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PHYSIOLOGY Flashcards

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1
Q

the kidney is an endocrine gland, what 2 hormones does it produce

A

renin for RAAS

erythropoietin (EPO) type of RBC

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2
Q

where is renin produced for RAAS

A

juxtamedullary cells in the afferent arteriole of the juxtaglomerular apparatus

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3
Q

what do the juxtamedullary cells in the afferent arteriole pick up on themselves thats causes renin release (for RAAS = Na reabsorption)

A

decreased pressure in afferent arteriole

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4
Q

increase in (parasympathetic/sympathetic?) activity results in renin release form juxtamedullary cells = RAAS activation = Na reabsorption = increase in BP

A

sympathetic

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5
Q

decrease in Na+ is picked up by … cells in the distal convoluted tubule

what does this cause the juxtamedullary cells in the afferent arteriole to do

A

macula densa

release renin = activation of RAAS = increased Na reabsorption = increase in BP

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6
Q

presence of ADH Causes the water channels in the collecting duct to ….

what does this cause

A

open

water reabsorption from tubule fluid to interstitial fluid

more concentrated low volume urine

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7
Q

in what physiological state is ADH present

A

dehydration

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8
Q

as a general rule, what follows the movement of salt

A

water

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9
Q

what is osmotic diuresis and water diuresis

A

osmotic diuresis - loss of salt and water

water diuresis - loss of water without salt

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10
Q

what is the body fluid osmolarity (same for ECF and ICF)

A

300 mosmol/l

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11
Q

what happens to the fluid in a cell when immersed in a hypotonic solution

A

enters cell = cell lysis

hypotonic solution = low conc of particles = high conc of water = water wants to move from high to low conc

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12
Q

which type of fluid (ECF or ICF) has more Na and Cl

A

extracellular

think bc we used to be sea creatures that the water outside our cells likes to be salty (Na)

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13
Q

apart from urine, what is the 2 biggest loses of water form the body

A 
skin diffusion (not sweat) 
lungs
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14
Q

% of plasma that enters the glomerulus that filters at bowmans capsule into tubules

A

20%

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15
Q

what is the glomerular filtration rate normally

A

125ml/min

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16
Q

what is tubular secretion

A

movement of things from peritubular artery/vasa recta into tubules

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17
Q

what is tubular reabsorption

A

movement of things from tubules into peritubular artery/vasa recta

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18
Q

tubular reabsorption>tubular secretion = net …

A

net reabsorption

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19
Q

tubular secretion>tubular reabsorption = net …

A

net secretion

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20
Q

what change in afferent arteriole size can increase GFR

A

vasodilation = increased blood flow

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21
Q

what change in afferent arteriole size can decrease GFR

A

vasoconstriction = decreased blood flow (hypoperfusion)

eg from haemorrhage

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22
Q

plasma clearance marker (2)

why

A

inulin IV or creatinine

bc their clearance is the same as GFR (they aren’t reabsorbed or secreted in the tubules)

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23
Q

why is creatinine used instead of inulin

why is inulin more accurate (2)

what is creatinine

A

inulin needs to be administered IV

slight tubular secretion of creatinine
initial creatinine levels (before filtration) vary dependant on age, gender, muscle size etc

