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NURS 5315: Advanced Patho Exam 5|Latest Update Graded A+

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NURS 5315: Advanced Patho Exam 5|Latest Update
Graded A+
What are the key functions of the kidneys?
Excretion of metabolic waste.
Regulation of water and electrolyte balance
Regulation of arterial BP
Erythrocyte production
1, 25 -dihyydroxy vitamin production (calcitriol)
Gluconeogenesis

What metabolic waste do the kidneys excrete?
Urea
Creatinine
Bilirubin
Drugs
Hormone metabolites

How do the kidneys regulate arterial blood pressure?
RAAS

The renin-angiotensin-aldosterone system (RAAS) is a critical regulator of blood volume, electrolyte
balance, and systemic vascular resistance.

How do the kidneys regulate acid base balance?
Exertion of H+ ions and reabsorption of sodium bicarb.

How does blood flow into and out of the kidneys?
In through the renal artery.
i. Interlobal artery.
ii. Arcuate arteries.
iii. Capillary beds
Out through the renal vein

Renal capillary beds.
1. Afferent (glomerular capillaries)
a. filtration
2. Efferent (peritubal capillaries)
a. Water, electrolytes, substances exchanged between blood and filtrate making urine.
b. Vasa recta (long efferent arterioles-extend through medullar glomerulus to form the
juxtaglomerular cells)
i. Regulate urine and serum concentration and volume.
ii. Reabsorb filtrate to return to systemic circulation.

How does filtrate and urine move through the kidney?
1. Bowmans capsule
2. Proximal tubule
3. Loop of Henle
a. Descending (thin)
b. Ascending (thick)

,4. Macula densa
5. Distal tubule
6. Collecting tubule
a.) 8-10 collecting tubules combine to form
7. Medullary collecting tubule
8. Collecting duct.
9. Renal pelvis

What are the components of a nephron?
Glomerulus: glomerular capillaries
a.) Fluid is filtered from the blood to form filtrate which enters the tubule
b.) Tubule where filtrate is processed into urine.

What are the two types of nephron?
1. Cortical: glomerulus in the outer cortex and tubules that are superficial in the medulla
2. Juxtaglomerular: deep in the cortex with tubes deep in the medulla (vasa recta is here-determine
urine concentration)

What contributes to the glomerular filtration rate?
1. Hydrostatic pressure
2. Colloid oncotic pressure
3. Equals net filtration pressure

Urine is formed as a result of ___________.
Tubular processing of filtrate.
a. Glomerular filtration
b. Reabsorption of substances from the renal tubules into the blood.
c. Excretion of substances from the blood into the renal tubules.

What are the structures of the glomerular membrane?
Endothelium
Basement membrane
Podocyte

What is the structure of the endothelium (fenestrae)?
(Glomerular membrane)
Regulates vasomotor tone, homeostasis and trafficking of leukocytes.

What is the function of the basement membrane (collagen & proteoglycan)
(Glomerular membrane)
Scaffold supporting the function of the endothelium and podocytes (problems with the basement
membrane result in albumin leaking into filtrate)

What is the function of the Podocyte (filtration slits/slit membranes)? (Glomerular membrane)
The slits serve as a barrier between the foot process to prevent leaking of albumin into the filtrate.

How can GFR be manipulated?
Increase or decrease GFR.

, What is the big idea and mechanism for increasing GFR?
Big idea:
Hormones and autocoids: local angiotension II.
Mechanism: Constricts efferent arterioles; increased blood flow; increased GFR.

Big idea: Nitric oxide, prostaglandins. bradykinin
Mechanism: Dilate afferent artioarterioles; increased blood flow; increased GFR.

What is the big idea and mechanism for decreasing GFR?
Big idea: SNS: Norepinephrine and Epinephrine (adrenal medulla)
Mechanism: Constricts afferent arterioles, decreases blood flow, decreased GFR.

Big idea: Hormones: endo-thelin (vascular endothelium)
Mechanism: Constricts afferent arterioles, decreased blood flow, decreased GFR.

What happens in the proximal tubule?
Sodium, Chloride, Phosphourous, sodium bicarbonate, glucose, amino acids, are reabsorbed. Very
water permeable.

Hydrogen, organic acids, organic bases (metabolic by products, bile salts, uric acid, catecholamines)
are secreted.

Controlled by: Angiotensin II (increased sodium and H20 absorption) PTH (decreased Phosphorous
reabsorption).

What happens in the thin descending loop of Henle?
Small amounts of sodium are reabsorbed. Highly water permeable.

What happens in the thin ascending loop of Henle?
Dilutes filtrate. Highly water permeable.

What happens in the thick ascending loop of Henle?
Sodium, chloride, potassium, calcium, magnesium, bicarb, are reabsorbed. Impermeable to water;
dilutes filtrate.

Hydrogen ions are secreted here.

Controlled by angiotensin II (NaCl reabsorption/H+ secretion) Parathyroid hormone (calcium
reabsorption)

What happens in the collecting tubules?
Sodium, chloride, calcium, bicarb are reabsorbed here. Permeable to water. Antidiuretic hormone
requires.

Potassium, hydrogen, and urea are secreted here.

Controlled by aldosterone (increased NaCl and K secretion) Vasopressin/ADH (increased H20
reabsorption); ANP (decreased Na reabsorption).

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