Midterm Flashcards
(102 cards)
1
Q
What are the three main functions of the kidney?
A
Clear blood of nitrogenous and other waste metabolic products, balance concentration of body fluids and electrolytes, recover small molecules/ions/water via reabsorption to maintain homeostasis
** Kidneys also can regulate blood pressure/acid balance and is also an endocrine organ that releases renin, Vitamin D, erythropoietin, etc.
2
Q
If you were to have a loss of blood supply to the lobar artery that goes to the apical lobe, would you still be able to get blood there?
A
No, because there is no cross talk between lobar arteries
3
Q
There are two types of nephrons,
__ has its renal corpuscle located in the outer region of the cortex, a short loop of henle that only goes to the outer medulla, and an efferent glomerular arteriole that branches into a peritubular capillary network.
__ has its renal corpuscle located in the cortex region adjacent to the medulla, a long loop of henle that goes to the inner medulla, and a efferent glomerular arteriole that branches into the vasa recta
A
Cortical, Juxtamedullary
4
Q
The renal corpuscle, which contains the glomerulus and Bowman’s capsule, is where __ occurs
A
filtration
5
Q
There is a __ layer that surrounds the glomerular capillaries and there is a __ layer that lines the space (associated with the connective tissue stroma)
**Separated by the urinary space
The visceral layer is lined by epithelial cells called __, reinforced by a basal lamina.
The parietal layer is covered by a basal lamina supported by ___ epithelial cells and is continuous with the ___ epithelium of the proximal convoluted tube
A
Visceral, Parietal
Podocytes
simple squamous, simple cuboidal
6
Q
Along with podocytes found in the renal corpuscle, __ cells that are supporting cells aka modified smooth muscle cells can also be found either intraglomerularly or extraglomerularly
Their most important function is what?
Less important but still significant is that in areas where the visceral layer of the renal corpuscle is absent (aka no podcytes present) they can act as __ cells, and also they play a role in ___ aka the resorption and maintenance of the basal lamina
A
Mesangial Cells
Regulating the amount of blood that can get in and out of the glomerulus. **This is done via contraction or secreting various molecules to cause constriction and this decreases the Kf via decreasing surface area in the equation GFR = Kf x PUF and therefore filtration rate is decreased
Supportive, Phagocytic
7
Q
The endothelium of the glomerular capillary is ___
A
fenestrated
8
Q
The glomerular filtration barrier consists of what three things (name both subdivisions for the podocytes)?
And polyanionic ___ charges are on both basal lamina and podocytes, therefore if you have a negative ion in the blood, it will not make it through the __ layer and if you have a larger molecule in the blood, it will not make it through the __ layer (or at least it will go in more slowly)
A
Fenestrated capillary endothelium, basal lamina, podocytes (get in between their processes called pedicels and filtration slits )
negative
basal lamina
Podocyte (their filtration slits aka slit diaphragms)
**Glomerular basement membrane is the same thing as basal lamina
9
Q
One more time, the filtration process is this….
Blood enters the glomerulus via ___ arterioles, arteriole pressure forces fluid through capillary endothelium that is ___, larger molecules are trapped by the ___, and negatively charged molecules are stopped by the __ and __, and finally fluid must pass through the pores in ___ to enter the urinary space
A
afferent, fenestraeted, basal lamina, basal lamina and podocytes, slit diaphragms
10
Q
The podocyte filtration slit diaphragm contains __, (it holds the podocyte processes together to prevent large molecules from entering like albumin) so if there is a mutation in this then congenital nephrotic syndrome will occur and leakage of albumin in urine and edema result
** So you see proteins in the urine aka albumin aka albuminuria or proteinuria
**Diabetes mellitus, hypertension, or glomerulonephritis can also cause proteinuria due to damaged filtration membranes
What system would you want to block to fix this problem?
A
Nephrin
RAAS **via an ACE inhibitor because you’d stop efferent arteriole constriction causing a decrease in GFR so less proteins are filtered and more can stay in the blood
11
Q
If a type 4 collagen disease occured including Goodpasture syndrome, Alport’s syndrome, or Benign familial hematuria, what part of the filtration barrier was affected?
A
Basal lamina
12
Q
Extensive reabsorption of glomerular filtrate occurs in the ___ and leads to a __ in fluid volume and proteins and small peptides are endocytosed
A
proximal tubule, reduction
13
Q
The function of the loop of Henle is to make __tonic urine by establishing an osmotic gradient in the interstitial fluid of the medulla
A
hyper
14
Q
The descending portion of the loop of henle is permeable to both salt and water but mainly __ gets drawn out of the loop while the ascending portion is more important in setting up the osmotic gradient required to make the interstitium hypertonic and is NOT permeable to __
A
water, water
15
Q
The ___ is located at the transition between the ____ of Henle and the ___ wall and it is sensitive to Cl- or NaCl content and creates signals to regulate the rate of ___ filtration
A
Macula Densa, thick ascending loop and DCT, Glomerular
16
Q
The ___ is involved in maintaining blood pressure and volume the three major players involved in the apparatus are __ cells that produce renin, extraglomerular __ cells, and the ___ located at the loop of henle/DCT transition
A
Juxtaglomerular Apparatus
JG (Juxtaglomerular), Mesangial, macula densa
17
Q
For the Juxtaglomerular apparatus, lets say for example you have a decrease in blood volume or pressure.
