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Renal Exam 1: Part 3
Chapter 2: Function and Structure of the Kidneys and LUT
| Question | Answer |
|---|---|
| Where are the kidneys found | under the 12th rib |
| What is the weight, length, width, and thickness of the kidneys | 115-177g, 11cm, 6cm, 3cm |
| What are the 3 parts of the kidney? | Cortex, medulla, and papilla |
| What is the kidney composed of? | nephrons, blood vessels, lymphatics, and nerves |
| How many conical masses is the medulla divided into and what are they called? | 8-12; renal pyramids, minor calyces, renal pelvis |
| what percent of blood flows to the kidneys? | 25% cardiac output; 1.25L/minImportant for filtration |
| Kidneys constitue what percent of total body weight? | <0.5% total body weight |
| How does the blood flow to, in, and out the kidney? | Renal->interlobar->arcuate->interlobular->afferent arteriole->glomerular capillaries->efferent arteriole |
| what brings blood into nephrons? What carries blood out? | In-afferent arterioleOut-efferent arteriole |
| What is the capillary network around nephrons? | peritubular capillaries |
| What do the peritubular capilaries supply blood to? | nephrons |
| What does the juxtamedullary nephron's peritubular capillaries give rise to? | vasa recta |
| How does blood flow from ascending recti to the renal vein? | ascending recti->arcuate vein->interloar vein and renal vein |
| what does the renal vein course beside? | Ureter |
| What are vasa recta? | specialization contining long hairpin-shaped vessels that serves as osmotic exchanger for productin concentrated urine |
| What course does vasa recta follow? | loop of henle |
| What is the functional unit of the kidney? | nephron |
| Each kidney contains how many nephrons? | 1.2 million |
| What are 2 things the nephron consists of? | Glomerulus and renal tubule |
| What does the Glomerulus consist of? | Glomerular capillaries and Bowman's membrane |
| What are capillary tufts from afferent arterioles located inside Bowman's membrane called? | Glomerular capillaries |
| Blood is ultrafiltered across glomerular capillaries into where? What step is this in urine formation? | Bowman's capsule1st step |
| what is passive movement of protein-free fluid from the glomerular capillaries? | ultrafiltration |
| what are the 3 things that make up the ultrastructure of the nephron corpuscle? | podocytes, filtration barrier, and mesangium |
| what are glomerular capillary covered by epithelial cells and can do phagocytosis and are proleative in nature (Endocytic) | Podocytes |
| What 3 things make up the Filtration Barier | Endothelium, Basement membrane, Filtration Slits |
| what is fenestrated and allows water, sodium, urea, glucose and small proteins thru? | Endothelieum |
| The Endodothelias cells are lined w/? What do they retard? | negative charged glycoproteinsRetard large anionic proteins |
| Endothelial cells synthesize 2 substances that regulate what? And what are these two substances? | Regulate BPNO-VasoDILATES, Endothelin-VasoCONSTRICTS |
| What is a porous matrix of extracellular proteins, type IV collagen, lamina, fibronectin, and other negatively charged particles? | Basement Membrane |
| Is the Basement membrane charge selective? If yes, what to? | yes and to plasma proteins on the basis of charge |
| what is the function of the Filtration slits? | retard filtration of some proteins and acromolecules |
| What are transmembrane protiens of slit diaphragms? | Nephrin Podocin, Actinin |
| What happens when a Nephrin gene is mutated? | abormal slit diaphragm and massive proteinuria and renal failure |
| what is the dimension of the slits? | 40-140A |
| What are 2 parts of the Mesangium? | Mesangial cells and matrix |
| What are the Mesangial cells involved with? | immune complex mediated glomerular disease: obliterates glomerulus |
| Are mesangial cells phagocytic? what do they secrete? | yesSecrete prostaglandin and cytokines |
| How do Mesangial ells influence GFR? | they contract and regulate blood flow |
| Can the mesangial matrix contract and influence GFR | Yes |
| What is the remainder of the nephron? | Tubular structure lined w/ epithelial cells |
| What are Renal tubules specialized for? | Reabsorbtion from tubular lumen into peritubular capillar blood secretion and vice versa. |
| What are the two membranes of the Renal Tubule? | Luminal membrane (Apical)Basolateral membrane (Blood side) |
| What are 5 things the Renal tubule is constructed of? | Proximal Convoluted Tubule (Brush Border)Proximal straight tubuleLoop of HenleDistal Convoluted TuuleCollecting ducts |
| what are the 3 limbs of the loop of henle? | Thin Descending LimbThin Ascending LImbThick Ascending limb TAL |
| what are the types of cells found in the collecting ducts that reabsorb K? | principal and intercalated |
