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psc2019 > lecture 1 (renal) > Flashcards

lecture 1 (renal) Flashcards

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1
Q

where does most renal blood flow go to?

A
  • kidneys
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2
Q

where does the blood get distributed in the kidneys?

A
  • cortex gets 93%
  • medulla gets 7%
  • papilla gets 1%
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3
Q

what are the 3 types of nephrons?

A
  • superficial
  • mid cortical
  • juxtamedullary
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4
Q

what are superficial nephrons?

A
  • where glomerulus is higher than the cortex and loop of henle barely touches medulla
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5
Q

what are mid cortical nephonrs?

A
  • middle of Cortex
  • loop of henle reaches the outer medulla
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6
Q

what are juxtamedullary nephrons?

A
  • on border of cortex and medulla
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7
Q

what happens once blood leaves glomerulus?

A
  • enters venous circulation
  • constriction of efferent arterioles
  • causes resistance and prevents pressure drop
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8
Q

what is the blood supply to the proximal tubules called?

A
  • vaso recta
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9
Q

what is the interlobular artery?

A
  • artery feeding between the lobes
  • supplies glomerulus
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10
Q

what happens to pressure along renal vasculature?

A
  • decreases from interlobular artery to the peritubular capillary
  • higher pressure than systemic capillary
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11
Q

what does this show about perfusion pressure?

A
  • perfusion pressure held relatively constant
  • means constant driving force
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12
Q

what is the renal corpuscle for?

A
  • glomerulus and surrounding tissues
  • filters blood
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13
Q

what occurs if afferent resistance is increased?

A
  • renal blood flow decreases
  • filtration pressure decreases
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14
Q

what occurs if afferent resistance is decreased?

A
  • renal blood flow increases
  • filtration pressure increases
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15
Q

what occurs if efferent resistance is increased?

A
  • renal blood flow decreases
  • filtration pressure increases
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16
Q

what occurs if efferent resistance is decreased?

A
  • renal blood flow increases
  • filtration pressure decreases
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17
Q

what does changing afferent resistance control?

A
  • blood pressure
  • GFR
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18
Q

what happens when systemic blood pressure increases?

A
  • RBF increases
  • afferent arteriole stretch
  • reflex contraction of smooth muscle
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19
Q

what is the glomerular tubular feedback loop?

A
  • increased glomerular pressure and plasma flow
  • increased GFR
  • increased delivery of NaCl to distal tubule
  • macula densa sense increased flow rates
  • vasoactive compound released
  • vasoactive agent increases afferent resistance
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20
Q

what happens with an increased blood supply tot kidney tubule?

A

-increase in sodium delivery to macula dense cells

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21
Q

what occurs as the sodium increases?

A

-accumulates so needs tone removed
- pumped out of intersititum by ATP

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22
Q

what is the auto regulation mechanism?

A
  • ATP converted to ADP then AMP
  • phosphate group - adenosine is released
  • diffusible mediator
  • adenosine diffuses across intersititum
  • binds to a1 receptor on afferent arteriole
  • causes calcium release and vasoconstriction
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23
Q

what’re the vasoconstrictors (mostly hormonal)?

A
  • noradrenaline
  • adrenaline
  • angiotensin II
  • endothelin
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24
Q

what are the vasodilators (mainly local) ?

