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Flashcards in Renal I Deck (98):
1

8 major functions of the kidneys

1. excretion of metabolic waste and foreign substances
2. regulation of water and electrolytes
3. regulation of extracellular fluid volume
4. regulation of plasma osmolality
5. regulation of RBC production
6. regulation of vascular resistance
7. regulation of acid-base balance
8. regulation of vitamin d production

2

path through kidneys

bownman's capsule/renal corpuscle - proximal convoluted tubule- HENLE (straight proximal tubule- descending thin limb- ascending thin limb- ascending thick limb)- macula densa- distal convoluted tubule- cortical collecting duct- medullary collecting duct- papillary duct

3

parts of the JG apparatus

macula densa + extraglomerular mesangial cells (EGM)+ JG cells that produce renin/angiotensin II of afferent arterioles

4

3 layers of the filtration barrier for capillaries in the glomerulus

1. endothelium of capillaries
2. capillary basement membrane
3. interdigitated podocytes

5

structure-function: glomerulus

(passive) ultrafiltration of low molecular weight substances & H20 from capillaries to bowman's space

6

segments of proximal tubule

proximal convoluted tubule, proximal straight tubule

7

segments of henle's loop

descending thin limb
ascending thin limb
ascending thick limb
(includes macula densa)

8

segments of collecting duct

connecting tubule
cortical collecting duct
outer medullary collecting duct
inner medullary collecting duct

9

structure-function: proximal tubule

- high volume, low gradient re-absorption
- has brush border to increase surface area
- has lots of mitochondria to pump Na

10

3 basic processes of urine formation

1) ultrafilration- into bowman's capsule
2) reabsorption of water from ultrafiltrate into tissue
3) secretion of solutes IN to tubular fluid to be excreted

11

structure-function: loop of henle

- makes high interstitial osmolarity
- poorly developed apical & basolateral surfaces

12

structure-function: distal tubule

low-volume, high gradient re-absoption
- lots of mitochondria & extensive infoldings (well developed apical & basolateral surfaces)

13

structure-function: macula densa

contains the JGA, senses tubular flow

14

structure-function: collecting duct

- concentration/dilution of final urine
- has principal and intercalated cells

15

principal cells

moderately invaginated basolateral membrane, few mitochondria- reabsorb NaCl and secrete K+
- acted on by aldosterone

16

intercalated cells

- NO CILIUM
- regulate acid-base
- have high density of mitochondria
- some secrete H+ (reabsorb HCO3-) and some secrete HCO3-

17

what are the two renal blood flow routes after the efferent arteriole?

1) peritubular capillaries- reabsorption of water & solutes from CORTEX= 90%
2) vasa recta capillaries- reabsorption of water and solutes in the medulla= 10% (8% outer)

18

what is clearance and what are its units?

the volume of plasma completely cleared of any substance in 1 min; mL/min

19

what is the mass-balance relationship for the kidney?

Pa*RPFa= (Pv*RPFv)+(U*V)

20

two equations for excretion

Excretion= Filtration+ Secretion- Reabsorption
Or
Excretion= urine concentration* urine flow rate

21

what is the formula for clearance?

Cx= Ux * V/Px

or remember UV=PC

22

C < GFR
C= GFR
C > GFR

C < GFR- filtered & reabsorbed
C= GFR- filtered
C > GFR- filtered & secreted

23

what is inulin used to measure? what are some advantages/disadvantages?

-with inulin, GFR= clearance - tells you how well the kidneys are filtering
- good b/c R=0, S=0; no hidden reserve, isn't eaten or made, is measurable

24

what is creatinine used to measure? what are some advantages/disadvantages?

- also used to measure GFR (GFR=clearance), but is a little off because there is some secretion
- overestimates GFR
- easy to measure in plasma, see constant relationship between GFR and plasma creatinine
- remember creatinine increases in a muscular person

25

What is BUN used for?

- BUN= plasma creatinine x 10, so also used to measure GFR BUT is less stable

26

what is PAH used to measure? what are some advantages/disadvantages?

- the clearance rate is larger than the GFR normally (lots of secretion), but in people with low plasma, its almost all excreted
- is used to measure renal plasma flow

27

what is eRPF?

effective renal plasma flow measured with PAH; assuming venous plasma concentration is 0 (which is isn't, is actually about 10%, so RPF= 1.1xeRPF

28

how do you calculate RBF from RPF?

RBF= RPF/1-hct

29

what is the filtration fraction?

