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Renal System I
TaskOriented Learning Objectives – Week 1
Lecture 1: Introduction to Kidney Function (Laiken)
General functions of the kidney
1. List and briefly describe the major functions of the kidney
1. Regulate water and electrolyte balance
2. Regulate acidbase balance
Regulates HCO3 excretion, and synthesizes new HCO3
3. Excrete metabolic waste
Urea, uric acid, creatinine (used to evaluate kidney function), pigments
4. Excrete hormones, drugs, and metabolites
need to alter drug doses in patients with kidney diseases
5. Regulation of BP
Barorereceptor reflex is important for short term BP
Kidney is important for long term because it regulates
extracellular fluid volume, and regulate vascular
resistance It does this by affecting it so the Na
volume is okay
6. Regulation of RBC production
rate of production is controlled by erythropoietin
patient with kidney disease are often anemic
7. Synthesize VitD
Vitamin D is eaten in food/skin and it is altered in
liver, and then activated by kidney
8. Gluconeogenesis – mostly in liver but can also occur in kidney
2. Define balance, explaining why longterm balance at steady state must equal zero for water and electrolytes
In a nongrowing, normal, nonpregnant adult, balance = inputoutput
Balance has to be zero in the long term
Constant ratio of solutes to water for constant plasma osmolarity
3. As a review from Cardiovascular System I, define homeostasis and explain why the negative feedback loop is an
important mechanism for homeostasis – tendency for individual to maintain stable internal environment
Functional anatomy of the kidney
4. Given a cross section of a kidney, identify the renal cortex, renal medulla, medullary
pyramids, renal calyces, renal pelvis, ureter, hilum
In the Medulla, there are pyramids, and the tip of each pyramid is the papilla
The hilium is where the ureter leaves the kidney and blood vessels and nerves come
in
Only sympathetic innervation
5. Distinguish between cortical (superficial, midcortical) and juxtamedullary nephrons based
on the location of the glomerulus and the length of the loop of Henle
Functional unit: nephron (made up of renal corpuscle and a tubule)
Tubule makes makes loop of henle
MODIFICATION OF TUBULAR FLUID
Renal corpuscle – have bowman’s capsule and glomerulus
Important for GLOMERULAR FILTRATION
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
You can have cortical or juxtamedullary nephron depending on where the renal corpuscle is
If it is far from the medulla, it is cortical, if it is close to medulla, it is juxtamedullary
Cortical is short looped (8090%)
Juxtamedullary is longlooped (1020%) goes far into the medulla
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
6. Describe in sequence the vessels through which blood flows
when passing from the renal artery to the renal vein,
identifying a unique feature of the kidney’s vascular bed
Has high reflection conefficient (sigma = 1) –
FENETRATED CAPILLARIES IN GLOMERULAR
CAPILLARIES – which means not that much protein can
get out
And has the highest resting blood flow/unit mass, has low
AV O2 concentration difference because high BF
Two capillary beds in series
Renal artery has branches into arcuate arteries which run on the border of medulla and cortex
The cortex gets branch of arcuate arteries called interlobular artery which divides into efferent
arterioles for the 2nd capillary bed
For the cortical nephron, you get the peritubular capillaries
for the juxtomedullary is the vasa
recta
7. Given a drawing of the glomerular portion of the nephron,
identify the afferent and efferent arterioles, glomerular
capillaries, mesangial cells, Bowman’s capsule,
juxtaglomerular apparatus
Afferent arteriole comes in and out at the vascular
pole
Urinary Pole is where the bowman’s capulse is
connected to the tubule
Mesangial cells (?)– in spaces, matrix of connective
tissue, smooth muscle cells, phagocytes, regulate amount of filtration
Capillary endothelium fenetratration
8. Describe the three layers comprising the glomerular filtration barrier
9. Describe in sequence the tubular segments of the nephron
1. Proximal tubule
2. Loop of Henle
different sizes refers to the squamous/cube epithelium
Between the corpulse and the loop of henle is the
JUXTAGLOMERULAR APPARATUS
Macula densa comes back to corpsule
This monitors solute delivery and flow to
distal nephron
Send signals to afferent arteriole to regulate glomerular filtration and RBF
Affects renin secretion sends signal to granular cells
Granular cells – smooth muscle cells, renin
Extraglomerular mesangial cells
3. Distal nephron
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
nephrons share collecting ducts (23 to one) , collecting duct technically part of the urinary tract
10. Describe in sequence the structures of the urinary tract
Inner medullary collecting duct minor calyx major calyx renal pelvis ureter bladder
internal sphincter external sphincter
Basic processes in the kidney and their quantification
11. Compare the filtration of fluid in systemic capillaries vs. glomerular capillaries, keeping in mind that filtration in
all capillaries can be described by the Starling equation
in typical capillaries <0.1% goes into interstitial fluid and
all capillaries filter 4 L/day
Glomerular capillaries filter 20% into Bowman’s space = 180 L/day
(this is the glomerular filtration rate GFR)
Filtrate includes small proteins and electrolytes, no RBC and
plasma proteins
They are carried across using convective transport –
dragged out by fluid filtering out
12. Define and list typical normal values for renal blood flow (RBF), renal
plasma flow (RPF), glomerular filtration rate (GFR), and filtration fraction
(FF)
GFR = 180 L/day
FF is 20% = GRF / RPF (?)
