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19 Cards in this Set
- Front
- Back
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Review the main anatomical structures of the kidney from superficial to deep.
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Capsule, cortex, medulla (pyramids and papilla), calyxes, pelvis
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Trace the vascularization of the kidney from interlobar artery to vasa recta
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Interlobar artery → arcuate → interlobular→ afferent arteriole→ glomerulus → efferent → vasa recta → corresponding veins (interlobular, arcuate, etc)
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Trace the path renal filtrate takes to get to the tubules starting from the anastamosing capillaries that make up the glomerulus.
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→ through capillary endothelium → basal lamina → thin podocyte diaphram covering the flitration slits on the visceral layer of Bowman's capsule
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What stops macromolecules from getting into the renal filtrate?
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Basal lamina traps them.
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How does the body prevent the basal lamina of Bowman's capsule from being clogged with debris during filtration?
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The basal lamina is phagocytosed by intraglomerular mesangial cells and then replaced by Bowman's visceral layer and glomerular endothelial cells.
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Name the 3 elements that make up the juxtaglomerular apparatus.
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Macula densa, juxtaglomerular cells, and extraglomerular mesangial cells.
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What are the juxtaglomerular cells and what do they do?
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Specialized smooth muscle cells in the tunica of the afferent arteriole that are responsible for the secretion of renin.
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What signals the release of renin from the juxtaglomerular cells?
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↓ NaCl (sensed by macula densa caused by a decrease in GFR), ↓ hydrostatic pressure (sensed directly), or beta1 stimulation.
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What does renin do?
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Converts angiotensinogen to angiotensin I
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What are the effects of angiotensin II?
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Vasoconstriction
↓ renin ↑ thirst, ADH, NE, aldosterone ( = ↑ water and salt retention) |
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What are the general symptoms in someone with renal problems?
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volume distrubances, abnormal urine sediments, proteinuria, hypertension/edema, lyte abnormalities, and fever/pain
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What is azotemia?
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retention of nitrogenous wastes BUN and creatinine, indicating a decrease in GFR
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What's a good measure of GFR? Why?
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Creatinine
It is freely filtered at the glomerulus, very little is excreted in the proximal tubule and it's not reabsorbed. |
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What's the differential for acute azotemia?
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Dec in renal perfusion (pre-renal)
Obstruction (post-renal) Glomerulonephritis or interstitial disease (intrarenal) |
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What percent of post-renal obstructive causes of acute azotemia progress to acute renal failure?
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<5%
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What does a U/A look like in acute renal failure? (BUN/PCr, Urine Na, Urine osmolality)
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Dilute with lots of Na and BUN:PCr = 10-15:1 (normal since both urea and Creat aren't getting out)
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What does a U/A look like in prerenal acute azotemia?
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Very concentrated with little Na (due to reabs) and BUN/PCr > 20:1 (urea's reabsorbed with the Na and water but cr's still getting excreted)
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What should you test next if you see a patient with hematuria?
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Test protein. If + bx after blood exam. If (-), check WBC (+ culture) then do 24 urine and cytology with US and bx if needed
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What should you test next if you see a patient with proteinuria?
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Do 24 quant. If micro = early DM, htn, or glomerulonephritis. If lots (>3500) = neprotic syndrome, DM, amyloidosis, etc...
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