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Renal Exam 1: Part 3

Chapter 2: Function and Structure of the Kidneys and LUT

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
Created by: SparkleBabies