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Physio II > Renal > Flashcards

Renal Flashcards

1
Q

What is homeostasis?

A

tendency of the body to seek and maintain a condition of balance or equilibrium within its internal environment, even when faced with external changes

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2
Q

The total body water (TBW) makes up how much of the body weight?

A

60%

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3
Q

ICF

A

Intracellular Fluid

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4
Q

ECF

A

Extracellular Fluid

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5
Q

How much of the body fluid is ICF?

A

2/3 of body fluid

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6
Q

How much of the body weight is ICF?

A

40% of body weight

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7
Q

How much of the body fluid is ECF?

A

1/3 of body fluid

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8
Q

How much of the body weight is ECF?

A

20% of body weight

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9
Q

What 3 things make up the ECF?

A
  • Interstitial fluid (ISF)
  • Intravascular fluid (IVF)
  • Transcellular fluid (TCF)
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10
Q

What percentage of body weight is ISF?

A

15% of body weight

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11
Q

What percentage of body weight is IVF?

A

5% of body weight

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12
Q

What is one of the most important functions of the kidney?

A

maintain composition and vol. of the ECF

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13
Q

Na+ in plasma?

A

142 mEq/L

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14
Q

Na+ in ISF?

A

145 mEq/L

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15
Q

Na+ in ICF?

A

12 mEq/L

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16
Q

K+ in plasma?

A

4.3 mEq/L

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17
Q

K+ in ISF?

A

4.4 mEq/L

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18
Q

K+ in ICF?

A

150 mEq/L

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19
Q

Ca2+ in plasma?

A

5 mEq/L

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20
Q

Ca2+ in ISF?

A

2.4 mEq/L

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21
Q

Ca2+ in ICF?

A

4 mEq/L

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22
Q

Mg2+ in plasma?

A

3 mEq/L

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23
Q

Mg2+ in ISF?

A

1.5 mEq/L

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24
Q

Mg2+ in ICF?

A

34 mEq/L

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25
Q

Cl- in plasma?

A

104 mEq/L

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26
Q

Cl- in ISF?

A

117 mEq/L

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27
Q

Cl- in ICF?

A

4 mEq/L

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28
Q

HCO3- in plasma?

A

24 mEq/L

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29
Q

HCO3- in ISF?

A

27 mEq/L

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30
Q

HCO3- in ICF?

A

12 mEq/L

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31
Q

Phosphates in plasma?

A

2 mEq/L

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32
Q

Phosphates in ISF?

A

2 mEq/L

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33
Q

Phosphates in ICF?

A

40 mEq/L

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34
Q

Proteins in plasma?

A

14 mEq/L

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35
Q

Proteins in ISF?

A

0 mEq/L

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36
Q

Proteins in ICF?

A

54 mEq/L

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37
Q

What is osmotic pressure?

A

the force that a dissolved substance exerts on a semipermeable membrane, through which it cannot penetrate, when separated by it from pure solvent

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38
Q

With osmotic pressure, the vol of a given compartment depends on what?

A

number of solute particles in that compartment

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39
Q

With osmotic pressure, the vol of a given compartment does NOT depend on what?

A

any specific property of the solute, such as charge, size, or shape

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40
Q

2 ways water crosses cell membranes

A
  • between lipids of bilayer

- through specialized channels called aquaporins

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41
Q

Is it fast or slow for water to cross between lipids of the bilayer?

A

slow

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42
Q

Is it fast or slow for water to cross through aquaporins?

A

fast

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43
Q

T/F: An osmotic gradient is required to govern water movement across a membrane.

A

True

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44
Q

What is oncotic pressure?

A

osmotic pressure that is exerted by large molecules in a solution

AKA “colloid osmotic pressure’

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45
Q

How does the body govern how much fluid is in a particular compartment? (3 things)

A
  • osmotic pressure
  • hydrostatic pressure
  • oncotic pressure
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46
Q

What is the impact of oncotic pressure for trans-membrane water flux?

A

negligible

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47
Q

What is the impact of oncotic pressure for trans-capillary fluxes?

