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BMS 752 (Medical Physiology) > Renal Phys > Flashcards

Renal Phys Flashcards

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1
Q

what is the correct order of blood flow through vessels inside the kidney

A

afferent arterioles

glomerulus

efferent arterioles

pertubular capiliarries

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2
Q

patient presents with chronic kidney disease. What lab value would indicate the greatest absolute decrease in GFR?

A

a rise in plasma creatinine levels from 1mg/dl to 2mg/dl

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3
Q

which of the following is NOT a component of the filtration barriers in the glomerulus

  1. podocytes
  2. basement membrane
  3. capillary endothelium
  4. all of the above are part of the filtration barrier of the glomerulus
A

4, they are all barriers

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4
Q

if a drug causes vasoconstriction of the efferent arteriole _with no effec_t on the afferent arteriole, what is the expected trend in GFR and RBF compared to normal

A

GFR will increase and RBF will decrease

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5
Q

what is a condition that will allow GFR and RBF to not be related in parallel

A

renal response to atrial natruetic peptide

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6
Q

which of the following is NOT true in regards to atrial and brain natruretic peptide

  1. produced in the ventricles
  2. increases cardiac output
  3. serum BNP is a valuable index of cardiac stretch
  4. promotes sodium extretion
A

2, increases cardiac output

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7
Q

what is is the effect of renal artery stenosis due to atherosclerosis on renal function and blood pressure

  1. An increase in blood pressure due to stimulation of the rennin-angiotensin-aldosterone system which in turn will initially cause a transient increase in GFR
  2. reabsorption of sodium and water resulting in an increase in preload that can increase BP
  3. After the initial period, a further increased constriction of the afferent andefferent arterioles ensues which results in the retention of fluid and an increase blood pressure
  4. all of the above results from renal artery stenosis
A

4, all of the above

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8
Q

which of the following is not true regarding regulation of serum potassium

  • *a**. Insulin promotes the intake of potassium ion into tissues such as skeletal muscle.
  • *b**. Addisons disease can result in a decrease levels of serum potassium due to a decrease aldosterone levels.
  • *c**. Epinenphrine acting on the β 2 receptor promotes potassium uptake into cells.
  • *d**. Exercise increases the release of potassium from working muscles and the degree of hyperkalemia is dependent on the intensity of exercise.
A
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9
Q

what condition would you expect to be present in a patient with the following symptoms

pH 7.34, PCO2 46mmHg, Resp Rate 15, HCO3 25 meq/L

A

respiratory acidosis that is being compensated by the renal system

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10
Q

which of the following is NOT a partial compensation for fluid loss

a. A retention of water from the kidney that can actually in some case cause a hypo-osmotic plasma (< 290 mOsm/kg H 2 O)

b. The increase in sympathetic nervous stimulation of the kidney acting on Beta receptors on the JG cells increase the release of rennin and thus angiotensin II

c. An increase in the permeability of the collecting duct to urea to facilitate the osmotic gradient in the interstitial fluid of the kidney

d. A massive vasoconstriction occurs that essentially block blood flow to the kidneys in order to shunt blood to more important organs such as heart and brain.

A

d, A massive vasoconstriction occurs that essentially block blood flow to the kidneys in order to shunt blood to more important organs such as heart and brain.

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11
Q

which of the following about aldosterone is NOT true

  • *a**. High serum K+ levels increase the secretion of aldosterone by action on adrenal cells
  • *b**. Low sodium in the tubular fluid increases indirectly stimulate aldosterone by the secretion of renin
  • *c**. Aldosterone stimulates the secretion of hydrogen ion by intercalated cells in the collecting ducts
  • *d**. None of the above, all are true about aldosterone.
A

d, all of the above are true

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12
Q

what is the action of hydrochlorothiazide that helps control blood pressure

A

decrease in intravascular fluid that will decrease the amount of preload to the heart to decrease stroke volume and cardiac out put

