TEST 4 - RENAL SYSTEM Flashcards
(175 cards)
1
Q
The kidneys excrete end products of metabolism from the blood such as what 3 things, and others.
A
Urea
Creatinine
Metabolic acids
2
Q
In coordination with ______, kidneys regulate vascular interstitial, and intracellular osmolality and volume by regulating _______ volume and osmolality.
A
ADH
Urine
3
Q
The kidneys regulate electrolyte and other solute balance of body fluids. TRUE/FALSE
A
TRUE
4
Q
The kidneys regulate this in conjunction with body buffers and the lungs; by far the most powerful at this.
A
Acid-base balance
5
Q
Kidneys are the most powerful acid base buffers, and also the quickest to react. TRUE/FALSE
A
FALSE
Takes them longer to kick in and regulate acid-base balance, but can maintain for days, weeks, years.
6
Q
How do kidneys regulate blood pressure?
A
Controlling vascular volume
Secreting renin
Synthesis of angiotensin II
Aldosterone secretion
7
Q
How do kidneys regulate bone marrow production of RBCs?
A
Secreting erythropoietin
8
Q
Stimulates secretion of EPO
A
Hypoxia of epithelial cells of peritubular capillaries
9
Q
Kidneys Synthesize ______ to the active form, 1, 25-DHCC, which helps regulate calcium and phosphate balance and ______ formation.
A
Vitamin D
Bone formation
10
Q
Kidneys Synthesize various hormones that help regulate renal blood flow, such as what 3 things?
A
PGs (vasodilator)
Enothelin (vasoconstrictor)
Nitric oxide (vasodilator)
11
Q
Kidneys perform ________, the production of glucose from noncarbohydrate substances; also done by the liver.
A
Gluconeogenisis
12
Q
Kidneys help excrete ______ and _______ from the body fluids.
A
Drugs
Toxins
13
Q
Kidneys attached at the souther poles, can have normal fxn, but also can lead to dysfxn.
A
“Horse shoe kidney”
14
Q
Kidney should be ~_____cm longitudinally, nor more than _____cm difference between the two kidneys.
A
~11-13 cm
> 1.5cm difference
15
Q
Where is the kidney located?
A
Retroperitoneal space under ribcage
16
Q
_______ kidney sits slightly lower than the ______ kidney
A
Right sits lower than left
17
Q
Separate organ, sits on tops of kidney; has its own SNS innervation and BF etc.
A
Adrenal glands
18
Q
Kidneys recieve about ______% of CO, they are very vascular.
A
~20-25%
19
Q
Kidney fxn is dependent on renal _______.
A
Bloodflow
20
Q
Amount of blood delivered to the kidneys
A
Renal fraction
21
Q
Lined with smooth muscle, undergoes peristaltic contraction to propel urine to bladder
A
Ureters
22
Q
Other factor other than ureters that moves urine to bladder
A
Gravity
23
Q
If pt is flat for a long period of time, what are they at risk for?
A
Kidney infection
24
Q
What happens when the bladder fills and pressure increases, up to a certain point.
A
Reflexively relaxes
Increase in volume does not directly result in increase in pressure at first
25
_________ impulses sent to brain to let you know you need to pee.
Afferent
26
________ outflow contracts the bladder and relaxes the internal sphincter
Parasympathetic outflow
27
With average CO: renal blood flow is ~ ______ ml/min
100-1200 ml/min
28
Altered RBF = altered __________
Renal function
29
Fibrous capsule that protects kidney, but can injure if trauma, etc occurs.
Renal capsule
30
Kidney is separated into a renal _______ (outer part) and a renal ______ (inner part)
Renal cortex
Renal medulla
31
Pyramids are located here
Renal medulla
32
Urine is formed in the _______
Pyramids
33
After urine is formed it moves through renal _______ into ______ calyx, and then empties into ______ calyx.
Papilla
Minor
Major
34
Renal vein empties into _____
IVC
35
Just as important to have unobstructed outflow of blood as well as inflow. TRUE/FALSE
TRUE
Increased pressure and decreased inflow of blood
36
Renal artery divides into ________ arteries (superior, middle, and inferior)
Segmental
37
Segmental arteries branch into _______ arteries, which run along the sides of the pyramids.
