Exam

Name___________________________________

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

Figure 25.1

Using Figure 25.1, match the following:

1) Glomerulus. 1)

2) Afferent arteriole. 2)

3) Collecting duct. 3)

4) Nephron loop. 4)

5) Peritubular capillaries. 5)

6) Structure most closely associated with granular cells. 6)

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 7) Which label marks a structure at the medulla of the kidney? 7)

Figure 25.2

Using Figure 25.2, match the following:

8) Podocyte. 8)

9) Is composed of simple squamous epithelium. 9)

10) Collecting duct cells. 10)

11) Proximal convoluted tubule cells. 11)

12) Filtrate at the site of these cells is about the same osmolarity as blood plasma. 12)

13) Cells that are the most active in reabsorbing the filtrate. 13)

14) Cells that reabsorb virtually all the nutrients. 14)

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 15) Cells that are most affected by ADH. 15)

16) Almost no water is absorbed in these cells. 16)

MATCHING. Choose the item in column 2 that best matches each item in column 1.

Match the following:

17) Proximal convoluted tubule. A) Site of filtrate formation

17)

18) Glomerulus. B) Site at which most of the tubular

18)
reabsorption occurs
19) Peritubular capillaries.
19)
C) Blood supply that directly receives
20) Collecting duct. substances from the tubular cells
20)

D) Site that drains the distal convoluted

tubule

Match the following:

21) Low pressure, porous vessels that A) Glomerular capillaries

21)
reabsorb solutes and water from the
tubule cells. B) Efferent arterioles

22) High pressure vessel that forces fluid C) Afferent arterioles 22)
and solutes into the glomerular
capsule.
D) Vasa recta

23) May form meandering vessels or

E) Peritubular capillaries 23)
bundles of long straight vessels.

24) Play a role in urine concentration.

24)

25) Fenestrated vessels that allow passage

25)
of all plasma elements but not blood
cells.

TRUE/FALSE. Write 'T' if the statement is true and 'F' if the statement is false.

26) If the GFR is too low, needed substances may pass so quickly through the renal tubules that they 26)
are not absorbed and instead are lost in the urine.

27) In the kidneys, the countercurrent mechanism involves the interaction between the flow of filtrate 27)
through the nephron loop of the juxtamedullary nephrons (the countercurrent multiplier) and the
flow of blood through the limbs of adjacent blood vessels (the countercurrent exchanger). This
relationship establishes and maintains an osmotic gradient extending from the cortex through the
depths of the medulla that allows the kidneys to vary urine concentration dramatically.

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28) The path urine takes after it is formed until it leaves the body is the urethra, urinary bladder, and 28)
finally the ureter.

29) Water reabsorption through the proximal convoluted tubule is termed obligatory water 29)
reabsorption, whereas water reabsorption through the distal convoluted tubule is termed
facultative water reabsorption.

30) The position of the kidneys behind the peritoneal lining of the abdominal cavity is described by the 30)
term retroperitoneal.

31) The entire responsibility for urine formation lies with the nephron. 31)

32) Both the male and female urethras serve both the urinary and the reproductive systems. 32)

33) The act of emptying the bladder is called voiding. 33)

34) Glomerular filtration is an ATP-driven process. 34)

35) In the absence of hormones, the distal tubule and collecting ducts are relatively impermeable to 35)
water.

36) The collecting duct is impermeable to water in the presence of ADH. 36)

37) The urethra contains an internal sphincter of smooth muscle. 37)

38) High blood pressure triggers granular cells of the juxtaglomerular complex to release renin. 38)

39) Aldosterone is a hormone that causes the renal tubules to reclaim sodium ions from the filtrate. 39)

40) Blood pressure in the renal glomerulus is lower than in most parts of the body in order to conserve 40)
body water.