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13
Q

what are some buffered forms of hydrogen formed in the renal tubules that are in urine

a. Titratable acid such as phosphate (monobasic)
b. Water a byproduct of the addition of hydrogen and biocarbonate through action with carbonic anhydrase
c. Ammonium ion by the addition of the hydrogen ion to ammonia generated by the catabolism of glutamine
d. All of the above are forms of the hydrogen ion in excreted urine

A

d. All of the above are forms of the hydrogen ion in excreted urine

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14
Q

which of the following will cause a decrease in renin secretion from the kidney

a. Decreased fluid and solute delivery to the macula densa
b. Hemorrhage
c. Intervenous infusion of isotonic saline
d. Narrowing of the renal artery

A

c. Intervenous infusion of isotonic saline

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15
Q

which of the following are potential sites for K+ secretion in the nephron

a. Proximal tubule

b. Ascending loop of Henle
c. Distal convoluted tubule and collecting duct
d. Proximal convoluted tubule and distal convoluted tubule

A

c. Distal convoluted tubule and collecting duct

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16
Q

Gitelman’s syndrome is a genetic defect that affects the thiazide sensitive Na + /Cl - symporter in the distal convoluted tubule.

Which of the following would be observed in these patients?

a. Salt wasting
b. Hypokalemia
c. Hypocalcuria
d. All of the above would be observed in a patient with Gitelman’s syndrome

A

d. All of the above would be observed in a patient with Gitelman’s syndrome

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17
Q

what causes a detrimental accumulation of fluid by the kidneys in response to decreased ejection fraction in kidney faiilure

A

heart failure will cause a decrease in BP, which will trigger baroreceptors in the vasculature and kidneys, resulting in a decreased RBF and GFR to increase BP

this overrides the signals from the kidney that would elimiinate fliud

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18
Q

What are the generalized functions of the kidney

A

excretion of waste

regulation of fluid volume and content

balance electrolytes

react to changes in pH along with resp

Produce and secrete hormones

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19
Q

why would a failing kidney change the theraputic window of a drug

A

because unless the kidneys can excrete the drug it can stay in the blood and increase the amount circulating

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20
Q

what types of waste products are excreted by the kidneys

A

urea

uric acid

creatinine

metabolites of hormones (vitamins)

bilirubin

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21
Q

what are ions that can be excreted into urine

A

Na

K

Cl

HCO3

H+

Ca

P

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22
Q

what is the role of the kidneys in regulating pH

A

during acidosis the kidneys will hold on to HCO3

during alkalosis the kidneys will excrete HCO3

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23
Q

how would the lung react to decreased blood pH?

how would the kidneys

A

increasing respirations to blow off CO2

decreasing secretion of HCO3

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24
Q

how is the kidney a source of drug interaction

give an example

A

certain drugs can cause the preferential secretion of acids or bases

diuretics can increase the secretion of aspirin, an acid, and decrease secretion of basic drugs like amphetamines

