Human Physiology, 4e (Silverthorn) Chapter 19 The Kidneys

1) The urinary system A) maintains plasma ion balance. B) regulates the volume of the extracellular fluid. C) contributes to homeostatic regulation of pH. D) eliminates organic waste products and foreign substances. E) all of the above Answer: E

Skill: Level I: Reviewing Facts and Terms 2)

Functions of the kidneys include all but one of the following. Identify the exception. A) regulation of extracellular fluid volume B) maintenance of ion balance in body fluids C) regulation of blood protein levels D) regulation of blood osmolarity E) homeostatic regulation of blood pH Answer: C Skill: Level I: Reviewing Facts and Terms 3) Ions directly regulated by the kidney include all EXCEPT which of the following? A) 1

Na+ B) K+ Ca2+ D) HCO3OHAnswer: E Skill: Level I: Reviewing Facts and Terms 4) Urine is produced by the A) gall bladder. B) urinary bladder. C) kidney. ureter. E) urethra. Answer: D)

C)

E)

Skill: Level I: Reviewing Facts and Terms 5)

Urine is carried to the urinary bladder by A) blood vessels. B) lymphatics. C) 2

the ureters. D) the urethra. E) all of the above Answer: C Skill: Level I: Reviewing Facts and Terms 6) Each of the following organs is part of the urinary system except one. Identify the exception. A) kidney B)

urinary bladder C) liver ureter E) urethra Answer: D)

Skill: Level I: Reviewing Facts and Terms 7)

The outermost layer of kidney tissue is the A) renal cortex. B) renal medulla. C) major calyx. D) minor calyx. E) renal pelvis. 3

Answer: A

Skill: Level I: Reviewing Facts and Terms 8)

The following is a list of the blood vessels that carry blood to and within the kidney. 1. afferent arteriole 2. efferent arteriole 3. glomerulus 4. peritubular capillary The proper order in which blood passes through these vessels is A) 4, 2, 3, 1 1, 3, 2, 4 C) 4, 3, 2, 1 1, 2, 3, 4 E) 3, 4, 2, 1 Answer: D) B)

Skill: Level I: Reviewing Facts and Terms 9)

Which statement is NOT true? A) The blood supply to the kidneys comes through the renal arteries. B) As much as one fourth of the cardiac output may flow to the kidneys at any given moment. C) The kidneys lie in the abdominal cavity where they are protected by other visceral organs. D) The urinary bladder is filled by two ducts, called ureters, and emptied by the single urethra. E) Women are more likely to develop urinary tract infections than men. Answer: 4

C Skill: Level I: Reviewing Facts and Terms

10) The Bowman's capsule and glomerulus make up the A) renal pyramid. B) loop of Henle. C) renal corpuscle. D) renal papilla. E) collecting system. Answer: C

Skill: Level I: Reviewing Facts and Terms 11)

A glomerulus is A) the expanded end of a nephron. B) a "knot" of capillaries that lies within the renal corpuscle. C) the portion of the nephron closest to the renal corpuscle. D) the portion of the nephron that attaches to the collecting duct. E) the hairpin-shaped segment of the nephron. Answer: B Skill: Level I: Reviewing Facts and Terms 12) The portion of the nephron closest to the renal corpuscle is the A) loop of Henle. B) 6

proximal tubule. C) distal tubule. D) collecting duct. E) minor calyx. Answer: B

Skill: Level I: Reviewing Facts and Terms 13)

The portion of the nephron that attaches to the collecting duct is the A) loop of Henle. B) proximal tubule. C) distal tubule. D) collecting duct. E) minor calyx. Answer: C Skill: Level I: Reviewing Facts and Terms 14) The hairpin-shaped segment of the nephron is the A) loop of Henle. B) proximal tubule. C) distal tubule. D) collecting duct. 7

E) minor calyx. Answer: A Skill: Level I: Reviewing Facts and Terms

15) Glomerular filtration is favored by the A) hydraulic pressure of the blood in the glomerular capillaries. B) osmotic pressure inside the glomerular capillaries. C) fluid pressure produced by the displacement of the fluid in the lumen of the tubules. D) A and B E) A, B, and C Answer: A

Skill: Level I: Reviewing Facts and Terms 16)

