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Physiology BRS > Renal > Flashcards

Renal Flashcards

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0
Q

What percentage of the TBW does interstitial fluid occupy?

A

Interstitial fluid:3/4 of ECF
ECF:1/3 of TBW
>interstitial fluid :3/12 TBW

It is an ultrafiltrate of plasma

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1
Q

What percentage of the TBW does plasma occupy?

A

Plasma is 1/4 of the ECF
ECF is the1/3 of the TBW
>plasma:1/12 TBW

It consists of albumin,globulins,Na,Cl,HCO3-

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2
Q

How can we measure TBW?

A 
#tritiated water
#D2O
#antupyrene
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3
Q

How can we measure ECF?

A 
#sulfate
#inulin
#mannitol
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4
Q

How can we measure plasma?

A 
#radioiodinated serum albumin(RISA)
#evans blue
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5
Q

How is plasma osmolarity measured?

A

Posm=2Na+glucose/18+BUN/2,8

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6
Q

How much is the osmolarity difference between ECF and ICF at a steady phase?

A

They are equal>water shifts between ECF and ICF

NaCl,mannitol:do not cross cell membranes >ECF!

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7
Q

What kind of changes in volume/osmolarity of blood fluids can cause no change in Hct?!

A

HYPERosmotic-CONtraction: sweating,fever,DM> [plasm.prot]^+H2O out of the RBC>unchanged Hct

"Opposite changes"
#HYPOsmotic-EXPansion: SIADH>[plasma.pr.]low+H2O into the RBC>unchanged Hct
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8
Q

What kind of changes in volume/osmolarity of blood fluids do these changes cause?

  • SIADH
  • adrenal insufficiency
  • diarrhea
  • ^NaCl intake
  • isotonic NaCl infusion
  • DM
A
  • Hyposmotic expansion
  • Hyposmotic contraction
  • isotonic contraction
  • hyperosmotic expansion
  • isotonic expansion
  • Hyperosmotic contraction
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9
Q

What is the effect of prostaglandins E/I,bradykinin,NO,D in RBF?

A

They cause vasodilation of the renal arterioles >^RBF

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10
Q

How is the effective Renal Plasma Flow measured?

A

RPF=Upah*V/Ppah

PAH:filtered +secreted
This equation underestimates true RPF by 10%❗️

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11
Q

How is Renal Blood Flow RBF measured?

A

RBF=RPF/1-Hct

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12
Q

How is GFR measured?

A

GFR=Uinulin*V/Pinulin=Kf[(Pgc-Pbs)-(πgc-πbs)]

Inulin=FILTERED NOT SECRETED

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13
Q

How is filtration fracture estimated?

What effect does it have on the reabsorption in the proximal tubule!

A

Filtration fracture =GFR/RPF

Normally=0,2—>20%of RPF is filtered

#^FF=^[protein] of peri tubular capillary=^reabsorption in the proximal tubule.
#low FF=low[protein] of the peritubular capillary=low reabsorption
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14
Q

What are the components of glomerular filtration barrier?

A 
#fenestrated capillary endothelium>SIZE BARRIER
#fused basement membrane>NEGTIVE CHARGE BARRIER:loss in the nephrotic syndrome!
#epithelial layer>podocyte foot
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15
Q

What is the connection between a substance x and GFR ,as far as it’s clearance is concerned?

A

Cx>GFR=net tubular secretion of X
Cx<GFR=net tubular absorption
Cx=GFR=No secretion/no reabsorption.

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16
Q

How does Pgc change across the length of the capillary?

A

Pgc is CONSTANT across the length do the capillary

-^by the dilation of the afferent capillary or constriction of the efferent

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17
Q

How does πgc change along the length of the capillary?

A

Πgc increases across the length of the capillary>filtration of H2O>[protein]^

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18
Q

How does angII/sympathetic stimulation/prostaglandins affect FF?

A
  • ang II=constriction of the efferent>^GFR,same RPF>^FF
  • sympathetic=constriction of the afferent>low GFR,low RPF>same FF
  • prostaglandins=dilation of the afferent>^GFR,^RPF>same FF
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19
Q

How can Pbs be increased?

