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NBME 24 Answers

nbme24/Block 2/Question#7 (reveal difficulty score)
A 75-year-old man with a 10-year history of ...
Hydrostatic pressure in Bowman space 🔍 / 📺 / 🌳 / 📖
tags: renal

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submitted by hvancampen(7)
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According to lumen, "the Bowman’s capsule space exerts hydrostatic pressure of its own that pushes against the glomerulus. Increased Bowman’s capsule hydrostatic pressure will decrease GFR, while decreased Bowman’s capsule hydrostatic pressure will increase GFR.

An example of this is a ureter obstruction to the flow of urine that gradually causes a fluid buildup within the nephrons. An obstruction will increase the Bowman’s capsule hydrostatic pressure and will consequently decrease GFR."

https://courses.lumenlearning.com/boundless-ap/chapter/physiology-of-the-kidneys/

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 +1  upvote downvote
submitted by guillo12(58)
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Why there's no increase in Hydrostatic pressure in glomerular capillaries?

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rihan  Between the glomerulus and Bowman's space there is a hydrostatic pressure gradient. This gradient is normally the result of a LARGE glomerular hydrostatic pressure and a LOW pressure in Bowman's space which normally favors filtration. Diagram here: http://physiologyplus.com/wp-content/uploads/2017/08/Glomerular-Filtration.png In the case of post-renal obstruction, hydrostatic pressure behind the blockade will rise and urine will reflux into the capsular space and renal tubules (while glomerular hydrostatic pressure is unaffected) effectively decreasing the pressure gradient which reduces the filtration rate. +6
jurrutia  Why would an increase in pressure in blood vessels cause hydronephrosis? The problem has to be in the nephron itself. +
makingstrides  @jurrutia I think that is being demonstrated here. I picked glomerular capillaries thinking of the answers wrong. The ureteric obstruction causes a backup that leads a to a high hydrostatic pressure in the bowman space. Therefore, preventing filtration. The cause of the renal failure can't be from the glomerular capillaries because the block isn't being caused there; it is caused by something post ureter (dilated ureter). +



 +1  upvote downvote
submitted by mari17(2)
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The glomerular filtration rate (GFR) depends on the interplay of hydrostatic and oncotic pressures in the glomerular capillaries and Bowman's space. The GFR increases with higher glomerular hydrostatic pressure and decreases with increasing Bowman's capsule hydrostatic pressure or higher glomerular capillary oncotic pressure. Acute ureteral obstruction increases hydrostatic pressure proximal to the constriction. This pressure rise is transmitted back to the Bowman's space, resulting in decreased GFR.

Source: UWORLD

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 +0  upvote downvote
submitted by famylife(110)
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Not a full answer but it's a start (in the context of an obstruction): "Obstruction of urine flow results in an increase in hydrostatic pressures proximal to the site of obstruction. It is this buildup of pressure that leads to the accompanying pain, the distention of the collecting system in the kidney, and elevated intratubular pressures that initiate tubular dysfunction. In the first days of obstruction, the dilatation of the poorly compliant collecting system may be minimal. As the increased hydrostatic pressure is expressed in the urinary space of the glomeruli, further filtration decreases or stops completely." (Harrison's, 20e, Chapter 313)

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trichotillomaniac  the key here is the term hydronephrotic kidney. anytime there is that, there is a post renal obstruction of some sort. The fact that he has progressive renal failure just contributes to the idea that his kidneys have seen damage before and are not able to withstand the pressure from the back up as well. I got tripped up on this. The important thing to note is that Hydronephrosis and dilation = back up = increased in volume pressure (hydrostatic) +6



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submitted by an1(114)
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Asking about the CAUSE, not the response. The cause for a dilated ureter is increased GFR.

4 values are considered Pc (increases push into ureter direction) Pi (increases push into bowmans) πc (increases pull into bowmans) πi (increases pull into direction of ureter)

If ureter is dilated, the bowmans capsule is PUSHING out more fluid —> increased GFR (high Pc) and pulling less (low πc)

Got this wrong because I thought they wanted to know what the response would be...

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an1  to add to comment ^: B, C, D don’t affect GFR. E would increase GFR but is unlikely to be the cause here. +



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