First the __ will sense this drop off and cause renin to be secreted by ___ cells. Renin converts angioteninogen to angiotensin 1 then 2, and the __ is secreted via suprarenal glands and this causes ___ of Na and water and secrete K+ by the DCT, CT, and CD
A
Macula densa, JG, aldosterone, reabsorption
** You would also have constriction of the efferent arterioles
18
Q
To treat chronic hypertension, you would want to lower blood volume in order to lower blood pressure. This can be done by inhibiting ___ so that aldosterone is not secreted and therefore no reabsorption of water and Na occurs
A
ACE (angiotensin converting enzyme)
19
Q
__ secreted by atrial myocytes increases Na+ and water excretion
__ secreted by the DCT and CD cells inhibit NaCl and water reabsorption by the medullary part of the collecting ducts
A
ANF (Atrial natriuretic factor)
Urodilatin
20
Q
ADH increases the ___ permeability to water in order to increase water reabsorption and therefore you end up with a __tonic urine
A
collecting ducts, hypertonic
21
Q
The last player that effects the concentration of urine is in the __ via __ so if this is absent, the CDs are impermeable to H2O
A
collecting duct, ADH
22
Q
The epithelium that lines the ureter and the urinary bladder is a stratified thelium called the ___ that have a surface layer of large __ cells linked by desmosomes and tight junctions that make it hard for water to get through
A
urothelium, umbrella
23
Q
Urinary system develops from ___ mesoderm along the ___ abdominal wall of the abdominal cavity and initially it enters a cavity called the cloaca
** ___ cord (derived from the intermediate mesoderm) + urogenital ridge give rise to urogenital system
A
intermediate, posterior
Nephrogenic
24
Q
The first kidney formed is the ___ and it is nonfunctional and forms in the __ region. It is formed around the 4th week and degenerates around the end of the 4th week.
The next kidney formed is the __ and it is functional. It is derived from the upper thoracic to upper lumbar segments and also contains a ___ duct that runs down to the cloaca so that urine can be excreted. Present from 4th week to 10th week when it degenerates
** AKA you can filter blood and produce urine as this point
The final kidney is the ___ and it is built from the renogenic mesoderm (a region in the intermediate mesoderm at the tail of the embryo) called the __ that secretes growth factors and causes the ___ to grow out from the caudal portion of the ____
A
Pronephros, cervical
Mesonephros, mesonephric
Metanephros, metanephric blatema, ureteric bud, mesonephric duct
25
In males, the mesonpehric duct becomes the __ and in females it pretty much goes away
The ___ gives rise to the ureter, the renal pelvis, the major and minor calyces, and millions of tubules (the collecting system)
ductus deferens
Ureteric bud
26
So in other words, what two things do you need to make the final permanent kidney?
Metanephric blastema (intermediate mesoderm) and the ureteric bud (epithelium)
27
__ makes the mesenchyme of the metanephric blastema able to respond to the signals that are coming from the mesenchyme of the ureteric bud and a mutation in this results in cancer of the kidney called ___ tumor and is common in children under the age of 5
WT1, Wilms
28
In oligohydraminos, aka to __ amniotic fluid, this could be indicative of a kidney problem.
The specific name for the kidney problem that is most likely causing this is __
___ is normally associated with the absence of ductus deferens in males and can result from absence/abnormality of mesonephric duct
little
Bilateral renal agenesis (aka no kidneys) or urethral obstruction
Unilateral renal agenesis
29
If a patient has abdominal pelvic trauma, although the kidneys in most normal people have moved out of the pelvic area, it is not entirely impossible for the kidneys to have had a dysfunction moving to a normal position and therefore could be injured in the accident. If two kidneys fuse and don't move to their proper position due to being inhibited by the ___ artery, what is it called?
Also, note that ___arteries are common due to being formed during the ascent of the kidneys as they move from the pelvis to the lumbar region and are progressively revascularized from common iliac and aorta
inferior mesenteric, Horseshoe kidney
accessory renal
30
The cloaca is divided by the ___ that causes the dorsal (inferior) portion to develop into the ___ and __ and the ventral (superior) part develops into the __ and __
** The Urorectal septum is technically between the anal canal and urogenital sinus
Urorectal septum
rectum and anal canal
bladder and urogenital sinus
31
The bladder pulls in tissue from the ___ to enlarge itself. In the meantime, the ureteric bud is also incorporated into the bladder (aka it keeps the ureters where it needs to be).
