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All of this makes up the urine-forming unit of the kidney - the nephron
Note the Macula densa and Juxtaglomerular cells
“All the cells take in and use nutrients and other substances from their surroundings. Cells of the
intestine and the kidney are specialized to carry out absorption. Cells of the kidney tubules
reabsorb fluids and synthesize proteins. Intestinal epithelial cells reabsorb fluids and synthesize
protein enzymes” (McCance & Huether, pg. 2).
Plasma membrane functions: Protection, barrier to toxic molecules andmacromolecules [proteins, nucleic acid, polysaccharides]”
12. In cirrhosis, how does cholesterol alter the fluidity of the plasma membrane of erythrocytes?
“(1) They form protein channels [gap junctions] that directly coordinate the activities of adjacent
cells; (2) They display plasma membranebound
signaling molecules [receptors] that affect the
cell itself and other cells in direct physical contact; (3) [the most common means] they secretechemicals that signal to cells some distance away
Understand the transportation of potassium and sodium across plasma membranes.
Active transport and the sodiumpotassium
pump. Three Na+ ions bund to sodiumbinding
sites on the carrier’s inner face. At the same time an energycontaining
triphosphate (ATP) molecule produced by the cell’s mitochondria binds to the carrier. The ATP
breaks apart, transferring its stored energy to the carrier. The carrier then changes shape, releases
the three Na+ ions to the outside of the cell, and attracts two K+ ions to its potassiumbinding
sites. The carrier then returns to its original shape, releasing the two K+ions and the remnant of
the ATP molecule to the inside of the cell. The carrier is now ready for another pumping cycle”
All types of cells undergo mitosis during formation of the embryo, but many adult cells, such as
nerve cells, lens cells of the eye, and muscle cells, lost their ability to replicate and divide. The
cells of other tissues, particularly epithelial cells [e.g., of the intestine, lung, skin), divide continuously and rapidly, completing the entire cell cycle in less than 10 hours. - Liver, renal tubular and brains cells do NOT replicate and divide
When normal columnar ciliated epithelial cells of the bronchial lining are replaced by
stratified squamous epithelial cells, the process is called?
Metaplasia, is the reversible replacement of one mature cell by another. The best example of metaplasia is replacement of normal columnar
ciliated epithelial cells of the bronchial [airway] lining by the stratified squamous epithelial cells
The newly formed squamous epithelial cells do not secrete mucus or have cilia,
In hypoxic injury, why does sodium enter the cell and cause swelling?
Lipids (and carbohydrates) can be found throughout the
body but are mainly found in the spleen, liver and CNS. The most common site of
intracellular accumulation of lipids, called fatty change, is in the liver.
Reduced ATP levels cause NaK
pump to fail,
which leads to increased accumulation of sodium and calcium and diffusion of potassium out
of the cell. Calcium salts accumulate in both injured and dead tissues. Or it binds with
phosphate ions. When the phosphate ions react w/ calcium ions, they form deposits of
phosphate carbonate precipitates and crystalline formations of calcium phosphates.
In hypoxic injury, movement of
fluid and ions into the cell is s/t acute failure of metabolism and loss of ATP production.
In metabolic failure caused by hypoxia, reduced ATP and ATPase permits sodium to accumulate
in the cell, whereas potassium diffuses out. Increase in Na increases osmotic pressure, whichdraws more water into the cell.
pressure increases, which draw more water into the cell and causes swelling. Cisternae of
endoplasmic reticulum distend, rupture, and form vacuoles. This leads to extensive
vacuolation, which is called hydropic degeneration (degeneration by water).
Dry - mainly coagulative necrosis from loss of blood supply
Wet - liquefactive component from infection and coagulative necrosis from loss of blood supply
· Infants have a high metabolic rate and increased turnover of body fluids due to greater
body surface area.
· Renal mechanisms may not be mature enough to adapt to fluid regulation & electrolyte
conservation with diarrhea.
· Initial TBW is 7580%,decreases to 67% of TBW by 1 year.