The primary function of the proximal tubule is A) filtration. B) reabsorption of ions, organic molecules, and water. C) secretion of acids and ammonia. D) secretion of drugs. E) adjusting the urine volume. Answer: B Skill: Level I: Reviewing Facts and Terms 17) The process of urine formation involves A) filtration of plasma. B) 9

reabsorption of water. C) reabsorption of certain solutes. D) secretion of wastes. E) all of the above Answer: E

Skill: Level I: Reviewing Facts and Terms 18)

Glucose and amino acids are reabsorbed by A) diffusion. B) symport with sodium. C) cotransport. D) countertransport. Answer: B

Skill: Level I: Reviewing Facts and Terms 19)

Each of the following is a normal constituent of urine except one. Identify the exception. A) hydrogen ions B) urea C)

large proteins D) salts creatinine 10 E)

Answer: C

Skill: Level I: Reviewing Facts and Terms

11

20) During the micturition reflex, A) stimulation of stretch receptors in the bladder wall results in afferent impulses arriving in the cervical region of the spinal cord. B) there is increased activity of the parasympathetic motor neurons that control the smooth muscle of the bladder. C) the internal sphincter must be consciously relaxed. D) the external sphincter relaxes as the result of a parasympathetic reflex. E) all of the above Answer: B

Skill: Level I: Reviewing Facts and Terms 21)

Which of the following statements about autoregulation is NOT true? A) Myogenic response is the intrinsic ability of vascular smooth muscle to respond to pressure changes. B) Myogenic response is a paracrine signaling mechanism. C) In tubuloglomerular feedback, stretch-sensitive ion channels open resulting in depolarization of smooth muscle cells. D) In myogenic response, the macula densa cells send a paracrine message to the neighboring afferent arteriole. E) none of the above Answer: A

Skill: Level I: Reviewing Facts and Terms

Match each anatomical part to its description. 12

A. B. C. D. E. 22)

medulla urinary bladder nephron ureter cortex

one of these leads from each kidney to the urinary bladder Answer: D Skill: Level I: Reviewing Facts and Terms 23) a hollow expandable organ that collects and stores urine Answer: B Skill: Level I: Reviewing Facts and Terms 24) the outer layer of the kidney tissue Answer: E Skill: Level I: Reviewing Facts and Terms 25) the functional unit of the kidney Answer: C Skill: Level I: Reviewing Facts and Terms

13

26) the inner layer of the kidney tissue Answer: A Skill: Level I: Reviewing Facts and Terms Match each substance with its primary mode of transport across the kidney epithelium. A. B. C. D. 27) sodium Answer: transcytosis active transport symport with sodium passive reabsorption/diffusion

Skill: Level I: Reviewing Facts and Terms 28)

glucose

Answer:

Skill: Level I: Reviewing Facts and Terms 29)

urea

Answer:

Skill: Level I: Reviewing Facts and Terms 30)

plasma proteins Answer: A

Skill: Level I: Reviewing Facts and Terms

14

31) After it is formed, urine is temporarily stored in the __________. Answer: urinary bladder Skill: Level I: Reviewing Facts and Terms 32) Urine is carried to the external environment by the __________. Answer: urethra Skill: Level I: Reviewing Facts and Terms 33) The plasma concentration at which all of the renal carriers for a given substance are saturated is the __________. Answer: renal threshold Skill: Level I: Reviewing Facts and Terms 34) The amount of filtrate entering the proximal tubules of the kidneys each minute is the __________. Answer: GFR or glomerular filtration rate Skill: Level I: Reviewing Facts and Terms 35) The percentage of total plasma volume that filters is called the __________. Answer: filtration fraction Skill: Level I: Reviewing Facts and Terms 36) When fluid flow through the distal tubule increases as a result of increased GFR, the macula densa cells send a chemical message to the neighboring afferent arteriole. The afferent arteriole constricts, increasing resistance and decreasing GFR. This type of autoregulation 15

involving both the kidney tubule and the arteriole is known as __________. Answer: tubuloglomerular feedback Skill: Level I: Reviewing Facts and Terms 37) The __________ is composed of the kidneys and accessory structures. Answer: urinary system Skill: Level I: Reviewing Facts and Terms 38) The kidneys are sandwiched between the membraneous __________. Answer: peritoneum Skill: Level I: Reviewing Facts and Terms 39) The __________ branch off the __________ and supply blood to the kidneys. Answer: renal arteries, abdominal aorta Skill: Level I: Reviewing Facts and Terms 40) The __________ carry blood from the kidneys back to the __________. Answer: renal veins, inferior vena cava Skill: Level I: Reviewing Facts and Terms 41) 80% of the nephrons in a kidney are contained within __________, but the other 20%, called the __________ nephrons, dip down into the __________. Answer: cortex, juxtamedullary, medulla Skill: Level I: Reviewing Facts and Terms 16

