Anatomy Flashcards
(212 cards)
1
Q
Kidney taken during donor transplantation
A
Left kidney
2
Q
Reason left kidney taken during donor transplantation
A
Longer renal vein
3
Q
Vessels used to attached new kidney in transplantation
A
Iliac artery and vein
4
Q
Structure that may be damaged during ligation of uterine or ovarian vessels
A
Ureters
5
Q
Consequence of damage to ureters during ligation of uterine or ovarian vessels
A
Obstruction or leakage
6
Q
Components of glomerular filtration barrier
A
Basement membrane, podocytes, endothelial cells
7
Q
Cells that detect sodium and stimulate JG cells to secrete renin
A
Macula densa cells
8
Q
Cells stimulated by macula densa cells to secrete renin
A
JG cells
9
Q
Location of macula densa cells
A
Inside distal convoluted tubule
10
Q
Location of JG cells
A
Between distal convoluted tubule and afferent arteriol
11
Q
Cells that function to clean debris from the glomerulus
A
Mesangial cells
12
Q
Renal vein drains into what major vessel
A
Inferior vena cava
13
Q
Major vessel renal arteries branch from
A
Abdominal aorta
14
Q
Structures ureters pass under
A
Uterine artery or vas deferens
15
Q
Urine path
A
Pyramids - calyces - renal pelvis - ureter - bladder
16
Q
Renal blood flow
A
Renal artery - segmental artery - interlobar artery - arcuate artery - interlobular artery - afferent arteriole - glomerulus - efferent arteriole - vasa recta/peritubular capillaries - venous outflow
17
Q
Total body water percentage
A
60%
18
Q
Compartment made up of interstitial fluid and plasma
A
Extracellular compartment
19
Q
Percentage of ECF that makes up interstitial fluid
A
75%
20
Q
Fraction of total body water that makes up ECF
A
2/3
21
Q
Percentage of total mass of person that makes up ECF
A
40%
22
Q
Percentage of total mass of person that makes up ICF
A
20%
23
Q
Normal hematocrit percentage
A
45%
24
Q
Formula for calculating HCT %
A
HCT % = 3 x [Hb] in g/dL
25
Method for measuring plasma volume
Radiolabeling albumin
26
Method for measuring extracellular volume
Inulin or mannitol
27
Formula for measuring ECF volume
ECF = grams infused/equilibrium concentration
| Can be inulin or mannitol
28
Fraction of total body water that makes up ICF
20%
29
Responsible for filtration of plasma according to size and charge selectivity
Glomerular filtration barrier
30
Type of collagen found in glomerular filtration barrier
Type IV collagen
31
Layer of glomerular filtration barrier podocytes are found in
Epithelial layer
32
Components of basement membrane
Type IV collagen chains and heparan sulfate
33
Type of endothelium found in glomerular filtration capillaries
Fenestrated capillary endothelium
34
Glomerular filtration charge barrier properties
Negative charged glycoproteins prevent positive charge molecule entry
35
Glomerular filtration barrier structure preventing entry of > 100nm molecules and/or blood cells
Fenestrated capillaries
36
Glomerular filtration barrier structure preventing entry of > 50-60 nm molecules
Slit diaphragm
37
Structures that make up slit diaphragm in glomerular filtration barrier
Podocyte foot processes interposed with basement membrane
38
Volume of plasma from which a substance is completely cleared per unit time
Renal clearance (Cx)
39
If clearance of substance is less than GFR
Net tubular reabsorption
40
If clearance of substance is more than GFR
Net tubular secretion
41
If clearance of substance is equal to GFR
No net tubular secretion or reabsorption
42
Formula for renal clearance
```
Cx = UxV/Px
Ux = urine concentration of substance X
Px = plasma concentration of substance X
V = urine flow rate (ml/min)
```
43
Substance used to calculate GFR because it is freely filtered and is neither reabsorbed or secreted
Inulin
44
What is normal GFR
100 ml/min
45
Substance that is an approximate of GFR
Creatinine
46
Incremental reductions in GFR define what disease
Chronic kidney disease
47
Formula for GFR
GFR = U(inulin) x V/P(inulin) = Clearance(inulin)
48
Substance used to measure effective renal plasma flow
