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Exam 3 physio > Lecture 1 Renal > Flashcards

Lecture 1 Renal Flashcards

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1
Q

what are the 2 keys to maintaining homeostasis within the kidney

A

excrete wastes/ drugs, balance intake and secretion

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2
Q

5 functions of kidneys

A 
eliminate waste like urea
regulate water and salts
removal foreign chemicals like drugs
gluconeogenesis
produce hormones
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3
Q

3 hormones produced by kidneys

A

renin
1,25 dihydroxyvitamin D
erythropotietin

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4
Q

what does renin do
INC in renin?
DEC in renin

A

renin regulates BP part of angiotensin -aldesterone cascade
INC renin INC BP
DEC renin DEC BP

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5
Q

what is Erythropoietin for

A

acts in bone marrow to stimulate production of RBCs

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6
Q

what is 1,25 Dihydroxyvitamin D for

A

regulation of Ca reabsorption

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7
Q

End State Renal disease can be acute or chronic which one needs dialysis

A

chronic ESRD requires dialysis

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8
Q

What does ESRD causes concerning kidney function

A

causes inability to excrete N wastes leading to excess ammonium

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9
Q

what does excess ammonium production by kidney lead to

A

INC blood pH- blood becomes alkalized which leads to INC pH in mouth!

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10
Q

ESRD oral health affects (4)

A

gingival enlargment (side effect of ESRD drugs)
xerostomia
tooth problems (premature loss, narrowing of pulp chambers, necrosis beneath restorations)
ammonium breath - from INC pH

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11
Q

what tooth problems from restricted blood flow arise from ESRD

A

premature tooth loss - which indicates stage of ESRD
narrowing of pulp chambers
necrosis beneath restorations

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12
Q

Contras for ESRD pts?

A

DO NOT use nephrotoxic drugs such as tetracycline, acyclovir, apsirin, NSAIDs

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13
Q

PTs with ESRD have a INC in what? what is this caused from

A

PTs with ESRD have INC in bleeding due to destruction of platelets

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14
Q

PTs with ESRD have INC bleeding so what drugs would you not want to prescribe to them?

A

aspirin and NSAIDs

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15
Q

position of kidney in abdominal cavity

A

retroperitoneal

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16
Q

Structure of kidney

A

outer cortex and inner medulla composed of many nephrons

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17
Q

functional until of kidney

A

nephron

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18
Q

what happens in renal cortex

A

blood is filtrated through glomeruli and filtrate passes thru tubule of nephron

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19
Q

what concentrates urine

A

LoH

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20
Q

in the medulla what do portions of the nephron do?

A

concentration and collection of urine

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21
Q

what do the tubules empty into? what does this empty in to?

A

tubules > renal pelvis > ureter

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22
Q

ureter empties in to what? this empties in to what?

A

ureter > urinary bladder > urethra

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23
Q

how many nephrons in each kidney

A

1.2 x 10^6

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24
Q

what is a nephron made of (x 5)

