Week 5 - Study Guide Flashcards
Urinary
Hormones that regulate blood pressure & Na+/K+ balance
Renin-angiotensin → aldosterone
ADH
Blood cell production
Erythropoietin
Basic processes of urinary system
Filter
Secrete
Reabsorb
Toxicity in order of highest to lowest of Nitrogenous waste.
Ammonia
Urea
Uric Acid
Energy cost in order of highest to lowest of nitrogenous waste
Uric acid = 3 ATP
Urea = 1.5 ATP
Ammonia = NA
Water required for nitrogenous waste highest to lowest
- Ammonia (500 ml/g). (lot of h20)
- Urea (50 ml/g). (if trying to conserve h2o)
- Uric Acid (10 ml/g) (body under h20 constriction)
Solubility in highest to lowest for nitrogenous waste
- ammonia
- urea
- uric acid
Urine Formation - 4 basic steps
- Filtration
- Reabsorption
- Secretion
- Water conservation
Where kidneys are located
retroperitoneal (behind peritoneal cavity)
T-12 → L3
What holds the kidney in place
Perirenal fat capsule
Indent for ureter, blood & lymph vessels, nerves
Hilus
Protection of kidney (damage & Infection)
Protection (fibrous) capsule
Anchors kidney to abdominal wall
Renal Fascia
From fibrous capsule to medulla
cortex
Organized into renal pyramids, separated by renal columns, papilla
Medulla
Tip of pyramid releases urine to minor calyx
papilla
Contains branching extensions called calyces & is continuous with ureter (major calyces divide to minor calyces)
Pelvis
How much blood is reabsorbed at eth kidney
22% total Cardiac Output of Blood
Arteries blood supply for kidneys
- Aorta
- Renal Artery
- Segmental Artery
- Interlobar artery
- Arcuate Artery
- Cortical radiate artery
- Afferent arteriole
- Glomerulus (capillaries)
- Efferent arteriole
- (Peritubular capillaries and vasa recta)
Blood supply - veins back to heart
- Efferent arteriole
- Peritubular capillaries and vasa recta
- Cortical radiate vein
- Arcuate vein
- Interlobar vein
- Renal vein
- Inferior Vena Cava
- Right atrium
Bowman’s capsule & Glomerulus
Renal corpuscle
What projects into the medulla?
Loop of Henle
Nephrons have a portal = 2 capillary beds
- glomerulus
- peritubular capillaries or vasa recta
Juxtaglomerular apparatus = JGA contains
DCT joins with afferent arteriole
Where is Juxtaglomerular cells located, what does it monitor and secrete?
Afferent arteriole
Monitors Blood pressure - when BP is low it secretes Renin
What has chemoreceptors in DCT and measures solutes
Macula Densa cells
Where are Macula Densa Cells located, what do they secrete, what do they measure?
DCT
Measures solutes
releases Renin if solutes are low
Name for urination
micturition
Which sphincter has voluntary control
external
What sphincter is under control of CNS
Internal sphincter
Glomerulus is porous and is wrapped in what kind of cells?
Podocytes (endfeet)
What surrounds the glomerulus and captures filtrate
Bowman’s capsule
The component that attaches the kidneys to the abdominal wall is the ____ ?
renal fascia
The two components of the renal corpuscle are —?
Glomerulus & Bowman’s capsule
If bood pressure increased, in theory, what should this do to the rate of glomerular filtration?
⬆BP
⬆NGF. (more particles get through)
HPg = BP - what is the normal rate?
55 mmHg
HPc =
hydrostatic pressure in capsule
fluid pressure as it filters to capsule
OPg =
osmotic pressure on glomerulus
albumin & solutes in blood
water to move back via osmosis
Average NFP =
10 mmHg
NFP = HPg - (OPg + HPc)
10 mmHg = 55-(30+45)
Average GFR
120 ml/min
How much filtrate a day
180 L filtrate/day
What are the impacts of kidney disease on NFP & GFR?
Elevates NFP & GFR
low BV and low BP
more fluid going through
glomerulus becomes permeable to protein (albumin) decreasing OPg
What are the impacts of Hemorrhage on NFP & GFR?
Decreases NFP and GFR
less fluid going through
reduces HPg (BP)
What are the impacts of nervous control on NFP & GFR?