A

significant

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48
Q

How is homeostasis maintained when conditions change/

A

Concept of “Set Point”

  • system requires sensors/ detectors
  • coordination of sensed signals
  • feedback and adjustment mechanisms: effectors
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49
Q

Functions of the Kidney (7 things)

A
  • regulation of water and electrolyte balance
  • excretion of metabolic waste
  • excretion of drugs and hormones
  • regulation of arterial blood pressure
  • production of erythropoietin
  • conversion of vit. D to active form
  • gluconeogenesis
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50
Q

What is the basic functional unit of the kidney?

A

nephron

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51
Q

3 Generally Categories of Kidney Functions

A
  • Filtration
  • Absorption/Reabsorption
  • Secretion
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52
Q

T/F: Secretion is not the same thing as excretion

A

True

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53
Q

What causes the production of erythropoietin?

A

decrease in oxygen tension

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54
Q

In the renal corpuscle,what things are used for solute discrimination?

A
  • size
  • shape
  • charge
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55
Q

Where are the bulk of filtered solutes reabsorbed?

A

proximal tubule

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56
Q

What are the juxtamedullary nephrons important for?

A

concentrating mechanisms

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57
Q

Thick ascending limb (Loop of Henle)

A
  • high ACTIVE transport of NaCl - REQUIRES ATP

- No H2O permeability

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58
Q

Thin descending limb (Loop of Henle)

A
  • High H2O permeability

- No NaCl permeability

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59
Q

Thin ascending limb (Loop of Henle)

A
  • High NaCl permeability

- No H2O permeability

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60
Q

How is the medullary hypertonicity established and maintained?

A

By the selective permeabilities of loop of Henle segments

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61
Q

What is the medullary hypertonicity necessary for?

A

concentrating mechanism

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62
Q

Tubular fluid in the distal tubule is ____________.

A

hypotonic

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63
Q

Role of macula densa cells?

A

-sense salt load = very sensitive to NaCl concentrations

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64
Q

Tubuloglomerular feedback?

A

mechanism by which both renal blood flow and glomerular filtration rate are controlled

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65
Q

What cells make up the juxtaglomerular apparatus?

A
  • mesangial cells

- granular cells of the afferent arteriole

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66
Q

Absorption of what happens in the distal convoluted tubule?

A
  • Na+
  • Ca2+
  • Cl-
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67
Q

What are the cells of the connecting tubule like?

A

mix of DCT- and CD-like cells

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68
Q

How much of the cardiac output do the kidneys receive?

A

1/5

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69
Q

What is the percentage of plasma in the blood received by the kidneys?

A

50-55%

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70
Q

How much of the plasma delivered to the kidneys crosses into Bowman’s capsule?

A

20-35%

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71
Q

How much of the filtered plasma is excreted?

A

less than 1%

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72
Q

Where does filtration occur?

A

interface between vascular and epithelial structures

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73
Q

What determines the permeability across the glomerular filtration barrier?

A
  • size
  • charge
  • shape
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74
Q

In health, the oncotic pressure in the lumen of Bowman’s capsule should equal?

A

0 mmHg

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75
Q

How can the glomerular filtration be regulated?

A
  • hormonal
  • autoregulation
  • tubuloglomerular feedback
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76
Q

What is the stimulus for the renin-angiotensin-aldosterone system?

A

drop in blood pressure

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77
Q

What is the response for the renin-angiotensin-aldosterone system?

A

adjust vascular resistance and circulating blood vol.

78
Q

Where is renin made?

A

granular cells of afferent arterioles

79
Q

What is angiotensin?

A
  • peptide
  • circulates
  • made by liver
80
Q

Where is ACE made?

A

endothelial cells of lungs and kidneys

81
Q

What is aldosterone?

A
  • steroid

- made in adrenal cortex

82
Q

What does excessively high GFR result in?

A

elevated tubular flow rates and inefficient removal of NaCl by TALH

83
Q

What cells sense the high tubular NaCl?

A

macula densa cells

84
Q

After sensing high tubular NaCl, the macula densa cells release ATP and adenosine. What does that do?

A
  • INCREASES glomerular mesangial cell constriction

- DECREASES available glomerular capillary filtration area, and hence, Kf

85
Q

What is clearance?

A

the volume of plasma from which a substance is completely removed by the kidney in a given amount of time (usually a minute)

86
Q

How can clearance be a measure of GFR?