· Low albumin causes decreased plasma oncotic pressure which allows fluid to move into
· Common causes:
Decreased production of plasma proteinliver
disease, protein malnutrition,
nephritic syndrome, open wounds, hemorrhage, burns, cirrhosis
o Increased capillary permeability, typically with inflammatory and immune
response trauma from burns/crushing injuries, neoplastic disease, allergic reactions.
o Blocked lymphatic channel (usually absorb interstitial fluid and some proteins)
from tumor, infection, or surgical removal ? lymphedema.
· Capillary hydrostatic pressure caused by conditions (chf, renal failure, cirrhosis) that lead
to excess sodium and water ? volume overload ? ? venous pressure ? edema.
· Sodium regulated by aldosterones renal effects (from adrenal cortex) and natriuretic
by antidiuretic hormone (ADH, AKAargininevasopressin
from posterior pituitary)
-sodium level > 145 mEq/L
-serum osmo > 295
-most common causes result in inc. [ ] of ECF Na or deficit of ECF water
-causes: deficit of water in relation to Na level
water loss (such as DM, diarrhea, vomiting) leading to cellular dehydration (cell shrink = water pulled out) or ECF Na gain (hypertonicity)
a. strong response from IgM
b. level of protection provided by IgG - page 241
c. memory cells for IgE
d. rapid response from igA
Estrogens generally are associated with a depression of T-cell-dependent immune function and an enhancement of B-cell function.
Norepinephrinestimulates a-adrenergic and b1-adrenergic receptors and some b2-adrenergicreceptors and causes vasoconstriction. Epinephrine stimulates all 4 receptorsand induces general vasodilation because of the predominance of B-adrenergicreceptors in muscle vasculatures. (p 469-470) the metabolic effects of catacholemines promote hyperglycemia through a variety of mechanisms (p. 720)
What is the Syndrome of InappropriateAntidiuretic Hormone? #24
What is therelation of a primary adenoma and thyroid and adrenal hypofunction? #22
HHNKSdiffers from DKA in the degree of insulin deficiency (which is more profound inDKA) and the degree of fluid deficiency (which is more marked in HHNKS). Levels of free fatty acids in HHNKS areconsistently lower than those found in DKA. Neurologic changes, such as stupor, correlate with the degree ofhyperosmolarity and are more common in HHNKS than in DKA. Dehydration in HHNKS is far more severe thanthat in DKA. (p. 758)
An autoimmune disease that resultsin stimulation of the thyroid gland and results in hyper thyroidism. Genetic factors and environmental triggers play an important role in the pathogenesis Triggers for the onsetsymptoms include:Stressful life events; childbirth; and infection. A multisystem syndrome consisting of one of the following, hyperthyroidism, diffuse thyroid enlargement (goiter), Opthalmopathy, dermopathy (p. 736)
Corpusluteum cysts: Developsbecause of a hormonal imbalance in low LH and progesterone levels causing aninadequate development of the corpus luteum.
Dull pelvicpain, amenorrhea, or delayed menstruation, followed by irregular or heavierthan usual bleeding. If Rupture occursit can cause massive bleeding and severe pain, immediate surgery may berequired.BCP may prevent further cyst from forming (p. 837)
·Dermoidcysts: ovarian teratomas that contain elements of all three germlayers; common ovarian neoplasms. May contain maturing tissue including: skin,hair, muscle fibers, cartilage, bone, sebaceous and sweat glands. Usuallyasymptomatic and found on pelvic exam. Have malignant potential and should be removed. p.837
Endometrialpolyps: Benign mass of endometrial tissue Common cause of intermenstrual or excessive menstrualbleeding. Malignancy is rare. (p. 837)
·Endometrialcancer: Most common cause of cancer in the pelvic region in women.Peak incidence occurs in 50’s, white women. However, higher mortality inAfrican American women, almost twice a high. Treatment is based on the extentof the disease. (p. 845)
·Uterinesarcoma: rare neoplasm arising from the myometrial smooth muscle,endometrial stoma, and more rarely ubiquitous connective tissue elements. Fewwomen survive advance-stage disease. (p. 846)
·Leiomyomas: Commonlycalled uterine fibroids
Benign tumors of smooth muscle cells in the myometrium. Cause abnormal uterine bleeding, pain, and symptomsrelated to pressure on nearby structures. Prevalence increases over the age of30 to 50 and decreases at menopause.(p. 837)
