Renal Physiology: Tubular Structure and Function
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Questions and Answers

What percentage of Na+ is reabsorbed in the proximal convoluted tubule?

  • 40%
  • 25%
  • 65% (correct)
  • 90%

    • What is the primary mechanism of H2O reabsorption in the proximal convoluted tubule?

  • Facilitated diffusion
  • Active transport
  • Osmosis (correct)
  • Symport

    • What is the effect of high aldosterone concentrations on Na+ reabsorption?

  • Enhances Na+ reabsorption (correct)
  • Secretes Na+ into the filtrate
  • Inhibits Na+ reabsorption
  • Has no effect on Na+ reabsorption

    • What is the primary goal of Na+ reabsorption in the tubules?

    <p>Tailor Na+ reabsorption to need</p> Signup and view all the answers

    What is a key characteristic of Na+ reabsorption in the tubules?

    <p>Na+ is never secreted into the filtrate</p> Signup and view all the answers

    What is the clearance rate of substance X?

    <p>0 ml/min</p> Signup and view all the answers

    What is the primary use of creatinine in estimating GFR?

    <p>To give a quick and dirty estimate of GFR</p> Signup and view all the answers

    What is the primary difference between acute renal failure and chronic kidney failure?

    <p>Acute is a sudden onset, chronic develops slowly</p> Signup and view all the answers

    What is the primary function of autoregulation in regulating glomerular filtration?

    <p>To suppress changes in renal blood flow and GFR</p> Signup and view all the answers

    What happens when GFR increases and there is not enough time for reabsorption?

    <p>The concentration of NaCl in the filtrate remains high</p> Signup and view all the answers

    What is the typical duration of acute renal failure?

    <p>Hours or days</p> Signup and view all the answers

    What is the definition of renal failure?

    <p>The kidneys' failure to remove metabolic end products from the blood</p> Signup and view all the answers

    What do Macula Densa cells respond to?

    <p>Filtrate NaCl concentration</p> Signup and view all the answers

    What is the name of the substance that is neither reabsorbed nor secreted by the kidneys?

    <p>Inulin</p> Signup and view all the answers

    What is the effect of high NaCl concentration in the filtrate on the afferent arteriole?

    <p>It causes intense constriction</p> Signup and view all the answers

    What happens when the NaCl concentration in the filtrate is low?

    <p>ATP release from Macula Densa cells is inhibited</p> Signup and view all the answers

    What is the ultimate effect of tubulo-glomerular feedback on GFR?

    <p>It maintains a constant GFR</p> Signup and view all the answers

    What is the recommended temperature to send a urine sample for children?

    <p>&gt;38c</p> Signup and view all the answers

    What is the medication of choice for Lower Tract UTI in children?

    <p>Amoxicillin</p> Signup and view all the answers

    What is a risk factor for UTI in children?

    <p>Family history of vesicoureteric reflux (VUR) or renal disease</p> Signup and view all the answers

    What is the age at which leukocyte esterase and nitrite test is recommended for children?

    <p>3 years</p> Signup and view all the answers

    What is the medication of choice for Upper Tract UTI in children that is severe?

    <p>Cefotaxime or Gentamicin</p> Signup and view all the answers

    What is the NICE guideline for diagnosing and managing urinary tract infections in under 16s?

    <p>CG54</p> Signup and view all the answers

    What is a possible complication of CKD and its treatment?

    <p>Altered drug metabolism</p> Signup and view all the answers

    What is the primary site of infection in pyelonephritis?

    <p>Kidney</p> Signup and view all the answers

    What is the term for a UTI acquired in a hospital?

    <p>Nosocomial</p> Signup and view all the answers

    What is the term for a UTI that occurs through the bloodstream?

    <p>Haematogenous</p> Signup and view all the answers

    What is the term for a UTI that occurs through the urethra?

    <p>Ascending</p> Signup and view all the answers

    What is the term for a UTI involving the bladder?

    <p>Cystitis</p> Signup and view all the answers

    What percentage of women present to their GP with UTI symptoms each year?

    <p>5%</p> Signup and view all the answers

    What is the most common cause of UTI?

    <p>Escherichia coli</p> Signup and view all the answers

    What percentage of women will suffer from a symptomatic UTI during their lifetime?

    <p>50%</p> Signup and view all the answers

    What type of E. coli is associated with UTI?

    <p>UPEC</p> Signup and view all the answers

    What is the commonest cause of nosocomial infection?

    <p>Urinary Tract Infection</p> Signup and view all the answers

    What is associated with haemorrhagic cystitis?

    <p>Adenoviruses</p> Signup and view all the answers

    Why are infants at greater risk?

    <p>Low volume on lungs and high metabolic rate</p> Signup and view all the answers

    What percentage of sodium ions is reabsorbed in the proximal convoluted tubule and loop of Henle?

    <p>65% in PCT and 25% in loop of Henle</p> Signup and view all the answers

    What is the role of the kidneys in acid-base homeostasis?

    <p>Controlling HCO3- and H+ concentration</p> Signup and view all the answers

    Why are aged people at greater risk?

    <p>Both A and B</p> Signup and view all the answers

    What happens to sodium ions when aldosterone concentrations are high?

    <p>Essentially all remaining filtered sodium ions are actively reabsorbed</p> Signup and view all the answers

    What is the primary goal of the kidneys in maintaining pH balance?

