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MBBS1 Abdomen and Pelvis > Zoltan's Kidney Failure > Flashcards

Zoltan's Kidney Failure Flashcards

1
Q

What is the apex of a medullary pyramid called?

A

A renal papilla

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2
Q

How many nephrons are there in a kidney?

A

1,000,000 (10^6)

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3
Q

Where are erythropoietin producing cells located?

A

In the renal cortex

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4
Q

Are kidneys intrapertioneal or retroperitoneal?

A

Retroperitoneal

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5
Q

Where is the main site of Mg2+ reabsorption?

A

Thick ascending limb

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6
Q

What happens to proteins larger than 70kD at the basal lamina of the glomerulus?

A

They are excluded and not filtered

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7
Q

What do loop diuretics inhibit?

A

Inhibit Na+-K+-2Cl- pump

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8
Q

What is the thin transparent tough capsule surrounding the kidneys?

A

Renal capsule

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9
Q

Why is the collecting tubule negative?

A

ENac channels

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10
Q

What is clearance equal to in terms of urine and plasma concentration and urine volume?

A

(urine conc. divided by plasma conc.) x urine volume

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11
Q

How long is the long axis of a normal kidney?

A

10 cm

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12
Q

Which cells detect [Na]+?

A

Macula densa cells

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13
Q

How is the pH of someone’s blood tested?

A

A sample of arterial blood

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14
Q

What is the current preferred term for impaired kidney function with rapid onset?

A

Acute kidney injury

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15
Q

Name a drug that causes K+-sparing diuresis

A

Spirolactone

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16
Q

What causes pressure diuresis?

A

Prostaglandins and nitric oxide

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17
Q

Where do renal arteries usually arise from?

A

Lateral aspect of the abdominal aorta just below the superior mesenteric artery at L1/2

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18
Q

What does ADH cause reabsorption of?

A

Water and urea

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19
Q

What is the retroperitoneal organ lying between the kidneys?

A

The pancreas

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20
Q

What is the fat deep to the renal fascia known as?

A

Perirenal fat

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21
Q

What is Tm for glucose?

A

380mg/min

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22
Q

Where are ENaC channels found?

A

Late distal tubule and collecting duct principle cells

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23
Q

Where do the afferent nerves of the kidney go to?

A

T10-11 carrying sensory information

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24
Q

Does the DCT or PCT contain more urea?

A

DCT

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25
Q

What is the pKa of bicarbonate?

A

6.1

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26
Q

Which receptors and second messengers does ADH work via?

A

cAMP, V2 receptors and aquaporin-2

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27
Q

What muscles do the kidneys come into contact with and how?

A

Diaphragm is superior to the kidneys
Transversus abdominis is lateral and posterior to the kidneys, quadratus lumborum is middle and posterior and psoas major is medial and posterior

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28
Q

Does angiotension II constrict the efferent or afferent arteriole more?

A

Efferent

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29
Q

What kind of muscle surrounds ureters?

A

Smooth muscle

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30
Q

Which part of the Loop of Henle pumps out Na-K-2Cl?

A

The thick ascending limb

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31
Q

Which substance has a clearance most closely reflecting GFR?

A

Inulin

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32
Q

Which cells secrete renin and when?

A

Juxtaglomerular cells in response to low plasma [Na+] and low blood pressure

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33
Q

Which part of the Loop of Henle is impermeable to water?

A

The whole ascending limb

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34
Q

Where is ADH released from?

A

The posterior pituitary

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35
Q

Where do the PCT and afferent arteriole come into contact?

A

At the juxtaglomerular apparatus

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36
Q

How does the vena cava lie at the level of the kidney?

A

Right and anterior to the aorta

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37
Q

When are renal blood flow and glomerular filtration rate increased?

A

After feeding

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38
Q

Where does net H+ secretion occur?

A

In the collecting duct

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39
Q

How does the liver respond to acidaemia?

A

Producing glutamine from glutamate

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40
Q

What does acidosis cause?

A

Hyperkalemia

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41
Q

Where is oncotic pressure higher than hydrostatic pressure

A

In part of the efferent arteriole and peritubular capillaries

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42
Q

What are the three zones of the cortex of the suprarenal glands?

A

Zona glomerulosa, zona fasciculata and zona reticularis

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43
Q

What is the NHE pump?

A

Na+/H+ antiporter to secrete H+

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44
Q

What is the most important buffer in blood?

A

HCO3-

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45
Q

Where are mesangial cells found?

A

In the glomeralus

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46
Q

What does the paracellular pathway allow reabsorption of?

A

Water and ions

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47
Q

What percentage of nephrons have a long loop of Henle?

A

12%

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48
Q

Where do anatomical end-arteries supply in the urinary system?