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25
how is a positve ion balance maintained in the body negative
positive = excretion \< intake negative = excretion \> intake
26
what three organs work to maintain blood pH
lungs, kidneys, liver
27
what are the three hormones secreted by the kidneys
renin, calcitrol, erythropoietin
28
what is the function of renin
renin promotes the production of angiotensinogen from the liver, which is converted to angiotensin in the kidneys
29
wjhat is the function of angiotensinogen
regulated BP and Na/K balance
30
what is the function of calcitrol where is it produced
allows for normal absorption of Ca from the GI tract and deposiiton of Ca in bone it is converted from vitamin D in the proximal tubules
31
what hormone opposes the function of calcitrol
PTH
32
what does EPO do
increases red blood cell production
33
aside from production of hormones, what other important endocrine function does the kidney play
ir regulates clearance of hormones which can indirectly influence endocrine function
34
how can hypersecetion of PTH effect other systems
hyperseceretion of PTH can increase the amount of PTH produced, which can cause more calcium to be released
35
what is the functional unit of the kidney
the nephron
36
what structures are contained in the nephron
renal capsule proximal tubule loop of henle (distal, ascending, thick) distal tubule collecting system
37
two types of nephrons
superficial juxamedullary
38
what surrounds the nephron
peritubular capillaries
39
what is the function of the peritubular capillaries
deliver substances and O2 to the nephron and allow for reabsorption
40
three differences between superficial and juxtamedullay nephrons
JM nephrons have a long loop of henle their primary job is to concentrate or dilute urine has vasa recta
41
why do JM nephrons have a long loop of Henle
to take advantage of countercurrent ion regulatioin
42
why is there a brush boarder in nephron cels
to increase surface area and allow for more Na/K pumps
43
where does 70% of the absorption in the nephron happen
the proximal tubule
44
what happens in the thick loop of henle
temm-horsfall proteins are secreted
45
what to tamm horsfall proteins do
normally they are a defense against bacteria in the nephron, but the also form casts that can trap substances
46
two types of collecting tubule cells
principle cells intercalated cells
47
what differentiates principle cells from intercalated cells
moderate invaginations of the basolateral membrane main function is the the reabsorption of NaCl and secretion of K
48
what is the primary function of intercalated cells two types of intercalated cells and their function
regulation of acid base balance alpha (reabsorbs HCO3 in acidosis) beta (reabsobs H+ in alkalosis)
49
why do intercalated cells have a lot fo mitochrondria
the need lots of ATP the run the H+ ATPase that they use to fuel cell transport and regulate acid-base balance
50
what is the function of the renal corpuscle
produces ultra-filtrate from blood in the glomerular capilaries that ends up in the glomerular space
51
what is the structure of the renal corpuscle
fenestrated capillaries surrounded by podocytes
52
what covers the epithelial cells of the renal corpuscle what disease process might effect this layer and how
a basement membrane can be thickened by DM
53
what are the three anatomical strucutures of the filtration barrier in the renal corpus
fenestrated epithelium basement membrane podocyte from bowmans capsule
54
name three structures that are not normally allowed through the filtration barrier of the nephron
RBCs WBCs platelets
55
what stops the filtration of very large anionic molecules (proteins) through the filtration barrier
expression of negatively charged glycoproteins on the endothelial cells
56
what is the function of NO in the capillaries what about endothelian 1
NO is a vasodilator endothelian is a vasoconstrictor
57
when proteins are allowed to pass through holes in capillaries, what stops them from passing through the basement membrane
the fact that fenistrations in the basement membrane are too small to allow them to pass (25-65 nm)
58
what is the function of a podocytes
they wrap around capillaries and glomerular capsule to produce filtration slits that filter blood
59
glycosylation how would you assess this in a patient
a reaction in the glycoproteins on the basement membrane that decreases their ability to repel anionic proteins HbA1c levels or fasting glucose, along with albumin in the urine
60
what determines the composition of ultrafiltrate
the characteristics of the glomerular filtration barrier (endothelium, basement membrane, podocytes)
