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IPAP 21-2 Freshman Semester > APII RENAL > Flashcards

APII RENAL Flashcards

1
Q

What is the pH of ECF

A

7.35-7.45

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2
Q

PH varies based on what two compounds

A

HCO3-

Or partial pressures of CO2

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3
Q

What is a metabolic change in pH

A

When the pH changed is caused by HCO3

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4
Q

What is a respiratory change in pH

A

When the pH change is caused by PCO2

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5
Q

What is the first line of defense against acid-base abnormalities

A

In the ECF, the bicarbonate buffer system

In the ICF, when PCO2 increases, CO2 moves into the cell and combines to make H2CO3.

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6
Q

What is the bicarbonate buffer system

A

CO2 +H20=H2CO3= H*+HCO3-

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7
Q

What is the second line of defense for acid base balance

A

Respiratory center.

Blood PCO2 and pH are important regulators of ventilation rate.

Chemoreceptors send signals to compensate the RR for either acidosis or alkalosis

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8
Q

In acidosis the RR

A

Increases

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9
Q

In alkalosis RR

A

Decreases

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10
Q

What is the third line of defense in Acid Base Balance

A

Renal System

Tubules allow for secretion of H* that raise pH
Called renal net acid excretion (RNAE)

Tubules also allow for reabsorb of HCO3

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11
Q

Metabolic Acidosis

A

Ph< 7.35

Decrease HCO3-

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12
Q

metabolic alkalosis

A

Ph >7.45

Increase in HCO3-

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13
Q

respiratory acidosis

A

ph <7.35

Increase PCO2

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14
Q

Respiratory Alkolosis

A

PH above 7.45

Decrease pCO2

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15
Q

What is ammonia

A

Is nitrogenous waste when proteins are catabolized

Can be toxic if excess accumulation

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16
Q

Where is ammonia mostly converted to urea

A

Liver

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17
Q

What is urea

A

Less toxic than ammonia

Important in osmotic gradient in the tubules in the renal medulla

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18
Q

If you let urea sit what will happen

A

Converts back to ammonia

Why pees smells

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19
Q

What is Uremia

A

Excess build up of urea in the blood stream

Caused by kidney failure

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20
Q

What is the BUN

A

Blood Uria Nitrogen Levels

A marker of liver and kidney function

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21
Q

What part of the tubule get the biggest bang for the buck

A

THE PCT

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22
Q

What percentage of filtrate is reabsorbed in the tubules

A

99%

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23
Q

What is absorbed/ reabsorbed in the PCT

A

Largest amount o solute and water is reabsorption is in the PCT

100% of glucose, amino acids, and vitamins
50% of Cl-
80-90 of filtered HCO3
50 percent of Urea ( Urea recycling)

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24
Q

How is sodium transported out of the PCT

A

by active transport

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25
Q

What is cotransported with Na+

In the PCT

A

Glucose and a.a.

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26
Q

How do cl- ions pass in the PCT

A

passive movement created by Na*

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27
Q

What causes special permeability of water in the PCT and LoH

A

Aquaporin-1 channels

Protein water channels that increase the rate of water movement

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28
Q

What is solvent drag

A

The osmosis of water will often bring K* and Ca** with it in a motion called solvent drag

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29
Q

How does Urea move in the PCT

A

Passively moves out of the tubule into the interstitium

Can go into the peritubular capillaries, vasa recta, can stay in the interstitium

50% remains in the PCT
(Uria recycling creates osmotic movement)

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30
Q

What creates osmotic movement

A

Uria recycling

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31
Q

What areas of the PCT are impermeable to Urea

A

The thick ascending limb of the LoH and the Proximal DCT

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32
Q

What action does PTH have on PCT

A

Stimulates PCT to secrete phosphate
Stimulates production of calitriol to be made (released into blood)
**Stimulates the cells int he DCT to reabsorb more calcium ** (Not in the PCT)

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33
Q

How is reabsorption in the LoH

A

Solvent and water are independently regulated

15% of water is regulated in descending portion only

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34
Q

The descending limb of the LoH

A

Mostly water reabsorption and solute secretions (concentrates the filtrate)

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35
Q

Reabsorption in the ascending limb of LoH

A

No water reabsorption, but reabsorption of solutes are reabsorbed ( dilutes the filtrate)

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36
Q

Is the thin portion of the LoH permeable to water

A

No, has no Aquaporin channels

As water is held in, solutes move out and dilute the filtrate

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37
Q

Where is a lot of energy expenditure happen in the LoH

A

Thick portion

Active reabsorption of ions
As filtrate moves up the limb, filtrate becomes more dilute

