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A&P Final > 11/13 > Flashcards

11/13 Flashcards

1
Q

Roles of the kidneys:

A
  • manager of blood pressure
  • manger of pH
  • hematocrit
  • electrolyte regulator
  • Vitamin D regulator
  • long term blood glucose levels manager
  • some drug clearance
  • LT metabolic waste disposal
  • osmolarity regulator
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2
Q

if someone has long term High blood pressure then something is wrong with their

A

kidneys

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3
Q

kidney’s roles in managing pH

A
  • decides how much HCO3- to get rid of
  • source of HCO3-
  • in charge of getting rid of excess protons
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4
Q

what is the short term pH regulator system?

A

the lungs

  • They get rid of CO2 which helps lower the pH but they cannot get rid of excess protons
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5
Q

How do the kidneys help control the hematocrit?

A

The deep medullary structures in the kidneys detect low Oxygen levels and releases erythropoietin (EPO) which acts to stimulate the bone marrow to increase RBC production. This should fix the low oxygen problem and increases HCT.

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6
Q

Why is it that you are thirsty a couple of hours after eating a pizza?

A

The intestines just reabsorbs all the Na+. The kidney has to excrete it.

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7
Q

How do we maintain Ca++ levels via the kidneys?

A

The kidneys choose how much to reabsorb.

They also kidney activate Vit. D to help us absorb Ca++ from the food we eat

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8
Q

What is the kidneys role in managing long term glucose levels?

A

The more we filter the more we reabsorb. If BG is a high then the kidney reabsorbs it.

But if BG is really high for a long time (like 900) then it is way higher than the transport/reabsorption max so the kidney’s get rid of it

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9
Q

What is the safety or blow off valve when we have really high blood glucose levels?

A

the kidney

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10
Q

The kidney doesn’t process many drugs, but when it does, how does it work?

A

secretory process

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11
Q

A pt. that has long term severe diabetes, what do they produce besides glucose that the kidney is in charge of clearing?

A

Nitrogenous products like urea

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12
Q

How does the body regulate osmolarity?

A

by choosing to hang on to or get rid of salt and/or water

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13
Q

If NaCl is high in the body then kidney regulates this by:

A

get rid of salt and hold onto water

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14
Q

The kidney has the ability to _______ between sodium and water and therefore can pick and choose what to get rid of and what to hold on to. What is this regulated by?

A

differentiate

ADH and osmoreceptors in the brain

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15
Q

What is the order of the renal blood vessels from renal arteries to renal veins?

A

renal artery
—split—
segmental arteries
interlobar arteries
arcuate arteries
interlobular arteries
afferent arterioles
glomerular capillaries
efferent arterioles
peritubular capillaries
—converge—
interlobular veins
arcuate veins
interlobar veins
segmental veins
renal veins

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16
Q

What is the purpose of the tubular system

A

To reabsorb stuff that has been filtered and to secrete things to get rid of in the urine

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17
Q

What is a collection of blood vessels plus the tubular capillaries?

A

a nephron

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18
Q

How many nephrons do you have at birth?

A

2 million
1 million in each kidney

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19
Q

At what age do you start to lose nephrons?

A

40 yr/old

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20
Q

What is the basic functional unit of kidney?

A

nephron

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21
Q

What are the 2 types of nephrons?

A

superficial nephrons
deep nephrons -medullary nephrons

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22
Q

about ____% of nephrons are cortical

A

90-95%

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23
Q

what % of neprhons are deep medullary neprhons?

A

5-10%

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24
Q

The top of the cortical nephrons will be in the _______

A

cortex

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25
Q

The deeper peritubular capillaries and tubules that are associated with those are where in the nephron?

A

They dip into the outer part of the medulla

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26
Q

Are there a lot of peritubular capillaries of the deep medullary nephrons(vasa recta)?

A

not as many as the peritubular capillaries of the cortical nephrons

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27
Q

One feature of the of the deep medullary peritubular capillaries(vasa recta)?

A

They have an unequal number of descending and ascending capillaries. The ascending capillaries split into multiple but the descending capillaries stay whole.