61
molecules below what size are freely filtered in the nephon what size will prohibit free filtration
\<20 angstroms \>42 angstroms
62
why are cations more likely to be filtered than anions
because the glycoproteins on the basement membrane are negatively charged, so anions would be repelled and cations would be attracted
63
what are mesangial cells
smooth muscle cells that remove proteins and trapped residues from the basement membrane to keep the filter from getting clogged
64
five specific functions of mesangial cells
provides structural support to the glomerular capillaries secretes extracellular matrix acts as a phagocyte secretes prostaglandins and pro-inflammatory cytokines influences GFR by regulating blood floow
65
how can mesangial cells influence filtration
by changing the surface area for diffusion
66
why would renal failure cause anemia
because mesangial cells in the kidney produce EPO, and as the kidneys fail those cells loose their secretory capacity
67
what is the primary function of the juxaglomerular apparatus
regulation of filtration rate and renal blood flow by detecting the amount of NaCl in filtrate and changes in renal blood pressure
68
where is the juxaglomerular apparatus found what are three cells found there
between the distal tubule and the afferent arteriole macula densa extraglomerular messangial cells renin/angiotensin producing cells
69
where is are the macula densa found what is their function
superior border of the thick loop of henle detects NaCl concentration in the distal tubule
70
where are the extraglomerular messnagial cells found in the juxtaglomerular apparatus what is their function
near the macula densa their function is unknown
71
where are the renin/angiotensin cells in the juxtaglomerular apparatus what is their function
near the afferent tubule secretion of hormones into the blood based on renal blood pressure
72
why is innervation of the kidney necessary
to regulate RBF, GFR, salt and H2O reabsorption
73
what provides sympathetic innervation to the kidnets
the celiac plexus through the aorticorenal ganglia
74
T/F there is significant parasympathetic innervaion to the kidney
false, there is none
75
what two neurotransimitters are secreted by the sympathetic neurons of the kidney
norepinephrine and dopamine
76
what structures are innervated by sympathetic nerves in the kidney
renin producing glandular cells
77
what are three functions of norepinephrine on the kidney
increase in renin production (beta adrenergic receptors) increase in NaCl and water reabsorption vasoconstriction via alpha adrenergic pathways
78
what are the two effects of dopamine in the kidney
naturesis vasodilation
79
what is the function of vagus nerve fibers in the kidney
unknown, possibly afferent fibers
80
what does sympathetic innervation of the kidneys react to the produce vasoconstriction of renal blood vessels if vasoconstriction is excessive, what can happen
decrease in renal blood flow acute tubular necrosis
81
how does the sympathetic innervation of tubular cells create "natures little IV" this is important in what speficic disese process
by increasing NaCl absorption shock
82
what will the effect of sympathetic innervation be on renin producing cells what are two consequences of that
increases renin secretion increase in systemic BP increase in K secretion in urine
83
why does there need to be high hydrostatic pressure in the glomerular capillaries
because there need to be pressure to push all the filtrates out of blood
84
why is important that the peritubular capillaries be have low hydrostatic pressure compared to the glomerular capilaries
because the peritubular capilaries need to reabsorb and then secrete substances based on need
85
explain this formula Ex = Fx - Rx + Sx
excretion rate of a substance is equal it is filtration rate minus the reabsorption rate plus the secretion rate
86
T/F there are no cellular elements and very little protein typically found in ultrafiltrate
true
87
what forces control the production of ultrafiltration
starling forces
88
what are the starling forces
hydrostatic pressure in the artery osmotic pressure in the artery hydrostatic pressure in the tubule osmotic pressure in the tubule
89
of the starling forces, which is the primary driving force behind filtration
hydrostatic pressure in the arteries
90
what are the starling forces that oppose filtration
hydrostatic pressure in the tubule osmotic pressure in the the capillary
91
why is the osmotic pressure of the bowmans capusle typically a nonfactor in filtration
because there should be relatively little protein the space
92
