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Patho 2 > 1 - Renal 02 > Flashcards

1 - Renal 02 Flashcards

(78 cards)

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1
Q

Urea is essential in allowing the kidney to:

A

develop concentrated urine

this is why people with high protein diets can concentrate urine better

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2
Q

The _______ serve as countercurrent exchangers, minimizing the washout of solutes from the medullary interstitium.

A

vasa recta

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3
Q

An increase in medullary blood flow would have what effect on urine concentration?

A

Decreased ability to concentrate urine d/t decreased solute load

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4
Q

Why does a decrease in ADH lead to a less concentrated renal medulla?

A

Less urea is being reabsorbed in the medulla

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5
Q

Why is tubular fluid in the thick ascending loop so dilute?

A

the loop is completely impermeable to water

BUT

all of the sodium, chloride etc is sucked out, leaving dilute tubular fluid

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6
Q

In the late distal tubule and cortical collecting tubules, the osmolarity of the tubular fluid depends on:

A

the amount of ADH

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7
Q

How can you tell if DI is nephrogenic or central?

A

Give desmopressin

If it gets better, it has to be caused by decreased ADH (central)

If it doesn’t get better, the problem is that the kidneys can’t respond to ADH

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8
Q

Plasma osmolarity can be roughly calculated by:

A

multiplying serum sodium by 2.1

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9
Q

A more exact calculation for plasma osmolarity would be:

A

POSM = 2.1 [PNa + PGluc + PUrea]

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10
Q

How does increased plasma sodium concentration stimulate ADH secretion?

A

Causes osmoreceptor cells in the hypothalamus to shrink

Shrinkage of these cells causes them to fire

Action potentials are conducted to the posterior pituitary

ADH is released

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11
Q

What effect does nausea have on ADH levels?

A

Increases ADH levels for up to an hour after vomiting

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12
Q

Name six stimulants of ADH

A
  1. Increased osmolarity
  2. decreased blood volume
  3. decreased blood pressure
  4. nausea
  5. hypoxia
  6. Morphine and Nicotine
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13
Q

Name three drugs that decrease ADH stimulation

A

clonidine

haldol

alcohol

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14
Q

Name five things that increase thirst

A

increased plasma osmolarity

decreased BP

decreased blood volume

increased angiotensin II

dry mouth

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15
Q

What effect do aldosterone and angiotensin have on sodium plasma concentration?

A

None! They control the total body sodium. Not sodium concentration.

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16
Q

Name four factors that cause potassium to shift into cells

A

Insulin

Aldosterone

B-adrenergic stimulation

alkalosis

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17
Q

Name 7 factors that cause potassium to shift out of cells

A

insulin deficiency (diabetes)

Aldosterone deficiency (addison disease)

B-adrenergic blockade

Acidosis

Cell Lysis

Exercise

Increased plasma osmolarity

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18
Q

Most of the daily potassium reabsorption and excretion occurs where?

A

the late distal and cortical collecting tubules

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19
Q

Which cells in the late distal and cortical collecting tubules secrete potassium?

A

Principal cells

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20
Q

In patients with Addison’s disease, serum potassium levels are:

A

extremely high

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21
Q

In a high-sodium diet, aldosterone would be low, so you’d think potassium would be high. But it isn’t. Why?

A

the low aldosterone decreases the amount of K secreted, but the high tubular flow rate that results from being fluid overloaded increases potassium excretion, so the balance stays pretty much the same

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22
Q

Acute acidosis ______ potassium secretion

A

reduces

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23
Q

How is most calcium excreted?

