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Flashcards in Renal, Topnotch + CDB Deck (170):
1

Length of the ureter

25-35 cm

2

Origin of the nephron

Metanephric blastema

3

Origin of the collecting duct system

Ureteric bud

4

pH compatible with life

6.8-8.0

5

Stimulus for EPO production by interstitial cells of kidney

Hypoxia

6

Form of vitamin D produced in kidneys

1,25-hydroxycholecalciferol

7

Enzyme in the kidney that converts vitamin D to its active form

1a-hydroxylase

8

Function of kidney during starvation

Gluconeogenesis

9

Vertebral level of kidneys

T12-L3

10

Weight of 1 kidney

150g

11

Part of kidney that is pain sensitive

Capsule

12

Organism implicated in staghorn calculi/mg ammonium po4/struvite

Proteus mirabilis

13

Renal circulation

Renal artery > segmental artery > interlobar artery > arcuate artery > interlobular artery (cortical/radial) > afferent arteriole > glomerular capillaries > efferent arteriole > peritubular capillaries/vasa recta > interlobular vein > arcuate vein > interlobar vein > segmental vein > renal vein

14

Cxs of glomerular capillaries (2)

1) Highly fenestrated hence responsible for GFR
2) Only capillaries that leas to arterioles and not venules

15

Hairpin loop-shaped peritubular capillaries of the juxtamedullary nephrons

Vasa recta

16

Creates corticopapillary osmotic gradient

Countercurrent multipliers

17

Structure known as the countercurrent multiplier

Loop of Henle

18

Maintains the corticopapillary osmotic gradient

Countercurrent exchangers

19

Structure known as the countercurrent exchanger

Vasa recta

20

Substances moved in circles by the countercurrent exchanger (2)

1) Na
2) Urea

21

Urge to urinate

150 mL

22

Reflex contraction

300mL

23

Sense of fullness

400mL

24

# of nephrons per kidney

1M

25

The kidneys undergo compensatory regeneration upon __% damage to nephrons

75%

26

Cortical vs Juxtamedullary nephrons: Percentage

75%, 25%

27

Cortical vs Juxtamedullary nephrons: Loops of Henle

Short-long

28

Cortical vs Juxtamedullary nephrons: Capillary network

Peritubular capillaries-vasa recta

29

Diameter of pores of capillary endothelium

8nm or 80A

30

Vasoactive substances secreted by capillary endothelium

1) NO
2) ET-1

31

Form the visceral epithelium in the glomerulus

Podocytes

32

Where filtrations slits are located in kidneys

Podocytes

33

Function of mesangial cells

1) Contractile elements
2) Mediate filtration
3) Take up immune complexes

34

Components of JG apparatus

1) JG cells
2) Macula densa
3) Lacis cells

35

Glomerular cells of the afferent arterioles

JG cells

36

What JG cells secrete

Renin

37

Where macula densa is located

Wall of DCT

38

Function of the macula densa

Monitor Na concentration in the DCT

39

Site of kidneys most susceptible to ischemia

PCT

40

% sodium, K, and H2O reabsorbed in the PCT

66%

41

% glucose and aa reabsorbed in PCT

100%

42

Part of loop of Henle permeable to water but not to solutes

Descending limb

43

Part of loop of Henle permeable to solute but not to water

Ascending limb

44

Substances that kidneys filter only (2)

1) Inulin
2) Creatinine

45

Substances that kidneys filter and secrete (2)

1) PAH
2) Organic acids and bases

46

GFR is __% lower in females

20-25%

47

Fraction of renal plasma flow that is filtered

Filtration fraction

48

Normal filtration fraction

20%

49

Formulas for filtration fraction

GFR/RPF

50

Substance used to determine RPF (gold std)

PAH

51

Size of substance freely filtered in kidneys

20A or less

52

Size of substance not filtered at all in kidneys

>42

53

Filterability of 1.0

Freely filtered as water

54

Filterability of 0.75

Filtered only 75% as rapidly as water

55

Filterability according to charge

Positive > neutral > negative

56

Portion of renal corpuscle affected by NSAID and mechanism

Afferent arteriole; inhibition of PG (dilates afferent arteriole)

57

Portion of renal corpuscle affected by ACEI and mechanism

Efferent arteriole; inhibition of ATII (constricts efferent arteriole)

58

Glomerular hydrostatic pressure

60 mmHg

59

Net filtration pressure (GFR)