    <p>Reabsorbing filtered bicarbonate</p> Signup and view all the answers

    What is a characteristic of sodium ion reabsorption in the tubules?

    <p>It is never secreted into the filtrate</p> Signup and view all the answers

    What is the net effect of daily diet and metabolism?

    <p>A net increase in acids</p> Signup and view all the answers

    What is the purpose of sodium ion reabsorption in the tubules?

    <p>To precisely tailor sodium ion levels to the body's needs</p> Signup and view all the answers

    What is the primary mechanism of water reabsorption in the proximal convoluted tubule?

    <p>Osmosis</p> Signup and view all the answers

    How do the kidneys respond to the body's needs?

    <p>By reabsorbing or excreting bicarbonate</p> Signup and view all the answers

    What is the significance of sodium ion reabsorption in the distal convoluted tubules and collecting ducts?

    <p>It ensures precise control of sodium ion levels</p> Signup and view all the answers

    What is the primary route of acquisition of pyelonephritis in urinary tract infections?

    <p>Haematogenous from blood to kidney</p> Signup and view all the answers

    What is the function of Lactoferrin in host defenses against UTI?

    <p>To chelate iron and prevent bacterial growth</p> Signup and view all the answers

    What is the characteristic of Type 1 fimbriae of Uropathogenic E. coli?

    <p>They bind to mannose residues on host cells</p> Signup and view all the answers

    What is the risk factor for UTI in the given text?

    <p>Female sex</p> Signup and view all the answers

    What is the function of sIgA in host defenses against UTI?

    <p>To prevent bacterial adhesion</p> Signup and view all the answers

    What is the type of fimbriae associated with pyelonephritis-causing strains of Uropathogenic E. coli?

    <p>Type P fimbriae</p> Signup and view all the answers

    What percentage of uncomplicated lower UTI cases in otherwise fit women may resolve spontaneously?

    <p>50%</p> Signup and view all the answers

    What is the recommended duration of antimicrobial courses for uncomplicated lower UTI?

    <p>3 days</p> Signup and view all the answers

    What is an important consideration when choosing antimicrobials for uncomplicated lower UTI?

    <p>Local resistance patterns</p> Signup and view all the answers

    What is a characteristic of trimethoprim?

    <p>Cheap</p> Signup and view all the answers

    What is a limitation of nitrofurantoin?

    <p>It is not effective against Proteus species</p> Signup and view all the answers

    Why should ampicillin/amoxicillin not be used empirically for uncomplicated lower UTI?

    <p>They have high rates of resistance</p> Signup and view all the answers

    Why may short courses of antimicrobials result in fewer side effects?

    <p>They are associated with shorter exposure to antimicrobials</p> Signup and view all the answers

    What percentage of the filtered K+ is reabsorbed at the proximal tubules and the thick ascending limb of the nephron loop?

    <p>90%</p> Signup and view all the answers

    What happens to K+ excretion when ECF K+ concentrations are abnormally low?

    <p>K+ excretion decreases to a minimum</p> Signup and view all the answers

    What is the role of estrogen in the renal system?

    <p>It increases NaCl reabsorption</p> Signup and view all the answers

    What is the primary function of anti-diuretic hormone (ADH) in the renal system?

    <p>It decreases urine output</p> Signup and view all the answers

    What is the role of aldosterone in the renal system?

    <p>It regulates NaCl reabsorption</p> Signup and view all the answers

    What is the primary site of K+ secretion in the renal system?

    <p>Cortical collecting ducts</p> Signup and view all the answers

    What happens to K+ excretion when ECF K+ concentrations are high?

    <p>K+ excretion increases</p> Signup and view all the answers

    What is the primary abnormality in respiratory alkalosis?

    <p>Decreased pCO2</p> Signup and view all the answers

    What is the result of the carbonic anhydrase reaction?

    <p>H2CO3 → HCO3- + H+</p> Signup and view all the answers

    What is the term for the gain of acid or the loss of bicarbonate?

    <p>Metabolic acidosis</p> Signup and view all the answers

    What is a common cause of metabolic acidosis?

    <p>Uncontrolled diabetes mellitus</p> Signup and view all the answers

    What is the result of exercise on the body's acid-base balance?

    <p>Mild metabolic acidosis</p> Signup and view all the answers

    What is the primary abnormality in metabolic alkalosis?

    <p>Increased HCO3-</p> Signup and view all the answers

    What would happen if the respiratory system had a problem with ventilation?

    <p>Respiratory acidosis</p> Signup and view all the answers

    What is the normal pH range?

    <p>7.35 - 7.45</p> Signup and view all the answers

    What is the primary goal of the kidneys in maintaining pH balance?

    <p>To eliminate excess bicarbonate and regulate pH</p> Signup and view all the answers

    What is the term for a condition where the pH is too low?

    <p>Acidemia</p> Signup and view all the answers

    What is the normal range of CO2 in mmHg?

    <p>35 - 45</p> Signup and view all the answers

    What is the primary question to ask when interpreting an arterial blood gas (ABG) result?

    <p>Does the patient exhibit acidosis or alkalosis?</p> Signup and view all the answers

    What is the term for a condition where the pH is too high?

    <p>Alkalemia</p> Signup and view all the answers

    What is the normal range of HCO3 in mEq/L?

    <p>22 - 26</p> Signup and view all the answers

    What percentage of women each year present to their GP with UTI symptoms?