Adenomyosis:Islands of endometrial glands surrounded by benign endometrialstroma within the myometrium.(p.839)
Lessthan 35mg/dl in newborns for the first 48 hours and less than 45-60 mg/dl inchildren and adults.Can be an acute complication ofdiabetes mellitus.Most often caused by insulinoverdose; may be combined with inadequate food intake, usually increasedexercise, decrease in insulin requirement, or potentiating medications. Sx adregenic tachycardia, palpitations, diaphoresis, tremors, pallor. neuro- HA, dizzy, confusion, fatigue, hunger, sz, coma. Tx is glucose (p. 754-755)
-Excessive blood glucose levels dueto insulin resistance, inadequate insulin secretion, or glucose intolerance. Before hyperglycemia occurs, 80%to 90% of the function of the insulin-secreting beta cells in the islet ofLangerhans. Most commonly cause by aninteraction of genetic and environmental factors. Sx type 1 polydypsia, polyuria, wt loss and fatigue Type 2 add infection, pruritis, visual changes and neuropathy. Tx includes insulin, po agents, lifestyle modifications (p. 745-755)
infection istransmitted from mother to infant through the infected birth canal “likegonorrhea” (60-70% transmission rate). Leading cause of tubal infertility inwomen.(p. 935)
What is the primary function of the kidney?
The primary function of the kidney is to maintain a stable internal environment for optimal cell and tissue metabolism
The kidneys also have an endocrine function, what do they secrete?
What do each do?
Renin - regulation of bp
Erythropoitin - for erythrocyte production1,25-dihydroxy-vitamin D3 - for calcium metabolism
What can the kidneys synthesize from Amino Acids? and how
What is the renal capsule?
How is the kidney attached to the posterior abdominal wall?
What is the hilum?
What makes up the calyces? What do they form?
The ______ is the functional unit of the kidney. What is its major function?
The major function of the nephron is urine formation....it is called the "functional unit" bc this is where excretion of waste and maintenance of water actually happen
The nephron is a tubular structure made up of what, and what do they all contribute to?
Composed of the glomerulus, proximal convoluted tubule, hairpin loops of Henle, distal convoluted tubule, and collecting duct, which all contribute to the formation of urine
what is the urine forming unit of the kidney?
Where is the glomerulus?
What lies between and supports the glomerular capillaries?
Together the Bowman capsule, the glomerulus, and mesangial cells make up what?
The renal corpuscle
The primary urine
Each of the three layers has unique structural properties that allow all components of blood to be filtered, with what exceptions?
Blood cells and plasma proteins with a MW > 70,000
these help regulate glomerular blood flow
The outer layer, visceral epithelium of the bowmans capsule is composed of what type of cells?
Composed of podocytes (foot-like processes) that interlock to provide filtration slits
How do the podocytes work?
The endothelium, basement membrane, and podocytes are covered with protein molecules bearing anionic (negative) charges, why is that?
The negative charges retard the filtration of anionic proteins and prevent proteinuria
How is the glomerulus supplied and drained?
What specialized cells are located around the afferent arteriole where the afferent arteriole enters the glomerulus?
What is the Macula densa?
Together the Juxtaglomerular cells and Mucula densa form what?
What does it control?
They together form the Juxtaglomerular apparatus
The macula densa are cells in the juxtaglomerular apparatus that detect which solute concentration?
Na+ and Cl–
by the renal tubules....What makes up the renal tubules?
What is unique about the proximal convoluted tubule?
Why is this important
The proximal convoluted tubule joins what?
What does the distal convoluted tubule connect?
What 2 types of endothelial cells is the collecting duct composed of? and what are their functions?
How do we maintain acid/base balance within the kidney?
The ureters extend from the renal pelvis to what?
The ureters extend from the renal pelvis to the posterior wall of the bladder.
How does urine flow through the ureters?
What happens during micturition?
What is the bladder composed of?
