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Foundations of Medicine > Week 9 Science and Scholarship: Urinary System > Flashcards

Week 9 Science and Scholarship: Urinary System Flashcards

1
Q

structure of kidneys

A

bean shaped paired retroperitoneal organs

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1
Q

list the organs of the urinary system

A

kidneys, ureters, bladder, urethra

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2
Q

structure of ureters

A

-muscular paired narrow tubes
-made of transitional epithelium
-has muscularis layer (upper 2/3 have 2 layers lower 1/3 has 3 layers)

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3
Q

structure of bladder

A

hollow organ
-mucosa, muscularis and sphincters
-3 layers of muscularis
-internal (involuntary) and external (voluntary) sphincters
-

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4
Q

structure of urethra

A

-tube at terminal end of urinary tract
-stratified transitional epithelium
-goes from columnar to squamous
-2 layers of muscularis
-varies in men (20-25cm) and women (4cm)

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5
Q

list the functions of the kidney

A

plasma flitration
nutrient conservation
BP regulation
blood pH regulation
hormone release

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6
Q

how is the kidney involved in plasma filtration

A

removes wastes and excess substances from blood

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7
Q

how is the kidney involved in nutrient conservation

A

reabsorbs essential nutrients and ions to maintain body balance

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8
Q

how is the kidney involved in BP regulation

A

regulates BP and volume through fluid balance mechanisms

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9
Q

how is the kidney involved in blood pH regulation

A

maintains blood pH and BGL via various mechanisms

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10
Q

how is the kidney involved in hormone release

A

secretes hormones like renin and erythropoietin to regulate BP and RBC production

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11
Q

name the external features of the kidney

A

renal artery, renal vein, hilum, ureter, renal pelvis

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12
Q

function of renal artery

A

blood vessel carrying oxygenated blood to the kidney for filtration

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13
Q

function of renal vein

A

blood vessel carrying filtered blood away from the kidney

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14
Q

function of hilum

A

indentation on the kidney where the renal artery, renal vein and ureter enter and exit

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15
Q

function of ureter

A

tube that carries urine from kidney to bladder

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16
Q

function of renal pelvis

A

central collecting chamber where urine from the kidney nephrons is funnelled before entering the ureter

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17
Q

name the internal features of the kidney

A

fibrous capsule
perinephric/perineal fat
renal fascia
renal medulla
renal cortex
renal sinus
renal pyramids
renal column
kidney lobes

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18
Q

whats the fibrous capsule of kidney

A

collagen fibres that cover entire organ

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19
Q

whats the perineal fat of kidney

A

a thick, cushioning layer of adipose tissue

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20
Q

whats the renal fascia of kidney

A

dense, fibrous outer layer that anchors the kidney to surrounding structures

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21
Q

whats the renal medulla of kidney

A

layer beneath the cortex that regulates concentration of urine

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22
Q

whats the renal cortex of kidney

A

outermost area of kidney
-enables filtration and reabsorption of blood

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23
Q

whats the renal sinus of kidney

A

central cavity that contains renal pelvis, renal calyces, blood vessels and fat

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24
Q

whats the renal pyramid of kidney

A

cone structures that extend from the cortex to renal sinus,
-8 to 10 per kidney
-transport urine from cortex to sinus
-apex is known as renal papilla

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25
Q

what is the renal columns of kidney

A

bands of tissue that seperate adjacent renal pyramids

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26
Q

whats the kidney lobes of kidney

A

consists of a renal pyramid, overlying renal cortex and adjacent tissues of renal columns

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27
Q

List the pathway through which filtrate drains from each kidney lobe into ureter

A

renal papilla
minor calyces
major calyces
renal pelvis
ureter

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28
Q

function of ureter

A

transports urine from the kidney to urinary bladder

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29
Q

function of bladder

A

storage and expulsion of urine

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30
Q

function of urethra

A

transport urine from bladder to outside of Body

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31
Q

Describe the pathway of blood flow through the kidney (up until nephron)

A

-oxygen rich blood arrives via renal artery
-renal artery divides into renal sinus and segmental arteries
-segmental arteries branch into interlobar arteries which run along columns
-interlobar arteries continue to branch, until they culminate at the nephron level

