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A&P Final > 11/15 > Flashcards

11/15 Flashcards

1
Q

why don’t we use inulin more often?

A

more difficult to do
requires more measurements
expensive

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2
Q

A person who normally has a good blood pressure has a bp of 200mmHg today.
What does the kidney do in response to this?

A

constricts the afferent arteriole to protect the kidney. It helps but it isn’t enough to prevent the glomerular capillaries from seeing a higher blood pressure.

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3
Q

If we wanted to turn NFP into something that is more useful then what formula do you use?

A

GFR= kf X NFP

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4
Q

If our kidneys were not very good at autoregulating and we had a renal artery pressure of 200mmHg which lead to a glomerular capillary pressure of 90mmHg, how much fluid would we pee out every minute?

What does this example illustrate?

A

12.5X40mmHg= 500mL/min
500mL/min-124mL/min(reabsorbed)= 376mL/min

That we have to have tight regulation within our kidney or changes in blood pressure would cause huge problems, like dumping fluid when working out.

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5
Q

If we have a low blood pressure, say a renal arteriole BP 50mmHg, and our glomerular capillary BP is 40mmHg, what effect does this have on the kidney?

A

With the pressure so low, it won’t be filtering very much fluid. This means our kidney aren’t very good filters with this low blood pressure.

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6
Q

Reabsorption depends on _______

A

time.
The more time we stay in the tubule the more time we have for reabsorption.

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7
Q

In order to have good filtration you need to have

A

good kidneys. This includes a good blood pressure in the glomerular capillaries to have a good GFR.

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8
Q

If bp is low then the kidneys can’t

A

do it’s job. It can’t selectively choose what to reabsorb and what to get rid of.

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9
Q

if bp is ridiculously high we worry about______ however this isn’t usually an issue, why?

A

increased urine output.

The kidney autoregulates well with intermittent higher pressures.

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10
Q

How does the kidney try to increase pressure to the glomerular capillaries when blood pressure is low?

A

it dilates the afferent arteriole

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11
Q

Oxidative stress like LT diabetes
or LT HTN makes the vessels in the body ______

A

very stiff and thick. This prevents them from being able to relax which means when blood pressure is low in patients with these diseases, they aren’t able to compensate and dilate their afferent arteriole

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12
Q

We can have dysfunction in the afferent arteriole as a result of long term _______

A

HTN

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13
Q

If we have a high renal arterial pressure the majority of the excessive pressure is going to be knocked down by the constriction in the afferent arteriole.
BUT the Glomerular Capillaries still have a higher than normal pressure.
After a long time like 10 years which structures in the glomerular capillaries are damaged?

A

podocytes and fenestrations are effected and you have scarring of the capillary bed.

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14
Q

Long term htn affects which part of the kidney the most?

A

the glomerular capillary.
fenestrations get bigger
podocytes get beat up and don’t hold structure as well.
Could be bulging and leaky which means they can’t really do their job

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15
Q

Can you have the afferent and efferent constricted or dilated at the same time?

A

Yes.

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16
Q

Which drugs effect the Afferent more than the efferent artery?

A

most drugs in the medicine cabinet. He specifically mentions:
b blocker
ca channel blocker
NO donor
Generic pressor constrict both but they all focus more on the afferent.

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17
Q

All drugs Smidt knows of except for angiotensin II effects which vessel more?

A

afferent arteriole

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18
Q

with angiotensin II think

A

efferent arteriole.

constricts both but does efferent more than afferent

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19
Q

If we have a filtration deficiency the kidney can see this at the macula densa. It increases angiotensin II which constricts the efferent arteriole. is the opposite true?

A

Yes, if you have a high bp driving high filtration rate, the macula densa reduces angiotensin II which dilates the efferent arteriole which decreases filtration.

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20
Q

We reabsorb a ton at the ______ tubule

but there is reabsorption of something at every _____of the tubule

A

PCT

segment. some more than others.

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21
Q

______ is freely filtered and not reabsorbed in the PCT, however water is freely reabsorbed in the PCT. This means that we we go down the PCT, the concentration of this substance will be more or less concentrated?

A

Cr

More concentrated.

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22
Q

If we have a normal amount being reabsorbed in the early part of tubule then there should be a normal amount of things like _____ that would make their way to the sensory(macula densa) area

A

a lot of Na+
some Cl-

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23
Q

macula densa looks at how many Na+ go past the sensor per amount of time, in this case each minute. The body uses this to decide what?

