Urinary System physiology Flashcards

1
Q
A
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2
Q

What are the main functions of the kidneys?

A

Excretion of wastes, H2O balance, Plasma volume control, Blood pressure control, Renin production, Acid-base balance, Blood cell production (erythropoietin), Vitamin D activation

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3
Q

What components make up the urinary system?

A

Kidneys, Ureters, Urinary bladder, Urethra, Blood supply (20% of total flow)

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4
Q

What is the functional unit of the kidney?

A

Nephron

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5
Q

How many nephrons are typically found in one kidney?

A

Approximately 1 million

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6
Q

What are the parts of the kidney?

A

-Renal calyces
-Renal cortex (outer)
-Renal medulla (inner)
-Renal pelvis

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7
Q

What are the two types of nephrons?

A
  • Cortical (85%): shorter
  • Juxtamedullary (15%): longer looped and important in establishing the osmostic gradient
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8
Q

Vascular components of nephron

A

1) renal artery
2) afferent arteriole
3) glomerulus
4) efferent arteriole
5) peritubular capillaries
6) renal vein

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9
Q

What is the glomerulus?

A

-Tuft of capillaries that filters a protein-free plasma into the tubular component
-Very permeabled because they are genestrated capillaries

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10
Q

What do the peritubular capillaries do?

A

supply the renal tissue with exchanges from the blood

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11
Q

Tubular components of nephrons

A

1) bowman’s capsule (surrounding glomerulus)
2) proximal tubule
3) loop of henle - ascending and descending
4) distal tubule
5) collecting duct

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12
Q

What is glomerular filtration?

A

Nondiscriminant filtration of protein-free plasma from the glomerulus (blood) into Bowman’s capsule (tubule)

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13
Q

What is tubular reabsorption?

A

Movement from tubule back into blood

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14
Q

What is tubular secretion?

A

Molecules that are too big that we move from blood into the tubule

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15
Q

What processes result in urine formation?

A

Glomerular filtration, Tubular reabsorption, Tubular secretion

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16
Q

Sites of action for filtration, reabsorption, secretion

A

Filtration: bowman’s capsule

Reabsorption: loop of henle, proximal tubule, distal tubule, collecting ducts

Secretion: proximal tubule, distal tubule, collecting ducts

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17
Q

Is the proximal or distal tubule free for all or hormonally controlled?

A

Proximal: free for all
Distal: hormone controlled

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18
Q

What does glomerular filtration filter?

A

All but RBCs and proteins (too big)
-Peptides are ok though

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19
Q

What gets reabsorbed?

A

Na, Cl, Ca, PO4, water, glucose

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20
Q

What gets secreted?

A

potassium, hydrogren, large organics

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21
Q

What is the role of podocytes in the glomerulus?

A

They encircle the glomerulus tuft and can change shape of filtration slit to control filtration

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22
Q

Which layers does glomerular filtration have to pass?

A

-Glomerular capillary wall through pores
-Basement membrane: acellular gelatinous layer made of collagen and glycoproteins
-Inner layer of Bowman’s capsule

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23
Q

How much glomerular filtration occurs per day?

A

160 to 180 L/day

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24
Q

Urine is composed of _______% of filtrate

A

1%

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25
Q

What happens to podocytes in renal failure?

A

Large slits which allow proteins and RBCs in

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26
Q

What are the three main physical forces involved in glomerular filtration?

A
  • Glomerular capillary blood pressure
  • Plasma-colloid osmotic pressure
  • Bowman’s capsule hydrostatic pressure
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27
Q

Glomerular capillary blood pressure

A

-Greatest force
-Pushes water into tubule
-Favours filtration
55 mmHg

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28
Q

Plasma-colloid osmotic pressure

A

-Pull water into capillary
-Opposes filtration
-30 mmHg

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29
Q

Bowman’s capsule hydrostatic pressure

A

-Pulls water into capillary
-Opposes filtration
-15 mmHg

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30
Q

What is the net filtration pressure in the glomerulus?

