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Flashcards in Renal Q1 Deck (125):
1

What is the term for Uremic Toxicity due to increased plasma creatinine and BUN (urea)

Azotemia

2

Give an example of 2 endogenous waste products excreted by the kidney

UREA (aka BUN - Blood Urea Nitrogen)

Creatinine

3

An increase in Angiotensin II will do what?

Increase Vasoconstriction

4

An increase in aldosterone will do what?

Decrease urinary Na+ excretion

5

What form of Vitamin D does the Kidney produce?

1,25 (OH)2 Vitamin D

6

What are 2 consequences of Impaired Renal Function that go hand in hand?

Low pH (metabolic acidosis)

High Potassium (Hyperkalemia)

7

What 2 places is Erythropoietin synthesized?

By what transcription factor?

Peritubular fibroblasts and Endothelial cells

HIF-1

8

Where does 25 Vita D convert into 1,25 Vita D in the kidney?

What enzyme is involved?

Proximal tubule cells

via 1 alpha-Hydroxylase

9

T/F
The kidney is involved in gluconeogenesis

True

10

What pH is considered Metabolic Acidosis?

What Potassium level is considered Hyperkalemic?

pH 4.0 mEq/L

11

What does a decrease in 1,25 VitaD cause?

Calcium Phosphate imbalance and Bone Fractures

12

What does Plasma Protein Imbalance cause?

Edema

(excess interstitial fluid)

13

T/F
Impaired renal function can decrease the immune system

True

14

T/F
Impaired renal function can cause Anemia

True

Decreases Erythropoietin synthesis

15

What is Renal functional reserve capacity?

What is the lower limit of fluid homeostatic maintenance?

At what point does the patient need dialysis?

Kidney can maintain GFR (glomerular filtration rate) at reduced function

20%

10-15%

16

What percentage of adults have some form of kidney disease?

10%`

17

Name 3 causes of Acute Renal Failure (ARF)

Pre-renal (decrease renal blood flow)

Intra-renal (e.g. acute tubular necrosis)

Post-renal (obstruction)

18

T/F
ARF is usually reversible

True

19

T/F
CRF is usually reversible

False

20

Name 3 causes of Chronic Renal Failure (CRF)

Diabetes
Hypertension
Glomerulonephritis

21

What are the 2 treatment options for End Stage Renal Disease?

Dialysis
Transplant

22

How does Hemodialysis differ from Peritoneal dialysis?

Hemodialysis: Blood pumped into machine across membrane

Peritoneal dialysis: fluid exchanged through peritoneum

23

In Hemodialysis, what 3 things usually diffuse out of blood?
What diffuses in?

Water, Creatinine, Potassium

Bicarb

24

How often is Hemodialysis administered?

What drug must be taken?

3-4 times/week
3-4 hours each session

Blood thinners

25

How often is fluid exchanged in CAPD (chronic ambulatory peritoneal dialysis)?

What is a major risk?

4-6 times/day

Infection

26

Is body fluid homeostasis maintained with hemodialysis?

No

27

What occurs between hemodialysis sessions?
(2 limitations)

Body weight increases
(water retention)

Plasma creatinine increases
(synth > output)

28

1 millimolar solution of CaCl2 = _____ mEq Ca+2 and _____ mEq Cl-

2
2

29

What 2 factors affect the percentage or TBW (total body water)?

Gender
Age

30

What percentage of TBW is intracellular and extracellular?

Intracellular - 2/3
Extracellular - 1/3

31

What are the 3 components of the ECF (extracellular fluid) and what is their breakdown?

Interstitial fluid - 75%
Plasma - 25%
Transcellular fluid - 5%

32

What makes up transcellular fluid?

CSF
Aqueous humor
GI tract secretions
Urine

33

What separates body fluid compartments?

Vascular Endothelium

34

Intracellular fluid is high in what cation?
Extracellular fluid is high in what cation?

What sets up this dynamic?

Intra - potassium

Extra - sodium

sodium potassium pump

35

What 3 things is ICF high in?