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28
Q

What is the purpose of the split in the ascending capillaries in the deep medullary capillaries (vasa recta)?

A

Velocity of blood through the ascending blood vessels is slower which is important to maintain a normal number of solutes in the deep interstitium of the renal medulla.

If flow is too fast it will “wash out” the renal interstitium. if you change the concentration of the interstitium this would effect reabsorption.

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29
Q

name of deep medullary capillaries

A

vasa recta

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30
Q

Blood vessels are in charge of delivering nutrients to tissues. Why don’t we have any issue delivering oxygen and nutrients to the cortical nephrons vs the deep medullary nephrons?

A

the deep medullary nephrons only have 5-10% of the vessels. Less vessels= less blood

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31
Q

why are the deep medullary nephrons very sensitive low blood pressure?

A

d/t the limited number of peritubular capillaries. Only 5-10% of the renal peritubular capillaries

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32
Q

what does DVR and AVR stand for?

A

descending and ascending vasa recta

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33
Q

Where are the kidneys housed?

A

right under the diaphragm

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34
Q

What are the renal arteries and veins below?

A

right below the mesenteric arteries

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35
Q

What is seated on top of each of the kidneys?

A

adrenal glands

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36
Q

What are the ureters?

A

collection system of whatever fluid is left over in the tubules that needs to be removed from the body.

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37
Q

what is the purpose of the bladder?

A

to store urine

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38
Q

what is a suprarenal gland?

A

adrenal glands

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39
Q

first part of urine emptying system

A

renal papilla

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40
Q

The top lateral part of the right kidney comes in contact with the?

Lower lateral part of the right kidney comes into contact with the?

A

liver
colon

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41
Q

The top part of the left kidney comes in contact with the ____?

What is the name of this area of the kidney?

A

stomach

gastric surface

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42
Q

The top middle part of the left kidney comes in contact with the ____?

A

pancreas

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42
Q

The top lateral part of the left kidney comes in contact with the ____?

A

spleen

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43
Q

The colon comes into contact with which kidney?

A

Both left and right

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44
Q

Why does it matter what is touching the kidneys?

A

Cancer can spread very easily to things that are in close proximity of it

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45
Q

Why is cancer less likely in the kidneys?

A

the nephrons die off as you get older, they do not proliferate quickly.

Heart also doesn’t proliferate quickly which is why you don’t really hear about heart cancer

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46
Q

Which abdominal quadrant are the kidneys in?

A

right upper quadrant
left upper quadrant

47
Q

The minor calyx come together to form what?

A

the ureter

48
Q

what does the ureter empty into?
where does that empty through?

A

bladder
urethra

49
Q

where can kidney stones happen?

A

calyx
ureter
bladder
urethra

50
Q

Where does it hurt when you have a kidney stone?

A

lower back

51
Q

most kidney stones pass on their

A

own

52
Q

difference between men and women’s urethra

A

men: gland surrounding urethra called the prostate

women: shorter urethra

53
Q

problems with the prostate as men get older:

A

cancer
prostate enlargement

54
Q

why do older men have to go to the bathroom frequently?

A

have a hard time emptying bladder d/t constriction in the prostate.
nearly impossible to completey empty bladder only overflow can be emptied

55
Q

what controls the bladder?

A

SNS and PNS both.

Can lose control of our bladder or can find it difficult to empty the bladder when nervous

56
Q

Control of the emptying of the bladder is typically a function what nerve?

A

pudendal nerve

57
Q

What spinal nerves do the Pudendal nerve come from?

A

S2
S3
S4

58
Q

which nerve controls the solid waste excretion?

A

Pudendal nerve

59
Q

It is important to keep things intact at spinal nerves ________ if you want to keep things off the floor in the OR

A

S2
S3
S4

60
Q

Which nerve runs very close to the prostate gland?

A

Pudendal nerve

removal of the gland is easy but pudendal nerve can get cut inadvertently

61
Q

what is responsible for erections in men?