A

what filtration rate is

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24
Q

A higher quantity of sodium and chloride being filtered at the glomerular capillaries d/t high filtration rate with a normal amount being reabsorbed means there is a higher amount of NaCl making it to the macula densa. The Kidney interprets this increase in NaCl counts as meaning what? Is this this the correct interpretation?

A

That GFR is high.
Yes, it is correct.

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25
Q

If we have a low GFR we won’t be filtering as many NaCl but we still reabsorb a normal amount. This would reduce the NaCl seen by the macula densa which then interprets this as what?
Is this the correct interpretation?

A

that GFR is low.
That is correct.

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26
Q

How does the macula densa “see” how much NaCl is flowing past it?

A

It acts as a “counter” that looks at the number of Na+ and Cl- and literally counts them as they pass by

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27
Q

Angiotensin II does not only constrict the efferent arteriole to increase GFR, it also

A

increases the number of NaCl that is filtered and then reabsorbed by the PCT. This in turn increases the amount of water that we reabsorb and helps to raise blood pressure

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28
Q

If GFR is normal,
NaCl is normal, and
Reabsorption is normal
then what is the response by Macula Densa?

A

nothing. Everything is working fine.

29
Q

If GFR is normal
NaCl is normal
but Reabsorption is high, this means that less NaCl is going to be seen by the macula densa.
What is the response by the MD?

Which drugs help with this scenario?

What would cause reabsorption to be higher than normal?

A

MD thinks GFR is low when in fact the GFR is fine, just the reabsorption is higher than normal. It would then increase Angiotensin II to constrict the efferent arteriole, but it was normal to begin with. This would cause damage to the glomerular capillaries over time.

ACE inhibitor

A high blood glucose or amino acid concentration being filtered and consequently reabsorbed in the PCT.

30
Q

PCT reabsorbs what?

A

glucose and Na+ and amino acids

31
Q

All of the glucose that gets reabsorbed in the kidney is done where?

A

PCT. It is the only place with transporters and things

32
Q

For every glucose we reabsorb we have to remove ______ with it

A

1 Na+

33
Q

If we had a normal amount of glucose being filtered then we would expect a ______ amount of sodium to be reabsorbed with it

A

normal

34
Q

If we have a BG of 200mg/dL.
More glucose being filtered= more glucose being reabsorbed. How does this effect Na+?

A

Na+ is reabsorbed right along with it at a 1:1 ratio

35
Q

What are a couple of reasons why having high BG is bad?

A

glucose is sticky and gets stuck to things. This activates the immune system to come in and destroy whatever it is stuck to. The glomerular capillaries are prone to this as well as hyperfiltration.

36
Q

What is the word to describe what causes damage to the nephrons with unmanaged high blood sugar?

A

hyperfiltration

The MD tries to do things to increase GFR when GFR is actually fine. This leads to wear and tear of the nephron which makes it die faster. When it dies it puts more work on the remaining nephrons which accelerates kidney damage.

37
Q

Amino acids are small and get filtered

A

easily

38
Q

Body normally reabsorbs _____ amino acids

A

all

39
Q

How does the kidney reabsorb amino acids?

A

Through secondary active transport of Na+

For every Na+ coming into the cell we reabsorb an amino acid.

40
Q

If we have too high of an amino acid concentration in the blood then what happens in the kidney?

A

we have more amino acids filtered.
this means more are reabsorbed.
Since this is connected to Na+, we also reabsorb more Na+. MD thinks the GFR is low and releases Angiotensin II which constricts efferent arteriole and harms kidney.

41
Q

Excessive protein shakes and pre workout causes ______ in the kidney.

A

hyperfiltration

42
Q

The tubular lumen is referred to as the _______ side of a cell.

A

apical tubule

43
Q

What is the name of the side of a cell that makes up the walls of the tubule and faces the interstitium?

A

basolateral

44
Q

The SGLT is a generic Na+/glucose transporter. what kind of transport does it use?

A

secondary active transport.
It uses Na+ concentration gradient to pull in Glucose at a 1:1 ratio

45
Q

If we want the glucose concentration at the end of the tubule to be 0mg/dL, what do we need to accomplish this?

A

energy consuming transporters. The SGLT are not strong enough to pump in glucose at very low concentrations.

46
Q

What is the glut transporter? Where is it found?

A

A transporter on the basolateral side of the cell that allows sodium to leave the cell without using energy.

Glucose is passively going down it’s concentration gradient. It has to have this transporter to leave because it is too big to simply diffuse out.

47
Q

PCT is split into what 3 parts.

A

s1

s2

s3

48
Q

s1 segment is the early part where most of our _______ is reabsorbed.

Which isoforms of glucose transporters are found here and what percent of glucose do these process?