Filtration fraction in Glomerular capillaries is two orders of magnitude larger than FF in typical capillaries
13. Given the cardiac output and hematocrit in a normal individual, predict the RBF, RPF, and GFR
14. Define glomerular filtration, tubular reabsorption, tubular secretion, and urinary excretion
Tubular reabsorption = TF blood
Tubular secretion = blood TF
15. Use the four terms described in TOLO 14 to write a general equation that summarizes the kidney’s handling of a
substance (the “fundamental law of the kidney”)
Excretion = filtration + secretion – reabsorption
16. Identify the abbreviations and describe the units that are most commonly used in kidney physiology for the
plasma concentration of solute X, urine concentration of solute X, urine flow rate, rate of tubular reabsorption of
solute X, and rate of tubular secretion of solute X
Px = plasma concentration
Ux = urine concentration, same units
V (ml/min, L/day) = Urine flow rate
Rx = tubular reabsorption
Sx = tubular secretion
17. List the typical normal plasma concentrations (in mM) of sodium (P Na), potassium (PK), chloride (PCl), and
bicarbonate (PHCO3)
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
18. Define the rate of filtration of solute X, describe its units, and write an equation for calculating the rate of
filtration of (a) a freely filtered solute; (b) a solute that binds to plasma proteins (assume that f u is the fraction of
the solute that is unbound)
Rate of filtration = amount of solute filtered per unit time = fu* Px * GFR – dragged by convective transport
Assumes that the solute is freely filtered – easy to drag (less than 5 KDa) and not bound to albumin
Fu =1 if freely filterable
GFR = volume of plasma that is filtered per unit time – which drags the solute
Rate of excretion = Ux * V
Fundamental law of kidney =
19. Define the rate of excretion of solute X, describe its units, and write an equation for its calculation
20. Use the quantities and symbols defined in TOLOs 16 and 1819 to write the Excretion = Filtration + Secretion –
Reabsorption equation (the “fundamental law of the kidney”) for solute X (assume that X is freely filtered), then
write a modified form of the equation for
(a) a solute that is filtered but not reabsorbed or secreted (creatinine) = UxV = PxGFR
(b) a solute that is filtered and reabsorbed but not secreted = UxV = PxGFR Rx
(c) a solute that is filtered and secreted but not reabsorbed = UxV = PxGFR + Sx
(d) a solute that is filtered, reabsorbed, and secreted with reabsorption > secretion (net reabsorption)
UxV = PxGFR – net Rx
(e) a solute that is filtered, reabsorbed, and secreted with secretion > reabsorption (net secretion)
UxV = PxGFR + net Sx
(f) water = V (urine flow rate) = GFR – RH20 (volume/time)
Overview of kidney function and its regulation
21. List the major electrolytes, nutrients, and waste products that represent the “cast of characters” for Renal System I
Electrolytes (NaCl, K, Bicarb, Phosphate, Ca, Mg), nutrients (Glucose, AA, waste (creatinine, urea, uric
acid)
22. Starting with a template of the “favorite figure” for Renal System I (posted on the course website):
a) Label the epithelial cells, blood vessels, and granular cells
b) Identify the segments of the tubule that (1) are always permeable to water; (2) are never permeable to
water; (3) have ADHregulated water permeability
Proximal tubule is always permeable
Loop is never permeable
Distal tubule is permeable to ADH
c) Label and briefly describe the reabsorption of (1) sodium plus anions; (2) water
Sodium
o Proximal tubule 60% Na absorbs, water follows
o Loop – thick AL – absorb 25% Na, water does not follow
o
d) Identify the concentrating and diluting segments
Diluting segments is the thick AL, DCT, CNT, CD (wihout ADH)
Concentrating : CD with ADH
e) Define and label the medullary gradient
Gradient in the medulla, in the presence of ADH, you can draw out more water than solute
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
describe two mechanisms for regulating its secretion, identifying the mechanism that is most important in the
minutetominute regulation of kidney function
ADH made in hypothalamus in posterior pituitary
Regulates water permeability and urea permeability of inner medullary CD
o Urea contributes to the medullary gradient so it gets reabsorbs to inc water reabsorb
Less stretch on arterial BR, or increased osmolarity (in hypothalamus), you get increased ADH
b) For Ang II, review its synthesis and the regulation of its secretion from Cardiovascular System I (also to be
reviewed in the ACE Inhibitors and ARBs lecture); briefly describe the direct and indirect mechanisms for its
slow pressor effects; briefly explain why it is
appropriate to use the term RAAS instead of RAS
when discussing Ang II
Direct Ang II increases reabsorption of Na
in PT, DCT, and CNT/CD, which inc water
reabsorb
Indirect inc aldosterone, which increases Na reabsorption in CNT/CD
c) For aldosterone, identify its site of synthesis and secretion; list its major effects on tubular transport; and
briefly describe two mechanisms for regulating its secretion
Secreted by adrenal cortex, and is stimulated by Ang II, and Pk
Causes Na reabsorption and increased K+ secretion in CNT/CD
d) For ANP, review the regulation of its secretion from Cardiovascular System I; briefly describe its effects on
the tubular transport of sodium, appreciating that its effects on sodium are opposite to those of Ang II and
aldosterone
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Released in atria by stretch, and will decrease Na reabsorption in CD
Decrease Renin secretion
e) For the sympathetic division, briefly describe its general effects on kidney function, identifying one direct and
one indirect mechanism for these effects; briefly describe a
mechanism for initiating an increase in sympathetic tone to
the kidneys
Reduced stretch of arterial BR inc
sympathetic tone to kidney
Direct increases sodium reabsorption
Indirect increase renin secretion
f) Appreciate that PTH is involved in regulating the
excretion of the bone minerals
g) Appreciate that the regulators of RBF and GFR include
Ang II, the sympathetic division, ANP, and other
mediators (e.g., adenosine, vasodilator prostaglandins,
NO)
26. Draw a schematic of a simple negative feedback loop for a physiological parameter (e.g., BP), defining its
components
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Lecture 2: Body Fluids (Laiken)
1. Define the following major body fluid compartments and indicate the size
of each as a percentage of body weight: total body water (TBW),
intracellular fluid (ICF), extracellular fluid (ECF), interstitial fluid (ISF),
plasma
Total body water = 60% of body weight
1/3 of that is ECF (20%), 2/3 is ICF (40%)
2. Describe the use of the dilution principle to measure plasma volume, ECF, and TBW, identifying the marker
substances used in such measurements
Volume = amount / concentration.
Give a specific amount of maker and measure the concentration to get
the volume
3. Compare the ionic composition and osmolality of ECF and ICF
There is cell membrane so there is difference between ECF and ICF.
However, in ECF, the plasma and the ISF is very similar except plasma has more plasma proteins
4. Describe the GibbsDonnan effect and explain its effects on the composition and osmolality of plasma vs. ISF
Plasma has more cations, the ISF has more anions. This is because in plasma, proteins are anions so they
attract cations
There is potential difference across tubular epithelium in the nephron which is important!!!
5. Define osmolality, isoosmotic, hyperosmotic, hypoosmotic
Plasma osmolality (Posm) = 290 mmOsm/kg H20
Main contributions to Posm is electrolytes, glucose, and urea
Isoosmotic, solution with osmolality = Posm
6. Define the isoosmolality principle, explaining why the body fluids are iso
osmotic
Isoosmolality principle – all body fluids have same osmolality
because cell membranes have aquaporins so water is freely permeable.