A

pudendal nerve

62
Q

Bowman’s capsule is also known as

A

corpuscle

63
Q

Order of the kidney tubule:

A

Corpuscle/ Bowman’s capsule
Proximal Convoluted Tubule
Proximal Straight Tubule
Descending Thin Limb of Henle
Ascending Thin Limb of Henle
Thick Ascending Limb
–Macula Densa
Distal Convoluted Tubule
Connecting Duct
Cortical Collecting Duct
outer Medullary Collecting Duct
inner Medullary collecting duct
papillary duct

64
Q

what is located in the Thick ascending limb that tells the kidney how much fluid is being filtered?

A

Macula Densa

a “speedometer”

65
Q

Where in the loop of Henle is the macula Densa?

A

TAL in the loop of Henle
some books say DCT

66
Q

which comes into contact with the afferent and efferent arterioles that controls GFR?

A

macula densa

67
Q

difference between the oMCD and iMCD

A

more superficial
very deep

68
Q

which cells sit next to the afferent and efferent arterioles in the kidney
and detect blood flow ?

A

juxtaglomerular cells

69
Q

what is released from the juxtaglomerular cells at the afferent and efferent arterioles when pressure is sensed to be low?

A

renin

70
Q

what does renin do?

A

eventually increases angiotensin II which preferentially constricts the efferent arteriole which increases pressure in the capillaries which increases filtration which restores flow to something that looks more normal.

71
Q

What happens when the juxtaglomerular cells sense that flow is too high?

A

Less renin is released which vasodilates the efferent arteriole to decrease pressure in the glomerular capillaries

72
Q

associate angiotensin II with

A

something that controls the juxtaglomerular apparatus

73
Q

Famous guy with prostate cancer and why he was famous:

A

Linus Pauling

He was a chemist and was a huge proponent of taking vit. c to slow down or prevent cancer. He ended up living a long time.

74
Q

strong enough antioxidant can slow down or prevent:

A

cancer

75
Q

free radical oxidative stress studies looked at what compounds?

A

vit. C
They were inconclusive

76
Q

How much Vit. C did Linus Pauling take every day?

A

20,000 units vit. C a day

77
Q

what is renal clearance

A

quantity of a plasma that is cleared of a substance per time

mL/min
volume/time

78
Q

If the kidneys reabsorbs a lot of fluid and does not reabsorb the stuff in the fluid then renal clearance is

A

high

79
Q

if kidney reabsorbs a lot of fluid and all of the things in the fluid then renal clearance for that compound is

A

low

80
Q

A dot over the top of a V is the symbol for

A

Volume per unit of time.

81
Q

What symbol is used for urine volume/min?

A

A U with a dot over it.

Same thing as a V with a dot over it

82
Q

What are the characteristics of something that is easily filtered

A

smaller than a protein
positive charge or no charge

83
Q

What would the concentration in the tubule look like compared to the plasma, if you have a compound that is smaller than a protein and positively charged or has no charge?

A

should look about the same as the plasma before it was filtered.

If there’s no impediment to filtering the compound then the concentration in the Bowan’s capsule should look like the concentration at the top of the tubule.

84
Q

About ______ of almost everything gets reabsorbed at the pct

A

2/3

85
Q

Glucose has no problem being filtered from the glomerular capillary into the tubule because it is

A

small and uncharged

86
Q

If there is none of the substance you are filtering in the urine, then the clearance would be ______

What compound should do this?

A

0

glucose. There are transporters that pull all of it back into the cardiovascular system.

87
Q

If you have a compound X that is filtered freely at the glomerular capillaries into the tubule but you don’t reabsorb any of it, how much plasma can be reabsorbed into the CV system? what is this called?

How much fluid/min is excreted?

A

124mL/min

clearance rate

1mL/min

88
Q

If you have a compound X that is filtered freely at the glomerular capillaries into the tubule but you don’t reabsorb any of it, what concentrations would you expect to see:
1. early on in the tubule

  1. later on as reabsorption happens
  2. in the collecting duct
A
  1. same as plasma

l. high since we are actively reabsorbing water but none of the compound.

3.a very high concentration. All of the compound is now in 1mL of fluid

89
Q

If you have a compound X that is filtered freely at the glomerular capillaries into the tubule but you don’t reabsorb any of it, what concentrations would you expect to see in the efferent arteriole?

