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RENAL > Contanzo Physio > Flashcards

Contanzo Physio Flashcards

1
Q

What hormones are synthesized by the kidneys?

A

renin, EPO, 1,25 dihydroxycholecalciferol

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2
Q

What is the functional unit of the kidney?

A

nephron

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3
Q

What is histologically unique about the PCT epithelium?

A

Large surface area with microvilli (brushborder) on luminal side, used for reabsorption

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4
Q

What are the two types of nephron?

A

superficial cortical and juxtamedullary nephron

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5
Q

How can you distinguished between the two types of nephrons?

A

cortical - outer cortex with short loop of henle
juxtamedullary nephron: LARGE glomerulus (higher filtration rate) near the corticomedullary border with a longer loop of Henle.

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6
Q

Define vasa recta

A

long, hairpin-shaped vessels that follow loop of Henle; serves as osmotic exchange

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7
Q

What is the average Total Body Water (TBW)?

A

60% of body weight

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8
Q

What factors influence TBW?

A
  • gender and amount of adipose tissues

- Increase in fat = Decrease in H20 content (inverse proportions)

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9
Q

What % of TBW is ICF? ECF?

A

2/3 (40% of body weight) and 1/3 (20% of body weight)

60-40-20 rule

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10
Q

What % of ECF is plasma? interstitial?

A

25% and 75% respectively

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11
Q

What is the major cation for ICF? anion for ICF?

A

K+, Mg2+; proteins, organic phosphate (AMP,ADP, ATP)

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12
Q

What is the major cation for ECF? anion?

A

Na+; Cl-, HCO3-

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13
Q

Plasma is what % of blood volume? HCT is what % of BV?

A

55% and 45% respectively

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14
Q

Gibbs-Donnan Effect results in

A

higher Na+ and lower Cl- in the plasma

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15
Q

In terms of fluid compartments, mannitol is a good marker for what?

A

ECF

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16
Q

In terms of fluid compartments, D2O is a good marker for what?

A

Total Body Water

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17
Q

In terms of fluid compartments, evan blue is a good marker for what?

Hint: Evan blue dye binds to albumin

A

Plasma Volume

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18
Q

What is a good marker for ICF?

A

I dont know… If you find one let me know. Costanzo said there is no good marker and you have to determine it indirectly.

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19
Q

What is a good marker for interstitial fluid?

A

I dont know… If you find one let me know. Costanzo said there is no good marker and you have to determine it indirectly.

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20
Q

How do you calculate ICF?

A

(Total body water - ECF)

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21
Q

Volume contraction results in?

A

decrease in ECF volume

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22
Q

Volume expansion results in?

A

increase in ECF volume

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23
Q

what is an example of isosmotic volume contraction?

A

diarrhea or burn

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24
Q

In diarrhea, what physiological changes do you see?

A
  • Decrease in ECF volume
  • ICF volume - No Change (N/C)
  • osmolarity - N/C
  • Increase HCT
  • Increase Plasma protein
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25
Q

What is an example of hyperosmotic volume contraction?

A
  • sweat, fever, or diabetes insipidus
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26
Q

In sweating, what physiological changes do you see?

A
  • ECF volume decrease
  • ICF volume decrease
  • osmolarity increase
  • HCT N/C
  • plasma protein increase
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27
Q

What is an example of hyposmotic volume contraction?

A
  • adrenal insufficiency
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28
Q

In adrenal insufficiency, what physiological changes do you see?

A
  • ECF vol decrease
  • ICF vol increase
  • osmolarity decrease
  • HCT: increase
  • Plasma protein Increase
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29
Q

What is an example of isomotic volume expansion?

A

infusion of isotonic NaCl

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30
Q

Infusion of isotonic NaCl results in what physiological changes?

A
  • ECF vol: increase
  • ICF vol : N/C
  • Osmolarity: N/C
  • HCT: decrease
  • plasma protein : decrease
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31
Q

What is an example of hyperosmotic volume expansion?