And paracellular and small pore system movement
7. Identify the major solutes that contribute to P osm and write an equation for
the calculation of Posm that includes the contributions of these solutes
8. Describe two situations in which the approximation Posm ≈ 2 PNa is not valid
Not enough time to equlibriate and in the kidney where its not permeable to water
9. List important exceptions to the isoosmolality principle
Plasma vs ISF, Plasma Osm is higher because it has plasma proteins which attract more ions into
the plasma
When considering the plasma osmolarity, the additional proteins does not affect Posm that much so
you can assume plasma and ISF are equal. However, when considering water, you cannot do that
because the proteins drive water movements
10. Describe the gradients that drive the movement of water
(a) between ECF and ICF; osmotic gradients,
(b) across the tubular epithelium in nephron segments that are permeable to water; osmotic
gradients
(c) between plasma and ISF; net filtration pressure in starling equation, oncotic and water
pressure gradients
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
(d) across the filtration barrier during glomerular filtration : starling equation, net filtration
pressure
11. Define effective circulating volume (ECV), explaining how it differs from ECF
Effective circulating volume = related to Extracellular fluid. Part of the ECF that can activate
mechanisms that can affect changes in Na excretion
ECV – part of ECF in arterial system, can affect by arterial stretch
Normal patients, ECV = ECF but in disease states, these can be different
12. Briefly explain why abnormalities in PNa and Posm are important, appreciating
that these abnormalities generally are disturbances of water balance
13. List the assumptions that commonly are made when calculating the effects of
fluid and electrolyte perturbations on PNa and Posm
1. Assume isoomolality – all are equilibrium
2. Π is ignored. Only contributes 1.1 osm anyways in capillary endothelium
3. Na and K are only osmoles that affect water movement across ECF and ICF, assume they stuck
on either side
14. Write two important total body equations that can be used to calculate the effects of fluid and electrolyte
perturbations on PNa and Posm
TB = total body
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Lecture 3: Quantification of Kidney Function (Ix)
1. Define filtration, secretion, reabsorption, and excretion
Filtration – process of water and solutes remove from vascular system go through Bowman’s space
Secretion – move from peritubular capillaries to tubular lumen
Reabsorption – opposite of secretion
Excretion – remove from body
2. Explain the clearance principle, write an equation for calculating the clearance of solute X (C x), and describe the
units of clearance
Clearance – measure of rate of removal of substance from the plasma
Units = volume of plasma per unit time from which all of a substance is removed (ml/min)
Clearance – imaginary volume that no longer has any of the unit, by pushing all of the units to one volume
that would have the same concentration as before
3. Describe how the clearance equation and an appropriate compound can be used to measure the GFR
Inulin is fiber, which is not absorbed by GI and is soluble by water, 5.8 kDa
If you inject it, it is freely filtered in glomerulus, not reabsorbed, not secreted, not made in kidney or
metabolized, or affect the function, and you can measure it in the urine and blood
So therefore, inulin filtered = inulin excreted in urine so
Inulin =GFR, and rate of filtration = rate of excretion
Since Pin * GFR = Uin * V
4. Compare the use of inulin clearance and creatinine clearance as measures of GFR
Creatinine is produced by muscles at constant rate, freely filtered, not reabsorbed, there is 15% secretion
into urine, and if there is problem with kidney, it will have decreased filtration but okay secretion
If you ignore secretion, you have endogenous marker for GFR
5. Identify the most common problem encountered in measuring an accurate creatinine clearance
Needs empty bladder at start of collection and have to get precise collection of urine at an allotted time
You can also do this without collecting urine because high serum creatinine means low GFR
6. Explain the use of creatinine excretion (UCrV•) as an indicator of timed urine collection accuracy
It is easier to use than inulin because you do not need to constantly take in inulin
7. Explain why PCr can be used to estimate GFR, and write the equation that is most commonly used to estimate
GFR from PCr
It can be used to estimate GFR if you do not take into account that some of it is also secreted.
GFR = Ucr* V / Pcr
You can also estimate GFR clearance by considering muscle
mass
8. Describe important examples of errors that can result when GFR is estimated from P Cr
15% of urine creatinine is secreted
Therefore, the predicted value overpredicts the GFR and some drugs can increase creatinine secretion
Relationship of serum creatinine to GFR is not linear and a lot of GFR loss has to cause change in serum
creatinine
Have to consider muscle mass for different gender
You also assume serum creatinine is in steady state and it takes a long time to get there
After surgery, you get increasing serum creatinine, which eventually reaches steady state. At that
point, the amount made by muscles = amount excreted, and this looks the same as before the
surgery
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Therefore, clearance is a better indication that the
amount excreted
EXCRETION IS DIFFERENT THAN CLEARANCE
9. Describe how the clearance equation and an appropriate compound can
be used to estimate the RPF
EXCRETION does not tell you kidney function. Even if you have
one less kidney, since you are exposed to a higher level of serum
creatinine, you can get the same amount out that you did before
Clearance tells you kidney function
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
10. Explain how tubular fluid concentration/plasma concentration (TF/P) ratios for inulin (or creatinine) can be used
to determine the fraction of the filtered water that is reabsorbed in a given segment of the nephron
by seeing the TF/P ratio go up, it is not because inulin is getting secreted, but because it is getting more
concentrated with less water
11. Explain why the TF/P ratio for a substance other than inulin (or creatinine) does not provide complete information
about the renal handling of that substance
You have to compare it to inulin because you need to know baseline of whether it is reabsorbed, or
secreted, and how much of the increase in the ratio is due to water reabsorption
12. Explain how a comparison of the TF/P ratio for a substance to the TF/P ratio for inulin (or creatinine) can be used
to determine whether a substance is reabsorbed or secreted in a given segment of the nephron and to quantitate the
amount of reabsorption or secretion in that segment
Since you know that inulin is not reabsorbed or secreted, any more or less of a ratio for TF/P for the other
substance can determine if it was secreted or absorbed and where the ratio changes
13. Explain how the TF/P ratio for a substance in Bowman’s space can be used to determine if the substance is freely
filtered
If the TF/P ratio is not 1 at Bowman’s space, that means that the substance is not freely filtered
14. Define fractional excretion
Since you cannot do micropuncture in humans, you can understand overall picture of kidney’s health
Fraction excretion: for any substance, the percent filtered at the glomerulus that is
excreted in the urine
Rate of excretion / rate of filtration
15. Write two equations for calculating the fractional excretion of a substance (FE X), including
one equation that allows fractional excretion to be calculated without a timed urine collection
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Lecture 4: Renal Blood Flow and Glomerular Filtration Rate (Laiken)
1. Apply the general resistance equation and Starling equation to RBF and GFR, respectively
V=IR, Q = P/R,
2. Explain the physiological reasons for the following unique characteristics of the kidneys:
a) Blood flow per 100 g tissue is highest of all organs
Vascular resistance is lower in the kidney because it has multiple resistances in parallel and all
capillaries are always open
The pressure perfusing the kidney = delta P = MAP RAP
b) O2 consumption per 100 g tissue is highest of all organs except the heart
Need for transporters for reabsorption and active transport
In the heart, if there is not enough O2, you can increase CBF to protect against ischemia.