The bladder is a bag composed of the detrusor and trigone muscles and innervated by parasympathetic fibers.
What stimulates the micturition reflex?
When accumulation of urine reaches 250 to 300 mL, mechanoreceptors, which respond to stretching of tissue, stimulate the micturition reflex.
The spinal reflux are is also known as what
The micturition arc
(When the bladder has 250-300 ml of urine the internal urethral sphincter relaxes through activation of the spinal reflex arc)
How long is the urethra in females?
Which artery supplies the kidney with blood?
and how much of the cardiac output is this?
How do the Afferent arterioles subdivide
How much renal blood flows through a minute?
Renal blood flows at about 1000 to 1200 mL/min, or 20% to 25% of the cardiac output
What is GFR?
The filtration of plasma per unit of time is known as the glomerular filtration rate (GFR), which is directly r/t the perfusion pressure in the glomerular capillaries
If 20% is filtered at the glomerulus, what happens to the remaining 80%?
Flows through the efferent arterioles to the peritubular capillaries
Blood flow through the glomerular capillaries is maintained at a constant rate in spite of a wide range of arterial pressures, what is this called?
Give an example of how the afferent arterioles of the kidney performs their local autoregulation
As systemic bp increases, the afferent arterioles constrict, preventing an increase in filtration pressure.
This is why the GFR stays pretty consistent when arterial pressure is between 90 - 180 mmHg
RBF and GFR have what type of relationship?
They are constant, are directly related to each other
How are the blood vessels of the kidney innervated?
What is going on with the baroreceptor reflex?
Where is renin secreted from?
Renin is an enzyme secreted from the juxtaglomerular apparatus
What happens when Renin is secreted?
It causes the generation of angiotensin I, which is converted to angiotensin II by the action of ACE. Angiotensin II is a potent vasoconstrictor and also stimulates the release of aldosterone from the adrenal cortex. Thus, the renin-angiotensin-aldosterone system is a regulator of renal blood flow and blood pressure.
Natriuretic peptides promote sodium and water loss by??
The major function of the kidney is urine formation, the nephron is composed of which three processes involved in urine formation?
What is glomerular filtration favored by and opposed by?
Glomerular filtration is favored by capillary hydrostatic pressure and opposed by oncotic pressure in the capillary and hydrostatic pressure in the Bowman capsule. The balance of favoring and opposing filtration forces is the net filtration pressure (NFP).
At the glomerulus what is filtered out of the blood?
This is active transport, from the PCT into the peritubular capillaries.
Water reabsorption as well, but this occurs by osmosis
Secretion occurs in the DCT, by what and whats secreted?
occurs from peritubular capillaries into DCT by active transport
What is the total volume of fluid by the glomeruli per minute?
about 120 ml/minute
How much of the filtrate is reabsorbed?
How does tubular transport occur?
What is the primary function of the proximal convoluted terminal?
Reabsorption of sodium from the PCT to the peritubular capillaries
What causes the increased concentration of urea in the tubular lumen?
The reabsorption of water into the peritubular capillaries
What is the loop of Henle's role?
By the time the filtrate reaches the end of the PCT, what has occurred?
What is Tm?
What the collecting duct permeable to and controlled by?
Permeable to water, controlled by ADH.
The countercurrent exchange system of the long loops of Henle and their accompanying capillaries establishes a concentration gradient within the renal medulla to facilitate the reabsorption of water from the collecting duct.
How does the distal nephron regulate acid-base balance?
What does the adrenal medulla secrete?
The catecholamines, epi and norepi
(Renalase is hormone produced by the kidney that degrades catecholamines and regulates bp)
1. Maintains constant internal environment.
Radiation, conduction, convection, vasodilation, decreased muscle tone, evaporation, increased ventilation, voluntary mechani
9 methods of heat loss.
Right marginal branch
Posterior descending branch-
Phase 1 of Cardiac Cycle
Secondary polycythemia- caused by increased erythropoietin from chronic hypoxia. (high altitudes, smoking, COPD, etc).
- Most common type of congenital heart lesion
- Systolic ejection murmur at right upper sternal border