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32
Q

Describe the pathway of blood flow through the kidney (nephron onwards)

A

-the efferent arteriole carries blood from the glomerulus to peritubular capillaries
-the peritubular capillaries surround the renal tubule, water and solvents are absorbed
-peritubular capillaries drain into cortical veins which carry filtered blood back to heart via IVC

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33
Q

Explain the role of peritubular capillaries and vasa recta in filtering blood

A

-peritubular capillaries surround renal tubules and are vital to reabsorbing substances eg glucose and AA’s into blood
-vasa recta run along side the loop of Henle, they maintain the concentration gradient, vital for concentration of urine
-both structures are very permeable

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34
Q

contrast the types of nephrons

A

-cortical nephrons are found in the renal cortex whereas juxtamedullary nephrons have longer loops and extend into renal medulla
-cortical nephrons excrete waste products into urine whereas juxtamedullary nephrons concentrate urine

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35
Q

name the structural components of the nephron

A

-PCT
-Loop of Henle
-DCT
-collecting ducts

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36
Q

function of the proximal convoluted tubule (PCT)

A

extends from the Bowmans capsule and is essential in reabsorption of nutrients eg glucose, amino acids, ions and water

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37
Q

function of loop of henle

A

consists of ascending and descending limbs, creates a osmotic gradient in the medulla for water and ions reabsorption

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38
Q

function of distal convoluted tubule (DCT)

A

further modifies filtrate by selectively reabsorbing ions eg Na,K,Ca (regulate pH)

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39
Q

function of collecting duct

A

receives filtrate form multiple nephrons and concentrates urine , sending to renal pelvis for elimination (electrolyte balance)

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40
Q

name the 3 functions of the nephron

A

filtration, reabsorption and secretion

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41
Q

Describe filtration and where it occurs

A

occurs at renal corpuscle, solutes within the blood pass through filtration membrane into nephron due to hydrostatic pressure

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42
Q

Describe reabsorption and where it occurs

A

occurs at tubules, transport of water and solutes from tubular fluid into the peritubular fluid

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43
Q

other name for tubular fluid

A

filtrate

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44
Q

other name for peritubular fluid

A

blood

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45
Q

Describe secretion and where it occurs

A

occurs at collecting ducts, solutes (wastes or drugs) are transported from the tubular fluid into peritubular fluid

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46
Q

what makes up the renal corpuscle

A

glomerulus and bowman’s capsule

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47
Q

function of glomerulus

A

a tuft of capillaries, where small molecules pass through and larger proteins and cells are retained

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48
Q

function of Bowmans capsule

A

surrounds glomerulus and collects filtrate, forcing it to renal tubules for further processing

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49
Q

what is the filtration membrane

A

site of filtration of blood from the glomerulus into the glomerular capsule

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50
Q

Name the features that enhance glomerular filtration at the renal corpuscle

A

Glomerular pressure
capillary surface area
membrane thickness

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51
Q

how does glomerular pressure enhance glomerular filtration

A

-afferent arterioles have lower blood pressure than efferent arterioles
-t/f blood is drawn into glomerulus via afferent pathways and exported via efferent pathway

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52
Q

how does capillary surface area enhance glomerular filtration

A

-the glomerular capillaries have a high surface area, enabling the rapid transport of filtrate

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53
Q

how does membrane thickness enhance glomerular filtration

A

the filtration membrane is thin, this enables the rapid transport of materials cross it

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54
Q

name the three components of the filtration membrane

A

fenestrated endothelium
basement membrane
pedicels

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55
Q

function of fenestrated endothelium in filtration membrane

A

contains fenestrations; this allows some substances to flow through, and prevents the flow of larger substances

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56
Q

function of basement membrane in filtration membrane

A

prevents the travel of large portions

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57
Q

function of the pedicels in the filtration membrane

A

filtration sits between pedicels (of podocytes), prevents the transport of medium proteins into the nephron

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58
Q

list the purposes of mesangial cells in the renal corpuscle

A

structural support
phagocytosis
cytokine secretion

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59
Q

how do mesangial cells provide structural support to renal corpuscle

A

-provide structural support to the glomerular capillaries and maintain integrity of glomerular tuft
-help prevent collapse and maintain SA

