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Systems 2nd Year Renal > Renal Physiology > Flashcards

Renal Physiology Flashcards

1
Q

How is micturition controlled

A

cortical centre causes bladder sensation and conscious inhibition of micturition

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2
Q

Where is the micturition centre

A

pons

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3
Q

where is the micturition reflex

A

s2-s4

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4
Q

Relaxation of internal urethral sphincter is said to be

A

autonomic - sympathetic

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5
Q

relaxation of external urethral sphincter is said to be

A

somatic

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6
Q

contraction of detrusor muscle is said to be

A

autonomic parasympathetic

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7
Q

How much protein free filtrate of plasma is there in renal physiology

A

20%

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8
Q

What is the glomerular filtration rate

A

180/l a day

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9
Q

what does the glomerular filtration rate do

A

regulates ecf volume and composition

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10
Q

Where do the substances that the body doesn’t want go in renal physiology

A

tubule then excreted

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11
Q

substances the body wants in renal physiology are

A

reabsorbed

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12
Q

which substances are reabsorbed in proximal tubule

A

NACI
Water
Amino Acid
sugar

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13
Q

which substances are reabsorbed in distal tubule

A

NaCI

Water

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14
Q

which substances are secreted in proximal tubule

A

Organic Ions

Drugs

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15
Q

which substances are secreted in distal tubule

A

K and H

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16
Q

Kidneys blood flow is

A

1200mls

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17
Q

How much of cardiac output does kidneys receive

A

20-25%

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18
Q

Kidneys weight what of Body Weight

A

<1%

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19
Q

What is filtered through into Bowmen Capsule

A

Fraction of plasma no red cells

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20
Q

Remainder of Plasma that doesn’t go through Bowman capsule goes via

A

efferent arterioles into peritubular capillaries and then to renal vein

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21
Q

Plasma constitutes how much of total body volume

A

55%

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22
Q

what is renal plasma flow total

A

660mls

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23
Q

GFR is normally

A

125mls

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24
Q

how much of renal plasma becomes glomerular filtrate

A

19%

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25
Q

Glomerular filtration is dependent on balance between

A

hydrostatic forces favouring filtration and oncotic pressures forces favouring reabsorption (starling forces)

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26
Q

what prevents filtration of larger proteins

A

basal lamina of glomerulus

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27
Q

Why is glomerular capillary pressure higher than in most of capillaries in body

A

afferent arteriole short/wide/little resistance to flow

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28
Q

blood arriving at glomerulus has what hydrostatic pressure

A

high

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29
Q

The efferent arteriole in glomerulus is

A

Long/Narrow/High Resistance

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30
Q

If you have a high resistance hydrostatic pressure upstream is

A

increased and pressure downstream decreased

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31
Q

what contributes to very high glomerular capillaries pressure

A

afferent and efferent arterioles

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32
Q

at glomerular capillaries what exceeds oncotic pressure

A

hydrostatic pressure favouring filtration

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33
Q

What occurs at glomerular capillaries

A

only filtration

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34
Q

What is net filtration pressure at glomerulus

A

10mmHg

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35
Q

What factors affect GFR

A

Afferent and Efferent Arteriolar Diameter/Resistance.

Subject to Extrinsic Control

a) Sympathetic VC nerves - afferent and efferent constriction, greater sensitivity of afferent arteriole.
b) Circulating catecholamines - constriction 1 degree afferent
c) Angiotensin II to constriction, of efferent at [low], both afferent and efferent at [high].

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36
Q

Afferent and Efferent Arteriolar Diameter/Resistance is subject to what control

A

extrinsic control

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37
Q

There is greater sensitivity of what arteriole afferent or efferent

A

afferent

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38
Q

circulating catecholamines cause what to happen to afferent arteriole

A

constriction by 1 degrees

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39
Q

angiotensin ii causes constriction of efferent at what pressure

A

low

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40
Q

angiotensin ii causes constriction of afferent and efferent at what pressure

A

high

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41
Q

GFR does what as glomerular capillary pressure increases

A

It increases

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42
Q

decreased capillary blood pressure causes

A

decreased GFR and RBF through increased resistance in afferent arteriole

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43
Q

when resistance increases in afferent arteriole what happens to gfr and capillary blood pressure

