W1 Urology and Nephrology Fundamentals (Joey) Flashcards
Inner lining of ureter is __________. This is important because it is often an area of __________. and __________.
Inner lining of ureter is transitional epithelium. This is important because it is often an area of bleeding and bladder cancer
Describe the circulation of blood flow in the kidney lobe
Renal artery → segmental artery → interlobar artery → arcuate artery → cortical radiate artery → afferent arteriole → glomerulus → efferent arteriole leaves the glomerulus → peritubular capillaries surround the nephron
→ venule → cortical radiate vein → arcuate vein → interlobar vein → renal vein
SAIC = segmental, interlobal, arcuate, cortical
Kidneys are located between the ________ vertebra, partially protected by ribs ________ and are considered ________ organs.
The ________ kidney is lower
They filter ________ litres of blood per day.
Approximately ________ litres are produced every day in a healthy adult
Water is reabsorbed in ________, ________ and ________ — NOT the ________
60-70% Ca++ is reabsorbed in the ________ and _______
Kidneys are located between the T12 and L3 vertebrae, partially protected by ribs 11 and 12 and are considered retroperitoneal organs.
The right kidney is lower
They filter 150 litres of blood per day.
Approximately 1-2L are produced every day in a healthy adult
Water is reabsorbed in PCT, descending limb of the loop of Henle and collecting ducts — NOT the ascending limb
60-70% Ca++ is reabsorbed in the PCT and collecting duct
Hyper-precision of Ca++ in the DCT, only 5-10% but the exchange is very high
Up to date: approximately two-thirds of the filtered calcium is reabsorbed in the PCT.
In the PCT ______, ______, ______, ______, ______, ______ and ______ are reabsorbed, whereas ______ , ______ and many ______ secreted (secreted = into the lumen of the tubule)
Aldosterone (salt retaining hormone, draws water in) acts on the ______ and the ______
Aldosterone promotes expression of ______.
In the PCT sodium, chloride, potassium, GLUCOSE, AA, urea and H2O are reabsorbed, whereas H+, creatinine and many drugs secreted (secreted = into the lumen of the tubule)
Aldosterone (salt retaining hormone, draws water in) acts on the late distal convoluted tubule and the collecting duct
Aldosterone promotes expression of Na/K+ symporter.
Na+ out of the nephron (reabsorption), water follows, K+ secreted into nephron (to then be excreted)
3 Na+ into the interstitial space and 2 K+ into the lumen
Go back through Loop of Henle:
Descending Limb: MAJOR site of _______ reabsorption
Ascending Limb: Reabsorption of _______, _______, _______
DCT:
Reabsorption of _______, _______, _______, ________, _______ and _______
Although 90% of _______ is reabsorbed in the PCT via the ______ mechanism
Secretion of _______ and _______ back into the tubule lumen
Note that Na+ reabsorption and K+ secretion is mediated in the DCT via a Na+/K+ exchange transporter
Loop of Henle:
Descending Limb: MAJOR site of H2O resorption
Ascending Limb: Reabsorption of sodium, chloride and potassium
DCT:
Reabsorption of sodium, chloride, potassium, calcium, magnesium and bicarb (HCO3-)
Although 90% of bicarb is reabsorbed in the PCT via the carbonic anhydrase mechanism
Secretion of H+ and potassium back into the tubule lumen
Note that Na+ reabsorption and K+ secretion is mediated in the DCT via a Na+/K+ exchange transporter
Collecting duct:
Reabsorption of ______, ______, ______, ______, and very little ______
Reabsorption of ______ is also very important and is the second site of urine ______
Collecting Duct:
Reabsorption of sodium, chloride, H20, Urea, and very little Ca++
Note that in addition to the H2O reabsorption in the descending loop of henle, H2O reabsorption here is also extremely important and the secondary major site of urine solute concentration
What is Anuria?
What is it NOT?
Failure of the kidneys to produce urine
— Note that this is not the same as a person not being able to urinate (failure to eliminate urine from the bladder, also known as urinary retention). True anuria is a failed process more upstream at the level of the kidneys, and can be thought of as failure of the kidneys themselves at producing any volume of urine throughout the renal filtration process
— May occur in severe / complete renal failure
— If you catheterize a patient and you get return of urine, this patient is not anuric (may be oliguric vs urinary retention)
What is Oliguria?
True (cc per hour and 24hr)
and rough definition
True definition:
urinary formation / output of
< 400 cc / 24 hours
or < 20 cc / hr
normal is ~1.5L
Normal elimination = 1-2L of urine per day
—More rough definition: decreased urogenesis / output compared to what should be expected based on their expected volume status and renal perfusion
—May be a sign of hypovolemia, poor renal perfusion, severe renal failure, or early sign of complete renal failure
Urinary retention is?