| What cells of the proximal convoluted tubule ave microvilli that provide the area for absorption? | Brush boder |
| Brush border cells have a high density of what What does this do? | mitochondria to increase surface area for reabsorptive function. |
| What is a genetic disease from a mutation in PKD gene? | Polycystic Kidney Disease |
| What is a common effect of the kidney to Polycystic kidney disease? | Kidney enlarges due to hundreds of cysts that formed from defective calcium uptake |
| What are 2 types of nephrons? | Superficial Cortical & Juxtamedullary |
| where are the 2 nephrons located? | SC-glomeruli located in outer cortex, JM-glomeruli located near corticomedullary border |
| What nephron have a short loop of Henley whch descends only in the outer layer? | Superficial Cortical Nephrons |
| What nephron has alonger loop of Henle and descends deep into medulla and papilla? | Juxtamedullary |
| Why does the Juxtamedullary nephrons allow more time for water consumption? | b/c they have larger cortical nephrons and loop of henle |
| What type of nephron has a higher GFR? | juxtamedullary |
| What are 2 things the efferent arteriole forms? | network of eritubular capilriies and vascular loops called vasa recta |
| In the Vasa Recta, what is the flow of blood? | afferent arteriole->glomerular capillaries across which ultrafiltration occurs->out the efferent arterials |
| What % of the Renal blood flow enters the vasa recta? | <0.7% |
| What are 4 functions of the Vasa recta? | 1. osmotic exchangers 2. concentrate and dilute urine 3. convey Oxygen and nutrients to nephron segments4. Return reabsorbed water and solutes to blood. |
| 3 things that make up the ultrastructure of Juxtaglomerular Apparatus. | Macula densa, Extraglomerular mesangial cells, and renin |
| is the Juxtaglomerular apparatus part of the Tuboglomerular feedback mechanism? | yes |
| what does renin produce | granular cells of the afferent arteriole |
| What are granular cells and what do they do? | modified smooth muscle cells that produce renin |
| How does renin regulate BP? | indirectly thru renin, angiotensin, aldosterone pathway system |
| Renin leads to the formation of? which secretes what? | formation of angiotensin II that secretes aldosterone |
| What is the function of the Tubuloglomerular Feedback Mechanism? | autoregulation of RBF and GFR |
| What helps regulate RBF, GFR, water, and reabsorbtion y the nephron? | Renal nerves |
| What is the nerve supply of the kidney? | SNS fibers originating in celiac plexus |
| Is there Parasympathetic innervation? | no |
| What are 2 things the adrenergic fibers release? | NE and Dopamine |
| Adrenergic fibers effect what cells of the renal artery and afferent arterioles | smooth muscle |
| Adrenergic fibers cause secretion of what from granluar cells of afferent arterioles? | renin |
| Sympathtic activation of the adrenergic fibers enhances what? | Na reabsorption by nephron segments |
| what syndrome is characterized by increase in protein permeability in glomular capillaries? | Nephrotic Syndrome |
| HOw is proteinuria described? | increase protein in urine >3.5g/day |
| What does proteinuria indicate? | Kidney/Renal failure or leaky glomerulus that lets the proteins out |
| what causes the increase permeability in glomerular capillaries? | thinning of foot processes |
| Patients with nephrotic syndrome may also develop? | Hypoalbuminemia and Generalized Edema |
| What are 4 things that may cause Nephrotic Syndrome? | 1. Uncontrolled Diabetes2. Membranous glomerulaopathy (too much leak in GFB)3. Foot Process disease4. Amyloidosis |
| What are 2 characteristics of Alport's Syndrome | Hematuria(blood in urine)Glomerulonephritis |
| what percent of renal failure occurs due to Glomerulonephritis? | 1-2% |
| What is the cause of Alport's Syndrome? | genetic defect in type 4 collagen of basement membrane. BM fails to serve as an effective filtration barrier. |
| What makes up the lower urinary tract? | Ureter and Bladder |
| What is the structure of the ureter? | mucular tubes 30cm long |
| HOw does urine pass in the LUT? | leaves renal calyces and pyramids->lenters ureters->enters bladder in posterior aspect near base and above bladder neck |
| Where is urine stored? | bladder |
| What are the 2 parts of the bladder? | Neck and fundus(body) |
| how big is the neck of the bladder and what does it connect to? | 2/3cm funnel shapeconnects w/ urethra |
| In a female, where does urinary tract end? | bladder = point of exit of urine |
| In a male, where does the urinary tract end? | The bladder is considered the post-urethra and urine passes thru it to the anterior-urethra(where urine exits) |
| what is a region of posterior bladder wall found above the posterior urethra nd below the ureters? | Trigone |