What 3 things is ECF high in?

ICF - K+, proteins, organic phosphates

ECF - Na+, Cl-, bicarb

36

What are 2 factors that help set up solute differential between ECF and ICF?

ATP-ase Na/K pump
Membrane transporters

37

Why is ECF volume directly related to total NaCl content?

Na+ and attendant ions (Cl-/HCO3-) account for 95% ECF osmolarity

38

What is the dilution principle equation?

Volume = Amount added / Concentration

39

What are the 4 markers used to measure Extracellular Volume?

Radiolabeled sodium
Sucrose
Mannitol
Inulin

40

What are 2 markers used to measure Plasma Volume?

Iodinated Albumin
T-1824 (Evans blue)

41

What are 3 markers used to measure Total Body Water?

Tritiated water
Heavy water
Antipyrine

42

How does one measure Interstitial Volume?

Extracellular fluid volume - Plasma volume

43

How does one measure Intracellular Volume?

Total body water - Extracellular Fluid volume

44

Why is it not possible to measure Interstitial or Intracellular volume directly?

There is no clinical method for taking a direct interstitial or intracellular fluid sample from a living patient

45

Why is it important to use a single marker if multiple measurements of a specific compartment volume are required?

Markers that are used in the same space may give slightly varying values based on composition differences of the marker

46

What happens to RBC in hypotonic solution?

Expansion

47

What happens to RBC in hypertonic solution?

Shrinkage

48

Why is urea often Hypotonic?

Cell membrane is permeable to urea
Reflection coefficient is not zero

(quantitatively might appear isotonic, but remember this is referring to water - if permeable to urea will often be Hypo)

49

Name 4 ways the intracellular-extracellular fluid volume can be disrupted.

Water ingestion
dehydration
infusions
fluid loss

50

Fluid exchange between the interstitium and the intracellular space is driven primarily by...

Osmotic Pressure

*water movement only

51

What are the 2 major renal zones?

Outer Cortex
Inner Medulla

52

What is the relationship between the renal tissue and the renal calyces and pelvis?

Distal proximal tubules of nephrons transfer filtrate to medullary collecting ducts that converge at inner edge of medulla forming calyces

53

What are the 4 principal segments of the Nephron?

Proximal tubule
Loop of Henle
Distal tubule
Collecting tubule

54

What are the 2 types of nephrons?

Where are the glomeruli located?

Cortical (short looped)
glomerulus close to surface

Juxtamedullary (long looped)
glomerulus at cortex/medulla junction

55

In the Cortical (short looped) nephron, where are the following located:

Proximal and distal tubule

Loop of Henle

Collecting tubule

Cortex

Cortex and Outer Medulla

Cortex, Outer medulla, Inner medulla

56

In the Juxtamedullary nephron, where are the following located:

Proximal and distal tubule

Loop of Henle

Collecting tubule

Cortex

Cortex, Outer and Inner Medulla

Cortex, Outer and Inner Medulla

57

What is the anatomical difference between the Cortical and Juxtamedullary Nephrons?

Juxtamedullary has

Loop of Henle in Inner Medulla


*cortical nephrons only go as far as outer medulla

58

What are the proportions of Cortical and Juxtamedullary Nephrons?

Cortical - 80%

Juxtamedullary - 20%

59

Juxtamedullary Nephrons appear to have a cross species function of what?

Concentrating Urine

60

In what way is the vascular arrangement surrounding the glomerulus unique?

What is the pathway?
(4 things)

2 sets of Arterioles

afferent arteriole > glomerular capillaries > efferent arteriole > peritubular capillaries

61

What do 2 sets of Arterioles do in the glomerulus?

Help regulate Glomerular Filtration

*upstream and downstream regulation of glomerular capillaries

62

What is the function of peritubular capillaries?

Reabsorption

*travel alongside length of nephron
**Vasa Recta in Loop of Henle

63

What is the Vasa Recta?