**This also reroutes the mesonpehric duct, which will become the ductus deferens and it allows it to open __ to the bladder
Mesonephric duct
inferior
32
Failure of the musculature of the ___ abdominal walls to fuse cause ___ of the bladder and this causes the interior of the bladder to be open to the external environment
anterior, exstrophy
33
Initially, the urinary bladder is continuous with the allantois. However, eventually the allantois degenerates and it is now an opening called the ___ that connects the apex of the bladder with the umbilicus. Normally, this is suppose to be filled in and turn into the median umbilical ligament, but there can be problems if it remains open.
Name the type of defect
1) Urine is draining from the umbilicus (an entirely tubular urachus connects the bladder to the umbilicus)
2) Caudally and proximally the urachus partially obliterates
3) When the lumen in the upper part persists aka the caudal urachus partially obliterates (aka the pouch opens towards the umbilicus)
4) The proximal urachus partially obliterates
urachus
1) Urachal fistula (patent urachus)
2) Urachal cyst
3) Urachal sinus
4) Bladder (Urachal) diverticulum
34
A ___ occurs when before the ureteric bud gets to the metanephric blastema (the mesoderm) it branches early
If you end up with some signaling problem and have __ ureteric buds form then you end up with a problem where one of the ureteric buds mimics the mesonephric duct. The __ one acts like a normal uteter and the __ one acts like a mesonephric duct and can open someplace lower than the bladder such as into the vagina/uterus/prostate/etc.
** This causes urine to be constantly leaked out since you don't have sphincters to control this where the second ureter attaches (most often found in kids trying to be potty trained and can't)
bifid ureter
ectopic (aka duplicate)
lower, upper
35
___ kidney disease is due to a mutation that causes cilia to not function properly and causes cysts and therefore the nephrons do not function properly
Which autosomal inheritance occurs in kids and which one in adults?
Congenital polycystic kidney disease
ARPKD or ADPKD (Autosomal - Dominant/recessive - polycystic kidney disease)
```
Recessive = kids
Dominant = adults
```
36
Failures of __ folds to develop result in rectourethral fistulas, rectoprostatic fistulas, rectocloacal canals, or rectovaginal fistulas
** Pretty much just problems in partitioning of the cloaca
Rathke
37
Total body water is __ % and that means the ICF is __ % and the ECF is __ %
60, 40 (since it's 2/3rds), 20 (since it's 1/3rd)
38
Except for brief periods of seconds to minutes, the ICF and ECF are in osmotic ___ and therefore a measurement of plasma osmolality provides a measure of both the ECF and ICF osmolality
equilibrium
39
Name what happens to the ICF and ECF
1) Addition of water (dextrose in water also referred to as D5W) - given to hyper-osmotic patients
2) Addition of isotonic saline
3) Addition of salt (NaCl) - given to hypotonic patients
1) Expands both ICF and ECF
2) ECF expands, ICF does not change
3) ECF expands, ICF shrinks
40
__ is the major cation of the ECF and __ is for the ICF
__ is the major anion of the ECF and ___ is for the ICF
** This is all due to the Na-K pump so if the pump gets damaged, then there will be an increase of Na+ in the ___, which causes water to follow it and therefore cellular swelling occurs and many other problems
Na+, K+
Cl- and HCO3-, Organic molecules (like Phosphate) and proteins
ICF
41
Under some pathologic conditions, additional fluid may accumulate in a "__ space" which is part of the __ and includes the accumulation of fluid in the paritoneal cavity (ascites) of people with liver disease
** This is where transcellular fluid exists
Third, ECF
42
Plasma OSMOLALLLLLITY = ? (using plasma sodium concentration)
** This also is how you calculate ECF and ICF since everything is the same
2 x plasma sodium concentration
Or use 2 X [Na] + glucose/18 + urea(aka BUN)/2.8
43
The __ effect is negligible, but the idea is that the interstitial fluid has __ proteins than the plasma and therefore the plasma has a greater negative anion charger (since proteins are anionic) and therefore this differential concentration of proteins can affect the distribution of cations and anions between these two compartments
** Therefore the plasma holds on to positive ions, which means Na and K concentration is slightly higher in the vasculature than expected aka the plasma compartment has a slightly ___ concentration of small cations and a slightly __ concentration of small anions
Donnan, less
higher, lower
44
__ pressure differences between ECF and ICF are responsible for fluid movement between these compartments
Osmotic
45
Name of the force pushes fluid out or in at the glomerular capillaries
1) Bowman's space oncotic pressure
2) Glomerular capillary oncotic pressure
3) Bowman's space hydrostatic pressure
4) Glomerular capillary hydrostatic pressure
1) Out
2) In
3) In
4) Out
46
Some examples of body fluid changes
What would happen to ECF and ICF in...
