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AU17: Physiology > Renal II > Flashcards

Renal II Flashcards

(103 cards)

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1
Q

What is the normal pH range of body fluids?

A

7.35-7.45

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2
Q

What pH values are not life sustainable?

A

< 6.8

> 7.8

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3
Q

T/F: Fluids are at greater risk for becoming too basic than too acidic.

A

False

Body takes in and produces more acid

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4
Q

How is the majority of volatile acid excreted?

A

Exhalation

Ex. CO2

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5
Q

How are nonvolatile acids excreted?

A

Urine

Must be neutralized with HCO3

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6
Q

T/F: Volatile acids are regulated in the renal system.

A

False

Nonvolatile

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7
Q

How does the kidney neutralize the acids produced by the body?

A

Reabsorbes all of the filtered bicarbonate and produces new bicarbonate

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8
Q

______ allow us to keep urine pH at 4.4, yet still excrete the necessary amount of acids.

A

Buffers

Bind to excess H+

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9
Q

What molecules does the renal system use as buffers?

A
  1. Bicarbonate
  2. Phosphate
  3. Ammonium
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10
Q

Which buffer is used first?

A

Phosphate

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11
Q

Of the three forms of excreted acids, which are titratable?

A

H+ and HPO4

NH4 is NOT titratable

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12
Q

T/F: Net acid excretion should remove all volatile acid from the body.

A

False

Nonvolatile

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13
Q

The kidney regulates acidity of the urine by regulating ______ reabsorption.

A

bicarbonate

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14
Q

How can the renal system decrease the body pH?

A

Not reabsorbing all HCO3

Produces basic urine and acidic body fluids

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15
Q

What will be the result of the renal system resorbing all HCO3?

A

No effect on body pH and the urine will have a neutral pH

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16
Q

How can the renal system increase the bodies pH?

Typical state of the body

A

Reabsorb all HCO3 and produce more

Produces acidic urine and makes body fluids basic

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17
Q

Why does the urine become more acidic when HCO3 is resorbed?

A

Reaction results in H+ being secreted

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18
Q

T/F: 80% of HCO3 is resorbed in the proximal tubule.

A

True

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19
Q

What produces H+ and HCO3?

A

Carbonic anhydrase in tubular epithelium

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20
Q

Which cells in the collecting duct produce H+ and HCO3?

A

Intercalated cells

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21
Q

Differentiate between mechanisms of H+ secretion in the proximal tubule and the collecting duct.

A

Tubules have an Na+/H+ anti porter and ducts do not

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22
Q

How is HCO3 reabsorbed?

A

Transported across basolateral membrane

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23
Q

T/F: There are intercalated cells that reverse the process to reabsorb H+ and secrete HCO3.

A

True

Activity very low

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24
Q

T/F: Cells in the proximal tubule can alter CA activity based on intracellular pH.

