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Chapter 35
Structure and Function of Renal and Urologic Systems
134
Nursing
Graduate
04/16/2012

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Term
Functions of Kidneys
Definition
1. Excrete metabolic wastes 2. Regulate acid-base balance 3. Secrete hormones 4. Convert vitamin D to a usable form 5. Regulate blood volume 6. Regulate serum osmolarity
Term
What metabolic wastes do the kidneys excrete?
Definition
Creatinine
Urea
Some drugs
Term
What is urea?
Definition
End product of protein metabolism
Term
How do kidneys regulate acid-base balance?
Definition
H+ and HCO3
Term
What hormones do kidneys secrete?
Definition
Renin
Erythropoietin
Term
How do kidneys regulate serum osmolarity?
Definition
Water/sodium balance
Term
What hormone helps kidneys regulate serum osmolarity?
Definition
Antidiuretic Hormone (ADH)
Term
What is the outer part of the kidney called?
Definition
Cortex
Term
What does the cortex contain?
Definition
Glomeruli
Majority of proximal tubules
Some segments distal tubles
Term
What is the inner kidney called?
Definition
Medulla
Term
What is in the medulla?
Definition
Pyramids
Proximal tubules
Term
What is in the pyramids?
Definition
Loop of Henle
Collecting ducts
Term
What do the calyces receive urine from?
Definition
Collecting ducts
Term
What do calyces form?
Definition
Entry to renal pelvis
Term
What is the structural and functional unit of the kidney?
Definition
Nephron
Term
How many nephron are per kidney?
Definition
Approx. 1.2 million
Term
What are the 2 types of nephrons?
Definition
Cortical
Juxtamedullary
Term
What is the major type of nephron?
Definition
Cortical nephron
Term
Where do cortical nephrons extend to?
Definition
Partially to medulla
Term
Where does concentration of urine occur?
Definition
Juxtamedullary nephron
Term
What does a nephron consist of?
Definition
Glomerulus
Renal Tubule
Term
Where is glomerulus located?
Definition
Tuft of capillaries
Term
What does the glomerulus loop into?
Definition
Bowman capsule
Term
What is the glomerular filtration membrane?
Definition
Filters blood through 3 layers
Term
What forms primary urine?
Definition
Glomerulus
Term
What does renal tubule reabsorb?
Definition
Most of filtrate
Term
What does renal tubule secrete?
Definition
unwanted components into tubular fluid
Term
What does renal tubule regulate?
Definition
water balance
Term
What are structures of the renal tubule?
Definition
Loop of Henle
Distal tubule
Collecting duct
Term
What are 2 types of cells in distal tubule?
Definition
Principal cells
Intercalated cells
Term
What do principal cells reabsorb?
Definition
Na+
Term
What do principal cells secrete?
Definition
K+
Term
What to intercalated cells reabsorb?
Definition
K+
Bicarbonate
Term
What do intercalated cells secrete?
Definition
H+
Term
What are the 3 arteries that are involved with kidneys?
Definition
Renal
Interlobar
Arcuate
Term
What types of arterioles are involved with kidneys?
Definition
Afferent
Efferent
Term
What types of capillaries are involved with kidneys?
Definition
Glomerular
Peritubular
Term
What is the only blood supply to medulla of kidney?
Definition
Vasa recta
Term
What is the vein that supplies the kidneys?
Definition
Renal vein
Term
What are the 3 urinary structures?
Definition
Ureter
Urinary bladder
Urethra
Term
What connects kidney to urinary bladder?
Definition
Ureter
Term
What brings urine out of body?
Definition
Urethra
Term
How long is the ureter?
Definition
30 cm
Term
Where do ureters receive urine from?
Definition
Renal pelvis
Term
What type of muscle bundles are ureters?
Definition
Long, interwining muscle bundles
Term
What activity moves urine along the ureters?
Definition
Peristaltic activity
Term
What does the lower end of the ureter pass through?
Definition
Posterior wall of bladdewr
Term
What is another term for urination?
Definition
Micturition
Term
What happens during urination?