Decreases NFP & GFR
sympathetic NS constricts afferent & efferent arteriole
What is NFP = 0
renal suppression
No net drive/movement
Smooth membrane, tightly adherent to the kidney surface
fibrous capsule
Portion of the kidney containing mostly collecting ducts
medulla
portion of the kidney containing the bulk of the nephron structures
cortex
Superficial region of kidney tissue
cortex
basinlike area of the kidney, continuous with the ureter
renal pelvis
a cup-shaped extension of the pelvis that encircles the apex of a pyramid
minor calyx
area of cortical tissue running between the medullary pyramids
renal column
Tonicity drives
osmosis
Where does most of the reabsorption happen in the tubulars?
PCT = 65%
DCT
What is the maximum reabsorption capacity of tubes, excess goes to urine (diabetes & glucose)
Tubular Maximum
If reabsorption declines, which of the following occur?
a. more urine produced
b. loss of potentially valuable resources
c. decline in filtration
d. inability to rid body of appropriate toxins and waste
e. both a & b
f. a, c, & d are all true
g. all of the above
e. both a & b
Solutes first followed by water
What are the commonly secreted items?
K+
NH4- (ammonium)
H+
foreign substanes
NH4- & H+ are pH issue
Hypotonic urine =
well hydrated
low solutes - high volume
got rid of solutes
produced more urine volume
Hypertonic urine =
Dehydrated
high solutes - low volume
holding onto urine
ADH - Aldosterone
cortical nephrons =
peritubular capillaries
Which capillaries are about filtering?
peritubular capillaries
cortical nephrons
filtering - not concentrated urine
Which capillaries are about concentrated urine?
Vasa Recta
juxtamedullary nephron
Creates concentrated urine
Countercurrent exchange
Vasa Recta
Countercurrent multiplier
Loop of Henle
What cells secrete renin if BP falls and where are they located?
Juxtaglomerular cells in the afferent arteriole
What cells secrete renin if solutes fall and where are they located?
Macula densa cells - chemoreceptors in the DCT
What are the concentration levels in the cortex vs the medulla in a juxtamedullar nephron?
300 mOsm in the cortex
1200 mOsm in the medulla
Define counter-current flow
opposite directions in 2 tubes
More efficient
Counter-current multiplier refers to what structure within the kidney?
Loop of Henle of the Juxtamedullary nephrons
Counter-current exchanger refers to what structure within the kidney?
Vasa Recta of the juxtamedullary nephrons
What happens to the solute concentration within the interstitial space as you move from the cortex to the medulla?
Increases - 300-1200 mOsm
If the descending limb of the vasa recta vessels suddenly became more permeable to H2O, what impact could this have on the function of the kidney?
Job of exchanger - create a concentration gradient
During respiratory acidosis, the kidneys should?
Reabsorb HCO3- (blood) and retain H+ & NH4+
Get rid of bicarb - making pH too high
Remember - Reabsorption of flitered HCO3- is coupled to H+ secretion
Inverse relationship
If the levels of aldosterone increased in the body which of the following would occur?
a. [sodium] in the urine rises
b. urine volume increases
c. [sodium] in the blood rises
d. urine volume decreases
e. [potassium] in the blood decreases
c. [sodium] in the blood rises
d. urine volume decreases
e. [potassium] in the blood decreases
If ADH is produced, which of these processes occur?
a. decreased H2O reabsorption
b. increased plasma solute concentration
c. increased sodium reabsorption
d. decreased urine production
e. decreased urine concentration
d. decreased urine production
What is the specific action of ADH on the nephrons?
Aquaporins in the collecting ducts allow water to leave the collecting ducts via osmosis.
WATER FOLLOWS NA+ into interstitial fluid
water moves into vasa recta and back into general circulation
Diabetes Insipidus does not make what hormone?
ADH
Urine volume up due to lack of ADH.
Nothing to stop the urine
Excess sugar - glucose
SIADH does what?
Syndrome of inappropriate ADH
When hydrated - retaining H2O when not needed.
Dilutes concentration
Temperature effects urine -
If you want to decrease the frequency of urination would it better to crank heat up to 90° or turn the heat off.