para-aminohippuric acid (PAH) clearance
49
Effective renal plasma flow formula
eRPF = U(PAH) x V/P(PAH) = Clearance(PAH)
50
Formula for renal blood flow
RBF = RPF/(1 - Hct)
51
Formula for calculating plasma from Hct
Plasma = 1 - Hct
52
Measurement that underestimates true renal plasma flow slightly
Effective renal plasma flow
53
Measurement that overestimates GFR
Creatinine clearance
54
Formula for calculating filtration fraction
GFR/RPF
55
What is the normal filtration fraction (%)
20%
56
Formula for calculating filtered load (mg/min)
GR x plasma concentration
57
GFR can be best estimated with what measurement
Creatinine clearance
58
RPF can be best estimated with what measurement
PAH clearance
59
Lipid compounds that dilate afferent arteriole
Prostaglandins
60
Drugs that prevent constriction of efferent arteriole
ACE inhibitors
61
Peptide hormone that preferentially constricts efferent arteriole
Angiotensin II
62
Effect of ACE inhibitor
Blocks angiotensin II, increases renin, dilates efferent arteriole
63
Effects of afferent arteriole constriction
Decreased GFR, RPF
| No change in FF
64
Effects of efferent arteriole constriction
Increased GFR, FF
| Decreased RPF
65
Effect of increased plasma protein concentration
Decreased GFR, FF
| No change in RPF
66
Effect of decreased plasma protein concentration
Increased GFR, FF
| No change in RPF
67
Effect of constricting ureter on glomerular dynamics
Decreased GFR, FF
| No change in RPF
68
Effect of dehydration on glomerular dynamics
Decreased GFR and severe decrease in RPF
| Increased FF
69
Drugs that inhibit prostaglandin synthesis
NSAIDs
70
Glomerular arteriole that is affected by NSAIDs
Afferent arteriole
71
Effect of NSAIDs on glomerular arteriole
Vasodilates afferent arteriole
72
Formula for calculating excretion rate
V x [U] of substance
73
Formula for reabsorption rate
Reabsorption rate = filtered - excreted
74
Formula for secretion rate
Secretion rate = excreted - filtered
75
Formula for calculating fraction of excreted sodium
Fe(Na) = P(cr)/U(cr) x U(Na)/P(Na)
76
Section of renal tubule that reabsorbs glucose
Proximal convoluted tubule
77
Percentage of glucose reabsorption in healthy individual
100%
78
Plasma glucose concentration glucosuria begins
200 mg/dL
79
Rate at which all glucose transporters are saturated
375 mg/min
80
Mechanism of gestational diabetes
Decreased ability of PCT to reabsorb glucose
81
Glucose transporter located in proximal convoluted tubule
SGLT2
82
Drugs that inhibit SGLT2 and permit glucosuria at glucose plasma concentrations < 200 mg/dL
Flozin drugs
83
The region of substance clearance between threshold and glucose transporter saturation
Splay
84
Section of renal tubule that contains brush border
Early PCT
85
Section of renal tubule that generates and secretes NH3
Early PCT
86
Hormone that inhibits sodium-phosphate contransport leading to phosphate excretion
PTH
87
Peptide hormone that stimulates sodium-H+ transporter leading to increased sodium, water and bicarb reabsorption
Angiotensin II
88
Consequence of stimulating sodium-H+ transporter leading to increased sodium, water and bicarb reabsorption
Contraction alkalosis
89
Section of renal tubule where 60-80% of sodium is reabsorbed
Early PCT
90
Section of renal tubule that is impermeable to sodium
Thin descending loop of Henle
91
Function of thin descending loop of Henle
Passively reabsorb water, concentrate urine
92
Section of renal tubule that makes urine hypertonic
Thin descending loop of Henle
93
Section of renal tubule that is impermeable to water
Thick ascending loop of Henle
94
Thick ascending loop of Henle has paracellular transport of what ions
Calcium and magnesium
95
Mechanism of paracellular transport of calcium and magnesium in thick ascending loop of Henle
Positive lumen potential generated by potassium back leak
96
Section of renal tubule that makes urine less concentrated
Thick ascending loop of Henle
97
Drug that inhibits carbonic anhydrase
Acetazolamide
98
Side effect of acetazolamide
Renal tubular acidosis type II
99