Definition
Contraction of the bladder
Term
What happens to prevent reflux of urine?
Definition
Compression of lower end of ureter
Term
What is the bladder?
Definition
Bag of smooth muscle fibers
Term
What does the bladder form?
Definition
Detrusor muscle
Term
What types of cells compose the bladder?
Definition
Transitional epithelium
Term
What orifices does the trigone correspond with?
Definition
the ureters and urethra
Term
What are 2 types of urethra sphincters?
Definition
Internal
External
Term
What does the the urethra contain?
Definition
Mucus secreting glands
Term
How long is the female urethra?
Definition
3-4 cm
Term
How long is the male urethra?
Definition
18-20 cm
Term
What system controls the urologic system?
Definition
Parasympathetic Nervous System
Term
How much urine stimulates the micturition reflex?
Definition
250-300 mL
Term
The bladder and internal urethral sphincter are innervated by the?
Definition
Parasympathetic nervous system
Term
How much blood per minute do the kidneys receive?
Definition
1000-1200 mL
Term
What percentage of cardiac output do the kidneys receive per minute?
Definition
20-25% (this is a significantly lg. portion of the blood)
Term
How much blood is renal plasma flow (RPF)?
Definition
600-700 mL
Term
What is the glomerular filtration rate (GFR)?
Definition
Filtration of plasma into the Bowman space
Term
What should the GFR be?
Definition
Approx 20% of RPF or 120-140 ml/min
Term
What is GFR directly related to?
Definition
Perfusion pressure in the glomerular capillaries
Term
What perfusion pressure do we need to provide constant GFR?
Definition
80-180 mmHG
Term
what 3 systems work together to regulate renal blood flow (RBF)?
Definition
1.Autoregulation(tubuloglomarular feedback)
2. Neural regulation(sympathetic)
3. Hormonal (renin -angiotensin)
Term
what is autoregulation
Definition
tubuloglomarular feedback system that occurs in the glomerulus and the renal tubule
Term
autoregulation is sensitive to what?
Definition
Na content
Term
the neural regulation is parasympathetic or sympathetic?
Definition
sympathetic-there is NO parasympathetic innervation
Term
What hormonal system regulates RBF?
Definition
Renin-angiotensin system
Term
TQ>>>>What does the renin-angiotensin system do for renal blood flow?
Definition
increases systemic arterial pressure which changes RBF (renal blood flow)
Term
Renin is released in response to?
Definition
Decrease in Na+ concentration (A decrease in NA concentration in the distal tubule stimulates the release of renin)
Term
What does a decrease in BP cause?
Definition
A decrease in blood pressure is sensed by the juxtaglomerular cells and stimulates release of renin
Term
A reduced juxtaglomerular stretch is detected with hypotension and stimulates?
Definition
Renin release
Term
What is glomerular filtration?
Definition
Movement of protein free plasma
Term
what artery feeds the kidney
Definition
renal artery
Term
what is a risk factor for impared renal function?
Definition
Hypertension
Term
does the right or left kidney sit lower in the body?
Definition
Right-due to the placement of the liver and the lung
Term
in the kidneys renin controls what?
Definition
blood pressure/Heart
Term
what does the blood test BUN signify/represent?
Definition
the break down of amino acids
Term
what happens if we do not maintain 80-180 mmHg perfusion press. to provide constant GFR?
Definition
kidneys will not function properly
Term
the glomarular cappillary pressure opposes or favors glomarular filtration
Definition
Favors
Term
the oncotic pressure opposes or favors glomarular filtration?
Definition
opposes
Term
one of the forces favoring filtration in the glomarulus is what?
Definition
capillary hydrostatic pressure
Term
the movement of fluid/solute from tubular lumen to peritubular capillaries is?
Definition
tubular reabsorbtion
Term
how much of the glomarular filtrate is reabsorbed?
Definition
99%
Term
what three things happen during tubular transport?
Definition
tubular reabsorbtion
tubular secretion
excretion
Term
the transfer of substances from peritubular capillaries to tubular lumen is what?
Definition
tubualar secretion
Term
excretion in the tubules is what?