41) The proximal convoluted tubule is the portion of the nephron that attaches to the collecting duct. 41)

42) Salt is actively transported out of the filtrate in the nephron loop. 42)

43) Incontinence is the inability to control voluntary micturition. 43)

44) The myogenic mechanism reflects the tendency of vascular smooth muscle to stretch. 44)

45) An excessive urine output is called anuria. 45)

46) Tubular secretion is effective in controlling blood pH. 46)

47) The trigone is so named because of the shape of the urinary bladder. 47)

48) Atrial natriuretic peptide inhibits sodium reabsorption. 48)

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 49) The macula densa cells are chemoreceptors that respond to changes in the urea content of the 49)
filtrate.

50) Blood in the urine may be a symptom of bladder cancer. 50)

51) Obligatory water reabsorption involves the movement of water along an osmotic gradient. 51)

52) Having a kinked ureter is called renal ptosis. 52)

53) Cortical nephrons are responsible for producing concentrated urine. 53)

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

54) Which of the following is the best explanation for why the cells of the proximal convoluted tubule 54)
(PCT) contain so many mitochondria?
A) A great deal of active transport takes place in the PCT.
B) Contraction of the PCT moves filtrate through the tubule.
C) This provides the energy needed to fight kidney infection.
D) Cells of the PCT go through a great deal of mitosis.

55) What is the best explanation for the microvilli on the apical surface of the proximal convoluted 55)
tubule (PCT)?
A) They hold on to enzymes that cleanse the filtrate before reabsorption.
B) Their movements propel the filtrate through the tubules.
C) They increase the amount of surface area that comes in contact with the blood's plasma to
help actively excrete toxins.
D) They increase the surface area and allow for a greater volume of filtrate components to be
reabsorbed.

56) The thin segment of the nephron loop's descending limb ________. 56)
A) helps to pack a greater number of nephron loops into a smaller space
B) aids in the passive movement of water out of the tubule
C) is easily broken and replaced often
D) aids in the passive excretion of nitrogenous waste

57) The relatively long half-life of lipid-soluble hormones (steroid hormones) compared to 57)
water-soluble hormones is due in part to the way that these hormones are passed into the filtrate
from the glomerular capillaries. From the list below select the best explanation for why
lipid-soluble (steroid) hormones have a relatively long half -life.
A) Steroid hormones travel in the plasma on large transport proteins that cannot pass through
the filtration membrane.
B) Steroid hormones are absorbed by target cells before they can reach the kidneys.
C) The large size of the steroid hormones prevents them from passing through the filtration
membrane.
D) The relatively small size of steroid hormones allows them to easily pass back into the
peritubular capillaries if released into the filtrate.

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58) The presence of protein in the urine indicates which of the following? 58)
A) damage to the renal tubules
B) high levels of transcription and translation by the bodies tissues
C) too much protein in the diet
D) damage to the filtration membrane

59) Hydrostatic pressure is the primary driving force of plasma through the filtration membrane into 59)
the capsular space. All but one of the following statements reflects why hydrostatic pressure is so
high in the glomerular capillaries. Select the one statement that does NOT explain the high
pressure within the glomerular capillaries.
A) The volume of plasma in the efferent arteriole is higher when compared to the afferent
arteriole.
B) The efferent arteriole has higher resistance to blood flow than the afferent arteriole.
C) The diameter of the efferent arteriole is smaller than the afferent arteriole.
D) The flow of blood is reduced as blood reaches the efferent arteriole.

60) Cells and transport proteins are physically prevented from passing through the filtration 60)
membrane. This has the following effect on filtration.
A) increasing osmotic pressure in the glomerular capillaries that reduces the amount of filtration
B) increased osmotic pressure in the filtrate that draws plasma through the membrane
C) neutral change in osmotic pressure with no effect on filtration
D) decreased osmotic pressure in the filtrate that increases the amount of filtration

61) If the diameter of the afferent arterioles leading to the glomerulus increases (vasodilation), which 61)
of the following is NOT likely to occur?
A) Glomerular filtration rate will increase. B) Urine output will increase.
C) Systemic blood pressure will go up. D) Net filtration pressure will increase.