A

10 mm Hg

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31
Q

What is the Glomerular Filtration Rate (GFR)?

A

The rate at which fluid is filtered through the glomeruli

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32
Q

What influences the Glomerular Filtration Rate (GFR)?

A
  • Net filtration pressure
  • Glomerular surface area
  • Permeability of the glomerular membrane (podocytes and slit sizes)
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33
Q

Tubuloglomerular feedback

A
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34
Q

What is the effect of the afferent arteriole constricting on GFR?

A

Lower GFR

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35
Q

What is the effect of the efferent arteriole constricting on GFR?

A

Higher GFR

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36
Q

What is the effect of the efferent arteriole dilating on GFR?

A

Lower GFR

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37
Q

What is the effect of the afferent arteriole dilating on GFR?

A

Higher GFR

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38
Q

What is the role of the macula densa in regulating GFR?

A

It senses flow through the tubule and adjusts the afferent arteriole resistance

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39
Q

Extrinsinc control on GFR

A

-Sympathetic control
-Long-term regulation of arterial BP
-Input to afferent arterioles
-Lower blood pressure means lower GFR and retention of fluids

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40
Q

How do changes to plasma-colloid osmotic pressure affect GFR?

A

-Loss of proteins from blood to repair sites (in the case of severe injury) lowers osmotic pressure, and GRF increases
-Diarrhea results in loss of fluids, increasing osmotic pressure, and GRF decreases

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41
Q

How do changes to bowman’s capsule hydrostatic pressure affect GFR?

A

-Obstructions such as kidney stones elevate capsular hydrostatic pressure
-Decreases filtration

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42
Q

What substance is used to measure GFR?

A

Inulin

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43
Q

What is the main process of sodium reabsorption in the kidneys?

A

Active transport via Na+/K+ ATPase pump

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44
Q

Why is paracellular transport for reabsorption preferable?

A

-Because it is only passive transport through diffusion

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45
Q

Where in the nephron is the majority of sodium reabsorbed?

A

Proximal tubule (67%)

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46
Q

How is sodium reabsorbed?

A

-sodium potassium pump in tubular cell membrane lowers sodium concentration inside cell, and releases sodium into interstitial fluid
-sodium diffuses down its concentration gradient into the cell from lumen
-sodium in interstitial fluid diffuses into peritubular capillary

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47
Q

which other substances follow the reabsorption of sodium?

A

-water follows osmotic gradient created (into capillaries)
-Cl follows electrical gradient of positive charges (into capillaries)
-glucose by carriers

48
Q

glucose reabsorption (in proximal tubule)

A

-sodium pulls glucose with SGLT protein into the cell
-glucose diffuses out using the GLUT protein

49
Q

tubular maximum

A

-point where all the glucose carriers are full
-excess glucose stays in the tubules and is lost in the urine

50
Q

renal threshold

A

-blood glucose level where the carriers are full and glucose is seen in the urine
(as seen in diabetes mellitus)

51
Q

What is the function of the loop of Henle?

A

Creates an osmotic gradient critical for urine concentration

52
Q

What role does the distal and collecting tubules play in sodium reabsorption?

A

Variable reabsorption subject to hormonal control (8%)

53
Q

True or False: The majority of plasma entering the kidney is excreted as urine.

54
Q

Fill in the blank: The _______ is the site of glomerular filtration.

A

Bowman’s capsule

55
Q

What is the primary method of urea reabsorption? How much is reabsorbed

A

Passive process to equilibrium
50%

56
Q

What percentage of Na+ is typically reabsorbed in the kidneys?

57
Q

What percentage of Cl and water is reabsorbed in kidneys?

58
Q

what percentage of glucose is reabsorbed under normal circumstances

59
Q

what percentage of potassium is secreted and reabsorbed in kidneys?

60
Q

What hormone controls Na+/K+ ATPase pumps?

A

Aldosterone

61
Q

When is aldosterone release?

A

when blood volume is low

62
Q

What is the effect of high aldosterone levels on Na+ reabsorption?

