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Semester 2 (1st year) > Wk 26 > Flashcards

Wk 26 Flashcards

1
Q

What are the 5 roles of the kidneys in homeostasis?

A

Fluid and electrolyte balance

Acid base balance

Endocrine functions

Waste excretion

Blood pressure control

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2
Q

What are the 3 major tasks the kidney performs to produce urine?

A

Filtration

Reabsorption

Secretion

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3
Q

What are the 3 parts of the kidney? anatomy

A

Cortex

Medulla

Pelvis

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4
Q

What does the cortex contain? (filtering apparatus- 2 things)

A

Renal corpuscles and convoluted tubules

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5
Q

What does the medulla contain? 3

A

Blood vessels

Loops of Henle

Collecting ducts

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6
Q

What does the pelvis of the kidney do?

A

Receives urine and sends to ureters

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7
Q

What are the kidney artery and vein?

A

Renal artery and renal vein

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8
Q

What are the functional units of the kidneys?

A

Nephrons

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9
Q

What are the 2 classes of nephrons?

Which are more common?

A

Cortical nephrons (more common -85%)

Juxtamedullary nephrons

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10
Q

How do kidneys maintain fluid and electrolyte balance…

What determines electrolyte balance?

What is it largely regulated by?

A

Balance of filtration, reabsorption, secretion (excretion of water and electrolytes must match intake)

Endocrine signals

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11
Q

How do kidneys maintain acid-base balance?

What affects concentrations and pH in tubules?

A

Bicarbonate buffer system

Electrolyte concentrations

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12
Q

What hormones (not all hormones) does the kidney produce? 4

A

Erythropoetin (in response to cellular hypoxia)

Renin

Prostaglandins

Vitamin D

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13
Q

What 6 hormones have affects on the kidney?

A

Atrial natriuretic peptide (reduce blood vol)

Antidiuretic hormone (increases blood vol)

Aldosterone (increase blood vol)

Cortisol

Parathyroid hormone

Calcitonin

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14
Q

What is the Juxtaglomerular Complex made up of?

A

Part of the afferent arteriole, just before it enters the Bowmen’s capsule and a set of the DCT of the same nephron

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15
Q

What do juxtaglomerular cells do?

A

They contain renin so when the systolic blood pressure is low in the afferent arteriole, they release renin which activates the angiotensin system which increases BP

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16
Q

What are macula densa cells?

What do they do?

A

Modified DCT cells in the juxtaglomerula complex

They are sensitive to Na conc co when there is lower BP, there is lower amounts of Na coming by so it stimulates the release of renin via juxtaglomerula cells

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17
Q

What are Lacis cells/ Polkissen cells?

A

Extra glomerular mesangial cells

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18
Q

What is the waste excreted by the kidneys?

A

Nitrogenous wastes (urea, creatinine)

By-products of metabolism (Ammonia, uric acid, urea, creatinine)

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19
Q

Protein deamination occurs in the liver and the product is ammonia (NH3) which is toxic.

What does it turn into?

A

NH3 goes into the urea cycle and produces urea (which is excreted by the kidneys)

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20
Q

Nucleic acid components (nucleosides) are metabolised into…

Pyrimidines (cytosine, uracil and thymine)=

Purines (adenine, guanine)=

A

Pyrimidines= NH4 (which enters urea cycle)

Purines= uric acid

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21
Q

What does the urea cycle and where does it take place?

A

It converts ammonia to urea

Takes place in the mitochondria and cytosol of hepatocytes

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22
Q

What is creatinine the breakdown product of?

A

Creatine and phosphocreatine

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23
Q

What is Azotaemia?

A

Increased circulating nitrogenous products (BUN- blood urea nitrogen) due to kidneys not excreting waste properly

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24
Q

What are the effects of Nitrogenous wastes (primarily urea and creatinine) on the CNS?

How do the nitrogenous wastes affect the digestive system?

How does it affect the skin?

A

Confusion
Seizures
Coma

Loss of appetite
Nausea
Mucosal bleeding

Pruritus and ‘uraemic frost’ on skin as urea crystalises

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25
Q

When the kidney is struggling and it doesn’t clear waste as efficiently, Gout and Nephrolithiasis (kidney stones) occur- why is this?

A

Because decreased uric acid clearance so higher concentration in blood so it crystalizes in joints (gout) and in the kidneys

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26
Q

How do the kidneys change blood pressure?

A

Direct effect on blood volume

Indirect effect on vascular tone through release of endocrine signals

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27
Q

Kidneys excrete…

Which solutes?

