Renal - Exam 2 Flashcards
(124 cards)
1
Q
functions of kidney - 5
A
- excretion of wastes/foreign substances
- regulation of electrolyte balance
- regulation of acid-base balance
- regulation of fluid osmolality/volume
- production and secretion of hormones
2
Q
3 hormones kidneys produce and secrete
A
Vit D3, erythropoetin, renin
3
Q
nutcracker syndrome is where the..
A
LEFT renal vein becomes compressed between the SMA and AORTA
4
Q
results of nutcracker syndrome - 3
A
- kidney enlargement
- venous HTN
- rupture of thin walled veins of collecting system (HEMATURIA)
5
Q
urinary tract obstructions are caused by
A
many mechanisms
6
Q
list 5 causes of urinary tract obstructions
A
- polycystic kidney
- kidney stones
- blood clot
- carcinoma
- endometriosis
7
Q
___ is the outer portion of the kidney, houses the glomerulus (filtration) and is where the renal artery becomes the renal vein
A
cortex
8
Q
____ is the pyramid shaped inner portion of the kidney which houses most of the nephron (maintenance of salt and water balance in blood)
A
medulla
9
Q
____ is the functional filtering unit of the kidney
A
nephron
10
Q
we have ___ million nephrons in each kidney, number naturally declines with age
A
1.2 million
11
Q
each nephron filters…
A
a small amount of blood
12
Q
5 parts of the nephron
A
- glomerulus (cortex - filtration)
- proximal tubule (cortex)
- loop of Henle (medulla - concentrates urine)
- distal tubule (cortex)
- collecting ducts (medulla)
13
Q
the nephron works by:
- the glomerulus lets ____ and ____ pass but not ____ or ___
- filtered fluid passes through the tubule which sends minerals to blood and removes waste. the product is ____
A
the nephron works by:
- the glomerulus lets fluid and _waste pass but not cells or protein
- filtered fluid passes through the tubule which sends minerals to blood and removes waste. the product is urine
14
Q
JGA is formed by ____ and ___
A
DCT and glomerular afferent arteriole
15
Q
JGA regulates ___ and ____
A
BP and GFR
16
Q
3 cell types in the JGA
A
- juxtaglomerular cells
- extraglomerular cells
- macula densa
17
Q
juxtaglomerular cells are in the ___ and produce ____
A
afferent arteriole wall, produce renin
18
Q
extraglomerular cells AKA
A
lacis cells
19
Q
macula densa cells are in the ____
A
DCT
20
Q
macula densa cells sense respond to ____ and…
A
INC NaCL, they vasodilate afferent arterioles and INC renal blood flow to maintain GFR
21
Q
fx of glomerulus is
A
plasma filtration
22
Q
____ brings blood into Bowmans capsule and goes out through the _____
A
AFFERENT brings blood in, EFFERENT out
23
Q
the glomerulus contains a ____ ____
A
filtration barrier
24
Q
___ and ____ cannot cross the barrier
A
cells and proteins
25
what 7 things are filtered in the glomerulus
1. h20
2. glucose
3. electrolytes
4. creatinine
5. small peptides
6. amino acids
7. small chemicals
26
3 barriers to filtration in glomerulus
1. endothelial cells
2. GBM
3. podocytes
27
endothelial cells have _____, small holes that allow plasma through but not protein/cells
fenestration
28
the GBM has a _____ that keeps ___ out
strong negative charge that keeps albumin out
29
the GBM is formed by
a matrix of proteins
30
___ is a disease that breaks down the GBM (loses neg charge and albumin is lost of urine, NOT normal)
DM
31
_____ like scleroderma causes changes in fenestration of endothelial cells
autoimmune diseases
32
podocytes are a cell unique to the
kidney
33
podocytes create a ____ formed by interdigitate interaction of adjacent podocytes
filtration slit
34
in minimal change disease ___ disappear
podocytes
35
mesangial cells are ____ in the filtration barrier of the glomerulus
support cells
36
net filtration pressure is ___ and favors...