62) If the diameter of the efferent arterioles leading away from the glomerulus increases (vasodilation), 62)
which of the following is NOT likely to occur?
A) Glomerular filtration rate will decrease. B) Urine output will decrease.
C) Net filtration pressure will decrease. D) Systemic blood pressure will decrease.

63) If the diameter of the afferent arterioles leading to the glomerulus decreases (vasoconstriction), 63)
which of the following is NOT likely to occur?
A) Glomerular filtration rate will decrease. B) Systemic blood pressure will decrease.
C) Urine output will decrease. D) Net filtration pressure will decrease.

64) If the diameter of the efferent arterioles leading away from the glomerulus decreases 64)
(vasoconstriction), which of the following is NOT likely to occur?
A) Systemic blood pressure will go up. B) Net filtration pressure will increase.
C) Glomerular filtration rate will increase. D) Urine output will increase.

65) If the glomerular mesangial cells contract, reducing the overall surface area of the glomerulus, 65)
which of the following is NOT likely to occur?
A) Systemic blood pressure will be lowered. B) Glomerular filtration rate will decrease.
C) Net filtration rate will decrease. D) Urine output will decrease.

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66) If blood pressure drops very low (MAP is below 80mmHg) renin enzyme will be secreted by 66)
granular cells. Which of the following is NOT likely to occur?
A) Blood plasma and extracellular fluids volume will increase.
B) Net filtration pressure (NFP) will decrease.
C) Kidney perfusion will increase.
D) Glomerular filtration rate (GFR) will decrease.

67) Which of the following statements best describes the difference between the intrinsic and extrinsic 67)
controls of the kidney?
A) Extrinsic controls will reduce blood plasma volume while intrinsic controls will increase
blood plasma volumes.
B) Extrinsic and intrinsic controls work in nearly opposite ways.
C) Intrinsic controls raise blood pressure while extrinsic controls lower blood pressure.
D) Extrinsic controls have the greatest effect on systemic blood pressure while intrinsic controls
have a greater effect on GFR.

68) Reabsorption of nutrients like glucose and amino acids takes place in the proximal convoluted 68)
tubule (PCT) via cotransporters that utilize secondary active transport. Which of the following
would stop the reabsorption of glucose at the apical surface of the cells in the PCT?
A) increasing Na+ concentration in the filtrate
B) increasing Na+ in the interstitial fluid
C) loss of K+ leak channels at the apical surface
D) loss of Na+ -K+ ATPase in the basolateral surface of PCT cells

69) Bulk flow of nutrients, ions and water into the peritubular capillaries is the result of all of the 69)
following except one. Select the answer below that does NOT describe a cause of bulk flow of fluids
into the peritubular capillaries.
A) leaky tight junctions of peritubular capillary's endothelium
B) higher osmotic pressure in the peritubular capillary
C) increased resistance to blood flow at the efferent arteriole
D) lower hydrostatic pressure in the peritubular capillary

70) The mechanism that establishes the medullary osmotic gradient depends most on the permeability 70)
properties of the ________.
A) nephron loop B) glomerular filtration membrane
C) distal convoluted tubule D) collecting duct

71) Which of the following is NOT associated with the renal corpuscle? 71)
A) a fenestrated capillary B) a vasa recta
C) an efferent arteriole D) a podocyte

72) An increase in the permeability of the cells of the collecting tubule to water is due to a(n) ________. 72)
A) decrease in the production of ADH
B) increase in the production of aldosterone
C) increase in the production of ADH
D) decrease in the concentration of the blood plasma

73) The urinary bladder is composed of ________ epithelium. 73)

A) transitional B) stratified squamous
C) simple squamous D) pseudostratified columnar

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74) The kidneys are stimulated to produce renin ________. 74)
A) when the peritubular capillaries are dilated
B) by a decrease in the blood pressure
C) when the specific gravity of urine rises above 1.10
D) when the pH of the urine decreases