A

By constriction of the ureters(stone)

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20
Q

What does juxtaglomerular apparatus consist of?

A 
#mesangial cells
#JG cells=modified smooth cells of the afferent arteriole)>renin
#macula densa=NaCl sensor at the DCT>adenosine
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21
Q

How is filtered load/excretion rate/reabsorption/secretion estimated?

A

Filtered load=GFRP
Excretion rate=UV
Reabsorption=filtered-excreted
Secretion=excreted-filtered

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22
Q

How does filtered load affect reabsorption?

Study These Flashcards
A

^filtered load>^reabsorption

23
Q

At what point does the glucose reabsorption stop and we start seeing glucosuria..?under what condition is glucosuria considered “normal”?

Study These Flashcards
A

(heterogeneity of nephrons)

Normal pregnancy may cause glucosuria+aminoaciduria

24
How is amino acids clearance determined?
They are ~100%reabsorbed in the PCT via Na-cotransport
25
What is the Hartnup disease?
ARecessive Deficiency of neutral amino acids transporters>I.e. tryptophane> low niacin(B3)>pellagra-like symptoms=3D:Diarrhea,Dementia,Dermatitis
26
Before the Tm point,PAH clearance equals...?
Filtration+secretion~>RPF | Once the Tm for secretion is exceeded >all carriers are satires >flat excretion rate
27
What is the correct order of relative clearances of the several components of plasma?
PAH>K(in high diet)>inulin>urea>Na>glucose,amino acids,HCO3-
28
What alteration can we do to the urine pH in order to increase excretion of salicylic acid and morphine?
#salicylic acid:weak acid>alkalization of the urine=^A->low reabsorption #morphine:weak base>acidification of the urine=^BH+>low reabsorption
29
What does TF/P ratio stands for?
TF/P ratio=compares the concentration of a substance in tubular fluids with the concentration in plasma #TF/P=1 -no reabsorption of the substance -reabsorption was proportional to H2O reabsorption=ίδιες συγκεντρώσεις #TF/P1 -H2Oreabsorption>reabsorption of the substance -secretion of the substance
30
What is the TF/P ration for Cl in the PCT?
It is >1 because reabsorption of Cl is proportionally less than reabsorption of H2O=σταθερή γραμμή
31
What is the TF/P ration in the bowman space for any freely filtered substance?
It is 1
32
What is the TF/P ratio for inulin across the tubule length?
Inulin is filtered but neither reabsorbed nor secreted.thus,the m(inulin) I the TF Is fixed throughout the tubules.but,as we move toward the collecting duct H20reabsorption steadily increases>lower V left in the tubules>steady increase in the [inulin]tf>steady increase in the TF/p ratio
33
How can TF/P inulin be used to measure H20 reabsorption?
[inulin]tf is determined solely by how much water remains in the TF Fraction of filtered H20reabsorbed=1-1/TF/Pinulin
34
What are the 7causes of shifting K outside of cell>^K+?
``` #Digitalis #hyperOsmolarity #Lysis(Ca,exercise) #Acidosis>counter transport of H/K #b-blockers #^blood Sugar ```
35
What are the 4 causes that shift K into cells?>Hypokalemia ?
``` #hyposmolarity #alkalosis #b-adrenergic agonist #insulin ```
36
What are the 6 causes of increased distal K secretion?
``` #Hyperaldosteronism #^K diet #alkalosis #thiazide diuretics #loop diuretics #luminal anions ```
37
What are the 4 causes of decreased distal K secretion?
``` #low K diet #low aldosterone #acidosis#K sparing diuretics ```
38
What kind of diuretics could be used to treat hypercalcemia?
Loop diuretics>block Na reabs>block Ca-Na cotransport
39
What kind of diuretics could be used to treat idiopathic hypercalciuria?
Thiazide diuretics>^Ca reabsorption>low Ca secretion>lower Ca in the urine
40
What part of the nephron is considered a concentrating segment?
Thin descending >impermeable to Na/passively reabsorbs H2O
41
What parts of the nephron are considered diluting?