explain this forula PUF = PGC - (PBS + πGC)
the pressure of ultra filtrate is equal to the hydrostatic pressure of the glomerular capilaries minus the sum of the pressure in bowmans space and the osmotic pressure of the glomerular capillary
93
what happens to PGC and πGC as the ultrafiltrate passes through the nephron why is this relevant
PGC decreases pi GC increases promotes reabsorption in the peritubular capillaries
94
describe the equation GFR = Kf \* PUF
the glomerular filtration rate is equal to the product of hydraulic conductivity and surface area (Kf) times the pressure of ultrafiltrate
95
what is the typical GFR how much of that volume is reabsorbed
125 mL/min 99%
96
four important factors in determining GFR
Starling forces permability of the glomerular capilary surface area of the capilaries plasma flow rate
97
four factors that will increase GFR
increase in arterial BP vasodilation of the afferent arteriole vasoconstriction of the efferenet arteriole increase renal blood flow
98
three main ways the pressure in the glomerular capsule (PGC) can be altered
changing the resistance in the afferent arteriole changing the efferent arteriole resistance changing the renal arteriole pressure
99
two ways to alter afferent arteriole resistance with their effects
decreased resistance through dilation: increase PGC and GFR increased resistance through constriction: decreased PGC and GFR
100
two ways altering efferent arteriole resistance can effect PGC
decreased resistance throght dialtion: decreased PGC and GFR increased resistnace through constriction: increased PGC and GFR
101
two ways altering renal arteriolar pressure will change PGC
increased BP leads to a transient increase in PGC and GFR decreased BP leads to transient decrase in PGC and GFR
102
how can the kidneys regulate blood pressure
regulate water and Na reabsorption producing renin for the RAA cycle
103
what will the kidney do in response to hypotension
decrease GFR to conserve water
104
what will increase RBF what will decrease RBF which of the two trumps the other
vasodilation vasoconstriction vasoconstriction
105
five reasons why RBF is important
Indirectly determines GFR modifies the rate of solute and water reabsorption be proximal tubule participates in the concentration and dilution of urine delivers O2, nutrients, and hormones to renal cells delivers substrates for excretion
106
what would be the result of decreased renal blood flow from cardiogenic shock
acute tubular necrosis if enough cells are destroyed which can escalate into renal failure
107
define clearance of a solute
the virtual volume of blood plasma volume per unit of time inflow needed to supply the amount of solute that appears in the renal veins or in the urine
108
why is the amount of solute in the renal veins less important than the amount removed from blood
because solute in the veins is recycled
109
explain this equation Q = deltaP/R
renal blood flow equals the mean arterial-venous pressure to the organ divided by the resistance through the organ
110
why is the clearance of P-aminohippurate of note
clearance of PAH almost equals renal plamsa flow, and RPF = RBF
111
how is PAH used to test renal blood flow
PAH IV is given PAH is filtered almost completely bt the kidney the clearance of PAH divided by the extraction of PAH is an indirect measure of the RPF
112
explain this equation RPF = CPAH/EPAH
renal plasma flow
113
what is the relationship between RBF and RPF
RBF = RPF/1-hematocrit
114
what is normal resting renal blood flow what is that in percent of cardiac output
1.2L/min around 20-25%
115
normal resting plasma flow
650 mL/min
116
what is the RPF in a normal adult
600-700ml/min
117
between what MAP does renal blood flow remain constant what happens to GFR in this range
80-180 it remains basically the same
118
in what ways is autoregulation of renal blood flow maintained
changes in vascular resistance in the afferent and efferent arterioles
119
two mechanisms responsible for autoregulation of renal blood flow
myogenic response to arterial pressure tubuloglomerular feedback
120
what does tubuloglomerular feed back respond to
changes in NaCl in the intertubular fluid
121
what structure is effected by mygoenic and tubuloglomerular feed back
the radius of the afferent tubules
122
describe the sequence of autoregulation inresponse to increased GFR (8)
1. GRF increase 2. increase flow through the tubule 3. flow past the macula densa increases 4. paracrine stimulation from macula to afferent arteriole 5. afferent arteriole constricts 6. increased resistnace 7. decreased hydrostatic pressure in the glomerulus 8. decreased GFR
123
