Week 1

Question 1

Roles of the kidney

Answer 1

Elimination of endogenous and exogenous compounds
Maintenance of chemical homeostasis including pH
Maintenance of volume status
Endocrine signalling

Question 2

Role of lower urinary tract

Answer 2

Storage of urine
Urination at a socially appropriate time and place
Maintenance of continence

Question 3

Renal interaction respiratory

Answer 3

Regulation pH: metabolic and respiratory acidosis/alkalosis
Joint metabolic pathways for the regulation of renin/angiotensin system

Question 4

Renal interaction cardiovascular

Answer 4

Maintenance of blood pressure through a regulation of volume and hence filling pressure
Regulating the tight ionic composition required for appropriate cardiac muscle function
Regulation of volume required for vascular filling; adaptation to hypovolaemic shock

Question 5

Renal interaction: autonomic nervous system

Answer 5

Kidneys receive an afferent innervation and efferent nerves controlling blood flow in the kidney. This interaction is current the target of new clinical therapies for hypertension particularly renal Denervation
Autonomic innervation of the bladder and urethra are essential for controlling the storage or urine and micturition

Question 6

Renal interaction: endocrine

Answer 6

Through the renin-angiotensin system, regulates the secretion of aldosterone from the adrenal cortex and hence renal Na+, K+ and water regulation
Vitamin D regulation and hence regulation of Ca2+
Is the target of central hormonal control by vasopressin (anti diuretic hormone ADH)
Diabetes: the kidney is a common target organ and ultimate cause of death in many with diabetes 44% of the incidence of new onset chronic renal failure. Commenest cause of end stage renal failure

Question 7

Renal interaction: gastrointestinal system

Answer 7

While the gut mostly regulates input, the kidney regulates output, hence equilibrium is the balance between these 2 systems
The gut can be a source of rapid water K+, H+, HCO3- loss, similarly there are no infrequently high inputs from the gut (such as water poisoning) the kidney is key to returning equilibrium
Hepatic failure: through hypoalbuminaemia, causes large changes in renal fluid handling

Question 8

Renal interaction haematology

Answer 8

Through erythropoietin the kidneys regulate the production of erythrotcytes
Many hematological malignancies (particularly myelomas and leukaemias) lead to renal disease through the deposition of antibodies

Question 9

Renal interaction musculoskeletal

Answer 9

Response to crush injury: in particular the adaptation to high K+ and myoglobin
Pelvic floor: important for the maintenance of continence particular in women
Skeletal muscle controls the external urethral sphincter