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M2 Renal/FEK > 1. Intro and Review > Flashcards

1. Intro and Review Flashcards

1
Q

intracellular compartment: what portion of total body water? what are Na and K concentrations?

A

8/12 total body fluid (or 2/3). Low Na: 10. High K: 150.

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2
Q

Plasma volume: what portion of total body water? what are Na and K concentrations?

A

1/12 total body fluid. High Na: 140, Low K (4)

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3
Q

Interstitial volume: what portion of total body water? what are Na and K concentrations?

A

3/12 total body fluid. High Na: 140, Low K (4)

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4
Q

what is the primary osmole in intracellular compartment?

A

K+

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5
Q

what is the primary osmole in extracellular compartments?

A

Na+

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6
Q

1200cc of water: how will it distribute?

A

800 to intracellular
300 to interstitial
100 to plasma

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7
Q

1200cc of 0.9% NaCl solution: how will it distribute? (isotonic to plasma)

A

900 to interstitial
300 to plasma
None to intracellular (NO osmotic gradient)

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8
Q

1200cc of KCl solution: how will it distribute? (assume isotonic to plasma)

A

all to intracellular.
none to interstitial
none to plasma

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9
Q

1200cc of 0.45% NaCl solution: how will it distribute? (half of normal saline)

A

divide into half NS and half pure water
600cc water: 400 intracellular, 150 interstitial, 50 plasma
600cc NS: 450 interstitial, 150 plasma

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10
Q

overall kidney functions?

A
  • maintain homeostasis of fluids and electrolytes

- regulate and produce hormones

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11
Q

kidney filtration: where does it occur? what pressure assists with filtration? what is the filtration barrier?

A

occurs in glomerulus. hydraulic pressure in glomerular capillary forces fluid into urinary space. basement membrane provides a filtration barrier

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12
Q

qualities of the glomerular basement membrane (GBM)? what particles will get across easily? what is minimally filtered?

A

charge and size barrier - smaller and + charged particles will move across easily. (electrolytes, glucose, urea are freely filtered). albumin is minimally filtered due to large size and neg charge

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13
Q

in renal physiology, what does it mean that a substance is freely filtered?

A

means that it crosses freely through the GBM. meaning = filtered THROUGH, not filtered OUT.

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14
Q

GFR is determined by what?

A

GFR = hydrostatic pressure - oncotic pressure

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15
Q

how is creatinine handled in the kidney?

A

it can be secreted into the filtrate, but not reabsorbed back into the blood stream

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16
Q

what is the normal GFR?

A

approx 180L/day

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17
Q

where does reabsorption occur?

A

prox tubule

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18
Q

reabsorption and secretion occur where?

A

throughout the rest of the tubule (past prox tubule)

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19
Q

Prox Tubule: what % of filtered substances are reabsorbed here?

A

-reabsorption of 50-90% of filtered substances

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20
Q

Prox Tubule: how does reab generally occur?

A

-reab generally coupled to Na+ uptake

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21
Q

Prox Tubule: how does water generally act here?

A

-water passively follows gradient

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22
Q

Prox Tubule: urine leaving has what tonicity?

A

-urine leaving the prox tub is isotonic to serum

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23
Q

PT: what % Na is reabsorbed here?

A

50-65%

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24
Q

PT: what % HCO3- is reabsorbed here?

A

90%

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25
Q

PT: what % of glucose and AAs are reabsorbed here?

A

100%

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26
Q

Loop of Henle: what kind of transporter works here? what blocks it?

A

Na/K/2Cl COtransporter.

blocked by loop diuretics

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27
Q

LoH: water permeability?

A

descending portion is water permeable

ascending is water impermeable

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28
Q

LoH: tonicity pattern?

A

tonicity increases as you move deeper into medulla. concentrates urine: makes it hypertonic

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29
Q

DT: what kind of transporter? blocked by what?

A

Na/Cl CO transporter

blocked by thiazide diuretics

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30
Q

DT: what happens to tonicity of urine? why?

A

becomes relatively dilute as NaCl is reabsorbed

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31
Q

DT: major site of reabsorption of what cation?

A

Ca2+

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32
Q

CD: what type of channel? blocked by what?

A

Na+ channel (aldosterone dependent)

blocked by K+ sparing diuretics

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33
Q

CD: what type of water resorption here?

A

ADH-dependent water reabsorption via aquaporins

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34
Q

CD: main site for regulating what cation?

A

K+

35
Q

CD: main site for excreting what? what kind of cells are key to this?

A

excretion of acid (H+). intercalated cells.

36
Q

describe the countercurrent mechanism

A

descending limb of LoH is water permeable. urine becomes concentrated as it descends into medulla. ascending limb is water impermeable. NaCl is reabsorbed here, maintaining high osmolality.

37
Q

what 3 hormones are produced by the kidney?

A

renin, erythropoietin, calcitriol

38
Q

what 6 hormones act on the kidney?

A

aldosterone, ANP, AtII, ADH, PTH, calcitriol

39
Q

what ion is the primary determinant of intravascular volume?

A

Na+

40
Q

what will stimulate renin production by the kidney?

A

slow tubular flow rate, low pressure.

renin –> angiotensin –> aldosterone

41
Q

what stimulates Na reabsorption?

A

aldosterone

42
Q

is Na reabsorption stimulated by hyponatremia?

A

NO

43
Q

what is the major regulator of K+ secretion?

A

aldosterone. stimulates Na reuptake, K secretion, and H secretion

44
Q

how do tubular flow rates affect K+ secretion?

