglomerular apparatus? (4)

A
  1. Juxtaglomerular cells (afferent arteriole)
  2. Efferent arteriole
  3. Macula densa (distal convoluted tubule)
  4. Mesangial cells
22
Q

What does the kidney/juxtaglomerular apparatus respond to (3)?

A
  1. Depletion of ECF >ADH release
  2. Decrease in renal BP >Ang II
  3. Decrease in sodium concentration > aldosterone
23
Q

What happens if there is a decrease in BP, ECF or Na concentration?

A
  • Juxtaglomerular cells release renin
  • Renin converts angiotensinogen to Ang-I
  • Ang-I to Ang II via ACE
  • Ang-II has 3 effects
24
Q

What are the 3 effects of Ang II?

A
  • Release ADH from pituitary: greater reabsorption and decrease water excretion
  • Constriction of AA: less plasma filtered=conserve more water
  • Release aldosterone from adrenal cortex=increase K excretion and Na retention (water follows Na)
25
Q

What organ is affected the most with too much K?

A
  • Heart!
    o Need to pee it out!
26
Q

Nephron

A
  • Functional unit of kidney
  • Fixed number throughout life time
  • *all parts are interdependent=if damage one part=damage the whole nephron
    o Collecting duct is NOT part of the nephron
27
Q

Glomerulus function

A
  • Production of ultrafiltrate
  • Goes from vessels lined by endothelial cells to tubular structure lined by epithelial cells
28
Q

Glomerulus structure

A
  • Capillaries
    o Many small ones to increase SA
  • Mesangial cells
    o Hold together the capillaries
  • Podocytes (epithelial cells)
    o Foot processes attached to basement membrane of capillaries
29
Q

What is the glomerular filtration barrier composed of?

A
  • Fenestrated endothelium
  • Glomerular basement membrane
  • Podocytes
30
Q

What is between each 2 foot processes of podocytes?

A
  • Filtration slit covered by a diaphragm
31
Q

What is the selective permeability of the glomerular filtration barrier based on? (3)

A
  • Size (<70,000 Da)
  • Charge: negative=repelled (ex. albumin, some goes through ~70kDa)
  • Capillary pressure: high=more filtration
32
Q

Proximal convoluted tubules

A
  • Reabsorb water solutes, glucose, AA
    o BRUSHBORDER (microvillus border)
  • Excrete hydrogen
  • *large number of mitochondria
  • *NOT uncommon to see necrosis secondary to shock and toxin injury
33
Q

What are the 2 key points to remember about the proximal convoluted tubule?

A
  • Resorptive capacity is dictated by energy (oxidative phosphorylation form mitochondria)
    o Very O2 dependent on function and survival
    o *very prone to ischemic injury
  • First portion to receive what is in the ultrafiltrate=very susceptible to toxins and toxic injury
34
Q

Loop of Henle

A
  • Establishes hypertonicity within the medullary interstitium through the ‘counter current multiplier mechanism’
    o U: multiplier
  • Creates a CORTICOPAPILLARY OSMOLARITY GRADIENT
  • Descending loop: permeable to water only (water goes out)
  • Ascending loop: permeable to solutes only (solutes go out)
35
Q

How is urine concentrated? 2 requirements

A
  1. Cortico-papillary osmolarity gradient within interstitum (papilla=1200, cortical=300)
  2. Presence of ADH
36
Q

What are the 4 points about urine concentration?

A
  1. Most water reabsorbed form PCTs and DLH and goes back to blood
  2. Mechanisms to keep interstitium very concentrated compared to urine flowing through DCTs and CD (ultrafiltrate is then hypotonic)
  3. If need to conserve water=ADH released
  4. ADH makes DCT and CD permeable to water=water is taken by the blood immediately
37
Q

How is the cortico-papillary osmolarity gradient created? What maintains it?

A
  1. Countercurrent multiple (loop of Henle)
  2. Urea recycling in renal medulla
    *maintain by countercurrent exchanger (vasa recta)
38
Q

Urea recycling

A
  • Only segment permeable to urea is medullary CD
    o High concentration and some leaves to interstitium
    o Then eventually goes back into loop of Henle and is recycled
39
Q

Distal convoluted tubule

A
  • Contains macula densa
    o Sensor for Sodium
  • Susceptible to aldosterone hormone
40
Q

Collecting duct

A
  • Permeable to small amount of water but NOT urea (except in distal end)
  • Susceptible to ADH
    o Increases water reabsorption from 4-24%
41
Q

Interstitium

A
  • Contains peritubular capillaries and fibroblasts
  • *expansion is ABNORMAL
    o Due to edema, infiltrate or fibrosis
42
Q

Gross examination of the kidney

A
  • *autolyze quickly (due to being very metabolically active)
  • Position and number
  • Size (normally the size to 2 vertebra or 2 ribs)
  • Connection with ureters
  • Capsular adherence
  • Colour
  • Contours
  • C:M ratio
  • Papilla/crest
  • Pelvic/calyces
43
Q

**Capsular adherence

A
  • In most (except horses), it should peal easily
  • **If not easy=might be adhered to underlying parenchyma because of fibrosis
44
Q

What are the 4 main functions of the kidney?

A
  1. Formation of urine elimination of waste and conservation of water
  2. Acid-base regulation(excretes H and reabsorbs bicarbonate)
  3. Maintenance of electrolyte balance: **pee K+
  4. Endocrine function
    a. Renin-angiotensin system
    b. Erythropoietin
    c. Vitamin D
45
Q

What are the 3 things needed for the kidney to function?

A
  • Adequate blood flow
  • Functioning nephrons
  • Excretion of urine

SYSTEMIC PATHOLOGY 3 (6 decks)

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