However, if you do this in the kidney to increase its blood flow, you also increase the GFR so
its O2 demand increases
c) (Cao 2 – Cvo2) difference is the lowest of all major organs
3. List the approximate Po2 in the renal artery, renal cortex, renal medulla, and renal vein, explaining how
preglomerular shunting and countercurrent O2 exchange affect Po2 in the renal cortex and medulla
Preglomerular shunting – artery and veins are tightly packed so sometimes, the O2 molecule will
go from artery to vein without going to cortex.
Therefore, cortex and medulla have low PO2
PO2 in cortex = 45 mmHg, and PO2 in medulla is 30 mmHg
PVo2 = 70 mmHg. It is high venous PO2. And even if you raise the PaO2, you cdo not
improve the cortex and medulla. There is also very low medullary flow as well
4. On a graph of pressure (yaxis) vs. distance along the renal vessels (xaxis), plot the approximate
hydraulic pressure from renal artery to renal vein, estimating the
contribution to
the renal vascular
resistance (RVR)
of each of the
following
vascular
segments: afferent
arterioles;
glomerular
capillaries; efferent arterioles, peritubular capillaries
5. Compare the Starling equation for GFR to the Starling equation for filtration in a typical capillary (e.g.,
skeletal muscle capillary)
Pgc = Pressure pushing out of glomerular capillary into bowman’s capsule
Pbs = Pressure putting out of bowman’s capsule into capillary
There is no protein filtered so there is not much oncotic pressure in bowman’s capsule
6. On a graph of pressure (yaxis) vs. distance along a glomerular capillary (xaxis), plot the pressures in the
Starling equation (PGC – PBS, πGC), indicating the net filtration
pressure and the point at which filtration equilibrium occurs;
compare this graph to a graph of Starling pressures vs. distance
along a typical capillary (e.g., skeletal muscle capillary)
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
filtration equilibrium – the oncotic pressure catches up to the pressure difference
Net filtration pressure is larger in typical capillaries but the Kf in the GCs is 1000x greater than in
typical capillaries – because they are FENESTRATED and selective for cations (liver only make
25 mg of albumin per day)+ small molecules
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
7. Compare the filtration fraction in the glomerular capillaries to the filtration fraction in typical capillaries,
explaining why the former is much higher
Filtration fraction in GC is 20 while FF in capillaries is 0.1%. The GC is high because there is
fenestratation that allow for more filtration
8. Describe the features of albumin and the filtration barrier
that result in a normal filtration fraction for albumin of
less than 0.1%, explaining why a low albumin filtration
fraction is important
There is size selectivity in filtration barrier in the
foot processes of the podocytes and the
glycocalyx
There is charge selecticity in all of the filtration
barrier layers
Albumin is retarded by all of these because liver only makes a little per day
9. Compare the effect of changes in afferent arteriolar resistance (R AA) on RVR
and PGC to the effect of changes in efferent arteriolar resistance (R EA) on RVR
and PGC
If you increase Raa or Rea, you will get increase in the RVR
However, if you increase Raa, you will get dec Pgc. If you increase Pea, you will inc Pgc
10. Define autoregulation and describe two mechanisms for autoregulation of RBF and GFR, listing the
sequence of events in the autoregulatory response to a change in blood pressure
Autoregulation – constant flow over wide range of pressures, most efficient in the kidney
1. Done through the myogenic response, can occur only in afferent arterioles to keep PGC constant
and increase RVR
2. Tubloglomerular feedback – when the macula densa comes back, can send signals to afferent
arteriole to regulate RBF and GFR
monitor NaCl (inc NaCl will lead to AA constrict) and sense changes in flow
You pee a lot because caffeine is adenosine inhibitor so you get increased RBF
If you have too little NaCl, you will get increase PGE2 to get dilated AA
slower than myogenic response
11. Given that both RBF and GFR are autoregulated, identify the major site of the autoregulatory changes in
renal vascular resistance
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
12. Predict the acute effect on RBF and GFR of decreased solute reabsorption in each of the following
nephron segments: proximal tubule, thick ascending limb, distal nephron
13. Compare the tubuloglomeraular feedback (TGF) mechanism for the autoregulation of RBF and GFR to
the macula densa mechanism for the regulation of renin secretion
TGF happens in the macula densa cells as well in response to increased NaCl and then they release
adenosine which causes vasoconstriction
PRIORITIZE KIDNEY CONSTANT FOR SOLUTE DELIVERY
The adenosine will also act on renin and decrease its secretion from the granular cells, which
would decrease Ang II
PRIORITIZE REGULATION OF BP because maybe NaCl is too large in general, not
increased flow
If NaCl is too small, then PGs will be released instead of adenosine
14. Compare the resetting of the autoregulatory plateau in the renal circulation to the resetting of the plateau
that occurs in the coronary circulation
Neural and hormonal inputs can reset kidney plateau
In coronary circulation, it will be changes due to metabolic needs
15. On a graph of nephron filtration rate (SNGFR, yaxis) vs. flow rate to the macular
densa (xaxis), illustrate the TGF response, and (a) identify the portion of the
curve where TGF is most efficient; (b) explain why the TGF curve shifts in
response to persistent changes in flow rate to the macula densa (e.g., due to a
persistent hormonal effect)
It is most efficient right in the middle because it can increase and decrease
easily
If it does not shift, then there will not be anywhere that TGF can adjust
with
16. With the aid of the Starling equation for GFR, describe regulators,
physiological changes, and diseases that can change the GFR
RPF is also important regulator of GFR
If you have increased RPF, you will have more fluid
to work with, which will decrease the rate of rise of
the oncotic pressure
17. Make three copies of the graph constructed in LO 6; on each graph
plot the pressures in the Starling equation (PGC – PBS, πGC) for one of
the following RPF examples, indicating the net filtration pressure,
the point at which filtration equilibrium occurs (if applicable), and the effect on filtration fraction:
(a) decreased RPF;
(b) increased RPF with filtration equilibrium;
(c) increased RPF with a failure to reach filtration equilibrium
18. Describe the regulation of RBF and GFR by the sympathetic division of the ANS, appreciating that these
effects occur only at high levels of nerve traffic
