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diffusion is _______ process where solutes move across a permeable membrane from _____ concentration to ______ concentration

passive ; higher ; lower

osmosis describes the movement of this

water

water moves from an area of ______ solute concentration to _____ solute concentration

lower ; higher

most solutes in body fluids are

electrolytes
Na+ K+ Cl-

formed elements in the blood

RBCs
WBCs
platelets

a large plasma protein

albumin

Average male GFR

125 ml/min

Average female GFR

105 ml/min

if GFR is too high

useful substances excreted in the urine

if GFR is too low

certain waste products may not be adequately excreted

when does the process of reabsorption begin

when the filtrate enters the renal tubules

where does most reabsorption occur

proximal nephron

where does fine tuning of fluid and electrolytes occur

distal nephron

destiny of most peritubular secretions

excreted in urine

renal tubules consist of

single epithelial cell layer
peritubular capillaries /vesa recta single endothelial cell layer

single cell layer of membranes

enhances solute transport

most important mechanism for solute exchange between the blood and interstial fluid

diffusion

transport mechanism for large lipid-insoluble molecules

transcytosis

transcytosis uses these to enter endothelial cells

pinocytic vesicles

bulk flow descibes the passive movement of

large numbers of ions

bulk flow occurs from ____ pressure to ____ pressure

high to low

these cells secrete ANP

cardiac myocytes (right atrium)

ANP is released in response to

increased blood volume

ANP ____afferent arterioles

dialates

ANP _____ efferent arteriole

contricts

when GBHP increses

GFR increases

an increased GFR _____ Na+ and water excretion

increase

an increased GFR ____ blood volume

decreases

angiotensin II is a very potent

systemic vasoconstrictor

angiotensin II ______ glomerular mesangial cells

contracts

DLOH is impermiable to

Na+

DLOH plays a role in

urine concentration

in early DCT ______ is transported into tubule cells

Na+ and Cl-

blood hydrostatic pressure BHP

pressure generated by the pumping action of the heart

interstitial fluid osmotic pressure IFOP

pressure exerted by the presence of small proteins in interstitial fluid

IFOP is usually

low ~1mmHg

which pressures promote filtration

BHP & IFOP

which pressures promote reabsoption

BCOP & IFHP

blood colloid osmotic pressure BCOP

pressure exerted by colloidal suspension of large plasma proteins

interstitial fluid hydrostatic pressure IFHP

normally very low

IFHP is usually

very low ~0mmHg

net filtration pressure NFP

the balance of all 4 pressures that determines if the blood volume and interstitial fluid changes or remains steady

calculate NFP

(BHP + IFOP) - (BCOP + IFHP)
Ffiltration reabsorption

Starling's law of the capillaries

explains the near equilibrium between the fluid and solutes in the plasma and the interstitial fluid

in normal bulk flow _______ of the fluid filtered out of the capillaries at the arteriolar end is reabsorbed into the venule end

most (85%)

20 liters of fluid is filtered and ____ is reabsorbed

17 L

where does the excess filterd fluid within the interstital (3L) go

enters the lymphatic capillaries and returned to blood circulation (via thoracic duct)

dehydration

body water loss > body water gain

decrease in body water volume will

decrease arterial blood pressure

if arterial blood pressure decreases what is activated

RAAS renin-angiotensin-aldosterone-system

an increase in body water osmolarity is detected in

osmoreceptors in the hypothalamus

what stimulates thirst

hypothalamus osmoreceptors

the main factor determining body fluid volume

urinary NaCl loss

the main factor determining body fluid osmolarity

urinary water loss

kidney functions

reg blood pH
reg fluid/electrolyte balance: bp & blood volume
excretion of metabolic waste products
hormone production (renin, erythropoietin)
vitD (calcitriol) production for Ca homeostasis
ammoniagenesis (increases when acidotic-help H+ buffering)
gluconeogenesis

where are the kidneys located

retroperitoneal

what ribs protect the kidneys

11th & 12th

which kidney is more superior?

the left kidney

which kidney is more inferior? why

the right kidney b/c of the liver

what is the function of the renal hilum

blood, lymph vessels, ureters, and nerves enter/exit here

if you decrease the GFR, you get

sodium reabsorption

an increase in sodium reabsorption leads to

an increase in blood volume

where does renin come from

JG cells

if it comes out of JG cells it goes to

afferent arterioles

what makes up the JG apparatus

JG cell + macula densa cells

is angiotensin I or II a greater vasoconstrictor

II > I

in the DCT aldosterone stimulates _______ retention

sodium and water

in the DCTaldosterone stimulates ______ secretion

potassium and hydrogen (ions)

where does ANP come from

cardiac myocytes

ANP opposes the actions of

angiotensin II

ANP leads to an increase in

GFR

when GFR increases sodium reabsorption ____

is inhibited

natriuresis and diuresis leads to

decreased ECF volume

where does urodilantin come from; where is it secreted

renal tubules

what is urodilantin

a naturietic peptide related to ANP

what does urodilantin do

decreases sodium reabsorption in the collecting ducts

when do HCO3/Cl antiporters function

only during alkalosis

what cells have the ability to secrete HCO3 into the filtrate during alkalosis

beta intercalated cells

what cells secrete H+

alpha intercalated cells

Na+ - (Cl- + HCO3-)