1) Diarrhea or loss of blood
2) Infusion of isotonic saline
3) Loops (lose sodium and water) or Addison's disease (that causes an absence of aldosterone so you lose sodium)
4) SIADH or drink to much water
5) Sweating
1) ECF volume decrease, ECF osmo NC, ICF volume and osmo NC
2) ECF volume increase, ECF osmo NC, ICF volume and osmo NC
3) ECF osmo decrease, ECF volume decreases, ICF volume increase, ICF osmo NC
4) ECF osmo decrease (since you are diluting it by adding water), ECF volume increase (since you add water), ICF volume increases, ICF osmo decreases
5) ECF volume decreases, ECF osmo increases, ICF volume decrease, ICF osmo increase
47
Any change in the volume is sensed by atrial volume receptors and any change in osmolarity is sensed by hypothalamic osmoreceptors and they activate ___ reflexes
neurohormonal (sympathetic discharge and hormones)
48
The need to maintain __ takes precedence over the need to maintain __
volume, osmolarity
49
ADH promotes water ___ from the collecting duct and makes it isotonic or hypertonic as required
Aldosterone promotes ___ of sodium and potassium ___ from the DCT
reabsorption (goes from duct to blood)
reabsorption, potassium
50
If plasma osmolarity rises above 290 mOsm/L, then what is the best way to get it down
Simply drinking more water (thirst)
51
In the kidneys, an ___ is interposed between two ___s. An afferent arterial gives rise to a mass of capillaries, the ___. Then these capillaries coalesce to form an efferent arteriole, which gives rise to two capillary networks __ (close to the sub capsular region aka in the cortex) and __ (close to the juxtamedullary region) that surround the nephron
Arteriole, capillary networks
Glomerulus, PeriTubular capillary network and vasa recta
52
The urethra has two sphincters that control voiding (emptying the bladder) the __ sphincter is involuntary control via __ muscle and the __ sphincter is voluntary control via __ muscle
internal, smooth
external, skeletal
53
The sympathetic innervation of the bladder arises from __ - __ and the pre ganglionic fibers go to either sympathetic chain ganglia or inferior mesenteric ganglion where they synapse on post ganglionic fibers. These travel to the bladder via the ___ nerves and __ the detrusor muscle (aka causes it to relax) and causes the constriction of the internal urethral sphincter (involuntary sphincter)
** ^ This opposes micturition
Parasympathetic innervation arises from __ - __ and the pre ganglionic axons travel to the bladder via the __ splanchnic nerves where they synapse on the post-ganglionic cells near or on the bladder to __ the detrusor muscle (causes it to contract) and stops contraction of the internal urethral sphincter (aka relax) (involuntary sphincter)
** ^ This is PRO urination
Somatic innervation goes to the ___ urethral sphincter and is from the CNS at __ - __ . The part that travels to the external urethral sphincter travels with the ___ nerve to synapse on it and causes voluntary control
The afferent fibers (aka sensory fibers) are mainly __ receptors and both send their info through the pelvic splanchnic nerve or hypogastric plexus
L1-L3 (T10-L2 in our book), hypogastric, inhibit
S2-S4, pelvic, stimulate
External, S2-S4, pudendal
Stretch
54
Afferent fibers run through the level of __ - __ and can either relay information that shows bladder fullness or bladder pain and these afferent fibers go through either the pelvic splanchnic nerve or hypogastric plexus
S2-S4
55
There is also an arch for the micturition reflex called the ___ and includes both the sacral detrusor nucleus and the sacral pudendal nucleus.
One pathway is from an afferent fiber of the bladder going to the sacral __ nucleus and then it stimulates an efferent fiber to go back to the __ to cause contraction of the detrusor muscle
** ^ Helps with bladder contractions and this is parasympathetic**
The other path is from the urethra which sends its afferent fiber to synapse at the sacral __ nucleus and then the efferent fibers that go out to the ___ are inhibited so that the external sphincter can relax
** Causes voluntary sphincter to relax and micturition to occur and this is somatic**
** Both of these reflex arch actions are stimulated via sensory (afferent) fibers being stretched and therefore activates the __sympathetics and micturition to occur
** So in other words, if afferent fibers go to the SCM, it excites the sacral detrusor nucleus to cause contraction of the detrusor and therefore voiding, and it also inhibits the sacral pudendal nucleus to cause relaxation of both intrinsic and extrinsic sphincters so that you can void.
