Urine Luck!
Renal slides
by
Dan Cushman
Donations accepted and strongly encouraged
Lobe
Interlobar
artery
Cortex
Medulla
Renal
artery
divides into
anterior and
posterior
branches.
Renal
vein
Renal pelvis
Ureter
Kidney parasite
Parasitium nephrotium
(Just kidding, of course,
it’s a nephron)
Vessels
Name the arteries of the
kidney from largest to
smallest
1. Renal Artery
2. Interlobar artery
3. Arcuate artery
4. Interlobular artery
5. Afferent arteriole
6. Efferent arteriole
Kidney vessels
Renal
corpuscles
Cortex
Interlobular
vessels
Arcuate
vessels
Medulla
Interlobar
vessels
X10
Nephron segments
Proximal convoluted
tubule
Proximal straight
tubule
Descending limb
of Henle
Thin Ascending limb
of Henle
Thick Ascending
limb of Henle
Distal convoluted
tubule
Collecting duct
Cortex
Medulla
Renal corpuscle
(Layer)
Efferent
arteriole
Afferent
arteriole
Visceral layer
Urinary
pole
(Layer)
Parietal layer
What is the best
word in
nephrology?
Corpuscle
What is the best
structure in There really is not an
nephrology? answer to this question.
It’s more of a personal
reflection question with
no objective answer.
“Best” is hard to quantify.
Filtration apparatus
Endothelial cell
nucleus
Podocyte
Primary
process
Secondary
process
(pedicel)
Where are
large anions
repelled?
Glomerular Capillary
basement
lumen
(Glomerulus
membrane lumen)
What is this?
Can’t you read?
Mesangial cells
Visceral layer –
What are the functions of mesangial cells?
Podocyte
Efferent
a. Phagocytic – clean the basement membrane,
arteriole
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
Afferent
injury.
arteriole
Parietal layer
So… tell me about the juxtaglomerular cells.
Maculamuscle cells of the afferent arteriole.
a. Smooth
Theydensa
are innervated by sympathetic neurons
Distal and secrete renin into the blood.
convoluted
tubule
Afferent
arteriole
Juxtaglomerular
cells
Which is which?
(Brush Border)
Proximal Tubule
Distal Tubule
Which is which?
Full Bladder
Empty Bladder
Which portion
What is its main
turns into a kidney?
signaler?
Neural tube
Paraxial
Mesoderm
Gut
Intermediate
Mesoderm
Order these three chronologically
Which
one
turns
Mesonephric kidney
Pronephric kidney
into your kidney?
Metanephric kidney
Which one turns
into the ductus
deferens?
Metanephros
What
transcription
Mesonephros tubules
factor do I create?
Hindgut
Mesonephric
duct
WT1
Cloaca
Ureteric
bud
Which
induces
what other factor?
Metanephric
Mesoderm
(blastema)
GDNF
Name the defect
Pelvic
kidney
Bifid
ureter
Horseshoe
kidney
Where’s the bladder?
Here
Where’s the
love?
All around us
Normals
Property
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
Substances
Substance
Importance
PAH
CPAH = ERPF
Inulin
Cinulin = GFR
Creatinine
Ccreatinine = GFR (overestimate)
Match each to a line
Filtered
Excreted
Secreted
Will the hypertonic gradient in the
medullary interstitium ↑ or ↓?
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
↓
Match transporters with location
Thick ascending
loop of Henle
Na/HCO3
antiport
Thin ascending
loop of Henle
Na/glucose
symport
Descending
loop of Henle
Na/H antiport
Proximal
Tubule
Na/K/2 Cl
symport
How do V2 receptors function?
They are localized in the basolateral
What
causes
ADH
release
(6)?
membranes of principal cells.
Activation of V2 receptors elevates
•Increase in plasma osmolarity (1-2%
cyclic AMP in these cells, which leads to
threshold)
insertion of water-permeable channels
•Reduction in circulating blood volume (>10%)
(AQP2) into the lumenal membrane.
and blood pressure
•Angiotensin II
•Stress (physical or emotional), pain
•Nausea
•Standing upright (→orthostatic antidiuresis)
What percentage is reabsorbed in
each section?
65%
65%
Na
H2O
Coupled with
which anions?
Cl- (50% of its
filtered amount)
and HCO3- (90%)
25% Na
15% H2O
Cl- (33% of its
filtered amount)
Coupled with
which anions?
Where is the lower O2 content?
The cortex
The medulla
Rearrange these urea transporters
to make a face.
Order these in terms of reaction
speed
Baroreceptor
reflex
Fast
Renal control
of body NaCl
Medium
Angiotensin II
Slow
Renal Regulation: High,
Intermediate, or Low?
Intermediate
Low
[Cr]P ↑ as nephrons are lost
HCO3Creatinine
Low
Urea
High
Na+
High
Water
Intermediate
Ca2+
Match the lines
Which will have
the greatest
osmolarity?