A

Increases Na+ reabsorption and water reabsorption, leading to decreased urine volume

63
Q

What is the role of Atrial Natriuretic Peptide (ANP) in kidney function?

A

Antagonist to aldosterone that inhibits Na+ reabsorption by inactivating the Na+/K+ pump

64
Q

What triggers the release of ANP?

A

higher blood pressure/volume, large quantities of sodium, stretch of the atria (increase blood volume)

65
Q

Which things are secreted?

A

potassium, hydrogen (acid-base balance), and large organics (alcohol)

66
Q

What is the primary site of water reabsorption controlled by ADH? What function does this serve?

A

Collecting ducts (medulla region)
-Concentrates the urine by pulling the water out

67
Q

What is the counter-current mechanism in the Loop of Henle?

A

Creates a zone of high solute concentration in renal medulla by selective reabsorption of salt and urea

68
Q

Characteristics of descending loop of Henle

A

-Permeable to water
-Impermeable to salts
-Filtrate becomes more concentrated

69
Q

Characteristics of ascending loop of Henle

A

-Permeable to salts (actively reabsorbs NaCl)
-Impermeable to water
-Filtrate becomes less concentrated

70
Q

What is the role of the vasa recta in renal physiology?

A

-Maintains osmotic gradient in blood supply
-Follows the loop of Henle

71
Q

What does ADH stand for?

A

Anti-diuretic hormone

72
Q

What is the effect of low ADH levels on urine?

A

-Due to water loading
-Makes collecting ducts impermeable to water, resulting in dilute urine

73
Q

What is the effect of high ADH levels on urine?

A

-Due to high blood osmolarity and dehydration
-makes collecting ducts permeable to water
-concentrates urine

74
Q

Effects of dehydration on ADH, aldosterone, ANP. List some behavioural mechanisms.

A

increases in ADH, aldosterone, water reabsorption

decreases in ANP, urine

Behavioural: thirst, low sodium stimulates salt appetite, avoidance behaviours

75
Q

Effects of water loading on ADH, aldosterone, ANP.

A

increases in ANP, urine volume

decreases in ADH, aldosterone, water reabsorption

76
Q

What’s happening in the proximal tubule?

A

-67% of Na, Cl, and water reabsorption.
-100% of glucose and amino acids reabsorbed
-K is secreted and reabsorbed (small amount)
-Variable H secretion
-Organic ion secretion
-Phosphate and electrolytes reabsorbed
-Urea reabsorption

77
Q

What’s happening in the distal tubule?

A

-Variable Na and water reabsorption (aldosterone and ANP control)
-Variable K secretion/reabsorption (aldosterone control)
-Variable H secretion (depends on acid-base balance)

78
Q

What’s happening in the collecting ducts?

A

-Variable water reabsorption (ADH control)
-Variable H secretion
-Variable urea reabsorption (related to loop of Henle)

79
Q

Fill in the blank: Excretion = filtration – ______ + secretion.

A

reabsorption

80
Q

What is the formula for renal clearance (RC)?

A

RC = UV/P

U = concentration (mg/ml) of the substance in urine
V = flow rate of urine formation (ml/min aka GFR)
P = concentration of the same substance in plasma

81
Q

What is renal clearance?

A

-Rate at which a solute disappears from the body
-Opposite of reabsorption
-Inulin clearance is equal to GFR

82
Q

What is the clearance rate for urea if 50% is reabsorbed?

83
Q

What is the typical renal clearance for penicillin if more penicillin is excreted than was filtered?

A

150 mL/min

84
Q

What is the micturition reflex?

A

Autonomic control of sphincters and detrusor muscle for urination

85
Q

What can override the micturition reflex?

86
Q

Bladder and sphincters during filling vs micturition

A

Filling: bladder (detrusor) muscle is relaxed, sphincters are contracted

Micturition: stretch receptors increase their firing, detrusor muscle contracts, sphincters relax

87
Q

What are common causes of renal failure?