A

glucose

SGLT2 (90%) of glucose reabsorption on apical side. pull in 1 glucose for 1 Na+
They are high efficiency transporters.
Low affinity for glucose compared to other parts of the tubule

Glut 2 transporters are on the basolateral side. No energy required just glucose passively leaving the cell
low affinity high capacity

49
Q

Which isoforms of glucose transporters are found in the s2 segment and s3 segment and what percent of glucose do these process?

A

SGLT1 (10%) mostly in s2, less in s3
2Na+ for 1 glucose
high affinity pump on apical side

Harder to pump a very diluted solution so has a higher affinity low capacity

glut-1 on basolateral side

50
Q

The amount of glucose being filtered is primarily determined by what?

A

What the plasma concentration is of glucose

51
Q

what is a normal blood glucose?

A

100mg/dL

52
Q

What is filtered load?

A

The quantity of “stuff” being filtered.
Dependent on plasma concentration of glucose and takes into account GFR

53
Q

How to solve for filtered load.

A

concentration X flow

100mg/dL X 1.25dL of plasma/min= 125mg/min

54
Q

filtered load is

A

Stuff dissolved in the plasma that is being filtered. If you have a freely filtered thing like glucose then you would expect that the filtered load would equal the plasma concentration of it X the rate at which it is filtered.

55
Q

What is threshold in regards to plasma glucose concentration?

A

The point at which bg is high enough that we should see bg in the urine d/t all the transporters being so overloaded that some glucose sneaks by.

not the same as transport maximum. The transporters aren’t saturated here, they’re just a little overworked and underpaid so some things are slipping through the cracks

56
Q

What is the threshold for glucose showing up in the urine?

A

higher than 100mg/dl but less than 200mg/dl

57
Q

What is transport maximum?

A

a point that is above threshold so high that the reabsorption pumps are completely saturated and they can not change their structure any faster to move glucose any faster. Now every single glucose that shows up that is over their max gets pushed out into the urine.

58
Q

What is the transport maximum number?

A

300mg/dl

59
Q

Where is the macula densa?

A

end of TAL best answer
beginning of DCT

60
Q

Where are the juxtaglomerular cells?

A

They are the cells that surround the afferent and efferent arterioles. They sit next to the macula densa.

61
Q

what is the process of renin release?

A

The macula densa things the GFR is too low and tells the juxtaglomerular cells to release Renin.

62
Q

What is the rate limiting step in the formation of angiotensin II?

A

Renin

63
Q

What is the process of the RAAS system?

A
  • angiotensinogen is produced at the liver.
    1. Renin converts angiotensinogen into angiotensin I
  1. ACE which is found in the lungs turns angiotensin I into angiotensin II which is the signaling arm which acts on the efferent arteriole.
64
Q

If you have
decreased arterial pressure
decreased glomerular hydrostatic pressure
decrease GFR
decreased NaCl at macula densa

What is the primary and secondary reaction of the kidney?

A

PRIMARY
increased renin
increased ang2
increased efferent arteriolar resistance
increases the glomerular hydrostatic pressure
increases GFR

SECONDARY
direct relaxation of the afferent arteriole via Nitric Oxide from the cells.

If decreased arteriole pressure is the root cause of decreases GFR, it would cause a reduced renal blood flow which causes decreased GFR. Constricting the efferent arteriole in itself won’t help the renal blood flow, but if we relax the afferent arteriole, this should drive up pressure in the glomerular capillaries which increases renal blood flow and also increases GFR.

65
Q

angiotensin II causes an increase in the amount of NaCl and water reabsorbed in the PCT, how does it do this?

A

by constricting the efferent arteriole it drives up the filtration rate. The more that is filtered means more is reabsorbed. The more NaCl that is reabsorbed means more water is reabsorbed. This helps with blood volume which helps blood pressure.

66
Q

SGLT2 inhibitor helps with weight loss in theory but the side effects include:

A

glucose in urethra= breeding ground for bacteria
glucose sticks to cells in that area and the immune system attacks them.

67
Q

What does Smidt think that a lot of the weight loss from GLP 1 agonist is from?

A

losing muscle and things that we shouldn’t be losing
“bc glucagon does a lot of things”

68
Q

Salt used to be worth its weight in gold, why?

A

It is a good preservative and not easy to extract everywhere in the world.

69
Q

The body is set up in a way that is not used to having food in excess. “CONSERVATION MODE”
In modern times we consume way more than the body should have and while the body does adjust well to excess, over time this leads to

A

problems, health issues

A&P Final (8 decks)

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