Definition
elimination of fluids/substances in final urine
Term
what is renal clearance
Definition
the ability of the kidnesy to filter a substance and excrete it in the urine
Term
renal clearance reflects what things
Definition
1. GFR (glomarular filtration rate)
2. Tubular reabsorbtion
3. Tubualar Secretion
Term
countercurrent exchange system occurs where
Definition
in the loop of henley
Term
the countercurrent exchange system contributes to production of concentrated or unconcentrated urine?
Definition
concentrated
Term
the longer the loop in the loop of henly the greater or less of the concentration gradient?
Definition
greater
Term
fluid flows parrallel or opposite directions through the parallel tubes in the loop of henley
Definition
opposite directions
Term
fluid moves how down the parallel limbs of hte loop of Henle?
Definition
up and down
Term
the primary function of the Loop of Henle is to ?
Definition
establish a hyperosmotic state within the medullary interstitial fluid
Term
Antidiuretic Hormone is secreted for the ?
Definition
posterior pituitary
Term
what other hormone is secreted from the post. pituitary?
Definition
oxytocin
Term
what does ADH do in relation to the kidneys?
Definition
increases permieability and reabsorbtion in distal tubule and collecting duct
Term
Aldosterone is synthesized and secreted by the ?
Definition
adrenal cortex
Term
aldosterone is regulated by what system?
Definition
Renin-Angiotensin system
Term
what does aldosterone do?
Definition
stimulates epithelial cell of distal tubule and collecting ducts to reabsorb Na+ and water
Term
where are the Atrial natriuretic peptide secreted?
Definition
secreted by the right atria cells with increased pressure
Term
atrial natriuric peptide inhibits secretion of what?
Definition
renin
Term
Urodilantin is produced where
Definition
produced by the distal tubule and collecting ducts
Term
urodilantin is released when?
Definition
when there is an increase in circulating volume or BP
Term
Urodilantin does what once it is secreted?
Definition
inhibits Na+ and water reabsorbtion
Term
hypocalcemia causes _____phospatemia
Definition
hypocalcemia=hyperphospatemia
Term
hypercalcemia causes____phosphatemia
Definition
hypercalcemia=hypophosphatemia
Term
what vitamin is required for absorbtion of calcium and phospate by the small intestine?
Definition
Vitamin D
Term
Vitamin D is found in many forms, and needs activation by what two organs?
Definition
liver and kidney
Term
if we have decreased calcium it stimulates what hormone?
Definition
parathyroid
Term
renal patients have deficiency in what vitamin?
Definition
Vitamin D
Term
if patient has vitamin d deficiency they therefor have problems with balancing what 2 things?
Definition
Calcium and Phoshate
Term
erythropoietin stimulates __________ to produce______ with hypoxia
Definition
bone marrow.....RBC's
Term
renal patients are at risk of what?
Definition
anemia of chronic renal failure
Term
what is the major constitute of urine along with water?
Definition
urea
Term
what % of urea is reabsorbed?
what % of urea is excreted in the urine?
Definition
50% of each
Term
urea provides what
Definition
osmotic gradient
Term
urine color?
Definition
straw
Term
urine specific gravity
Definition
1.10-1.20
Term
urine pH?
Definition
6
Term
what are the sediments found in urine that are measured in a urinalysis (U/A)?
Definition
RBC's, casts, crystals, WBC's
Term
before do a procedure with contrast dye should measure what for a patient?
Definition
Creatine level
Term
when testing GFR what must we know?
Definition
1.provides estimate of renal function
2.requires a blood test and 24 hr. urine sample
3.creatine clearance is commonly used as measurement but slightly overestimates GFR
Term
what test is used to monitor chronic renal disease?
Definition
plasma creatine
Term
normal plasma creatine?
Definition
0.7-1.2mg/dL
Term
what other blood test can be used to measure renal function other than creatine?
Definition
BUN-blood urea nitrogen
Term
what is normal level for BUN?
Definition
10-20 mg/dL
Term
BUN increases with an decrease in what?
Definition
GFR(glomarular filtration rate)-acute and chronic renal failure, dehydration
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