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DS1102 > Week 8 - Wrap Up Renal System Disorders + RAAS > Flashcards

Week 8 - Wrap Up Renal System Disorders + RAAS Flashcards

1
Q
A
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2
Q

What is the renin-angiotensin system

A

AKA renin-angiotensin-aldosterone system (RAAS)

A hormone system which regulates blood volume and vascular resistance (vasoconstriction/dilation)

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3
Q

What is the function of the renin-angiotensin system and how

A
  • Decreases arterial pressure
  • decreased salt delivery to the distal tubule
  • and or beta agonism
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4
Q

What are the 3 major compounds of the renin angiotensin system

A
  • renin
  • angiotensin 2
  • aldosterone
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5
Q

What is the Juxtaglomerular apparatus

A

apparatus is a specialized structure in the kidneys that functions to maintain blood pressure and as quality control mechanism to ensure proper glomerular flow rate and efficient sodium reabsorption

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6
Q

What are the key components of the Juxtaglomerular apparatus

A
  • Juxtaglomerular (granular) cells
  • Macula densa
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7
Q

What is the Juxtaglomerular (granular) cells

A
  • in arteriole wall
  • enlarged smooth muscle cells with secretory granules containing renin
  • act a mechanoreceptors, detecting changes in blood pressure in afferent arteriole
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8
Q

What is macula densa

A
  • group of tall, densely packed distal tubule cells adjacent to Juxtaglomerular (granular) cells
  • osmoreceptors
  • respond to changes in solute content in the filtrate in the renal tubule
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9
Q

What triggers renin to be released from JG cells (3)

A
  • reduced stretch of the JG cells e.g. drop in systemic blood pressure below 80mmHg
  • Stimulation of the JG cells by the macula densa in response to rapid filtrate flow or decreased Na+ load in the distal tubule
  • stimulation of the JG cells by renal sympathetic nerves (B1 adrenergic receptors)
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10
Q

What is the function of renin

A

renin cleaves angiotensinogen into angiotensin 1

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11
Q

What is the function of angiotensin 1

A

Angiotensin 1 physiologically inactive but is the precursor for angiotensin 2

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12
Q

What is the function of angiotensin converting enzyme (ACE)

A

catalyzes conversion of angiotensin 1 to angiotensin 2

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13
Q

What are the functions of Angiotensin 2

A
  • increases sodium reabsorption (rapid effect) - as it stimulate Na+ to H+ exchange in proximal convoluted tubule
  • Stimulates aldosterone release resulting in increased NaCl and water reabsorption from distal tubule and collecting duct
  • vasoconstriction
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14
Q

What is the function of angiotensin 2 in the brain

A
  • Binds to hypothalamus to stimulate thirst and increase water intake
  • stimulates release of ADH
  • decreases sensitivity of the baroreceptor reflex - diminished response to blood pressure increases
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15
Q

what is the net effect of angiontensin 2

A

increase in total sodium, total water and vascular tone = increased blood pressure

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16
Q

What aldosterone

A

Aldosterone is a steroid hormone produced by the adrenal glands. It play a key role in regulating blood pressure, fluid balance, and electrolyte levels in the body, particularly by acting on the kidneys.

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17
Q

What are the functions of aldosterone

A
  • Major influence on the regulation of Na+ levels in extracellular fluid
  • At high Aldosterone levels essentially all the remaining Na+ (NaCl) reabsorbed in distal tubules and collecting duct
  • Water will follow Na+ if ADH is also released
  • Inhibited aldosterone release - virtually no Na+ reabsorption in distal tubule - excretion of large amounts of Na+ along with water
  • Mot important trigger for aldosterone release is the renin angiotensin mechaism
  • Aldosterone release also directly stimulated by increase in level of extracellular K+ ions
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18
Q

What is the order of which urine travels to be excreted (4)

A
  1. collecting ducts fuse to form large ducts (papillary ducts) as they approach the renal pelvis
  2. Deliver urine to the minor calyces
  3. Stretch of calyces initiates peristaltic contract - begins in calyces, spreads to pelvis, and continues along ureter, forcing urine from renal pelvis to bladder
  4. A bladder fills and pressure increases, it compresses, closing the distal ends of ureters
19
Q

What is the urethra

A

thin walled muscular tube that drains urine from the bladder to outside

20
Q

What are the 2 components of the urethra

A
  • Internal urethral sphincter
  • External Urethral sphincter
21
Q

What does the internal urethral sphincter do

A
  • at bladder urethra junction
  • prevents leakage of urine
  • Not under voluntary control
22
Q