    <p>5%</p> Signup and view all the answers

    What is the commonest cause of UTI?

    <p>Escherichia coli</p> Signup and view all the answers

    What is associated with haemorrhagic cystitis?

    <p>BK and JC viruses</p> Signup and view all the answers

    What is the primary source of UPEC in individuals who experience relapsing/recurring UTI?

    <p>Resident population of UPEC in the large bowel</p> Signup and view all the answers

    What is the term for a UTI acquired in a hospital?

    <p>Nosocomial infection</p> Signup and view all the answers

    What percentage of women will suffer from a symptomatic UTI during their lifetime?

    <p>50%</p> Signup and view all the answers

    What is the primary goal of the kidneys in maintaining pH balance?

    <p>Regulation of acid-base levels</p> Signup and view all the answers

    What is a common factor that increases the risk of urinary tract infections?

    <p>Pregnancy</p> Signup and view all the answers

    What is a consequence of incomplete emptying of the bladder?

    <p>Residual urine</p> Signup and view all the answers

    What is a common effect of catheterization?

    <p>Bypasses host defenses</p> Signup and view all the answers

    What is a complication of urinary tract infections?

    <p>Reflux of urine from bladder to kidney</p> Signup and view all the answers

    What is a risk factor for urinary tract infections in children?

    <p>Spina bifida</p> Signup and view all the answers

    What is a consequence of biofilm formation?

    <p>Bacteria are less accessible to host defenses</p> Signup and view all the answers

    What is a common cause of urinary tract infections?

    <p>Foreign body (e.g. stones)</p> Signup and view all the answers

    What is a complication of urinary tract infections in pregnancy?

    <p>Dilated ureters</p> Signup and view all the answers

    What is a risk factor for urinary tract infections?

    <p>Incomplete emptying of bladder</p> Signup and view all the answers

    What is a consequence of urinary tract infections?

    <p>Stagnant urine</p> Signup and view all the answers

    What is the primary purpose of the ammonia buffer system?

    <p>To generate new bicarbonate</p> Signup and view all the answers

    What is the major proportion of the buffering capacity in the body?

    <p>In the extracellular space</p> Signup and view all the answers

    What is the consequence of continuous H+ secretion in the proximal convoluted tubule?

    <p>Decrease in urine pH</p> Signup and view all the answers

    What is the primary site of H+ secretion in the nephron?

    <p>Proximal convoluted tubule</p> Signup and view all the answers

    What is the term for a condition where the pH is below 7.35?

    <p>Acidosis</p> Signup and view all the answers

    What is the percentage of buffering capacity attributed to the phosphate buffer system?

    <p>1%</p> Signup and view all the answers

    What percentage of Na+ reabsorption occurs in the proximal convoluted tubule and loop of Henle?

    <p>65% and 25%</p> Signup and view all the answers

    What is the result of H+ secretion ceasing when urine pH falls to 4.5?

    <p>Any additional H+ is neutralized in the filtrate</p> Signup and view all the answers

    What is the effect of high aldosterone concentrations on Na+ reabsorption?

    <p>It essentially reabsorbs all remaining filtered Na+ in the distal convoluted tubules and collecting ducts.</p> Signup and view all the answers

    What is the primary mechanism of H2O reabsorption in the proximal convoluted tubule?

    <p>Osmosis</p> Signup and view all the answers

    What is the purpose of sodium ion reabsorption in the tubules?

    <p>To maintain blood volume and pressure</p> Signup and view all the answers

    What is the net effect of sodium reabsorption in the tubules?

    <p>It decreases sodium excretion in the urine</p> Signup and view all the answers

    What is the result of the carbonic anhydrase reaction?

    <p>Generating H+</p> Signup and view all the answers

    What is the primary function of the kidney in regulating potassium levels?

    <p>To regulate potassium excretion</p> Signup and view all the answers

    What is metabolic acidosis caused by?

    <p>Gain of acid or loss of bicarbonate</p> Signup and view all the answers

    What is the ultimate effect of high aldosterone concentrations on potassium excretion?

    <p>It increases potassium excretion</p> Signup and view all the answers

    What is respiratory alkalosis caused by?

    <p>Hyperventilation</p> Signup and view all the answers

    What is metabolic alkalosis caused by?

    <p>Gain of base or loss of acid</p> Signup and view all the answers

    What is a consequence of exercise on the body's acid-base balance?

    <p>Mild metabolic acidosis</p> Signup and view all the answers

    What is a common cause of metabolic acidosis?

    <p>Generation of ketone bodies in uncontrolled diabetes mellitus</p> Signup and view all the answers

    What is the primary abnormality in respiratory alkalosis?

    <p>Decreased pCO2</p> Signup and view all the answers

    What is the percentage of women who will suffer from a symptomatic UTI at least once in their lifetime?

    <p>1 in 5</p> Signup and view all the answers

    What is the commonest cause of nosocomial infection?

    <p>Urinary Tract Infection</p> Signup and view all the answers

    What is the primary source of UPEC in individuals who experience relapsing/recurring UTI?

    <p>Large bowel</p> Signup and view all the answers

    Which virus is associated with haemorrhagic cystitis?

    <p>All of the above</p> Signup and view all the answers

    What is the serotype of UPEC?

    <p>Restricted number</p> Signup and view all the answers

    What is the association of E. coli O157?

