1. Urine formation 2. Fluid and electrolyte balance 3. Regulation of acid-base balance 4. Exretion of the waste products of protein metabolism 5. Exrection of drugs and toxins 6. Secretion of hormones

Renal Function Flashcards by John Lesther Alonsagay

Size of kidney

10-12cm

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Location of kidney

Between T12-L3

12th thoracic vertebrae
3rd lumbar vertebra

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Renal medulla is ___ Shaped

heart shaped

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Functional unit of kidneys

nephrons

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filter the substance needed to be filtered

Glomerulus

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___ Made up of tuft of capillaries and covered by the ___

Glomerulus, Bowman’s capsule

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Site of filtration of the substances

Glomerulus

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Kidney functions

Urine formation
Fluid and electrolyte balance
Regulation of acid-base balance
Exretion of the waste products of protein metabolism
Exrection of drugs and toxins
Secretion of hormones

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Hormone reponsible for production of RBC

Erythropoietin

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Discreased vit D means

rickets

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Process of the substances from the glomerulus to the bownman’s space to the urine

Glomerular filtration

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Reabsorbs from the tubules to the capillaries back to the blood

Tubular Absorption

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Molecular cutoff value of about

66,000 Da or 66kDa

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The basement membrane is ___-charged

Negatively

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The renal blood flow is ___mL/min

1,200 - 1,500 mL/min

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Glumerular filtrate is ___ mL/min

130 - 150 mL/min

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CAN pass through the glomerulus:

● Water
● Electrolytes
● Glucose
● Amino acids
● Urea
● Creatinine

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CANNOT pass through the glomerulus:

● Plasma proteins
○ Albumin, hemoglobin
● Cellular elements
○ RBC, WBC, PLT
● Protein-bound molecules (lipids, bilirubin)

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uses energy, transport mechanisms, carriers,
proteins to transport the substance from the
tubules back to the capillaries

Active transport

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uses energy, transport mechanisms, carriers,
proteins to transport the substance from the
tubules back to the capillaries

Active transport

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Freely flowing

Passive transport

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Sodium is reabsorbed but controlled by
aldosterone

Distal convoluted tubule

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ADH controlled H20 reabsorption

Collecting duct

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○ Excess of aldosterone
○ If there will be excess of aldosterone, sodium
will be reabsorbed.

■ Sodium in urine = decreased
■ Sodium in blood = increased

Conn Syndrome

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○ Deficiency of aldosterone ○ Sodium will not be reabsorbed ■ Sodium in urine = increased ■ Sodium in blood = decreased

Addison’s Disease

○ Excess in ADH ○ Water will be reabsorbed from the tubule to the blood ○ Water in the urine will be decreased ○ Urine will be more concentrated ○ Water in the blood will increase

Syndrome of Inappropriate ADH secretion (SIADH)

○ Decrease in ADH ○ Water will be freely flowing and will not be reabsorbed ○ Water in the urine will increase ■ Urine will be more dilute ○ Water in blood will decrease

Diabetes Insipidus

Movement of the substances from the peritubular capillary plasma to the tubular lumen

Tubular Secretion

RENAL FUNCTION TESTS

1. Glomerular Filtration Tests 2. Tubular Reabsorption Tests 3. Tubular Secretion Tests 4. Renal Blood Flow Tests

Standard test used to measure the filtering capacity of the glomeruli

Clearance test

Measures the rate at which the kidneys are able to remove a filterable substance from the blood

Clearance test

Substances that can be filtered by the glomerulus:

○ Urea clearance test ○ Creatinine clearance test ○ Inulin clearance ○ Cystatin C

Often the first function to be affected in renal disease

Tubular Reabsorption Tests

Tests to determine the ability of the tubules to reabsorb the essential salts and water that have been non-selectively filtered by the glomerulus

Tubular Reabsorption Tests

measures the amount of solute-free water excreted in the kidney

Free water clearance

24 hours fluid deprivation

Fishberg Test

Day vs Night concentration function

Mosential Test

Sodium, chloride, & water will be filtered by the glomerulus but the body needs these, so the tubules will reabsorbed those substances

Tubular Reabsorption Tests

➢ non toxic substance ➢ not present on the body so it is being taken orally ➢ loosely bound to plasma protein

PAH (p-aminohippuric) test

measure the amount of acid present in the solution

Titratable acidity

total acidity - titratable acidity (hydrogen ion present) = concentration of ammonia

Urinary Ammonia

NON-PROTEIN NITROGEN COMPOUNDS

● Urea ● Uric acid ● Creatinine ● Ammonia

NPN with the highest concentration in the blood

urea

Major excretory product of protein metabolism ○ When the proteins in the body are metabolized or broken down, it becomes urea

