Zoltan's Kidney Failure Flashcards
(149 cards)
1
Q
What is the apex of a medullary pyramid called?
A
A renal papilla
2
Q
How many nephrons are there in a kidney?
A
1,000,000 (10^6)
3
Q
Where are erythropoietin producing cells located?
A
In the renal cortex
4
Q
Are kidneys intrapertioneal or retroperitoneal?
A
Retroperitoneal
5
Q
Where is the main site of Mg2+ reabsorption?
A
Thick ascending limb
6
Q
What happens to proteins larger than 70kD at the basal lamina of the glomerulus?
A
They are excluded and not filtered
7
Q
What do loop diuretics inhibit?
A
Inhibit Na+-K+-2Cl- pump
8
Q
What is the thin transparent tough capsule surrounding the kidneys?
A
Renal capsule
9
Q
Why is the collecting tubule negative?
A
ENac channels
10
Q
What is clearance equal to in terms of urine and plasma concentration and urine volume?
A
(urine conc. divided by plasma conc.) x urine volume
11
Q
How long is the long axis of a normal kidney?
A
10 cm
12
Q
Which cells detect [Na]+?
A
Macula densa cells
13
Q
How is the pH of someone’s blood tested?
A
A sample of arterial blood
14
Q
What is the current preferred term for impaired kidney function with rapid onset?
A
Acute kidney injury
15
Q
Name a drug that causes K+-sparing diuresis
A
Spirolactone
16
Q
What causes pressure diuresis?
A
Prostaglandins and nitric oxide
17
Q
Where do renal arteries usually arise from?
A
Lateral aspect of the abdominal aorta just below the superior mesenteric artery at L1/2
18
Q
What does ADH cause reabsorption of?
A
Water and urea
19
Q
What is the retroperitoneal organ lying between the kidneys?
A
The pancreas
20
Q
What is the fat deep to the renal fascia known as?
A
Perirenal fat
21
Q
What is Tm for glucose?
A
380mg/min
22
Q
Where are ENaC channels found?
A
Late distal tubule and collecting duct principle cells
23
Q
Where do the afferent nerves of the kidney go to?
A
T10-11 carrying sensory information
24
Q
Does the DCT or PCT contain more urea?
A
DCT
25
What is the pKa of bicarbonate?
6.1
26
Which receptors and second messengers does ADH work via?
cAMP, V2 receptors and aquaporin-2
27
What muscles do the kidneys come into contact with and how?
Diaphragm is superior to the kidneys
Transversus abdominis is lateral and posterior to the kidneys, quadratus lumborum is middle and posterior and psoas major is medial and posterior
28
Does angiotension II constrict the efferent or afferent arteriole more?
Efferent
29
What kind of muscle surrounds ureters?
Smooth muscle
30
Which part of the Loop of Henle pumps out Na-K-2Cl?
The thick ascending limb
31
Which substance has a clearance most closely reflecting GFR?
Inulin
32
Which cells secrete renin and when?
Juxtaglomerular cells in response to low plasma [Na+] and low blood pressure
33
Which part of the Loop of Henle is impermeable to water?
The whole ascending limb
34
Where is ADH released from?
The posterior pituitary
35
Where do the PCT and afferent arteriole come into contact?
At the juxtaglomerular apparatus
36
How does the vena cava lie at the level of the kidney?
Right and anterior to the aorta
37
When are renal blood flow and glomerular filtration rate increased?
After feeding
38
Where does net H+ secretion occur?
In the collecting duct
39
How does the liver respond to acidaemia?
Producing glutamine from glutamate
40
What does acidosis cause?
Hyperkalemia
41
Where is oncotic pressure higher than hydrostatic pressure
In part of the efferent arteriole and peritubular capillaries
42
What are the three zones of the cortex of the suprarenal glands?
Zona glomerulosa, zona fasciculata and zona reticularis
43
What is the NHE pump?
Na+/H+ antiporter to secrete H+
44
What is the most important buffer in blood?
HCO3-
45
Where are mesangial cells found?
In the glomeralus
46
What does the paracellular pathway allow reabsorption of?