(Contains macula densa cells)

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38
Q

What is the reabosbption in the DCT

A

By the late portion 90-95 percent of solutes/wate has be reabsorbed and returned to the interstitium/ blood stream

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39
Q

What are two specific cells found in the DCT

A

Principle cells

Intercalated cells

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40
Q

What effect does ADH have

A

Causes principle cells in the DCT to become more permeable to water via aquaporin II cells

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41
Q

How is the urine in the presence of ADH

A

Small amounts of highly concentrated urine

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42
Q

How much urine is produced at maximal ADH secretion

A

As little as 400-500 ml of very concentrated urine

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43
Q

Aquaporin II are only effect where

A

In the DCT in the presence of ADH

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44
Q

What effect does aldosterone have on the principle cells of the DCT

A

Causes sodium reabsorbtion ( brings h20 along)

And potassium secretion.

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45
Q

What causes secretion of aldosterone

A

Hyperkalemia

Angiotensin II

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46
Q

What are two types of Intercalated cells

A

Type A: causes secretion oh H*
Reabsorb bicarbonate
Reabsorbed potassium

Type B: does the exact opposite

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47
Q

How does ANP effect the DCT and collecting DUCTS

A

Inhibits the reabsorption of sodium and water,

Meaning dieresis/ diuretics

inhibits Renin-angiotensin-aldosterone syndrome.

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48
Q

What is the function of the kidney

A 
Regulate Blood Ionic Composition 
Regulate Blood pH
Regulate Blood Volume and Pressure 
Maintain Blood Osmolarity 
Produce Hormones 
Regulate Blood Glucose Levels 
Excrete Waste and foreign substances
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49
Q

How does the kidney regulate blood pH

A

Secrets H* and retains HCO3-

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50
Q

What enzyme/ hormone does the kidney secretes

A

Renin
EPO
Caltriol

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51
Q

What are the wastes secreted in the kidney

A 
Urea/ Ammonia 
Bilirubin 
Creatine 
Uric Acid 
Hormone Metabolites
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52
Q

Where is Urea/ Ammonia from

A

Deamination of a.a.

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53
Q

What is bilirubin from

A

catabolism of hemoglobin

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54
Q

what is Creatinine from

A

Break down of creatine phosphate in muscles

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55
Q

Where is uric acid from

A

Catabolism of nucleic acids

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56
Q

Where is the Kidneys located

A

Anatomically between the last thoracic and the 3rd lumbar vertebrae

Partially protected by the 11th and 12 ribs

Approx 4-5 in long, 2-3 in wide, 1 in thick

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57
Q

What is the concave border of the kidney called

A

Hilum

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58
Q

What are the three external layers of the kidney

A

Renal fascia
Adipose capsule
renal capsule

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59
Q

What it’s the renal fascia

A

Outermost layer of the kidney

Dense C.T. That anchors the kidney and adrenal gland to the retro peritoneal wall

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60
Q

What is the adipose capsule of the kidney

A

Middle External layer

Called the renal fat pad

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61
Q

What is the renal capsule

A

The innermost layer of the external anatomy of the kidney

Smooth transparent C.T. That is continuos with the ureters

Maintains shape of kidney

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62
Q

What contains all of the glomeruli and convoluted tubules of the nephrons
-also makes the columns that lay between the pyramids

A

The Adrenal Cortex

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63
Q

Describe the Renal Medulla

A

Collection of all renal pyramids and contains all of the LoH and Collecting Ducts

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64
Q

Approx # of pyramids per kidney

A

8-18

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65
Q

What is the papilla

A

Narrow apex of the pyramid

-contains the papillary duct leading to the minor calyx

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66
Q

What makes up a renal lobe

A

Pyramid (medulla) the overlying cortex, and 1/2 of each adjacent column (cortex)

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67
Q

What is a minor calyx

A

Small chambers that collect urine directly from the papilla

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68
Q

What is a major calyx

A

Larger chambers that collect urine from the minor calyces

-2 to 3 per kidney, are extensions of the ureters

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69
Q

Describe the renal pelvis

A

Where Major calyces drain into one large chamber

  • mixes and collects all urine in the entire kidney
  • connects to the ureter
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70
Q

What is the renal sinus

A

3-d space that houses the blood vessels, adipose tissue and nerve supply to the kidney

