College aantekeningen
College aantekeningen Kidney: from bench to bedside (BM079)
College aantekeningen kidney: from bench to bedside
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Voorbeeld 4 van de 81 pagina's
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Kidney: Bench to BedsideLecture 1 – Introduction
The kidney
1500 L of blood is passing through the kidney every day.
We have 5 litres of blood. That results in the formation of
180 L of filtrate. If then nothing would happen, we would
spend the whole day at the toilet, so luckily most of that is
reabsorbed along the kidney tubule and in the end we
have an urine production of 1.5 L a day. It costs a lot of
energy to reabsorb all the ions and other molecules. The
kidney one of the most energy consuming organs in the
body. But it allows this constant reabsorption and filtration
to tightly regulate the amount of sodium, calcium,
magnesium or other ions in the blood. This is important
for the regulation of blood pressure, but also the calcium
balance.
The kidney works like if you are cleaning your house. You first put everything outside, and
then you decide what you take back. You take back 99% of everything, but a few things you
will throw away.
How do the kidneys work?
This is all the processes where the kidney plays an
important role. Blood pressure (cardiac system),
there are many hormones that regulate the
reabsorption. The angiotensin-aldosterone system
and the vasopressin are the most well-known. The
kidney itself is also producing hormones, i.e. epo,
active vitamin D. It plays a role in many processes.
What if your kidneys don’t work? Dialysis is one
option. Peritoneal dialysis or hemodyalsis. The
classis dialysis is the hemodyalsis, you’re three
times a week in the hospital for 4 hours. The blood
gets filtered in a machine outside of the body, then
you get rid of all your waste products. Peritoneal
dialysis is over night at home. The dialysis fluid is
pumped into your peritoneal space and then the
peritoneal is used to filter the blood itself. This takes much longer so you have to do it all
night. The advantage is that you can do it at home. Peritoneal dialysis has more risks of
infections.
Kidney research
What type of kidney research is now done in the world? We will discuss a lot of these
research. In the last part of the course we will make a research proposal in groups.
,Part 1: Kidney physiology
• Basic renal anatomy (computer training)
• Function of the glomerulus & the nephron
• Volume & osmoregulation
Quiz - Kidney: Bench to Bedside
Question 1
In which part of the kidney glomeruli can be detected?
- Cortex
- Medulla
- Major Calix
- Pelvis
Question 2
Which of the following is absent in urine of healthy individuals?
- Sodium
- Glucose
- Ureum
- Potassium
All glucose is reabsorbed in the proximal tubule (first part). In diabetes there is too much
glucose in the blood and the proximal tubule doesn’t have sufficient capacity to reabsorb
everything. Once it has passed the proximal tubule there are no glucose channels anymore
in the kidney tubule so then it gets in the urine.
Question 3
Which of the following segments is involved in the tubule-glomerular feedback system?
- Proximal tubule
- Macula densa
- Collecting duct
- Loop of Henle
The macula densa cells measure the amount of solvents which is present in the preurine
when the tubule gets back to the glomerulus and then it determines whether hormones
should be released but it also gives feedback to the pressure in the glomerulus to make sure
that we always have a constant flow of preurine. If the blood pressure rises, then you will
have more filtration due to the higher pressure on the glomerulus, so more fluid and solvents
will end up in the pre urine. To compensate for that you get feedback to the glomerulus and
the two arteries that regulate the pressure in the glomerulus will act and the pressure will be
released to keep it constant. This system makes sure that the filtration of the kidney is
independent of the blood pressure.
Question 4
What is the charge of the glomerular basement membrane?
- Negative
- Neutral
- Positive
,This is important because almost all of the proteins are negatively charged. By having a
filtration barrier that is also negatively charged, it will repulse the proteins and therefore you
do not filtrate all the proteins. Only small proteins get filtrated.
Question 5
Which of the following renal disease is characterized by the presence of red blood cells in
the urine?
- Nephritis
- Nephrotic syndrome
- Minimal change disease
- Acute kidney injury
In nephritis you have a chronic inflammation in the glomerulus. It disrupts the endothelial
barrier and therefore you also get red blood cells in the urine.
Question 6
Which of he following substances increases the oncotic pressure in the glomerulus?
- Sodium
- Potassium
- Glucose
- Albumin
Oncotic pressure is the pressure that is dependent on the concentration of molecules within
the glomerulus and the space of Bowman. This is the attraction of fluid because of a higher
concentration of molecules in the blood vessels. Albumin is not filtered in the glomerulus, so
it remains in the blood so it keeps on attracting water, whereas sodium, potassium and
glucose are filtered.
Question 7
The renal handling of which substance is essential for volume regulation?
- Potassium
- Glucose
- Sodium
- Water
Volume is the amount of water in the body. The blood pressure depends also on the vascular
resistance. The volume is not dependent by the regulation of water but sodium because
sodium will attract the water. The amount of sodium will determine how much water is there.
Question 8
Where are the baroreceptors located?
- Carotid sinus
- Hypothalamus
- Juxtaglomerular apparatus
- Adrenal gland
The pressure and volume are sensed by baroreceptors. Your carotids are in several places
but mainly in your aorta.
Question 9
What happens to the volume of the intracellular and extracellular fluid compartments during
an isotonic infusion?
, - ICF and ECF remain the same
- ICF volume increases, ECF volume remains the same
- ICF volume remains the same, ECF volume increases
- ICF and ECF volume increases
The extracellular fluid increases after an infusion, because you put more fluid. It is isotonic,
then it will not change the intracellular fluid because the osmolarity will stay the same so
there will be no water transport between these two compartments. An infusion in the hospital
should always be isotonic because otherwise you would change the volume of your cells and
you don’t’want that.
Question 10
which of the following diuretics is considered potassium-sparing?
- Acetazolemide
- Thiazide
- Furosemide
- Amiloride
This has to do with the potassium reabsorption in the collecting duct. If you reabsorb sodium,
then you secrete potassium. If you block this system with amiloride this transport is stopped,
so you keep the potassium in the body rather than secreting it.
Question 11
Insulin results in the cellular uptake of which ion?
- Sodium
- Potassium
- Calcium
- Chloride
Insulin also regulates sodium uptake in the kidney, but when we speak about cellular uptake,
then potassium is the right answer. Potassium is directly reabsorbed in cells as soon as
insulin is released. This is important because if this is not the case then a banana will kill
you. A banana has a lot of potassium. If you eat a banana, insulin will get up. If you reabsorb
the potassium from the banana it is immediately taken up into the cells. The normal
concentration of sodium in the blood is high (40 mM), potassium is low (5 mM). You can
imagine that to keep this potassium low it is important that you immediately reabsorb that
into cells. To keep the normal concentration stable is important for action potentials, for
muscle function, it determines your membrane potential.
Question 12
What is the function of Henle’s loop?
- Urine concentration
- Production of hormones
- Protein reabsorption
- Regulation of the GFR
It determines the urine concentration indirectly because it creates the gradient of osmolarity
towards the medulla, that increases.
Question 13
Which of the following hormones regulates the osmolarity of the blood?
- Aldosterone
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