A

Acute: infections, toxic agents, inappropriate immune responses, obstruction of urine flow, insufficient renal blood supply

Chronic: hypertension, diabetes, chronic exposure to toxins/drugs

88
Q

What happens during renal failure?

A

-Build up of wastes to toxic levels
-Loss of calcium
-Na and K imbalance (affects nerve and muscle)
-Loss of proteins
-Loss of RBCs
-Low blood pressure (decreased renin)

89
Q

What are the effects of renal failure on edema?

A

-Loss of proteins makes water stay in tissues and creates edema

90
Q

What are the effects of renal failure on calcium levels?

A

Loss of calcium leads to osteoporosis

91
Q

Kidney stones

A

-crystallization of minerals in either the kidney, ureters, or bladder
-composed of calcium
-dehydration causes

92
Q

What is the normal pH range for the blood? tissue?

A

7.35–7.45
7.38 - 7.42

93
Q

What can abnormal pH levels affect?

A

Tertiary structure of proteins and the nervous system

94
Q

What is the primary role of buffers in acid-base balance?

A

Combines with or releases H+ to regulate hydrogen ion and pH balance in the body

95
Q

What are some buffers?

A

-HCO3
-Proteins, hemoglobin, phosphates in cells
-Phosphates and ammonia in urine

96
Q

What happens to neurons during acidosis?

A

Neurons become less excitable and CNS depression occurs

97
Q

What happens to neurons with alkalosis?

A

they become hyperexcitable

98
Q

What is metabolic acidosis caused by?

A
  • Metabolic organic acid production
  • Lactic acid (exercise)
  • Ketoacids (diabetes)
  • Diarrhea
  • Organic acids intake (diet)
99
Q

What is respiratory acidosis primarily due to?

A

Production of CO2

100
Q

What conditions can cause metabolic alkalosis?

A
  • Vomiting
  • Dietary sources of bases (e.g., Tums)
  • Pyloric stenosis (where bicarbonate builds up)
101
Q

What triggers respiratory alkalosis?

A

Hyperventilation (high altitude)

102
Q

Which mechanism of acid-base balance is the fastest?

A

Buffers (response within seconds)

103
Q

What is the role of renal regulation in acid-base balance? Is it fast or slow?

A

-Directly excreting or reabsorbing H+
-Slowest (within hours)

104
Q

How does ventilation respond to pH disturbances?

A

-By changing the rate and depth of breathing
-Responds within minutes
-Reflex pathway can correct for metabolic acidosis (increased breathing)

105
Q

What is the role of type A intercalated cells?

A

-Secrete H+ and reabsorb bicarbonate
-Functions in acidosis

106
Q

What is the function of type B intercalated cells?

A

-Secrete bicarbonate and reabsorb H+
-Functions in alkalosis

107
Q

What is the correction for acidosis in the body?

A

1) buffers bind to H+
2) breathing increases to decrease CO2 and H via carbonic acid
3) kidneys excrete H and keep bicarbonate

108
Q

What occurs in the body to correct alkalosis?

A

1) Buffers release H+
2) breathing slows down, retains CO2 and H+
3) kidneys retain H+ and secretes bicarbonates

109
Q

What are the three mechanisms of acid-base balance?

A
  • Buffers
  • Ventilation
  • Renal regulation
110
Q

What is the impact of abnormal pH on proteins?

A

It can alter the tertiary structure of proteins

111
Q

True or False: Acidosis makes the nervous system hyperexcitable.

112
Q

Fill in the blank: The plasma pH is maintained by _______.

A

[buffers, ventilation, renal regulation]

113
Q

What is the primary function of hemoglobin in acid-base balance?

A

Acts as a buffer

114
Q

How does the body raise pH during acidosis?

A

By increasing breathing to decrease CO2 and H+

115
Q

What is the role of chemoreceptors in respiratory compensation?

A

Monitor plasma PCO2 and H+ (pH)

116
Q

What is the relationship between H2O, CO2, and H2CO3 in acid-base balance?

A

H2O + CO2 ↔ H2CO3 ↔ H+ + HCO3-