A

There shouldn’t be much of a change from the plasma because nothing selectively left it behind in the capillaries.

90
Q

If you have a compound X that is filtered freely at the glomerular capillaries into the tubule but you don’t reabsorb any of it, what concentrations would you expect to see in the peritubular capillaries?

A

a very diluted solution because the reabsorbed solution doesn’t have any compound x so the only compound x that makes it to the peritubular capillaries is what snuck through the glomerular capillaries without being filtered.

91
Q

If you have a compound X that is filtered freely at the glomerular capillaries into the tubule but you don’t reabsorb any of it, you would you expect to see a lower concentration of compound in the renal ______ vs renal______

A

vein vs artery

92
Q
  • If the concentration of compound X in the plasma is 1mg/dL
  • If X is freely filterable
  1. How much of compound X did I filter?
  2. what is the concentration of X in the urine? This is also called the excretion rate.
A

Filtration rate: 125mL/min=1.25dL/min
Concentration is 1mg/1dL
You filtered 1.25mg/min

Qty removed or concentration in the urine is 1.25mg/1mL/min urine

93
Q

what is a dL in mL?

A

100mL

94
Q

If you have filtration with no reabsorption or secretion, the clearance rate should be about the same as our?

A

GFR
GFR is 125mL/min
Kidney reabsorbs (clearance) 124mL/min
the rest is excreted.

95
Q

solve for clearance to estimate our GFR
V= 1mL/min
Ux=1.25mg/mL
Px=1mg/100mL

A

C=VU/P
1.25mg/min/1mg/100mL

1.25mg/min X 100mL/1mg

clearance=125mL/min

96
Q

clearance=
Cx=

A

(V*Ux)/Px

urinary flow rate normal is 1ml/min X urinary concentration this is the excretion rate / plasma concentration

97
Q

compound X represented

A

inulin

98
Q

What is the gold standard for figuring out GFR?

A

inulin.

Exogenous compound the kidneys cannot reabsorb and does not secrete.

given iv. let time pass. take 2 measurements to look at urinary plasma concentration at time A and B and then extrapolate GFR

99
Q

Why is in inulin better than cr?

A

inulin doesn’t get reabsorbed or secreted where Cr gets secreted. This would mean using Cr would give us an overestimation of GFR

100
Q

what is cr

A

a biproduct of skeletal muscle metabolism

101
Q

if you have an old patient who hasn’t gotten out of bed in a long time how does this effect Cr?

A

Cr is low

102
Q

Cr gives an artificially ______ GFR

A

high

103
Q

If you have a compound Y that is filtered freely at the glomerular capillaries into the tubule and is then highly secreted, what concentrations would you expect to see in the:

  1. tubule
  2. peritubular capillaries
A
  1. a highly concentrated amount from everything that was filtered plus secreted
  2. little to no compound y if the pump is secreting 99-100% of compound Y back into the tubule
104
Q

formula for secretion rate

A

secretion rate=excretion rate-filtered load

mg/min

105
Q

If you have a compound Y that is filtered freely at the glomerular capillaries into the tubule and is then highly secreted, then the really clearance rate is ______ and is equivalent to

A

very high

renal plasma flow

106
Q

if you know what renal plasma flow is and you have a Hct, you can figure out

A

renal blood flow

107
Q

compound Y is

A

PAH

108
Q

Glomerular filtration rate equation

A

GFR= Uinulin X V/ Pinulin

no unit?

109
Q

Clearance ratio equation

A

Clearance ratio= Cs /Cinulin

no unit

110
Q

Effective renal plasma flow formula

A

ERPF=CPAH=UPAHXV

mL/min

111
Q

formula to convert Renal Plasma Flow to Renal Blood Flow

A

RBF=RPF/1-Hematocrit(usually 0.4)

mL/min

112
Q

What % of the PAH does the kidney normally pull out?

A

90%

113
Q

excretion rate

A

Us X V

mg/min

114
Q

Formula for reabsorption rate

A

Reabsorption rate=(GFRXPs)-(U X V)

mg/min

A&P Final (8 decks)

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