Interlobar
38
When interlobar arteries reach the base of pyramids (outer part), they make a hairpin turn and become ______ arteries, then become _______ arteries, which is at the microscopic level.
Arcuate
Interlobular
39
Interlobular arteries divide into MULTIPLE ______ arterioles, which are delivering blood towards the glomerulus, 12-24 capillaries.
Afferent
40
Capillaries of the glomerulus join back to form _______ arteriole which divides into _______ capillaries that transport blood away form the glomerulus.
Efferent
Peritubular
41
Peritubular capillaries join back together to form _________ veins -- _______ veins--- _____ veins, which then join to form the renal vein and empty into IVC.
Interlobular
Arcuate
Interlobar
42
Vascular and tubular component of the kidney
Nephron
43
Each kidney has how many nephrons?
1-1.25 million nephrons
44
Blood is filtered from the glomerular capillaries and enters __________; which completely surrounds the capillaries.
Bowman's capsule
45
Bowman's capsule empties into the ________ tubule.
Proximal
46
Proximal tubule starts out as _________prox tubule and straightens out to become __________ prox tubule.
Convoluted
Straight
47
The straight proximal tubule thins out and becomes ___________; also called the _________ segment.
Thin descending limb of loop of Henle
Concentrating
48
Loops of henle makes a hairpin turn and becomes ________, or __________ segment
Thin ascending loop of henle
Passive diluting segment
49
Thin, ascending loop of henle becomes ___________ loop of henle or __________ segment
Thick ascending limb
Active diluting segment
50
Thick ascending loop of henle turns into _______ tubule; can be divided how?
Distal
Early and late distal tubule
51
This part of the distal tubule is very similar in form/fxn of thick ascending limb of LOH.
Early distal tubule
52
Late distal tubule is very similar in form/fxn to what? (Next part of the tubule
Cortical collecting duct
53
When tubule gets down to medulla it becomes ________
Medullary collecting duct
54
When does fluid officially become urine? (Cannot be altered at this point)
When moves from medullary collecting duct (renal papilla) into minor calyx
55
Two types of nephrons
Cortical
Juxtomedullary
56
Cortical nephrons compose ~__% of nephrons and most components are located in ____ of the kidney.
~85% (most abundant)
Cortex
57
Juxtomedullary nephrons make up ~___% of nephrons; what is different about their LOH?
~15%
Very long thin LOH that dive way down into medulla of kidney
58
The long, thin LOH of the juxtomedullary nephrons are very important because they are responsible for determining the final _______ and _______ of the urine.
Volume and osmolality
59
Vascular structures that lie adjacent to long, thin LOH in JM nephrons; also play role in final volume/osm of urine.
Vasa recta
60
This lies between afferent and efferent arterioles; plays a role in tubuloglomerular feedback.
Distal tubule
61
Cells associated with distal tubule
Macula densa cells
62
Group of cells affiliated with afferent arteriole; secrete_________.
Juxtaglomerular cells
Secrete renin
63
Collectively JG cells and macula densa are referred to as what? (Play major role in JG feedback)
Juxtoglomerular apparatus
64
3 layers water/solutes must traverse to get form glomerular capillaries into bowman's capsule
Capillary endothelium
Basement membrane
Podocyte cells
65
First layer water/solutes traverse when moving into bowmans capsule
Capillary endothelium
66
Capillary endothelium has openings, larger than normal, in the capillaries; called ________; allow some substances to pass through and prevents others.
Fenestrae
67
RBC, WBC, plts, and albumin should move through the capillary endothelium. TRUE/FALSE
FALSE.
ONLY ALBUMIN should move through
68
Basement membrane has openings as well, strongly lined with __________; allows/prevents substances from moving into capsule
Negative charges
69
RBC, WBC, plts should not move through the basement membrane. TRUE/FALSE
TRUE
70
Why should albumin not be able to move through basement membrane?