42) The __________ are the long peritubular capillaries that dip into the medulla. Answer: vasa recta Skill: Level I: Reviewing Facts and Terms 43) The nephron begins with a hollow, ball-like structure called __________. Answer: Bowman's capsule Skill: Level I: Reviewing Facts and Terms 44) The __________ lie between and around the glomerular capillaries. Answer: mesangial cells Skill: Level I: Reviewing Facts and Terms 45) The specialized cells found in the capsule epithelium are called __________. These cells have long cytoplasmic extensions called __________. Answer: podocytes, foot processes Skill: Level I: Reviewing Facts and Terms 46) Neural control of GFR is mediated by __________ that innervate __________ receptors on vascular smooth muscle causing __________. Answer: sympathetic neurons, alpha, vasoconstriction Skill: Level I: Reviewing Facts and Terms 47) The excretion of glucose in the urine is called __________. 17

glucosuria or glycosuria Skill: Level I: Reviewing Facts and Terms 48) When the plasma concentration of a substance exceeds its renal concentration, more of the substance will be A) filtered. B) reabsorbed. C) secreted. D) excreted. E)

none of the above Answer: D Skill: Level II: Reviewing Concepts 49) Damage to the renal medulla would interfere first with the functioning of the A) Bowman's capsule. B) distal tubule. C) collecting ducts. D) proximal tubule. E) glomerulus. Answer: C

Skill: Level II: Reviewing Concepts 50) 18

An obstruction in a glomerulus would affect the flow of blood into the A) renal artery. B) efferent arteriole. C) afferent arteriole. D) renal vein. Answer: B Skill: Level II: Reviewing Concepts 51) If blood flow through the afferent arterioles increases, A) stretch reflexes trigger vasoconstriction to reduce the flow. B) the smooth muscle in the vessel walls stretches to accommodate the increased flow. C) the stretch triggers further relaxation of the arteriolar wall, lessening blood pressure. D) B and C Answer: A Skill: Level II: Reviewing Concepts 52) Urea is A) actively secreted in the distal tubule. B) actively reabsorbed in the proximal tubule. C) passively reabsorbed in the proximal tubule. D) completely eliminated in the urine. 19

E) actively transported into the filtrate by the cells of the collecting duct. Answer: C Skill: Level II: Reviewing Concepts 53) In the lumen of the proximal tubule, Na+ concentration __________ the Na+ concentration inside the cells of the tubule wall. A) is much higher than B) is slightly higher than C) is about the same as D) is slightly lower than E) is much lower than Answer: A Skill: Level II: Reviewing Concepts 54) Glucose is brought into the cytoplasm of kidney tubular cells against its concentration gradient by A) symport with sodium. B) harnessing the energy of Na+ moving down its electrochemical gradient. C) dialysis. D) diffusion. A and B Answer: 20 E)

E Skill: Level II: Reviewing Concepts 55) The same basic pattern holds for molecules absorbed by Na+-dependent transport: an apical __________ and a basolateral __________. A) facilitated diffusion carrier, osmotic gradient B) symport protein, facilitated diffusion carrier C) symport protein, osmotic gradient D) osmotic gradient, symport protein E) facilitated diffusion carrier, symport protein Answer: B Skill: Level II: Reviewing Concepts 56) One substance has no membrane transporters to move it, but can diffuse freely through open leak channels if there is a concentration gradient. Initially, this substance's concentrations in the filtrate and extracellular fluid are equal. Later, however, the active transport of Na+ and other solutes creates a gradient by removing water from the lumen of the tubule where it is located. What substance is this? A) glucose calcium C) urea A and B E) A, B, and C Answer: C D) B)

