Urine Luck!
Renal slidesby
Dan CushmanDonations accepted and strongly encouraged
Renal pelvis
Renal vein
Cortex
Interlobar artery
Renalartery
divides intoanterior and
posterior branches.Medulla
Ureter
Lobe
Kidney parasiteParasitium nephrotium
(Just kidding, of course, it’s a nephron)
VesselsName the arteries of the kidney from largest to smallest
1. Renal Artery2. Interlobar artery
3. Arcuate artery4. Interlobular artery
5. Afferent arteriole6. Efferent arteriole
Kidney vessels Renalcorpuscles
Arcuate vessels
Interlobar vessels
Cortex
Medulla
Interlobular vessels
X10
Nephron segments
Cortex
Medulla
Proximal straight tubule
Distal convoluted tubule
Descending limb of HenleThin Ascending limb of Henle
Collecting duct
Proximal convoluted tubule
Thick Ascending limb of Henle
Renal corpuscle
Afferent arteriole
Efferentarteriole
(Layer)
Urinary pole
Parietal layer
(Layer)
Visceral layer
What is the best word in
nephrology?Corpuscle
What is the best structure in nephrology?
There really is not an answer to this question. It’s more of a personal reflection question with no objective answer. “Best” is hard to quantify.
Filtration apparatus
Capillary lumenSecondary
process(pedicel)
Glomerularbasement membrane
Endothelial cell nucleus
PodocytePrimaryprocess
(Glomerulus lumen)
Where are large anions repelled?
What is this?
Can’t you read?
Mesangial cells
Parietal layer
Visceral layer – PodocyteEfferent
arteriole
Afferentarteriole
What are the functions of mesangial cells?a. Phagocytic – clean the basement membrane,
ex. Remove immune complexes from the membrane.
b. Support – podocytes.c. They are contractile- can regulate glomerular
lumen.d. Secretory – Interleukin-1 and platelet-derived
growth factor. These respond to glomerular injury.
Macula densa
Juxtaglomerular cells
Afferentarteriole
Distalconvolutedtubule
So… tell me about the juxtaglomerular cells.a. Smooth muscle cells of the afferent arteriole.
They are innervated by sympathetic neurons and secrete renin into the blood.
Which is which?Proximal Tubule
Distal Tubule
(Brush Border)
Which is which?Full Bladder
Empty Bladder
Neural tubeIntermediateMesoderm Paraxial
Mesoderm
Gut
Which portion turns into a kidney?What is its main
signaler?
Order these three chronologicallyMesonephric kidney Pronephric kidney
Metanephric kidney
Which one turns into your kidney?
Which one turns into the ductus
deferens?
Metanephros
Cloaca
Mesonephros tubules
Hindgut
Mesonephric duct
MetanephricMesoderm(blastema)
Uretericbud
What transcription factor do I create?
GDNFWhich induces what other factor?
WT1
Name the defect
Pelvic kidney
Bifidureter
Horseshoekidney
Where’s the bladder?
Here
Where’s the love?
All around us
NormalsProperty Value
Renal blood flow (mL/min) 1200
Renal plasma flow (mL/min) 660
GFR (mL/min) 125
Filtration fraction 0.20 – 0.25
Total body water (% of total body weight) 60%
ICFV (% of total body water) 60-67%
ECFV (% of total body water) 33-40%
Plasma volume (% of total body weight) 4%
Urine osmolarity (mosm/L) 500-800
Plasma osmolarity (mosm/L) 285
Substance Importance
PAH CPAH = ERPF
Inulin Cinulin = GFR
Creatinine Ccreatinine = GFR (overestimate)
Substances
Match each to a line
Filtered
Excreted
Secreted
Event Increase or decrease
Solute diuresis ↓
Reduced blood flow through vasa recta ↑
Inhibition of Na, K, 2 Cl cotransporter ↓
Washout of urea ↓
Increased number of JM nephrons ↑
Renal disease ↓
Will the hypertonic gradient in the medullary interstitium ↑ or ↓?
Match transporters with locationThick ascending
loop of Henle
Thin ascending loop of Henle
Proximal Tubule
Na/K/2 Cl symport
Descending loop of Henle Na/H antiport
Na/glucose symport
Na/HCO3 antiport
Proximal Tubule
Proximal Tubule
How do V2 receptors function?They are localized in the basolateral
membranes of principal cells. Activation of V2 receptors elevates
cyclic AMP in these cells, which leads to insertion of water-permeable channels
(AQP2) into the lumenal membrane.