75) Which of the choices below is NOT a function of the urinary system? 75)
A) regulates blood glucose levels and produces hormones
B) maintains blood osmolarity
C) helps maintain homeostasis by controlling the composition, volume, and pressure of blood
D) eliminates solid, undigested wastes and excretes carbon dioxide, water, salts, and heat

76) The ________ artery lies on the boundary between the cortex and medulla of the kidney. 76)
A) arcuate B) interlobar C) cortical radiate D) lobar

77) The glomerulus differs from other capillaries in the body in that it ________. 77)
A) has a blood pressure much lower than other organ systems
B) is drained by an efferent arteriole
C) has a basement membrane
D) is impermeable to most substances

78) The descending limb of the nephron loop ________. 78)

A) is freely permeable to sodium and urea
B) pulls water by osmosis into the lumen of the tubule
C) contains fluid that becomes more concentrated as it moves down into the medulla
D) is not permeable to water

79) Select the correct statement about the ureters. 79)

A) The epithelium is stratified squamous like the skin, which allows a great deal of stretch.
B) The ureters are capable of peristalsis like that of the gastrointestinal tract.
C) The ureter is innervated by parasympathetic nerve endings only.
D) Ureters contain sphincters at the entrance to the bladder to prevent the backflow of urine.

80) The fatty tissue surrounding the kidneys is important because it ________. 80)
A) stabilizes the position of the kidneys by holding them in their normal position
B) ensures adequate energy for the adrenal glands to operate efficiently
C) is necessary as a barrier between the adrenal glands and kidneys
D) produces vitamin D and other chemicals needed by the kidney

81) The renal corpuscle is made up of ________. 81)

A) Bowman's capsule and glomerulus B) the renal pyramid
C) the renal papilla D) the descending nephron loop

82) The functional and structural unit of the kidneys is the ________. 82)
A) glomerular capsule B) nephron loop
C) capsular space D) nephron

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83) Which of the following does NOT describe the juxtaglomerular complex? 83)
A) Its granular cells produce rennin.
B) It helps control systemic blood pressure.
C) Its macula densa cells produce aldosterone.
D) It regulates the rate of filtrate formation.

84) The chief force pushing water and solutes out of the blood across the filtration membrane is 84)
________.
A) glomerular hydrostatic pressure (glomerular blood pressure)
B) protein-regulated diffusion
C) the size of the pores in the basement membrane of the capillaries
D) the ionic electrochemical gradient

85) Which of the following acts as the trigger for the initiation of micturition (voiding)? 85)
A) motor neurons B) the pressure of the fluid in the bladder
C) the stretching of the bladder wall D) the sympathetic efferents

86) The filtration membrane includes all EXCEPT ________. 86)

A) basement membrane B) renal fascia
C) glomerular endothelium D) podocytes

87) The mechanism of water reabsorption by the renal tubules is ________. 87)
A) filtration B) cotransport with sodium ions
C) osmosis D) active transport

88) The glomerular capsular space contains ________. 88)

A) plasma B) urine C) blood D) filtrate

89) The macula densa cells respond to ________. 89)

A) aldosterone B) changes in pressure in the tubule
C) antidiuretic hormone D) changes in Na + content of the filtrate

90) Which of the following is NOT reabsorbed by the proximal convoluted tubule? 90)
A) Na+ B) glucose C) creatinine D) K+

91) The fluid in glomerular capsule is similar to plasma except that it does NOT contain a significant 91)
amount of ________.
A) plasma protein B) hormones C) electrolytes D) glucose

92) Alcohol acts as a diuretic because it ________. 92)

A) inhibits the release of ADH B) increases the rate of glomerular filtration
C) increases secretion of ADH D) is not reabsorbed by the tubule cells

93) The function of angiotensin II is to ________. 93)

A) decrease water absorption
B) decrease the production of aldosterone
C) constrict arterioles and increase blood pressure
D) decrease arterial blood pressure

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 94) An important physical characteristic of urine is its specific gravity or density, which is ________. 94)
A) less than water B) much higher than water
C) the same as water D) slightly higher than water

95) Place the following in correct sequence from the formation of a drop of urine to its elimination 95)
from the body.