Skill: Level II: Reviewing Concepts 21

22

57) A person with cirrhosis of the liver has lower than normal levels of plasma proteins and a higher than normal GFR. Explain why a decrease in plasma protein concentration would cause an increase in GFR. Answer: The primary driving force for GFR is blood pressure, opposed by fluid pressure in Bowman's capsule and osmotic pressure due to plasma proteins. If a person has fewer plasma proteins due to liver disease, the plasma will have a lower osmotic pressure. With less osmotic pressure opposing the GFR, GFR will increase. Skill: Level II: Reviewing Concepts 58) Patrick's urine sample reveals a high concentration of glucose. Suggest two possible mechanisms to explain why the kidney would excrete glucose. Answer: Glucose transporters may be saturated, preventing complete reabsorption of glucose (filtration exceeds reabsorption). A genetic defect resulting in an insufficient number of glucose transporters is another possibility. Skill: Level II: Reviewing Concepts 59) Trace a drop of water through the urinary system. Answer: Water moves from plasma into the nephrons, passes into a ureter, then to the urinary bladder; finally, it is expelled as urine through the urethra. Skill: Level II: Reviewing Concepts 60) What are the three filtration barriers that substances leaving the plasma must pass through before entering the tubule lumen? Answer: 1. the glomerular capillary endothelium 2. a basal lamina 3. the epithelium of Bowman's capsule Skill: Level II: Reviewing Concepts 61) What forces drive filtration across the walls of glomerular capillaries? Answer: 23

1. hydrostatic pressure 2. colloid osmotic pressure 3. hydrostatic fluid pressure Skill: Level II: Reviewing Concepts 62) Reabsorption involves what two methods of transports? Describe each. What determines which route a solute will take? Answer: 1. transepithelial transport: substances cross both apical and basolateral membranes of the tubule epithelial cell. 2. paracellular pathway: substances pass through the junction between two adjacent cells. The permeability of the epithelial junction and the electrochemical gradient for the solute determines which route it will take. Skill: Level II: Reviewing Concepts

24

63) In a normal kidney, which of the following conditions would cause an increase in the glomerular filtration rate (GFR)? A) constriction of the afferent arteriole B) a decrease in the hydraulic pressure of the glomerulus C) an increase in the capsular hydraulic pressure D) a decrease in the concentration of plasma proteins in the blood E) a decrease in the net glomerular filtration pressure Answer: D Skill: Level III: Problem Solving 64) Ruby is 77 years old and can no longer control her urination. What changed in the reflex pathway that used to control her urination? Answer: Micturition normally occurs when stretch receptors in the bladder wall are stimulated by distension due to the accumulation of urine. The stretch receptors project to an integration center in the spinal cord, which stimulates parasympathetic neurons of the bladder wall, which stimulates bladder contraction, forcing the internal urethral sphincter to open. At the same time, the spinal control center inhibits somatic motor neurons that control the external urethral sphincter, which relaxes in response, so that urine can flow out. The spinal reflex is normally over-ridden by descending control from the brainstem and cerebral cortex. The brain inhibits the parasympathetic output to the bladder and stimulates the somatic motor output to the external urethral sphincter, thus preventing urination until a convenient time. It is likely that Ruby's descending control is what is no longer working properly, thus she is not able to suppress the urge until she can get to a toilet. Skill: Level III: Problem Solving 65) Sylvia is suffering from severe edema in her arms and legs. Her physician prescribes a diuretic (a substance that will increase the volume of urine produced). Why might this help to alleviate Sylvia's problem? Answer: One simple answer is that a diuretic reduces the free fluid in the body. A more complex explanation is that increasing the volume of urine produced would decrease the total blood 25

volume of the body. This in turn would lead to a decreased blood hydraulic pressure. Edema is frequently the result of hydraulic pressure of the blood exceeding the opposing forces at the capillaries in the affected area. Depending on the actual cause of the edema, decreasing the blood hydraulic pressure would decrease edema formation and possibly cause some of the fluid to move from the interstitial space back to the blood. Diuresis would also increase the concentration of the proteins in the plasma, contributing to the fluid's movement out of the tissues and into the blood. Skill: Level III: Problem Solving 66) Make a map of the following terms: blood, Bowman's capsule, collecting duct, distal tubule, excretion, external environment, filtration, loop of Henle, lumen, osmosis, peritubular capillaries, proximal tubule, urine, water. Add terms as needed. Answer: Maps will vary. Refer to Chapter 19 "Overview of Kidney Function" and Figure 19-2. Skill: Level III: Problem Solving