    <p>Intestinal disease</p> Signup and view all the answers

    What is the parasitic infection associated with UTI?

    <p>Schistosoma haematobium</p> Signup and view all the answers

    What is associated with lower birth weight, premature delivery, and increased perinatal morbidity in pregnant women?

    <p>Bacteriuria and lower UTI</p> Signup and view all the answers

    What is the typical symptom of cystitis in elderly patients?

    <p>Sudden onset of confusion</p> Signup and view all the answers

    What is the significance of a positive protein test in urinalysis?

    <p>It has a high positive predictive value</p> Signup and view all the answers

    What is the purpose of leukocyte esterase in laboratory diagnosis of UTI?

    <p>To detect white cells</p> Signup and view all the answers

    Why may nitrite test be falsely negative?

    <p>Due to some bacteria not converting nitrates to nitrites</p> Signup and view all the answers

    What is the significance of red cells in urine microscopy?

    <p>It is associated with menstruation in females</p> Signup and view all the answers

    What is the primary symptom of pyelonephritis?

    <p>Loin pain</p> Signup and view all the answers

    What is the consequence of untreated bacteriuria in pregnant women?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of cystitis in infants?

    <p>Poor feeding</p> Signup and view all the answers

    What is the purpose of urinalysis in the diagnosis of UTI?

    <p>To detect the presence of white cells and bacteria</p> Signup and view all the answers

    What is the effect of progesterone on Na+ reabsorption?

    <p>It blocks the effect of aldosterone on the renal tubules</p> Signup and view all the answers

    What is the effect of glucocorticoids on Na+ reabsorption?

    <p>They promote an increased glomerular filtration rate</p> Signup and view all the answers

    What is the pH range for acidosis?

    <p>less than 7.35</p> Signup and view all the answers

    What is the primary problem if the pCO2 is the only abnormal value?

    <p>Respiratory</p> Signup and view all the answers

    What is the purpose of buffers in the body?

    <p>To regulate H+ concentration</p> Signup and view all the answers

    What is the sequence of regulation of H+ concentration in the blood?

    <p>Chemical buffers, respiratory centers, renal system</p> Signup and view all the answers

    What happens when the body is attempting to compensate for an imbalance?

    <p>Both CO2 and Bicarbonate are high or both low</p> Signup and view all the answers

    What makes infants and elderly more susceptible to acid-base imbalance?

    <p>Not specified in the text</p> Signup and view all the answers

    What is the primary function of the renal system in acid-base balance?

    <p>To excrete excess H+ ions</p> Signup and view all the answers

    What is alkalosis?

    <p>A pH greater than 7.45</p> Signup and view all the answers

    What is the effect of increasing hydrogen ion concentration on pH?

    <p>pH decreases</p> Signup and view all the answers

    What is the role of bases in acid-base balance?

    <p>To accept protons</p> Signup and view all the answers

    What is the first step in assessing acid-base balance?

    <p>Determine the pH</p> Signup and view all the answers

    What happens if the HCO3- is the only abnormal value?

    <p>It is metabolic</p> Signup and view all the answers

    What is the primary component of the phosphate buffer system?

    <p>HPO42-</p> Signup and view all the answers

    What is the term for a condition where the pH is low?

    <p>Acidosis</p> Signup and view all the answers

    What is the role of the phosphate buffer system in cells?

    <p>To maintain acid-base balance</p> Signup and view all the answers

    What is the function of hydrogen phosphate ions (HPO42-) in the phosphate buffer system?

    <p>As a hydrogen-ion acceptor (base)</p> Signup and view all the answers

    What is the result of the chemical equation H2PO4- H+ + HPO42-?

    <p>Equilibrium between dihydrogen phosphate and hydrogen phosphate ions</p> Signup and view all the answers

    How do kidneys maintain acid-base balance?

    <p>By reabsorbing bicarbonate ions</p> Signup and view all the answers

    What is the role of carbonic anhydrase in the bicarbonate buffer system?

    <p>To combine CO2 and H2O to form H2CO3-</p> Signup and view all the answers

    What is the fate of H2CO3- in the bicarbonate buffer system?

    <p>It splits into CO2 and H2O</p> Signup and view all the answers

    What is the purpose of Na+ reabsorption in the peritubular capillary?

    <p>To maintain acid-base balance</p> Signup and view all the answers

    What is the effect of H+ excretion in the filtrate?

    <p>It decreases the concentration of HCO3-</p> Signup and view all the answers

    What is the definition of chronic renal failure?

    <p>Recognized by the presence of structural kidney damage Or a decreased GFR of less than 60mL/min/1.73m2 for more than 3 months</p> Signup and view all the answers

    What is a common cause of pre-renal acute kidney disease?

    <p>Hypovolemia (blood loss)</p> Signup and view all the answers

    What is a clinical manifestation of chronic renal failure?

    <p>Accumulation of nitrogenous wastes</p> Signup and view all the answers

    What is a type of bone disease associated with chronic renal failure?

    <p>Renal osteodystrophy</p> Signup and view all the answers

    What is a cause of acute kidney disease?

    <p>Acute tubular necrosis</p> Signup and view all the answers

    What is a common cause of post-renal acute kidney disease?

    <p>Ureteral/bladder obstruction</p> Signup and view all the answers

    What is a consequence of chronic renal failure?

    <p>Imbalances in bone metabolism</p> Signup and view all the answers

    What is a criterion for the diagnosis of acute kidney disease?