Sacral micturition center
detrusor, bladder
pudendal, voluntary sphincter
parasympathetic
56
The urge to void can be overcome by the brain and is located in the __ center aka the pontine micturition center and it does this through the controlling of __pathetic outflow since that is what inhibits micturition
Excitation of the cerebral cortex causes __
Barringtons
sympathetic
voiding (via activation of the SMC)
57
Urine from the kidney moves down the ureter into the bladder via ___
peristalsis
58
So lets think about it this way. If you want to pee, this is what needs to happen.... __pathetics need to be activated, you must __ the bladder (duh), you must ___ the internal urethral sphincter, you must __ the detrusor muscle, and you must __ somatic sensory input
If you want DO NOT want to pee, this is what needs to happen.... __pathetics need to be activated, you must __ the bladder, you must ___ the internal urethral sphincter, you must __ the detrusor muscle, and you must __ the somatic sensory input
parasympathertics, contract, relax (or you could also say - inhibit contraction), contract (or you could also say - stimulate contraction), inhibit (or you could say relax the sphincter - this is because somatic sensory input is via voluntary control of the external sphincter, so you want to inhibit being able to voluntarily control the external sphincter so that you can piss aka void)
Sympathetics, relax, contract (or you could say - stimulate contraction), relax (or you could say - inhibit contraction), stimulate (or you could say constrict the sphincter - so you can voluntarily have the external sphincter contracted to stop pee from leaking out)
59
There are 4 major problems that can occur from problems voiding
Name them
1) Destruction of the sensory inputs from the bladder to the sacral cord (deafferentation) and therefore when the bladder is stretched there is no transmission occurring and therefore bladder does not contract and becomes overfilled
2) Destruction of both afferent and effect fibers of the sacral micturition center so at first it becomes overfilled like in #1 ^, but then it randomly has spontaneous contractions and empties but since the fibers are all messed up it stays shrunk and the muscle wall hypertophies
3) This occurs if you injure the spinal cord above the sacral region and then spinal shock occurs and now the brain is getting no info on if it is filled or not, so it overflows and eventually you can recover but the reflex becomes over exaggerated so it contracts all the time because it doesn't know whats going on
4) Destruction of tracts carrying inhibitory impulses from the brain (aka higher brain center than can allow you to hold in your pee even if you need to go is cut off) so you void with small amounts of urine
Going back in order name if 1) Reflexes absent or exaggerated 2) Overflow absent or present 3) Bladder size small or large
1) Atonic (also called flaccid neuropathic) bladder
2) Denervated (also called hypertophic areflexic) bladder
3) Automatic (spastic neuopathic) bladder
4) Uninhibited neurogenic bladder (also called autonomic dysreflexia)
1) Absent, Present, Large
2) Absent, Present, Small
3) Exaggerated, Absent, Small
60
In UTI's you get continuous __ of the detrusor muscle and therefore that causes the micturition reflex and you constantly void
contraction
61
Cerebral cortex __ the SMC and basal ganglia __ the SMC
excite, inhibit
62
If you want to give a drug, give the range for where you would want the drug to stay in the compartment based on volume
1) Drug only in plasma
2) ECF
3) TBW (ECF + ICF)
4) Everywhere
1) 3L or less
2) 14
3) 40-45
4) 45 or more
63
If you inject crystalloid fluids, you would be affecting the __ compartment and if you inject colloid fluids you would b affecting the __ compartment
ECF only, Vasculature only
64
Edema is swelling produced by the filling of the ___ fluid volume (tissues) when the starling forces are changed and net filtration is increased. To compensate, renal retention of Na+ and increased water reabsorption occurs but this causes the ___ volume to increase and even more edema happens
What 2 things cause edema?
Non-pitting edema means most of the fluid volume is in the __
Pitting edema means most of the fluid is in the ___
Interstitial, ECF
1) Altered starling forces that cause fluid to move from vasculature into interstitial space (filtration) 2) Renal compensation (retention of Na+ and H20) causes exacerbation of edema
```
cells aka ICF
Interstitial fluid (tissue)
```
65
Peritubular capillaries run alongside loops of Henle of __ nephrons and Vasa recta run alongside loops of Henle of __ nephrons
cortical, Juxtamedullary
66
There are two sets of arterioles and 2 sets of capillary beds in __. The first is the glomerular capillaries and these have __ hydrostatic pressures so that fluid can be pushed out into the Bowmna's capsule (filtration) and the second it the peritubular capillaries with __ hydrostatic pressure since a lot of fluid has been pushed out
** The oncotic pressure is higher in the ___ capillaries since you have less fluid now aka it's more concentrated so now you are going to favor reabsorption instead of filtration!