creatinine is a marker of muscle breakdown

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24
Q

what do you use if you need an accurate GFR

A

51Cr-EDTA clearance

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25
what is the normal clearance of glucose in urine exception to normal, how does this present
0 - it is filtered at the glomerulus but is all completely reabsorbed in the tubules (by SGLT1 and 2) hyperglycaemia >14mmol/l = glucose in urine
26
what is the clearance of urea (below or above GFR)
27
what is the value or normal renal plasma flow (RPF)
650ml/min
28
what is the marker for renal plasma flow what is the criteria for this
para-amine hippuric acid (PAH) something that is filtered then completely secreted into tubules (none left in blood that leave kidneys)
29
calculation for filtration fraction explanation normal value
GFR/RPF how much filtration (out of the total plasma movement) of plasma happens at glomerulus compared to tubules 125/650 = 20%
30
what are the 2 reasons proteins might get filtered at the glomerulus
high GFR from overflow (eg hypervolaemia, hypertension) | leaky glomerulus = no barrier to proteins
31
what investigation do you want to do for proteinuria to figure out the cause (overflow or leaky glomerulus)
protein/creatinine ratio (PCR)
32
2 routes of reabsorption in the proximal convoluted tubule
transcellular | paracellular (through tight junctions)
33
where is most of the salt and water reabsorbed (from tubular fluid to blood stream)
proximal convoluted tubule
34
by which route (transcellular or paracellular) does water get reabsorbed does it need transporters
paracellular no - bc it follows the Na osmotic gradient, doesnt need any fancy transporters to move it across just goes through the gap junctions
35
by which route (transcellular or paracellular) does Na get reabsorbed does it need transporters
transcellular yes - Na+/K+ ATPase transporter at basolateral membrane
36
what 3 things contribute to the osmolarity gradient in the renal medulla
loop of henle vasa recta urea
37
what is the countercurrent multiplier
loop of henle
38
which type of nephron create a larger osmotic gradient
juxtamedullary nephron (bc loop of henle is larger)
39
which limb of the loop of henle (ascending or descending) reabsorbs water
descending
40
which limb of the loop of henle (ascending or descending) reabsorbs salt
ascending
41
in the ascending limb of the loop of henle what is the transporter that causes salt reabsorption what blocks this cotransporter
Na+, K+. Cl- triple cotransporter loop diuretics
42
what is the difference in osmolarity of ascending loop of henle and the interstitial fluid
200 mosmol/l
43
what happens to water and salt in the vasa recta as you go down the loop of henle
water is lost salt is gained to match the osmolarity of the interstitial fluid (osmolarity increases as you go down)
44
what happens to water and salt in the vasa recta as you go back up the loop of henle
water is gained salt is lost to match the osmolarity of the interstitial fluid (osmolarity decreases as you go back up the loop of henle)
45
overall what happens to the osmolarity of the vasa recta before and after it follows the loop of henle
nothing - it increases as you go down and decreases as you go up, but will be the same at the start and the end (300 mosmol/l)
46
which part of the nephron does ADH work on
the collecting duct
47
what does ADH do to aquqporin channels (water channels) in the collecting duct what does this result in
increase their numbers water reabsorption from tubular fluid to interstitial fluid (then blood)
48
what physiological state is ADH high in
dehydration
49
what physiological state is ADH low in
hydration
50
where is ADH secreted from
posterior pituitary
51
alternative name for ADH
vasopressin
52
what type of urine (volume and conc) is produced in the presence of ADH
concentrated and low volume ADH = increased aquaporins = water reabsorption = concentrated and low volume
53
what type of urine (volume and conc) is produced in the absence of ADH
dilute and high volume no ADH = decreased aquaporins = no water reabsorption = dilute and high volume urine
54
in response to what 2 things is aldosterone produced (and hence why
hyperkalaemia | hyponatraemia
55
2 functions of aldosterone
increase K secretion | increase Na reabsorption
56
function of aldosterone in RAAS
Na reabsorption = increase bp
57
function of aldosterone in hyperkalaemia
increases K secretion into tubules = decreases serum K
58
what hormone does the opposite to RAAS
ANH (atrial natriuretic hormone)
59
where is ANH made in response to what hence what does it do
heart hypertension (heart muscle stretched) decreased Na reabsorption/increased Na secretion to lower bp
60
when H+ is reabsorbed back into blood as HCO3, what enzyme is needed
carbonic anhydrase
61
what 2 things are H+ secreted as, that cause HCO3 to be reabsorbed as a 1:1 excretion:reabsorption ratio
NH4 (ammonia) and H2PO4 (acid phosphate)
62
normal fluid daily requirements
30ml/kg of fluid
63
hyponatraemia and dry (not fluid overloaded) treatment
0.9% saline 500ml bolus and monitor
64
hyponatraemia and fluid overloaded treatment
fix problem of fluid overload, dont give fluids bc the Na is actually fine, it is just 'low' bc of the high volume
65
emergency hyponatraemia treatment
100ml 3% saline over 10-15mins
66
complication of treated hyponatraemia
osmotic demyelination (irreversible brain damage, aka locked in syndrome)

J Renal (12 decks)

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