    <p>All of the above</p> Signup and view all the answers

    What percentage of women each year present to their GP with UTI symptoms?

    <p>5% of women</p> Signup and view all the answers

    What is the most common cause of UTI?

    <p>Escherichia coli</p> Signup and view all the answers

    What percentage of women will suffer from a symptomatic UTI during their lifetime?

    <p>50% of women</p> Signup and view all the answers

    What is the primary source of UPEC in individuals who experience relapsing/recurring UTI?

    <p>Resident population of UPEC</p> Signup and view all the answers

    What is the term for a UTI involving the bladder?

    <p>Cystitis</p> Signup and view all the answers

    Which virus is associated with haemorrhagic cystitis?

    <p>Adenoviruses</p> Signup and view all the answers

    What is a complication of urinary tract infections in pregnancy?

    <p>All of the above</p> Signup and view all the answers

    What is a limitation of nitrofurantoin?

    <p>It is not effective against kidney infections</p> Signup and view all the answers

    What percentage of sodium ions is reabsorbed in the proximal convoluted tubule and loop of Henle?

    <p>65% and 25%</p> Signup and view all the answers

    What is the primary function of the renal system in terms of blood glucose regulation?

    <p>Gluconeogenesis: conversion of lactate, amino acids and glycerol into glucose</p> Signup and view all the answers

    What happens to sodium ions when aldosterone concentrations are high?

    <p>They are actively reabsorbed in the distal convoluted tubules and collecting ducts</p> Signup and view all the answers

    What is the primary mechanism of water reabsorption in the proximal convoluted tubule?

    <p>Osmosis</p> Signup and view all the answers

    What is the term for the process by which the kidneys maintain a stable GFR despite changes in blood pressure?

    <p>Autoregulation</p> Signup and view all the answers

    What is the significance of potassium regulation by the kidney?

    <p>It helps regulate electrolyte balance</p> Signup and view all the answers

    Which of the following is NOT a function of the urinary system?

    <p>Producing hormones</p> Signup and view all the answers

    How much of the filtered sodium is reabsorbed in the tubules?

    <p>Almost all of it is reabsorbed</p> Signup and view all the answers

    What is the primary function of the Renin-Angiotensin-Aldosterone System (RAAS) in relation to GFR?

    <p>To regulate blood pressure and maintain GFR</p> Signup and view all the answers

    What is the term for the assessment of kidney function?

    <p>Creatinine clearance</p> Signup and view all the answers

    What is the best measure of stable kidney function?

    <p>Estimated glomerular filtration rate (eGFR)</p> Signup and view all the answers

    What is the consequence of chronic kidney disease on the quality of life?

    <p>Impaired quality of life and reduced exercise capacity</p> Signup and view all the answers

    What is the effect of sodium retention on blood pressure in chronic kidney disease?

    <p>Increased blood pressure</p> Signup and view all the answers

    What is the term for the accumulation of toxic waste products in chronic kidney disease?

    <p>Retention nitrogenous waste</p> Signup and view all the answers

    What is the effect of chronic kidney disease on bone health?

    <p>Renal Mineral Bone Disease</p> Signup and view all the answers

    What is the consequence of pulmonary oedema in chronic kidney disease?

    <p>Hypertension and oedema</p> Signup and view all the answers

    What is a effective way to prevent catheter-associated urinary tract infections?

    <p>Limiting the duration of catheterization</p> Signup and view all the answers

    What percentage of women with clinical features of cystitis have negative urine cultures?

    <p>50%</p> Signup and view all the answers

    What is a possible reason for negative urine cultures in women with clinical features of cystitis?

    <p>Fastidious bacteria that do not grow on routine culture media</p> Signup and view all the answers

    What is the significance of Ag++-bonded catheters in preventing urinary tract infections?

    <p>They are effective in preventing UTIs in some patients</p> Signup and view all the answers

    What is a common feature of urinary catheters?

    <p>They are eventually colonized</p> Signup and view all the answers

    What is the correct approach to treating catheter-associated bacteriuria?

    <p>Only treat if the patient has signs or symptoms of infection</p> Signup and view all the answers

    What is the primary function of autoregulation in the regulation of glomerular filtration?

    <p>To regulate blood flow to individual organs based on their immediate requirements</p> Signup and view all the answers

    What happens when GFR increases in the tubulo-glomerular feedback mechanism?

    <p>Macula densa cells release vasoconstrictors, decreasing blood flow to the glomerulus</p> Signup and view all the answers

    What is the effect of high NaCl concentration in the filtrate on Macula densa cells?

    <p>It stimulates the release of vasoconstrictors, decreasing blood flow to the glomerulus</p> Signup and view all the answers

    What is the ultimate effect of the tubulo-glomerular feedback mechanism on GFR?

    <p>It slows the flow of filtrate, allowing more time for reabsorption</p> Signup and view all the answers

    What is the purpose of autoregulation in the regulation of glomerular filtration?

    <p>To maintain a constant GFR in the face of changing blood pressure</p> Signup and view all the answers

    What is the response of Macula densa cells to low NaCl concentration in the filtrate?

    <p>They release vasodilators, increasing blood flow to the glomerulus</p> Signup and view all the answers

    What can act as a foreign body and bypass host defenses in the urinary tract?

    <p>Catheter</p> Signup and view all the answers

    What is a risk factor for urinary tract infections in pregnant women?

