Renal--Physiology--Micturition Renal Disease

Front 1

What happens to the composition of urine once its in the ureter?

Back 1

unchanged

Front 2

What type of muscle and innervation does the ureter have?

Back 2

peristaltic smoothe muscle w/ both sympathetic and parasympathetic innervation

Front 3

What triggers peristaltic contractions of the ureters?

Back 3

Stretch of the renal calices

Front 4

How is backflow during urination prevented?

Back 4

via bladder contraction squeezing the ureter closed

Front 5

What is the level of pain fiber innervation?

Back 5

rich

Front 6

What type of epithelium lines the bladder?

Back 6

transitional

Front 7

What muscle type is the detrusor muscle?

Back 7

smoothe

Front 8

What coupling does the detrusor muscle exhibit?

Back 8

electrical coupling so they act as a unit

Front 9

What forms the internal sphincter?

Back 9

thickening of the detrusor muscle

Front 10

What does the internal sphincter do?

Back 10

During basal tone, the thickening of the detrusor muscle prevents spontaneous emptying

Front 11

What type of control is the detrusor muscle under

Back 11

involuntary

Front 12

What type of control is the internal sphincter under?

Back 12

involuntary

Front 13

What type of muscle makes up the external sphincter

Back 13

skeletal muscle

Front 14

What type of control is the external sphincter under

Back 14

voluntary

Front 15

What does the external sphincter do?

Back 15

prevent/interrupt urination

Front 16

What is micturition and describe control?

Back 16

emptying of the bladder, under voluntary control in an adult

Front 17

What is micturition reflex and describe control?

Back 17

autonomic reflex, when bladder full, stretches mechanoreceptors on the bladder wall, afferent nerves transmit this signal triggerring parasymp outflow and contracting detrusor muscle causing urination.

Front 18

Can you override the micturition reflex?

Back 18

yes

Front 19

What is the state and specific control of the detrusor muscle during bladder filling?

Back 19

relaxed
sympathetic B2 control

Front 20

What is the state and specific control of the detrusor muscle during bladder emptying?

Back 20

contracted
parasympathetic muscarinic

Front 21

What is the state and specific control of the internal sphincter during bladder filling?

Back 21

contracted
sympathetic a1

Front 22

What is the state and specific control of the internal sphincter during bladder emptying?

Back 22

relaxed
parasympathetic muscarinic

Front 23

What is the state and specific control of the external sphincter during bladder filling?

Back 23

contracted
voluntary

Front 24

What is the state and specific control of the external sphincter during bladder emptying?

Back 24

relaxed voluntary

Front 25

What type of reserve capacity do kidneys have and what does that entail?

Back 25

Large-- electrolyte and water balance can be maintained w/ 10-15% of normal GFR

Front 26

What is the recovery potential during actue renal failure?

Back 26

kidneys will sometimes eventually recover but need to provide support for patients in the meantime

Front 27

What two things CAN characterize acute renal failure

Back 27

1) oliguria- decreased urine flow
2) anuria- no urine flow

Front 28

What are the three types of acute renal failure (def'n unnecessary)

Back 28

1) prerenal
2) intrarenal
3) postrenal

Front 29

What is prerenal ARF?

Back 29

lack of perfusion to kidney

Front 30

What is intrarenal ARF?

Back 30

when blood vessels, glomeruli, tubules, or interstitium of kidney affected

Front 31

What is postrenal ARF

Back 31

obstructed outflow fro tubule

Front 32

What are causes of prerenal ARF?

Back 32

low arterial pressure or hemorrhage

Front 33

WHat is the prognosis of hypoxia in prerenal ARF?

Back 33

renal tissue begins to die and there is less likelihood of recovery

Front 34

Why is the kidney somewhat tolerant to hypoxia in acute renal failure? What parts suffer the most?

Back 34

Much of the 02 demand is for transport, but w/ less blood flow the GFR falls and there is less transport. The medullary regions suffer the most b/c they already recieve very little blood

Front 35

What happens to kidney in postrenal ARF

Back 35

pressure in the ureter is raised and transmits into high pressure in renal tubule, eventually preventing filtration

Front 36

What are causes of intrarenal ARF?

Back 36

several! bacteria, toxins, allergies

Front 37

When do kidneys recover after intrarenal ARF?

Back 37

after insult is removed- ie after infection/inflammation/toxin is removed

Front 38

What are two major causes of CRF?

Back 38

persistent hypertension, diabetes

Front 39

What happens to nephrons in CRF?

Back 39

they are lost and not replaced

Front 40

Up till roughly what decline in function can the kidney still maintain Na+ and H20 balance in CRF?

Back 40

10% funcitoning

Front 41

What happens to GFR in CRF?

Back 41

non specific loss of filtration (low GFR)

Front 42

What is the hallmark of the progression of CRF?

Back 42

protein in the urine and the loss of concentrating and diluting capacity

Front 43

If you subjected someone to a sudden Na+ load, how woudl that person respond if they had kidney disease versus if they were normal?

Back 43

someone with renal disease takes a lot longer to restore balance, longer lag phase

Front 44

What happens to creatinine during nephron loss of function?

Back 44

as GFR declines, creatinine declines with it as a reflection

Front 45

What is uremia?

Back 45

the increase in nitrogenous waste associated w/ renal failure

Front 46

What four things result due to untreated renal failure and what are they grouped under?

Back 46

Group: uremia
1) Waste products accumulate (creatinine and BUN rise)
2) K+ excretion impaired-
3) Acidosis
4) Proteinuria

Front 47

What are the two treatments offered to support the kidney in RF?

Back 47

1) Dialysis
2) Transplantation

Front 48

What are the two structural changes as a result of nephron loss in RF?

Back 48

Hypertrophy:
1) glomerular increase
2) Tubular diameter increase

Front 49

What are the two functional changes in response to nephron loss in RF?

Back 49

1) increase in (SN) GFR=hyperfiltration
2) increase in reabsorptive capacity

Front 50

What happens as we age?

Back 50

we naturally loose functional nephron mass

Front 51

Describe the viscious cycle in chronic renal disease?

Back 51

1)Primary kidney disease-->decrease in nephron number
2) decrease in nephron number leads to hypertrophy and vasodilation of surviving nephrons and increase in arterial pressure
3) this leads to increase in glomerular presure and filtration
4) this leads to glomerular secrosis
5) leading to an even more decrease in nephron number

Front 52

Why do patients w/ untreated RF become hyperkalemic?

Back 52

K+ secretion/excretion impaired

Front 53

Why do patients with untreated renal failure become acidotic?

Back 53

bicarb reabsorption/addition is impaired

Front 54

Why do they have protein in their urine?

Back 54

Glomerula filtration barrier breaks down

Front 55

Why do you become anemic when kidneys don't work??

Back 55

Decreased erythropoeitin secretion

Front 56

Why is there a buildup of waste products in blood

Back 56

What is not removed as more nephrons start loosing function

Front 57

What happens to blood pressure

Back 57

there is increaesed renin secretion from the damaged nephrons so angiotensin II incrases and BP increases

Front 58

What happens to plasma osmolarity?

Back 58

loss of kidney's ability to dilute or concentrate urin therefore if high water intake low osmolarity, low water intake high osmolarity