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NURS 2514 > Week 3 - The Urinary System > Flashcards

Week 3 - The Urinary System Flashcards

1
Q

define elimination

A
  • the excretion of waste products primarily through the urinary system (in the urine) and the GI system (bile & feces)
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2
Q

list the 5 major roles of the kidneys

A
  1. filter and excrete water soluble metabolic wastes
  2. regulate blood vol & bp
  3. production of erythropoietin
  4. regulation of electrolytes
  5. regulate pH
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3
Q

where are metabolic wastes filtered from? how are they excreted?

A
  • filtered from the blood into filtrate

- excreted in the urine

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4
Q

list 3 metabolic wastes the kidneys filter & excrete

A
  1. urea
  2. uric acid
  3. creatinine
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5
Q

how are metabolic wastes produced?

A
  • waste products are generated during metabolism in cells
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6
Q

what is urea

A
  • waste product produced when we metabolize amino acids/the detoxification of ammonium
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7
Q

describe how the metabolism of amino acids forms urea; include whether or not ammonium is toxic to the body

A
  • each amino acid contains an amino head & acid tail
  • the amino head contains nitrogen
  • when we break down proteins into amino acids & then break down the amino acids for fuel, the nitrogen in the amino head becomes ammonium
  • ammonium is very toxic to the body & we do not want it to accumulate
  • to avoid this accumulation, we deliver aa to the liver which removes the ammonium and creates urea thru the urea cycle
  • urea is then put back into the blood & removed thru the kidneys
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8
Q

is urea toxic or non-toxic to the body

A
  • no but its elevations are
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9
Q

what is uric acid

A
  • waste product produced due to DNA and RNA catabolism
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10
Q

what 2 things does accumulation of uric acid cause?

A
  1. kidney stones

2. gout

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11
Q

what is creatine

A
  • by-product produced from muscle tissue

- specifically it is a breakdown product of creatine phosphate

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12
Q

describe how creatine is formed from the breakdown of creatine phosphat

A
  • creatine phosphate is what the muscle tissue uses to regenerate ATP when we use our muscles vigorously
  • creatine phosphate donates a phosphate to ADP to create ATP
  • and then we are left with creatinine
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13
Q

is creatine toxic to the body?

A
  • it is not toxic itself, but it’s elevation is
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14
Q

how do the kidneys regulate blood volume & pressure? (3)

A
  • alter the amt of urine produced
  • release the enzyme renin into the blood
  • antidiuretic hormone released from the pituitary gland acts on the kidneys
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15
Q

when is renin released? what is the function of renin?

A
  • renin is released when blood volume &bp is low

- it then acts on angiotensignogen to convert it to angiotensin 1

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16
Q

describe the RAAS system

A
  • renin is released when bp low
  • turns angiotensinogen into angiotensin 1
  • ACE turns angiotensin 1 into angiotensin 2
  • angiotesin 2 causes vasoconstricition & aldo secretion
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17
Q

what is the function of aldo

A
  • tells the kidneys to keep Na and water & get rid of K+
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18
Q

what is the function of ADH

A
  • tells the kidneys to keep water
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19
Q

what triggers the kidneys to produce erythropoietin

A
  • produces it in response to low blood O2 levels
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20
Q

what does erythropoietin do>

A
  • stimulaed erythrocyte production in the bone marrow
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21
Q

list 5 main electrolytes the kidneys regulate

A
  1. Na
  2. K
  3. Ca
  4. Cl
  5. Phosphate
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22
Q

list 3 ways the kidneys regulate electrolytes

A
  1. alteration of the urine conc
  2. alteration of urine composition
  3. activation of vit D
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23
Q

describe why the kidneys need to activate vit D? what does this activation cause?

A
  • when we absorb vit D into our skin via the sun it is inactive
  • the kidneys then activate the vit D
  • activation of vit D promotes Ca++ absorption in the small intestine
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24
Q

what other hormone promotes Ca++ absorption

A
  • parathyroid hormone
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25
Q

how do the kidneys regulate the body’s pH

A
  • control the amount of H+ secreted
  • & the amount of HCO3- reabsorbed from the filrate

note: for every molecule of H+ secreted, one HCO3- is reabsorbed

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26
Q

where are the kidneys located? what are they partially protected by>

A
  • located posterior to the peritoneum in the retroperitoneal area
  • partially protected by the lower ribs
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27
Q

where do the kidneys receive blood from? where do these come from?

A
  • the renal arteries

- these branch directly from the aorta

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28
Q

how do the kidneys return their cleansed blood to the heart?

A
  • thru the renal veins into the inferior vena cava
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29
Q

describe the movement of urine (4 steps)

A
  1. it is produced in the kidneys
  2. travels down the ureters
  3. moves into the urinary bladder for storage
  4. then leaves the body thru the urthera using contraction of the bladder
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30
Q

each kidney is covered by ____ and _____

A
  • a fibrous capsule

- layer of adipose tissue

31
Q

where are pain receptors located in the urinary system? what does this mean

A
  • none in the kidney
    = pain only present when there is impingement on the renal capsule (fibrous capsule) or in the ureter (because these 2 have pain receptors)
  • no pain if shrunken, pain if swollen
32
Q

where does blood go once it enters the kidney?

A
  • it is transported by smaller arteries to the outer portion of the kidney = the cortex
33
Q

where is the majority of blood in the kidney filtered?

A
  • in the cortex
34
Q

what is the innner portion of the kidney called

A
  • the medulla
35
Q

what is the function of the medulla (2)

A
  • alters the composition of the filtrate (thru reabsorption)

- creates urine

36
Q

which area of the kidney is highly suscpetible to ischemic damage? why?