12 mmHg and favors pushing plasma into filtration in bowman's capsule
37
the ____ in the cortex is the major site of reabsorption
PCT
38
___ % Na, ___ % H2O, __ % bicarb, __ % of other electrolytes are reabsorbed in the PCT
60% Na, 70% H2O, 80% bicarb, 90% other electrolytes
39
type of cells in PCT
tubular epithelial cells
40
tubular epithelial cells have ___ and ___
brush border and mitochondria
41
the brush border
INC SA to touch as much filtrate as possible
42
the mitochonidria
provide energy for active transport of filtrate via transporter proteins
43
____ is death of the tubular epithelial cells which are susceptible to a lack of O2
ATN (acute tubular necrosis)
44
with dec blood vol, there is dec circulation to kidneys this cell dies first so you have problems with reabsorption
tubular epithelial cells
45
ATP independent processes - 3
symporters, channels, exchangers (depend on conc. gradient)
46
ATP dependent processes need
transporter proteins
47
the capacity of transporter proteins can be ___ and the function can be ____
capacity can be saturated, fx regulated
48
____, ____, ____ are absorbed in the PCT by transporter proteins (ATP dependent)
ions, glucose, AA
49
H2O is absorbed by ____ and ____
tight junction and water channel (aquaporin)
50
bicarb cant enter as an ion, must be in the form of
CO2 gas
51
bicarb is reabsorbed into the blood in the PCT by
sodium bicarb transporter, symporter
52
peptides are absorbed via
receptor mediated endocytosis (megalin/cubilin complex)
53
loop of henle aka
countercurrent multiplier
54
loop of henle fx is to establish a _____ state in the
hyperosmotic state in the medullary interstitial fluid
55
thin descending segment is
1. H2O ____
2. moderate permeability to ___ and ____
thin descending segment is
1. H2O PERMEABLE
2. moderate permeability to Na and urea
56
thin ascending segment is
1. H2O ____
2. ONLY ____ reabsorbed
thin ascending segment is
1. H2O IMPERMEABLE
2. ONLY Na reabsorbed
57
thick ascending segment is
1. HIGHLY ____ permeable
2. ___ and ____ IMPERMEABLE
thick ascending segment is
1. HIGHLY Na, K, Cl permeable
2. urea and H2O IMPERMEABLE
58
filtrate entering the nephron is _____ to blood plasma and interstitial fluid
isosmotic
59
water moves ____ the filtrate in the DESCENDING limb down its osmotic gradient which concentrates the fluid
OUT OF
60
filtrate reaches its highest conc at the
bend of the bloop (WATER CANT GET OUT)
61
Na and Cl are pumped out of the filtrate which ___ the interstitial osmolality
INC
62
filtrate is MOST DILUTE as it
leaves the nephron loop (100 most it is hypo osmotic to the interstitial fluid)
63
____ and ____ destroy the countercurrent multiplication system so that the kidney CANT reabsorb water
loop inhibitors and loop diuretics
64
the two functions of the DCT
electrolyte homeostasis and hemodynamic regulation
65
in the DCT, __ is reabsorbed (___ acts here)
Ca reabsorbed, PTH acts here
66
cells responsible for hemodynamic regulation
macula densa
67
macula densa release renin when
Na levels are low
68
___ is the action site for hormones
collecting duct
69
which hormones act in the collecting duct
aldosterone and ADH (vasopressin)
70
two types of cells in the collecting duct
intercalated and principal
71
intercalated cells have ____ reabsorption and ___ secretion
bicarb reabsorption and H secretion
72
principal cells/aldosterone regulate ___ absorption and ___ secretion
NaCl absorption and K secretion
73
the collecting duct leads to the
renal pelvis
74
______ is a steroid hormone
aldosterone
75
aldosterone is produced in the
adrenal gland
76
antagonist to aldosterone
sprionolactone
77
aldosterone acts on ____ to...
prinicpal cells to INC reabsorption of Na and secretion of K (leads to H2O retention and INC BP)
78
____ disease is a lack of aldosterone, which INC K and DEC Na
addisons
79
ADH/vasopression is made of
9 AA
80
ADH is produced in the
hypothalamus (stored in the posterior pituitary)
81
ADH is released in response to
INC plasma osmolality
82
if you are dehydrated, ADH is released which acts on the..