series, High, Low
Peritubular
67
The kidneys have sympathetic innervation that synapse on the ___ muscle to cause arteriolar ___ and they also synapse on __ of the juxtaglomerular apparatus to cause release of ___ in afferent arterioles and that leads to increased thirst and reabsorption of Na+ since ADH and Aldosterone are secreted in response to renin
** Afferents constrict more than efferent in response to sympathetic stimulation, but remember as we will see later on, efferents constrict more in response to the RAAS
smooth (cause thats what blood vessels are made up of), constriction
Granular (aka juxtaglomerular cells), renin
68
Filtration rate (aka filter load) = ___
Urine excretion rate = ___
** If you minus these two, you get the amount reabsorbed... so if you excrete ___ than you filtered (EX: filter 100mg/min and excrete 75 mEq/day) then you must have had net reabsorption (25 is reabsorbed)... But if you excrete ___ than you filtered (EX: filter 100mg/min and excrete 125 mEq/day) then you must have had net secretion (secreted 25 back into urine from blood)
GFR (in ml/min) x Plasma concentration of substance
Urine flow rate x Concentraion of substance in urine
Less, more
69
Clearance (substance is only filtered and then cleared) =
Clearance is directly proportional to __
What molecule do you use that is filtered and not secreted or reabsorbed?
(Concentration of substance in urine X Urine volume) / concentration of X in plasma
GFR
Creatinine
70
So lets think of it like this, as kidney function decreases, the clearance function starts to decrease as well, which means the plasma concentrations of creatinine goes ___
** So if you measure plasma increase creatinine over a period of time, that means it isn't being cleared so that means your GFR is going down
So if GFR falls 25%, that means plasma creatinine concentrations would be 4x greater (since 1/4 -> 4/1)
up
71
If you have a BUN/creatinine ratio of greater than 20/1, then you know the problem must me __ aka some problem like dehydration/ hemorage or really anything that contributes to a loss of blood volume/ blood pressure
A BUN/creatinine level of 10-21/1 is __
A BUN/creatinine level of less than 10/1 is a __ problem
prerenal (BUN is so high because low blood volume causes Na+ reabsorption and therefore water follows and some BUN is also reabsorbed so when you measure the serum you'd have more BUN than creatinine since creatinine can't be reabsorbed)
Normal
Intrarenal (aka damage to the tubes and this causes a reduced reabsorption of BUN into the blood plasma)
72
Cystatine C can also be used as a marker and unlike creatinine, it is not affected by __, age, or gender
muscle mass
73
__ measures renal plasma flow because it is freely filtered and all secreted so you can see how much you put into the plasma and how fast it goes through the renal system and back via excretion
PAH (Para-aminohippuric acid)
74
Filtration Fraction = __
If you were to increase the filtration fraction (FF) then what would happen to the oncotic pressure in the efferent arterioles?
So one step further, if you have a hemorrhage or some blockage that causes renal plasma flow (RPF) to decrease, then what would happen to the filtration factor and why?
GFR/RPF
It would increase.. since you increase FF, more fluid is filtered out, so even more concentrated particles are left behind, so oncotic pressure goes even further up
Decreased RPF -> Increased FF -> increased oncotic pressure -> Increased reabsorption of water -> increased blood volume
75
Creatinine can be ___estimated due to the fact that some of it made in the body can be slightly secreted into the urine so that you think more is being excreted than it really is
overestimated
76
A __ in GFR indicates disease progression
fall
77
What 3 factors affect GFR and what two combined make the ultrafiltration coefficient (Kf)
1) How many holes are in the capillary, 2) the surface area, and 3) the capillary ultrafiltration pressure
1 x 2 = Kf
78
Revisiting Glomerular mesangial cells, ___ of these cells shorten the capillary loops, causing the Kf to __ and therefore the GFR to decrease since GFR = Kf x PUF
**You can also decrease or increase the GFR due to alterations in the Glomerular Hydrostatic pressure
contraction, decrease
79
If you constrict the afferent arteriole, you would have less blood flowing into the glomerular capillary, so glomerular hydrostatic pressure would ___, which means GFR would ___ (since you now have less filtration) and then renal blood flow downstream would also fall and your filtration fraction does not change
If you constrict the efferent arteriole (**Mainly via Ang II), you would have more blood in the glomerular capillary, so GHP would __ and then GFR would __ but you would still have less renal blood flow downstream and therefore this ___ your filtration fraction
If you dilate the afferent arteriole via prostaglandins or NO then you __ GFR and you __ RPF so your filtration fraction doesn't change
If you dilate the efferent arteriole, you __ GFR and __ RPF so your filtration fraction would decrease
decrease, decrease
increase, increase, increases
increase, increase
decrease, increase
80
Hypovolemia (low blood volume) -> SNS activation -> Release of renin -> Angiotensin formed -> Systemic vasoconstriction/__ferrent arteriole constriction