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60
Q

why do mesangial cells allowing phagocytosis aid renal corpuscle

A

-they can remove debris, engulf immune complexes and other debris that may accumulate in glomerulus

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61
Q

how do cytokine secretions by mesangial cells aid renal corpuscle

A

-can secrete various cytokines and growth factors that are involved in tissue repair and immune responses of glomerulus

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62
Q

Distinguish between the microscopic appearance of the renal corpuscle and the renal tubules

A

Renal corpuscle:
-spherical
-glomerulus is tightly packed, has a parietal and visceral layer
-parietal layer is squamous epithelium and visceral layer is podocytes

Renal tubules:
-long
-PCT (contain microvilli) & DCT are convoluted structures with single epithelial lining
-collecting ducts are larger and can have cuboidal or columnar lining

63
Q

how does concentration of urine work according to the counter-current multiplier mechanism

A

works between the loop of henle and vasa recta
-descending loop of henle is permeable to water and ascending loop is permeable to ions
-water follows salt and they enter interstitial fluid
-this establishes a concentration gradient
-higher concentration in renal medulla
-water can be reabsorbed at ducts and instead urine is more concentrated

64
Q

ADH and aldosterone make urine ___ concentrated

A

more

65
Q

Describe the influence of the Anti-Diuretic Hormone (ADH) on the renal tubules and collecting ducts

A

-low water level or high osmolarity (stimulus)
-specialised cells of hypothalamus detect a change in blood osmolarity or concentration
-ADH released by pituitary gland and acts on kidneys to increase water reabsorption
-less water loss (more concentrated urine)

66
Q

Describe the influence of Aldosterone on the renal tubules and collecting ducts

A

-mineralocorticoid receptors in tubules and ducts are stimulated
-aldosterone released & stimulates reabsorption of Na+ from collecting ducts
-more water is also reabsorbed as it flows salt
-increased blood volume and BP
-also, K+ is excreted into filtrate to maintain potassium levels

67
Q

list the components of the juxtaglomerular apparatus

A

juxtaglomerular cells
macula densa
mesangial cells
extraglomerular mesangial cells

68
Q

what are juxtaglomerular cells and what do juxtaglomerular cells do in the juxtaglomerular apparatus

A

-specialised smooth muscle cells in the walls of the afferent arteriole where it comes in contact with glomerulus
-secrete enzyme renin

69
Q

what is macula densa and what does macula densa do in the juxtaglomerular apparatus

A

-group of specialised cells in DCT, close to juxtaglomerular cells
-detects sodium chloride concentration in tubular fluid

70
Q

what are mesangial cells and what do mesangial cells do in the juxtaglomerual apparatus

A

-supporting cells located between the glomerular capillaries
-help regulate blood flow in glomerulus and support its structure

71
Q

what are extraglomerular mesangial cells and what do extraglomerular mesangial cells do in the juxtaglomerual apparatus

A

-cells found in space between afferent and efferent arterioles
-communicate with juxtaglomerular cells and macula densa cells, regulating the glomerulus

72
Q

define the term diuretic

A

a medication or substance that increases urine production and excretion from the body

73
Q

list some common diuretic

A

caffeine
alcohol
watermelon
cranberries
marijuana
MDMA
nicotine
celery

74
Q

list three metabolic waste products found in urine

A

urea, creatine and uric acid

75
Q

how does BP influence glomerular filtration rate

A

-when BP increases, afferent arterioles contract, limiting amount of blood flow into glomerular capillaries
-when BP decreases, affect arterioles dilate, increasing amount of blood flow into glomerular capillaries

75
Q

Explain the concept of haemodynamic regulation of glomerular filtration

A

-GFR is regulated by blood flow and pressure within glomerular capillaries
involves:
auto regulation of renal blood flow
hormonal regulation of renal blood flow
podocyte contraction

76
Q

List the primary determinants of GFR

A

glomerular capillary pressure
renal blood flow
glomerular SA
permeability of filtration barrier