A

clearance of a special substance can be used to measure GFR

87
Q

Why is inulin ideal for measuring GFR?

A
  • freely filtered
  • non-toxic
  • not secreted
  • not absorbed
  • not metabolized
  • Cin = GFR
88
Q

T/F: GFR and inulin clearance do NOT depend on [Pin}

A

True

89
Q

As inulin needs to be infused constantly to measure GFR, what is another substance that can be used?

A

creatinine

90
Q

Characteristics of creatinine

A
  • normal product of protein metabolism

- production does not vary sig. w/ time

91
Q

Pro of using inulin?

A

Cin = GFR

92
Q

Cons of using inulin?

A
  • requires IV and constant infusion
  • requires complete bladder emptying before and after the test
  • urine flow must be high to obtain enough urine sample
93
Q

Pros of using creatinine?

A
  • Ccr ~ GFR
  • endogenous; no need for IV or infusion
  • can collect urine sample over longer period of time
94
Q

Con to using creatinine?

A

secretion can produce an overestimate of GFR

- gen. doesn’t d/t limitations of test

95
Q

Transcellular transport

A

through the cell

96
Q

Paracellular transport

A

between cells

97
Q

Absorption

A
  • endocytosis

- transcytosis

98
Q

Secretion

A

exocytosis of stored or newly synthesized proteins

99
Q

Types of transport proteins

A
  • pumps
  • carriers
  • channels
100
Q

Types of carriers

A
  • symporters = cotransporters
  • antiporters = exchangers = countertransporters
  • uniporters
101
Q

Transport processes

A
  • active
  • secondary active (coupled carriers)
  • passive (channels, some carriers)
102
Q

How many sodium does the Na+/K+ pump move out of the cell?

A

3

103
Q

How many potassium does the Na+/K+ pump move into the cell?

A

2

104
Q

In a healthy individual, how much of the filtered glucose is reclaimed in the PT?

A

virtually ALL of it!

105
Q

Why is glucosuria seen in diabetes mellitus?

A

The PT glucose transport rate is exceeded

106
Q

Diabetes Mellitus Type I

A

insulin deficient = inability of pancreas to secrete insulin

107
Q

Diabetes Mellitus Type II

A

insulin resistant = target tissues do not respond to insulin

may also be insulin-insufficient

108
Q

What mediates the proximal tubular reabsorption of HCO3-?

A

sodium gradient

109
Q

T/F: HCO3- reabsorption does not rely on the gradient maintained by the Na+/K+ ATPase

A

False.

It does rely on the gradient.

110
Q

What does the PT efficiently recover? (3)

A
  • filtered amino acids
  • oligopeptides
  • low molecular weight proteins (LMPs)
111
Q

How does Cl- mediated Na+ transport work? (3)

A
  • early PT, lumen (-) potential difference; late PT, luminal [Cl-] increased
  • “leaky” tight junctions
  • sodium follows chloride
112
Q

Percentage of filtered Na+ (re)absorbed in the PT?

A

~65%

113
Q

Recovery of filtered LMPS via transcytosis in the proximal tubule (4 steps)

A
  1. endocytosis of LMPs
  2. fusion w/ lysosome
  3. lysosomal degradation and fusion w/ multivesicular body
  4. transport of amino acids to interstitial space
114
Q

Transport by the thin segments of the Loop of Henle are ______________.

A

passive

115
Q

NaCl transport by TAL is _______.

A

active

116
Q

The active transport of NaCl by the TAL reclaims how much more of the filtered NaCl load?

A

25%

117
Q

K+ and Cl- move __ their concentration gradients in TAL.

A

UP

118
Q

As the TAL is not permeable to water, what happens to the luminal fluid?

A

It is diluted

119
Q

What do loop diuretics affect? Examples?

A

Affect TAL

Examples

  • bumetanide (bumex)
  • furosemide (lasix)
120
Q

What is Bartter syndrome?