1. major calyx
2. minor calyx
3. nephron
4. urethra
5. ureter
6. collecting duct

A) 2, 1, 3, 6, 5, 4 B) 6, 3, 2, 1, 5, 4 C) 3, 1, 2, 6, 5, 4 D) 3, 6, 2, 1, 5, 4

96) Select the correct statement about the nephrons. 96)

A) Filtration slits are the pores that give fenestrated capillaries their name.
B) The glomerulus is correctly described as the proximal end of the proximal convoluted tubule.
C) The parietal layer of the glomerular capsule is simple squamous epithelium.
D) Podocytes are the branching epithelial cells that line the tubules of the nephron.

97) What would happen if the capsular hydrostatic pressure were increased above normal? 97)
A) Net filtration would decrease.
B) Net filtration would increase above normal.
C) Filtration would increase in proportion to the increase in capsular pressure.
D) Capsular osmotic pressure would compensate so that filtration would not change.

98) Which of the following is NOT a part of the juxtaglomerular complex? 98)
A) macula densa B) podocyte cells C) granular cells D) mesangial cells

99) Which of the following is incorrect? 99)

A) Urine concentration and volume are determined by countercurrent mechanisms
B) The kidneys produce a small volume of concentrated urine when dehydrated.
C) The concentration of urine is lower when urine volume is reduced.
D) The kidneys produce a large volume of dilute urine when overhydrated.

100) Reabsorption of high levels of glucose and amino acids in the filtrate is accomplished by ________. 100)
A) facilitated diffusion B) countertransport
C) secondary active transport D) passive transport

101) Which of the choices below is a function of the nephron loop? 101)
A) absorb water and electrolytes into the tubular network
B) form a large volume of very dilute urine or a small volume of very concentrated urine
C) absorb electrolytes actively and water by osmosis in the same segments
D) form a large volume of very concentrated urine or a small volume of very dilute urine

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102) What is the effect of antidiuretic hormone on the cells of the collecting duct? 102)
A) causes aquaporins to be inserted into the apical membranes
B) inhibits sodium reabsorption through the apical membranes
C) triggers synthesis of more potassium channels in the apical membranes
D) triggers synthesis of more sodium channels in the apical membranes

103) Which of the following hormones acting on the collecting duct is most responsible for retaining 103)
sodium ions in the blood?
A) atrial natriuretic peptide B) parathyroid hormone
C) antidiuretic hormone D) aldosterone

104) The factor that promotes filtrate formation at the glomerulus is the ________. 104)
A) capsular hydrostatic pressure B) colloid osmotic pressure of the blood
C) glomerular hydrostatic pressure D) myogenic mechanism

105) Glomerular filtration rate can be controlled by manipulating one major variable, which is 105)
________.
A) activation of sympathetic nerve fibers
B) systemic blood pressure
C) glomerular hydrostatic pressure
D) the renin-angiotensin-aldosterone mechanism

106) If one says that the clearance value of glucose is zero, what does this mean? 106)
A) Most of the glucose is filtered out of the blood and is not reabsorbed in the convoluted
tubules.
B) The clearance value of glucose is relatively high in a healthy adult.
C) 100% of glucose is reabsorbed.
D) The glucose molecule is too large to be filtered out of the blood.