anion gap

anion gap is used to differentiate between

uncompensated metabolic acidosis caused by acid gain or bicaeb loss

where does bicarb loss commonly occur

lower GI tract

every time you loss bicarb, what do you gain

chloride

the renal fascia is

the most superficial layer surrounding the kidney

what does the renal fascia do

anchors the kidney to the abdominal wall & surrounding structure

what hormones does the kidney make

renin
erythropoetin
calcitrol

where is the adipose capsule

deep to the renal fascia

what does the adipose capsule do

its a fatty tissue layed that protects and firmly holds the kidney in place

what is the deepest layer surrounding the kidney

renal capsule

what does the renal capsule do

maintains the shape of the kidney & serves as a barrier against trauma

external kidney tissue layers deepest to most superficial

renal capsule, adipose capsule, renal fascia

external kidney tissue layers superficial to deep

renal fascia, adipose capsule, renal capsule

the kidneys are innervated by ______ division nerve fibers

sympathetic

renal nerves are mostly ______ nerve

vasomotor

what is the main function of renal nerves

regulate blood flow through the kidneys

_____ mechanisms insure adequate blood flow & glomerular filtration during resting/tonic SNS input

intrarenal

resting GFR must increase efferent arterioles will ______ while afferent arteriole _______

constrict ; vasodialte

internal anatomy of the kidney

cortex, medulla, renal lobes, minor calyces, major calyces, renal pelvis, renal sinuses, nephrons

where is the renal cortex

renal capsule to the base of the pyramids

the cortex between the pyramids is know as

renal columns

how many renal pyramids make up the medulla

8-18

the apex of the pyramids is also known as

renal papilla

what does the base of each pyramid contact

the cortex

what makes up a renal lobe

single pyramid
overlying area of renal cortex
1/2 of each adjacent renal column

what does the minor calyces do

receives urine from the papillary ducts of 1 renal papilla and delivers it to a major calyces

what does the major calyces do

recieves urine from the minor calyces

how many major calyces does each kidney have

2-3

the renal pelvis

receives urine from the major calyces

the ureter

transports urine from the renal pelvis top the bladder

3 anatomical regions of the male urethra

prostatic
membranous
spongy (penile)

the male urethra passes through

the prostate
deep perineal muscles
penis

length of the male urethra

~8"

length of female urethra

~1.5"

where is the female external urtheral orifice

between the clitoris and vaginal opening

what is the urethra

a small tube leading leading from the internal urethral sphincter (in the bladder floor) to the outside
for the discharge of urine

micturition

urination or voiding

where is the micturition reflex center

sacral spinal cord

what action does the parasympathetic nervous system (ACh) have on the bladder

contration of the detrusor and relaxtion of the sphincter

how much urine volume in the bladder is required to stimulate the stretch receptors

~200-400mL

which comes 1st bladder filling or the micturition reflex

bladder filling, it causes a sensation of fullness that initiates a conscious desire to to urinate (before micturition reflex occurs)

tissue layers of the ureters, deepest to superficial

mucosa, muscularis, adventitia

tissue layers of the ureters superficial to deep

adventitia, muscularis, mucosa

what do the ureters have at the distal (1/3) end

extra layer of longitudinal muscle fibers

why do the ureters have a muscular layer

peristatlsis

the mucosa layer of the ureters is made up of

goblet cells

what is the function of ureteral goblet cells

secrete mucoius to protect the epithelial cells from acidic urine

what is the function of the ureteral adventitia

anchor the ureters in place in the abdominal cavity

where is the urinary bladder in males

anterior to the rectum

where is the urinary bladder in females

anterior to the vagina and inferior to the uterus

what holds the bladder in place

peritoneal folds

trigone

small triangular area in the bladder floor
posterior corners - urteral ostia
anterior - internal urethral orifice

generally where does the unrinary bladder

pelvic cavity posterior to the pubic symphysis

wall layers of the bladder deep to superficial

mucosa, detrusor muscle, adventitia (posterior/inferior) and serosa (superior)

wall layers of the bladder superficial to deep

serosa (superior, adventitia (posterior/inferior), detrusor muscle, mucosa

what is the external sphincter muscle made of

voluntary skeletal muscle

the internal urethral sphincter is made of

circular detrusor muscle fibers

where is the internal urethral sphincter

surrounding the opening to the urethra

where is the external sphincter muscle

inferior to the internal urethral sphincter

trace the flow of urine

nephrones, collecting ducts, papillary duct, minor calyx, major calyx, renal pelvis, ureter, bladder, urethra

what valve prevents backflow from the bladder to the ureters

there is no anatomical valves at the junction

how does urine move through the ureters to the bladder

peristaltic waves

how do the ureters enter the bladder

posteriorly at an oblique angle

cystitis

bladder infection

pyelonephritis

kidney infection

what prevents the back flow of urine from the bladder into the ureters

physiological valves

normal urine pH

4.4 - 8.0

the average range for urine pH

5.5 - 6.5

this pH is observed in a pt w/ SEVERE metabolic acidosis

4.4

what would you use to evalute a pts acid-base balance

pH
PCO2
HCO3-

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