A

The kidney lobes but not sections of the ureter

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49
Q

Where do arcuate arteries run?

A

Between renal cortex and renal medulla

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50
Q

What does hypokalemia result in?

A

Neuromuscular depression

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51
Q

Where else except the kidney do renal arteries give branches?

A

A small inferior suprarenal branch to the suprarenal gland and a branch to the ureter

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52
Q

How are right and left suprarenal glands shaped?

A

Right: triangular
Left: crescent shaped

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53
Q

How is filtered protein reabsorbed?

A

Endocytosis

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54
Q

What does calcium bind to in DCT epithelial cells?

A

Calbindin

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55
Q

What does the counter-current multipler partially depend on?

A

Action of ADH on urea transport

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56
Q

What is the diameter of a filtration slit?

A

25-65 nm

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57
Q

What happens to the osmolality of fluid as it ascends the loop of Henle?

A

Decreases osmolality

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58
Q

What is a renal pyramid?

A

A segment of renal medulla ending at the renal papilla

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59
Q

What is a medullary ray?

A

A projection of renal medulla into renal cortex

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60
Q

What does the vasa recta supply?

A

The renal medulla

61
Q

What is normal bicarbonate concentration?

A

24 mM

62
Q

Where do thiazide diuretics work? What do they inhibit?

A

DCT. Na+-Cl-

63
Q

Where are the kidneys located in terms of vertebra, costal cartilage and plane?

A

At vertebra T12- L3, 11-12th costal cartilage in the transpyloric plane

64
Q

How are amino acids reabsorbed?

A

Via Na+ cotransporter

65
Q

How much K+ is filtered and excreted?

A

5%

66
Q

How many lobes does a kidney have?

A

10-18

67
Q

What is the normal range for urine concentration?

A

60-1400 mOsm

68
Q

What is the autonomic innervation of the kidney?

A

Sympathetic T10-12 controlling renal perfusion

69
Q

How many litres of plasma do the kidneys filter per day?

A

180 L

70
Q

Why is the basolateral membrane of the PCT covered in many interdigitations?

A

For many Na+/K+ATPase transporters

71
Q

How is inulin treated by the kidneys?

A

Filtered and none reabsorbed

72
Q

Where does ADH increase water reabsorption?

A

Collecting duct

73
Q

Where are the ureters compressed?

A

The pelvo-ureteric junction, external iliac artery and uretero-vesical junction

74
Q

What does the macula densa sense and what does it release?

A

Senses Na+, K+ and Cl-

Releases adenosine

75
Q

What happens to kidneys during chronic kidney disease?

A

They shrink

76
Q

What do thiazide diuretics inhibit?

A

Na+-Cl- pump in early DCT

77
Q

What is normal H+ concentration?

A

40 nM

78
Q

What is normal anion gap metabolic acidosis due to?

A

Bicarbonate loss

79
Q

How is glomerular filtration rate autoregulated?

A

Intrinsic constriction of afferent arteriole and tubuloglomerular feedback from DCT

80
Q

Where are macula densa cells found?

A

In the DCT

81
Q

Which diuretics are often used together?

A

Furosemide and amiloride

82
Q

What do mesangial cells do?

A

Carry out phagocytosis

83
Q

What is the normal pH of urine?

A

3-5

84
Q

What do podocytes share a basal lamina with?

A

Fenestrated glomerular endothelium

85
Q

How does sodium excretion in kidney determine blood volume?

A

Indirectly, by altering plasma osmolarity

86
Q

Which side does the renal vein receive the gonadal vein on?

A

The left

87
Q

How do oncotic and hydrostatic pressures change as you move along the glomerular capillaries?

A

Hydrostatic remains the same and oncotic pressure goes from low to high

88
Q

What is average glomerular filtration rate?

A

120ml/min

89
Q

Where are Vitamin-D producing cells located?

A

In the proximal tubule

90
Q

What does increased H+ conc. do to K+ conc.?

A

Increases it

91
Q

When does the collecting duct become permeable?

A

In response to ADH

92
Q

Where does ketoacidosis affect water reabsorption?

A

In the collecting duct

93
Q

What can cause hyperkalemia?

A

Renal failure, ACE inhibitors

94
Q

How is HCO3- treated by the kidneys?

A

Filtered and all reabsorbed

95
Q

Which substance is completely filtered and secreted?

A

PAH

96
Q

What is the glomerulus?

A

The ball of capillaries through which blood plasma enters the renal tubule

97
Q

What do ROMK channels facilitate?

A

K+ efflux into the tubule

98
Q

What is the maximum length of a kidney tubule?

A

55mm

99
Q

What does renin cause?

A

Conversion of angiotensinogen to angiotensin

100
Q

What finding may indicate kidney disease?

