RENAL PHYSIOLOGY

KIDNEY/URINARY SYSTEM

REVISION KIT
Fundamental Principles that you need to know on this subject)

Written by Siwale D.R (MSc. Physiology)

first EDITION 2023

QUESTIONS

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PART 1; FUNCTIONAL ANATOMY OF THE KIDNEYS

1. Label the internal Anatomy of the Kidneys shown below

2. Describe the Blood Supply of the Kidneys

3. Describe the Nerve supply of the Kidney
4. Describe the various Nephron segments?
5. List any 10 functions of the Kidneys?
6. Explain the Histology of the following parts
A. Juxtaglomerular apparatus
B. nephrons and collecting duct
7. What’s the function of the Juxtaglomerular apparatus

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PARRT 2: MECHANISM of Function of KIDNEY

1. THE KIDNEYS PRODUCE RENIN? DISCUSS THE PHYSIOLOGY RENIN?

2. Explain the role of the Macula densa in the secretion of Renin by the
Juxtaglomerular cells?

3. The kidneys produce erythropoietin? Discuss the physiology erythropoietin?

4. The kidneys produce Naturally occurring Vitamin D? Discuss the physiology
Vitamin D?
5. Describe the function of the following local hormones produced by the kidneys
a. Endothelins
b. Prostaglandins
c. Natriuretic peptide
d. Nitric oxide
6. Complete the following short word questions;
a. The number of nephrons in each kidney is approximately?
b. The endothelium of the glomerular capillaries is fenestrated, with pores that
are …………………. nm in diameter.
c. Functionally, the glomerular membrane permits the free passage of neutral
substances up to…………nm in diameter and almost totally excludes those with
diameters greater than …………………………nm.

d. The macula, the neighboring lacis cells, and the renin-secreting granular cells in
the afferent arteriole form the……………………………………………

e. The specialized cells of the collecting duct epithelium involved in Na+ and ADH-
stimulated water reabsorption are……………………….

f. The specialized cells of the collecting duct epithelium involved in secretion of

acid and HCO3- transport are……………………………..
g. The specialized fibroblast like cells of the kidneys that are the major site of
cyclooxygenase 2 (COX-2) and prostaglandin synthase (PGES) expression are
called……………………………..
h. The efferent arterioles from cortical glomeruli branch diffusely
as …………………….. , while those from juxtamedullary glomeruli branch as
long microvascular loops called ……………………in the medulla.

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 i. The amount of plasma ultra-filtrate formed each minute by the kidneys
is………………………………
j. The volume of plasma from which a substance is completely removed by the
kidney in a given amount of time (usually minutes) is known
as…………………………………………..

PART 3: GLOMERULAR FILTRATION

1. Describe the layers of the Filtration Membrane

2. Describe the four pressures controlling Ultra filtration and show how the Net
Filtration Pressure is calculated?
3. Define Glomerular Filtration Rate? List factors affecting GFR
4. What is auto regulation mechanism of Blood flow to the Kidneys?
5. Explain the Neural Regulation and Hormonal Regulation of GFR

PART 4: TUBULAR REABSORPTION AND TUBULAR SECRETION

1. Define Tubular Reabsorption and Secretion? Explain on the Reabsorption Routes

and Transport Mechanism
2. Explain Reabsorption and Secretion in the Proximal Convoluted Tubule?
3. Explain Reabsorption in the Loop of Henle?
4. Explain Reabsorption in the Early Distal Convoluted Tubule and late?
5. Explain Distal Convoluted Tubule and Collecting Duct reabsorption mechanisms
taking place here?
6. Explain how the following hormonal substances affects Tubular Reabsorption and
Tubular Secretion
a. Renin–Angiotensin–Aldosterone System
b. Antidiuretic Hormone
c. Atrial Natriuretic Peptide
d. Parathyroid Hormone

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PART 5: PRODUCTION OF DILUTE AND CONCENTRATED URINE

1. Define Dilute urine and explain the Formation of Dilute Urine

2. Explain the following concept in renal physiology
a. Countercurrent Multiplication
b. Countercurrent Exchange

3. Define concentrated urine and the Formation of Concentrated Urine

PART 6: KIDNEY FUNCTIONAL TEST

1. The following is a dipstick. What kidney functional tests can be analyzed by the
dipstick?
2. What is Urinalysis and its importance?
3. What Blood Tests can be done in order to evaluate the Kidney function?
4. Explain the concept of Renal Plasma Clearance?
5. How is GFR determined?
6. The Normal cystometograph is shown below? Interpret this graph? What’s the
significance of this graph?
7. Answer the following question on creatinine
a. Where is the source of creatinine in blood
b. State the normal concentration of serum creatinine
c. Explain why serum creatinine does not rise above 60-104 µmol/L
d. List any 5 differential diagnosis of creatinine level of 6 mg/dL and above