Condition that affects sodium-potassium pump at PCT
Hyperkalemia
100
How do potassium and chloride move from tubule to interstitium
Diffusion down electrochemical gradient
101
Drugs that act on thick ascending loop of Henle
Loop diuretics (furosemide)
102
Amount of sodium reabsorbed at thick ascending loop of Henle
10-20%
103
Section of renal tubule that makes urine fully dilute
Early DCT
104
Ions absorbed at DCT
Sodium and chloride
105
Hormone that increases calcium-sodium exchange leading to calcium reabsorption
PTH
106
Amount of sodium reabsorbed in DCT
5-10%
107
Drugs that act on DCT
Thiazide diuretics
108
Section of renal tubule that is regulated by aldosterone
Collecting tubule
109
Effect of ADH binding to V2 receptor
Insertion of aquaporins on apical side of principal cell
110
Site of action of potassium sparing diuretics
ENaC channel on principal cell
111
Renal tubular defect associated with increased excretion of nearly all amino acids, glucose, bicarb, and phosphate causing renal tubular acidosis
Fanconi syndrome
112
Site of action of Fanconi syndrome
Proximal renal tubule
113
Type of acidosis caused by Fanconi syndrome
Renal tubular acidosis type II
114
Autosomal recessive disorder presenting similar to chronic loop diuretic use
Bartter syndrome
115
Site of action of Bartter syndrome
Na/K/2Cl cotransporter in thick ascending loop of Henle
116
Findings in Bartter syndrome
Causes hypokalemia, metabolic alkalosis with hypercalciuria, hypochloremia, increased renin
117
Components of the juxtaglomerular apparatus
Macula densa cells, mesangial cells and JG cells
118
Autosomal recessive disorder presenting similar to being on life-long thiazide diuretics
Gitelman syndrome
119
Site of action of Gitelman syndrome
Na/Cl cotransporter in DCT
120
Findings in Gitelman syndrome
Hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria, hypochloremia
121
Autosomal dominant disorder causing a gain of function mutation presenting like hyperaldosteronism
Liddle syndrome
122
Site of action of Liddle syndrome
Increased activity of Na channel in collecting duct
123
Findings in Liddle syndrome
Hypertension, hypokalemia, metabolic alkalosis
124
Treatment for Liddle syndrome
Amiloride
125
Hereditary deficiency of 11-B-hydroxysteroid dehydrogenase leading to excess cortisol levels
Syndrome of Apparent Mineralocorticoid Excess (SAME)
126
Findings in Syndrome of Apparent Mineralocorticoid Excess
Low aldosterone, hypertension, hypokalemia, metabolic alkalosis
127
Acquired form of Syndrome of Apparent Mineralocorticoid Excess is caused from what
Eating licorice - has glycyrrhetinic acid which inhibits 11-B-hydroxysteroid dehydrogenase
128
Treatment for Syndrome of Apparent Mineralocorticoid Excess
Corticosteroids
129
Mechanism of exogenous corticosteroids in Syndrome of Apparent Mineralocorticoid Excess
Decrease endogenous cortisol production leading to decrease mineralocorticoid receptor activity
130
Function of 11-B-hydroxysteroid dehydrogenase
Convert cortisol to cortisone
131
Function of renin
Convert angiotensinogen to angiotensin I
132
Function of ACE
Convert angiotensin I to angiotensin II and breakdown bradykinin
133
Mechanism of renin release
JG cells secrete due to low BP, sympathetic discharge from B1 effect, macula densa cells from low sodium
134
Angiotensin II effects on afferent arteriole
Vasoconstrict to raise FF to preserve kidney function in low volume states
135
Angiotensin II effects on posterior pituitary
Secrete ADH for aquaporin insertion in principal cells for water reabsorption
136
Angiotensin II effects on vascular smooth muscle
Binds ATII receptor causing vasoconstriction and raising BP
137
Angiotensin II effects on hypothalamus
Stimulates thirst
138
Angiotensin II effects on PCT
Increase Na/H+ activity to increase Na, HCO3, water reabsorption
139
Cells that release atrial natriuretic peptide (ANP)
Atrial myocytes in response to increased volume
140
Function of ANP
Relaxes smooth muscle via cGMP to increase GFR and decrease renin secretion
Also...