FF= GFR/RPF= Cinulin/CPAH
normally, 20%

30

volume relationship between renal liquid volumes

RBF > RPF> GFR> V

31

characteristics of glomerular capillaries

- large filtration coefficient
- low resistance
- negatively charged
- form ultrafiltrate
- exclude plasma proteins

32

what is the equation for GFR?

GFR= Kf * (Pgc-Pbs-^gc+^bs)

33

what is Kf? greater in glomerular or systemic capillaries?

an intrinsic property of the glomerular capillary; Kf= permeability of gc * area of gc
- greater in glomerular caps

34

how is GFR normally regulated?

- changes in hydrostatic glomerular capillary pressure by changing afferent/efferent arteriolar resistant or pressure (amt of blood flow)

35

what is the equation for renal blood flow? what is the normal value?

RBF= (Prenal artery-Prenal vein)/ Rrenal vasculature
~ 4 mL blood/min *gm tissue
~ 1200 mL blood/min

36

ranking of blood flow in different areas of the kidney

renal cortex (90%)
outer medulla (8%)
inner medulla (2%)

37

where is the greatest decrease in hydrostatic pressure? where does oncotic pressure increase and decrease?

- across arterioles (efferent & afferent) b/c of high R
- increases in glomerular capillaries & decreases in peritubular capillaries

38

what happens to GFR, Pgc, and RBF when you constrict the efferent arteriole?

GFR and PGC increase
but constriction ALWAYS decreases renal blood flow

39

ways intrinsic autoregulation occurs to regulate GFR and RBF

1) smooth muscle myogenic theory
2) tubuloglomerular feedback theory
3) intrinsic vasodilators and vasoconstrictors

40

steps of tubuloglomerular feedback theory

1) increased GFR
2) increased NaCl content in Henle's loop (not re-absorbed)
3) increased NaCl sensed by macula densa
4) signal generated to increase the resistance in the afferent arteriole
5) GFR is decreased

41

what is the difference between renal shutdown and renal death?

- renal shutdown- GFR=0, RBF= +, Urine production- none; happens when bp<70

- renal death- RBF=0, happens when bp=0

42

ways extrinsic regulation occurs to regulate GFR and RBF

1) sympathetics
2) blood borne & metabolic substances
3) stress factors (hypoxia, hemorrage, RAAS)

43

major vasoconstrictors & vasodilators

vasoconstrictors- sympathetics, angiotensin II, endothelin

vasodilators- prostaglandins (no change on GFR), NO, bradykinin, natriuretic peptides (no effect on RBF)

44

2 routes for the reabsorption of solute & water

1- paracellular- 1 step- around cells
2- transcellular- 2 steps- through cells

45

3 types of membrane transport mechanisms

- passive (simple, facilitated, osmosis)
- 1* active- move up concentration gradient from hydrolysis of ATP
- 2* active- required indirect energy source such as an ion gradient

46

what is the take away from Fick's principle in the kidney?

if blood flow is restricted to the kidney, the kidney requires less oxygen

47

what are Tm and RPT? which is reached first and why?

Tm- transport maximum
RPT- renal plasma threshold (mg/ml)
- RPT reached first because of splay

48

what is actively occurring in glucose transport? how to calculated Tm for glucose?

- normally filtered and ACTIVELY reabsorbed, if not get excretion
- Tm= Pa*GFR-U*V

49

what is actively occurring in PAH transport? how to calculated Tm for PAH?

- normally excreted and ACTIVELY secreted, if not get filtration
Tm= U*V-Pa*GFR
- filtered is always linear

50

what is diuresis and what are two examples of things that cause it?

- urine flow rate > 1 mL/min
- mannitol (filtered but not reabsorbed), glucose (when its not reabsorbed)

51

what percent of water/Na/Cl/K is reabsorbed in the proximal tubule?
what percent of glucose/aa's is reabsorbed in the proximal tubule?

67% & 100%

52

how is Na+ transported in the proximal tubule? what is the gradient driven by?

- Na-H+ antiporter (H+ from H20+CO2 9n cells)
- Na-organic substance symporter
- later, have Na-2Cl-H+-anion paracellular antiporter

53

what are the major regulatory hormones for the proximal tubule?

angiotensin II, NE, E, Dop

54

how is Na+ transported in the loop of henle? what is the percent reabsorbed? which segment is impermeable?

- Na/K/2Cl symporter
- 25%
- thin descending loop

55

how is Na+ transported in the distal tubule? what is the percent reabsorbed?

- NaCl symporter early
- Na+ channels late
~5 %

56

how is Na+ transported in the collecting duct? what is the percent reabsorbed?

- Na channels
- ~3%

57

major regulatory hormones for the loop of henle and distal tubule?