10 mmHg

60

Effect on GFR when efferent arteriole is moderately constricted

Increase

61

Effect on GFR when efferent arteriole is severely constricted

Decrease

62

Effect on GFR when ultrafiltration coefficient (Kf) is increased

Increase

63

Causes of decreased Kf

1) DM
2) Htn
3) Renal diseases

64

Cause of increased hydrostatic pressure in the bowman's space

Urinary tract obstruction

65

Glomerular filtration forms

Primitive urine

66

% CO received by kidneys

25%

67

Organs that are sensitive to ischemia

1) Brain
2) Liver
3) Kidney

68

Type of infarct in the kidney

Wedge-shaped white or anemic infarct

69

Renal cortex vs medulla: greater renal blood flow

Renal cortex

70

BP at which renal autoregulation is optimal

80-170 mmHg

71

Massive sympathetic stimulation that results in massive vasoconstriction of kidneys

CNS ischemic response

72

Substances secreted as autoregulatory mechanisms to maintain GFR

1) Adenosine
2) NO
3) ATII

73

Effect of adenosine on kidneys

Afferent arteriole vasoconstriction

74

Effect of nitric oxide on kidneys

Afferent arteriole vasodilation

75

Percentage of solute reabsorbed is held constant

Glomerulotubular balance

76

Concentration at which substance starts to appear in the urine

Renal threshold

77

Concentration at which all excess substance appear in the urine or the limit to the rate at which solute can be transported (reabsorbed)

Renal transport maximum

78

Renal Tmax of glucose

375 mg/dL

79

Renal threshold of glucose

200 mg/dL

80

Filtered load at renal threshold of glucose

250 mg/min

81

Normal filtered load of glucose

125 mg/min

82

Kidney transport mechanism that does not exhibit Tmax and threshold

Gradient-time transport

83

Factors that affect transport of substances that use the gradient-time mechanism (3)

1) Electrochemical gradient
2) Membrane permeability
3) Time

84

Relationship between flow rate and rate of transport in gradient-time transport

Inverse

85

Epithelium of PCT

Low columnar with extensive brush border

86

Osmolarity of PCT

Isosmotic

87

Epithelium of thin segments of loop of Henle

Simple squamous

88

Epithelium of thick segments of loop of Henle

Simple cuboidal

89

% of filtered water reabsorbed in loop of Henle

20%

90

% of filtered Na,K,Cl reabsorbed in loop of Henle

25%

91

Ion channel inhibited by loop diuretics (Furosemide, Bumetanide, Ethacrynic acid)

Na-K-2Cl

92

Epithelial lining of distal tubule

Simple cuboidal

93

Aka Goormatigh or Polkissen cells or agranular cells

Lacis cells

94

Cells found in second part of distal tubule

1) Principal cells
2) Intercalated cells

95

Function of principal cells (3)

1) Reabsorb Na
2) Secrete K
3) Reabsorb H2O

96

Function of intercalated cells (2)

1) Reabsorb K
2) Secrete Na
3) HCO3 regulation

97

Transport systems by which intercalated cells secrete H+ (2)

1) Na-H countertransport
2) H-ATPase

98

Part of kidney responsive to aldosterone

DT

99

Part of kidney responsive to vasopressin

DT and CD

100

% filtered water reabsorbed in DT

5

101

Part of renal tubules impermeable to urea

DT

102

Part of renal tubules permeable to urea

CD

103

Site for regulation of final urine volume and concentration

CD

104

Effect of aldosterone on kidneys (3)

1) Na reabsorption
2) Water reabsorption
3) K secretion

105

Effect of ATII on kidneys (2)

1) Na reabsorption
2) Water reabsorption

106

Effect of ANP and BNP on kidneys

Decrease Na reabsorption

107

Effect of PTH on kidneys

1) Increase Ca reabsorption
2) Decrease PO4 reabsorption
3) Increase 1a-hydroxylase

108

Triggers for ADH secretion and respective sensors

1) Increased osmolarity (Hypothalamus)
2) Decreased BP (atrial stretch receptors)
3) Decreased blood volume (carotid sinus and aortic arch)