107) Excretion of dilute urine requires ________. 107)

A) the presence of ADH
B) transport of sodium and chloride ions out of the descending nephron loop
C) relative permeability of the distal tubule to water
D) impermeability of the collecting tubule to water

108) Which of the choices below is NOT a method by which the cells of the renal tubules can raise blood 108)
pH?
A) by reabsorbing filtered bicarbonate ions
B) by producing new bicarbonate ions
C) by secreting sodium ions
D) by secreting hydrogen ions into the filtrate

109) In the ascending limb of the nephron loop the ________. 109)
A) thick segment moves ions out into interstitial spaces for reabsorption
B) thick segment is permeable to water
C) thin segment is not permeable to sodium and chloride
D) thin segment is freely permeable to water

11
 110) Except for potassium ions, tubular secretion of most unwanted substances occurs in the ________. 110)
A) collecting duct B) nephron loop
C) proximal convoluted tubule D) distal convoluted tubule

111) What is the most direct function of the juxtaglomerular apparatus? 111)
A) help regulate urea absorption by the kidneys
B) help regulate blood pressure and the rate of blood filtration by the kidneys
C) help regulate blood pressure and the rate of excretion by the kidneys
D) help regulate water and electrolyte excretion by the kidneys

112) Which of the choices below is the salt level-monitoring part of the nephron? 112)
A) macula densa B) vasa recta C) principal cell D) nephron loop

113) Which of the hormones below is responsible for facultative water reabsorption? 113)
A) atrial natriuretic peptide B) thyroxine
C) ADH D) aldosterone

114) Which of the choices below is NOT a glomerular filtration rate control method? 114)
A) neural regulation B) electrolyte levels
C) renal autoregulation D) hormonal regulation

115) Which of the choices below are the most important hormone regulators of electrolyte reabsorption 115)
and secretion?
A) angiotensin II and aldosterone
B) angiotensin I and atrial natriuretic peptide
C) angiotensin I and epinephrine
D) angiotensin II and ADH

SHORT ANSWER. Write the word or phrase that best completes each statement or answers the question.

116) ADH activated water channels called ________ are essential for water reabsorption in the 116)
collecting duct.

117) The need to get up in the middle of the night to urinate is called ________. 117)

118) The area between the ureters and urethra that is often the location of infection is called the 118)
________ in a bladder.

119) The ________ mechanism is the general tendency of vascular smooth muscle to contract 119)
when stretched.

120) The presence of pus in the urine is a condition called ________. 120)

121) Sodium-linked water flow across a membrane not under hormonal control is called 121)
________ water reabsorption.

122) Explain how filtration works in the glomerular capillaries. 122)

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 123) List three substances that are abnormal urinary constituents and provide the proper 123)
clinical term for such abnormalities.

124) Explain the role of aldosterone in sodium and water balance. 124)

125) Explain what is meant by the terms cotransport process and transport maximum. 125)

126) Humans can survive for a period of time without water thanks to the ability of the kidneys 126)
to produce concentrated urine. Briefly explain the factors that allow this to happen.

127) List and describe three pressures operating at the filtration membrane, and explain how 127)
each influences net filtration pressure.

128) What are aquaporins? 128)

129) Freshly voided urine has very little smell, but shortly after voiding it can give off a very 129)
strong smell. Why?

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

130) An older man sees his doctor for severe pain in his lower abdominal or flank area, elevated temperature, and
nausea. Exhaustive tests rule out abdominal obstructions and infections. Plain X -rays indicate a radiopaque
(whitish) spot in the area of his right ureter. Diagnose his problem. Give suggested treatment and prognosis.

131) What clinical effects would low blood pressure have on the kidneys of a burn patient?

132) Eleven-year-old Harry is complaining of a severe sore throat and gets to stay home from school. His
pediatrician prescribes a course of broad-spectrum antibiotics, and Harry feels much better within a few days.
However, some two weeks later, Harry has a dull, bilateral pain in his lower back and his urine is a smoky
brown color. On the basis of Harry's signs and symptoms, diagnose his condition and indicate the relationship
(if any) between his present condition and his earlier sore throat.

133) Ellen, a 47-year-old woman who has suffered kidney disease for several years, has been diagnosed with
proteinuria. Her legs and feet are so swollen that she has difficulty walking. Her hands and her left arm are
also swollen. What is proteinuria, and could this condition be playing a role in her swollen limbs?