A

A GFR below 60 ml/min

101
Q

Where is fluid hypotonic in the absence of ADH?

A

DCT and collecting duct

102
Q

What does the clearance of a substance which is completely filtered and secreted equal?

A

Renal plasma flow

103
Q

How much water and NaCl is absorbed in the PCT?

A

50% of both

104
Q

What does the zona reticularis do?

A

Secretes precursors of steroid sex hormones

105
Q

Where do osmotic diuretics work? What do they inhibit?

A

Entire tubule, none

106
Q

Where does active reabsorption of NaCl take place?

A

In the thick ascending limb, distal tubule and collecting duct

107
Q

Where do loop diuretics work? What do they inhibit?

A

Thick ascending limb. Na+-K+-Cl-

108
Q

When will the clearance of a substance equal GFR?

A

When it is filtered, not secreted and not reabsorbed

109
Q

What does aldosterone do to K+ and Na+?

A

Causes K+ excretion and Na+ reabsorption

110
Q

Where does the suprarenal vein drain into on the right and left?

A

The vena cava on the right and the renal vein on the left

111
Q

What are the resistances of afferent and efferent arterioles in the glomerulus?

A

Both high

112
Q

How can diuretics cause hypokalemia?

A

K+ secretion in collecting duct

113
Q

How is PAH treated by the kidneys?

A

Filtered, not reabsorbed, and secreted

114
Q

Where does the ureter enter the bladder?

A

Obliquely into the base of the bladder at the apices of the trigone

115
Q

Where does ADH work?

A

The principal cells of the collecting duct

116
Q

How do renal arteries divide after they enter the hilum of the kidney?

A

Into 5 segmental arteries then into interlobar, arcuate and cortical radiate arteries before forming the afferent arteries for the glomeruli

117
Q

How much Mg2+ is reabsorbed in the PCT?

A

30%

118
Q

What is the consequence of segmental arteries being end arteries?

A

If they are tied off or blocked then the section of kidney that is supplied by that artery will die (become ischemic)

119
Q

What is anuria?

A

Daily urine production of up to 50ml

120
Q

What is hydrostatic pressure in Bowman’s space?

A

10 mmHg

121
Q

What are the main urinary buffers?

A

HPO42- and NH3

122
Q

What is the diaphragm between podocyte foot processes called?

A

A filtration slit

123
Q

What is the half life of ADH?

A

15 min

124
Q

How small must a molecule be for filtration of it to be unselective?

A

10kD

125
Q

When is anion gap relevant?

A

In metabolic acidosis

126
Q

Which part of the colon does the left kidney lie next to?

A

The splenic flexure, posteriorly

127
Q

Which kidney does the duodenum lie next to?

A

Right kidney

128
Q

What happens to H+ and HCO3- in type A intercalated cells of the collecting duct?

A

H+ is secreted and HCO3- synthesised

129
Q

What can hyperkalemia result in?

A

Cardiac arrest

130
Q

What does hyperkalemia cause?

A

Acidosis

131
Q

What is the anion gap?

A

[measured plasma cations] - [measured plasma anions]

132
Q

How does ANP work?

A

Inhibiting renin-angiotensin system and ENaC channels

133
Q

Which cells detect blood pressure?

A

Juxtaglomerular cells

134
Q

What substances does the sodium gradient in the PCT help recover?

A

Amino acids and glucose

135
Q

What does the zona glomerulosa do?

A

Controls salt and water balance

136
Q

Where are osmoreceptors located?

A

Hypothalamus

137
Q

Where does the left kidney reach, posteriorly?

A

11th rib and L2-3

138
Q

What kind of epithelium has thickened plaques of membrane which can be internalised?

A

Transitional epithlium

139
Q

What does the zona fasciculata do?

A

Regulates body carbohydrates

140
Q

What is minimum urine production a day?

A

400ml

141
Q

What is a nephron composed of?

A

A renal corpuscle and a renal tubule

142
Q

Where do K+-sparing diuretics work? What do they inhibit?

A

Collecting tubule. ENaC and ROMK

143
Q

At what concentration will glucose appear in the urine?

A

11mM

144
Q

What is normal GFR?

A

125ml/min

145
Q

What is the main pump on the basolateral membrane of the PCT?

A

Na+-K+ATPase

146
Q

What does the medulla of the suprarenal glands do?

A

Has chromaffin cells that augment the sympathetic nervous system by secreting adrenaline and noradrenaline

147
Q

Which substance decreases in concentration along the length of the PCT?

A

HCO3-

148
Q

Which physiological cation is secreted the most?

A

H+

149
Q

What does Tm apply to?

A

Reabsorption and secretion

MBBS1 Abdomen and Pelvis (6 decks)

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