Dilates afferent arteriole, constricts efferent arteriole and promotes natriuresis
141
Function of ADH
Regulates osmolarity.
| Also responds to low blood volume states
142
Function of aldosterone
Regulate ECF volume and Na content.
Also responds to low blood volume states
Increases K excretion during hyperkalemia
143
Mechanism of B-blockers on juxtaglomerular apparatus (JGA)
Bind B1-receptors of JGA, decreasing renin which lowers BP
144
Glycoprotein released by interstitial cells in peritubular capillary bed in response to hypoxia
Erythropoietin
145
Function of erythropoietin
Stimulate RBC proliferation in bone marrow
146
Consequence of low erythropoietin
Anemia
147
Active form of vitamin D
1,25-(OH)2 Vitamin D3
148
Site of conversion to active form of vitamin D
Cells of PCT
149
Enzyme that converts 25-OH vitamin D3 to 1,25-(OH)2 Vitamin D3
1a-hydroxylase
150
Hormone that acts with 1a-hydroxylase to convert 25-OH vitamin D3 to 1,25-(OH)2 Vitamin D3
PTH
151
NSAID side effect in low renal blood flow states
Acute renal failure
152
Effect of prostaglandin on renal vasculature
Vasodilates afferent arteriole to increase RBF
153
Direct sympathomimetic secreted by PCT cells which dilates interlobular arteries, afferent and efferent arterioles at low doses and acts as vasoconstrictor at higher doses
Dopamine
154
Effect of vasodilatory effects of dopamine on renal vasculature
Increase renal blood flow, little to change in GFR
155
Hormone secreted in response to low Ca, 1,25-(OH)2 Vitamin D3 and increased plasma phosphate
PTH
156
Effect of PTH
Increases Ca reabsorption, phosphate secretion and 1,25-(OH)2 Vitamin D3 production
157
Net effect of atrial natriuretic peptide
Water and Na loss
158
Digitalis MOA
Blocks Na/K/ATPase shifting K out of cells and H+ into cells
159
Effect of hypo-osmolarity on potassium
Hypokalemia
160
Effect of alkalosis on potassium
Hypokalemia
161
Effect of B-blockers on potassium
Hyperkalemia
162
Effect of insulin on potassium
Hypokalemia
163
Effect of hyperosmolarity on potassium
Hyperkalemia
164
Insulin MOA in hypokalemia
Increases Na/K/ATPase activity shifting K into cells
165
Effect of high blood sugar on potassium
Hyperkalemia
166
High blood sugar MOA in hyperkalemia
Solvent drag pulls K out of cells
167
Effect of succinylcholine on potassium
Hyperkalemia
168
Succinylcholine MOA
Increase risk in burns and muscle trauma lysis cells leaking K out of cells
169
Effect of cell lysis on potassium
Hyperkalemia - K leaks out of cells
170
Primary disturbance in Bartter syndrome
Increased urinary calcium
171
Primary disturbance in Gitelman syndrome
Decreased urinary calcium
172
Primary disturbance in Liddle syndrome
Decreased aldosterone
173
Primary disturbance in Primary hyperaldosteronism
Increased aldosterone
174
Primary disturbance in renin-secreting tumor
Increased renin
175
Renal disorder with a primary disturbance of increased urinary Ca and secondary high renin and aldosterone with normal BP
Bartter syndrome
176
Renal disorder with a primary disturbance of decreased urinary Ca and secondary high renin and aldosterone, low Mg with normal BP
Gitelman syndrome
177
Renal disorder with a primary disturbance of decreased aldosterone and secondary high BP, low renin and aldosterone
Liddle syndrome
178