Water and ions
47
What percentage of nephrons have a long loop of Henle?
12%
48
Where do anatomical end-arteries supply in the urinary system?
The kidney lobes but not sections of the ureter
49
Where do arcuate arteries run?
Between renal cortex and renal medulla
50
What does hypokalemia result in?
Neuromuscular depression
51
Where else except the kidney do renal arteries give branches?
A small inferior suprarenal branch to the suprarenal gland and a branch to the ureter
52
How are right and left suprarenal glands shaped?
Right: triangular
Left: crescent shaped
53
How is filtered protein reabsorbed?
Endocytosis
54
What does calcium bind to in DCT epithelial cells?
Calbindin
55
What does the counter-current multipler partially depend on?
Action of ADH on urea transport
56
What is the diameter of a filtration slit?
25-65 nm
57
What happens to the osmolality of fluid as it ascends the loop of Henle?
Decreases osmolality
58
What is a renal pyramid?
A segment of renal medulla ending at the renal papilla
59
What is a medullary ray?
A projection of renal medulla into renal cortex
60
What does the vasa recta supply?
The renal medulla
61
What is normal bicarbonate concentration?
24 mM
62
Where do thiazide diuretics work? What do they inhibit?
DCT. Na+-Cl-
63
Where are the kidneys located in terms of vertebra, costal cartilage and plane?
At vertebra T12- L3, 11-12th costal cartilage in the transpyloric plane
64
How are amino acids reabsorbed?
Via Na+ cotransporter
65
How much K+ is filtered and excreted?
5%
66
How many lobes does a kidney have?
10-18
67
What is the normal range for urine concentration?
60-1400 mOsm
68
What is the autonomic innervation of the kidney?
Sympathetic T10-12 controlling renal perfusion
69
How many litres of plasma do the kidneys filter per day?
180 L
70
Why is the basolateral membrane of the PCT covered in many interdigitations?
For many Na+/K+ATPase transporters
71
How is inulin treated by the kidneys?
Filtered and none reabsorbed
72
Where does ADH increase water reabsorption?
Collecting duct
73
Where are the ureters compressed?
The pelvo-ureteric junction, external iliac artery and uretero-vesical junction
74
What does the macula densa sense and what does it release?
Senses Na+, K+ and Cl-
| Releases adenosine
75
What happens to kidneys during chronic kidney disease?
They shrink
76
What do thiazide diuretics inhibit?
Na+-Cl- pump in early DCT
77
What is normal H+ concentration?
40 nM
78
What is normal anion gap metabolic acidosis due to?
Bicarbonate loss
79
How is glomerular filtration rate autoregulated?
Intrinsic constriction of afferent arteriole and tubuloglomerular feedback from DCT
80
Where are macula densa cells found?
In the DCT
81
Which diuretics are often used together?
Furosemide and amiloride
82
What do mesangial cells do?
Carry out phagocytosis
83
What is the normal pH of urine?
3-5
84
What do podocytes share a basal lamina with?
Fenestrated glomerular endothelium
85
How does sodium excretion in kidney determine blood volume?
Indirectly, by altering plasma osmolarity
86
Which side does the renal vein receive the gonadal vein on?
The left
87
How do oncotic and hydrostatic pressures change as you move along the glomerular capillaries?
Hydrostatic remains the same and oncotic pressure goes from low to high
88
What is average glomerular filtration rate?
120ml/min
89
Where are Vitamin-D producing cells located?
In the proximal tubule
90
What does increased H+ conc. do to K+ conc.?
Increases it
91
When does the collecting duct become permeable?
In response to ADH
92
Where does ketoacidosis affect water reabsorption?
In the collecting duct
93
What can cause hyperkalemia?
Renal failure, ACE inhibitors
94
How is HCO3- treated by the kidneys?
Filtered and all reabsorbed
95
Which substance is completely filtered and secreted?
PAH
96
What is the glomerulus?
The ball of capillaries through which blood plasma enters the renal tubule
97
What do ROMK channels facilitate?
K+ efflux into the tubule
98
What is the maximum length of a kidney tubule?
55mm
99
What does renin cause?