Urea

Obsolete term because we have to measure urea as a whole not just the nitrogen in the urea

BUN → Blood Urea Nitrogen

BUN x 2.14

Urea

Has 2 amino groups and 1 carboxyl group

urea

Urea is formed in the liver from __ and __ (from the deamination of proteins)

CO2, ammonia

elevation of urea in the blood

Azotemia

Elevation of urea with renal failure

Uremia

Causes of azotemia in the blood Before the kidney

Prerenal

Causes of azotemia in the blood Kidney

Renal

Causes of azotemia in the blood After Kidney

Postrenal

CAUSES OF ABNORMAL PLASMA UREA CONCENTRATION Increased concentration Prerenal (Reduced renal blood flow)

Congestive heart failure- Heart no longer pumps blood efficiently kaya nagiging congested with blood. If there is congestion, there is improper functioning sa pag pump ng heart. No proper renal blood flow. Accumulation of urea concentration in the body Shock, hemorrhage hemorrhage- bleeding shock- not enough blood flow; life threatening condition Dehydration- lack of fluid, no waste product is excreted Increased protein catabolism High-protein diet

CAUSES OF ABNORMAL PLASMA UREA CONCENTRATION Renal(decreased renal function)

Acute and chronic renal failure Renal disease, including glomerular nephritis and tubular necrosis - Nephritis- inflammation in your glomerulus. no proper filtration of urea - Necrosis- death in body tissue. Tubules cannot reabsorb properly

CAUSES OF ABNORMAL PLASMA UREA CONCENTRATION Postrenal

Urinary tract obstruction

CAUSES OF ABNORMAL PLASMA UREA CONCENTRATION Decreased concentration

Low protein intake- Low urea concentration Severe vomiting and diarrhea Liver disease Pregnancy- Hormonal changes. Plasma urea concentration will be decreased during pregnancy

Normal BUN / Creatinine ratio is __

10:1 to 20:1

increased BUN / Creat ratio 𝐼𝑛𝑐𝑟𝑒𝑎𝑠𝑒𝑑 𝐵𝑈𝑁 𝑁𝑜𝑟𝑚𝑎𝑙 𝐶𝑟𝑒𝑎𝑡 ○ BUN is more susceptible to non-renal factors

Pre-renal

○ increased ratio BUN / Creat ratio 𝐼𝑛𝑐𝑟𝑒𝑎𝑠𝑒𝑑 𝐵𝑈𝑁 𝐼𝑛𝑐𝑟𝑒𝑎𝑠𝑒𝑑 𝐶𝑟𝑒𝑎𝑡 ○ Both BUN and Creat are elevated ○ We are looking at excretion

Post-renal

○ Decreased BUN / Creat ratio 𝐷𝑒𝑐𝑟𝑒𝑎𝑠𝑒𝑑 𝐵𝑈𝑁 𝑁𝑜𝑟𝑚𝑎𝑙 𝐶𝑟𝑒𝑎𝑡 ○ Low dietary protein or severe liver disease ○ Disclaimer: Could either be increased or decreased ■ Depends on what specific renal disease

Renal

Formed from creatine and creatine phosphate in the muscle

Creatinine

Released to the plasma in proportion to muscle mass ○ The greater the muscle mass, the higher the creatinine and serum in urine ○ Iba ang reference range ng males and females ○ Could also be affected by age and race

Creatinine

Directly proportional to kidney function

Creatinine

Creatine is synthesized by

Arginine, glycine, methionine

These 3 will undergo transamination forming

guanidinoacetic acid

The enzyme that will catalyze this reaction will be your __

L-Arginine:glycine amidinotransferase (AGAT)

Guanidinoacetic acid will undergo methylation with the substance ___ forming creatine

S-adenosylmethionine

Creatine with the help of the enzyme creatine kinase will form __ aka creatine phosphate.

phosphocreatine

Creatinine is a byproduct of both

creatine and phosphocreatine

Creatine clearance forumla

(UV/P)(1.73/A)

Average body surface sa isa ka tao

1.73

V/1440 x U/P x 1.73/A

Product of the catabolism of purine nucleic acids

uric acide

Guanine and Adenosine

Purine

Guanine and Adenosine

Relatively insoluble in plasma and, in high concentrations, can be deposited in the joints and tissue causing pain and inflammation

Gouty Arthritis

98-100% of filtered uric acid is reabsorbed in the

Proximal Convoluted

Most uric acid in the plasma is in the form of __

Monosodium urate

At concentrations , the plasma is saturated forming urate crystals

>6.8 mg/dL