77
Q

how does glomerular capillary pressure impact GFR

A

if pressure is too high, more fluid will be filtered than necessary and if its too low less fluid will be filtered

78
Q

how does renal blood flow impact GFR

A

-the amount of blood flow into the kidney determines the amount of fluid that is filtered by the glomerulus, if renal blood flow decreases GFR decreases

79
Q

how does glomerular SA impact GFR

A

decreased SA (due to damaged glomerular capillaries) , decreases GFR

80
Q

how does permeability of filtration barrier impact GFR

A

-permeability determines the quantity of substance that can be filtered, increased permeably increases GFR

81
Q

outline how GFR is estimated

A

-using equations that consider age, sex, race and serum creatine levels

82
Q

what is the most common way of estimating GFR

A

chronic kidney disease epidemiology collaboration
CKD-EPI

83
Q

most accurate way of determining GFR

A

using clearance of exogenous filtration markers

84
Q

name the ways to measure GFR

A

CKD-EPI equations
blood tests
creatine clearance
clearance of exogenous filtration markers

85
Q

Explain inulin clearance

A

performed using timed urine and blood collections, with insulin clearance calculated as the amount of insulin cleared from blood over set time

86
Q

why is inulin clearance useful clinically

A

-insulin can not be reabsorbed or secreted
-used to monitor CKD, medications and dialysis

87
Q

Explain the concept of ‘first-pass metabolism as it applies to inulin clearance.

A

-first-pass metabolism is the initial metabolism of a substance that occurs when its absorbed from GI tract and passes through liver before entering systemic circulation
-insulin exogenously administered, bypassing GI tract and liver, meaning its filtered rapidly
-insulin clearance isn’t impacted by first pass metabolism as it doesn’t undergo hepatic metabolism before entering systemic circulation

88
Q

name the broad categories of drugs that influence the urinary system

A

-loop diuretics
-Thiazide Diuretic
-Mineralocorticoid antagonist
-Potassium-sparing diuretics
-Angiotensin Converting Enzyme inhibitors (ACE inhibitors)
-Angiotensin Receptor Blockers (ARB

89
Q

describe the action of loop diuretics

A

inhibit the sodium-potassium-chloride co-transporter in renal tubules, reducing reabsorption of sodium, chloride and water in the ascending loop of henle

90
Q

describe the action of thiazide diuretics

A

inhibit the sodium-chloride co transporter (NCC) in renal tubules, reducing reabsorption of sodium and chloride

91
Q

describe the action of mineralocorticoid antagonists

A

block the effects of aldosterone, reducing sodium and water retention

92
Q

describe the action of potassium-sparing diuretics

A

inhibit sodium channels or sodium-potassium exchange pumps, reducing sodium reabsorption and potassium secretion

93
Q

describe the action of ACE inhibitors

A

block the action of angiotensin converting enzymes, reducing the conversion of angiotensin I into angiotensin II

94
Q

describe action of angiotensin-receptor blockers

A

block angiotensin II receptors, preventing its vasoconstrictor and aldosterone-stimulating effects

95
Q

effect of loop diuretics

A

increased urine volume and excretion of sodium and other electrolytes

96
Q

effect of thiazide diuretic

A

increased urine volume, excretion of sodium and chloride, modest decrease in potassium secretion

97
Q

effect of mineralocorticoid antagonist

A

increased sodium and water excretion, while reducing potassium excretion

98
Q

effect of potassium-sparing diuretics

A

increased urine volume, with. minimal potassium loss

99
Q

effect of ACE inhibitors

A

vasodilation, decreased aldosterone secretion, reduced sodium and water reabsorption, lower BP and lower blood volume

100
Q

effect of angiotensin receptor blockers

A

vasodilation, decreased aldosterone secretion, reduced sodium and water reabsorption,

101
Q

what is intracellular fluid

A

the fluid that is found inside cells, and is separated from the extracellular fluid by the -PCM (2/3 body fluid)
-high [K+]

102
Q

what is extracellular fluid

A

the fluid that is found outside cells, includes interstitial fluid, plasma and lymph