Crank the heat up to 90°
Diuretics -
increase urine volume by decreasing reabsorption of water or solutes
What inhibits ADH
Alcohol - no ADH more fluid out
What inhibits Na+ reabsorption
caffeine
Increases urine
Increase in BP = increases filtration
increase in [na+ solute] = excessive sodium intake = more urine
Decreased blood [plasma protein]
liver damage - liver disease – not producing Albumin in - not enough osmosis pressure in glomerulus to pull fluid back = more urine
Renal clearance
RC=UV/P
volume of blood plasma from which a substance is completely removed in one minute
U= urine concentrtion
V= flow rate of urine formation
P = concentration of substance in plasma
Three options only:
Fliter
Reabsorb
Secrete
What does a urinalysis reveal?
Kidney disease
gall bladder problems
heart disease
pregnancy
What damage does albuminuria indicate?
abnormal constituents of albumin
Damage
chemical toxicity
High BP
all at the kidney
What damage does glycosuria indicate?
glucose > tubular maximum
cortisol stress
pregnancy
diabetes
excess carbs
not making insulin - mobilizing sugar into the bloodstream
What damage does hematuria indicate?
erythrocytes - RBCs in urine
indicates inflammation of glomerulus or serious damage
What damage does pyuria indicate?
Leukocytes - milky - WBCs should not be there
indicates UTI
What damage does acetonuria indicate?
Ketone bodies
Not always bad - burning fat you will see ketones
indicates starvation or depressed CHO intake
Different colors of urine:
red-brown =
presence of blood
Different colors of urine:
red-amber =
urobilinogen (cirrhosis of the liver)
fecal waste is why it is brown
Different colors of urine:
brown-green =
bile pigments - gall bladder
Different colors of urine:
milky =
bacteria
WBCs or urate
infection
Specific gravity of urine density/water density
1.010-1.020
don’t go below or don’t go over
Urinary Disorders:
Inflammation of urinary bladder.
Caused by bacterial infection OR chemical OR
Cystitis
Urinary Disorders:
Inflammation of kidney tissue
Nephritis
Urinary Disorders:
Inflammation of nephron
Glomerulonephritis
Associated with streptococcal infections due to toxins filtered from blood
Gold, lead, & mercury can also damage glomerulus
Urinary Disorders:
Inflammation of renal pelvis & calyces
Pyelitus
Urinary Disorders:
Inflammation of renal pelvis, calyces, & renal tubules
Pyelonephritis
Another name for kidney stones
renal calculi
insoluble salts of various metabolic products.
- Obstruct urinary pathway
- Exact formation process unkown
- Predisposing factors
What are some predisposing factors of kidney stones?
- milk consumption (and a lot of tea)
- low water consumption
- extensive bed reset with little urine output
- some infections
What is it called - passing kidney stones?
renal colic
Renal Failure =
abnormally low urine production
low bp = does not allow filtration
extensive blood loss = low cardiac output
Artificial filtration of blood in patients with urinary disease or loss
Hemodialysis
Net filtration pressure is calculated by:
equation
NFP = (HPg) - (OPg +HPc)
This balance tells you how much fluid will be filtered based upon glomerular blood pressure, [solute] in glomerulus, and the fluid pressure of the filtrate itself.
NFP tells us about filtration dynamics..
which will be regulated in part by the function of the podocytes regulating the degree of permeability at the glomerulus
If you look at the NFP value over time - you can determine GFR
CounterCurrent mechanism =
juxtamedullary nephron
Countercurrent Multiplier =
Vasa Recta
Important in filtrating blood, but do NOT produce concentrated urine, and HAVE peritubular capillaries
Cortical Nephrons
Produce concentrated urine by descending deep into the medulla where solute concentration is very high (1200 mOsm)
Juxtamedullary nephrons
Three filtration membranes of the glomerulus
- Fenestrated Epithelia
- Basement Membrane. (negatively charged) (connective tissue that is filled with collagen)
- Podocytes
Glomerulus filtration rate is higher means -
get rid of more stuff
Glomerulus filtration rate is lower means -
hold on to more stuff
How to influence GFR - in the afferent arteriole
making diameter smaller (vasoconstrict)
- less blood going to the glomerulus
Pressure in glomerulus ⬇
Less filtration. ⬇
How to influence GFR - in the efferent arteriole
Make diameter smaller (vasoconstrict)
Pressure in glomerulus ⬆
More filtration ⬆