A

feces

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24
Q

Hypocalcemia causes ________ excitability

Hypercalcemia causes _______ excitability

A

increased

decreased

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25
Why are patients with alkalosis more susceptible to *hypo*calcemic tetany?
hydrogen ion concentration alters calcium binding. When there's a high hydrogen ion concentration, more calcium is free (ionized). When there's a low hydrogen ion concentration, less calcium is free (ionized), which means less calcium is technically available for use
26
Name six factors that decrease calcium excretion
Increased PTH decreased BP decreased blood volume Increased plasma [phos] Alkalosis Vit D
27
Name five factors that increase Ca excretion
Decreased PTH increased blood volume increased BP decreased plasma [phos] acidosis
28
Name four factors that increase Phos excretion
increased dietary intake PTH metabolic acidosis HTN
29
Name four factors that decrease Phos excretion
decreased intake Vit D Alkalosis Thyroid Hormone
30
Magnesium concentration is directly related to _______ concentration
calcium as calcium excretion increases, magnesium excretion increases (and vice versa)
31
What is pressure natriuresis?
As blood pressure increases, sodium excretion increases
32
what is pressure diuresis?
An increase in BP increases diuresis
33
Why do so many patients in heart failure need ACE inhibitors?
under normal circumstances, angtiotensin II causes a large amount of water and sodium to be reabsorbed BUT with a normal heart, this results in almost no change in ECF volume BECAUSE the increased volume causes increased pressure diuresis. BUT in a sick heart, it can't pump effectively enough to increase pressure in the kidney and cause pressure diuresis. So angiotensin II is still retaining Na, but the kidney isn't compensating via pressure diuresis. Water accumulates and causes CHF
34
Which does ADH effect more: ECF volume or plasma [Na]?
Plasma sodium concentration ADH actually causes very little ECF overload, even when present in large amounts BECAUSE of pressure natriuresis BUT excess ADH creates ECF that is extremely low in sodium, because sodium is not being reabsorbed with the water AND sodium excretion is increased by pressure natriuresis
35
destruction of ______ causes an inability to create ADH
supraoptic nuclei
36
Why does blood volume increase as a woman becomes more pregnant?
As vascular capacitance increases (due to the constant formation of new blood vessels), the kidneys retain salt and water to add volume to essentially fill a bigger tank
37
Why are the kidneys more resilient to ischemia than other organs?
As perfusion decreases, so does the GFR, which means the kidney is expending WAAAYY less energy reabsorbing sodium
38
What causes acute glomerulonephritis?
abnormal immune reaction that damages the glomeruli occurs 1-3 weeks after infection d/t antibody production
39
What kind of pathogen is usually the instigator of glomerulonephritis?
Group A Beta Strep
40
What is tubular necrosis?
destruction of the epithelial cells of the tubules
41
What causes Acute Tubular Necrosis?
Either severe ischemia or toxins/meds
42
In CKD, serious symptoms aren't seen until the number of functional nephrons decreases to \_\_\_\_\_\_
20-25% of normal
43
What is the most common cause of ESRD?
Diabetes
44
Why does lupus often lead to kidney failure?
Causes chronic glomerulonephritis
45
minimal-change nephropathy is:
protein loss with no visible defect in the basement membrane most common in children aged 2-6
46
What is isosthenuria?
inability of the kidney to concentrate urine
47
What is renal tubular acidosis?
Inability of the tubules to secrete H results in a severe loss of bicarb
48
What is Fanconi Syndrome?
increased urinary excretion of virtually all amino acids, glucose, and phosphate
49
What is Bartter Syndrome?
Decreased Sodium, Chloride, and Potassium Reabsorption in the Loops of Henle Impaired NCCK
50
What is Liddle Syndrome?
Increased sodium reabsorption autosomal-dominant disorder resulting from various mutations in the amiloride-sensitive epithelial sodium channel (ENaC) in the distal and collecting tubules
51
Renal glucose release is stimulated by _____ and inhibited by \_\_\_\_\_\_
epinephrine insulin
52
\_\_\_\_\_\_\_ suppresses glucose release in both the kidneys and liver
insulin
53
All glomeruli are located in the \_\_\_\_\_\_\_
cortex
54
The structural unit of the kidney is the \_\_\_\_\_\_ the functional unit of the kidney is the \_\_\_\_\_\_\_
lobe nephron
55
How many lobes are there in each kidney?
14
56
Each lobe is composed of:
a medullary pyramid and the overlying cortex
57
\_\_\_\_\_\_ cells create a matrix and support the glomerular capillaries
mesangial
58
Podocytes are responsible for forming:
filtration slits that modulate filtration
59
The endothelium, basement membrane, and podocytes are covered with ______ to prevent proteinuria
anionic protein molecules
60
juxtaglomerular cells are located in the ______ and release ________ in response to \_\_\_\_\_\_
Afferent arteriole renin sodium changes in the macula densa
61
the wall of the ______ is the only surface in the nephron that contains microvilli
proximal convoluted tubule
62
Compare the ascending and descending thin loops of henle
Descending: no active transport, highly permeable to water Ascending: permeable to ions, impermeable to water
63
The distal tubule extends from the ______ to the \_\_\_\_\_
macula densa collecting duct
64
Principal cells and intercalated cells make up the epithelium of the:
distal tubule
65
Principal cells reabsorb _____ and secrete \_\_\_\_\_\_
sodium and water potassium
66
The ________ is the only blood supply to the medulla
vasa recta closely follows the loop of henle
67
What is the function of the uroepithelium?
lines the entire urinary tract maintains barrier between water and solutes in the urine and the blood supply
68
What is the trigone?
smooth triangular area lying between the openings of the two ureters and the urethra
69
the internal urethral sphincter is made of: the external is made of:
smooth muscle striated muscle (under voluntary control)
70
Which nerves innervate the external urethral sphincter?
somatic motor neurons in the pudendal nerves
71
Where does blood that is not filtered through the glomerulus go?
Through the efferent arteriole into the peritubular capillaries
72
What effect does parasympathetic stimulation have on renal perfusion?
There's almost no parasympathetic innervation to the kidneys
73
What is the role of prostaglandins in regulation?
dampen vasoconstriction caused by sympathetic nerves and angtiotensin II Prevent harmful vasoconstriction and renal ischemia
74
Low serum plasam levels will ______ the GFR
decreases the effective oncotic pressure that would normally keep fluid in the glomerular capillaries instead of flowing into the capsule (being filtered) increases GFR
75
High serum plasma levels will ______ the GFR
decrease Keeps fluid in the glomerular capillaries instead of being filtered into the glomerulus
76
How are chloride, water, and urea absorbed?
passively but linked to the active transport of sodium
77
What is the primary function of the proximal tubule?
active sodium reabsorption everything else is cotransported with sodium and water is reabsorbed by osmosis with sodium concentration
78
How does the structure of the loop of henle alter the efficiency of water conservation?
The longer the loop, the greater the ability to concentrate urine

Patho 2 (24 decks)

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