A

human dz d/t loss of function mutation

121
Q

Symptoms of Bartter syndrome? (5)

A
  • present w/ hypotension and salt wasting
  • NaCl absorption is impaired
  • insufficient dilution of luminal fluid results
  • high medullary interstitial tonicity cannot be achieved
  • overall renal concentration mechanism is compromised!
122
Q

T/F: Na+ gradient also drives NaCl uptake by the distal tubule (DT)

A

True

123
Q

T/F: the apical transporter in the DT depends on the presence of K+

A

FALSE

Apical transporter in the DT does NOT depend on the presence of K+

124
Q

What do thiazide diuretics affect? Example?

A

Affect DT

Example
-chlorothiazide (diuril)

125
Q

What is DT Ca2+ absorption regulated by?

A

parathyroid hormone (PTH)

126
Q

Cells of the Collecting Duct System (2 categories)

A
  • Intercalated

- Principle

127
Q

Types of intercalated cells

A
  • alpha

- beta

128
Q

What do alpha intercalated cells secrete?

A

acid

129
Q

What do beta intercalated cells secrete?

A

base

130
Q

What intercalated cells are found more in carnivores?

A

alpha

131
Q

what intercalated cells are found more in herbivores?

A

beta

132
Q

What type of cells predominate throughout all segments of the CD?

A

priniciple cells

133
Q

What is the function of epithelial Na+ channels (ENaC)?

A

permits downhill movement of Na+ from tubular lumen and into cell

134
Q

ENaC abundance and activity is regulated by?

A

aldosterone

135
Q

How is the ENaC put together?

A

assembly of 3 subunits encoded by 3 genes belonging to a large cation channel gene family

136
Q

what is something that inhibits ENaC, therefore blocking Na+ absorption?

A

amiloride

137
Q

PHA Type I (humans)

A
  • loss of function mutations in ENaC (alpha, beta, and gamma)
  • leads to renal salt wasting
138
Q

Liddle Syndrome (humans)

A
  • gain of function mutations in ENaC (beta and gamma)
  • increased renal Na+ uptake
  • hypertension
139
Q

The water permeability of the collecting duct principle cells is modulated by?

A

ADH (anti-diuretic hormone)

140
Q

How does ADH affect water permeability of CD principle cells?

A
  • binding of circulating ADH to its basolaterally-localized receptor increases intracellular cAMP
  • this then stimulates the fusion of vesicles to the apical membrane
  • water exits via aquaporins 3 and 4
141
Q

Aquaporin 2 contains __________ and is regulated by __________.

A

pre-synthesized water channels; ADH

142
Q

As aquaporins 3 and 4 are always around, do they need ADH stimulation?

A

no

143
Q

AQP2 and CD ADH-regulated water permeability

Loss of Function Mutation

A
  • NEPHROGENIC diabetes insipidus (DI)
  • inability to concentrate urine
  • massive water diuresis
144
Q

3 things that facilitate absorption by the PT

A
  • subcellular specializations
  • secondary structural features
  • tertiary structural features
145
Q

PT erubcellular specializations

A
  • mitochondria rich

- wide range of specialized transporters

146
Q

PT secondary structural features

A

-brush border membrane

147
Q

PT tertiary structural features

A
  • convolutions of early proximal tubule

- proximity of all nephronal segments to the vasa recta

148
Q

In relation to substances being IN THE URINE, what is the role of filtration, absorption, and secretion?

A 
filtration = input
absorption = output
secretion = additional input
149
Q

Why is it important to understand clearance?

A
  • Inulin/creatinine clearance measures GFR
  • Regular GFR monitoring can help time when dialysis is NECESSARY
  • Chronic kidney dz is not curable
150
Q

Why is knowledge of renal functions essential and critical ?

A

For safe and proper drug dosage

151
Q

What is PAH?

A

para-aminohippurate

152
Q

What is PAH a useful indicator of?

A

renal plasma flow (RPF)

153
Q

In a healthy individual, with normal plasma glucose levels, how much of the glucose is reabsorbed in the PT?

A

100%

154
Q

How can glucose end up in the urine?

A

When the level of plasma glucose exceeds the PT glucose transport maximum (Tm)

155
Q

How the medullary interstitial hypertonicity generated?

A
  • Active NaCl absorption by TALH

* role of urea recycling

156
Q

How is the medullary interstitial hypertonicity maintained?

