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Renal I Flashcards

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1
Q

What are the general considerations of the kidneys?

A
  • -Regulate volume and composition of body fluids
  • -Excretion (secretion) of end products of metabolism
  • -Retention (reabsorption) of nutrients
  • -Secrete hormones
  • -Metabolize hormones
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2
Q

Excretion is also known as what?** In terms of end products of metabolism?

A

Excretion (secretion) of end products of metabolism (urea)**** Uric acid, creatinine, and end products of hemoglobin break down

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3
Q

What hormones dose the kidney secrete??**

A

Secrete hormones Renin, erythropoetin activated form of Vitamin D**

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4
Q

The kidneys metabolize hormones such as?

A

Metabolize hormones

insulin

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5
Q

The kidneys regulate volume and composition of body fluids, such as?

A

Regulate volume and composition of body fluids (electrolytes, minerals, and ions)

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6
Q

What are the three essential functions of the kidneys?**

A
  1. Glomerarly filtration
  2. Tublar reabsorption
  3. Excretion
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7
Q

In terms of the essential function of the kidney, what is glomerarly filtration?**

A

1.Glomerarly filtration – forcing of fluids through a membrane under pressure
GFR 125ml/min
20% of CO are sent to the kidneys
Kidneys will bleed if you cut it, that will be the difference between a total nephrectomy vs. partial

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8
Q

In terms of essential function of the kidney, what is Tubular reabsorption?**

A

2.Tubular reabsorption – retention – movement of filtrate back into the blood form the renal tubule (these are the nutrients, such as amino acid and glucose)

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9
Q

In terms of essential function of the kidney, what is Excretion or secretion?**

A

3.Excretion – secretion - Movement of substances from the blood to the filtrate such as urea, uric acid, and creatinine

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10
Q

In terms of anatomy, where is the right kidney in relation to the left kidney?

A

Right kidney slightly lower than left kidney (due to the liver)

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11
Q

What is the sympathetic innervation of the kidneys?

A

Sympathetic innervation: renal plexus nerves are vasomotor, they regulate circulation of blood in the kidneys

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12
Q

What are the three layers of the kidneys?

A

Three layers to the kidneys

  1. Fiberous membrane that covers the kidneys itself
  2. Adipose capsule
  3. Renal facisa – anchors the kidneys to the abdominal wall and surrounding structures
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13
Q

What is the inner and outer portion of the kidneys called?*****

A

Each kidney consists of cortical portion (outer) and medullary portion (inner)*****

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14
Q

What contains the short loops of henle?**

A

Cortical nephrons contain “short loops of henle”*****(in the cortex)

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15
Q

What contains the longer loops of henle???***

A

Juxtamedullary nephrons contain “longer loops of henle”**** located in the medulla

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16
Q

What is the ratio for cortical nephron to juxtamedullary nephrons

A

7 to 1… cortical nephron to juxtamedullary nephrons

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17
Q

About how many nephrons does each kidney contain?

A

Each kidney contains 1-1.2 million functional units called nephrons

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18
Q

What are the components of the nephron?

A

Components include glomerulus and renal tubule 6 segments

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19
Q

what part of the nephron is the ultrafiltrate formed?

A

Ultrafiltrate is formed at proximal end

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20
Q

What is the final product of the nephron eliminated as?

A

Final product eliminated as urine

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21
Q

Filtered fluid is converted to urine in what part of the nephron?**

A

Tubule system is where Filtered fluid will convert to urine**

GFR 125ml/min

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22
Q

Glomerulus composed of tufts of capillaries that jut into Bowman’s capsule, what is reason for tufts of capillaries?**

A

Glomerulus composed of tufts of capillaries (increases surface area) that jut into Bowman’s capsule**

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23
Q

What is the major function of the proximal tubule?

A

Major function: reabsorption (retention) of sodium**

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24
Q

How is the Flomerulus feed? in terms of blood supply?***

A

Glomerulus is feed by one Afferent Arterial and drained by one efferent arterial**