describe the process of tubuloglomerular feedback in repsonse to high GFR
NaCl increase is detected by the macula densa macula releases ATP and adenosine signaling to the afferent arterioles to constrict constriction decreases GFR
124
what will happen if there is a decrease in ATP and adenosine how does this change in the presence of NO what about angiotensin II
vasodilation of the afferent arteriole NO will decrease vasoconstriction caused by ATP and adenosie Angiotensin II will increase the vasoconstrictive effects of adenosine
125
what are two things that can modulate autoregulation
sympathetic tone and hormones
126
what is the effect of sympathetic tone if the content of the extracellular fluid is nomal
there is minimal effect
127
what is the effect of norepinehprine and dopamine on the kidney what will be the effect
vasoconstrcitons through alpha adenoreceptors on the afferent arterioloe dcreased in RBF and GFR
128
what is the function of renalase why is this important
degrade catecholamines and allow them to be removed from the kidney it stops vasocontrictions from dopamine and NE
129
three vasoconstrictors in the kidney
SNS angiotensin II endothelian
130
what does the SNS respond to produce vasoconstriction of the kidney what is the effect on GFR and RBF
decreased extracellular fluid volume both will decrease
131
what are the SNS hormones that will vasoconstrict what wll reverse their effect
Epi and NE renalase
132
what stimulus will increase NO production what is the effect
increased shear stress, histamine, bradykinin increased in GFR, increase in RBF
133
what is the effect of NO on the action of angiotensin II, NE, and Epi
it will decrease the amount of vasoconstriction
134
what stimulus will produce bradykinin what will the effect be on GFR and RBF
increased prostafglandins and decreased acetylchloline increase in both
135
what effect will the increase of bradykinin have on the release of NO and prostaglandins
it will stimulate the release of both, which will further incrased GFR and RBF
136
what will stimulate the release of natriuretic peptide what will the effect be on GFR and RBF
increase GFR, no effect on RBF
137
what would increased levels or atrial and brain natruiretic peptide be indicative of
congestive heart failure
138
what is the function of atrial natriuretic peptide
it attempts to decrease fluid volume in response to excessive stretch in the atria
139
what stimulus will release angiotensin II what will the efect be on GFR and RBF
decreased extracellular volume decreased GFR and RBF
140
what will the effect of angiotensin II be on BP and ECFV
will constrcit the afferent and efferent arterioles to increase them both
141
wha stimulus with stimulate the release of endothelian what is the effect on GFR and RBF how does it accomplish this
increased tensions in the vessel wall, angiotensin, decreased ECFV decrease in both constriction of the efferent and afferent arterioles
142
four vasodilators of the kidney
prostaglandins NO bradykinin natriuretic peptides
143
what is the function of adenosine in the kidneys what is its effect on GFR and RBF
vasoconstriction decrease in both
144
what will the effect of ATP in the interstitial fluid be
in tubuloglomerular feedback it constricts afferent arterioles to decrease GFR and RBF in some conditions it can stimulate NO and increase GFR and RBF
145
where is atrial natriuetic peptide produced BNP?
the atria the ventricles
146
what stimulus will cause the secretion of ANP and BNP
stretch in the atria
147
what is the difference in ANP and BNP, aside from where they are produced
ANP has a higher affinity, BNP is longer lived
148
four functions of ANP/BNP
decreased vascular resistance decreased central venous pressure increased natriuresis decreased cardiac output
149
why would BNP be a good test for CHF
increased stretch on the vessel walll will increase BNP production BNP as a long half life
150
how does BNP/ANP increase GRF
dilation of the afferent arterioles constriction of the efferent arterioles increase in glomerular hydrostatic prssure
151
what is the effect of theraputic doses of glucocorticoids have on GFR and RBF
increases both
152
what is the effect of histamine on RBF
increase RBF through decreasing resistance in the afferent and efferent arterioles
153
what is the effect of dopamine on RBF
increases
154
explain this formula Cx = (Ux \* V)/Pax
clearance of a substance is equal to the amount in urine times the volume of urine per day divided by the arterial concentration
155
how is clearance corrected for body size
clearnance \* 1.73m2/body surface area in m2
156
four criteria to determine if a substance can be used to calculate GFR