A

High NaCl Intake

32
Q

During high salt intake, what physiological changes do you see?

A
  • ECF vol: increase
  • ICF vol: decrease
  • osmolarity: increase
  • HCT: decrease
  • Plasma proteins: decrease
33
Q

What is an example of hyposmotic volume expasion?

A

Syndrome of inappropriate ADH

34
Q

In SIADH, what physiological changes do you see?

A
  • ECF vol: increase
  • ICF vol: increase
  • Osmolarity: decrease
  • HCT: N/C
  • plasma protein: decrease
35
Q

What is the clearance rate equation?

A

CL = U(x) * V / P(x)

36
Q

What is the renal clearance of glucose in a normal person?

A

0

37
Q

What does clearance ratio tell you?

A
  • if it is reabsorbed, filtered and/or secreted.
38
Q

CR >1 ; examples?

A

filtered and secreted; organic acid and bases, K+

39
Q

CR <1 ; examples?

A

Not filtered or filtered and reabsorbed;

albumin, NaCl, HCO3

40
Q

CR = 1 ; examples

A

filtered but not reabsorbed nor secreted; inulin

41
Q

What is the equation for Renal Blood Flow (RBF)?

A

change in pressure / change in resistance or Pressure / resistance

42
Q

What is the major mechanism for RBF?

A

change in arteriolar resistance (afferent or efferent)

43
Q

Name 3 substances that cause vasoconstriction?

A
  • catecholamines (sympathetics), Angiotensin II, endothelin
44
Q

Name 5 substances that cause vasodilation?

A

PGE2, PGI2, NO, bradykinin, dopamine

45
Q

How does the sympathetic nervous system regulate RBF?

A
  • they activate alpha receptors (which is more abundant on the afferent arterioles)
  • Net result is Decrease in RBF and GFR

During blood loss, there is a decrease in arterial pressure which is sensed by baroreceptors in the carotid plexus. This results in a sympathetic response to vasoconstrict the afferent arterioles, thus preventing further volume lost by decreasing GFR and RBF.

  • the CV system will increase arterial pressure at the expense of blood flow to the kidney
46
Q

Angiotensin II, how does it work?

A

low levels: constrict efferent arterioles and increase GFR

high levels: constrict both afferent and efferent arterioles; decrease GFR.

  • efferent arterioles are more sensitive to Angiotensin II than afferent.
  • both situation decrease RPF
47
Q

What does Prostaglandin do?

A

protective, modulates amount of vasoconstriction by angiotensin II and sympathetics.
- released locally to protect kidneys
NSAID blocks COX and PG production

48
Q

Do changes in plasma concentration (increase or decrease) influence RBF?

A

NO! Only GFR

49
Q

Constriction of afferent arteriole result in what to RBF, GFR, and filtration fraction?

A

RPF: decrease
GFR: decrease
FF: N/C

50
Q

Constriction of efferent arteriole result in what to RBF, GFR, and filtration fraction?

A

RPF: decrease
GFR: increase
FF: increase

51
Q

Increase in plasma protein concentration result in what to RBF, GFR, and filtration fraction?

A

RPF: N/C
GFR: decrease
FF: decrease

52
Q

Decrease in plasma protein concentration result in what to RBF, GFR, and filtration fraction?

A

RPF: N/C
GFR: increase
FF: increase

53
Q

Constriction of ureter result in what to RBF, GFR, and filtration fraction?

A

RPF: N/C
GFR: decrease
FF: decrease

54
Q

What is a marker for RPF, Renal Plasma Flow?

Note: Plasma not blood.

A

PAH - para-aminohippuric acid

  • it’s a good marker because it is not metabolized, absorbed nor synthesized by the kidney
  • it does not alter RPF
  • removed by filtration and secretion
  • no organ except kidney can excrete PAH so concentration entering kidney is the same as in blood.
55
Q

What is Fick’s principles and how does it relate to RPF?