A
  • the medulla

- it is very metabolically active but has low O2 tension because blood goes to the cortex first

37
Q

describe the shape of the medulla; what are these called

A
  • arranged in triangular shaped structures = medullary pyramids
38
Q

where does the urine go after the medulla alters the composition & forms urine?

A
  • drains into collecting ducts in the medulla
  • then goes through the renal calcyes which combine to form one big funnel called the renal pevlis
  • the urine goes from the renal pelvis into the ureters for transport to the urinary bladder
39
Q

why is blood pressure to the kidneys importanT

A
  • important to maintain filtration

- NOT to satisfy the metabolic needs of the tissue

40
Q

at rest, the kidneys receive ___% of the cardiac output

A

25%

41
Q

list 2 things that cause less cardiac output to go to the kidneys

A
  • exercise

- exertion

42
Q

what is the average blood pressure in the glomerular capillaries

A
  • ~55 mmHg
43
Q

what 2 things maintain glomerular blood pressure? what is the formula

A
  • flow through the afferent arteriole (BFG)
  • high resistance to flow in the efferent arteriole (RG)
    BPg = BFg x Rg
44
Q

the glomerular blood pressure is the driving force for what?

A
  • to create filtration
45
Q

describe the relation between BFg and BPg; what would cause BPg to increase? decrease?

A
  • if BFg increases with afferent arteriole dilation = increased BPG
  • if BFG decreases with afferent aertiorole constiction = decreased BPG
46
Q

describe the relation between RG and BPG; what would cause BPG to increase? decrease?

A
  • RG is increased with efferent constriction = increased BPG

- RG is decreased with efferent dilation = decreased BPG

47
Q

what effect does increased BPG have on filtration? decreased?

A
  • increased BPG = increased filtration

- decreased BPG = decreased filtration

48
Q

the glomerular capillaries are formed from…?

A
  • the afferent arteriole
49
Q

what are glomerular capillaries composed of? (3)

A
  • fenestrations
  • basement membrane in between
  • podocytes
50
Q

what is the glomerulus?

A
  • a tuft of capillaries surrounded by bowman’s capsule
51
Q

what are fenestrations

A
  • endothelial cells with holes in them
52
Q

what are podocytes

A
  • epithelial cells with foot-like structures & slits
53
Q

does fluid first go thru the fenestrations or podocytes

A
  • fenestrations –> basement membrane –> podocytes
54
Q

what is Bowman’s capsule continuous with?

A
  • the renal tubule
55
Q

what is the juxtaglomerular apparatus? what is it made of?

A
  • regulatory unit composed of:
    1. afferent arteriole
    2. efferent arteriole
    3. juxtaglomerular cells
    4. macula densa
56
Q

what is the function of the juxtaglomerular cells

A
  • secrete renin in response to low BP or SNS stimulation
57
Q

what is the function of the macula densa (3)

A
  • part of the distal tubule
  • senses changes in the conc of the filtrate
  • can dilate or constrict the arterioles appropriately
58
Q

what is the function of the fenestrations in the glomerular capillaries

A
  • only allow particles less than 8 nm to pass
59
Q

what is a con to the size limit of the fenestrations? how do we overcome this?

A
  • proteins like albumin are smaller than 8 nm
  • the capillary basement membrane contains negatively charged proteoglycan which repels other anions (negatively charged molecules) like albumin
60
Q

describe the role/relation between inflammation & the immune system to the glomerulus

A
  • the glomerulus is commonly injured by immune complexes
  • this complexes get caught in the fenestrations or slits
  • this produces an inflammatory response in an attempt to destroy the immune complex thru phagocytosis
61
Q

what is nephritic syndrome

A
  • occurs if the immune complexes are within the endothelial layer (on the fenestration side of the basement membrane) & accessible to phagocytes
62
Q

what is nephrotic syndrome

A
  • occurs if the immune complexes lie within the epithelial cells (podocytes) and are not accessible to phagocytes
63
Q

what does inflammation of the glomerulus cause

A
  • allows protein to inter the filtrate & urine
64
Q

describe the urine in nephritic vs nephrotic syndrome

A
  • nephritic = there are blood cells in the urine = hematuria

- nephrotic = there are not

65
Q

what 3 forces regulate filtration thru the glomeruluar capillaries

A
  1. glomerular (blood) hydrostatic P
  2. blood colloid osmotic P
  3. capsular hydrostatic P
66
Q

what does the glomerular blood hydrostatic P cause? what is the pressure exerted?

A
  • pushes fluid out of the glomerulus

= 55 mmHg

67
Q

what does the blood colloid osmotic P cause? what is the amt of pressure exerted?

A
  • pushed water back into the glomerular capillary because there are more proteins in the blood
    = 30 mmHg
68
Q

what does the capsular hydrostatic pressure cause? what is the amt of pressure exerted?

A
  • pushes a small amount of fluid back into the capillary

= 15 mmHg

69
Q

what helps increase the permeability of the glomerular capillaries? (2)

A
  • fenestrations

- higher bp compared to other capillaries

70
Q

what is the glomerular filtration rate

A
  • the amount of blood plasma filtered thru the capillaries in 1 min
71
Q

what is the typical glomerular filtration rate?

A

125 mL/min

72
Q

how is GFR primarily regulated

A
  • by altering the BPg (and therefore altering BFg and Rg)
73
Q

what 2 things cause an increase in GFR

A
  • afferent dilation = increased flow thru the capillaries

- efferent constriction = increased resistance to flow

74
Q

what 2 things cause a decrease in GFR

A
  • afferent constriction = decreased flow thru the capillaries
  • efferent dilation = decreased resistance

NURS 2514 (75 decks)

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