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JKC Med Phys Spring '24 > Renal part 2- Exam 3 > Flashcards

Renal part 2- Exam 3 Flashcards

1
Q

What is the formula for urinary excretion?

A

Glomerular filtration - tubular reabsorption + tubular secretion

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2
Q

____ is the more important that secretion in determining the final urinary excretion rate.

A

Reabsorption

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3
Q

Glomerular filtration is relatively (selective/nonselective)

A

nonselective

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4
Q

Tubular reabsorption is (selective/nonselective)

A

highly selective

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5
Q

What three substances are highly reabsorbed?

A

Sodium
chloride
bicarb

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6
Q

What 2 things are poorly reabsorbed?

A

urea and creatinine and are excreted in large amounts

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7
Q

In order for reabsorption to occur, what must happen?

A

must be transported across the tubular epithelial into the renal interstitial fluid, then through the peritubular capillary membrane back to the blood

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8
Q

What are the two pathways tubular reabsorption can take?

A

transcellular route

paracellular route

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9
Q

How does the water and solutes get into the peritubular capillary?

A

by ultrafiltration (bulk flow)

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10
Q

What two forces mediate ultrafiltration?

A

hydrostatic and colloid osmotic forces

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11
Q

Somethings are pumped out of the lumen across the cell and into the peritubular capillary through ____

A

active transport using ATP

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12
Q

What is secondary active transport? Give an example

A

Glucose, if indirectly coupled to an energy source

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13
Q

Renal tubular cells are held together by ______

A

tight junctions

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14
Q

Name 4 kinds of kidney primary active transporters

A

Hydrogen ATPase
Hydrogen-potassium ATPase
Calcium ATPase

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15
Q

How many mv does the reabsorption of sodium ions across the proximal tubular membrane create?

A

-70mv charge

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16
Q

Secondary active transport of glucose and amino acids in the _____

A

proximal tubule

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17
Q

What are the 2 sodium glucose co transporters?

A

SGLT2 and SGL1

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18
Q

Why do you not see glucose or amino acids in your urine?

A

because they are reabsorbed via secondary active transport, all 100% of them

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19
Q

What drug class is Invokana? How does it work?

A

SGLT inhibitors

blocks the reabsorption of glucose into the blood resulting in increased levels of glucose in the urine

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20
Q

90% of the filtered glucose is reabsorbed by the ____ in the (early/late) proximal tubule

A

SGLT2

early

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21
Q

10% by the ____ in the (early/late) the proximal tubule

A

SGLT1

late

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22
Q

Why does the type I diabetic have glucose in the urine?

A

have a complete saturation and exceeded capacity of SGLT2 transporter, so glucose in the urine

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23
Q

What is counter transport?

A

energy liberated from the downhill movement of one of the substances (sodium ions) enables uphill movement of a second substance in the opposite direction (hydrogen ions)

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24
Q

What is counter transport mediated by?

A

specific protein in the brush border of the luminal membrane
SODIUM-HYDROGEN EXCHANGER (NHE)

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25
Q

What is the tubular load?

A

the amount of solute delivered to the tubule

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26
Q

what does the transport maximum limit?

A

rate at which the solute can be transported, activity reabsorbed or secreted

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27
Q

What is the threshold for glucose?

A

[plasma glucose] is 200 mg/dl – increases the filtered load to 250 mg/min,

When a small amount of glucose begins to appear in the urine

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28
Q

What is the overall glucose transport max

A

375 mg/min

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29
Q

What type of substances have a transport maximum?

A

substances that have a protein transporter

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30
Q

What types of substances do NOT have a transport maximum?

A

substances that are passively reabsorbed
substances that use an electrochemical gradient for diffusion

sodium

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31
Q

The rate of transport is determined by what three things?

A

-Electrochemical gradient for diffusion
-The permeability of the membrane for the substance
-The time that the fluid containing the substance remains within the tubule.

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32
Q

T/F: Sodium has a transport maximum

A

FALSE, because the ATPase pump activity is far greater than the actual rate of net sodium reabsorption

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33
Q

for sodium, the greater amount of sodium the ____ the reabsorption

A

greater

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34
Q

The slower the flow rate of tubular fluid, the _____ the % of sodium that can be reabsorbed

A

greater

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35
Q

Decreased macula densa sodium chloride causes _____ of afferent arterioles and _____ renin release

A

Dilation

Increased

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36
Q

What does the macula densa sense?

