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Patho1Renal
Patho1 Renal Barry
| Question | Answer |
|---|---|
| Urinary system is considered a <blank> system because it has contact with the <blank>. | Dirty, outside world. |
| Describe the difference between female and male urethras. | Female urethra is shorter and wider and is only for the urinary system. Male urethra is longer and narrower and is shared by the urinary and reproductive system. |
| There is some difference in the capacity of the female bladder because... | The uterus changes size during the month and during pregnancy. |
| The urinary system is in charge of... | Producing urine. |
| What are the components of the urinary system? | Kidneys, ureters, urinary bladder, urethra. |
| True or false: the most important function of the kidneys is long term blood pressure regulation by way of the renin-angiotensin mechanism. | False. The most important function of the kidneys is the production of urine. |
| True or false: The first and most important function of the kidneys is production of urine. The second important function is long term blood pressure regulation by way of the renin-angiotensin mechanism. | True. |
| In the juxtaglomerular apparatus there are some cells in the <blank> that detect and monitor the concentration, composition, and pressure of the blood getting into renal arteries and respond to that feedback with the secretion of a hormone called renin. | Macula densa. |
| Where are the macula densa? | In the juxtaglomerular apparatus. |
| What do cells in the macula densa do? | Detect and monitor the concentration, composition, and pressure of the blood getting into renal arteries and respond to that feedback with the secretion of a hormone called Renin. |
| In the juxtaglomerular apparatus there are cells in the macula densa that detect and monitor the <blank>, <blank>, and <blank> of the blood getting into the renal arteries. | Concentration, composition, and pressure. |
| In the juxtaglomerular apparatus there are cells in the macula densa that secrete what? | The hormone Renin. |
| What does Renin do? | This hormone goes to the blood and activates a circulating hormone called angiotensinogen. |
| What activates angiotensinogen? | Renin. |
| Angiotensinogen is converted into... | Angiotensin 1. |
| What is the precursor of Angiotensin 1? | Angiotensinogen. |
| Where is Angiotensin 1 converted into Angiotensin 2? | The lungs. |
| What is Angiotensin 2 made from? | Angiotensin 1. |
| What converts Angiotensin 1 into Angiotensin 2? | Angiotensin converting enzyme(ACE). |
| What medications inhibit the conversion of Angiotensin 1 into Angiotensin 2? | ACE inhibitors. |
| True or false: ACE inhibitors stop Angiotensin converting enzyme from converting Angiotensin 1 into Angiotensin 2 in the kidneys. | False. ACE inhibitors stop Angiotensin converting enzyme from converting Angiotensin 1 into Angiotensin 2 in the LUNGS. |
| Angiotensin 2 regulates BP by <blank> different methods. | Two. |
| True or false: one way Angiotensin 2 regulates BP is by directly acting on the vessels, because Angiotensin 2 is a direct vasoconstrictor. | True. |
| As important as its direct vasoconstriction effects in increasing BP is the stimulation that Angiotensin 2 has on the... | Suprarenal cortex. |
| What does Angiotensin 2 do at the suprarenal cortex? | It helps the suprarenal cortex in the secretion of aldosterone that we retain water and increase the volume. |
| Describe the speed of the Renin-Angiotensin mechanism: | It is slow acting. |
| The Renin-Angiotensin mechanism is for <blank> control of BP. | Long-term. |
| BP is regulated in three different ways: | 1. Immediate neuroregulation, 2. vessels regulation (relaxation/constriction) (intermediate response), 3. long term is by the kidneys by the renin-angiotensin mechanism. |
| What is the fastest way to regulate BP? | Neuroregulation. |
| What is the intermediate way to regulate BP? | Vessels regulation(relaxation/constriction). |
| What is the long-term method of BP regulation? | Long-term is by the kidneys by the renin-angiotensin mechanism. |
| In addition to urine formation, what are three other functions of the kidneys? | 1. Regulation of fluids and electrolytes in the body. 2. Hematopoesis-formation of red blood cells. 3. Long-term regulation of acid/base equilibrium. |
| How do the kidneys aid in hematopoesis of red blood cells? | Kidneys produce a hormone called hematopoetin which stimulates formation of erythrocytes. |