109

Effect of alcohol on body fluid regulation of kidneys

Decreases ADH secretion

110

Hormone secreted by DT and CD that acts similar to ANP

Urodilatin

111

Change in osm that triggers ADH secretion

1%

112

Change in blood volume that triggers ADH secretion

10%

113

Stimulus for renin secretion by JG cells

Decrease in BP

114

Effect of renin

Angiotensinogen > angiotensin I in liver

115

Where and angiotensin I is converted to angiotensin II and enzyme responsible

Lungs and kidneys via ACE

116

CKD with normal size

1) SLE
2) HIV
3) PTB
4) Amyloidosis
5) Sarcoidosis

117

All tubular capillaries are derived from

Efferent arterioles

118

Onion-skinning or fibrinoid necrosis is seen in what renal disease

Malignant nephrosclerosis

119

Most common site of abdominal aneurysm

Infrarenal/before bifurcation of abdominal aorta

120

Symptom of abdominal aneurysm

Abdominal bruit

121

Most common type of htn

Essential/idiopathic

122

Most common cause of secondary htn

Renovascular dse

123

Most common renovascular disease

Renal artery stenosis

124

Filtration rate - reabsorption rate + secretion rate

Excretion rate

125

How many times is plasma volume filtered in a day

60x

126

% water reabsorbed from filtered volume

99%

127

% phenol reabsorbed from filtered volume

0%

128

Regulation of urine concentration (2)

1) Medullary countercurrent system
2) Vasopressin

129

High permeability of thin descending limb to water is via

Aquaporin-1

130

Nodular sclerosis of glomerular membrane is seen in what disease

DM

131

Microscopic finding in kidneys with DM

Kimmelsteil-Wilson Lesions

132

Microscopic finding in kidneys with minimal change disease

Effacement of podocytes

133

Combined blood flow through both kidneys in an average adult

1100mL/min

134

Renal vessels with greatest resistance (4)

1) Interlobar artery
2) Interlobular artery
3) Afferent arteriole
4) Efferent arteriole

135

Formula for renal blood flow

(R artery pressure-R vein pressure)/Total renal vascular resistance

136

Drug that causes diabetes insipidus by interfering with ADH receptors on DT

Lithium

137

Major ion secreted into tubules coupled with sodium entry

Hydrogen

138

Forces that propel the urine along the ureter

1) Gravity
2) Peristaltic contractions

139

Treatment for post-operative bladder atony

Bethanechol

140

Where EPO is produced

Interstitial peritubular cells

141

Usual daily urine output

700-1400mL

142

Why ACEI exacerbates cough

ACE inhibits bradykinin

143

Normal venous pH

7.35

144

Normal interstitial fluid pH

7.35

145

Body fluid buffer systems (3)

1) Bicarbonate
2) Phosphate
3) Intracellular proteins

146

The respiratory buffer responds to

H+ levels

147

Respiratory regulation of acid-base balance is __% effective in returning pH back to normal

50-75%

148

Respiratory regulation returns pH back to normal within ___ minutes

3-12

149

Mechanisms of renal regulation of acid-base balance (3)

1) Excess H+ secretion
2) HCO3 reabsorption
3) Production of new HCO3 using ammonia and phosphate buffers

150

Normal HCO3

22-26 mmol/L

151

Normal pCO2

35-45 mmHg

152

Acid-base imbalance due to conditions resulting in decreased ventilation

Respiratory acidosis

153

Acid-base imbalance due to conditions resulting in increased ventilation

Respiratory alkalosis

154

Respi acid vs alka: Airway obstruction

Respi acid

155

Respi acid vs alka: Pneumonia

Respi alka

156

Respi acid vs alka: ARDS

Respi acid

157

Respi acid vs alka: Pulmonary embolus

Respi alka

158

Respi acid vs alka: COPD

Respi acid

159

Respi acid vs alka: High altitude

Respi alka

160

Respi acid vs alka: Psychogenic

Respi alka

161

Respi acid vs alka: Salicylate intoxication

Respi alka

162

Formula for plasma anion gap

Na - (HCO3 + Cl-)

163

Met acidosis where there is excess organic anions to maintain electroneutrality

HAGMA

164

Met acidosis where there is increased chloride to maintain electroneutrality

NAGMA

165

HAGMA (11)

MUDPILES
Methanol, uremia, DKA, paraldehyde, propylene glycol, iron, isoniazid, idiopathic acidosis, lactic acidosis, ethylene glycol, ethanol, salicylic acid

166

NAGMA (6)

HARD UP
Hyperalimentation, acetazolamide, RTA, diarrhea, ureteroenteric fistula, pancreaticoduodenal fistula

167

Conditions resulting in metabolic alkalosis (5)

1) Loop diuretics
2) Thiazide diuretics
3) Vomiting
4) Hyperaldosteronism
5) Ingestion of alkaline drugs

168

Osmolarity of medullary interstitium

1200-1400

169

Segment of tubules that is virtually impermeable to water

TALH

170

Most important cause of high medullary osmolarity

TALH