A

decrease

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44
Q

in increased resistance to efferent arteriole what happens to ph and gfr

A

increased but rbf decreases

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45
Q

Renal vasculature has a intrinsic or extrinsic ability

A

intrinsic which allows for auto regulation

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46
Q

When MBP is below 50

A

Filtration ceases

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47
Q

If mean arterial pressure increases what happens to afferent arteriolar constriction

A

increases preventing rise in glomerular pic

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48
Q

dilation occurs if what happens

A

pressure falls

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49
Q

auto regulation is independent of

A

everything

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50
Q

how much plasma volume enters afferent arteriole

A

100%

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51
Q

how much fluid is reabsorbed from afferent arteriole plasma volume

A

19%

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52
Q

what is responsible for reabsorption

A

peritubular capillaries

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53
Q

how much is filtered through glomerulus into renal tubule

A

180 l/day

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54
Q

what is hydrostatic pressure figure

A

15mmhg

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55
Q

what only occurs at glomerular capillaries

A

filtration

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56
Q

how much plasma filters into bowmen capsule and is known as filtration fracture

A

20%

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57
Q

which substances are reabsorbed by carrier mediated transport system

A 
glucose
amino acids
organic adis
sulphate
phosphate ions
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58
Q

If Maximum Transport Capacity is exceeded then what happens to excess substrate

A

it enters urine

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59
Q

what is renal threshold

A

plasma threshold at which saturation occurs

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60
Q

How much glucose can be reabsorbed

A

up to 10mmols

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61
Q

what is the renal plasma threshold for glucose

A

10mmls the rest will be excreted in urine

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62
Q

does kidney regulate glucose or insulin

A

no

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63
Q

the appearance of glucose in urine in diabetic patients is called

A

glycosuria

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64
Q

glycosuria is due to failure of

A

insulin not the kidney

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65
Q

Which substances does the kidney regulate by Tm mechanism

A

Sulphate and Phosphate

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66
Q

which substances does the kidney not regulate

A

Glucose
Insulin
Amino Acids

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67
Q

which ions are the most abundant in ECF

A

Na+

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68
Q

how much Na+ is reabsorbed

A

99.5%

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69
Q

65-75% of ion reabsorption occurs in

A

prox tubule by active transport which establishes gradient

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70
Q

ion reabsorption does not occur by

A

Tm mechanism

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71
Q

where are active Na+ pumps found

A

basolateral surfaces where high density of mitochondria

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72
Q

basolateral surfaces having na+ pumps what does this do to epithelial cells

A

decreased na+ in epithelial cells

increasing gradient for na ions to move into cells passively across luminal membrane

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73
Q

na+ is pumped out basolateral side of cell by what

A

Na+/K+ ATPase

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74
Q

Where has higher permeability to Na+ ions than most other membranes in body

A

Brush border of prox tubule

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75
Q

Negative Ions such as CI diffuse how across prox tubular membrane

A

Passively by Electrical Gradient Na+ made by it’s active transport

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76
Q

The active transport of Na+ out of the tubule followed by Cl- creates an

A

osmotic force drawing water out into tubules

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77
Q

H2O removed by osmosis from the tubule fluid does what

A

concentrates all substances left in tubule creating outgoing concentration gradients

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78
Q

How is na+ reabsorbed

A

active transport

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79
Q

what will determine extent of concentration gradient

A

amount of water removed

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80
Q

tubule membrane is what to urea

A

moderately permeable

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81
Q

how much urea is reabsorbed in tubule

A

50%

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82
Q

For insulin and mannitol what is the tubular membrane to them

A

impermeable so it passes out into urine

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83
Q

What establishes the gradients down with ions, water and solutes pass passively

A

active transport of Na+

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84
Q

Low Na+ inhibits what

A

glucose transport

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85
Q

To transport glucose what does Na+ need

A

SGLT

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86
Q

Where are substances secreted from

A

Peritbular capillaries into tubule lumen.

