1. Quiz #5 available until 11pm on Monday 6/2. Exam #3 rebuttals due today Review tonight at 7pm Slides for tomorrow’s lecture are on GoPost

2. Location of the Kidneys posterior abdominal wall retroperitoneal T12-L3 adrenal gland: superomedial Functions of Kidney filter blood plasma excretion of waste regulate blood volume & pressure secrete renin – blood pressure secrete erythropoietin – RBC final step in vitamin D synthesis and more……

3. L1 L3

4. Renal artery & vein Hilum Renal capsule Renal fascia Adipose capsule

7. Nephron = Renal corpuscle + renal tubule Renal corpuscle: glomerulus + Bowman’s (glomerular) capsule glomerular filtration creating plasma-like filtrate of the blood Afferent arteriole Efferent arteriole Glomerular capillaries with podocytes (visceral) Proximal convoluted tubule Simple, squamous epithelium (parietal) Vascular pole

8. Podocytes Capsule space glomerular filtrate Urinary pole Filtration slits Endothelial cells w/ basement membrane Filtration membrane Hematuria = blood Proteinuria = protein

9. Renal tubule Renal corpuscle Proximal convolute tubule Loop of Henle Distal convoluted tubule Collecting duct Renal papilla

10. Juxtaglomerular apparatus macula densa JG cells mesangial cells Macula densa epithelial cells monitor flow/comp of fluid in DCT comm with JG cells JG cells smooth muscle constrict afferent art Mesangial cells DCT Juxta = next to Macula = spot, patch

11. Kidney stones (renal calculus) calcium, phosphate, uric acid, protein form in renal pelvis excess calcium, dehydration, pH imbalance, cystitis Renal pelvis ureter

12. Staghorn calculi Shah et al. BMC Urology 2006 6:1 doi:10.1186/1471-2490-6-1

14. Urinary bladder Detrusor mm Parietal peritoneum Urethral openings in trigone Internal urethral sphincter smooth muscle External urethral sphincter skeletal muscle

16. urethra Spongy urethra Prostatic urethra Membranous urethra

17. Benign Prostatic Hyperplasia Berry, SJ, Coffey, DS, Walsh, PC, et al. The development of human benign prostatic hyperplasia with age. J Urol 1984;132:474. accessed via UpToDate 5.23.2008

18. Severe bladder distension Bladder!! Mayo Clin Proc 1995;70:1077-1079

19. Pubis sym. sacrum Levator ani coccygeus piriformis Pelvic floor muscles

20. (A) Urine storage reflexes. During the storage of urine, distention of the bladder produces low level vesical afferent firing, which in turn stimulates (1) the sympathetic outflow to the bladder outlet (base and urethra) and (2) pudendal outflow to the external urethral sphincter. These responses occur by spinal reflex pathways and represent "guarding reflexes," which promote continence. Sympathetic firing also inhibits detrusor muscle and modulates transmission in bladder ganglia. A region in the rostral pons (the pontine storage center, or "L" region) increases external urethral sphincter activity. (B) Voiding reflexes. During elimination of urine, intense bladder afferent firing activates spinobulbospinal reflex pathways passing through the pontine micturition center, which stimulate the parasympathetic outflow to the bladder and internal sphincter smooth muscle and inhibit the sympathetic and pudendal outflow to the urethral outlet. Ascending afferent input from the spinal cord may pass through relay neurons in the periaqueductal gray (PAG) before reaching the pontine micturition center. DuBeau, CE. Epidemiology, risk factors, and pathogenesis of urinary incontinence. Accessed 5/27/08 at UpToDate.