A

Sense a change in volume delivery to the distal tubule.
By sensing a reduction of sodium and chloride in the tubule

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37
Q

What a decrease in GFR cause?

A

an increase in sodium and chloride reabsorption

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38
Q

What end of the tubule is highly permeable to water? Due to ?

A

promixal tubule

tight junctions between the epithelial cells

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39
Q

water is (more/less) permeable in the loop of Henle and distal parts of the nephron

A

Less

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40
Q

______ can greatly increase water permeability in the distal and collecting tubules

A

Antidiuretic hormone

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41
Q

in the proximal tubular ____ of water and sodium are reabsorbed

A

65%

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42
Q

Proximal tubular reabsorption has _____ brush border for SA

A

extensive

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43
Q

proximal tubular reabsorption has (many/few) protein carriers

A

many

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44
Q

proximal tubule has (low/high) co transport and counter transport

A

high

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45
Q

Descending loop of Henle is (thick/thin)

A

thin

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46
Q

Descending loop of Henle is (highly/lowly) permeable to water

A

highly- 20% of filtered water

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47
Q

What is the main function of the descending loop of Henle?

A

Mainly allows simple diffusion of substances through its walls

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48
Q

Descending loop of Henle is (low/moderate/high) permeable to most solutes

A

moderately

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49
Q

The ascending LOH has two sections. Name them

A

Thin part and thick part

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50
Q

In the ascending LOH, the ___ section has LOWER reabsoptive capacity than _____

A

thin

thick

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51
Q

What is happening in the thick ascending section of LOH?

A

lots of metabolic activity- 25%

active reabsorption of sodium, chloride and potassium, calcium, bicarb and magnesium

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52
Q

The __ section of the ascending LOH has ???. What does it promote?

A

thick

sodium/potassium pump

Favorable gradient for moving of sodium from the tubular fluid into the cell.

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53
Q

In the thick ascending loop, movement of sodium across the luminal membrane is mediated by a ???

A

1-sodium,2-chloride,1-potassium co-transporter.

Uses the potential energy released by downhill diffusion of sodium into the cell to drive the reabsorption of potassium into the cell against a concentration gradient.

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54
Q

***Loop diuretics works on what part of the kidney? How does it work?

A

thick ascending LOH

blocks 1-sodium,2-chloride,1-potassium co-transporter which keeps the electrolytes in the filtrate, so more water stays in the tube and ends up in urine. Drys the patient out

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55
Q

Loop diuretics (increase/decrease) the ability of the kidneys to concentrate the urine

A

decrease

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56
Q

Memorize this chart

A

DO IT!!

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57
Q

The first portion of the distal tubule forms the ______

A

macula densa

58
Q

The distal tubule, describe what is happening to water?

A

NOT permeable to water

lots of ions reabsorption

59
Q

____ section dilutes the tubular fluid

A

thick section of the ascending LOH

60
Q

the early distal tubule reabsorbs ____ of the filtered load of sodium-chloride

A

5%

61
Q

How does the early distal tubule move sodium chloride?

A

through a sodium-chloride co-transporter that moves from the tubular lumen into the cell

62
Q

_____ are widely used to treat disorders such as hypertension and heart failure. How do they work?

A

Thiazide diuretics

inhibit the sodium-chloride co-transporter
in the distal tubule

63
Q

The late distal tubules and cortical collecting tubules are composed of what kind of cells

A

principal cells and intercalcated cells

64
Q

What is the role of the principal cells?

A

Reabsorb sodium and water from the lumen and secret potassium ions into the lumen

65
Q

How do potassium sparing diuretics work?

A

Compete with aldosterone for receptors sites in the principal cell

66
Q

Name two potassium sparing diuretics

A

spironlactone and eplerenone

67
Q

Name two sodium channel blockers

A

Amiloride
Triamterene (Dyrenium)

68
Q

What is the role of intercalated cells?

A

Reabsorb potassium ions and secrete hydrogen ions into the lumen
Reabsorbs bicarbonate ions

69
Q

Medullary collecting ducts reabsorb less than ____ of the filtered water and sodium

A

10%

70
Q

What is the final site for processing the urine?

A

Medullary collecting duct

71
Q

the _____ is extremely important role in determining the final urine output of water and solutes

A

Medullary collecting ducts

72
Q

In the medullary collecting ducts, what is the permeability of water controlled by?