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87
Q

Where is Penicllin, Asprin, PAH, Choline, creatinine secreted

A

Prox Tubule

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88
Q

How to calculate amount of solute excreted

A

Amount Filtered - Amount Reabsorbed + Amount Secreted = Amount of Solute Excreted

89
Q

What is the major cation in cells of body and essential for life

A

K+

90
Q

Normal ECF K+

A

4%

91
Q

If K is up to to 5.5mmols =

A

Hyperkalaemia

92
Q

Hyperkalaemia leads to

A

Decreased RM potential of excitable cells = Vent Fib = Death

93
Q

If K is <3.5 =

A

Hypokalaemia

94
Q

Hypokalaemia =

A

Increased RM Potential = Hyperpolarise = Arrythmias = Death

95
Q

what happens to K Filtered at Glomerulus i

A

reabsorbed with some at prox tubule

96
Q

Changes in K excretion are due to changes in

A

secretion in distal tubule

97
Q

Any increase in renal tubule cell K+ due to increased ingestion will do what to K+

A

increase secretion

98
Q

Any decrease in renal tubule cell K+ will

A

reduce secretion

99
Q

what is k secretion regulated by

A

adrenal cortical hormone aldosterone

100
Q

Aldosterone stimulates kidneys to stimulate

A

increase in renal tubule cell k secretion

101
Q

H+ ions are actively secreted from

A

tubule cells into lumen

102
Q

K+ is regulated by

A

aldosterone

103
Q

Where is a major site of reabsorption in kidney

A

proximal tubule in particular 65-75% of all NaCI and H20

104
Q

How much albumin gets through Proximal Tubule

A

30g per day which 0.5 of total amount presented at glomerulus

105
Q

The rest of Albumin is reabsorbed where

A

By Tm carrier mechanism in Prox Tubule

106
Q

Where is a major site of tubular secretion in kidney

A

proximal tubule

107
Q

collecting duct of medulla is site of

A

water regulation under control of ADH

108
Q

The fluid that leaves the proximal tubule is

A

isomotic with plasma

109
Q

All solute movements from proximal tubule is accompanied by

A

equivalent water movements so maintain osmotic equilibrium

110
Q

Nephrons have all of their proximal and distal tubules in

A

Cortex

111
Q

Maximum concentration of urine that can be produced by the human kidney

A

1200-1400mOsmoles

112
Q

The urea, sulphate, phosphate, other waste products and non-waste ions (Na+ and K+ ) which must be excreted each day amount to

A

600 mOsmoles requires minimum water loss of 500mls

113
Q

even if no water and kidneys functioning what volume will be excreted every day

A

600mOsmoles

114
Q

In conditions of excess H20 intake, H20 is excreted in excess of

A

solute

115
Q

What acts as counter current multiples in renal physiology

A

loops of hence of juxtamedullary nephrons

116
Q

Loops of hence and juxtamedullary nephrons allows fluid to do what

A

flow down descending limb and up ascending limb

117
Q

Ascending limb of loop of hence actively co-transports what?

A

Na+ and CI+ ions out of tubule lumen into interstitum

118
Q

The ascending limb is impermeable to

A

water

119
Q

descending limb is freely permeable to

A

water

120
Q

what is a key step in loop of hence counter current multiple

A

active removal of NaCi from ascending limb. Decreasing osmolarity in tubule and increase in interstitum.

121
Q

H20 does not stay in interstitum it is reabsorbed by

A

High osmotic pressure

122
Q

The fluid in the tubule is progressively concentrated as it moves

A

down the descending limb and progressively diluted as it moves up the ascending limb.

123
Q

As more and more concentrated fluid is delivered to the ascending limb, what happens to interstitial

A

becomes more and more concentrated.

124
Q

Vertical gradient in interstitium goes from

A

300 to 1200

125
Q

Active transport of NaCi is out of

A

ascending limb

126
Q

what can abolish active transport of NaCi out of ascending limb

A

frusemide therefore kidney would only produce isotonic urine

127
Q

How does countercurrent multiple work

A

Concentrates fluid on the way down and promptly re-dilutes it on the way back up, NOT by adding H2O, but by removing NaCl.