| True or false: Urine formation is a continuous process. The function of urine is to eliminate waste. There is a continuous blood circulation inside the kidneys. The blood flow never stops. Filtration is the first process in urine formation. | True. |
| What is not eliminated in the first pass must come back again and again. This is why we need to have such a huge... | Renal blood flow. |
| External portion of the kidney is... | Renal cortex. |
| What is the connective tissue surrounding the kidney? | Renal capsule. |
| The cortex is divided from central portion known as the... | Medulla. |
| What separates the medulla from the cortex? | The arcuate vessels. |
| True or false: All the nephrons are in the cortex. All the glomeruli are in the cortex. Urine formation happens in the cortex of the organ. | True. |
| Where are the nephrons? | In the cortex. |
| Where are the glomeruli? | In the cortex. |
| Where does urine formation happen in the kidney? | In the cortex. |
| The cortex is <blank> compared to the medulla. | Thin. |
| The medulla contains the <blank> portion of the kidney. | Excretory. |
| The medulla is division into different structures known as... | Pyramids. |
| The base of they pyramid is near the <blank> and the apex of the pyramid toward the <blank> of the organ. | Cortex, center. |
| In between the pyramids is connective tissue called <blank> which divide one pyramid from another. | Renal columns. |
| At the apex of the pyramid is the... | Papilla. |
| In the medulla are a series of tubes that bring the urine toward... | The receptor point which is called the calyx. |
| Each papilla drains into one... | Calyx. |
| Each pyramid drains fluid into the <blank> into a <blank>. | Papilla, minor calyx. |
| Several minor calyxes make one... | Major calyx. |
| All the major calyxes together are the... | Renal pelvis. |
| What is the point of infection in pyelonephritis? | This is an infection in the renal pelvis. |
| Renal pelvis continues to the... | Ureter. |
| What is the only purpose of the ureter? | To transport urine to the urinary bladder. |
| Urinary bladder’s only function is... | To store urine. |
| Kidneys are highly vascular organs, because they work by sensing, monitoring, and responding to... | Conditions, composition, density, and pressure of the blood. |
| Thus the kidneys require a high percentage of CO. They use <blank> of CO. | 15%. |
| Each kidney receives arterial blood by... | One renal artery. |
| The renal helium is made of... | renal artery, renal vein, and ureter. |
| At the moment of entering the kidney in the area known as the renal helium (this renal helium is made of renal artery, renal vein, and ureter), at that moment the renal artery divides into... | One or two segmental arteries. |
| How many renal arteries per kidney? | One. |
| Each renal artery at the moment of entering the kidney divides into usually... | Two, sometimes three, segmental arteries. |
| Each of these segmental arteries is divided into... | Several lobar arteries. |
| Each of these lobar arteries continues going toward the cortex in between... | The pyramids. |
| Each of these lobar arteries continues going toward the cortex in between the pyramids. That is known as... | Interlobar arteries. |
| The medulla is divided into lobes. The lobes usually contain... | One or two pyramids. |
| Renal artery to <blank> artery to <blank> artery to <blank> artery. | Segmental, lobar, interlobar. |
| The interlobar artery goes to the base of the pyramid where it bends and becomes... | Arcuate artery. |
| The interlobar artery goes to the base of the pyramid where it bends and becomes arcuate artery. This is also the point where... | The cortex is divided from the medulla. |
| Each arcuate artery produces a series of branches which are called... | Interlobular arteries. |
| Each arcuate artery produces a series of branches which are called intralobular arteries. They are called this because... | They divide the lobules of the kidneys. |
| The lobules are in the <blank>. The lobes are in the <blank>. | Cortex, medulla. |
| Describe the flow of blood into the kidney from the renal artery: | Renal artery to segmental arteries to lobar arteries to interlobar arteries to arcuate arteries, interlobular arteries to arterioles. |
| Arterioles go to the functional units of the kidney which is the... | Nephron. |
| Arterioles go to the functional units of the kidney which is the nephron. Because they are going there they are called... | Afferent arteroles. |
| The afferent arteroles are going to the first structure of the nephron which is the... | Glomerulus. |
| The <blank> brings high oxygenated arterial blood to the nephron, specifically to the glomerulus. | Afferent arteriole. |