103
Q

what is plasma

A

liquid component of the blood, that contains water, electrolytes, hormones, proteins, and other substances
-is separated from the formed elements of blood by the cellular components of blood
-(1/15th body fluid)
-high [Na+]

104
Q

what is interstitial fluid

A

fluid that surrounds and bathes cells, and is found in the spaces between cells and capillaries in tissues

105
Q

how can fluid gain occur

A

-oral intake of water or consumption of water rich food
-metabolic processes produce water as a byproduct

106
Q

how can fluid loss occur

A

-through urine, perspiration, respiratory evaporation

107
Q

Outline the pathway for ADH in regulation of blood volume

A

-ADH is released by pituitary gland in response to stimulation by osmoreceptors of the hypothalamus (low water levels)
-ADH acts on kidneys to increase water reabsorption
-concentrated urine and less water loss

108
Q

Describe alkalosis

A

a condition characterised by an excess of base in the blood resulting in pH > 7.45

109
Q

Describe acidosis

A

a condition characterised by an excess of acid in the blood resulting in pH < 7.45

110
Q

causes of alkalosis

A

hyperventilation (lower CO2) t/f high pH

111
Q

symptoms of alkalosis

A

muscle twitching, numbness, or tingling

112
Q

causes of acidosis

A

-hypoventilation (high CO2) t/f low pH
-kidney disease or diabetics

113
Q

symptoms of acidosis

A

lethargy, SOB, cephalgia

114
Q

where are peripheral chemoreceptors

A

carotid sinus and aortic arch

115
Q

where are central chemoreceptors

A

medulla

116
Q

Explain the role of the juxtaglomerular apparatus response in regulating BP

A

-the macula densa (in the DCT) detects decrease in the NaCl concentration in the urine
-macula densa stimulates release of renin by JG cells
-this acts on afferent arterioles
-causing vasoconstriction and decreased GFR
-less Na and water is excreted and reduces urine production

117
Q

Explain the role of the Renin-Angiotensin-Aldosterone System (RAAS) in the control of blood pressure and electrolyte balance.

A

-specialised cells in JGA detect low Na+ or low BP and secretes renin
-renin acts on angiotensinogen and converts it into angiotensin I
-angiotensin I is further converted to angiotensin II by ACE
-angiotensin II stimulates release of aldosterone from adrenal glands, causing vasoconstriction of efferent arterioles
-aldosterone acts on DCT and collecting ducts, promoting sodium reabsorption and potassium excretion
-increased sodium reabsorption, increased water reabsorption and blood volume
-negative feedback loops work and Renin is inhibited

118
Q

the thirst response is regulated by ___

A

osmoreceptors of hypothalamus

119
Q

Describe the micturition reflex

A

-receptors in the wall of the bladder detect stretch and send a signal to spinal chord (via a neuron)
-detrusor muscles surrounding the bladder contract, causing the bladder to ‘squeeze’ urine out
-the internal sphincter relaxes enabling urine to exit the bladder and enter the urethra
-an afferent signal is sent to brain, which processes the response and sends efferent signal to urethra
-external sphincter relaxes or contracts depending on desired outcome

120
Q

what steps are voluntary and involuntary in micturition reflex

A

1,2,3 Involuntary
4,5 voluntary

121
Q

volume of bladder

A

700-800 mL

122
Q

at what volume does the urge to urinate begin

A

200mL

123
Q

Describe the voluntary and involuntary regulation of urination with reference to appropriate sphincters

A

-at 200mL there is a voluntary urge to urinate
-at 500mL detrusor muscle contraction forces the internal (involuntary) sphincter to open
-if neurological pathway for external voluntary sphincter hasn’t been established urination occurs involuntarily (Infants)
-if external voluntary sphincter isn’t powerful enough, urination can occur (elderly)

124
Q

what input does the bladder receive

A

-receives both parasympathetic and sympathetic input
-spin reflex

125
Q

describe autonomic innervation of bladder

A

Consists of detrusor muscle, external and internal sphincter
-detrusor muscle is contracted during urination and receives parasympathetic input
-internal sphincter is relaxed during urination and receives reduced sympathetic outflow
-external sphincter is relaxed during urination and receives somatic nervous innervation