You get vasoconstriction in AA which will decrease RBF and GFR
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
This is initiated during BRR response to decreased BP, so the kidney gives itself up for brain and
heart
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
19. Describe the regulation of RBF and GFR by hormones and other endogenous mediators
Andeonsine – constricts, mediator for TGF for autoregulation
Ang II, constricts AA and EA. EA is CONSTRICTED MOE
ADH – decrease blood flow to inner medulla to form more concentrated urine, vasoconstriction
ANP – Dilates AA and minor constriction of EA
Decreased RVR and Raa will lead to increases in RBF and GFR
Vasodilator prostaglandins (PGE2, PGI2) – mediators in TGF and dilates AA
If you eat too many NSAIDs, you get vasoconstriction
NO – vasodilator, increased by Ang II
20. Describe the changes in RBF and GFR that occur during pregnancy, following a proteinrich meal, and after the
removal of one kidney
Pregnancy increases RBF and GFR by 3035%
Proteinrich meal increases RBF and GFR – help elimination of urea, can involve TGF
AA in TF will go up, so then NaAA cotransport reabsorption will increase. Therefore since there
is decreased NaCl which will go to the macula densa, which will increase RBF, and GFR
Removing one kidney – acute response will decrease GFR by 50%
Long term, hypertrophy and eventually get back to 7585% of baseline
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Lecture 5: TBL: Body Fluids (Laiken)
1. List the assumptions that commonly are made when calculating the effects of fluid and electrolyte perturbations
on PNa and Posm
1. Isoosmolality principle
2. Ignore oncotic pressure
3. Na, K and accompanying ions are only osmoles that can affect
water movement between ECF and ICF
2. Write two important total body equations that can be used to calculate the
effects of fluid and electrolyte perturbations on PNa and Posm
3.
Explain why it almost always is necessary to start with a total body equation from LO 2 when calculating the
effects of fluid and electrolyte perturbations on PNa and Posm
A change in intracellular or extracellular solute will change osmolality and fluid shifts can only be
predicted with Total body equation
4. Given the body weight and PNa or Posm of a normal, nonobese young adult male and an intervention in which a
specif ic amount of water, sodium, potassium, or osmoles is added to or lost from the body,
a) calculate the effect of the intervention on PNa and Posm;
if you lose any sodium, potassium ion, it will decrease the overall Posm so you have to use total body
equation
(b) describe the effect of the intervention on ECF and ICF (increase, decrease, no change)
if you lose sodium, it comes out of the ECF
if you lose potassium, it comes from the ICF
5. Given the body weight of a normal, nonobese young adult male with an abnormal P Na or Posm, calculate the
specific amount of water, sodium, potassium, or osmoles that was added to or lost from the body to produce the
abnormal PNa or Posm
If you get additional water, the osmoles in TB, ECF and ICF stay the same
1/3 comes from ECF and 2/3 comes from ICF
6. Define tonicity, explaining how it differs from osmolality
Osmolality – total concentration of all solutes
Effective osmolality (tonicity) – concentration of effective osmoles
o Effective osmoles include Na, and other ions, and glucose
7. Define effective osmole and ineffective osmole, identifying the most
important physiological examples of each
Effective osmoles – cannot freely cross cell membranes, like
Na, glucose
Ineffective osmoles – Urea, can cross most cell membranes
(except some places in kidney)
8. Define isotonic, hypertonic, and hypotonic, predicting the fluid shifts that
would occur if a RBC is placed in solutions of different tonicities
9. Compare glucose and urea as osmotic solutes
Glucose is an effective osmole, and urea is an ineffective osmole
10. hyponatremia
Appreciate that most patients with hyponatremia have hypotonic
This is because sodium is the major contributor to the tonicity
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
If it is hypertonic hyponatremia, it is because of glucose, which will shift water from ICF to ECF,
leading to hyponatremia
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Lecture 6: Tubular Function 1 (Vallon)
1. For an individual on a normal diet, list the fractional reabsorption (FR) of water and sodium
Filter more than 99% of water and sodium
GFR is the determinant of how much O2 your kidney needs because you basically filter out all your water
and sodium
If you get older or have kidney disease, you have decreased ability to concentrate urine
Generally, healthy human has max urine osmolarity of 1200 and needs to lose 0.5 L to get rid of it
If you have max 300 osm/kg concentration, and you injest 600, you need to pee 2 L per day
2. Name the factor that determines the rate of sodium excretion (mEq/day)
The amount of salt you take in is the amount that should be excreted
3. List four routes for water output from the body, identifying the output that is most closely regulated
2/3 Water in PCT that follows the NaCl
4. Appreciate that the kidney must be able to regulate solute (NaCl) and water balance independently
5. List a typical normal plasma osmolality (Posm) and the typical range for urine osmolality (Uosm)
Normal Posm is 290
Typical range is up to 1200
6. Estimate the fluid intake needed to excrete an osmotic load of
600 mOsm/day if Uosm is equal to the normal: a) maximum Uosm;
b) Posm; c) minimum Uosm
Max Usm is 1200 so you would need 0.5 L, min is 300
so you would need 2 L
7. Define isosmotic reabsorption, list four general steps involved
isosmotic reabsorption from the proximal tubule (PT) into the
peritubular capillaries, and list the driving forces for each step
8. For transcellular solute reabsorption:
a) Describe the energy sources for primary active transport and for secondary active transport in moving
solutes against their electrochemical gradients
Energy source for primary active transport is ATP to create the sodium gradient
The secondary active transport brings sodium and another ion across
Example: Sodium glucose cotransporter SGLT
b) Name examples of antiporters (exchangers), symporters (cotransporters), uniporters, and channels that are
important in tubular epithelial cells in the kidney, identifying those that also are important in intestinal
epithelial cells in the GI tract
Na H antiporter exchanger – NHE3
GLUT2 – get glucose on onside side
9. Describe the driving force and pathway for paracellular solute reabsorption and list
important examples of solutes reabsorbed by this route in
the PT
Leaky tight junctions are permeable only to select
ions
This is passive transport, esp in PCT!!!