A

differential NaCl and H2O permeabilities of all segments of the Loop of Henle

157
Q

Thin descending limb (DTL)

A
  • H2O permeable

- NOT NaCl permeable

158
Q

Thick ascending limb (TALH)

A
  • ACTIVE NaCl transport

- NOT H2O permeable

159
Q

Thin ascending limb (ATL)

A
  • PASSIVE NaCl transport
  • NOT H2O permeable
  • UREA SECRETION
160
Q

Where does urea secretion occur?

A

thin ascending limb

161
Q

Medullary Collecting Duct

A
  • REGULAR permeability to NaCl and H2O

- UREA REABSORPTION

162
Q

Where does urea reabsorption occur?

A

medullary collecting duct

163
Q

What maintains the vertical gradient in the medullary interstitium?

A

countercurrent exchange between the descending and ascending vasa recta

164
Q

T/F: Vasa recta are not freely permeable to both NaCl and H2O

A

False.

They are freely permeable to both NaCl and H2O.

165
Q

What is the importance of medullary interstital hypertonicity?

A

required for urine concentration

166
Q

Urea (7 things)

A
  • small
  • highly polar
  • protein metabolite
  • highly H2O soluble
  • freely filtered
  • major product for removal of free ammonia in vivo
  • contributes to medullary hypertonicity
167
Q

Can urea pass through pure lipid bilayers?

A

No; needs urea transporters

168
Q

Urea transports in the ATL do what?

A

mediate secretion

169
Q

Urea transports in the IMCD do what?

A

fascilitate reabsorption

170
Q

IMCD stands for?

A

Inner Medullary Collecting Duct

171
Q

ADH

A

Anti-diuretic Hormone

172
Q

Effect of ADH

A
  • induction of thrist

- pressor effects = aid in maintaining perfusion during vol. depletion

173
Q

T/F: A change in osmolarity will overrule a change in blood vol.

A

True.

174
Q

Primary action of ADH in kidney?

A

increase H2O permeability of cells in the CD

Ultimately leads to H2O reabsorption and excretion of concentrated urine

175
Q

How does ADH also increase urea recycling?

A

promoting urea transport in CD

176
Q

Disruptions to ADH reaching its target cells?

A

nephrogenic DI

177
Q

Diuresis

A
  • removal of ADH leads to endocytosis of AQP2 from apical membrane
  • decreases H2O permeability of CD, therefor decreases reclamation of H2O from urine
  • excreted urine is therefore very dilute
178
Q

Central diabetes insipidus

A
  • ADH RELEASE is impaired

- defect is at the SOURCE

179
Q

Nephrogenic diabetes insipidus

A
  • ADH SIGNALING is impaired

- defect is at the TARGET

180
Q

Why do you perform a water deprivation test?

A

H2O deprivation should stimulate an ADH response and increase H2O reabsorption (concentrate urine) in ANY non-DI subject

181
Q

Why do you perform an ADH Response Test?

A

Administration of ADH should increase H2O reabsorption in non-DI AND CENTRAL DI subjects, but NOT in nephrogenic DI subject

182
Q

What is the outcome for both water deprivation test and ADH Response Test?

A

increase in urine specific gravity for positive response

183
Q

Who should not increase H2O absorption with a dose of ADH?

A

nephrogenic DI subjects

184
Q

T/F: The concentration of Na+ in the ECF is a good indicator of ECF volume.

A

False.

[Na+] in ECF is not a good indicator of ECF volume.

185
Q

Aldosterone

A
  • released by zona glomerulosa cells of adrenal cortex
  • stimulated by angiotensin II
  • also stimulated by elevated plasma K+ and ACTH
186
Q

What is ACTH?

A

adrenalcoricotrophic hormone

stress increases this one

187
Q

How does aldosterone relate to Na+ absorption?

A

increases sodium absorption from luminal fluid in CD

This causes Na+ to be retained

188
Q

T/F: Increased Na+ intake decreases aldosterone synthesis

A

True

189
Q

Amiloride

A
  • binds to apically located ENaC

- blocks Na+ conduction by that protein = INHIBITS Na+ REABSORPTION

190
Q

What increases the production of epithelial sodium channels (ENaC)?

A

aldosterone

Physio II (8 decks)

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