Renal

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Anonymous
ID:
123295
Filename:
Renal
Updated:
2011-12-12 23:43:14
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Renal
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Renal
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  1. Mictrurition Reflex

    Filling vs. Voiding
    • Filling:
    • Stretch receptors - monitor volume
    • Afferent fibers - send info to PMC
    • SNS - stimulate internal sphincter
    • PSNS - inactive

    • Voiding:
    • PSNS - stimulate detrusor muscle
    • SNS - inactive
    • Pudendal - reduce activity to external sphincter
  2. Mictrurition Nerves
    • Detrusor muscle (PSNS - S2,3)
    • External sphincter (pudendal n. - S2,3)
    • Internal sphincter (SNS L2)
  3. Origins of the bladder
    • majority - endoderm (urogenital sinus)
    • trigone - mesoderm (mesonephros)
  4. 3 kidney system and derivatives?
    • pronephric - vestigial nephrotomes
    • mesonephric - nephrogenic cords & mesonephric duct (ureteric bud in metanephros)
    • metanephric - metanephric blastoma
  5. Origin of collecting system & excretory unit?
    • Collecting system (CT --> ureter): ureteric bud - mesonephros
    • Excretory unit (BC --> DCT): metanephros
  6. Wt1
    transcription factor on mesenchyme responds to induction by uteric bud
  7. Bladder & Urethra development
    • Wk 4-7: cloaca divided by urorectal system (ant-1o urogenital sinus & post-rectal canal)
    • Wk 8: perineal body
    • 3 mo: urethra outgrowths
  8. Wilm's Tumor
    Wt1 mutation
  9. WAGR Syndrome
    • Wilm's tumor
    • Anidiria
    • Genitourinary anomalies
    • Retardation
    • 11p deletion
  10. Potter's Sequence
    • apical appearance - oligohydramnios
    • anuria
    • lack of kidney
    • hypoplastic lungs
  11. Exstrophy of bladder & cloaca
    ventral wall body defect associated w/epispadias
  12. Freely filtered substance?
    Completely reabsorbed?
    Completely secreted?
    • Freely filtered substance: inulin or creatinine
    • Completely reabsorbed: glucose
    • Completely secreted: PAH
  13. Hereditary nephrotic syndrome
    • heavy proteinuria & renal failure
    • mutations in NPHS1 (nephrin) & NPHS2 (podocin)
  14. Nephrotic disease
    • severe proteinuria
    • severe edema
    • NO change in GFR
    • normal urine volume
    • Affects PODOCYTES - impacts composition of filtrate
  15. Nephritic Disease
    • mild proteinuria
    • mild edema
    • decreased GFR
    • oliguria
    • HEMATURIA
    • Affects CAPILLARY endothelial integrity & diameter - impacts GFR
  16. Ultra filtration Pressure
    Pgc - Pbs - Ogc = Net ultra filtration pressure

    absorption: Ogc> Pgc
  17. Transporters in Proximal Tubule & Special Feature
    • 1st half:
    • Na/X symporter
    • Na/H antiporter
    • Na/K pump

    • 2nd half:
    • Na/H antiporter
    • Na/K pump
    • Base/Cl antiporter
    • Ion reabsorption

    Special Feature: secretion of H+, NH3, organic cations & anions
  18. Transporters in Thick Ascending limb & special feature of Loop of Henle
    • Na/2Cl/K co transporter
    • K leak channels
    • Na/H exchanger
    • Na/K pump
    • Paracellular ion reabsorption

    Special Feature: descending limb - hypotonic, ascending limb - hypertonic
  19. Transporters of DCT & special feature
    • Na/Cl symporter
    • ENaC
    • Na/K pump
    • Special Feature:
    • K+ secretion (light/principal cells)
    • H+ secretion & HCO3- reabsorption (dark//intercalated cells)
  20. Transporters of Collecting duct & Special Feature
    • ENaCNa/K pump
    • Special Feature:
    • K+ secretion (light/principal cells)
    • H+ secretion & HCO3- reabsorption (dark//intercalated cells)
    • Aldosterone (inc. Na reabsorption & K secretion)
    • ADH (inc. H2) permeability)
    • ANP
  21. Ion Reabsorption:
    Ca2+
    Mg2+
    PO4
    • Ca2+: para (PT & TAL), trans (PT* & DT)
    • Mg2+: para (PT & TAL*), trans (DCT)
    • PO4: trans (PT - SLC34A)
  22. Urea reabsorption in PCT, loop of Henle & Collecting duct - transporters
    • PCT: reabsorbed - passive diffusion & solvent drag
    • Loop of Henle: secreted - UT2
    • Collecting duct: reabsorbed - UT1 & UT4 (ADH regulated)
  23. Diuresis vs. Antidiuresis
    • Diuresis: high volume, hypotonic (-ADH)
    • Antidiuresis: low volume, hypertonic (+ADH)
  24. ADH effect determined by plasma osmotic pressure:
    hypovolemic
    hypervolemic
    • hypovolemic: enhanced response
    • hypervolemic: dampened response
  25. Controls of Na excretion
    • fractional Na excretion
    • RAAS
    • SNS
    • ADH
    • ANF
  26. Renal Effects of Angiotensin II
    • stronger effect on efferent arteriole
    • inc. GFR dec. RPF
    • inc. proximal Na reabsorption
    • +
    • dec. blood flow of vasa recta
    • inc. loop Na reabsorption
    • = dec. Na excretion & H2O excretion
  27. Effects of Aldosterone
    normally
    excessively
    • Normal:
    • increased Na reabsorption & K secretion
    • Excess:
    • Na retention (hypervolemia, hypertension, edema)
    • K wasting (weak muscles, ECG changes, constipation)
    • H wasting (alkalosis-tetany, cramps)

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