134) Rachael has been complaining of frequent and burning urination. She also reported seeing some blood in her
urine. Her physician suspects cystitis. What is cystitis, and how can it cause these symptoms?

135) An 18-year-old patient has a complaint of painful urination, fever, chills, and back pain. This is her second
urinary tract infection (UTI) within 5 months. How can the doctor instruct the patient on prevention of another
UTI?

136) A 58-year-old woman complains of loss of urine when coughing and sneezing, and during exercise. She has
had three children. Describe the possible causes of urinary incontinence in this patient.

137) Explain how an angiotensin converting enzyme inhibitor (ACE inhibitor) such as captopril would be effective
as an antihypertensive.

13
Answer Key
Testname: UNTITLED25

1) C
2) A
3) B
4) E
5) D
6) A
7) E
8) B
9) A
10) C
11) E
12) E
13) E
14) E
15) C
16) D
17) B
18) A
19) C
20) D
21) E
22) C
23) B
24) D
25) A
26) FALSE
27) TRUE
28) FALSE
29) TRUE
30) TRUE
31) TRUE
32) FALSE
33) TRUE
34) FALSE
35) TRUE
36) FALSE
37) TRUE
38) FALSE
39) TRUE
40) FALSE
41) FALSE
42) TRUE
43) TRUE
44) FALSE
45) FALSE
46) TRUE
47) FALSE
48) TRUE
49) FALSE
50) TRUE
14
Answer Key
Testname: UNTITLED25

51) TRUE
52) FALSE
53) FALSE
54) A
55) D
56) B
57) A
58) D
59) A
60) A
61) C
62) D
63) B
64) A
65) A
66) C
67) D
68) D
69) A
70) A
71) B
72) C
73) A
74) B
75) D
76) A
77) B
78) C
79) B
80) A
81) A
82) D
83) C
84) A
85) C
86) B
87) C
88) D
89) D
90) C
91) A
92) A
93) C
94) D
95) D
96) C
97) A
98) B
99) C
100) C
15
Answer Key
Testname: UNTITLED25

101) B
102) A
103) D
104) C
105) C
106) C
107) D
108) C
109) A
110) C
111) B
112) A
113) C
114) B
115) A
116) aquaporins
117) nocturia
118) trigone
119) myogenic
120) pyuria
121) obligatory
122) The glomerular capillaries are fenestrated, allowing fairly large molecules to pass through. The substances must pass
through the basement membrane, where they are further selected for size by the filtration slits of the podocytes.
123) Abnormal urinary constituents include the following (the clinical term for each is listed in parentheses): glucose
(glycosuria), proteins (proteinuria or albuminuria), ketone bodies (ketonuria), hemoglobin (hemoglobinuria), bile
pigments (bilirubinuria), erythrocytes (hematuria), and leukocytes (pyuria).
124) Aldosterone targets the distal tubule and collecting duct and enhances sodium ion reabsorption so that very little
leaves the body in urine. Aldosterone also causes increased water reabsorption because, as sodium is reabsorbed,
water follows it back into the blood.
125) Cotransport process refers to the active transport of one solute "uphill" (against a concentration gradient) coupled to
the "downhill" (with a concentration gradient) movement of another during tubular reabsorption. Transport
maximum reflects the number of carriers in the renal tubules available to "ferry" a particular substance.
126) Facultative water reabsorption depends on the presence of antidiuretic hormone. In the presence of ADH, the pores of
the collecting tubule increase in number and the filtrate loses water by osmosis as it passes through the medullary
regions of increasing osmolarity. Consequently, water is conserved and urine becomes concentrated. The water that
passes through these regions is reabsorbed by the body in order to prevent dehydration.
127) Glomerular hydrostatic pressure is the chief force pushing water and solutes across the filtration membrane. The
higher the glomerular hydrostatic pressure, the more filtrate is pushed across the membrane. Colloid osmotic pressure
of plasma proteins in the glomerular blood, and capsular hydrostatic pressure exerted by fluids in the glomerular
capsule, drive fluids back into the glomerular capillaries. The net filtration pressure equals glomerular hydrostatic
pressure minus the sum of colloid osmotic pressure of glomerular blood and capsular hydrostatic pressure.
128) Aquaporins are transmembrane proteins that form water -filled pores in water-permeable portions of the convoluted
tubules such as the PCT and collecting duct.
129) Freshly voided urine is relatively sterile but if it is allowed to stand, bacteria begin to metabolize the urea solutes to
release ammonia and other smells depending on the person's diet. A fruity smell generally means there is a diabetes
problem.
130) The symptoms indicate a kidney stone that has been passed into the ureter. Recommended treatments include IV
therapy to flush the stone out, surgery, or ultrasound waves to shatter the calculi. The usual prognosis is for complete
recovery. There is a possibility of kidney stones forming again.