** Remember that if you constrict the systemic circulation, it means you increase blood pressure. Constricting the efferent arteriole also increases blood pressure. So now you have a fucking high blood pressure that causes increased GFR and a greater oncotic pressure further down in the renal vasculature so now a shit load of water can be reabsorbed to increase blood pressure and volume
efferent
81
In order to protect ourselves from prolonged constriction of blood vessels, ADH causes __ to be released which is a vasodilator and therefore helps in maintenance
**So if you inhibit prostaglandins while someone is dehydrated you will damage their kidneys
prostaglandin (and NO)
82
A __ response occurs due to increased systemic arterial pressure and this is due to the blood vessels of the systemic system being stretched, and then Ca2+ is automatically released so that the __ arteriole can constrict and maintain that pressure gradient
A ___ response is due to increased or decreased GFR
Myogenic, afferent
Tubuloglomerular feedback
83
During tubuloglomerular feedback (TGF), the ___ cells get feedback via NaCl fluid delivery to see if the GFR has increased (increased NaCl delivery) or decreased (decreased NaCl delivery) and this in turn controls the afferent and efferent arterioles by telling the JG cells to release or not release renin
** Juxtaglomerular apparatus is in the distal tubule
macula densa
84
TGF's response to an increased renal perfusion pressure causes __ of the afferent arteriole so that the GFR can be decreased so that less Na+ is being excreted in the urine
TGF's response to a decreased renal perfusion pressure causes the __ to constrict by secreting renin which eventually causes efferent arterial resistance to increased and cosntriction
constriction
efferent ** You could also have increased afferent arterial resistance so more blood is flowing into the closed of glomerulus and you would further increased GFR
** ^ Occurs in a patient with hemorrhage
85
In Hartnup disease, there is a defect in the transportation of __ and __ amino acids from the nephron back into the blood, mainly the amino acid __
Since this amino acid is now being excreted out in the urine, this is bad because normally we need tryptophan to manufacture ___, which is a __ vitamin
Neutral and Nonpolar, tryptophan
Niacin, B vitamin
86
Cystinuria is due to the inability to transport ___ amino acids, specifically cystine, lysine, arginine, and ornithine from the nephron into the blood and when cystine stays in the nephron it concentrates the solution and causes __
dibasic, kidney stones
87
Maple syrup disease is from the accumulation of what three organic compounds?
** ^ Aka it's from a deficiency in what enzyme?
Classical PKU (phenylketonuria) is when there is a disfunction enzyme called __ that causes Phe to not get converted to Tyr and therefore a buildup of occurs in the urine and a musty oder is smelt
The inability to recycle or use __ causes there to also be a problem converting Phe to Tyr causing non-classical PKU
**On a side note, the purine ___ is a precursor for THB production and THB also is needed to produce NO
** Both of these result in brain toxicity because of buildup of phenylketones
Valine, Leucine (Leu), and Isoleucine(Ile)
BCKD (Branched-chain alpha-keto acid dehydrogenase)
Phenylalanine hydroxylase
THB (Tetrahydrobiopterin)
Guanosine triphosphate
88
Maple syrup disease is from the accumulation of what three organic compounds?
** ^ Aka it's from a deficiency in what enzyme?
Classical PKU (phenylketonuria) is when there is a disfunction enzyme called __ that causes Phe to not get converted to Tyr and therefore a buildup of occurs in the urine and a musty oder is smelt
The inability to recycle or use __ causes there to also be a problem converting Phe to Tyr causing non-classical PKU
**On a side note, the purine ___ is a precursor for THB production and THB also is needed to produce NO
** Both of these result in brain toxicity because of buildup of phenylketones
Valine, Leucine (Leu), and Isoleucine(Ile)
BCKD (Branched-chain alpha-keto acid dehydrogenase)
Phenylalanine hydroxylase
THB (Tetrahydrobiopterin)
Guanosine triphosphate
In Alkaptonuria, the enzyme __ is dysfunctional and causes a buildup of Homogentisate and one of the clinical signs is if the urine is the color __
Tyrosinemia type 1 is from a defect in the enzyme ___ and is detected via a cabbage smell of the urine
Tyrosinemia type II is due to a defect in the enzyme __
Tyrosinemia type III is due to a defect in the enzyme ___
Homogentisate oxidase, blue
Fumarylacetoacetate hydrolase
Tyrosine aminotransferase p
P-hydroxyphenylpuruvate oxidase
** All three types of tyrosinemia have elevated blood levels of Tyrosine and Type 1 causes succinylacetone to be made which is toxic
89
One way to test for increased catecholamines due to overproduction from the adrenal glands is by testing for ___ in the urine and this is produced because the increased catecholamine concentration is broken down by MAOs and COMTs that cause NE to be broken down into this product
**Due to pheochromocytomas aka a hormone secreting tumor and indicative of overproduction of catecholamines
Tyr can also be broken down into melanin via the enzyme __ so if this enzyme is defective, albinism occurs
VMAs (Vanillylmandelic acid)
tyrosinase
90
Homocystinuria can occur two main ways. One is from a defect in the __ enzyme that normally would cause homocysteine to be broken down into a not harmful product, but this defect is rare.