A

ADH levels

73
Q

If the ADH level is high, water is _____. Urine volume _____

A

reabsorbed

decreases

74
Q

Is the medullary collecting ducts permeable to urea?

A

yes, has special urea transporters

75
Q

If more water gets reabsorbed than solute, what will the concentration do?

A

concentration rises to greater than 1

76
Q

If the ratio becomes less than 1, what does this mean?

A

more solute than water has been reabsorbed

77
Q

Glomerulotubular balance: when GFR increases, what happens to reabsorption

A

reabsorption increases

78
Q

When GFR increases what does it prevent?

A

overload of the distal tubular segments

79
Q

Aldosterone ____ sodium reabsorption and stimulates ____ secretion

A

increases

potassium

80
Q

Where is the site of action for aldosterone?

A

principal cells of the cortical collecting tubule

81
Q

aldosterone stimulate the ______ (pump) on what side of the cortical collecting tubule? What does it promote?

A

ATPase

basolateral

promotes potassium to be excrete and Na be reabsorbed

82
Q

dehydration causes aldosterone to be (high/low)

A

high

83
Q

What does the kidneys do with extra water?

A

pee it out

84
Q

The urine becomes more (solute/dilute) as it passes along the tubule

A

dilute

everything get reabsorbed

85
Q

The ____ loop is responsible for concentrating the urine

A

descending loop

86
Q

____ loop is NOT permeable to water

A

thick segment of the ascending loop

87
Q

Tubular fluid remains _____ in the proximal tubules

A

isosomotic

88
Q

the fluid leaving the early distal tubular segment is _____. Does ADH have an effect?

A

hypo-osmotic

ADH does not have an effect

89
Q

Water is continuously lost from the body by what four organ systems?

A

lungs
GI
Skin
Kidneys

90
Q

Urine specific gravity tests what?

A

rapid estimate of urine solute concentration

91
Q

If you are dehydrated, the urine specific gravity will increase/decrease?

A

increase

more solutes compared to water in the urine

92
Q

concentrated urine will have a high/low ADH level

A

high

93
Q

A hyperosmotic renal medulla interstitium will result in a (diluted/concentrated) urine

A

concentrated

94
Q

add the chart with the the loop and what parts are permeable to what substances

A
95
Q

What are the steps that cause hyperosmotic medullary

A
  1. assume loop is filled with fluid with a concentration of 300mOSM/L
  2. Ion pump of the thick ascending limb reduces the concentration inside the tubule and raises the interstitial concentration because the ions leave and water CANNOT follow
    3.Descending limb of the loop and the interstitial fluid quickly reach equilibrium by osmosis of water out of the descending limb
  3. Additional flow of fluid into the loop from the proximal tubule
  4. Additional ions are pumped into the interstitium with water remaining in the tubular fluid
  5. Steps repeated over and over
96
Q

diagram of the steps of the hyperosmotic medullary

A
97
Q

What is it called when the kidney can concentrate the urine

A

Counter current multiplier

98
Q

What portion of the loop is critically dependent on ADH?

A

Cortical collecting tubule

99
Q

In the cortical collecting tubule, in the absence of ADH the segment is (super permeable/ impermeable to water)

A

impermeable

100
Q

When ADH is high in the distal tubule and collecting ducts, what happens?

A

cortical collecting tubule becomes highly permeable to water and the water leaves the tubules and the urines gets more concentrated (more water is retained by the body)

101
Q

_____ accounts for 40% of the hyperosmotic renal medullary interstitium

A

urea

102
Q

When ADH is high, what happens to urea?

A

large amounts of urea is REABSORBED

103
Q

What does the recirculation of urea help with?

A

helps to trap the urea in the renal medulla and contributes to the hyperosmolarity of the renal medulla

104
Q

The countercurrent exchange in the Vasa Recta leads to ?

A

preserves hyperosmolarity of the renal medulla

105
Q

When the medullary blood flow is low, what 2 things happen?

A

minimizes solute loss from the medullary interstitium

the vasa recta serves as a countercurrent exchanger

106
Q

What is happening in the descending loop of the vasa recta?

A

the plasma flowing down the descending limbs becomes more hyperosmotic because the diffusion of water out of the blood.

diffusion of solutes from the renal interstitial fluid into the blood

107
Q

What is happening in the ascending limb of the vasa recta?