Renal disorder with a normal to high BP, low renin and aldosterone
SIADH
179
Renal disorder with a primary disturbance of increased aldosterone and secondary high BP and low renin
Primary hyperaldosteronism
180
Renal disorder with a primary disturbance of increased renin and secondary high BP and aldosterone
Renin-secreting tumor
181
Metabolic acidosis immediate compensatory response
Hyperventilation
182
Plasma changes in metabolic acidosis
Primary disturbance - low bicarb
| Compensatory - low pH, low PCO2
183
Metabolic alkalosis immediate compensatory response
Hypoventilation
184
Plasma changes in metabolic alkalosis
Primary disturbance - high bicarb
| Compensatory - high pH, high PCO2
185
Respiratory acidosis delayed compensatory response
Increased renal bicarb reabsorption
186
Plasma changes in respiratory acidosis
Primary disturbance - high PCO2
| Compensatory - low pH, high bicarb
187
Plasma changes in respiratory alkalosis
Primary disturbance - low PCO2
| Compensatory - high pH, low bicarb
188
Henderson-Hasselbalch equation
pH = 6.1 + log [HCO3-]/0.03 PCO2
189
How do you determine metabolic acidosis
Look at pH, bicarb and PCO2 if all low more likely metabolic acidosis
190
Causes of increased anion gap acidosis
```
MUDPILES:
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)
```
191
Causes of normal anion gap acidosis
```
HARDASS:
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
```
192
Causes of Respiratory acidosis in hypoventilation
```
Airway obstruction
Acute lung disease
Chronic lung disease
Opioids, sedatives
Weakening of respiratory muscles
```
193
Formula to calculate anion gap
AG = Na - (Cl + HCO3)
194
Causes of respiratory alkalosis in hyperventilation
```
Hysteria
Hypoxemia (high altitude)
Salicylates (early)
Tumor
Pulmonary embolism
```
195
Causes of metabolic alkalosis in H+ loss/HCO3- excess
Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism
196
Winters formula
PCO2 = 1.5 [HCO3] + 8 (+/-) 2
197
A disorder of the renal tubules that leads to normal anion gap metabolic acidosis
Renal tubular acidosis
198
Mechanism of hypokalemia in RTA type 1
Since H+ not excreted, K+ excreted to luminal charge
199
Findings in RTA type 1
Urine pH > 5.5, hypokalemia
200
Causes of RTA type 1
Amphotericin B, analgesics, congenital anomalies of urinary tract
201
Mechanism of RTA type 1
Inability of a-intercalated cells in collecting duct to excrete H+ and regenerate bicarb
202
Treatment for RTA type 1
Oral bicarb
203
Findings in RTA type 2
Urine pH < 5.5, hypokalemia
204
Mechanism of hypokalemia in RTA type 2
Increased bicarb in lumen leads to negative lumen which pull K+ into lumen increasing excretion
205
Causes of RTA type 2
Fanconi syndrome, carbonic anhydrase inhibitors
206
Mechanism of RTA type 2
Inability of PCT to reabsorb bicarb
207
What causes acidification of urine in RTA type 2
a-intercalated cells in collecting duct acidify urine
208
Other name for RTA type 1
Distal renal tubular acidosis
209
Other name for RTA type 2
Proximal renal tubular acidosis
210
Mechanism of hyperkalemia in RTA type 4
Hypoaldosteronism
211
Mechanism of RTA type 4
Hypoaldosteronism causes hyperkalemia decreasing ammonia synthesis in PCT decreasing ammonium excretion
212
Findings in RTA type 4
Urine pH < 5.5
Hyperkalemia, hyperchloremia
Hyponatremia