26

67) Measurements in a nephron reveal a glomerular hydraulic pressure of 69 mm Hg, and a fluid pressure in the Bowman's capsule of 15 mm Hg. Assuming that the plasma osmotic pressure is 30 mm Hg, and that essentially no plasma proteins are filtered by the glomerulus, what is the net glomerular filtration pressure in this case? A) -6 mm Hg B) 24 mm Hg C) 54 mm Hg D) 84 mm Hg E)

114 mm Hg Answer: B Skill: Level IV: Quantitative Problems 68) Fred weighs 100 kg. Assume his total blood volume is 7%, his heart pumps his total blood volume within 90 seconds, and his renal blood flow is 20% of his cardiac output. Calculate the volume of blood that flows through Fred's kidneys each minute. Answer: Fred's blood volume = 100 kg 0.07 = 7 L = 7000 mL. At least two thirds of this volume must circulate per minute = 7000 mL 0.67 = 4690 mL/min minimum cardiac output (CO); values up to 5000 mL/min would still be within a normal range. 4690 20% = 938 mL/min; 5000 20% = 1000 mL/min, thus blood flow to Fred's kidneys approximates 938-1000 mL/min. Skill: Level IV: Quantitative Problems 69) You are a physiologist on a space flight to a distant planet. You discover intelligent humanoid aliens inhabiting the planet, and they willingly submit to your tests. You discover that the alien's kidney handles the sugar alcohol mannitol just like our kidneys handle inulin. You also test the alien for its renal handling of glucose. The data from that experiment are: Plasma level (constant over 24 hrs): 6 g/dL of mannitol and 2 g/dL of glucose. 24 hr. urine sample: volume of 2 L, containing 144 g mannitol and 52 g glucose. A. What is the alien's glomerular filtration rate? B. What is the alien's clearance rate for glucose? C. How does the alien kidney handle glucose? Answer: 27

Human kidneys filter inulin, a polysaccharide from dahlia roots, but do not reabsorb or secrete it. Thus, 100% of the inulin in a urine sample is filtered inulin. For this reason, the inulin excretion rate is the same as the glomerular filtration rate. A. The alien's GFR = excretion rate of mannitol/plasma conc. of mannitol = 144 g/day 1 dL/6 g 0.1 L/1 dL = 2.4 L/day. B. Using 2.4 L/day as GFR, the filtered load for glucose = plasma conc. of glucose GFR = 2 g/dL 2.4 L/day 1 dL/0.1 L = 48 g glucose. C. There were 52 g of glucose produced in 24 hours. Since the clearance of glucose is greater than the filtered load, some glucose must have been secreted. Therefore the alien's kidney filters and secretes glucose. Skill: Level IV: Quantitative Problems

28

70) A man's leg was crushed between a car bumper and a wall. His physicians believe their patient has suffered kidney damage from myoglobin blocking glomerular pores. Tests showed the following results: plasma creatinine: 30 mg/100 mL plasma 24 hour urine specimen: volume = 1 liter urine creatinine 30 mg/ml urine A. in the B. C. D. How many mg of creatinine are in the urine specimen? How much creatinine appears urine per hour? What is the patient's creatinine clearance in mL/min? What is the patient's GFR? Is this a normal GFR? Did the patient sustain kidney damage? Answer:

A. 1000 mL urine 30 mg creatinine/mL urine = 30,000 mg creatinine in the specimen. 30,000 mg/24 hr = 1250 mg creatinine. B. Creatinine clearance = excretion rate of creatinine/plasma concentration creatinine. clearance = 1250 mg creatinine/hr 1 hr/60 min/30 mg creatinine/100 mL plasma = 20.8 mg creatinine/min/0.3 mg creatinine/mL plasma = 69.4 mL plasma/min C. GFR approximately equal to clearance rate for creatinine, or approximately 70 mL/min. D. A more typical value for GFR is 125 mL/min so 70 mL/min represents a severe decline. Thus, kidney damage has most likely occurred. Skill: Level IV: Quantitative Problems

29