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Renal Science Flashcards

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1
Q

What is Osmolarity and units

A
  • Concentration of osmotically active particles in a solution
  • Osmol/l
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2
Q

Osmolality

A

osmol/kg water

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3
Q

Principle ions in intracellular fluid

A

K and Mg

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4
Q

Principle ions in extracellular fluid

A

Na, Cl and HCo3

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5
Q

Concentration of extra and intracellular fluid

A

Both 300mosmol

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6
Q

What happens to RBCs:

  • Hypertonic solution
  • Hypotonic solution
A
  • Hypertonic: RBCs shrink, less water, more concentrated

- Hypotonic: more water, cell lysis and burst

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7
Q

Value for: Inulin clearance

A

125mls/min not absorbed or secreted

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8
Q

Value for: Glucose clearance

A

Zero as it is not filtered or secreted

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9
Q

Value for: Urea Clearance

A
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10
Q

Value for: H+ clearance

A

> GFR as more leaves the nephron than enters

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11
Q

What is PAH used for?

A

To calculate the renal plasma flow at 650mls/min

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12
Q

Ideal GFR marker

A

Should be filtered freely and not secreted or reabsorbed

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13
Q

Ideal Renal Plasma Flow marker

A

Filtered and complete absorbed

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14
Q

How to calculate filtration fraction

A

GFR/Renal plasma flow–> 125/650–> 20%

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15
Q

Osmolality

A

osmol/kg water

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16
Q

Principle ions in intracellular fluid

A

K and Mg

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17
Q

Principle ions in extracellular fluid

A

Na, Cl and HCo3

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18
Q

Concentration of extra and intracellular fluid

A

Both 300mosmol

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19
Q

What happens to RBCs:

  • Hypertonic solution
  • Hypotonic solution
A
  • Hypertonic: RBCs shrink, less water, more concentrated

- Hypotonic: more water, cell lysis and burst

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20
Q
  • 80% of nephrons
  • Outer part of context
  • Do not fully descend into the medulla
  • Forms network of peritubular capillary
  • Reabsorption and secretion
  • Short loop of Henle
A

Cortical nephrons

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21
Q
  • 20% of Nephrons
  • Inner part of cortex
  • Descend deep into the medulla
  • Form Vasa Recta
  • Concentrate and dilute urine
  • Long loop of Henle
A