What causes ADH release (6)?
• Increase in plasma osmolarity (1-2% threshold)
• Reduction in circulating blood volume (>10%) and blood pressure
• Angiotensin II• Stress (physical or emotional), pain• Nausea • Standing upright (→orthostatic antidiuresis)
H2O
H2O
What percentage is reabsorbed in each section?
65%65%
25%15%
Coupled with which anions?Na
Cl- (50% of its filtered amount) and HCO3
- (90%)
NaCoupled with which anions?Cl- (33% of its
filtered amount)
Where is the lower O2 content?
The medulla
The cortex
Rearrange these urea transporters to make a face.
Order these in terms of reaction speed
Baroreceptor reflex
Renal control of body NaCl
Angiotensin II Slow
Medium
Fast
Renal Regulation: High, Intermediate, or Low?
Intermediate HCO3-
Creatinine
Urea
Na+
Water
Ca2+
Low [Cr]P ↑ as nephrons are lost
Low
High
High
Intermediate
Match the lines
AlcoholGlucose or water
Saline
Which will have the greatest osmolarity?
Saline
↑/↓ ↑/↓
↑/↓
↑/↓ ↑/↓
↑/↓
↑/↓
↑/↓ ↑/↓ ↑/↓
↑/↓ ↑/↓ ↑/↓
↑/↓ ↑/↓ ↑/↓
Each caused by what?
↑ perfusion pressure, NE, (ATII)
ATII
ATII
What will increase FENa?
Dilation of efferent arterioleConstriction or Dilation
Decrease activation of RAA systemIncrease or Decrease
Increase secretion of natriuretic hormones
Increase or Decrease
↑/↓
↑/↓
↑/↓
↑/↓↑/↓
↑/↓
↑/↓
↑/↓ ↑/↓
AldosteroneDirect stimulants (2): ↑ [K+]plasma, ATII
Acts on (2):Late distal tubule,
collecting ductsPrincipal cells do what (4):
- Increased Na+ permeability of lumenal membrane- Increased K+ permeability of lumenal membrane- Increased lumenal Na+/H+ exchange- Increase in activity and number of basolateral Na+,K+-ATPase pumps
Intercalated cells do what (1):- Increased lumenal H+-ATPase activity
Most importantly, what happens to
FENa?
It decreases!
↑/↓
↑/↓
↑/↓ ↑/↓↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓↑/↓
↑/↓
↑/↓
Choose: Osmoregulation or Volume Regulation?
Osmoregulation Senses plasma osmolality
Regulates ADH, thirst
Affects urine Na excretion
Takes days to occur
Edema is a physical sign
ADH, ANP, RAA system
Osmoregulation
Volume Regulation
Volume Regulation
Volume Regulation
Volume Regulation
Volume Regulation
↑ ATII
↑ Renin
↑ Sympathetics
Baroreceptors(Sensor)
(hormone)
Name the three substances that increase the Na/K ATPase activity
1
1
2
2
2 3
Which side represents a reaction to a state of low K+?
What exchange occurs in principal cells?
What exchange occurs in intercalated cells?
Na+ in, K+ and H+ out
K+ in, H+ out
Property Inc/Dec
Low K+ diet ↓
High K+ permeability of lum. membrane ↑
Decreased fluid flow through lumen ↓
Increased intralumenal negativity ↑
High Na+ diet ↑
Metabolic alkalosis ↑
Aldosterone + high fluid flow rates ↑↑
Effect on K+ excretion
Property Inc/Dec
Decreased filtered load of HCO3- ↓
Increased arterial pCO2 ↑
Low angiotensin II ↓
Respiratory acidosis ↑
Decreased ECFV ↑
↑ Aldosterone ↑
Effect on HCO3- Reabsorption
Property Inc/Dec
K+ elevation ↓
Acute respiratory acidosis ↑
Metabolic acidosis ↑
Acidic urinary pH ↑
Effect on Ammonium Excretion
Property Inc/Dec
High pH ↓
Increased filtered load of phosphate ↑
Decreased PTH ↓
Effect on Titratable Acidity of Urine
↑/↓ ↑/↓↑/↓
↑/↓ ↑/↓
↑/↓ ↑/↓
↑/↓
Property Value
Increased K+ intake Hyperkalemia
Increased GI loss Hypokalemia
Excessive insulin administration Hypokalemia
Renal failure Hyperkalemia
Untreated diabetes mellitus Hyperkalemia
Treatment with thiazides/L-A diuretics Hypokalemia
Primary hyperaldosterism Hypokalemia
This patient is treated with ACE inhibitors Hypokalemia
Treated with calcium chloride infusion Hyperkalemia
Treated with adrenergic agonist Hyperkalemia
Hyper- or Hypokalemia?