Inability to empty bladder when attempting to void (either not voiding at all, or only partially emptying bladder)
Bladder scan or straight cath to see if urinary retention or anuria
—-Urinary retention may be acute (typically presents as inability to void at all) or chronic (typically presents as ability to void, but having incomplete bladder emptying) - more on these later
Average healthy adult eliminates how much?
The average “healthy” adult eliminates about 1-2 L of urine per day (when taking in the approximate average recommended adult PO fluid intake of 2 - 2.5 L / day)
When the amount of urine that is produced in a day on average does not get eliminated in a day is when urinary retention or “incomplete bladder emptying” picture should be on your mind (as in examples: underactive bladder, or an obstructive uropathy (like BPH, a hypertonic pelvic floor, or another cause of bladder outlet / UT obstruction)
ADH, aka _______ is a hormone produced by the _______, though stored & released by _______, in response to _______ / _______, as well as hyperosmotic states (most commonly _______)
ADHʼs physiologic function is to promote expression of _______ in the _______ & _______, which leads to diffusion mediated _______ from the collecting duct lumen back into the vasculature, thereby > _______ and < _______
ADH has a second mechanism which is to promote ______ which helps to increase BP
______ is the only other major hormone to be released from the posterior pituitary gland
Anti-diuretic Hormone (ADH), aka Vasopressin is a hormone produced by the hypothalamus, though stored & released by posterior pituitary gland, in response to low plasma volume / hypotension, as well as hyperosmotic states (most commonly hypernatremia)
ADHʼs physiologic function is to promote expression of aquaporin channels in the DCT & Collecting Duct, which leads to diffusion mediated reabsorption of H2O from the collecting duct lumen back into the vasculature, thereby > intravascular pressure and < serum osmolarity & osmolality
ADH has a second mechanism which is to promote vasoconstriction which helps to increase BP
Oxytocin is the only other major hormone to be released from the posterior pituitary gland
RAAS system — walk through the steps
— Drop in blood pressure
— Liver releases angiotensinogen
— Kidneys release renin which
— Converts angiotensinogen to angiotensin I
— Lungs release ACE which converts angiotensin I to angiotensin II
— angiotensin II goes wild:
1. Acts on the adrenal glands to release aldosterone
—Aldosterone promotes expression of Na+ / K+ pump in the collecting duct in the kidneys : sodium absorbed, water follows
2. Acts on the blood vessels stimulating vasoconstriction
3. Acts on posterior pituitary gland to stimulate ADH secretion which leads to H20 reabsorption
4. Increases SNS activity
What do these anti-HTN medications do?
ACEI
ARBs
Aldosterone receptor antagonists
ACEIs (~prils)
—Inhibit pulmonary ACE, leading to decrease formation of angiotensin II and further downstream effects….
Angiotensin Receptor Blockers (“-sartans):
—Directly block the angiotensin II receptor, preventing release of aldosterone from adrenal cortex
—They also block AT2 receptors on the systemic vasculature, preventing vasoconstriction
Aldosterone receptor antagonists (spironolactone)
—prevents expression of Na+/K+ transporter (that normally draws in Na+ and secretes K+ into the tubule)
—this can lead to hyperkalemia
Loop diuretics:
—Block the ______ on the _______ symporter in the ______, inhibiting reabsorption of all, promoting ______ excretion
—Which one do you need to know?
What about thiazide diuretics:
—Block the “thiazide mediated” ______, preventing ______ and ______ reabsorption, promoting ______ excretion
Which electrolyte do they spare?
Loop Diuretics (“-semides” * -”amides”)
—Block the chloride binding sites on the Na+/K+/2Cl- symporter in the ascending LOH, inhibiting reabsorption of all, promoting H2O excretion
⭐️ KNOW LASIX (Furosamide)
Thiazide Diuretics (HCTZ, Chlorthalidone)
—Block the “thiazide mediated” Na+/Cl- symporter, preventing Na+ and Cl- reabsorption, promoting H2O excretion
—“Calcium Sparing Diuretics” (can be both helpful & harmful d/o situation)
Aldosterone receptor blockers block the expression of ______ in the ______
Commonly associated with ______
ADH secretion blockers cause a decrease in expression of ______
Aldosterone Receptor Blockers:
—Directly blocks the Aldosterone receptor whose agonism by Aldosterone normally promotes expression of the collecting duct Na+/K+ transporter), leading to increased Na+ loss, K+ retention, and increased H2O excretion
—Commonly a/w HyperKalemia
ADH Secretion Inhibitors:
—Just a note that EtOH, can prevent ADH release from the posterior pituitary, leading to < aquaporin surface channel expression, leading to decreased H2O reabsorption