Juxtamedullary nephrons

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22
Q

Value for: Inulin clearance

A

125mls/min not absorbed or secreted

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23
Q

Value for: Glucose clearance

A

Zero as it is not filtered or secreted

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24
Q

Value for: Urea Clearance

A
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25
Value for: H+ clearance
>GFR as more leaves the nephron than enters
26
What is PAH used for?
To calculate the renal plasma flow at 650mls/min
27
Ideal GFR marker
Should be filtered freely and not secreted or reabsorbed
28
Where do hormones affect the permeability of the kidney?
Late collecting duct
29
Distal Tubule: - What is reabsorbed: early and - Transporters? - Drugs used here
- Early: NaCl, NaK2C transport - Late: Ca reabsorption - Blocked by thiazide diuretics
30
Forces acting upon the glomerular capillary
- Glomerular capillary blood pressure - Bowman's capsule hydrostatic pressure - Bowman's capsule oncotic pressure - Capillary oncotic pressure
31
Value of Glomerular capillary blood pressure?
55mmHg
32
Value of Bowman's capsule hydrostatic pressure?
15mmHg
33
Value of Capillary oncotic pressure?
30mmHg
34
Value of Capillary oncotic pressure?
0mmHg
35
Cause of increased Bowman's capsule hydrostatic pressure and result on GFR?
Kidney stone, decreased GFR
36
Cause of increased Capillary oncotic pressure and result on GFR?
Diarrhoea, decreased GFR
37
Cause of decreased Capillary oncotic pressure and result on GFR?
Beverly burned patient, increase in GFR
38
Decrease in surface area for filtration and effect on GFR?
Decreased GFR
39
Extrinsic regulation of renal blood flow and GRF
Sympathetic via baroreceptor
40
Intrinsic regulation of renal blood flow and GFR
- Myogenic mechanism by stretch of smooth muscle | - Tubuloglomerular feedback mechanism
41
Proximal Tubule: - What is reabsorbed? - Transporters?
- 100% of glucose and AA - 67% of salt and water - NaKATPase - Cl via paracellular pathway - Water by osmosis
42
Ascending Loop: - What is reabsorbed? - Transporters? - Drugs used here
- Na and Cl - Triple cotransporter - Impermeable to water - Transporter blocked by diuretics
43
Descending Loop: | -What is reabsorbed?
- Highly permeable to water - Does NOT reabsorb NaCl - Fluid leaving descending loop is highly concentrated
44
Where do hormones affect the permeability of the kidney?
Distal tubule and collecting duct
45
Distal Tubule: - What is reabsorbed: early and - Transporters? - Drugs used here
- Early: NaCl, NaK2C transport - Late: Ca - Blocked by thiazide diuretics
46
How does ADH act on the collecting duct?
- ADH binds to Type 2 receptors expressed by the renal tubular cells (g coupled protein receptors) - Increase in cAMP - Increase in aquaporins - Increased permeability and water is reabsorbed
47
High ADH, hyper or hypo tonic urine?
High ADH, High water permeability, hypertonic urine (concentrated)
48
Low ADH, hyper or hypo tonic urine?
Low ADH, Low water permeability, hypotonic urine (dilute)
49
Effect of Nicotine and Alcohol on ADH
Nicotine stimulates ADH | Alcohol inhibits ADH
50
What receptors stimulate ADH
Hypothalamic osmoreceptors
51
How is the secretion of Aldosterone initiated?
- In response to increased K or decreased Na - Stimulates Na reabsorption and K secretion - Aldosterone increases the number and rate of production of transporters in distal tubule and collecting ducts to increase Na
52
What is the mechanism of ANP?
- Produced by heart, stored in atrial muscle cells - Released in response to stretch due to increased circulating plasma volume - Leads to excretion of Na and diuresis - Decreases plasma volume
53
What is pK?
Tells us the pH at which the reaction will reach equilibrium
54
What drives bicarbonate ion reabsorption into the tubule?
H+ ion
55
How is tubular acid excreted by the kidney?
- Vast majority of H+ section if used for HCO3 reabsorption to prevent generation of acidosis - Excreted as "acid phosphate"
56
What are the 3 components of the Juxtaglomerular Apparatus?
- Macula Densa - Juxtaglomerular cells - Extraglomerular mesangial cells
57
Role of Macula densa
- Sensory cells | - Senses ion composition in distal convoluted tubule and detects salt in tubular fluid
58
Role of Juxtaglomerular cells
- Effector cells - Modified smooth muscle cells in afferent arteriole - Secrete Renin
59
Role of Podocytes
-Interdigitating cell processes forming filtration slits
60
Role of Mesangial cells
Support cells and removal of debris
61
Difference between brush border at Proximal and distal convoluted loops
Proximal: "hairy" brush border Distal: not "hairy"
62
Where do Loop diuretics work?
- Block triple co-transporter | - At ascending limp
63
Where do Thiazide Diuretics work?
- Block NaCl transporter | - At distal convoluted tubule
64
Diuretics work at apical or basolateral membrane?
Apical
65
How are thiazide and loop diuretics transported into the glomerular filtrate?
- By anion transport | - NADC transport
66
Where does Aldosterone work?
- Distal tubule and collecting ducts | - Increases synthesis of Na/KATPase
67
Action of Spironolactone?
- Decreases number of Na/K channels at distal and collecting tubules - Decrease Na absorption - Blocks aldosterone receptors
68
Mg and Ca are excreted when using Loop or Thiazide diuretics?
- Mg and Ca excreted in Loop | - Mg but NOT Ca excreted in Diuretics
69
Action of Carbonic Anhydrase inhibitors
- Proximal tubule - Increased excretion of HCO3 with Na, K, H2O - Glaucoma
70
Action of Aquaretcis
- Water loss without accompanying Na - Competitive antagonists of vasopressin receptors - Used in SIDH to correct hypoatraemia
71
What are the major prostaglandins in the kidney?
PGE2- medulla PGI- glomeruli -Both act as vasodilators
72
Action of Urosuric agents?
Block reabsorption of rate in proximal tubule
73
Cortical nephrons
- 80% of nephrons - Outer part of context - Do not fully descend into the medulla - Forms network of peritubular capillary - Reabsorption and secretion - Short loop of Henle
74
Juxtamedullary nephrons
- 20% of Nephrons - Inner part of cortex - Descend deep into the medulla - Form Vasa Recta - Concentrate and dilute urine - Long loop of Henle

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