Subset of Peritubular capillaries running alongside Loop of Henle

64

From what are the Vasa Recta derived?

Efferent arterioles of Juxtamedullary Nephrons

65

What percentage of cardiac output is delivered to the kidney?

25%

66

How does Renal Oxygen consumption compare with other organs?

Very high

67

Why is artery-vein Oxygen concentration analysis in the kidney deceptive when ascertaining consumption?

Oxygen concentration difference low

BUT,

Blood flow is so high, Kidney Oxygen consumption also very high

68

How is Renal Oxygen consumption calculated?
(equation)

Oxygen consumption = a-v Oxygen difference x Blood Flow

69

Describe Phase 1 of Renal Blood flow and Oxygen consumption

Above 150, proportional

*no change in a-v Oxygen difference

70

Describe Phase 2 of Renal blood flow to Oxygen consumption

150-75, kidney works harder to extract oxygen

*a-v Oxygen difference increases

71

Describe Phase 3 of Renal blood flow to Oxygen consumption

Below 75, a-v difference maximal

*Renal Ischemia

72

What are the 3 principal elements of Renal Function?

Glomerular Filtration
Tubular Reabsorption
Tubular Secretion

73

What is the Filtration Fraction?

20%

*plasma entering glomerular capillaries filtered into Bowman's Space

74

What is the Filtered Load?

Concentration of Solutes in glomerular capillary

75

How does Tubular Secretion maintain homeostasis?
What is it making up for?

Glomerulus doesn't filter large, charged molecules.

(glomerulus selective)

76

Are conclusions drawn from urine concentration alone?

What must you know?

No.

Must know Urine Flow Rate

77

How does Urine move to the Bladder?

Calices initiate Peristaltic Contraction via inherent pacemaker activity

78

What is the Micturition Reflex?

What contracts and relaxes?

Parasympathetic response as bladder fills

Detrusor contracts
Bladder neck relaxes

79

What is the Voluntary component of the Micturition Reflex?

External Urethral Sphincter

*internal by bladder is involuntary

80

Name 2 Micturition abnormalities

Automatic bladder
(spinal cord damage of voluntary supression)

Atonic bladder
(loss of sensory nerves = no reflex, leads to overflow incontinence)

81

What are the principal structural components of the Glomerular filtration barrier?
(3 things)

Fenestrated Endothelium
Basement membrane
Epithelium (podocytes)

82

5 functions of Mesangial cells:

Structural support for capillaries
Secrete ECM
Phagocytosis
Secrete Prostaglandins/cytokines
Contractile

83

What 2 main factors determine filterability?

Size
Charge

84

T/F
For "freely filtered" substances, the concentration of solutes in Bowman's space will be = plasma.

True

85

What results in high protein plasma concentration immediately downstream of the Glomerulus?

Proteins aren't filtered across glomerulus

86

T/F
Bowman's glomerulus has no Oncotic Pressure

True

87

T/F
Oncotic Pressure increases from Afferent to Efferent arteriole.

True

88

What is often seen in Glomerular Disease?

Proteinuria

89

Name 4 consequences to Proteinuria do to Glomerular Disease.

Thrombosis
Infection
Hyperlipidemia
Edema

90

What are the main forces in the Glomerular capillary?

2 types?

Starling Forces

Hydrostatic and Oncotic

91

What is the difference between osmotic and oncotic pressure?

Oncotic due to Protein

92

What is the term for the Filtration coefficient?

How is it determined?

Kf

ability of capillaries to allow passage of water

93

T/F
Glomerular filtration (Kf) is much higher than in systemic capillaries

True

94

What causes Generalized Edema?

Na+ retention

*expands entire ECF volume

95

What are 3 causes of Localized Edema?

Venous obstruction (increase Pc)
Inflammation (increase Pc and Kf)
Lymphatic obstruction (increases Pi-c)

*protein not returned to systemic circulation in lymphatic obstruction

96

Why does Glomerular capillary Hydrostatic pressure remain relatively constant?