Bc it is negatively charges and so is the membrane
71
Podocyte cells have these that should NOT filter RBC, WBC, or plts through to the capsule
Filtration slits
72
What should primarily move to bowman's capsule?
Water and whatever is dissolved in it
73
All 3 layers have negative charges, just the basement membrane has the strongest. TRUE/FALSE
TRUE
74
Blood pressure in the glomerular capillary, moves fluid from the blood to bowman's capsule
Glomerular (hydrostatic) capillary pressure
75
GCP FAVORS/OPPOSES filtration.
Favors
76
Pressure in bowman's capsule that moves fluid from bowman's capsule into the glomerular capillary; opposes filtration
Capsule pressure
77
The blood protein concentration that moves fluid from bowman's capsule into the glomerular capillary by osmosis; opposes filtration.
Blood colloid osmotic pressure
78
Filtration pressure equation
GCP - CP - COP = FP
79
Average GFR in adults
100-125 ml/min
180 L/24hrs
80
_______% of filtrate reabsorbed from tubules into peritubular capillaries and back to systemic circulation; why we don't pee that much.
98-99%
81
Average 24 hr urine output is ______ L.
1-2L per 24 hrs
82
GFR remains fairly constant, despite MAP ~70-180mmHg bc of _________
Autoregulation
83
Innervates both afferent/efferent arterioles; constriction via alpha-1 receptors and decreases glom BF and GFR
SNS
84
What 2 things does tubuloglomerular feedback monitor?
Tubular filtrate flow rate
Tubular filtrate sodium concentration
85
If either flow rate/sodium content decrease, activates what cells>
Macula densa
| JG cells
86
Macula densa of distal activation causes what?
Afferent arteriole dilation
87
Activated JG cells of afferent arterioles causes what?
Secrete renin, produces renin-angiotensin II, abundant receptors on efferent arteriole = constriction
88
TGF increases _______, which increases GFR and helps maintain kidney fxn
GHCP
89
Indirect stimuli for renin secretion from SNS
Nor epi and epi-- alpha1 receptors on smooth muscle of AA-- AA constriction-- decreased blood flow into AA
90
Direct stimuli for renin secretion via SNS
Norepi and epi -- beta1 receptors on JG cells in wall of AA -- increase in cAMP-- increase renin secretion
91
Indirect stimuli for renin secretion via JG cells
Decreased sodium and/or decreased tubular filtrate flow rate at macula densa of distal tubule-- JG cells-- renin
92
Decreased RBF, SNS stimulation (epi/NE), and other stimuli cause JG cells to secrete _______.
Renin
93
Renin converts ________ (protein synthesized in the liver) into ________.
Angiotensinogen
Antiotensin I
94
Antiotensin I is converted to antiotensin II by _______.
ACE
| Angiotensin converting enzyme
95
Where does ACE come from?
Endothelial cells of small arterioles
96
Largest conglomeration of small arterioles where ACE is synthesized?
In the lungs
97
Other than converting angiotensin I to II, ACE decreases _________, which causes blood vessels to dilate normally.
Bradykinin
98
Angiotensin II is a potent _________ of arteries and veins; this results in increased ______, ______, _____, and _____.
Vasoconstrictor
Increased MAP,
Venous return
Preload
SV and CO
99
Angiotensin II, also has a direct effect on _______ and _______ which favors renal reabsorption of ____ and ____; this results in increased vascular volume, etc.
Renal tubules
Peritubular capillaries
Na+ and H2O
100
Antiotensin II is also a very potent stimulus for ______ secretion from the adrenal cortex.
Aldosterone
101
Aldosterone favors this, which results in increased vascular volume.
Renal reabsorption of Na+ and H2O
102
All of the effects of angiotensin II result in increased _______.
RBF
103
When RBF is increased, it sends _______ message back to the JGA to decrease renin secretion.
Negative feedback
104
Glomerular and tubular process where movement of water/solutes from lumen of tubules back into peritubular capillaries.
Tubular reabsorption
105
Glomerular and tubular process; movement of water/solutes from the peritubular capillaries back into the lumen of the tubule.