A

high flow rates maintain a gradient for K+ secretion

45
Q

how can the composition of the urine affect K secretion?

A

K follows its electrochemical gradient; negative charges in urine will enhance K secr.

46
Q

what is the primary regulator of H+ secretion?

A

pH sensors, aldosterone, H/K channels

47
Q

what effect does aldosterone have on H secr?

A

stimulates H+ secretion

48
Q

what effect does Angiotensin II have on bicarb reabsorption?

A

stimulates bicarb reabsorption

49
Q

H+ secr varies inversely with what levels?

A

K+

50
Q

what quality of the renal medulla makes it possible to reabsorb water?

A

the high osmolality of the renal medulla

51
Q

what quality of the distal tubule makes it possible to excrete water (ie, to dilute urine)?

A

NaCl reabsorption in the water-impermeable distal tubule

52
Q

what is the range for urine osmolality?

A

50-1200 mosm/Kg

53
Q

what regulates the amt of water reabsorption/secretion?

A

ADH

54
Q

what stimulates the release of ADH?

A

osmoreceptors, which detect a rise in plasma osmolality and stimulate ADH release to increase water reabsorption

55
Q

normally, what will shut down ADH secretion?

A

low plasma osmolality (ie, dilute plasma)

56
Q

what will low plasma Na+ do? what will it NOT do?

A

low plasma Na+ will decrease water reabsorption, but it will NOT stimulate Na reabsorption

57
Q

what fraction of water remains in the vascular space (plasma)?

A

1/12

58
Q

how good of a blood volume expander is water?

A

not great, but better than nothing

59
Q

what can override osmolar control to stimulate ADH release?

A

Hypovolemia can override osmolar control and stimulate ADH release irrespective of plasma osmolality.

60
Q

generally, what does disease of the med to large vessels tend to do to the kidney? (ie, renal artery stenosis, atherosclerosis, occlusion of branch arteries)

A

tends to limit blood flow to the glomerulus

61
Q

what happens when blood flow to the glomerulus is limited (perhaps by vascular disease)?

A

renal blood flow decreases but the filtration barrier and tubular function remain intact

62
Q

how does the JGA respond to a drop in renal blood flow?

A

JGA will produce renin when JG cells are NOT stretched by blood volume

63
Q

what is a mechanism to maintain/preserve GFR in the setting of hypertension?

A

efferent arteriolar constriction??

64
Q

what occurs in the late stages of vascular disease?

A

GFR falls despite efferent arteriolar constriction. substances that are normally filtered through will accumulate.

65
Q

define tubulointerstitial disease? what can it lead to?

A

alterations of tubular function that leads to wasting or retention of substances: glycosuria, renal tubular acidosis, potassium disorders, diabetes insipidus.

66
Q

tubular obstruction or necrosis can lead to what?

A

can decrease GFR by back pressure, or possibly by feedback mechanisms

67
Q

how can infection manifest in the kidneys? how will noninfectious inflammation present?

A

bacteriuria (bacteria in the urine) or pyuria (white blood cells in the urine).
noninfectious inflammation will present as sterily pyuria

68
Q

glomerular disease will manifest how?

A

as alteration in the filtration barrier: either proteinuria or hematuria. may also affect GFR.

69
Q

what is glomerulonephritis? what are examples?

A

inflammation of the glomerulus. ex: Goodpasture’s, membranoproliferative glomerulonephritis (MPGN)

70
Q

what is the principal manifestation of glomerulonephritis? what is pathognomonic sign?

A

hematuria.
RBCs are often dysmorphic.
RBC casts are pathognomonic for glomerulonephritis.

71
Q

what is the sine qua non of nephrotic syndrome? what else may be present?

A

proteinuria.

may also have edema, low serum albumin, hyperlipidemia, lipiduria

72
Q

what do we need for dx of nephrotic syndrome? (3 items)

A
  • proteinuria (>3g/d)
  • hypoalbuminemia (<3g/dL)
  • edema
73
Q

if a patient has lost 1L of blood volume, we’d have to use how much NS to replace it?

A

4L (only 1/4 or NS remains in vascular space - since there is Na it will all stay extracellular)

74
Q

urea concentration in plasma compares how to urea concentration in Bowman’s capsule?

A

same: urea filters freely

75
Q

what is a key biomarker for glomerular filtration?

A

creatinine

76
Q

if glucose is found in the urine, what should we conclude?

A

almost always a disease state

77
Q

how does the prox tubule accomplish the job of reabsorbtion?

A

couples reabsorbtion to Na uptake, which causes a chemical gradient.

78
Q

how do thiazide diuretics work? what is a side effect of thiazide diuretics?

A

block Na/Cl cotransporter in early DT. hypercalcemia

79
Q

where are the Principal cells located?

A

collecting duct

80
Q

what will cause the body to get rid of excess sodium?

A

hypervolemia. hypernatremia will not cause this response.

81
Q

mild hypovolemia will induce what response? what about more severe hypovolemia?

A

mild: activates aldosterone. more severe: activates ADH.

82
Q

2 things that activate aldosterone

A

Hyperkalemia

Angiotensin II

83
Q

3 functions of aldosterone

A

H secretion
K secretion
Na uptake (via ENaC)

84
Q

A/B - in event of alkalosis, what happens to K balance? acidosis?

A

alkalosis: hypokalemia - the H gets reabsorbed from the lumen and removes K (via H/K transporter)
acidosis: hyperkalemia

M2 Renal/FEK (20 decks)

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