collecting duct to produce aquaporin receptors so water is reabsorbed, urine is low in volume and concentrated
83
with DI (diabetes insidious) you lack
ADH
84
with DI you have an abnormally large amount of
urine that is insidious (water not reabsorbing in collecting duct)
85
with Central DI there is damage to the ____ which causes ____
damage to the hypothalamus/pituitary which causes disruption in the production, storage, and release of ADH
86
nephrogenic DI is when the
kidneys DONT RESPOND normally to vasopressin
87
3 types of regulation of RBF (renal blood flow)
1. autoregulation
2. neural regulation
3. hormonal regulation
88
autoregulation maintains a ____ RBF and GFR through a ___ mechanism
CONSTANT RBF and GFR through a myogenic mechanism (smooth muscle)
89
if there is an increase in arteriole pressure the arterioles ___
relax
90
neural regulation produces ___ and ___ GFR and RBF
vasoconstriction and DEC GFR/RBF
91
the afferent and efferent arterioles are innervated by
sympathetic non-adrenergic nerve
92
____ regulation of RBF takes place in an emergency volume depletion
neural
93
the major hormonal regulation of RGF
RAAS
94
the natural antagonizing agents of RAAS
natriuretic peptides
95
RAAS is activate by __ BP and ___ in DCT, releases
DEC BP and NaCl in DCT, releases RENIN
96
renin converts ___ to ____
angotensinogen to AT1
97
____ turns AT1 to AT2
ACE
98
___ is the active molecule which causes VASOCONSTRICTION and INC BP
AT2
99
RAAS causes
1. INC BP
2. vasoconstriction
3. INC NaCl
4. water follows
5. ALDOSTERONE secretion
6. INC perfusion of JGA
100
where are natriuretic peptides synthesized and secreted
heart cells
101
natriuretic peptides INHIBIT ___ and ____ secretion
aldosterone, renin
102
natriuretic peptides ____ afferent and efferent arterioles, dec blood vol, dec CO, dec BP
vasodilate
103
_____ of the kidney are mutations in critical proteins that produce BRUSH border cells in PCT
hereditary disorders
104
example of hereditary disorder of kidney
polycystic kindney disorder (mutation in proteins that form brush border cells)
105
6 acquired diseases of the kidney
1. inflammation (glomerulonephritis)
2. diabetes (diabetic nephropathy)
3. AKI (ischemic)
4. chronic kidney disease (HTN)
5. kidney stones
6. drugs and toxins
106
diabetic nephropathy is a chronic kidney disease characterized by these 4 things
1. INC proteinuria
2. DEC GFR
3. HTN (activates RAAS - A2 constricts efferent arteriole, INC glomerular capillary pressure)
4. INC risk/VC, morbidity/mortality
107
normal BG
70-130
108
diabetic BG
over 200
109
early stage diabetic nephropathy
INC GFR, reversible albuminuria
110
advanced diabetic nephropathy
GBM expansion, proliferation and hypertrophy
111
with diabetic nephropathy there is a thickening of the GBM due to
elevated cell proliferation mediators (PDGF, TGF-B, VEGF)
112
4 pathology signs of diabetic nephropathy
1. expansion of mesangial matrix
2. thickening of GBM
3. arteriosclerosis
4. tubulointerstitial fibrosis (proteins leaked into PCT initiate inflammatory response with leads to formation of fibroblasts)
113
AKI is the sudden decline in kidney fx with a ___ GFR and ___ Cut and BUN
DEC GFR, INC Crt and BUN
114
AKI is associated with oliguria (___) and anuria (____)
oliguria - less than 400 ml/day of urine
| anuria - less that 50 ml/day of urine
115
pre-renal AKI has
inadequate CO
116
intrarenal has ___ and ____
ATN (most common cause of infrarenal AKI) and acute interstitial necrosis
117
post renal is the
obstruction of urinary tract
118
patho of ATN
1. ischemia leads to cell injury
2. loss of brush border in PCT cells
3. loss of polarity and integrity of tight junctions
4. relocation of Na/K/ATPase pumps and interns to the apical membrane
5. cell death (apoptosis and necrosis)
6. cast formation and obstruction of tubular lumen
119
ATN is ____ if caught early
reversible (PCT cells are regenerative)
120
causes of ATN
hypoperfusion, ischemia, nephrotoxic antiRX, xray media, cisplatin
121
renal filtration regulation is composed of ___ and ___
GFR and RBF
122
___ is constant even with BP change
RBF
123
GFR = ___ per min and ___ per day
120 mL/min, 180 L/day
124
RBF = ____ mL/blood/min and ____ mL/plasma/min
1000-1200 mL/blood/min, and 600-700 mL/plasma/min