126
Q

name the three systems that control the micturition reflex

A

cortical centres
brainstem
spinal chord

127
Q

how are cortical centres involved in the micturition reflex

A

-CC in cerebral cortex, provides voluntary control over the inhibition and initiation of micturition through conscious decision making

128
Q

micturition reflex aka

A

void reflex

129
Q

how is the brainstem involved in micturition reflex

A

-consists of pontine micturition centres and periaquaductal grey (PAG)
-coordinates reflexive aspects of the reflex, involving the coordination between the bladder and external urethral sphincter

130
Q

how is the spinal chord involved in micturition reflex

A

-serves as the final integration centre for the reflex
-receives sensory information from the bladder and coordinates the reflex arc that mediates the coordinated contraction of the detrusor muscles and relaxation of external urethral sphincter during voiding

131
Q

contrast parasympathetic and sympathetic innervation of bladder

A

-parasympathetic NS contracts detrusor muscles, relaxes internal sphincter and promotes bladder function
-sympathetic NS relaxes detrusor muscles, contract internal sphincter and inhibits bladder function

132
Q

where does sympathetic innervation of urinary bladder begin and what ganglion are relevant

A

-thoracolumbar region T10 to L2
-superior hypogastric plexus and inferior mesenteric ganglia

133
Q

where does parasympathetic innervation of urinary bladder begin and what ganglion are relevant

A

-sacral region S2-S4
-intramural ganglia in the bladder wall

134
Q

whats a UTI

A

bacteria in upper or lower urinary tract
-upper (kidneys and ureter) are more serious

135
Q

whats a kidney stone

A

crystallisation of minerals and salts
-painful, more common in men

136
Q

define acute vs chronic renal failure

A

Acute is sudden and rapid decline in kidney functions vs chronic is progressive and irreversible loss of kidney function over time

137
Q

onset of acute vs chronic renal failure

A

acute develops rapidly within hours to days vs chronic develops gradually, months to years

138
Q

cause of acute vs chronic renal failure

A

acute occurs due to sudden injury, infection or dehydration vs chronic occurs due to diabetes, HTN, kidney diseases

139
Q

symptoms of acute vs chronic renal failure

A

acute leads to decreased urine output and fluid retention vs chronic leads fatigue, oedema, HTN and anaemia

140
Q

treatment of acute vs chronic renal failure

A

acute focuses on cause of condition and supporting kidney function vs chronic may need management, dialysis or transplants

141
Q

are acute and chronic renal failure reversible

A

generally, only acute is reversible

142
Q

name two types of dialysis

A

peritoneal and haemodialysis

143
Q

whats heamodialysis

A

a haemodialyser (machine) is used to withdraw, filter and then return pt blood into bloodstream

144
Q

whats peritoneal dialysis

A

-involves use of peritoneal membrane in patients abdomen as natural filter
-dialysate solution is injected via catheter
-dialysate absorbs fluids and wastes from blood vessels lining peritoneal membrane
-after a period of time, dialsyate is drained and replaced

145
Q

what are aquaporins

A
146
Q

provide a mechanistic explanation for polyuria in diabetes

A

Increased Blood Glucose Levels
Glucose Spillage into Urine
Osmotic Diuresis: glucose in the urine increases its osmotic pressure. This high osmolarity pulls water from the bloodstream into the urine.
Increased Urine Volume:
Polyuria:

147
Q

what are the microvascular and microvascular complications of diabetes

A

microvascular=retinopathy,nephropathy,neuropathy
macrovascular= stroke, MI, CVD

148
Q

symptoms of retinopathy

A

-blurred vision, dark spots, decreased night vision, vision loss

149
Q

symptoms of nephropathy

A

oedema, HTN, fatigue, anaemia, loss of appetite

150
Q

symptoms of neuropathy

A

sharp pain, tingling, numbness, loss of reflexes

151
Q

what kind of medication is ramipril

A

an ACE inhibitor

152
Q

how do statins work

A

Statins lower cholesterol by blocking liver enzyme, reducing “bad” cholesterol and lowering risk of heart disease and stroke.

153
Q
A

Foundations of Medicine (18 decks)

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