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Answer Key
Testname: UNTITLED25

131) This patient would have a much lower glomerular hydrostatic pressure due to water losses through burned skin and
would have a low GFR. This is highly dangerous, leading to failure of the nephron loop to maintain countercurrent
flow, flowed by anuria. It is made worse if any muscle is burned and myoglobin in the blood exceeds its transport
maximum, resulting in plugging of the tubules and death of the nephron. Often massive fluid transfusions are
required to maintain blood volume, high GFR, and dilution of myoglobinuria to avoid catastrophe.
132) Harry is showing the symptoms of kidney inflammation. Kidney inflammations usually result from infections either
of the lower urinary tract or, in Harry's case, from his earlier infection of a sore throat. Streptococcal infection of the
throat can induce anti-streptococcal antibodies that bind to them, depositing immune complexes in the glomerular
membranes. The kidney inflammation that primarily involves glomeruli is called glomerulonephritis, and if severe
enough can cause permanent renal failure. In post-streptococcal glomerulonephritis, the smoky brown color of urine
most commonly represents the leakage of blood cells through the damaged glomerular membrane.
133) Proteinuria is a condition in which the permeability of the glomerular capillaries is increased to such an extent that
large amounts of plasma proteins (mostly albumin) pass into the glomerular filtrate and are excreted in the urine. If
the condition is severe, the loss of plasma proteins may decrease osmotic pressure substantially. When this happens
there is a tendency for fluid to leave the systemic blood vessels and enter the tissue space. This is the reason for Ellen's
swollen limbs.
134) It is possible that Rachael has cystitis, a condition in which the mucous membrane lining the bladder becomes swollen
and bleeding occurs. This condition is caused by bacterial invasion of the bladder or by chemical or mechanical
irritation. Burning on urination alone implies urethritis – inflammation of the urethra alone, but urinary frequency
suggests the bladder itself is also involved, with the inflammation causing smooth muscle irritability lowering the
stretch trigger point for micturition.
135) Escherichia coli are normal residents of the digestive tract and generally cause no problems there, but these bacteria
account for 80% of all urinary tract infections. The doctor can instruct the patient on proper hygiene measures,
including wiping from front to back following urination to avoid introduction of anal bacteria, reduction in sexual
activity if sexually active, and increased fluid intake to increase flushing of the urethra. The doctor should also explain
that sexually transmitted infections can also inflame the urinary tract, clogging some of its ducts.
136) Stress incontinence is found most commonly in women with relaxed pelvic musculature deprived of estrogen. Stress
incontinence may occur with a sudden increase in intra-abdominal pressure such as coughing or sneezing, which
forces urine through the external sphincter. Aging, multiple pregnancies, and obesity are risk factors in increasing the
relaxation and/or pressure from above.
137) Angiotensin II is a potent vasoconstrictor activating smooth muscle of arterioles throughout the body, causing mean
arterial blood pressure to rise. ACE inhibitors reduce blood pressure by interrupting the
renin-angiotensin-aldosterone system.

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