Afferent and Efferent resistance points at arterioles

97

Why does oncotic pressure increase along the glomerular capillary?

Protein not filtered into glomerulus

98

When does the Net Filtration Pressure = 0?

When Oncotic Pressure in the glomerular capillary increases to the point it = Hydrostatic Pressure

99

Filtration Pressure Equilibrium and Disequilibrium?

???

100

Why is Hydrostatic pressure so low by the time the blood reaches the Peritubular capillaries?

It has passed 2 resistance points

*before and after Bowman's Capsule

101

What is the Ultrafiltration coefficient?

Filtration coefficient of a semipermeable membrane

102

How does the Glomerular Ultrafiltration coefficient compare to systemic Ultrafiltration?

Much higher in Glomerulus

103

How many times/day is the entire plasma volume filtered by the kidneys?

60

104

T/F
Everything increases/decreases with Afferent arteriole increase/decrease in pressure

True

*Hydrostatic Pressure, Glomerular Filtration Rate, and Renal Plasma Flow

105

T/F
Hydrostatic Pressure, Glomerular Filtration, and Renal Plasma flow all increase/decrease with increase/decrease of Efferent arteriole pressure.

False


*Inverse on Renal Plasma Flow

106

What primarily regulates Glomerular Filtration?

Afferent Arteriole

107

What two factors constrict the Afferent Arteriole?

Sympathetic nerves

Angiotensin II
(affects both afferent and efferent)

108

What do Prostaglandins do to regulate glomerular filtration?

What are 2 examples of such prostaglandins?

Vasodilate

PGE2 and PGI2

109

T/F
Angiotensin II, along with constricting the glomerular arterioles, also causes production of PGE2 and PGI2, which constricts said arterioles.

True

110

What can NSAID's + Sympathetic nerve activity lead to?

Acute Renal failure

*no vasodilation occurring
**runaway vasoconstriction of kidney

111

What does an increase in Afferent vasoconstriction due to Renal Sympathetic Activity and Angiotensin II cause?

"Pre-renal" acute renal failure

112

What are 3 main factors that adversely affect the GFR?

Kf (ultrafiltration coefficient) change
(glomerular disease or mesangial cell contractility)

Oncotic pressure change

Intratubular pressure change (obstruction)

113

What does Mesangial cell contractility affect?

Capillary surface area

114

How does complete Uretal obstruction stop GFR completely?

Damages glomeruli through pressure build-up

115

What is the Uretorenal reflex?

Sympathetic reflex constricting arterioles due to Uretal Obstruction

116

Why doesn't the GFR constantly change with normal fluctuations of pressure?

Autoregulatory nature of kidney

*maintains GFR over wide range of pressures
**70 and above

117

Why do we know Autoregulation of kidney is intrinsic?

Transplanted kidneys
Perfused isolated kidneys (in vitro, no hormones)

118

T/F
Resistance changes in the Afferent Arteriole cause changes in the Glomerular Filtration Rate and the Renal Perfusion Rate

True

*this is why we know Afferent Arteriole is control point

119

T/F
Autoregulation prevents changes in GFR and RPF and prevents large changes in water and solute excretion

True

120

Reflex resistance changes in the Afferent Arteriole is the _______ theory of Autoregulation.

Myogenic

121

T/F
Under the Myogenic theory, an increase in BP would decrease the radius of the Afferent arteriole.

True

122

A change in the flow rate/composition of tubular fluid sensed at the Macula Densa is the _____ theory of Autoregulation

Tubuloglomerular feedback theory

123

An increase in BP causing an increase of flow rate causes the Macula densa to decrease Afferent Arteriole diameter according to the tubuloglomerular feedback theory of autoregulation.

True

124

What is the Macula Densa?

Specialized cells at border of Distal Convoluted Tubule

*close proximity to the Afferent arteriole

125

What can override the Autoregulatory system in the Kidney?

Under what circumstances is this a good thing?

Sympathetic system

Trauma
(don't want vasodilation to occur with massive blood loss)

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