| What 3 layers does the Detrusor muscle form and what is it close to? | Inner longitudinal, middle circular, outer longitidinalNear the bladder neck |
| When do the smooth mucle cells in lower urinary tract contract and under what type of control? | contract when stretched and exhibit spontaneous action potentialsUnder autonomic control |
| What are the sphincters of the bladder? | INternal and External |
| what type of muscle forms the internal sphincter? | smooth muscle fibers in bladder neck |
| Is the internal sphincter a true sphincter under conscous control? | nope |
| what is the function of the internal sphincter? | stop urine flow for storage |
| what type of muscle forms the external sphincter? | skeletal muscle |
| What is the external sphincter's function? | prevent or interrupt urination esp in males. Poorly developed in females |
| What is the term for the highly folded and very distensible walls of the ureters, bladder, and urethra. | Rugae |
| What happens to the intravesicular pressure as the bladder volume increases when it fills with urine? | It changes only a little b/c the Rugae flatten out |
| The volume of the bladder increases from ___ with a pressure change of 5cm of water. | 10ml->400ml |
| What are the renal calyces, pelvis, ureter, and bladder lined w/? | transitional epithelim` |
| What is transitional epithelium surrounded by? | mixture of spiral and longitudinal smooth muscle fibers |
| How are the fibers arranged in the detruser muscle? | randomly |
| What 3 types of cells make up the renal calyces, pelvis, ureter, and bladder? | columnar(basal layer)cuboidal (intermediate)Squamous (superficial) |
| Does the bladder recieve SNS+, PSNS+, or both? and from what nerves? | SNS via hypogastric nervesPSNS via pelvic nerves |
| What is the function of the SNS alph-adrenergic receptors? What happens when these are stimulated? | 1. cause contraction in the bladder neck and urethra 2. causes closure of urethra for urine storage |
| What is the function of the PSNS muscarine receptors? | cause sustained bladder contraction |
| What fibers carry input from receptors that detect bladder fullness, pain, and temperature sensation? | sensory fibers/pelis visceral afferent (PSNS) |
| What nerves innervate the skeletal muscle fibers of the external sphincter to stimulate contraction? | Sacral Pudendal Nerves |
| What is Nephrolithiasis and what is the incidence rate? | kidney stones 5%women, 10%men |
| What is the composition and formation of Nephrolithiasis? | comp- 80-90% Ca salt, Form-crystallization of suprasaturated urine |
| What are the manifestations of Nephrolithiasis? | stones block ureter that causes severe flank pain due to constriction reflex of ureter and the the pelvic nerves percieve the pain. |
| In the kidneys, where does urine collect? | Renal calyces |
| What does stretch promote when the urine is accumulating? | pacemaker activity |
| What is the pathway for urine from kidney to bladder once the pacemaker activity initiates a peristaltic contraction? | renal calyces->pelvis->ureter |
| What is micturition and what are it's 2 processes? | -emptying of the bladder-Progressive filling & Neuronal reflex |
| In progressive filling, filling stretches the bladder wall until what is reached? | critical pressure... then the bladder contracts |
| What is another name for neuronal reflex? | micturition reflex |
| What process is an autonomic spinal crd reflex that empties the bladder? | Neuronal/micturition reflex |
| Intense PS stimulation of the detrusor muscle causes what cells to contract? | muscle cells in neck of bladder |
| When the muscle cells in neck of bladder contract what opens? | the bladder neck to let urine flow thru posterior urethra |
| what permits the flow of urine thru the external meatus? | voluntary relaxation of the external sphincter (it initiates micturition) |
| What is cystitis? | UTI |
| UTI is due to what? and if untreated what can it cause? | due to E.coli traveling from perineum up the short urethra.If untreated, causes pyelitis (infection of renal pelvis) |
| What is inflammation that spreads to renal cortex & nephrons? | Pylonephritis |
| Infections may also be caused by what in pylonephritis? | blood-bourne bacteria |
| What is caused by kidney stones or prostate enlargement that can cause and increased rsk with pylonephritis? | urine stagnation |
| what is it called when one is unable to hold their urine and it may involuntarily leak from bladder? | urinary incontinence |
| WHat are causes of urinary incontinece? | -incompetence of urinary sphincters-bladder irritation-brief surges of bladder pressure-pregnancy (pressure on bladder)-spinal cord injuries |
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