freely filtered no absorbed or secreted not metabolized or produced by the kidney does not alter GFR
157
what is the gold standard substance to determine GFR is it commonly used in clinic? why?
inulin because it has to be IV injected
158
explain this formula clearance ratio = Cx/Cinulin
the clearance ratio of substance x is equal to the clearance ratio over clearance of inulin
159
what would it mean if a substance had clearance ratio of 1 less that one greater than one
the substance is filtered and not reabsorbed the substance could not be filtered or is filtered then reabsorbed the substances is filtered and secreted
160
why is creatinine used to determine GFR
freely filtered at a reletively stead concentration of 1mg/dL almonst non is reabsorbed, secreted, or metabolized by the nephron
161
what percent of plasma is shunted and not filtered through the glomerulus
15-20%
162
what is the filtration fraction how is it calculated
the portion of blood that is shunted away from the glomerulus GFR/RBF
163
what are normal GFR values for males and females
125 ml/min 110 ml/min
164
what GFR value would be considered kidney failure kidney disease normal
0-15 ml/min 15-60 60-120
165
what would a creatinine plasma level of = 1.2 indicate 1.3-1.6 \>/= 1.7
normal borderline or increased creatinine due to muscle mass renal disease
166
what would albumen or glucose in the urine indicate
diabetic neuropathy
167
PAH clearance is equal to what
RPF
168
inulin clearance is equal to what
GFR
169
what is the basic process of urine formation
ultrafilatration of plasma reabsorption of water and solutes secretion excretion
170
where does most of the action happen in the kidney
in the PCT
171
67% of what substances filtered by the nephron are reabsorbed in the PCT
H2O, Na, Cl, K, others
172
nearly all of what two substances is reabsorbed in the PCT
glucose and AA
173
what pump on the basolateral membrane is the primary actor for reabsorption in the PCT
Na K pump
174
where in the PCT is Na absorbed HCO3 CL
the first 1/2 first 1/2 last 1/2
175
what is the function of phosphate that is filtered and remains in urine
buffering pH
176
where is the majority of Cl reabsorbed in the PCT
the DCT
177
what pump reabsorbs Na in the 1st 1/2 of the PCT What is a secondary effect of this
Na/H+ places HCO3 into the interstitium
178
what are four apical symporters found in the 1st PCT
Na/glucose Na/AA Na/Pi Na/Lactate
179
what is the main symporter found at the BL membrane in the first half of the PCT why is it important
Na/K it maintains the Na gradient
180
how are Na and Cl transported across the cell membrane in the 2nd PCT
transcellular and paracellularly
181
why is Cl transported instead of organic anions or HCO3
because most of the proteins and HCO3 have already be reabsorbed
182
what is the transcellular route of Na reabsorption in the 2nd PCT
parallel operation of Na/H antiporter and Cl anion antiporter
183
how is Na pumped cross the basolateral membrane in the 2nd PCT CL
Na K pump Cl/K symporter
184
what stops cesllls in the PCT from brust
Na K pump
185
where is most of the H2O absorbed
PCT
186
Where is most of the glucose absorbed
PCT
187
where are the most of the proteins absorbed in the kidney
PCT
188
what would glucose in the urine indicate
hyperglycemia, failure of glucose reabsorption
189
what would albumin in the urine indicate
high pressure, kidney failure
190
if protein is filtered where is it reabsorbed in the kidney
the proximal tubule
191
by what means of cellular transport are proteins reabsorbed what happens to them once they are reabsorbed
endocytotis they are digested and leave the cell via the basolateral membrane
192
why can urinalysis detect certain drugs
because some substances are secrete into the PCT and not reabsorbed
193
what is the process of exretion of organic anions into the tubules
intracellular ketogluterate is exchanged into the tubular fluid for OA with OAT1, 2, 3 ketoglutarate in the tubule fluid is exchanged with OA by OAT4 and MRP2
194
what enzymes are repsonsible for moving OAs into tubular cells from blood what enzymes are responsible for moving OAs into tubular fluid what is the common factor in each
OAT1, 2, 3 MRP2 and OAT4 OAT enzymes are ketogluterate antiporters
195
what is the process for excretion of organic cations
OCT enzymes transport OC from blood OC/H+ antiporter and MDR1 transport them out
196
where are the rate-limiting enzymes in the process of organic cation secretion
on apical membrane (OC/H and MDR1)
197
what are three factors that can stimulate the action of rate-limiting enzymes in secretion of organic cations
PKA, PKC, androgens
198