A
  • amount enters = amount leaves
    -As it relate to the kidney:
    amounting entering renal artery = amount in renal vein + urine
56
Q

How is RBF (Renal blood flow) and RPF (renal plasma flow) related?

A

RBF = RPF / (plasma) , where plasma = 1- HCT.

remember? Plasma = 55% of blood volume and HCT is 45% of BV)

57
Q

What is the fluid that is filtered through the glomerulus called? What is in it?

A
  • ultrafiltrate;
  • it contains water and small solutes of blood.
  • No proteins and blood cells.
58
Q
A
  • endothelium: large pores
  • basement membrane: lamina rara interna, lamina densa, lamina rara externa
  • epithelium: foot processes and filtration slits
59
Q

Why is the negative charged on the glomerular capillary barrier important?

A
  • the negative charged glycoproteins on all 3 layers allow more + solutes to be readily filtered and more - to be repelled.
  • large solutes like plasma proteins (albumin) are restricted mainly by charge.
60
Q

What are Starling Forces?

A
  • pressures that drive fluid across capillary wall
    4 forces: hydrostatic pressure in glomerular capillaries P(gc), hydrostatic pressure in bowman’s space P(bs), oncotic pressure in glomerular capillaries O(gc) and oncotic pressure in bowman’s space.
  • we can ignore oncotic pressure in bowman’s space because no proteins are filtered.
61
Q

What is an equation that relates GFR and starling forces?

A

GFR = K [ P(gc) - P(bs) - O(gc) ]

K = hydraulic conduction or filtration coefficient

62
Q

What starling forces favor filtration? what forces oppose filtration?

A

Favors: P(gc)
Oppose: P(bs) and O(gc)

63
Q

How are changes in P(gs) produced?

A
  • changes in resistance of the afferent and efferent arterioles.
64
Q

Revisiting this concept:

constriction of the afferent arterioles cause:

A

Decrease in RPF
Decrease in GFR b/c less blood flow
Decrease in P(gs)

  • HIGH angiotensin II and/or sympathetic nervous system
65
Q

Revisiting this concept:

constriction of the Efferent arterioles cause:

A

Decrease in RPF
Increase in GFR
Increase in P(gs)

  • LOW levels of angiotensin II
66
Q

Revisiting

- Volume Contraction:

A

Decrease renal profusion
Decrease GFR

Results in Increase BUN and Creatinine.

Important indication of volume contraction is increase ratio of plasma BUN/Creatinine >20; urea is reabsorbed and creatinine is not.

67
Q

What is filtration fraction?

A

GFR/ RPF

  • fraction of RPF that is filtered
    Normal 20%
68
Q

What is filter load? How do you calculate it?

A

amount of substance filtered into Bowman’s space per unit time

FL = GFR x P(x)

69
Q

What is excretion rate? How do you calculate it?

A

Amount of substance excreted per unit time.

ER = V x U(x)

70
Q

If filter load > excretion rate, then?

A

Net reabsorption

71
Q

If filter load < excretion rate< then?

A

Net secretion

72
Q

Where and how is glucose reabsorbed?

A

Na/ Glucose cotransporter (SGLT)

2 Na / 1 Glucose into ICF using Na gradient generated by Na/K ATPase.

In PCT

73
Q

Define Threshold, Tm and splay

A

Threshold: point where glucose is excreted
Tm= point where all the Na/glucose cotransporters are saturated
splay = heterogeneity of nephrons and glucose transporters in that some reach Tm quicker than others.

74
Q

What solute can be reabsorbed by passive diffusion?

A

Urea

- rate determined by concentration differences and permeability

75
Q

For weak acid and base, when are they excreted from the body?

A

When they are in the charged form. BH+ or A-.

Low urine pH favors HB+ excretion
High Urine pH favors A- excretion

RENAL (2 decks)

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