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25
How much of plasmids are filtered as they pass through Glomerulus??***
20% of plasmids are filtered as they pass through Glomerulus***
26
What is Glomerular filtration pressure?
Glomerular filtration pressure is about 60% of MAP***
27
What is responsible for maintaining a hypertonic medullary interstium??****
Loop of Henle - responsible for maintaining a hypertonic medullary interstium****
28
What happens if you vasodilate the afferent arterial?
If Vasodilate afferent arterial, we will decrease arterial tone and decrease arterial resistance, will increase renal blood flow and increase GFR
29
What happens if you vasoconstrict afferent arterial?
If we vasoconstrict afferent arterial, increase arterial tone and arterial resistance, this will decrease renal blood flow and decrease GFR
30
Distal tubule receives what type of solution?
Distal tubule: (receives hypotonic solution from the loop of henle)
31
What is the collecting tubule known for????*****
Collecting tubule: - Divided into cortical and medullary portions - Known for it’s concentrating ability******* - This would be in the presence of ADH
32
If we increase ADH, what happens to urine output?
If we increase ADH, decrease urine output (this is the concentrating ability)
33
If we decrease ADH, what happens to urine output?
If we decrease ADH, increase urine output (this is the concentrating ability)
34
what Contains the macula densa located near the glomerulus?
JUXTAGLOMERULAR APPARATUS Contains the macula densa located near the glomerulus
35
What does the Juxtaglomerular cells contain? and are they innervated with?*****
Juxtaglomerular cells contain renin and are innervated by the sympathetic nervous system*******located near the afferent arterial, which is next to the glomerulus
36
What is the major function of the JUXTAGLOMERULAR | APPARATUS?****
Major function: secretion of renin*****
37
The macula densa is Sensitive to NaCl concentration, It will sense sodium chloride. If there is a decrease in NaCl, What two two things happens?
1. decrease resistance to blood flow via the afferent arterial, leads to increase blow flow via vasodilation 2. increase renin release from juxtaflomerular cells
38
what happens in the macular desa senses an increase in NaCl?
If it sense an increase in NaCl -> increase resistance that will decrease blood flow, this will vaso constrict, and decrease renin release
39
What two things will cause the release of Renin?
Beta adranergic sympathetic stimulation can also release Renin Changes in afferent arterial wall pressure can release renin release as well,
40
Explain the RAAS?
Renin is release into the blood stream (released by the juxtaglomerular cells), act on angiotensinogen (a protein that is synthesized by the liver) to form angiotensin I, angiotensin I is converted into angiotensin II (in the lungs) by the ACE (plays a major role in BP regulation)
41
What brings blood to the bowmans capsule?
Afferent brings blood to the bowmans capsule
42
Renal function is intimately related to what?*
Renal function is intimately related to renal blood flow (normal urine formation denotes normal renal blood flow)
43
Oxygen consumption is determined by what?*
Oxygen consumption is determined by renal blood flow
44
Combined blood flow through both kidneys accounts for 20-25% of total cardiac output, what is Renal blood flow is going to be per min?*
Combined blood flow through both kidneys accounts for 20-25% of total cardiac output (Renal blood flow is going to be 1200ml per min.* each kidney is supplied by a single renal artery that will arise form abd aorta)
45
What is normal urine output?
0.5cc/kg/ml is normal urine output
46
Renal artery will turn into 6 segmental arteries divide, how are they divided?
5 anterior segmental arteries | 1 posterior segmental artery
47
What is renal blood flow?***
Renal blood flow: ~1200mL/minute 20-25%***
48
What is Glomerular filtration rate?***
Glomerular filtration rate: ~125mL/minute 180L/day***
49
The control mechanisms, in terms of renal blood flow, what is intrinsic regulation?
Control mechanisms: - -Intrinsic regulation - autoregulation of renal blood flow – occurs between MAP 80-180 (outside these limits it will be pressure dependent, the blood flow) - -Renal blood flow will be generally decrease if MAP less than 70, - --Glomerular filtration will cease or stop during 40-50torr
50
The control mechanisms, in terms of renal blood flow, what is Tubuloglomerulo balance?
Tubuloglomerulo balance (self limiting and feedback system), If it sense a increase in tubular flow, it will decrease GFR. If you have a decrease in tublar flow, it will send a message out to let more in.
51
If it sense a increase in tubular flow, what happens to GFR?
If it sense a increase in tubular flow, it will decrease GFR
52
If you have a decrease in tubular flow, what happens to GFR?
If you have a decrease in tubular flow, it will send a message out to let more in
53
With Renal blood flow, what is Hormonal regulation?***
Hormonal regulation Angiotensin II, epi and Noriepi, all will effect AFFERENT arterial tone, renal filtration rate will generally stay the same***
54
Dopamine will dilate afferent as well as efferent arterials, what will happen to the GFR???***
Dopamine will dilate afferent as well as efferent arterials, this will increase GFR***
55
With the renal blood flow, what is neuronal regulation?
Neuronal regulation – sympathetic innervations is responsible stressed induction in renal blood flow, this will decrease urinary output. Stress response to a decrease urinary output.
56
What are the overview effects of anesthesia on renal function?
- -Reversible decrease in renal blood flow and GFR - -Typically will be less if you provide regional anesthesia as long as hypotension is avoided. - -Maintain hydration and pressure (give them a drink)
57
What are the indirect effects, in terms of the cardiovascular effects?
Cardiovascular effects - Keep MAP between 80-180 (outside these ranges will be pressure dependent)
58
What are the indirect effects, in terms of the neural effects?
Neuronal effects – reduction in renal blood flow, caused by sympathetic system, this can be the stress response
59
What are the indirect effects, in terms of the endocrine effects?
Endocrine effects – reduced blood flow, reduced urinary blood flow, increase in catecholamine due to the stress response
60
What are the direct effects of volatile agents on renal function?
Direct effects Volatile agents – watch out for fluride (sevo), be aware of compound A (keep flow greater than 2L), watch out for the cardiac depressive effects of the gases
61
What are the IV agent effects on renal function?
IV agents – minimal effects renal function if used alone
62
What is the overview of diuretics on the renal system?
Overview: - Increase urinary output by decreasing reabsorption of sodium and water - Classified according to their mechanism of action
63
What are the different classes of diuretics?
---Osmotic diuretics Mannitol Loop diuretics lasix ---Thiazide-type diuretics SE hypokalemia ---Potassium-sparing diuretics (watch out for those on beta blockers) aldactone ---Carbonic anhydrase inhibitors diamox (for head cases)

Bioscience (9 decks)

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