| Inside the nephron, the glomerulus which is network or mesh of capillaries coming from the afferent arteriole. These capillaries converge to form... | Another arteriole. |
| How is the glomerulus an exception to the cardiovascular system? | The glomerulus is a structure that begins with an arteriole and ends with another arteriole. This is a structure where you get arterial blood in and arterial blood out. |
| Where do the efferent arteroles go? | These efferent arterioles go in different directions. Usually go to the peritubular capillaries. |
| Describe renal venous flow. | Efferent arteroles, peritubular capilaries, interlobular veins, arcuate veins, interlobar veins, which drain directly into the renal vein. There are no segmental veins, there are no lobar veins. Renal vein goes to inferior vena cava. |
| The nephron is the basic functional unit of the kidney. The nephron consists of two main portions: | The renal corpuscule which is the part that contains the Bowman’s capsule and the glomerulus, and the tubular system. |
| The tubular system consists of the proximal(close to the corpuscule) convoluted tubule and... | The descending and ascending length called the loop of Henle. |
| How is urine concentrated? | By the contercurrent mechanism that is happening deep in the medulla in the action in the loop of Henle. |
| After the loop of Henle is the... | Distal far convolute tubule. |
| Describe the path of the nephron: | Glomerulus, Bowman’s capsule, proximal convoluted tubule, loop of Henle, descending and ascencing loop, distal convoluted tubule. |
| Is the collecting duct system part of the nephron? | No. |
| Each nephron is connected to a structure called a... | collecting duct or collecting tube. |
| Each nephron is connected to <blank> collecting duct. Each collecting duct receives <blank> nephrons. | One, several. |
| What are the two types of nephrons? | Cortical and juxtomedullary. |
| The vast majority of nephrons are... | Cortical nephrons. |
| True or false: there are a minority of nephrons called juxtomedullary nephrons. These nephrons have their proximal and distal tubules in the cortex but the loop of Henle is deep in the medulla. | True. |
| Which nephrons are responsible for urine concentration? | Juxtomedullary nephrons. |
| Surrounding the glomerulus is... | Bowman's capsule. |
| Surrounding the glomerulus is Bowman’s capsule and there is only one way out of Bowman’s capsule... | Through the proximal tubule. |
| True or false: Whatever comes out of the capillaries in the glomerulus must go down the proximal convoluted tubule. There is no other way to escape. | True. |
| Blood enters through the <blank> arteriole and circulates through the <blank> and and leaves through the <blank> arteriole. | Afferent, glomerulus, efferent. |
| True or false: the efferent arteriole is wider and larger (has a larger diameter) than the afferent arteriole. | False. The AFFERENT arteriole is wider and larger (has a larger diameter) than the EFFERENT arteriole. |
| The afferent arteriole is wider and larger (has a larger diameter) than the efferent arteriole. This means that more blood is entering the glomerulus... | Than is leaving it in the time unit. |
| What causes an increased hydrostatic pressure inside the glomerulus which is the basis for the first process of urine formation that is known as filtration? | The fact that the afferent arterole has a larger diameter than the efferent arteriole. |
| What is the first process of urine formation? | Filtration. |
| The juxtoglomerular apparatus around the afferent arteriole is the place where you detect and monitor the <blank> of the blood entering the glomerulus. | Composition, viscosity, hbg content, and pressure. |
| Where is the composition, viscosity, hbg content, and pressure of the blood entering the glomerulus detected and monitored? | The juxtoglomerular apparatus. |
| What are some hormonal effects of the juxtoglomerular apparatus's monitoring of blood? | This is where Renin among other things, and erythropoietin, are produced. So, if the blood coming through the afferent arteriole is high pressure, the Renin production is reduced. |
| If you have a reduction in the blood supply to the glomerulus, the kidneys think you have a problem with the blood pressure/volume and they... | Retain fluid and send Renin and promote vasoconstriction because they don’t understand that you may be dehydrated or have some other problem. |
| If you have a blood loss, the juxtoglomerular apparatus does what? | They respond by sending erythropoietin. |