A

True

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25
If the body is acidic ______ will be used as an additional buffer to increase H+ excretion.
phosphate
26
After HCO3 has been reabsorbed and phosphate has been depleted, the kidney will produce _______ to increase H+ excretion.
Ammonium
27
Why can't ammonium enter the body?
Will convert to urea and produce H+
28
Where is ammonium produced?
Proximal tubules via glutamine metabolism
29
What are the two products of glutamine metabolism?
Ammonium: goes into tubular fluid Bicarbonate: goes into blood
30
What process allows for more ammonium to be added to the urine?
Diffusion trapping between loop and collecting duct
31
Respiratory acidosis is related to ___ build up.
CO2
32
What are the renal responses to respiratory acidosis and alkalosis?
Acidosis: produce HCO3 Alkalosis: excrete HCO3
33
What is metabolic acidosis?
Low pH due to low HCO3
34
Is there a respiratory response to metabolic acidosis/alkalosis?
Acidosis: hyperventilate Alkalosis: hypoventilate
35
How much of ECF calcium can be filtered at the glomerulus?
A little over half
36
Where is the majority of calcium?
Bone
37
_______ can lead to increased excitability of neural and muscle tissue (tetany).
Hypocalcemia
38
________ can lead to cardiac arrhythmia and disorientation (possibly death).
Hypercalcemia
39
T/F: A decrease in plasma pH will increase the amount of free calcium.
True Alkalosis can lead to hypocalcemia
40
Where are calcium sensing receptors found?
1. Parathyroid gland 2. Thyroid parafollicular cells 3. Proximal tubule
41
What are the three hormones that help regulate calcium?
1. Parathyroid hormone 2. Calcitriol (1,25 dihydroxyvitamin D) 3. Calcitonin
42
PTH is released during ________ and stimulates ________ production.
hypocalcemia; calcitriol
43
Which hormone is released in response to hypercalcemia?
Calcitonin Increases bone deposition
44
How is calcium reabsorbed in the proximal tubule?
paracellular transport (solvent drag)
45
How is calcium reabsorbed in the thick ascending limb?
Transcellular and paracellular (not solvent drag)
46
Transcellular reabsorption of Ca in the distal tubule is regulated by ____.
PTH
47
What is diuresis?
Excess urine output
48
T/F: Diuretics decrease urine output due to actions on the kidney.
False Increase
49
T/F: Diuretics inhibit water reabsorption.
True
50
What are two reasons for taking diuretics?
1. Congestive heart failure | 2. Hypertension
51
What parts of the nephron do osmotic diuretics work on?
Water permeable segments - PT and descending loop of Henle
52
Where is the major site of action for CA inhibitors?
Proximal tubule Reduce H20 reabsorption by reducing Na+ reabsorption
53
Where do loop diuretics act in the nephron?
TAL - inhibit Na+K+2Cl- symporter
54
Where do thiazides act in the nephron?
Early distal tubule - block Na+Cl- symporter
55
What are the two classes of K+ sparing diuretics and where do they act?
1. Aldosterone antagonists 2. ENAC blockers Late distal tubule/collecting duct
56
How do K+ sparing diuretics work?
Inhibit Na+ reabsorption and K+ secretion Spare K+
57
_______ work by acting as an ADH antagonist.
Aquaretics
58
T/F: Osmotic diuretics increase osmotic pressure in tubular fluid.
True
59
What are two examples of osmotic diuretics?
Mannitol and glucose
60
What is a secondary effect of osmotic diuretics?
As H2O reabsorption decreases so does Ca reabsorption via less solvent drag
61
How do osmotic diuretics gain access to the tubules?
Glomerular filtration
62
T/F: CA inhibitors will reduce amount of H+ available inside the epithelial cell.
True CA produces H+ to be used with H+/Na+ symporter. If Na+ can not get in the epithelial cell than it can not be pushed out into the blood
63
What is a common CA inhibitor?
Acetazolamide
64
T/F: CA inhibitors gain access to the tubule via glomerular filtration.
False Secretion
65
T/F: CA inhibitors have the strongest diuretic effect.
False Relatively weak
66
T/F: Loop diuretics have the strongest diuretic effect.
True
67
What is an example of a loop diuretic?
Furosemide
68
Loop diuretics gain access to the tubules via _______.
secretion
69
T/F: When loop diuretics are used, the urine that is excreted is much more dilute than the urine entering the collecting duct.
True
70
What is an example of a thiazide diuretic?
Chlorothiazide
71
Thiazides enter the tubules via ______.
secretion
72
T/F: Thiazides block water reabsorption in the collecting duct.
False Works in early distal tubule
73
Aldosterone antagonists (spironolactone) block aldosterone receptors in the ________ cells.
principal
74
T/F: Cortical nephrons are more superficial than juxtamedullary nephrons.
True
75
T/F: ENaC blockers (amiloride) must be in the principal cell to act.
False Can act on apical membrane from in the tubular fluid
76
Tolvaptan is an example of an _________.
Aquaretic
77
T/F: Aquaretics eliminate water without the loss of solutes.
True
78
What is the diuretic braking phenomenon?
Continued use of diuretics makes them less effective via compensatory mechanisms
79
How is the sympathetic nervous system involved in diuretic braking?
Reduced BP from diuretics -> increased symp activity -> decrease GFR -> increase proximal tubule reabsorption and increased renin
80
How does the increase in renin during diuretic braking counteract the diuretic?
Increased renin -> increased angiotensin II -> increased aldosterone -> decreased Na excretion
81
T/F: ADH release is stimulated during diuretic braking and inhibits the excretion of water.
True
82
K+ excretion is a secondary effect of all but what type of diuretics?
K+ sparing diuretics
83
________ lead to metabolic acidosis.
CA inhibitors and K+ sparing diuretics
84
__________ lead to metabolic alkalosis.
Loop and thiazide diuretics
85
All diuretics except for ________ alter calcium excretion.
K+ sparing diuretics
86
Osmotic and CA inhibitors act in the _________ and ________ reabsorption of calcium in that area.
proximal tubule; reduce
87
Loop diuretics increase calcium excretion by altering _________ transport of Ca.
paracellular
88
_________ stimulate reabsorption of calcium in the distal tubule.
Thiazide diuretics
89
T/F: In a dialyzer, the blood and fluid move in countercurrent directions.
True
90
Which molecules diffuse from the blood to the dialysis fluid?
Urea, potassium, and phosphate
91
Which molecule diffuses into the blood from the dialysis fluid?
Bicarbonate
92
T/F: NaCl concentrations in dialysis fluid are similar to that in blood.
True
93
What is the preferred way to access blood for long-term dialysis?
AV fistula
94
What are some risks of accessing blood through a catheter for dialysis?
scarring, vessel narrowing and occlusion
95
A _______ uses an artificial vessel to join an artery and vein.
AV graft
96
When would you use an AV graft?
Vascular problems prevent use of a fistula
97
What are some long-term consequences of dialysis?
Sepsis, endocarditis, and osteomyelitis Amyloid deposits in joints
98
Patients with chronic renal failure are almost always diagnosed with _______.
anemia Kidneys stop producing erythropoietin (EPO)
99
Where in the kidney is EPO produced?
Interstitial fibroblasts in renal cortex
100
EPO production is stimulated when _____ is low.
P(O2)
101
Which transcription factors regulate EPO synthesis?
HIF-1 and HIF-2
102
Patients with anemia are often treated with __________ to stimulate erythropoiesis.
Procrit
103
What are the side effects of Procrit?
Flu-like symptoms, headaches, high BP and CV problems

AU17: Physiology (12 decks)

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