128
Q

how much of initial filtrate is removed from loop of hence

A

15-20%

129
Q

fluid which enters distal tubule is what than plasma

A

more dilute

130
Q

what is the overwhelming significance of countercurrent multiple

A

creates increasingly concentrated gradient in interstitial

131
Q

Countercurrent Multiple also delivers what to distal tubule

A

Hypotonic Fluid

132
Q

Fluid enters distal tubule at

A

300

133
Q

fluid leaves distal tubule at

A

100

134
Q

Hypotonic fluid needs to be delivered to

A

distal tubule

135
Q

What acts as countercurrent exchangers

A

Peritubular Capillaries

136
Q

Vasa recta are freely permeable to what

A

Water and Solutes and equilibrate with medullary interstitial gradient

137
Q

Vasa Recta does not disturb

A

Interstitial Gradient

138
Q

Vasa Recta delivers what and removes what

A

delivers 02

removes volume

139
Q

functions of vasa recta

A

provide 02 for medulla
does not disturb gradient
removes volume from interstitial up to 36l/day

140
Q

flow rate through vasa recta

A

is very low

141
Q

site of water regulation is

A

collecting duct whose permeability is under control of ADH

142
Q

what is ADH also called

A

vasopressin

143
Q

collecting duct is under control of

A

ADH/Vasopressin

144
Q

Isomotic fluid leaving prox tubule becomes progressively more what in descending limb

A

concentrated

145
Q

what creates hyposomotic fluid

A

removal of solute in thick ascending limb

146
Q

what controls distal nephron permeability to water and solutes

A

hormones

147
Q

urine osmolarity depends on

A

reabsorption in collecting duct

148
Q

water regulation is controlled by

A

ADH/Vasopressin

149
Q

polypeptide (9aas) is synthesised in

A

synthesized in the supraoptic (SO) and paraventricular (PVN) nuclei of the hypothalamus in the brain.

150
Q

vasopressin/adh half life

A

10 mins

151
Q

What happens when the effective osmotic pressure of plasma increases

A

Rate of discharge of ADH secreting hormones in SO and PVN Increases = more release of adh from posterior pituitary

152
Q

where is adh released from

A

posterior pituitary

153
Q

changes in neuronal discharge are mediated by

A

osmoreceptors in ant hypothalamus

154
Q

lateral hypothalamus mediates

A

thirst

155
Q

what happens when osmolarity increases

A

h20 increased out of cell
cell shrinks
increased neural discharge and adh secretion

156
Q

what happens when osmolarity decreases

A

h20 enters cell
cell swells
decreased neural discharge and adh secretion

157
Q

normal plasma osmolarity is

A

289-290

158
Q

what happens with increase in osmolarity that does not cause increase in tonicity

A

no adh increase

159
Q

the amount of urine produced depends on

A

adh and amount of solute to be excreted

160
Q

urine osmolarity depends on

A

reabsorption in collecting duct

161
Q

If ADH is present then water is

A

able to leave collecting duct

162
Q

what creates hypertonic medullary interstitial gradient

A

countercurrent multiple of loop of henle

163
Q

If maximum ADH then contents become highly concentrated where

A

Tip of Medulla and small volume of highly concentrated urine produced

164
Q

When there is no adh what happens to collecting ducts in terms of water

A

Collecting ducts impermeable to water

Large volume dilute urine excreted

165
Q

In water deficit

A

we keep water

166
Q

what influences concentration of urea in duct in presence of adh

A

movement of water out of collecting ducts

167
Q

permeability of medullary collecting duct enhanced by

A

adh

168
Q

Urea needs to be reabsorbed why

A

If held in tubule it would hold water in tubule and reduce potential for rehydration

169
Q

When ECF volume increases what does ADH do

A

Decrease

170
Q

when ecf volume decreases what does adh do

A

Increase

171
Q

where are low p receptors found

A

L+R Atria and Great veins

172
Q

Where are high p receptors found

A

carotid and aortic arch baroreceptors

173
Q

adh secreting cells are

A

neurons

174
Q

what else can stimulate increase adh

A 
pain
emotion
stress
exercise
nicotine
morphine
trauma surgery
175
Q

what can stimulate decrease adh

A

alcohol

176
Q

where is adh/vasopressin released from

A

posterior pituitary

177
Q

when osmolarity is greater than 280mmo what receptors set of f

A

Hypothalamic Osmoreceptors to Interneurons to Hypothalamus overall water reabsorption