A

solutes diffuse back into the interstitial fluid and water diffuses back into the vasa recta

108
Q

Diagram of the countercurrent exchange in the vasa recta

A
109
Q

Know the flow chart of what happens when you are in a water deficit

A
110
Q

_____ are proteins that up-regulate and form channels in medullary collecting ducts

A

aquaporins

111
Q

Where does ADH comes from? What is other name for it?

A

posterior pituitary gland

vasopressin

112
Q

What is the function of the loop of Henle?

A

to make sure the interstitium is concentrated

113
Q

What is the function of the vasa recta?

A

to make sure the interstitium is salty aka not being diluted

114
Q

Descending part of the loop is (permeable/impermeable) to water

A

very permeable, water travels very easily across

115
Q

Thick ascending LOH is (permeable/impermeable) to water

A

impermeable to water

ions leave the loop and go into the interstitium

116
Q

**What is the diluting segment?

A

the thick portion of the ascending LOH, ions leave aka the filtrate is being diluted

117
Q

how are the ions transported across the membrane in the ascending LOH?

A

secondary messenger systems and ATPase pumps pump the ions out of the filtration

118
Q

What is the transport max for glucose?

A

375

119
Q

At 200 mg/dL of glucose present, what will you start to see?

A

glucose in the urine

120
Q

Why would a diabetic be thirsty?

A

because the patient is dumping glucose into the urine and water follows the glucose aka dehydrating yourself

121
Q

How does Invokana and similar type drugs work?

A

compete with and block the SGLT transport so that they becomes saturated much easier, so glucose is peed out

122
Q

Chronic kidney disease is measured on a _____ scale

A

1-5 scale

123
Q

______ renal failure results from decreased blood supply to the kidneys

A

Prerenal acute renal failure

124
Q

________ results from any abnormality origination from outside the kidneys

A

prerenal acutre renal failure

125
Q

______ is caused by any abnormalities within the kidney itself

A

intrarenal acute renal failure

126
Q

______ occurs when their is an obstruction of the urinary collecting system

A

postrenal acute renal failure

127
Q

Kidney stones are an example of what kind of acute kidney failure?

A

Postrenal acute kidney failure

128
Q

What are some causes of prerenal acute renal failure?

A

hemorrhage, diarrhea/vomiting, burns, MI, valvular damage, anaphylactic shock, anesthesia, sepsis, severe infections, primary renal hemodynamic abnormalities, renal artery stenosis, embolism and thrombosis of renal artery/vein

129
Q

T/F: Kidneys can not tolerate a lack of blood flow

A

FALSE, kidneys CAN tolerate a lack of blood flow to a certain degree, as long as blood flow does not fall below 25% the kidney is fine

130
Q

What are the three categories within intrarenal acute renal failure?

A

conditions that damage: 1. glomerular capillaries or other small renal vessels
2. renal tubular epithelium
3. renal interstitium

131
Q

What are some common causes of intrarenal acute renal failure?

A

vasculitis, cholesterol emboli, malignant hypertension, acute glomerulonephritis, acute tubular necrosis due to ischemia or toxins, acute pyelonephritis, acute allergic interstitial nephritis

132
Q

What is glomerulonephritis?

A

abnormal immune reaction that damages the glomeruli, usually caused by a group A beta streptococci bacterial infection

133
Q

Albumin in your urine is a sign of?

A

Glomerulonephritis

basement membrane is being destroyed

134
Q

crush injury can lead to ?

A

rhabdomyalsis, when the products released from crush injuries can cause severe kidney problems

135
Q

____ an irreversible decrease in the number of the functional nephrons

A

chronic renal failure

136
Q

What are some causes of chronic renal failure?

A

DM, obesity, HTN, renal vascular disorder, immunologic disorders, infections, primary tubular disorders, urinary tract obstruction

137
Q

_____ replacement of normal tissue with connective tissue

A

sclerosis

138
Q

What are some common causes of End Stage Renal Disease

A

DM-45% - Obesity
HTN- 27%- Obesity
Glomerulonephritis- 8%
Polysystic kidney disease- 2%
Other -18%

139
Q

_____ damage to the interstitium by bacterial infections

A

pyelonephritis

140
Q

______ excretion of proteins in the urine because of increased glomerular permeability

A

nephrotic syndrome

141
Q

What are some common causes of nephrotic syndome?

A

Chronic glomerulonephritis
amyloidosis
minimal charge nephrotic syndrome (loss of negative charges)

JKC Med Phys Spring '24 (18 decks)

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