    <p>Incomplete bladder emptying</p> Signup and view all the answers

    What is a complication of urinary tract infections?

    <p>Reflux of urine from bladder to kidney</p> Signup and view all the answers

    What can cause mucosal damage in the urinary tract?

    <p>Urinary tract surgery</p> Signup and view all the answers

    What can lead to biofilm formation in the urinary tract?

    <p>Catheterisation</p> Signup and view all the answers

    What percentage of the buffering capacity is in the cells?

    <p>52%</p> Signup and view all the answers

    What is the consequence of continuous H+ secretion in the PCT?

    <p>Urine pH falls</p> Signup and view all the answers

    What is the primary mechanism of generating new bicarbonate in the ammonia buffer system?

    <p>Glutamine metabolism</p> Signup and view all the answers

    What is the pH range below which H+ secretion ceases in the PCT?

    <p>4.5</p> Signup and view all the answers

    What is the percentage of the buffering capacity attributed to the bicarbonate buffer system?

    <p>40%</p> Signup and view all the answers

    What is the condition characterized by a pH below 7.35?

    <p>Acidosis</p> Signup and view all the answers

    What is the primary function of the renal clearance test?

    <p>To determine the glomerular filtration rate (GFR)</p> Signup and view all the answers

    What is the normal glomerular filtration rate (GFR)?

    <p>180L of plasma/day</p> Signup and view all the answers

    What is the role of inulin in renal clearance tests?

    <p>It is completely filtered by the glomeruli and is neither reabsorbed nor secreted</p> Signup and view all the answers

    What is the formula to calculate renal clearance?

    <p>C = UV/P</p> Signup and view all the answers

    What is the effect of the renin-angiotensin-aldosterone system (RAAS) on blood pressure?

    <p>It increases blood pressure</p> Signup and view all the answers

    What is the relationship between the glomerular filtration rate (GFR) and the amount of plasma filtered?

    <p>GFR is directly proportional to the amount of plasma filtered</p> Signup and view all the answers

    What is the benefit of 'rotation' of antibiotics in managing recurrent UTI?

    <p>Prevention of antibiotic resistance</p> Signup and view all the answers

    What is the recommended duration of antimicrobial prophylaxis for women with recurrent UTI?

    <p>6 months</p> Signup and view all the answers

    What is an alternative approach to managing recurrent UTI?

    <p>Self-medication with proanthocyanidins</p> Signup and view all the answers

    What is the significance of the 2008 Cochrane review on cranberry use?

    <p>It found no difference between cranberry consumption and controls</p> Signup and view all the answers

    What is the benefit of voiding post-intercourse in women with recurrent UTI?

    <p>Helps prevent recurrent UTI</p> Signup and view all the answers

    What is the significance of HRT in post-menopausal women with recurrent UTI?

    <p>It reduces the risk of recurrent UTI</p> Signup and view all the answers

    What is a risk factor for UTI in children?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended treatment for mild upper tract UTI in children?

    <p>Co-amoxiclav</p> Signup and view all the answers

    When should a urine sample be sent for children?

    <p>If temp &gt;38c for &gt;24 hours</p> Signup and view all the answers

    What is the recommended treatment for lower tract UTI in children?

    <p>Amoxicillin, trimethoprin or cephalexin</p> Signup and view all the answers

    Why is imaging may be appropriate in children with UTI?

    <p>To detect underlying abnormalities of the urinary tract</p> Signup and view all the answers

    What is the significance of leukocyte esterase and nitrite in children?

    <p>They are diagnostic tests for UTI</p> Signup and view all the answers

    Where are the kidneys located in the body?

    <p>Retroperitoneal, between T12 to L3 vertebral levels</p> Signup and view all the answers

    What is the anatomical relation of the renal hilum?

    <p>Opens anteromedially towards the abdominal aorta</p> Signup and view all the answers

    What is the function of the urinary tract?

    <p>Filtration of metabolic waste and other similar waste substances from the blood stream</p> Signup and view all the answers

    What is the significance of perinephric fat and renal fascia?

    <p>They provide mechanical support to the kidneys</p> Signup and view all the answers

    What is the relation of the kidneys to the surrounding muscles?

    <p>They are posterior to the psoas major</p> Signup and view all the answers

    What is the division of the urinary tract that includes the kidneys and ureters?

    <p>Upper urinary tract</p> Signup and view all the answers

    What is the location of the left kidney's anterior relation to the spleen?

    <p>Medial surface</p> Signup and view all the answers

    What is the innervation of the kidney?

    <p>Sympathetic from aorticorenal ganglia</p> Signup and view all the answers

    What is the structure of the ureter's muscular wall?

    <p>Inner longitudinal and outer circular</p> Signup and view all the answers

    What is the location of the right kidney's anterior relation to the duodenum?

    <p>D2, adjacent to the hilum</p> Signup and view all the answers

    What is the significance of the renal sympathetic nervous system?

    <p>Regulating blood flow and renin release</p> Signup and view all the answers

    What is the approximate length of the ureter?

    <p>25-30cm</p> Signup and view all the answers

    What type of epithelium is present in the ureters?

    <p>Transitional</p> Signup and view all the answers

    Where do the ureters cross the pelvic brim?

    <p>Near the iliac vessels</p> Signup and view all the answers

    What type of muscle layers are present in the ureters?