Name the drugs
B (3 drugs)A
Identify the
followingMetabolic alkalosis
Chronic respiratory acidosis
Chronic respiratory alkalosis
Acute respiratory acidosis
Effect (Plasma)
Cause (high)
[Na] pH [K] [Ca] [Mg] Pi HCO3 ADH Aldost Met Ac Met Alk
[Na] ↓ ↑ ↑/↓ ↓ ↑
pH ↓
[K] ↑ ↓ ↑
[Ca] ↑ ↓
[Mg]
Pi ↓
HCO3 ↓
ADH
Aldost ↑ ↑ ↓ ↑
Met Ac ↓ ↑ ↑ ↓
Met Alk ↑ ↓ ↓ ↑
Resp Ac ↓ ↑ ↓
Resp Alk ↑ ↓ ↓ ↑
PTH ↑ ↑ ↓
ANP ↓ ↓ ↓
↑/↓ ↑/↓ ↑/↓ ↑/↓ ↑/↓↑/↓
↑/↓ ↑/↓ ↑/↓
↑/↓ ↑/↓
↑/↓↑/↓
↑/↓ ↑/↓ ↑/↓ ↑/↓
↑/↓ ↑/↓ ↑/↓ ↑/↓↑/↓ ↑/↓ ↑/↓ ↑/↓↑/↓ ↑/↓ ↑/↓↑/↓ ↑/↓ ↑/↓ ↑/↓
↑/↓ ↑/↓ ↑/↓↑/↓ ↑/↓ ↑/↓
And now…
Kay’s slides
Everything wrong was her fault
Is Na+ reabsorbed or secreted in the proximal convoluted tubule?Reabsorbed!
By what mechanism is it reabsorbed?
By a wide variety of Na+-linked lumenal transporters and solvent drag.
Is Na+ reabsorbed or secreted in the thin descending limb of the loop of Henle?
Neither! For the most part, the thin descending limb only reabsorbs water.
XIs Na+ reabsorbed or secreted in the thin ascending limb of the loop of Henle?Passively reabsorbed.
Is Na+ reabsorbed or secreted in the thick ascending limb of the loop of Henle?
Reabsorbed via the Na+, K+, 2Cl- co-transporter. Known as the medullary diluting segment.
Is Na+ reabsorbed or secreted in the first 2/3 of the distal convoluted tubule?
Actively reabsorbed. Known as the cortical diluting segment.
And finally, what about the late distal convoluted tubule and the collecting duct?
What diuretics work here?
Loop-acting diuretics.
What diuretics work here?
Thiazides.
What diuretics work here?
K+-sparing diuretics.
Reabsorption occurs and is stimulated by aldosterone.
What diuretics work here?
Carbonic Anhydrase Inhibitors
In the proximal tubule, are the following secreted or reabsorbed?
Water: Reabsorbed % of filtered:65%Urea: Reabsorbed (50%)
K+: Reabsorbed (67%) Ca2+: Reabsorbed (67%)
Pi: Reabsorbed (majority)
What is reabsorbed in the thin descending limb of the loop of Henle?Mainly just water!
Mg2+: No movement
In the thin ascending limb of the loop of Henle, what is reabsorbed?
Na+, Cl-
What is secreted?Urea (60%-110%)
In the thick ascending limb of the loop of Henle, what is reabsorbed?
Na+, K+, Cl-, Ca2+, Mg2+
What happens in the first 2/3 of the distal convoluted tubule?• ALWAYS impermeable to water• Reabsorbs Na+
• Called the cortical diluting segment
What happens in the last 1/3 of the distal convoluted tubule?• Absorbs water ONLY when ADH
is present• Can reabsorb Na+ against a
large electrochemical gradient
Distal tubule in general also reabsorbs Ca2+ and a little bit of Mg2+
What about K+?K is actively reabsorbed by intercalated cells & passively secreted by principal cells
Finally, we come to the collecting duct:
Na+:Urea:
K+:
Water:
Mg2+:
Pi:
Ca2+:
Reabsorbed (40% to 70%)(only in the medullary region)
Reabsorbed (only w/ ADH)
Reabsorbed
Reabsorbed or secreted
No movement
No movementNo movement