| Where is the juxtoglomerular apparatus? | Right at the entrance of the glomerulus. |
| The vessel entering the glomerulus is arterial, and the vessel leaving the glomerulus is... | Arterial. |
| The lining of the tubes in the nephron are made of... | Epithelial tissue. |
| True or false: in the glomerulus, since we need a lot of filtration, we have very few pores and spaces that allow easy filtration when the hydrostatic pressure is high. | False. In the glomerulus, since we need a lot of filtration, we have A LOT of pores and spaces that allow easy filtration when the hydrostatic pressure is high |
| True or false: In the glomerulus, since we need a lot of filtration, we have a lot of pores and spaces that allow easy filtration when the hydrostatic pressure is high. | True. |
| When we get to the proximal convoluted tubule the tissue changes to one with a lot of mitrchondria and a lot of microvili because this is where... | Most of the absorption happens. |
| To have a lot of absorption(in the proximal convoluted tubule) you need a lot of <blank> and because it is mostly active transport, you need a lot of <blank>. | Microvilli, mitochondria. |
| What is the main function of the glomerulus? | Filtration. |
| These are the 3 processes of urine formation: | Filtration, reapsorption, secretion. (We don’t worry about excretion.) |
| True or false: All 3 processes(filtration, reabsorption, and secretion) happen in the cortex. Therefore we say that urine formation is a cortical function. | True. |
| Why do we call urine formation a cortical process? | Because filtration, reabsorption, and secretion all occur in the cortex. |
| Why does filtration happen? | Because of high intraglomerular pressure. |
| Urine filtration is a passive transport mechanism – it doesn’t require energy, this is why... | You don’t have mitochondria in the epithelial tissue of the glomeruli. |
| True or false: because filtration is passive, it moves in favor of the pressure gradient: both solvent and solids. | True. |
| Due to this pressure, filtration happens in the glomeruli. What is filtered? | Everything except large molecules. |
| Remember, the first step in urine formation, is not <blank>. Everything is filtered: good stuff, not so good stuff, bad stuff. | Selective. |
| True or false: because filtration is fast and passive,you don't filter out cells. If you ever see cells in urine, something is wrong. You don’t see protein unless something is wrong. So, very large molecules and cells should not be filtered. | True. |
| True or false: 1st step: filtration. A passive process. Not requiring energy, everything is out except large molecules, protein. | False. 1st step- filtration. A passive process. Not requiring energy, everything is out except large molecules, CELLS, protein. |
| Also in the glomerulus we filter sugar, sodium, chloride, water. And we have to <blank> them. | Reabsorb. |
| Where does reabsorption happen? | Most of the reabsorption happens in the proximal convulated tubule. |
| Reabsorption is an <blank> process, requiring a lot of energy. | Active. |
| The distal convoluted tubule at the collecting duct can reabsorb water under the action of hormones: | Anti-diuretic hormone and aldosterone. |
| Only <blank> will act at the cortical portion of the collecting duct. Remember that the collecting duct has a portion in the cortex. | Aldosterone. |
| True or false: The hydrostatic pressure will filter everything out into the Bowman’s capsule. Due to the pressure gradient: no energy is required. | True. |
| What is the pressure inside the capillaries in the glomerulus and is caused by the difference in diameter between the afferent and efferent arteriole? | Hydrostatic pressure. |
| What opposes hydrostatic pressure? | Oncotic pressure and capsular pressure. |
| What is capsular pressure? | As you’re filtering into the Bowman’s capsule there is volume and it’s causing some pressure. |
| True or false: the combined effect of the oncotic pressure and the capsular pressure is always lower than the hydrostatic pressure so you have a pressure gradient and filtration will happen. | True. |
| The normal glomerular filtration rate is... | 125ml/min. |
| As blood flows through glomerular capillaries, water and solutes filter out of the blood into Bowman's capsule through the... | Glomerular-capsular membrane. |
| What percent of filtrate is reabsorbed by the proximal convoluted tubule? | 80%. |
| How much filtrate goes into the loop of Henle? | About 25ml/min. |
| 25 ml/min. enter the loop of Henle. The descending loop of Henle is permeable to water and <blank> ml/min. are reabsorbed leaving <blank> ml/min. | 10, 15. |