Tubular secretion
106
3 components for glomerular and tubular processes
Glomerular filtration
Tubular reabsorption
Tubular secretion
107
Secretion and reabsorption can occur anywhere throughout the tubule. TRUE/FALSE
TRUE
108
Amount of solute filtered from glomerulus into tubular lumen (MINUS) total amount _________ form filtrate of tubular lumen into blood of peritubular capillaries (PLUS) total amount _______ from blood of peritubular capillaries into filtrate of tubular lumen = amount excreted into the urine or _________.
Reabsorbed
Secreted
Clearance
109
Clearance is how much of a solute is cleared by the kidneys each _________.
Minute
110
We can use _______ clearance as a clinical estimate of GFR.
Creatinine
111
GFR is a good indicator of kidney fxn. True/false
TRUE
112
The reason we use creatinine is bc why?
No problem getting into tubular lumen, readily filtered from glomerular capillaries into tubular lumen.
113
___% additional creatinine is secreted into _______ tubule; slightly overestimates GFR.
~10% or less
Proximal tubule
114
There is _____ reabsorption of creatinine from the tubular lumen
ZERO
115
This test requires one blood sample and lab measures volume of urine, UrCr, and Scr.
Cr. Clearance; 24 hr urine collection
116
UrVol (ml/min) x UrCr (mg/dl) / Scr (mg/dl)
Creatinine clearance; 24 hour urine sample
117
End result of CrCl equation is in ___/___, which indicated GFR; normal value is _______.
ml/min
100-125ml/min
118
(140-age in yrs) x (body wt. in kg) / 72 x Scr (mg/dl)
CrCl; Cockcroft-Gault method
119
With the Cockcroft-Gault method, you must multiple females results by ___%
85%
120
Cockcroft-Gault method overestimates GFR and renal fxn in _____ and ______ pts.
Obese
| Fluid overloaded
121
This type of cell makes up which part of the tubule?
Large, cuboidal epithelial cells/endothelial cells (line the inside of the tubule)
Proximal tubule
122
This type of cell makes up which part of the tubule?
Tons of mitochondria; lots of ATP and lots of active Tx.
Distal tubule
123
This type of cell makes up which part of the tubule?
Cells can change permeability to water dramatically; can be completely permeable/very impermeable
Medullary collecting duct
124
This type of cell makes up which part of the tubule?
Rudimentary border, small nucleus, few mitochondria and no transport proteins
Descending loop of LOH
125
This type of cell makes up which part of the tubule?
Luminal border faces inside of tubule; increases surface area and rapid reabsorption of solutes
Proximal tubule
126
This type of cell makes up which part of the tubule?
Active diluting segment; pumping out sodium, potassium, and chloride = diluting tubular filtrate
Distal tubule
127
This type of cell makes up which part of the tubule?
Permeability determined by presence of ADH, when present very permeable, when absent, impermeable.
Collecting duct
128
This type of cell makes up which part of the tubule?
Large nucleus, lots of DNA synthesis; lots of mitochondria = ATP for active tx of solutes from lumen to peritubular capillary
Proximal tubule
129
This type of cell makes up which part of the tubule?
Allow concentration of tubular filtrate; water is moving out into interstitium and sodium is staying in.
Descending LOH
130
This type of cell makes up which part of the tubule?
Basal border cells face interstitium which would face peritubular capillary
Proximal tubule
131
Overall, the _______ favors rapid reabsorption of filtrate
Proximal tubule
132
Present on basal border of tubular cell; necessary for secondary-active co-transport.
Primary active Na-K pump
133
Na-K pump pumps _______ out and _______ in everytinme it cycles; creates and maintains gradient for )________ to move from tubular lumen into the proximal tubule cell and eventually to peritubular capillary
3 Na out
2 K in
Sodium
134
There is a transport proteins on the brush border; AA and Na bind to binding site on tx protein at the same time; ____ goes with its gradient and ____ travels across with it, but against its conc gradient.