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PART 7: URINE TRANSPORTATION, STORAGE, AND ELIMINATION

1. Describe the Ureters

2. Describe Urinary Bladder, by explaining its Anatomy and Histology?
3. Describe The Micturition Reflex?
4. What will be effect of this reflex in the following conditions
a. Lesion of sacral segments of spinal cord (Conus medullaris)
b. Post central gyrus
c. Pyramidal tract lesion in the Spinal cord
d. Tabes Dorsalis
5. Predict the effect on the bladder when both afferent and efferent nerves are
destroyed due to cauda equine or filum terminale tumors?
6. Describe the Urethra of both males and females?
7. What is Enuresis? What causes this condition?
8. What is urinary retention? Explain any three factors that may cause this?

9. List the major classes of diuretics; and explain the mechanism by which each
operates to increase urine flow.

PART 8: Role of Kidneys in FLUID and ELECTROLYTE HOMEOSTASIS

1. Explain how the Kidneys handles water and sodium

PART 9: ROLE OF KIDNEYS IN ACID–BASE HOMEOSTASIS

1. Define the following terminologies

a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis

2. Describe the changes in blood chemistry that occur during the development of
metabolic acidosis and metabolic alkalosis, and the respiratory and renal
compensations for these conditions.

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3. Describe the changes in blood chemistry that occur during the development of
respiratory acidosis and respiratory alkalosis, and the renal compensation for these
conditions

PART 10: CLINICAL AND APPLIED RENAL PHYSIOLOGY

1. In normal healthy person state the correct values and units;

a. Urine produced in 24 hours
b. Specific gravity
c. Osmolality
d. Urine pH

2. State differential diagnosis of the following;

a. Hematuria b. Proteinuria c. Glucosuria d. Ketonuria e.Bacteria in
urine

3. Explain the reasons why Nephrotic syndrome is characterized by the following

features:
 Hypoalbuminaemia
 >3.5 g proteinuria/day
 Dyslipidemia
 Salt and water retention, leading to oedema.

4. Explain the reasons Acute nephritis (nephritic syndrome) patient will present
with following features;
 hematuria (macroscopic or microscopic) - with red-cell casts on urine
microscopy
 proteinuria
 hypertension
 oedema (periorbital, leg or sacral)
 temporary oliguria and uraemia.

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5. Explain how the following systemic diseases may cause renal system malfunction?
a. Diabetes Mellitus
b. Sickle cell disease
6. Define the following tubular disorders of the nephron
a. Fanconi syndrome
b. Bartter syndrome
c. Diabetes insipidus

7. What is the Role of Renin in Clinical Hypertension?

8. The diagram shows a patients receiving dialysis

a. Explain the operation of the dialysis machine?

b. State any three clinical uses of the dialysis machine?
c. State any three complications of the dialysis machine?

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9. Patients with inappropriate hypersecretion of vasopressin have been successfully
treated with demeclocycline, an antibiotic that reduces the renal response to
vasopressin.
a. What is the effect of inappropriate hypersecretion of vasopressin?
b. What’s the mechanism of action of demeclocycline?

10. Discuss the mechanism of reabsorption of glucose by the kidneys. Furthermore, give
a reason of glucosuria in patients with Diabetes mellitus?
11. Explain the following scenarios;

a. Sulfonamide derivatives have been used clinically as diuretics because of

their inhibitory effects on carbonic anhydrase in the kidney. Explain the
rationale for the use of these drugs as diuretic agents.
b. Constriction of one renal artery causes the development of sustained
hypertension called renal hypertension
c. ACE inhibitors such as captopril and enalapri are used to treat hypertension.
What’s the explanation
12. A 55 year old woman was diagnosed with congestive heart failure (CHF) by doctors
at Levy hospital. On physical examination, she is found to have peripheral and
pulmonary edema. Her Serum Na+ is normal at 142 mEq/L. For each of the
following, predict whether the values would be increased, decreased or unchanged
and from what would be predicted for a healthy individual (give a reason for your
answer)
a. ECF Volume;………………………..
b. ECV…………………………………
c. Plasma Osmolality……………………………………………
d. Fractional Na+ excretion………………………………………….
e. Renal sympathetic nerve activity;……………………………
f. ANP and BNP levels;……………………….
g. Angiotensin II levels;……………………………….
h. Aldosterone levels;…………………………….
i. Vasopressin levels;……………………………..

…………………………………… END …………………………………………