    <p>Smooth, bilayer</p> Signup and view all the answers

    What is the innervation of the ureters?

    <p>Both sympathetic and parasympathetic</p> Signup and view all the answers

    What is the lymphatic drainage of the ureters?

    <p>paraaortic lymph nodes</p> Signup and view all the answers

    What is the clinical significance of ureteric anatomy?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Substance Clearance Rates

    • Clearance rate of Substance X is 0 ml/min, indicating no excretion or filtration.
    • Inulin clearance is 125 ml/min, used as a benchmark for glomerular filtration rate (GFR); neither reabsorbed nor secreted.
    • Creatinine clearance is higher at 200 ml/min, involving net secretion; slight secretion compensates for inaccuracies, making it a common GFR estimation tool.

    Renal Failure Overview

    • Definition: Kidney's inability to filter blood, manage metabolic waste, or balance fluids, electrolytes, and pH.
    • Types:
      • Acute Kidney Failure: Sudden onset, often reversible if detected and treated early.
      • Chronic Kidney Failure: Progressive damage over years, often irreversible.

    Acute vs. Chronic Kidney Failure

    • Acute Renal Failure: Detectable by rapid serum creatinine rise or decreased urine output (>6 hours).
    • Chronic Renal Failure: Identified by structural kidney damage or GFR <60 ml/min for over 3 months, often linked to various health conditions.

    Kidney function and Regulation

    • HCO3- and Na+ Reabsorption:

      • 65% of Na+ reabsorbed in the Proximal Convoluted Tubule (PCT), with additional reabsorption in the Loop of Henle, responding primarily to systemic needs.
      • Aldosterone significantly affects Na+ reabsorption primarily in distal tubules when concentrations rise.

    • Regulation of Glomerular Filtration:

      • Intrinsic mechanisms involve autoregulation through adjustments in renal blood flow and GFR, critical between 80-180 mmHg.
      • Tubulo-Glomerular feedback by Macula Densa cells monitors NaCl concentration related to filtration flow and adjusts afferent arteriole constriction to modulate GFR.

    Urinary Tract Infections (UTIs)

    • Prevalence: UP to 50% of women experience symptomatic UTIs in their lifetime; most common bacterial infection in primary care.

    • Common Pathogen: Escherichia coli (UPEC) is the leading cause, with specific serotypes implicated in urinary infections.

    • Other Infectious Agents:

      • Adenoviruses and Mycobacterium tuberculosis linked to UTIs.

    • Symptoms of Cystitis and Pyelonephritis:

      • Cystitis: Frequent urination, dysuria, urgency, low-grade fever; more severe symptoms seen in infants and elderly.
      • Pyelonephritis: Includes abdominal pain, fever, renal angle tenderness.

    Diagnostic and Treatment Approaches

    • Urinalysis can identify presence of leukocyte esterase and nitrites, which help confirm UTI diagnosis.
    • Antimicrobial Treatment:
      • Common choices include Trimethoprim and Nitrofurantoin for uncomplicated UTIs, with considerations made based on local resistance patterns.

    Renal Acid-Base Balance

    • Acid-Base Regulation: Maintained by chemical buffers, respiratory systems, and renal processes over different time scales.
    • Buffer Systems: Bicarbonate is critical in balancing blood pH by adjusting H+ concentrations via renal mechanisms.

    Risk Factors for UTI and Chronic Conditions

    • Demographic Risks: Women are at higher risk due to anatomical factors (shorter urethra).
    • Children: Increased UTI risk when presenting temperatures >38°C; history of UTIs or urinary tract abnormalities may warrant imaging.

    Important Renal Functions

    • Regulation of water, electrolytes, blood pH, and metabolic waste excretion are critical kidney functions affected during renal failure.
    • Hormonal influences, including aldosterone and glucocorticoids, play significant roles in renal tubular functions and sodium management.

    Summary

    • Understanding kidney function, potential disorders, infection prevalence, diagnostic methods, and treatment options is crucial for practical clinical decision-making in urology and nephrology.### Proximal Convoluted Tubule (PCT) and Collecting Duct (CD) Functions
    • Up to 90% of filtered potassium (K+) is reabsorbed in the proximal tubules and the thick ascending limb of the nephron loop.
    • Principal cells in the cortical collecting ducts excrete K+ when extracellular fluid (ECF) K+ levels are high.
    • In low ECF K+ situations, kidneys conserve K+ by minimizing secretion and excretion.

    Osmotic Regulation of Urine

    • The medulla exhibits an osmotic gradient crucial for urine concentration and volume regulation.
    • The counter-current mechanism in the nephron optimizes water reabsorption and urine concentration.
    • AntiDiuretic Hormone (ADH, or vasopressin) increases water reabsorption in the renal collecting ducts.
    • Aldosterone promotes sodium (Na+) reabsorption, thereby influencing water retention.

    Acid-Base Balance

    • Normal pH range is 7.35 - 7.45; values outside this range indicate acidosis (pH < 7.35) or alkalosis (pH > 7.45).
    • Respiratory alkalosis often results from hyperventilation, leading to decreased pCO2.
    • Metabolic acidosis arises from acid gain or bicarbonate loss, with common causes including uncontrolled diabetes and diarrhea.
    • Metabolic alkalosis is linked to bicarbonate gain or acid loss, frequently due to vomiting or antacid consumption.