Conversion of angiotensinogen to angiotensin
100
What finding may indicate kidney disease?
A GFR below 60 ml/min
101
Where is fluid hypotonic in the absence of ADH?
DCT and collecting duct
102
What does the clearance of a substance which is completely filtered and secreted equal?
Renal plasma flow
103
How much water and NaCl is absorbed in the PCT?
50% of both
104
What does the zona reticularis do?
Secretes precursors of steroid sex hormones
105
Where do osmotic diuretics work? What do they inhibit?
Entire tubule, none
106
Where does active reabsorption of NaCl take place?
In the thick ascending limb, distal tubule and collecting duct
107
Where do loop diuretics work? What do they inhibit?
Thick ascending limb. Na+-K+-Cl-
108
When will the clearance of a substance equal GFR?
When it is filtered, not secreted and not reabsorbed
109
What does aldosterone do to K+ and Na+?
Causes K+ excretion and Na+ reabsorption
110
Where does the suprarenal vein drain into on the right and left?
The vena cava on the right and the renal vein on the left
111
What are the resistances of afferent and efferent arterioles in the glomerulus?
Both high
112
How can diuretics cause hypokalemia?
K+ secretion in collecting duct
113
How is PAH treated by the kidneys?
Filtered, not reabsorbed, and secreted
114
Where does the ureter enter the bladder?
Obliquely into the base of the bladder at the apices of the trigone
115
Where does ADH work?
The principal cells of the collecting duct
116
How do renal arteries divide after they enter the hilum of the kidney?
Into 5 segmental arteries then into interlobar, arcuate and cortical radiate arteries before forming the afferent arteries for the glomeruli
117
How much Mg2+ is reabsorbed in the PCT?
30%
118
What is the consequence of segmental arteries being end arteries?
If they are tied off or blocked then the section of kidney that is supplied by that artery will die (become ischemic)
119
What is anuria?
Daily urine production of up to 50ml
120
What is hydrostatic pressure in Bowman's space?
10 mmHg
121
What are the main urinary buffers?
HPO42- and NH3
122
What is the diaphragm between podocyte foot processes called?
A filtration slit
123
What is the half life of ADH?
15 min
124
How small must a molecule be for filtration of it to be unselective?
10kD
125
When is anion gap relevant?
In metabolic acidosis
126
Which part of the colon does the left kidney lie next to?
The splenic flexure, posteriorly
127
Which kidney does the duodenum lie next to?
Right kidney
128
What happens to H+ and HCO3- in type A intercalated cells of the collecting duct?
H+ is secreted and HCO3- synthesised
129
What can hyperkalemia result in?
Cardiac arrest
130
What does hyperkalemia cause?
Acidosis
131
What is the anion gap?
[measured plasma cations] - [measured plasma anions]
132
How does ANP work?
Inhibiting renin-angiotensin system and ENaC channels
133
Which cells detect blood pressure?
Juxtaglomerular cells
134
What substances does the sodium gradient in the PCT help recover?
Amino acids and glucose
135
What does the zona glomerulosa do?
Controls salt and water balance
136
Where are osmoreceptors located?
Hypothalamus
137
Where does the left kidney reach, posteriorly?
11th rib and L2-3
138
What kind of epithelium has thickened plaques of membrane which can be internalised?
Transitional epithlium
139
What does the zona fasciculata do?
Regulates body carbohydrates
140
What is minimum urine production a day?
400ml
141
What is a nephron composed of?
A renal corpuscle and a renal tubule
142
Where do K+-sparing diuretics work? What do they inhibit?
Collecting tubule. ENaC and ROMK
143
At what concentration will glucose appear in the urine?
11mM
144
What is normal GFR?
125ml/min
145
What is the main pump on the basolateral membrane of the PCT?
Na+-K+ATPase
146
What does the medulla of the suprarenal glands do?
Has chromaffin cells that augment the sympathetic nervous system by secreting adrenaline and noradrenaline
147
Which substance decreases in concentration along the length of the PCT?
HCO3-
148
Which physiological cation is secreted the most?
H+
149
What does Tm apply to?
Reabsorption and secretion