Which nitrogen compounds?

A 
Solutes: 
Sulfates
Phosphates
Na
K
Small conc of Ca, Mg, HCO3 
Nitrogen compounds: 
Ammonia/ Ammonium 
Urea
Uric acid 
Creatinine
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28
Q

What are Glomeruli?

What happens at the glomerulus?

A

Glomeruli= capillaries in the capsule of the nephron

Glomerulus is where filtration occurs

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29
Q

What filters through the glomerulus?

Is this active or passive?

A

Water and small plasma components

Passive (driven by blood hydrostatic pressure)

30
Q

Hydrostatic vs osmotic pressure=

A

Hydrostatic is going from high to low pressure

Osmotic pressure is blood following where the highest concentration is

31
Q

Where does the most resorption occur?

What are the 2 types of passive resorption?

What is the active type?

A

Proximal convoluted tubule

Osmosis, facilitated diffusion
Driven by counter current exchange

ATPase pump

32
Q

What are the main substances that get through the glomerular filtration barrier?

A 
Na
K
Cl-
H2O
urea
Glucose

(hemoglobin and serum albumin are big so only a tiny bit of these get through)

33
Q

Proximal convoluted tubule…

What is reabsorbed into the blood?
What is secreted into the tubule?

A

65% of filtrate volume is reabsorbed

  • H2O
  • Na, HCO3 and other ions
  • Glucose, AA and other nutrients

H+ and NH4 (also some drugs) secreted

34
Q

Loop of Henle…

What is reabsorbed into the blood?

What is secreted into the tubule?

A

H2O
-Na, K, Cl-

Urea

35
Q

Distal convoluted tubule…

What is reabsorbed into the blood?

What is secreted into the tubule?

A

Aldosterone causes reabsorption of Na, Cl-

K+

36
Q

Collecting duct….

What is reabsorbed into the blood?

What is secreted into the tubule?

What can be both and why?

A

H2O and Na and urea

K+

To maintain blood pH, reabsorption or secretion of H+, HCO3- and NH4+

37
Q

How many layers does the Glomerular filtration barrier have and what are they?

A

3

Endothelial cells

Glomerular basement membrane

Epithelial cells (podocytes)

38
Q

What percentage of glomerular filtration rate is excretion of urine?

A

1%

39
Q

What controls glomerular plasma flow and glomerular filtration rate?

A

Afferent and efferent arteriole resistances

40
Q

What mechanisms keeps renal blood flow and glomerular filtration rate relatively constant?

A

Renal myogenic response and tubuloglomerular feedback (TGF) mechanism

41
Q

What is the myogenic response?

A

Afferent arterioles can detect changes in vessel circumference by contracting or relaxing (decreasing or increasing glomerular filtration rate)

42
Q

What is Tubuloglomerular feedback….

What mediates it?

How does it work?

A

The juxtaglomerular apparatus mediates it

The macula densa cells in the distal convoluted tubule sense an increase in GFR so they tell the juxtaglomerular cells to contract the afferent arteriole, which lowers the GFR

43
Q

What is the juxtaglomerular complex consist of?

What cells are in this complex?

A

Part of the afferent arteriole, just before it enters the bowman’s capsule and a section of the distal convoluted tubule of the same nephron

Macula densa cells

Extraglomerular mesangial cells (Lacis cells/ Polkissen cells)

Granular cells (juxtaglomerular cells)

44
Q

What do juxtaglomerular cells do?

A

They contain renin so when they sense a decrease in BP in the afferent arteriole, they release renin (stimulates the renin-angiotensin-aldosterone mechanism) increasing BP

45
Q

What are macula densa cells and what do they do?

A

Modified DCT cells

They sense Na conc (indicates BP) and they stimulate release of renin if BP is low

46
Q

How does Arginine Vasopressin affect renal blood flow and therefore GFR?

A

Decreases vascular resistance so increases renal blood flow and GFR

47
Q

How does Atrial Natriuretic Peptide (ANP) affect renal blood flow and GFR?

A

Vasodilates so increases renal blood flow and GFR

48
Q

Do these things decrease or increase GFR?

Adrenalin/ Noreadrenalin?

Endothelin?

Nitric oxide?

Prostaglandins?

A

Decrease

Decrease

Increase

Increase

49
Q

*Prostaglandin synthesis occurs throughout the kidney

Which prostaglandins are most important in the kidney?

How do they affect GFR?