Saline
Saline
Glucose or water
Alcohol
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
Each caused by what?
↑ perfusion pressure,
NE, (ATII)
↑/↓
↑/↓
↑/↓
ATII
↑/↓
↑/↓
↑/↓
ATII
↑/↓
↑/↓
↑/↓
What will increase FENa?
Constriction orDilation
Dilation of efferent arteriole
Increase orDecrease
Decrease activation of RAA system
Increase or Decrease
Increase secretion of natriuretic
hormones
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
Aldosterone
Direct stimulants (2):
MostActs
importantly,
on (2):
what happens to
PrincipalFENa?
cells do what (4):
↑ [K+]plasma, ATII
Late distal tubule,
collecting ducts
- 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
It decreases!
Intercalated cells do what (1):
- Increased lumenal H+-ATPase activity
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
Choose: Osmoregulation or
Volume Regulation?
Osmoregulation
Senses plasma osmolality
Osmoregulation
Regulates ADH, thirst
Volume Regulation
Affects urine Na excretion
Volume Regulation
Takes days to occur
Volume Regulation
Edema is a physical sign
Volume Regulation
ADH, ANP, RAA system
Volume Regulation
(Sensor)
Baroreceptors
↑ Sympathetics
(hormone)
↑ Renin
↑ ATII
Name the three substances that
increase the Na/K ATPase activity
1
1
2
3
2
2
Which side represents a reaction
to a state of low K+?
What exchange occurs in
principal cells?
Na+ in, K+ and H+ out
What exchange occurs in
intercalated cells?
K+ in, H+ out
Effect on K+ excretion
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 HCO3- Reabsorption
Property
Inc/Dec
Decreased filtered load of HCO3-
↓
Increased arterial pCO2
↑
Low angiotensin II
↓
Respiratory acidosis
↑
Decreased ECFV
↑
↑ Aldosterone
↑
Effect on Ammonium Excretion
Property
Inc/Dec
K+ elevation
↓
Acute respiratory acidosis
↑
Metabolic acidosis
↑
Acidic urinary pH
↑
Effect on Titratable Acidity of Urine
Property
Inc/Dec
High pH
↓
Increased filtered load of phosphate
↑
Decreased PTH
↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
↑/↓
Hyper- or Hypokalemia?
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
Name the drugs
B (3 drugs)
A
Identify
the
following
Metabolic alkalosis
Chronic respiratory
acidosis
Chronic respiratory
alkalosis
Acute respiratory
acidosis
Effect (Plasma)
[Na]
pH
[Na]
[K]
[Ca]
↓
↑/↓
↑
↑/↓
[Mg]
Pi
HCO3
ADH
↑/↓
↑/↓
Aldost Met Ac Met Alk
↓
↑/↓
↓
↑/↓
pH
[K]
↑
↑/↓
[Ca]
↑
↑/↓
↓
↑/↓
↑
↑/↓
↓
↑/↓
Cause (high)
[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!
Actively
reabsorbed.
Known
Is Na+ reabsorbed
or secreted
as
the first
cortical
in the
2/3 diluting
of the distal
segment.
convoluted tubule?
By what mechanism is it
reabsorbed?
By a wide variety of Na+linked lumenal transporters
and solvent drag.
And finally,
whatand
about
Reabsorption
occurs
is the late
distal convoluted
tubule and the
stimulated
by aldosterone.
collecting duct?
What diuretics work here?
K+-sparing
diuretics.
X
What diuretics work here?
Thiazides.
What diuretics work here?
Is Na+ reabsorbed or secreted
in the thick ascending limb of
the loop of Henle?
Reabsorbed via the Na+, K+, 2Clco-transporter. Known as the
Neither! For
the most
part, the
medullary
diluting
segment.
+ reabsorbed
Is
Na
or
secreted
thin descending limb only
in
the thinwater.
descending limb of
reabsorbs
the loop of Henle?
Is Na+ reabsorbed or secreted
in the thin ascending limb of
thereabsorbed.
loop of Henle?
Passively
Carbonic Anhydrase Inhibitors
What diuretics work here?
Loop-acting diuretics.
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)
Mg2+: No movement
What is reabsorbed in the thin descending limb of the
loop of Henle?
Mainly just water!
In the thick ascending limb of the
loop of Henle, what is reabsorbed?
Na+, K+, Cl-, Ca2+, Mg2+
In the thin ascending limb of the loop
of Henle, what is reabsorbed?
Na+, Cl-
What is secreted?
Urea (60%-110%)
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+: Reabsorbed
Urea: Reabsorbed (40% to 70%)
(only in the medullary region)
K+: Reabsorbed or secreted
Water: Reabsorbed (only w/ ADH)
Mg2+: No movement
Pi:
No movement
Ca2+: No movement