Urinary Tract Flashcards

1
Q

what are the 6 homeostatic roles of the kidney?

A
  1. regulation of extracellular fluid volume
  2. Regulation of blood osmolarity
  3. Maintenance of electrolyte balance
  4. Regulation of blood pH
  5. excretion of waste
  6. hormone production
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2
Q

The homeostatic roles are achieved in 3 main events conducted in the nephrons.. which are?

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

What does glomerular filtration do?

A

removes solutes from the blood

- receives 12-30% of cardiac output

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4
Q

What happens in the glomerulus?

A

filtration of solutes from the blood

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5
Q

What covers the glomerulus?

A

Bowman’s capsule

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6
Q

What happens to the osmolarity as you descend into the renal medulla?

A

it increases

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7
Q

What happens at the proximal convoluted tubule?

A

Reabsorption of ions, water, and nutrients into the blood

removal of toxins and adjustment of filtrate pH

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8
Q

What is the proximal convoluted tubule lined with?

A

Simple cuboidal brush border epithelium

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9
Q

What proportion/% of nutrients/water/electrolytes are reabsorbed in the PCT?

A

nearly all of the essential nutrients and 70-80% of

electrolytes and water are reabsorbed

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10
Q

How does the PCT help to maintain the pH and ionic balance of body fluids?

A

by selective secretion of hydrogen ions, ammonia, and K+ into the filtrate and absorption of HCO3

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11
Q

What happens in the descending loop of Henle? What does this require

A

Aquaporins allow water to pass from the filtrate into the interstitial fluid

  • concentrate the filtrate
  • requires energy
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12
Q

What happens in the ascending loop of Henle?

A

Reabsorption of Na and CL from the filtrate into the interstitial fluid
- active or passive

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13
Q

What is the main role of the loop of Henle as a whole? (2 things actually)

A

to maintain high osmolarity of the interstitial fluid

production of concentrated urine

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14
Q

What happens to the filtrate as it passes up through the ascending loop of Henle?

A

it gets diluted due to the passage of electrolytes to the medullary fluid

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15
Q

What is the lining of the distal tubule like?

A

lined with simple cuboidal cells that lack a brush border

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16
Q

What happens in the distal tubule?

A

selective secretion and absorption of various ions in maintain blood pH and electrolyte balance
- Ca2+, K+, Na+

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17
Q

What does the collecting duct connect?

A

the nephron to the ureter

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18
Q

What happens in the collecting duct? (secretion/resorption)

A

The secretion of K+ and the resorption of Na+

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19
Q

What hormones regulate the collecting duct?

A

vasopressin and aldosterone

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20
Q

What are 4 hormones that are made in the kidney?

A
  1. Calcitriol
  2. Klotho
  3. Renin
  4. EPO
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21
Q

What cells in the kidney make calcitrol?

A

proximal tubular cells (PT)

22
Q

What cells in the kidney make klotho?

A

distal tubular cells (DT)

23
Q

What cells in the kidney produce renin? where ?

A

Juxtaglomerular epithelioid cells in the media layer of afferent arterioles

located at the entrance of the glomerulus

24
Q

What cells synthesize EPO?

A

interstitial fibroblast-like cells located between proximal tubules

25
Q

What is calcitriol? what is the main role?

A

Physiologically active form of vitamin D

Contributes to bone mineralization by regulating homeostasis of Ca2+ and phosphate

26
Q

What does calcitriol inhibit? what other functions does it have?

A

Inhibits renin expression

Also affects erythropoiesis and leukocyte activity

27
Q

What are the layers of the uerter? (inside to outside)

A
  1. Transitional epithelium
  2. Lamina propria
  3. Muscularis
  4. Adventitia
28
Q

What allows for expansion of the ureter?

A

Folding of the lamina propria and lumen

29
Q

What are the layers of the muscularis like in the ureter?

A

opposite from the GI tract

- inner longitudinal, middle circular, and outer longitudinal

30
Q

What kind of movement is the ureter capable of

A

peristaltic waves

31
Q

Filling of the bladder compresses…

A

the oblique openings to the ureters

32
Q

What allows for expansion of the urinary bladder?

A

Rugae

33
Q

What is the capacity of the urinary bladder like?

A

300-500 mL

34
Q

What is the transition of epithelium like in the female urethra? Where does this occur?

A

Epithelium of the female urethra changes from transitional at the bladder to non-keratinizing stratified squamous distally

35
Q

What is the change of epithelium like in the male urethra ?

A

changes to pseudostratified through prostatic, membranous and most of the penile uretha, then to non-keratinizing stratified squamous distally

36
Q

What are some common diseases of the kidney?

A
  1. Cancer: renal carcinoma (tubule cells)
  2. Polycystic kidney diseases
  3. Systemic lupus erythemoatosus which leads to lupus nephritis
  4. Chronic kidney disease due to things like diabetes and HPB
  5. Kidney and uretal stones
37
Q

When do kidney and uretal stones develop?

A

Develop in the kidneys when there are crystal in the urine and small particles surround and collect on them

38
Q

Circulating ___ may cause glomerular disease

A

immune complexes

39
Q

Many glomerular diseases are mediated by ..

A

antigen antibody immune complexes

40
Q

What type of hypersensitivity reactions are often involving complement activation?

A

type III

41
Q

What property of immune complexes determines the site of glomerular disease?

A

size
• small complexes move through the BM
•larger complexes get stuck in the mesangium or subendothelial

42
Q

What happens to immune complexes that deposit in the glomeruli?

A

activate complement and cause cellular damage

split complement products attract macrophages and neutrophils which cause further damage

43
Q

What are some common diseases of the urinary tract/bladder?

A
  1. Benign Prostatic hyperplasia
  2. Urinary incontinence
  3. Cancer: of tubule cells or renal cell carcinoma
  4. Bladder prolapse
  5. Hematuria
  6. Interstitial cystitis
  7. Nephritic Syndrome
  8. Urinary Tract Infection
44
Q

What is benign prostatic hyperplasia?

A

Enlargement of the prostate which causes pressure on the urethra

45
Q

What is nephrotic syndrome? What are 3 symptoms

A

Injury (from multiple causes) to the glomeruli results in…

  1. high levels of protein in the urine
  2. low levels of albumin in the blood
  3. leakage of fluid out of peripheral blood vessels = ankle swelling
46
Q

What kinds of diseases will NOT cause nephrotic syndrome?

A

diseases that affect tubules and interstitium

47
Q

What are 4 symptoms of Nephritic syndrome?

A
  1. Blood in the urine
  2. High BP
  3. Decreased GFR
  4. More inflammation than in nephrotic syndrome
48
Q

UTIs are defined by…

A

presence of microorganisms in the urinary tract

49
Q

What are 4 main non immune innate defences protecting against UTIs?

A
  1. Urine flow
  2. Batericidal factors in urine
  3. Sloughing of infected epithelial cells
  4. Tamm Horsfall protein
50
Q

What reflex is a major host determinant in the localization and severity of UTIs

A

Vesicoureteric reflux (urine backing into the kidneys)

51
Q

What does Tamm Horsfall Protein do? where is it made?

A

Made in the kidney

prevents attachment of fimbriated E. coli to epithelial cells

52
Q

What kind of Ig response is there to bacterial UTIs?

A

IgA