| Describe water/Na permeability of the loop of Henle. | The descending loop is permeable to water and the ascending loop is permeable to Na(with energy). |
| 15 ml/min of filtrate enter the distal tubule, <blank> ml/min are reabsorbed thus leaving <blank> ml/min to enter the collecting duct. | 13, 2. |
| The collecting duct will absorb water in the presence of... | ADH. |
| What is ADH? | Anti-diuretic hormone. |
| The collecting duct will absorb water in the presence of ADH and, usually, approximately <blank> ml/min is lost as urine by the nephron. | One. |
| When does filtrate become urine? | When it enters the collecting duct. |
| All the sugar, most of the water, all the sodium, is reabsorbed in the... | Proximal convulated tubule. |
| 180 L/day is what we filter, but the urine is... | 1-1.5 L. |
| GLOMERULAR FILTRATION RATE (GFR) is... | 125 ml/min = 180 L/day. |
| Urine can be acidic or alkaline, it can be hypertonic or hypotonic, or isotonic. This is how the kidney’s long-term regulate... | The electrolytes and acid/base balance. |
| Filtrate is <blank> with plasma. | Isotonic. |
| What is the tonicity of plasma (and filtrate)? | (290-300 mOsm). |
| Urine can be <blank> or <blank> depending on water intake. | Hypertonic or hypotonic. |
| True or false: collecting duct filtration is regulated by the kidney's intrinsic or auto regulatory system. This will maintain a constant GFR despite changes in BP. | False. GLOMERULAR filtration is regulated by the kidney's intrinsic or auto regulatory system. This will maintain a constant GFR despite changes in BP. |
| True or false: Reabsorption is selective and active. | True. |
| So, what do you reabsorb? | Almost everything: amino acids, most ions, glucose, and water. |
| Because all things need water to be transported. Up to <blank> of all the energy used in reabsorption is to reabsorb sodium. | 80%. |
| Most of the energy from the kidneys and tubular system is to... | Reabsorb sodium. |
| Transport maximum is... | The maximum amount that can be reabsorbed at a certain time unit. |
| True or false: Each substance has a transport maximum, and all substances have a transport maximum. If you don’t want to reabsorb a substance then its transport maximum is zero. | True. |
| If you want to reabsorb a substance like glucose you have a very high transport maximum, which is 375 mg/min. This is a glycemia of about... | 160. |
| When do you start seeing glucose in the urine? | At glycemia of 160 or above. |
| Another definition is the clearance: the amount you eliminate from the blood. If clearance of a substance is zero then... | Nothing is eliminated from the blood. |
| Total blood volume is filtered every... | 45 minutes. |
| You use <blank> for amino acids, large molecules, proteins. | Pinocytosis. |
| When do you use pinocytosis? | For amino acids, large molecules, proteins. |
| What is pinocytosis? | Pinocytosis (literally, cell-drinking). This process involves the uptake of fluids and solutes using small vesicles, generally less than 150 nm in diameter. |
| Sodium is bringing chloride and/or bicarbonate, depending on what you use, and water... | Follows sodium. |
| True or false: Sodium is bringing chloride and/or bicarbonate, depending on what you use, and water follows sodium. This is an example of the electrochemical gradient. | True. |
| Is uric acid reabsorbed? | Yes because of diffusion mechanism, it must then be secreted. |
| Secretion is for... | Those things that will not filter but that you need to eliminate or for those things that were reabsorbed and you still need to eliminate. |
| What is actively reabsorbed? | Glucose, amino acids, lactate, vitamins, most ions. |
| Sodium, chloride, bicarb: <blank>. Water: <blank>. | Electrochemical, osmotic. |
| What percentage of glucose and amino acids are reabsorbed in the proximal convoluted tubule? | 100%. |
| What percentage of Na is reabsorbed in the proximal convoluted tubule? | 75-80%. |
| What percentage of Water is reabsorbed in the proximal convoluted tubule? | 75-80%. |
| What percentage of uric acid and potassium are absorbed in the proximal convoluted tubule? | Nearly all(later secreted). |
| About sodium and water...no hormones acting means... | No reabsorption. |
| ADH: increases H2O reabsorption at the... | Distal tubule and collecting duct. |
| Aldosterone: increases Na+ reabsorption at the... | Distal tubule and cortical collecting duct. |
| 3rd step: when we need to eliminate things that were not filtered, or that were filtered and reabsorbed…this is called... | Secretion. |
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