What is the external urethral sphincter

A
  • surrounds the urethra as it passes through the urogenital diaphragm
  • voluntarily controlled
  • formed by skeletal muscle
23
Q

What are urinary tract infections (UTIs)

A
  • refers to presence of microorganisms in the urinary tract e.g. bladder, prostate, collecting systems and kidneys
  • Mainly a bacterial infection but can be fungal and viral infections
  • Most common infections in clinical practice are hospital acquired infections - urinary catheterisation
  • Medical treatment is antibiotics —> must be bactericidal with appropriate spectrum for enterobacteria and good urinary excretion profile
24
Q

What is pyelonephritis (kidney infection)

A

one of the most common renal disorders and serious complication of common UTIs - affects one or both kidneys

25
Q

What is the cause of pyelonephritis

A
  • Acute pyelonephritis is caused by bacterial infection
  • Chronic pyelonephritis is more complex - with a bacterial infection playing a dominant role but other factors such as vesicoureteral reflux or obstruction are involved
  • these infections can cause lasting kidney damage or bacteria can spread to blood stream and cause a dangerous infection
26
Q

What are clinical features of pyelonephritis

A
  • flank pain
  • fever
  • chills
  • dysuria
  • frequent urination or an urgent need to urinate
  • haematuria
27
Q

What is glomerulonephritis

A

Glomerulonephritis is the inflammation of the glomeruli leading to damage - includes acute and chronic

  • often asymptomatic - only diagnosed as a result of finding of protein and blood in the urine in the absence of infection
28
Q

What are causes of glomerulonephritis

A
  • little known about triggering agent
  • strep throat
  • abscessed teeth - immune system overreaction to infection
29
Q

what is the most common cause of chronic renal failure

A

Chronic glomerulonephritis

slow cumulative damage and scarring to glomeruli usually due to inflammation.

30
Q

how do you manage chronic glomerulonephritis

A

Management of hypertension (ACE inhibitors) critical to slow progression.

31
Q

What is the link between renal disease and hypertension

A

Renal disease (kidney disease) and hypertension (high blood pressure) are closely linked, often creating a cycle where one condition worsens the other. The kidneys play a crucial role in regulating blood pressure by managing fluid balance and electrolyte levels, and any dysfunction can lead to or exacerbate high blood pressure.

32
Q

What is acute renal failure (ARF)

A

Acute renal failure is a sudden reduction in kidney/renal function accompanied by accumulation of waste products in the blood

33
Q

What does acute renal failure cause

A

Results in a significant decrease in urine output, or rarely, urine flow ceases

34
Q

What are the 3 types of acute renal failure

A
  1. Pre-renal
  2. Intra renal
  3. Post renal
35
Q

What is pre renal acute renal failure

A

Associated with conditions that impair renal blood flow such as hypotension or renal artery blockage - normally easily reversed once the cause is identified and reversed.

36
Q

What is intra renal failure

A
  • occurs when the nephron itself is damaged
  • variety of factors can cause injury, including infection, autoimmune reactions, severe hypertension
  • Recovery usually slow or in the case of severe injury, may not occur at all - progression to chronic renal failure
37
Q

What is post renal failure

A
  • Due to an obstruction within the urinary collecting system distal to the kidney
  • Leads to a “back pressure” that impedes glomerular filtration - may be revered by removal of the obstruction (e.g. kidney stone)
38
Q

What is chronic renal failure

A

Chronic renal failure is the gradual and progressive loss of kidney function over moths or years. This is ultimately irreversible and leads to end stage renal disease.

39
Q

What are the 3 stages of chronic renal failure

A
  1. Decreased renal reserve
  2. Renal insufficiency
  3. End stage renal disease
40
Q

What is stage 1 of chronic renal failure - decreased renal reserve

A

Corresponds to a loss of up to 50% of the kidney’s nephrons - not associated with signs or symptoms of renal failure become of hyperfunction in the remaining nephrons

41
Q

What is stage 2 of chronic renal failure - renal insufficiency

A

Occurs when 75-80% of nephrons are damaged - ability of kidneys to concentrate urine is impaired, leading to increased urinary output

42
Q

What is stage 3 of chronic renal failure - end stage renal disease

A

> 90% of nephrons destroyed and symptoms typical of renal failure. Common causes include hypertension, glomerulonephritis, diabetes mellitus, renovascular disease, pyelonephritis

43
Q

what is end stage renal disease require

A
  • fatal without dialysis or kidney transplant
  • Dialysis replaces kidney functions - removal of metabolic waste products and excess fluids as well as maintenance of electrolyte balance
  • Kidney transplantation - alternative to dialysis in patients with end stage renal disease -primary limiting factor is availability of organs

DS1102 (37 decks)

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