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
10. Compare the Starling equations for glomerular filtration and peritubular capillary reabsorption, identifying values
that they have in common and explaining the reasons for values that differ
For transfer from interstitium to peritubular is governed by starling
Naturally, the hydraulic pressure drives capillary interstitum
However, the oncotic pressure in capillary is much larger than the insterstitum
If you increase FF, then you increase oncotic pressure and H20 reabsorb, and dec hydraulic pressure
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
On a graph of pressure vs. vessel length, diagram the hydraulic pressure difference and oncotic pressure difference
along the glomerular capillary, efferent arteriole, and peritubular capillary; make two copies of this graph, and on
each add the hydraulic pressure difference and oncotic pressure difference after one of the following
interventions, predicting the effect of the intervention on PT reabsorption (note that this TOLO is discussed in the
Starling Forces in the Renal Circulation ISM, which represents an Additional Reading for this lecture):
Isolated increase in GFR (i.e., increase in GFR with no change in RPF)
Isolated decrease in GFR (i.e., decrease in GFR with no change in RPF)
11. Define glomerulotubular balance (GTB) and briefly describe a:
More fluid you filter, the more fluid you reabsorb
Mechanism for GTB that involves changes in Starling forces in the peritubular capillaries
If you increase FF increase prox resabsorption
Luminal mechanism for GTB
If you detect sheer stress on prox tubule, brush border gets more Na cotrnasporters
12. Briefly describe the contribution of GTB to salt and water homeostasis (also discussed in the Regulation of
Sodium Excretion and Effective Circulating Volume lecture)
Decreases the urinary Na excretion when there is an increase in the GFR
13. List the FR in the PT for water, sodium, chloride, bicarbonate, nutrients (glucose and amino acids), and
bone minerals (calcium, phosphate)
14. Describe the most important examples of “asymmetrical” solute transport in the PT, explaining why such
asymmetrical solute transport is energetically more efficient for
the kidney
Asymmetery of reabsorption of the 2 major anions:
chloride and bicarb
In S1, only HCO3 is absorbed, and eventually there is a
Chloride gradient at the bottom between S2 and S3
The chloride is then all absorbed paracellularly
This creates a positive potential gradient that also pulls
the Na+ reabsorption
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
15. Describe the transcellular and/or paracellular reabsorption of the following solutes in the PT, identifying apical
transporters or enzymes that are important in the reabsorption process and noting any “asymmetry” along the PT:
sodium, bicarbonate, chloride, glucose, amino acids, phosphate
Sodium
Transcellular = NHE (which is affected by AngII)
Paracellular =secondary to paracellular Cl reabsorption
Bicarbonate –
Trancellular bicarb is converted into water and CO2, which diffuses into the cell, becomes
HCO3 again and gets transported out
Works together with the NHE by combining with the proton that comes out
Chloride
Transcellular – Clanion exchanger (uses formate that is recycled around with H+)
Looks like sodium chloride transporter
Paracellular – also very not absorbed early on and then lots of paracellular transport
Glucose
Transcellularly – 97% reabsorbed through SGLT2 (with 1 Na) – early PT
SGLT1 – 3% of glucose for 2 Na molecules because the sodium gradient is smaller
in the later PT
GLUT2 takes it back into the blood
Antidiabetic drugs block the transporter and have antidiabetic effects, antiCV because you get
less sodium reabsorption so less water retention, and since you also have more Na in the macula
densa, then you will decrease the GFR, which will decrease the O2 demand of the kidney
AA Transcellular (9598%) – Na coupled symport
Phosphate
Transcellular (80%) Na coupled symport
3 Na / 2 Na for one hPO4 – and activation of PTH can
bind basolaterally and cause endocytosis of the apical
transporters
Water – isosmotic and primary transcellular via aquaporin 1 (6570%)
1. Primary Na/ solute reabsorption
2. High constitutive water permeability via AQP1 to get isomotic
reabsorption
Proteins
Small proteins are endocytosized and broken down and returned
Also absorbs VitD, and activates it, and put into blood
Larger proteins are completely transcytosis
Transport limited in disease states so you get proteinuria
Organic cations (SECRETION) – drugs
Organic cations can use OCT with electrical potential, and then another OCT
Examples: creatinine and drugs (cimetidine and cisplatin)
Organic anions (SECRETION)
Basolateral OAT13, apical (ATPase MDR2)
Examples: creatinine, uremic toxins, penicillin, PAH
Important : secretion is not hindered by protein binding, LIMITED BY TM, or probenecid
Urate (SECRETION, and absorption)
Urate in blood goes through OAT, then go to urine to ABCG2
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Then it gets reabsorbed in urine with OAT4, URAT1, and GLUT9v2, and goes out again with
GLUT9v1. Too much in body you can get hyperuricemia / gout
DRUGS: probenecid and lesinurad – lower the urate levels in the blood which do not allow for
reabsorption
Thiazide competes for secretion
16. Identify and describe the mechanism for a class of antidiabetic drugs that acts in the PT
17. Define transport maximum (Tm), identifying an important solute that has a Tm in the PT
Glucose has a transport maximum and transcytosis of larger proteins
For a solute with Tmlimited reabsorption, construct a graph of plasma concentration (P X) on the xaxis
(e.g., in mg/dl) and solute flux (e.g., in mg/min) on the yaxis; on this graph:
a) Plot rate of filtration (PXGFR; aka filtered load) vs. PX, rate of tubular reabsorption (RX) vs. PX, and rate of
excretion (UXV•) vs. PX , labeling each line
b) Label the threshold and Tm
18. For a substance with Tmlimited reabsorption, and given the:
a) GFR, PX, and Tm, predict whether the solute will appear in urine
b) GFR and a series of PX and UX values, estimate Tm
19. Describe the relative water permeability (high constitutive, low constitutive, regulated) of the PT, thick ascending
limb (thick AL), distal convoluted tubule (DCT), connecting tubule (CNT), and collecting duct (CD), naming the
channel responsible for the water permeability of the PT
aquaporin
20. Assuming that 50% of solute and water are reabsorbed in segments S 1 and S2 of the PT, diagram (TF/P)X along S1
and S2 for inulin, osmolality, sodium, chloride, bicarbonate, glucose, amino acids, and creatinine, briefly
explaining the reason for the shape of each line
21. Appreciate that the Na+K+ ATPase “powers” almost all reabsorption in the PT
Creates the sodium gradient which allows sodium to bring all the other fun stuff like glucose and AA over
22. Briefly describe protein filtration and reabsorption in the PT
23. For organic cation and organic anion secretion:
a) Describe the basolateral and apical transporters involved
b) List important examples of endogenous molecules and drugs that are substrates
c) List examples of drugdrug and drugendogenous molecule interactions involving the transporters
24. Briefly describe urate transport in the PT and predict the effect of increased sodium reabsorption in the PT on
PUrate; name the disease associated with high PUrate ; name one drug that can increase PUrate, explaining the
mechanisms for this effect (also discussed in the Diuretics and Antidiuretics lecture); name one drug that can
decrease PUrate, explaining the mechanism for this effect
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
25. For the loop of Henle:
a) Describe water and sodium chloride transport in the thin descending limb (thin DL) and thin ascending limb
(thin AL)
Thin descending line – 10% of filtered H20 only
Thin ascending line – water impermeable, little salt transport
b) Describe the transporters or other pathways for reabsorption of sodium, potassium, chloride, calcium, and
magnesium in the thick AL, identifying the driving force for each
25% of filtered of filtered Na w/ ATPase, anions through the NKCC2 – which absorbs K, Cl, and Na
i. Potassium leaks back out since K+ levels are very low in the tubular fluid
ii. There is a lumen positivity compared to the basolateral, just like the cl at the end of the
proximal tubule
c) Predict the effect of inhibiting NKCC2 or ROMK on the reabsorption of sodium, potassium, chloride,
calcium, and magnesium in the thick AL – water loss and no driving force for any cations
Diuretics (furosemide) target the NKCC2 (which is also in the macula densa.. which senses Na)
26. Explain why the thick AL is a diluting segment, appreciating that tubular fluid at the macula densa has a lower
osmolality than plasma, regardless of the final osmolality of the urine
Thick AL is the driving force for all of the loop of
henle stuff
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Lecture 7: Structure and Development of the Kidneys and Urinary Tract (Kingston)