A

PGE2 and prostacyclin (PG12)

They increase GFR

50
Q

What class of enzymes are important for (phase 1) drug metabolism in the kidney?

A

Cytochrome P450 enzymes

51
Q

What does metabolism do to drugs to make them more easily excreted?

A

Makes them more hydrophilic and more polar

52
Q

Drugs excreted from the liver into the bile have 2 possible fates, what are they?

A

1) into poo

2) Get reabsorbed in SI and go into portal vein, back to liver and into systemic circulation

53
Q

What are the 2 transporters in Active tubular secretion?

A

Organic cation transporter (OCT) [positive molecules]

and

Organic anion transporter (OAT) [negative molecules]

54
Q

How can drugs enter the proximal convoluted tubule (other than OCT and OAT)?

A

Passive diffusion if molecule is uncharged

Facilitated diffusion (if charged or uncharged too)

55
Q

What types of molecules undergo net passive reabsorption back into the blood?

What is pH trapping?

A

Uncharged, weakly acidic or weakly basic

In distal tubule, ionized molecules aren’t able to passively travel back into blood so they are trapped and end up in urine

56
Q

What 3 things affect renal clearance?

A

Protein binding

Blood flow

Functional state of nephrons

57
Q

What 3 things happen in Chronic Kidney Disease (CKD)?

What does this lead to?

A

Interstitial fibrosis
Tubular atrophy
Nonfunctional glomeruli

  • Drop in GFR
  • Increased permeability of arterioles and glomerulus
58
Q

What are the 4 distinct phases of renal drug excretion?

A

1) Glomerular filtration
2) Active tubular secretion
3) Passive tubular reabsorption
4) Active tubular reabsorption

59
Q

What happens to the rate of drug elimination as the plasma drug concentration increases?

A

It also increases until the elimination mechanisms are saturated (Vmax) and then it plateaus

60
Q

What is a drug’s half life?

A

The time taken for the plasma conc of a drug to drop by half its original conc

61
Q

What 2 things can prolong half life of a drug?

A

Drop in the clearance or an increase in the distribution of the drug (because it is bound to protein and can’t be excreted)

62
Q

Where are aminoglycosides almost entirely excreted in the nephron?

What does this mean for someone with kidney impairment?

A

Excreted by glomerular filtration so really short half life

When kidney function impaired, half life is prolonged massively so you have to know the kidney function before administering these drugs or you can overdose

63
Q

What are the 3 main causes of Chronic Kidney Disease?

A

Diabetic nephropathy

Hypertension

Glomerulonephritis

64
Q

What are the 4 systemic effects of CKD?

A

Hypertension

Oedema (because of protein loss)

Dyspnea (because of metabolic acidosis so lungs try and breathe off acid)

Anaemia (because kidneys not making erythropoetin so bone marrow doesn’t make RBCs)

65
Q

Diabetic nephropathy is related to chronic hyperglycaemia and ischaemia and it also damages the glomerular basement membrane causing:

Symptoms and signs of this are known as:

The key feature of this is:

This leads to __ma and ______emia

A

Glomerulosclerosis

Nephrotic syndrome

Proteinuria

Odema and hyperlipidaemia

66
Q

What does angiotensin II do to the efferent arteriole?

A

Constricts it so GFR increases

67
Q

How does hypertension affect the small blood vessels in the kidney?

What does that lead to?

This signals _____ to be secreted, which ____ blood pressure

A

It damages them

Reduction in GFR

Renin

Raises (now even more hypertension)

68
Q

Acute Renal Failure types…

Pre-renal=

Intrinsic=

Post-renal=

A

Pre-renal= marked decrease in renal blood flow

Intrinsic= damage to structures within the kidney

Post-renal= obstruction of urine outflow from kidney

69
Q

Pyelonephritis vs glomerulonephritis

A

Pyelonephritis= usually ascend from UTI becomes from ureter into PELVIS (pyelo and pelvis)

Glomerulonephritis is pathogen coming down from blood into kidney
(can get post strep pyogenes GN)

70
Q

What are the symptoms of nephritic syndrome?

A 
Hypertension
Haematuria 
Proteinuria 
Odema 
Oliguria (not producing much urine) 
(Flank pain, nausea, vomiting, anorexia)
71
Q

Kidney stones

What are the 2 names?

What is the name for the insoluble stones and where do they get stuck?

What are the major components of kidney stones?

A

Nephrolithiasis or urolithiasis

Urinary calculi

They get stuck in the renal pelvis

Main components:
Calcium
Phosphate
Urate

Semester 2 (1st year) (13 decks)

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