Thick ascending>impermeable to H2O | DCT>cortical diluting segment>imper,enable to H2O
42
How is free water clearance estimated?
Ch2o=V-Cosm ``` ➕:loss of H20 >low ADH>hyposmotic urine #high H2O intake #cental diabetes insipidus #nephrogenic diabetes insipidus ``` ``` ➖:no loss of H2O>^ADH>hyposmotic urine #SIADH #water deprivation ``` 0⃣:treatment with loop diuretics>no contraction/no dilution
43
What is the main difference between SIADH and water deprivation as far osmolarity is concered?
Water deprivation will have normal/high serum osmolarity SIADH will have very low serum osmolarity due to the excess of H2O Both pathologies have: - ^ADH SERUM - hyperosmotic urine - low urine flow rate - negative Ch2o
44
What are the factors that stimulate renin secretion?
``` #Low BP>JG cells #low Na >macula densa #^sympathetic tone(β1) ```
45
Where is ACE mostly produced?
In the lungs(+kidneys)
46
What are the 6 effects of ANGII ?
``` #action on the AT1receptors>vasoconstriction>BP #constriction of the efferent>^GFR,low RPF>^FF #^aldosterone>^ENaC>^reabsorption of Na in the principal cells >^excretion of K in the principal cells >^excretion of H in the a-intercalated cells --->favorable gradient for reabsorption of Na and H2O #^ADH>^V2(cAMP)>aquaporins>H2Oreabsorption >^V1(IP3)>vasoconstriction #^Na/H activity in PCT>^Na,HCO2,H2O reabsorption>contraction alkalosis #hypothalamus>thirst ```
47
Via what molecular do ANP,BNP act?
ANP(atria),BNP(Ventricles)>^cGMP>relax vascular smooth muscle>^GFR>renin
48
What effect do NSAIDs have on the GFR?
NSAIDs block renal protective prostaglandins synthesis>less vasodilations>^constriction of the afferent>low GFR>acute renal failure
49
What are the buffers for HCO3 reabsorption in the PCT? | How is it regulated?
Reabsorption of HCO3(production via carbonic anydrase) Recycling of H+>conjunction with HCO3 in the lumen >CO2>diffusion back in the cell Regulation: #^filt.load>^reabsorption #^Pco2>^reabsorption #^ECF Volume>less reabsorption ^angII>^Na/H>^reabsorption:contraction alkalosis
50
H+ can be buffers through ti titriated acid and NH3. | H2PO4- buffering depends on what?
After HCO3- is reabsorbed ,H+ is secreted in the lumen via H/ATPase (^via aldosterone)>+HPO4->H2PO4->excreted ``` It depends on #the amount of urinary buffers(HPO4-) #pK of the buffer ```
51
H+ can be buffers through ti titriated acid and NH3. | NH3 buffering depends on what?
After HCO3- has been reabsorbed ,H+ is secreted in the lumen via H/ATPase(^via aldosterone)>+NH3>NH4+>excreted NH3 is produced into the cells from glutamine>diffused in the lumen ``` Depends on: #low pH of the urine>^gradient for diffusion of NH3>^excretion #low pH of the plasma>^synthesis of NH3>^excretion #^K>less production of NH3>less excretion of H+>renal tubular acidosis 4 ```
52
What are the causes of metabolic acidosis with ^anion gap?
``` MUDPILES: #methanol #uremia>renal failure #diabetic ketoacidosis #propylene glycol #iron tablets/isoniazid #lactic acidosis >shock #ethylene glycol #salicylates ```
53
What are the causes of metabolic acidosis with normal A-a gradient?
``` HARDASS #hyperalimentation #addison #renal tubular acidosis #diarrhea #acetazolamide #spironolactone #saline infusion ```
54
What other electrolyte disturbance can respiratory alkalosis cause?
Hypocalcemia. | Because H+ and Ca2+ compete for binding sites on plasma proteins>low H+>^Binding Ca2+>les ionized Ca2+
55
To maintain normal H+ balance !total daily excretion of H+ should equal the daily.....?
Fixed acid production plus fixed acid ingestion
56
Why is it not recommended for marathon athletes to drink distillates water?
When the athlete is sweating>more loss of H2O than salt>hyperosmotic volume contraction>h2O comes out of the ICF towards ECF>if he consume more H2O>even more Vecf>hyposmotic plasma

Physiology BRS (6 decks)

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