1. Relate this lecture’s bold terms to each other and to structures from prior lectures and labs.
2. Describe the position of the adult kidneys and their relationships to the vertebrae and ribs, diaphragm and
abdominal viscera. Explain how the developmental migration of the kidneys occasionally leads to the
presence of accessory renal arteries. Explain how abnormal
developmental migration leads to ectopic kidneys and state the
clinical consequences of horseshoe and thoracic kidneys.
R kidney (L1L3) – only related to Rib 12
L kidney (T12 – L2) – related to Rib 11 and 12
Muscles that touch the top is diaphragm, then in the middle
is quadratus lumbarum, and then on the side is psoas major
They come from pelvis and migrate up
Pelvic kidney – failure to ascend
If the kidneys are fused, then they get hooked at the IMA when moving up, it becomes
HORSESHOE KIDNEY
If there is no diaphragm, then you get thoracic kidney
3. Follow the path of blood from the heart to the kidneys and back. Describe the relationships of the renal
artery, pelvis and vein at the hilum of the kidney. State the relationship of the right and left gonadal
vessels to the right and left renal vessels, aorta and IVC. Explain the clinical significance of the
relationship between the left renal vein, abdominal aorta and
SMA. Describe the innervation of the kidneys.
3 adrenal arteries
o superior from diaphragm artery
o Middle artery from abdominal artery
o Inferior artery from renal artery
4. Follow the path of urine flowing from the kidneys through the ureters to the bladder. Describe the
relationships of the ureters to the common iliac and uterine arteries. State the number and locations of
the natural constrictions of the ureter and explain
their clinical significance. Describe the
developmental origin of the ureters.
Ureters are anterior to the bifurcation of
common illac
ureter artery hooks underneath the uterine
artery
3 natural constrictions
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
1. Ureteropelvic junction (right when it comes out)
o
2. Pelvic brim
o
3. Urethral orifice @ bladder
o
Ureterolithiasis – stone lodges in any of these natural constrictions
o
If you want to draw for bacteria in bladder, you make it full and do suprapubic aspiration
o
above the pubic symphysis
Bladder is innervated by the vesical artery
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
5. Relate the bladder to the bony pelvis, pelvic viscera and peritoneum. Identify the bladder’s apex, fundus,
trigone, ureteric and urethral orifices on diagrams and cadavers. Follow the path of blood from the heart
to the bladder and back in both females and males.
Describe the innervation of the bladder. Describe the
developmental origin of the bladder.
Women – urethra is short and close to anus so can
get uti
Men – long urethra, and encircled by prostate gland
so can get difficulty urinating with BPH
More difficult to catheterize or treat UTI
6. List the meso, meta and pronephros in the order they
appear during embryonic development and relate them to
their adult derivatives in the kidneys and urinary tract. Describe the formation of the bladder and fate of
the urachus, and explain the clinical consequence of a patent urachus.
Development – all come from the intermediate mesoderm
o Intermediate mesoderm nephrotome + nephrotome Pronephros @
cervical (degenerates)
o The mesonephros and ducts then develop @ thoracic/upper lumbar
o Then the body is like screw this, the pronephros wont work, the mesonephros
wont work, so I will make a METANEPHROS which will be my true kidneys
These develop from the mesonephric ducts
Anatomy Lab 18: Kidneys and Urinary Tract
18.1. Relate this lab’s bold terms to each other and to structures from prior lectures and labs.
18.2. Diagram three paths of blood flow from the abdominal aorta to the adrenal glands. Distinguish
between the right and left adrenal glands by shape and explain the clinical significance of this
distinction.
18.3. Relate the surfaces (anterior, posterior, medial and lateral) and poles (superior and inferior) of the
kidneys to nearby structures. Explain the clinical significance of the relationships between the left
renal vein, SMA and abdominal aorta. Explain the origin of accessory renal arteries. Trace the path of
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
filtered blood plasma through the nephron and relate its components to macroscopically identifiable
regions of the kidney. Trace the path of urine from a renal papilla to the bladder. Explain the clinical
significance of renal cysts.
18.4. Relate the bladder and pubic symphysis, and explain the clinical utility of this relationship for
suprapubic aspiration. Diagram the bladder as a tetrahedron, indicating its apex, trigone, ureteral
orifices and internal urethral orifice. Describe the ureter’s passage through the detrusor muscle and
explain its functional significance.