Aldosterone, angiotensin II

58

major regulatory hormones for collecting duct?

aldosterne, ANP, BNP, urodilatin, uroguanylin, guanylin, angiotensin II

59

where is no water reabsorbed?

- thin ascending & thick ascending limbs of Henle
- distal tubule

60

which drugs increase NaCl and H20 reabsorption?

angiotensin II, aldosterone, sympathetic nerves

61

which drugs decreased NaCl and H20 reabsoption

ANP, BNP, urodilatin, uroguanylin, guanylin, dopamine

62

which drugs affect H20 reabsorption independent of NaCl?

ADH

63

what is the break down of where fluid resides?

ICF= 25 L
ECF= 14 L (ISF= 10.5, P= 3.5)

64

what makes up most of the composition of solutes? what is the relative concentration of proteins?

- electrolytes (Na, K, Ca, Mg, Cl, HCO3)
- ICFp>Pp>ISFp

65

what is a positive water balance?

intake > loss ; make hypoosmotic urine

66

how do you measure the body's osmolarity?

- by looking at the plasma osmolarity, specifically the concentration of Na (~290 mOSM/L)

67

what is another name for ADH? What makes up the preprohormone?

- vasopressin
- signal peptide, ADH, neurophysin, copeptin

68

relationship between ADH and urine excretion?

- increased ADH decreases urine excretion

69

where is ADH made and stored?

- made in endocrine cells of hypothalamus
- stores in posterior pituitary

70

where are the two places with sensors that stimulate ADH release? what are they're actions? which is more sensitive?

- baroreceptors in carotid split & aortic arch (inhibits ADH release)
- osmoreceptors in hypothalamus ** more sensitive (stimulate ADH release)

71

pathway baroreceptors use to affect ADH

CN 9 & 10 - medulla - PVN/SO hypothalamus - posterior pituitary- exocytosis in blood

72

what allows ADH system to respond rapidly?

ADH is rapidly degraded in the blood

73

what is the threshold for change in plasma osmolarity to secrete ADH? threshold for baroreceptors?

- greater than 280 mosms
OR
- decreased in bp by 10%

74

how does a decreased bp affect sensitivity to osmolarity?

- becomes more sensitive to osmolarity, slope is increased

75

where does ADH target?

extracellular receptors in distal tubules & the collecting duct

76

what is the ADH pathway for increased H20 retention?

- receptors - increase Gs- increase cAMP- increase PKA- insertion of aquaporin II into the membrane - increase in H20 permeability

77

where is urea permeable?

lower collecting duct

78

what are the 6 challenges to homeostasis?

hyper/hypo/iso osmotic
expansion & contraction

79

drink sea water

hyperosmotic expansion

80

blood transfusion

isosmotic expansion

81

saline transfusion

hyposmotic expansion

82

water deprivation, excessive sweating

hyperosmotic contraction

83

bleeding

isomotic contraction

84

concentrated urine

hyposmotic contraction

85

what is the equation for the anion gap?

[Na]- ([Cl]+[HCO3-])= ~15 meq/L

86

if the anion gap is not greater than 15 meq, but there is a pH problem, where should you look?

renal or GI system

87

what is the anion gap for vomiting? for diabetes?

vomiting= GI= 15
diabetes= pancreas= 35

88

which diuretics are K+ wasting? which is the strongest?

- mannitol, diamox, lasix, hydrochlorothiazide
(MDLH spare K)
- lasix is the strongest

89

which diuretics are K+ sparing? where do they typically act?

spironolactone, amiloride, triamterene
- act on distal tubule & collecting duct

90

what does mannitol do?

holds H20 in proximal tubule (where majority of H20 is reabsorbed)

91

what does acetazolamide do?

inhibits carbonic anhydrase in the proximal tubule; no formation of CO2 & H20 which diffuse back into cell and provide H+ for antiport with Na; see more bicarb in both proximal & distal tubule b/c can't combine with protons

92

what does lasix do?

inhibits Na/Ca/Mg reapsorption in thick ascending limb

93

what does hydrochlorothiazide do?

inhibits Na/Cl transport in distal tubule by competing with Cl site on transporters

94

what does spironolactone do?

compete with aldosterone in distal tubule & collecting duct

95

what does amiloride do?

blocks Na channels on luminal side of the collecting duct

96

what does triamterne do?

blocks epithelial Na channels in collecting duct

97

what is hyperkalemia defined as in the clinical setting?

when potassium intake exceeds output ; when you have an ECF composition of 5mEq/L (4mEq/L is normal)

98

what is hypokalemia defined as in the clinical setting?

<3.5 mEq/L (4mEq/L is normal)