178
Q

when decreased blood pressure what do you want to happen to water reabsorption

A

increased

179
Q

What happens when collecting duct insensitive to adh

A

peripheral diabetes insipidus

180
Q

cranial diabetes insipidius can be treated with

A

adh

181
Q

what is adh receptor called

A

v2

182
Q

what are the major ECF osmoses

A

Na+ and CI+

183
Q

what are major ICF osmoles

A

K+

184
Q

what happens when decreased ECF volume

A

hypovolaemia

185
Q

Increased salt and water loss in diarrhoea, vomit or excess sweat causes everything to

A

decrease due to

  • increased renal arterial constriction
  • increased renin
  • increased angiotensin II
  • Increased Symptoms VC and TPR and BP
  • Increased adh
  • Increased prox tubule NaCi and H20 reabsorb
  • Increased aldosterone and distal tubule reabsorption
186
Q

Changes in proximal tubule Na+ reabsorption are due to

A

changes in the rate of uptake by the peritubular capillaries.

187
Q

changes in the rate of uptake by the peritubular capillaries determined by

A

osmotic pressure

188
Q

↑in Na+ reabsorption is because of

A

greater reabsorptive forces in the peritubular capillaries.

189
Q

The active transport mechanism that operates on the luminal surface of the thick ascending loop of Henle, actually involves

A

K+ ions as well as NaCI

Passive Process

Energy by Active Transport

190
Q

Loop Diuresis can cause

A

K+ ion wasting

191
Q

Any solute which remains in the tubule can cause an

A

osmotic diuresis to eliminate excess

192
Q

How to restore Alkalosis

A

NaCi

193
Q

Liquiorice can cause

A

Metabolic Alkalosis as it is similar to aldosterone

194
Q

Only what ion contribute to Ph

A

Free H+ Ions

195
Q

What represents respiratory acid

A

CO2 + H2O  H2CO3  H+ + HCO3-

196
Q

Carbonic acid can cause

A

Increase in Ventilation

197
Q

H2s04 is produced from

A

Phospholipids

198
Q

normal diet net gain to body of 50-100 mols of what a day

A

organic acids

199
Q

Major source of alkali is

A

oxidation of organic anions such as citrate

200
Q

what are buffers

A

Minimize changes in pH when H+ ions are added or removed

201
Q

what does Henderson hasselbalch equation define

A

pH in terms of the ratio of [A-]/[HA] NOT the absolute amounts

202
Q

Most important extracellular buffer

A

Bicarbonate

203
Q

Normal ph

A

7.4

204
Q

Range of ph compatible with life

A

7-7.6

205
Q

normal pco2 compatible with life

A

5.3

206
Q

elimination of h from body is by

A

kidneys coupled to regulation of plasma Hco3

207
Q

Intracellular buffer in erythrocytes

A

haemoglobin

208
Q

primary intracellular buffers

A

proteins

phosphates

209
Q

In acidosis the movement of K+ OUT OF CELLS INTO PLASMA CAN CAUSE

A

HYPERKALAEMIA = VENT FIB = DEATH = DEPOLARISE

210
Q

Increases in H+ in acidosis leads to

A

HYPERKALAEMIA

211
Q

How do the kidneys regulate Hco3

A

Reabsorb filtered HCo3

Generate new Hco3

212
Q

Where is H+ ion secretion taking place

A

tubule cells into lumen

213
Q

Mechanism of Reabsorption of HCo3

A

Active H+secretion from the tubule cells

coupled to passive Na+ reabsorption

filtered HCO3- reacts with the secreted H+ to form H2CO3. In the presence of carbonic anhydrase on the luminal membrane leads to CO2 and H2O

CO2 is freely permeable and enters the cell

Within the cell, CO2  H2CO3 in the presence of carbonic anhydrase (present in all tubule cells) which then dissociates to form H+ and HCO3-

214
Q

Carbonic Ahydrase is present

A

In all tubule cells

215
Q

HCO3 ions pass into

A

peritubular capillaries with Na+

216
Q

Bulk (90%) of HCo3 reabsorption occurs in

A

Prox Tubule

217
Q

There is no excretion of H+ ions during

A

HCo3 reabsorption

218
Q

Minimum Urine PH

A

4.5-5

Systems 2nd Year Renal (30 decks)

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