A
  • prostaglandins
  • nitric oxide
  • bradykinin
  • dopamine
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25
what is the renal response to haemorrhage?
- kidney still function for while after - body maintains GFR by mixture of controls
26
what occurs if mean arterial pressure decreases?
- renal sympathetic nerves are stimulated to release noradrenaline - renin secretion to form angiotensin II - together cause constriction of renal arteries
27
which vessels are the most sensitive?
- efferent to both hormones - needs half as much hormone to have response
28
what does angiotensin II have no effect on?
- afferent arteriole - powerful effect on efferent arteriole
29
what does this mean with GFR?
- only in very large levels blood loss is GFR abandoned
30
what occurs in normal low concentrations?
- low conc of angiotensin II and adrenaline maintain the vasoconstriction on efferent arteriole
31
what does this do to RBF and GFR?
- RBF decreases - GFR remains relatively constant (only drops slightly)
32
when does adrenaline act on the efferent arteriole?
- when pressure is crashing
33
what does adrenaline cause on efferent arteriole?
- decreases overall renal blood blow - decreases GFR - control of GFR abandoned as blood is diverted to systemic circulation
34
what does prostaglandin release maintain?
- renal perfusion
35
what occurs with too much vasoconstriction?
- renal blood flow decreases - less oxygen delivery
36
what is prostaglandin release inhibited by?
- NSAIDs - leads to possible renal damage
37
what does release of prostaglandin allow?
- the renal blood flow to return to normal - increases oxygen delivery
38
what is the role of nitric oxide?
- causes renal and peripheral vasodilation
39
what stimuli cause the release of nitric oxide?
- shear stress - histamines - bradykinin - ATP
40
what diseases have abnormal production of NO?
- diabetes mellitus - hypertension
41
what are the layers between the capillary and the urinary space?
- basement membrane (basal lamina) - fenestration pores - podocyte foot processes
42
what are the characteristics of fenestrated epithelium layer?
- very little resistance to diffusion
43
what are the characteristics of the basal lamina?
- collagen mesh - more restrictive - rbc cant pass through - 4nm thick
44
what are the characteristics of podocyte cell body?
- filtration silt diaphragms between them
45
what is nephrin?
- major transmembrane molecule of slit diaphragm - has overlapping molecules - pores where molecules dont overlap
46
what do nephrin mutations cause?
- abnormal pore size therefore proteinuria
47
what charge does the collagen matrix have?
- negative - so less permeable as repelled by negative charges on collagen
48
what drives glomerular filtration?
- capillary hydrostatic pressure - colloid osmotic pressure
49
what is capillary hydrostatic pressure?
- blood pressure within a kidney
50
what is colloid osmotic pressure?
- osmotic pressure exerted by molecules to hold water within a space
51
what occurs in systemic capillaries?
- large fluid exchange but no net movement - diagonal slope downwards - hydrostatic pressure balanced by colloid osmotic pressure (line straight ish)
52
what occurs in the glomerular capillary?
- net fluid movement from blood to urine driven by magnitude of hydrostatic pressure - occurs as consequence of fluid exiting COP -rises along length of capillary
53
what are the requirements of a substance to measure GFR?
- freely filtered at glomerulus - mustn't to be reabsorbed or secreted into nephron - must not be subject to metabolism or produced by kidney - must not alter GFR
54
what's the equation?
amount excreted = amount filtered urinary conc x rate of urine production = plasma conc x GFR
55
how is GFR calculated?
(urinary conc x rate of urine production) / plasma conc of insulin
56
what gives an estimate of GFR?
- plasma creatine
57
what is creatine produced at?
- constant rate directly proportional to muscle bulk
58
what are the limitations of creatine clearance?
- plasma creatine remains within normal limitations in early stages - production dependent on muscle bulk - plasma conc affected by hydration state
59
how is single nephron GFR measured?
(TF insulin x collection rate) / P insulin
60
what 4 variables is GFR controlled by?
- permeability coefficient (Kf) - hydrostatic pressure difference (P ) - colloid osmotic pressure difference (pi) - rate of blood flow through glomerulus
61
what is GFR controlled by?
- starlings forces (difference in osmotic and hydrostatic pressure)
62
what does changes in permeability cause?
- renal failure - diabetic nephropathy - nephrotic syndrome - nephritic syndrome
63
what is nephrotic syndrome?
- results from damage to glomerulus - symptoms include proteinurea
64
what is nephritic syndrome?
- glomerulonephritis - inflammation leading to thinner basement membrane - pores form in podocyte membranes allowing RBC through
65
what does high flow cause?
- more filtering
66
when is colloid osmotic pressure lower?
- when flow rate is higher
67
what occurs at higher flow rates?
- residence time in glomerulus is lower - removal of water is less extensive - lower increase in protein concentration along capillary - lesser increase of colloid osmotic pressure
68
what does a change in pressure of capillary cause?
- increased volume status - increased hypertension - increase in GFR
69
what does increase in pressure in bowman space cause?
- renal stones - kinks in ureter - blockage - decrease in GFR
70
what does changes in colloid osmotic pressure of capillary cause?
- volume status increases - protein status decreases - increase in GFR
71
what does changes in colloid osmotic pressure of bowman space cause?
- proteinurea - increase in GFR
72
how is net colloid osmotic pressure calculated?
- capillary pressure - bowman space

psc2019 (19 decks)

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