A 
renal corpuscle (glomerulus + capsule)
Prox tubule
loop of hence 
distal tubule
collecting duct (which is shared by several nephrons)
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25
what is the renal corpuscle made of
glomerulus and renal capsule
26
two types of nephrons
superficial (cortical nephrons) | JA nephrons
27
describe the position and length of medullary tubules of the superficial (cortical) nephron and urine produced
the cortical nephron is mostly in the renal cortex and has short LoH which produces diluted urine
28
majority of nephrons are which type
superficial (cortical nephrons)
29
describe position and length of medullary tubules of the JA nephron, and urine produced
JA nephrons very close to medulla, have LONG LoH, and produced very concentrated urine
30
what are the 3 renal processes of regulating blood composition
filtration secretion reabsorption
31
what is filtration
solutes and water pass from blood into tubular fluid in renal capsule (bowmans space)
32
where does filtration occur and how much plasma is filtered?
filtration occurs in glomerulus capillaries where 15-20% of plasma is filtered
33
where does blood leaving the glomerulus capillaries go? 2 names for this are?
blood > glomerulus capillaries > peritubular capillaries (AKA vasa recta)
34
what is secretion
secretion if the transport of substances from blood in vasa recta into tubular fluid
35
what is reabsorption
reabsorption is substances transported from tubular fluid into the blood in the vasa recta (peritubular capillaries)
36
does secretion and absorption occur throughout the length of the entire tubule?
YES
37
what is the glomerulus
glomerulus is a dense capillary bed where filtration occurs surrounded by the bowmans capsule
38
the renal capsule surrounds the glomerulus what is the renal capsules actions
the renal capsule collects filtrate from blood entering via AFFERENT ARTERIOLES
39
what transports blood from the renal corpsucle into the peritubular capillaries
EFFERENT ARTERIOLES
40
path of blood into renal corpuscle (glomerulus)
Afferent arterioles > renal corpuscle > Efferent arterioles
41
how is blood flow regulated thru the glomerulus (x3)
smooth muscle contraction of afferent and efferent arterioles JGA secretion of renin which regulates systemic BP
42
where the the juxtaglomerular apparatus?
the JGA is at the intersection of the macula dense of the distal tubule with Afferent and Efferent arterioles
43
actions of JGA? INC in Na causes what?
JGA secretes renin . | JGA senses INC in NA thus INC Renin thus INC BP
44
stimulation of sympathetic NS does what
reduces blood flow through the glomerulus
45
the Prox convoluted tubule drains the capsule what happens in the PCT
PCT reabsorbs 2/3 of filtered water and salts reabsorbs all filtered GLUCOSE AND AAs some diuretics act here
46
after the PCT is the Loop of Henle what is this divided into? and describe the urine makeup bc of the LoH
LoH = thin descending limb, thin ascending limb and thick ascending lim LoH DOES NOT CONCENTRATE URINE ITSELF! makes it possible for the urine to be concentrated later
47
LoH produces what kind of urine
LoH produces a dilute filtrate, but is a site of countercurrent mechanisms needed to concentrate later
48
the distal tubule drains the LoH what is the DCT actions
DCT = continued reabsorption of solutes, REGULATES Ca, site of action for diuretics
49
What is the site of action for Ca regulation?
Distal Tubule!!
50
Collecting duct collects fluid from multiple nephrons describe the collecting ducts site and action
Collecting duct extends from kidney context into the medullar regulates Na, K, and H2O diuretics act here
51
what is renal clearance
Renal clearance is the rate of excretion of a solute through the kidney represents the volume of plasma from which all of a substance is removed to urine helps monitor renal function
52
Renal clearance is used to monitor Glomerular Filtration rate (GFR) based on what 3 assumptions
substance is NOT secreted substance is NOT reabsorbed substance is freely filtered
53
what is the normal GFR from all nephrons
125 ml/ min | 180 L/ day
54
what are 2 substances that can be used for assessing GFR
inulin and creatinine
55
what is Inulin
Inulin is a small polysaccharide freely filtered and NOT secreted or absurd
56
what is creatinine
creatinine is a product of muscle metabolism FREELY FILTERED, NOT reabsorbed and ALMOST NO secretion Normal levels
57
female GFR
125 ml/ min
58
male GFR
90 -140 ml/ min
59
Glomerular capillaries are fenestrated and podocytes around the capillaries have filtration slits describe the filtrate going thru
Filtrate will be ACELLULAR and protein free Glucose, salts, AAs are freely filtered 42 A not filtered Charge matters! (negative charged moderate sized particles limited bc BM is neg charged)
60
where the route of filtrate
blood side > fenestrations in endothelium > Basement Membrane > filtration slits (bowman capsule) >
61
what are Starling forces?
Starling forces is why filtration occurs due to the pressure differences between the blood in capillaries and the fluid in the capsule
62
What is pressure due to fluid? | Higher in what?
Pressure due to fluid = hydrostatic pressure | P in capillaries > P in capsule fluid
63
what is pressure due to solutes in fluid? | higher in what?
oncotic pressure is pressure due to solutes including those NOT dissolved Oncotic pressure in capillaries > capsule fluid
64
Net filtration pressure favors what
filtration from blood into capsule bc GFR = (Pgc - Pbs) - (Oncotic cap - Oncotic BS)
65
Oncotic pressure in the bowman space is always what?
0!!
66
what two intrinsic mechanisms auto regulate blood flow through the glomerulus
myogenic mechanism and tubuloglomerular feedback
67
what is the myogenic mechanism | what happens during INC in sympathetic stimulation? DEC in Symp?
contraction and relaxation of smooth m affect BP thus affects RBF and GFR Thus Inc Symp = contraction = INC Bp = DEC RBF = DEC GFR DEC Symp = dilation = DEC BP = INC RBF = INC GFR
68
describe the tubuloglomerular feedback
feedback from the JGA adjusts afferent arteriole diameter and thus GFR
69
INC in GFR thus INC in NaCl in tubulular fluid > ? > ? finish path
INC GFR > INC NaCl tubular fluid > INC NaCl at macula densa > INC resistance in afferent arteriole > Dec GFR
70
what extrinsic mechanisms can regulate RBF and GFR
diet, dehydration/ hemorrhage, Symp NS, angiotensin alderstone cascase and natriuretic peptides
71
dehydration and hemorrhage leads to what of GFR
DEC GFR
72
INC sympathetic does what to GFR
INC BP so dec GFR (Symp limits production of urine)

Exam 3 physio (4 decks)

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