Na
AA
135
Under normal conditions, 100% of AA should be reabsorbed from the proximal tubule by secondary active co-tx along with Na, should never have AA in your urine. TRUE/FALSE
TRUE
136
This is also transported via secondary active cotransport; transport maximum is present
Glucose
137
100% of filtered glucose should be reabsorbed from the proximal tubule by secondary active cotransport along with Na. TRUE/FALSE
TRUE
138
K is also transported via secondary active cotransport, but what is different from it and AA/glucose?
Not all K is reabsorbed from the proximal tubule
139
This allowed buffering of H+ by excretion into the urine; maintains acid/base balance
Secondary active counter-transport of sodium-H+
140
Normal tubular load of glucose filtered from glomeruli into tubular lumen each minute
~125mg/min
141
If you have normal absorption/tubular load, you should have only small amount of glucose in the urine. TRUE/FALSE
FALSE
Should be NO spillage of glucose into urine
142
Tubular threshold is _______mg/min, where tx proteins are becoming saturated and cannot take on any more glucose.
~220 mg/min
143
At this point, glucose tx's are completely saturated and no more glucose can be reabsorbed. There is a direct linear relationship b/w increase in glucose and urine spillage
Tubular tx maximum
| ~320 mg/min
144
Tubular load equation
Blood glucose x GFR
145
Tubular load of glucose is a good indicator/representation of blood glucose. TRUE/FALSE
Why?
FALSE
NOT a good indicator; dependent on GFR
146
65-70% of ____ is actively reabsorbed
Sodium
147
65-70% of_______ reabsorbed via secondary active co-tx with sodium
K
148
65-70% of _____ passively reabsorbed
Calcium
149
~100% of _______ reabsorbed; regulated by PTH
Phosphate
150
25% ______ actively reabsorbed
Magnesium
151
________ is passively reabsorbed with cations; negatively charged
Chloride
152
100% of these two things are reabsorbed via secondary active co-tx
AA
| Glucose
153
100% of ______ reabsorbed by pinocytosis; very damaging to kidneys
Proteins
154
10% additional _______ secreted into tubule; overestimates GFR/kidney fxn
Creatinine
155
65-70% of ________ reabsorbed by osmotic gradient created by sodium reabsorption
Water
156
Acid-base balance begins where?
Secondary active countertransport
157
Volume of filtrate decreases by 65-70%, but osmolality DOES NOT CHNAGE and remains ~300 mosm throughout the proximal tubule; TRUE/FALSE
TRUE
158
Proximal tubule invaginates and absorbs ________, broken down to ______, then eventually reabsorbed back into peritubular capillary and into body fluids
Proteins
| AA
159
At the end of the LOH and additional ______% of Na, K, and water is reabsorbed; so ~______% of these are reabsorbed totally.
25-27%
95-97%
160
3 layers of the adrenal cortex
Zona glomerulosa
Zona fasciculata
Zona reticularis
161
Outer layer of adrenal cortex secretes aldosterone
Zona glomerulosa
162
Middle layer of adrenal cortex that secretes cortisol
Zona fasciculata
163
Innermost layer of adrenal cortex, secretes androgens
Zona reticularis
164
2 major stimuli for aldosterone secretion
Hyperkalemia
| Angiotensin II
165
Other stimuli for aldosterone secretion; not the two main ones
Hyponatremia
| ACTH from ant pit
166
Steroid based hormone; can directly cross cell membrane and bind to preceptors
Aldosterone
167
After aldosterone binds with receptors, there is increased activation of ________.
Ribosomal transport proteins
168
3 layers of the adrenal cortex
Zona glomerulosa
Zona fasciculata
Zona reticularis
169
Outer layer of adrenal cortex secretes aldosterone
Zona glomerulosa
170
Middle layer of adrenal cortex that secretes cortisol
Zona fasciculata
171
Innermost layer of adrenal cortex, secretes androgens
Zona reticularis
172
2 major stimuli for aldosterone secretion
Hyperkalemia
| Angiotensin II
173
Other stimuli for aldosterone secretion; not the two main ones
Hyponatremia
| ACTH from ant pit
174
Steroid based hormone; can directly cross cell membrane and bind to preceptors
Aldosterone
175
After aldosterone binds with receptors, there is increased activation of ________.
Ribosomal transport proteins