what two substance are reabsrbed in the loop of henle, along with the percent of what is in filtrate
25% of filtered NaCl 15% of filtered H2O
199
where does reabsorpton of NaCl happen in the loop of henle where does it not occur
the thick and thin loops no the descending limb
200
where does H2O reabsorption happen in the loop of henle what cellular protein is responsible for this
exclusively in the thin descending loop of henle aquaporin 1
201
T/F the descending limb of henle is impermable to water
false, the ascending limb is impermeable
202
what is the driving force behind the absorption of water in the descending loop of henle
the gradient created by absorption of NaCl in the ascending loop
203
what type of cellular transport is used for NaCl reabsorption in the ascending loop what happens to NaCl in the tubule as it approaches the macula densa
passive transport it diffuses out of the tubule into the interstitium
204
what happens to the osmolality of the tubular fluid as it moves towards the macula densa what morphological feature allow for this to happen
it decreases and NaCl is actively pumped out the loop of henle gets thicker to accomodate more mitochondria to fuel Na/K pumps
205
what enzymes are responsible for pumping Na out of the blood in the ascending loop of henle what about Cl
Na/K pump Cl/K symporter
206
what enzymes are responsible for the movement of Na and K out of the tubule in the ascending loop of henle
Na and K move with Na/K/2Cl symporter Na alone is by Na/H antiporter
207
why is the Na/K pump necessary to the reabsorption of solute in the thick loop of henle
it maintains a low intracellular Na gradient to fuel transport from the tubule
208
what happens to the the charge of tubular fluid as it passes through the thick loop of Henle why is this important
it acquires a positive charge the voltage is important for the reabsorption of cations like magnesium
209
what substances are absorbed in the distal tubule and collecting duct
NaCl (8%) variable amounts of H, K, and H2O inreaction to dehydration, alkalosis, or acidosis
210
what is absorbed in the intial distal loop of henle what is this strucutre impermable to
Na, Cl, and Ca impermeable to H2O
211
what enzyme is active in the intital segment of the DCT at the apical membrane BL membrane
Na/Cl symport Na/k pumps, Cl passive transport channels
212
what substance is not absorbed in the DCT what is the consequence of this
Na contentration decreases
213
what are two cell types in the DCT what are their functions
principle and intercalated principle reabsorb NaCl and H2O, secrete K into tubule incalated cells secrete H+ or HCO3 for acid base balance
214
how does Na move out of the later segments of the DCT what is the driving force behind this movement what other ion does the effect
diffusion through ENaC channel negative charge inside the DCT cell it sets up a gradient for Cl paracellular transport
215
what is the action of intercalated cells and principle cells on K
principle cells uptake K from the BL via Na/K, then it is secreted through passive diffusion Intercalated cells reabsorb K from the tubule via H+/K ATPase
216
what is the normal pH of urine what causes this
5.5 H+/K ATPase antiport excnages H in the tubule for K in the cell
217
what mediates H2O absorption in the later DCT
the effect of ADH on APQ2 on the apical and APQ3 and 4 on the BL membrane
218
what is the effect of ADH on the later DCT
decreased ADH will down regulate APQ's on the apical and Bl membranes, causing decreased H2O reabsorptiond and diuresis
219
what is the location of dysfunction barter syndrome what is the mechanism
ascending loop of henle problems withthe Na/K/2Cl pump
220
what diuretic would mimc barter syndrome what would the pathologic effects be
lasix (inhibition of Na/K/2Cl symporter) salt wasting, metabolic acidosis
221
what is the location of dysfunction in Gitelman syndrome what is the mechaniism
intitla DCT failure of the Na/CL symporter
222
what diuretic would mimic gitelman syndrome what would be the pathlogical effects of this
thaizaide hypocaluria
223
where is the location of dysfunctionin liddle syndrome what is the mechanism
later DCT hyperactive ENaC
224
what diuretic would mimic liddle syndrome what would the pathologcial effects be
amiloride (inhibits ENaC) metabolic acidosis
225
what diuretics act on the PCT
acetazolamide manitol
226
what diuretics act on the DCT
thiazides
227
what diuretics act on the thick asceening loop of henle
furosemide and bumetanide
228
what diuretics work on the collecting duct
amiloride and triamterene

BMS 752 (Medical Physiology) (13 decks)

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