    Kidney's Role in Acid-Base Regulation

    • Renal compensation is vital in acid-base imbalances, with carbonic anhydrase facilitating bicarbonate absorption and CO2 conversion.
    • Intercalated cells in the collecting ducts regulate H+ and bicarbonate, maintaining acid-base homeostasis.

    Common Urinary Tract Infections (UTIs)

    • UTIs account for about 5% of primary care consultations; approximately 50% of women experience symptomatic UTIs during their lifetimes.
    • Escherichia coli (UPEC) is the most common cause of UTIs, distinguished from other pathogenic E. coli strains.
    • Other UTI causes include viral infections (adenoviruses, BK and JC viruses), mycobacteria, and parasitic infections (e.g., Schistosoma haematobium).

    Risk Factors and Management for UTIs

    • Congenital urinary tract abnormalities and neurological disorders can predispose individuals to UTIs.
    • Catheter-associated UTIs are minimized by avoiding catheterization and ensuring aseptic technique.
    • Prophylactic antibiotics may be beneficial for women experiencing recurrent UTIs.

    Calculating Kidney Function

    • Serum creatinine, traditionally used to assess kidney function, is affected by factors like age and gender.
    • The estimated glomerular filtration rate (eGFR) provides a better reflection of kidney function.
    • Renal failure leads to retention of nitrogenous waste, causing complications like pulmonary edema and anaemia.

    Acid-Base Disturbances in Vulnerable Populations

    • Infants and the elderly are more susceptible to acid-base imbalances due to lower plasma buffering capacity.
    • 52% of buffering capacity resides in cells, while bicarbonate accounts for 40% of extracellular buffering.

    Summary of Key Hormonal Influences

    • Estrogens boost NaCl reabsorption, causing fluid retention, especially during the menstrual cycle and pregnancy.
    • Aldosterone and ADH significantly impact renal absorption of Na+ and water, inducing changes in urine concentration.

    Interpretation of Arterial Blood Gases (ABGs)

    • Determining acid-base status involves evaluating pH, identifying respiratory or metabolic issues, and assessing compensatory mechanisms.
    • ABGs provide critical insights into patient management in conditions affecting respiratory and renal function.### Congenital Abnormalities and Urinary Dysfunction
    • Congenital abnormalities of the urinary tract include diverticula and prostatic hypertrophy.
    • Urinary reflux from the bladder to the kidney can lead to stagnant urine and residual urine issues.

    Functional Abnormalities

    • Neurological disorders, such as spina bifida and multiple sclerosis, can result in incomplete bladder emptying requiring catheterization.
    • Catheterization acts as a foreign body and may contribute to biofilm formation.

    Pregnancy and Urinary Changes

    • Pregnancy may cause dilated ureters and incomplete bladder emptying.
    • Gestational glycosuria may occur, complicating urinary tract health.

    Urinary Tract Surgery Risks

    • Surgical procedures can cause mucosal damage, making bacteria more accessible and potentially leading to urinary tract infections.
    • Patients undergoing surgery may have preoperative infections or be frequently catheterized, increasing risk.

    Bicarbonate Generation and Acid-Base Balance

    • Carbonic anhydrase in intercalated cells aids in bicarbonate generation through ammonia and phosphate buffer systems.
    • Glutamine metabolism contributes to bicarbonate and ammonium production, critical for acid-base balance.

    Acid-Base Disturbances

    • Acidosis is characterized by increased H+ (pH < 7.35); alkalosis involves decreased H+ (pH > 7.45).
    • Respiratory acidosis results from CO2 accumulation in the bloodstream.

    Renin-Angiotensin-Aldosterone System

    • Renin is released by juxtaglomerular cells, triggering angiotensin II formation, influencing blood pressure and sodium retention.

    Kidney Function Assessment

    • Renal Clearance (RC) measures the plasma volume cleared of a substance per minute.
    • Glomerular Filtration Rate (GFR) is the volume of plasma filtered into Bowman’s space, typically around 180 liters/day.

    Urinary Tract Infections in Children

    • Urinary tract infections are common among children, with risk factors including poor urine flow and history of UTIs.
    • Infections in children can indicate underlying urinary tract abnormalities and may require imaging for diagnosis.

    Kidney and Ureter Anatomy

    • Kidneys are retroperitoneal and located between T12 and L3 vertebral levels, with significant anatomical relations to surrounding structures.
    • The renal hilum opens anteromedially, and the kidney is covered by a fibrous renal capsule.

    Kidney Function and Nephrons

    • Nephrons are renal functional units comprising the renal corpuscle and tubule, critical for filtering waste.
    • Blood supply to the kidneys is regulated by sympathetic nerves, impacting blood flow and renin release.

    Ureter Anatomy and Function

    • Ureters are muscular tubes connecting kidneys to the bladder, facilitating urine transport via peristalsis.
    • Their anatomical relations include proximity to reproductive organs and crossing of the pelvic brim.

    Lymphatic and Nervous System Involvement

    • Ureters are innervated by sympathetic and parasympathetic fibers, playing a role in pain perception and urinary regulation.
    • Lymphatic drainage occurs alongside ureters with specific nodes impacting kidney function.

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    Related Documents

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    Description

    Test your knowledge of tubular structure and function in the kidney, including HCO3- and Na+ reabsorption, K+ regulation, hormonal action, and the counter-current mechanism. Review the mechanisms of urine concentration and the roles of the proximal convoluted tubule and loop of Henle.

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