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Respiratory Histology
Overview
o Divided into Conducting zone and respiratory
zone
Conducting zone – NASAL CAVITY AND
TRACHEA
Respiratory zone – lungs (respiratory
bronchioles, alveolar duct and sac, alveoli
Nasal Cavity
o In each cavity (divided by the nasal septum) there
is the small anterior chamber (vestibule) and the
larger, narrow, posterior chamber (fossa)
Vestibule
Strat Squamous epithelium with
thick, short hairs (vibrissae) and lots
of sweat glands
Fossa
You have the chocae and meatuses
that cause turbulence
Roof – lined by olfactory epithelium
Bipolar neurons (olfactory cells)
olfactory nerve
Columnar supporting cells
Basal (stem cells) – can differentiate
Under olfactory epithelium is lamina propria – with Bowman’s glands
that secrete serous to trap odor
o Other regions have Ciliated psuedostratified columnar epithelium
Trachea
o Respiraotry epithelium
o Submucosa – seromucous glands and ducts
o Hyaline cartilage – provides support for trachea
Contains lacunae and chondrocytes
Has trachealis muscle – smooth muscle that connects tips
Lungs
o Trachea two bronchi (intrapulmonary portion of conducting zone)
o Smooth muscle goes away eventually for better gas diffusion
Airway stays open using Clara cell secretions in alveoli (type II pneumocytes)
Clara cells also have anti-microbial proteins
o Intrapulmonary bronchi
Very similar to trachea and primary bronchi
C rings of hydraline cartilage become smaller and are irregular plates
Smooth muscle is more complete
No bronchial glands
o Bronchioles
Simple columnar simple cuboidal, decreasing number of cilia
Goblet cells clara cells
No cartilage, only smooth muscle
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
o Terminal bronchioles – only clara cells and underlying smooth muscles
o Respiratory bronchioles – first part of respiratory zone – similar to terminal bronchioles
but have alveolar ducts!
Alveolar duct – are indents in the smooth muscle
Terminate at alveolar sacs – and project lots of alveoli
o Alveoli – thin wall of simple squamous (type I pneumocytes)
Type II – create tight junction and produce phospholipid surfactant
Between alveoli is interalveolar septum – has capillaries and fibroblasts to allow
for alveolar stretch and recoil
Macrophages (alveolar dust cells) – in septal connective tissue and alveolar air
space
Air is mixed through the simple squamous cells, is CONTINUOUS
epithelium but occasionally has alveolar pores to allow for alt way to
circulate air if bronchiole blocked
Epithelium Other feat of epithelium Special glands Under epithelium Muscle
(vestibule) cells, basal cells
epithelium (DNES), basal cells
plates layer
simple (marker of terminal
cuboidal bronchiole)
bronchioles
phospholipid surfactant spaces called alveolar
pores (of Kohn)
In general it is respiratory epithelium simple columnar, simple cuboidal simple squamous
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Renal Histology
Overview = Kidney and urinary tract (2 ureters, 1 bladder, 1 urethra)
Kidney (macroscopic)
o Lateral surface is covered by connective tissue capsule
o RENAL CORTEX
Contains renal corpuscles, proximal and distal convoluted tubules
o RENAL MEDULLA – tell the difference by looking if there are glomeruli
Medullary pyramids whose apices, (renal papillae) point to renal pelvis in the innermost
region of the medulla
Medullary pyramids have – connecting ducts, loops of henle, and vasa recta
Renal papillae minor calyces major calyces renal pelvis ureter
Kidney (microscopic)
o Functional subunits of kidney = renal corpuscle and renal tubules
Renal tubules collecting tubules collecting ducts renal papillae
o Renal corpuscle
Glomerulus inside a bowman’s capsule (cup like sac that has SIMPLE SQUMOUS
EPITHELIUM which interacts with kidney parietal layer and glomerular capillaries
Afferent and efferent arterioles of glomerulus enter/exit at vascular pole
Bowman’s space space between bowman’s capsule and the glomerulus
gets blood filtrate from glomerulus then drains into proximal convoluted
tubule at the URINARY POLE
glomerulus – capillary tuft from afferent arterioles that has fenestrated endothelium with
blood filtration
o Filtration organization
Made up of fenestrated endothelium of glomerular capillary, glomerular basement
membranes (made up of endothelial cells and podocytes) and filtration slits OF
PODOCYTES
Mesangial cells provide support to capillaries, modulate blood filtrate rate,
and clean
OVERALL, FILTRATION APPARATUS is size and charge filter
o Renal Tubules
Consist of proximal tubule, loop of henle, distal nephron (distal convoluted tubule +
collecting duct)
PCT – CUBOIDAL epithelium, with brush border to increase absorption
Absorbs 85% HCO3, 65% NaCl, All Glucose, AA, vit, 65% water
Prox vs distal convoluted tubule, PT is more ragged because of brush border
Loop of henle
Thin descending – squamous cells
Ascending – cuboidal cells
For the juxtamedullary long loop, there is squamous ascending cells
Has vasa recta that wraps it
Macula densa
Has densely packed, taller, and apical nuclei
Next to granula cells (smooth muscle) and mesangial cells (filter stuff)
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
All three (granular cells, mesangial cells, and macula densa )
juxtaglomerular apparatus
Distal convoluted tubule
Cuboidal epithelium – no brush border
Renal pelvis
Proximal ureter, calyces, larger renal arteries and veins
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
o Renal circulation
Arcuate arteries are on border of cortex and medulla
Arcuate arteries interlobular arteries (which go to cortex)
drained by efferent arterioles through cortical nephron capillaries or vasa recta
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Renal System I Task-Oriented Learning Objectives – Week 1 Winter 2018
Urinary tract
Overview: minor calyces tip of the urethra
o Renal calyces + renal pelvis urethers bladder urethra
Epithelium
o TRANSITIONAL EPITHELIUM AKA UROTHELIUM
o Impermeable to water and salt (tight junctions) and can stretch from cuboidal to squamous
Urothelial cells at the luminal surface are umbrella cells
Also there are membrane proteins (uroplakins) which protect luminal surface of
umbrella cells from hyperosmotic urine
Ureters
o Wall has transitional epithelium overlying basement membrane, lamina propria, and 2 layers of
smooth muscle (COLI), adventitia
o Peristalsis gets urine down and when you get to bladder, there are three layers of muscle in
bladder
Bladder
o Muscular sac – urothelium, lamina propria, 3 muscles (inner long, middle circle, outer long)
These muscles create the detrusor muscle
Urethra – carries urine from bladder to exteria
o Muscularies merge into fibromuscular stroma, and striated muscle
o Male urethra has three main regions:
1. Prostatic portion – transitional epithelium and is surrounded by prostate gland
This empties into the membranous portion – shortest part with striated muscle and has
pseudostatified columnar epithelium
Spongy penile urethra – is columnar / psudostratified epithelium, except for the end
which is stratified squamous
o Female – transitional epithelium strat squamous
37