The most important way Homocystinuria occurs when there is a deficiency in what three vitamins?
cystathionine Beta-synthase
PLP, B12, and THF (another B vitamin)
B12 and THF are needed for the recycling of homocysteine into Met
91
Detoxification of ammonia is accomplished through its conversion to __ by the __.
In the brain, ammonia (NH3) is very toxic because it can move through membranes...so Glutamate dehydrogenase and glutamine synthetase convert the ammonia ion into glutamine, (Alpha ketoglutarate is also used up) which carries the ammonia ion into the liver. In the liver, glutamine is converted to glutamate, and the ammonia ion is released and converted into urea via the enzyme __
** So increased ammonia causes CNS problems in the brain and TCA cycle problems since Alpha-ketoglutarate is used up
urea, liver, glutaminase
92
In gout, ___ is in excess and one way to get rid of this excess is to give the patient ___ that inhibits xanthine oxidase, the precursor to Uric acid
** This is Purine nucleotide catabolism (breakdown)
Uric acid, Allopurinol
93
The Ammonium ion (NH4+) produced in the liver is directed to the urea cycle (or directly excreted in the urine). First, it must be converted in the __ to carbamoyl phosphate via ___ and __ and if either of these are defective then hyperammonemia occurs
Carbamoyl phosphate is then transferred to the amino acid Ornithine and converted to Citrulline where it is removed from the mitochondria into the cytosol and the urea cycle continues. If there is a problem with the enzyme __, then that means ___ is not degraded and enters the cytosol leading to its excess. This compound is used in the ___ biosynthetic pathway so now that there is an excess of it, more is used in the pathway and therefore __ occurs so you end up with hyperammonemia with orotic aciduria
In the pyrimidine biosynthetic pathway, that occurs in the cytosol of cells, there can be a defect in the __ enzyme that causes orotic aciduria, but if this is the case, then ONLY orotic aciduria occurs and not in conjunction with hyperammonemia
mitochondria, CPS-1(Carbamoyl phosphate synthetase) and NAG
Ornithine transcarbamoylase, carbamoyl phosphate, pyrimidine, orotic aciduria
UMP synthase
94
Heme must be recycled, and when it is, the porofin ring structures are broken down and converted to bilirubin that gets secreted into the blood. Then the bilirubin attaches to albumin and gets moved into the liver. Now the bilirubin is referred to as __ and must be conjugated to bilirubin-diglucuronide aka __ bilirubin. This conjugation occurs via the enzyme __
If you have excess bilirubin aka hyperbilirubinemia, then Jaundice is most likely to occur.
indirect, direct, UDP-glucuronyl transferase (UDPGT)
** So unconjugated bilirubin is indirect and conjugated is direct and the direct is soluble and concentrated into the bile
95
If you take a plasma sample name what type of Billiruben you would calculate based on the technique
1) 50% Methanol and Diazo reagent
2) Diazo reagent only
How would you calculate the missing indirect calculation?
1) Total Bilirubin
2) Direct
Total - Direct
96
When doing a urinary analysis (UA), a positive __ test is indicative that there is bacteria in the urine. However, this can sometimes come up as negative simply because kids pee so much that there isn't much time for the nitrate to be converted to nitrite.
So if you do a urine dipstick test and find ___, then it can still be a UTI even if nitrite is negative. A positive test is indicative of pyuria
Nitrite (because bacteria was able to convert nitrate to nitrite)
Leukocyte esterase (an enzyme present in WBCs so if high, it means kidney infection)
97
___ is an acceptable method of urine collection for culture
Catheters (Super-pubic aspiration or a clean catch aka pee in a cup if they can void on command)
98
The most common urinary pathogen is children is ___
When kids are less than one, the gender most prone to UTIs are __and after that, it is most common in __
E Coli.
males, girls
99
For imaging, a __ is most likely to give you the best results to find a UTI if it's the first one
If there is any indication that the patient has had some infection before (febrile illnesses aka a illness but you don't know the cause), if you grow something other than e. coli, if they have an increased temp, **Or after the second UTI, then you also need to include a __
Renal and Bladder ultrasound (RBUS)
VCUG
100
Ureteropelvic Junction Obstruction (UJO) presents with renal scaring and on an ultrasound one kidney looks normal and the other is weird looking
__ presents when there is a obstruction of the urethra that causes everything to get backed up
Posterior urethral valves (PUV)
101
The criteria for the diagnosis of a UTI is urine collected by a clean catch must have both __ and at least __ colonies per ml via urinary analysis
The criteria for the diagnosis of a UTI is urine collected by a catheter must have both __ and at least __ colonies per ml via urinary analysis
What about if if urine is collected via suprapubic aspiration?
pyuria, 50,000
Pyuria, 10k-50k
Pyuria and ANY growth on culture
102
If you are not acutely ill and tolerating (po) then use the antibiotic __
**Aka impaired treatment
cephalosporin
