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Urinary > 2- Glomerulus, Clearance, Regulation Ca and PO4 > Flashcards

2- Glomerulus, Clearance, Regulation Ca and PO4 Flashcards

1
Q

Function of the Kidney

A

Regulation of ions
Excretion of waste
Endocrine: EPO, renin, prostaglandins
Metabolism: active forms of vit D, catabolism of insulin, PTH

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2
Q

What is almost 100% recovered

A 
Water
Sodium
Chloride
Bicarbonate
Glucose
Amino acids
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3
Q

What substances are actively secreted

A

H+

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4
Q

How much blood is filtered each day

A

180L/day

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5
Q

How much urine is produced each day

A

1.5L

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6
Q

Where is the glomerulus found

A

Cortex only

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7
Q

What is the filtration fraction

A

GFR/Renal plasma flow

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8
Q

How much of arriving blood exits unfiltered

A

80%

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9
Q

What are the two types of nephron

A

Cortical

Juxtamedullary

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10
Q

What is normal GFR

A

90-120 mL/min/1.73m2

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11
Q

How is the end product of filtration different from plasma

A

No large proteins and cells (RBC)

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12
Q

How do podocytes keep proteins out

A

Negatively charged so repel the neg charged proteins

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13
Q

What allows filtrate to pass through

A

Fenestrations

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14
Q

What pressures work in bowmans capsule

A

Hydrostatic of capillary
Hydrostatic of capsule
Oncotic of capillary and tubular lumen

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15
Q

Regulation of renal blood flow and GFR

A

Myogenic and tubuloglomerular feedback mechanism

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16
Q

Myogenic regulation

A

Arterial smooth muscle responds to increases and decreases in vascular wall tension
Rapid
Property of predominantly the preglomerular resistance vessels (afferent)
i.e to increase GFR constrict efferent or dilate afferent
to decrease GFR constrict afferent or dilate efferent

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17
Q

Tubuloglomerular feedback with high tubular flow

A

NaCl conc at macula densa linked with renal arteriolar resistance
The higher the flow of filtrate the higher Na conc
Increased NaCl = vasoconstriction of smooth muscle in afferent to reduce renal plasma flow to reduce GFR

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18
Q

Tubuloglomerular feedback with low BP

A

Release of prostaglandins reduce constriction of afferent arteriole
Renin released by juxtaglomerular cells in response to
1. sympathetic nerve stimulation
2. decrease stretch of afferent
3. macula densa signals in response to low NaCl
= RAAS

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19
Q

Where does RAAS mainly work

A

Constrict efferent arterioles = increase GFR

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20
Q

Issue with people on NSAIDs and ACEI

A

Inhibit prostaglandins and RAAS

21
Q

What is the equation for excretion

A

filtration-reabsorption+secretion

22
Q

What could cause a decreased GFR

A

Decrease number of nephrons

23
Q

What is renal clearance

A

Volume of plasma cleared of substance in a unit of time

Measure of kidney’s ability to remove substance and excrete it

24
Q

What is the clearance equation

A

C = conc of substance in urine (mg.mL) x urine flow rate (mL/min) / conc of substance in plasma

25
Q

What unit is clearance measure in

A

mL/min

26
Q

Where is most Ca stored and how is it stored

A

Calcium phosphate in the bones

27
Q

What is the difference between diffusible and non diffusible Ca

A

Diffusible: free ionised Ca, used for cellular processes

Non diffusible: bound to negatively charged proteins

28
Q

Where is most Ca reabsorbed

A

65% PCT
Solvent drag
Transcellular

29
Q

What happens in TAL to Ca

A

25% reabsorbed
50% trancellularly through Na/K/2Cl- then Na pumped out so lumen becomes positive so Ca repelled = moves between cells (Paracellularly)

30
Q

What is phosphate essential for and where is most of it found

A

Structure of bones and teeth

80% bones, 20% interstitial fluid

31
Q

Where is PO4 reabsorbed mainly

A

PCT

32
Q

How is PO4 reabsorbed

A

2Na for every PO4

33
Q

What causes itching

A

Increased PO4

34
Q

What is the relationship between Ca and PO4

A

They precipitate to form insoluble calcium phosphate
So if one increases the other is removed
Inversely proportional

35
Q

What is released in response to low Ca

A

PTH

36
Q

What are the effects of PTH

A

Decrease PO4 reabsorb in PCT
Increase in active Vit D
Increase Ca reabsorb in DCT
Increase bone reabsorb

All = increase plasma Ca

37
Q

What does low Ca lead to

A

Increase in neuromuscular excitability = tetany and convulsions, cramps and arrhythmias

38
Q

Causes of low Ca

A

Hyperphosphatasemia and low levels of active Vit D
Rickets and osteomalacia - low vit D
Tissue injury- cells die and release PO4
Alkalosis- reduced H to bind to protein so more Ca can bind = reduced free Ca

39
Q

Treatment of low Ca

A

Oral or IV Ca
Alfacalcidol
Vit D analogue

40
Q

What does high Ca cause

A 
Less excitable 
Slow reflexes
Weakness and constipation
Polyuria
Bone pain and fractures
Stones
Groans 
Moans
41
Q

Causes of high Ca

A 
Hyperparathyroidism
Acidosis- release of Ca from protein
Too much vit D
Bone destruction- malignancy
Granulomatous disease
Drugs
42
Q

Treatment of high Ca

A

Treat underlying cause
Rehydrate
Bisphosphonates

43
Q

Causes of low PO4

A

Excessive loss
Hyperparathyroidism- increase Ca so decrease PO4
Reduced GI absorption - alcohol or antacids
Reduced intake
Refeeding- move in to allow glycolysis
DKA- insulin given- big movement in to cell
Resp alkalosis- decrease CO2- shift intracellular- increase Ph cell stimulates glycolysis = lots of PO4 needed in cell

44
Q

How does
DKA
Resp alkalosis
Refeeding cause low PO4

A

Refeeding - move in to allow glycolysis
DKA- insulin given- big movement in to cell
Resp alkalosis- decrease CO2- shift intracellular- increase Ph cell stimulates glycolysis = lots of PO4 needed in cell

45
Q

Signs of low PO4

A

Stones, mones, bones, groans, psychiatric overtones

46
Q

Treatment of low PO4

A

Oral or IV PO4

Gradual refeeding

47
Q

Causes of high PO4

A

CKD - low GFR
Pseudohypoparathyroidism- kidneys don’t respond to PTH = low Ca so high PO4
Respiratory acidosis- decrease Ph = inhibits glycolysis
DKA- PO4 not taken out of blood- risk of low when insulin given

48
Q

Symptoms of high PO4

A 
Only with severe
Spontaneous firing of neurons
Tetany
Involuntary contraction of muscles
Calcium phosphate crystals- stones
49
Q

Treat high PO4

A

Phosphate binders
Low dietary intake
Forced diuresis

Urinary (11 decks)

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