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71
Q

What is the renal hilum

A

Indentation of the kidney where the ureters emerge along with the blood and lymph vessels, and nerves

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72
Q

Outline the blood flow from the Aorta to the Glomerulus

A 
Aorta 
Renal Artery 
Segmental Artery 
Interlobar Artery 
Arcuate Artery 
Interlobular Artery (Radial Artery) 
Afferent Arteriole 
Glomerulus
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73
Q

Outline the blood from from the glomerulus back to the vena cava

A 
Glomerulus 
Efferent Arteriole 
Peritubular Capillaries
Vase Recta (Juxtamedullary Only) 
Interlobular Vein (Radial Vein) 
Arcuate Vein 
Interlobar Vein 
Segmental Vein 
Renal Vein 
Inferior Vena Cava
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74
Q

What is total renal blood flow?

What is it per kidney

A

1200 ml per minute

600 ml per kidney per minute

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75
Q

The glomerulus allows for ________ but not _______

A

Filtration

Not reabsorbtion

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76
Q

What is the fluid in the nephron called

A

Filtrate

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77
Q

When does filtrate become Urine

A

After leaving the collecting duct

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78
Q

What are the two parts of the nephron

A

Renal Corpuscle

Renal Tubule

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79
Q

What comprises the renal corpuscle

A

Glomerulus

And Bowmans Capsule

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80
Q

What comprises the renal tubules

A

PCT
LoH
DCT

81
Q

Are the collecting ducts part of the nephron

A

NO

82
Q

What are the two types of Nephrons

A 
Coritcal nephrons ( most abundant) 
Juxztamedullary Nephons
83
Q

What is the most abundant type of nephron

A

Cortical nephrons

84
Q

Describe a cortical nephron

A

Renal Corpuscle lies int he outer renal cortex

Has a short LoH

Pertibular Capillaries only

85
Q

Describe Juxtamedullary Nephrons

A
  • Renal Corpuscles lie deep in the renal cortex
  • Long LoH
  • Peritubular Capillaries give rise to the vasa recta
86
Q

What type of nephron lies in the outer cortex

A

Cortical Nephrons

87
Q

What is signifigant about the afferent Arteriole

A

It brings blood TO the glomerulus

Has a wide thick lumen

88
Q

What is significant about the efferent Arteriole

A

Is the Arteriole LEAVING the glomerulus

Smaller and thinner lumen

89
Q

What is tubular reabsorption

A

Movement from the tubule to the capillaries

90
Q

What is tubular secretion

A

Movement from the capillaries to the tubules

91
Q

What percent of filtrate gets reabsorbed

A

99%

92
Q

What is the GFR

A

Is the sum of all filtration rates of all functioning nephrons

93
Q

How much filtrate do adults make a day , how much is reabsorbed , how much is made into urine

A
  • 150 to 180 Liters of Filtrate a day
  • 99% reabsorbed
  • 1 to 2 liters of urine a day
94
Q

What makes up the “leaky” barrier in the capsule/ glomerulus

A

Capillaries and Podocytes

95
Q

What are the three layers of the filtration membrane

A

Fenestrations of endothelial cells
Basal lamina
Slit membranes between podcytes

96
Q

What stops blood from passing into the Capsule

A

Fenestrated endothelial cells

97
Q

What stops proteins from entering the capsule

A

Basal Lamina and podocytes/ pedícles

98
Q

What regulates the surface area in the filtration membrane

A

Mesangial cells

99
Q

Mesangial cells when relaxed ____________
When contracted
__________

A
  • increase surface area

- reduce surface area

100
Q

Where is capillary pressure highest in the body

A

In the glomerulus

101
Q

Describe Glomerular Blood Hydrostatic pressure

A

GBHP

Pressure in the glomerulus pushing outward into the capsular space

~55mmhg

102
Q

Describe Capsular Hydrostatic Pressue

A

CHP

Pressure exerted by the filtrate in the capsular space that pushes inward on the visceral glomerulus

Aka back pressue

~15 mmhg

103
Q

Describe Blood Colloid Osmotic Pressure

A

BCOP

Pressure from proteins in blood plasma (MAINLY ALBUMIN)

Gravity
-opposes filtration-
~30mmhg

104
Q

What is the FP equation

A

GBHP-CHP-BCOP
~55mmhg-15mmhg-30mmhg
=10mmg

When postive then filtration occurs

105
Q

What is nephrolithiasis

A

Kidney Stone

106
Q

What is hydronephrosis

A

Fluid retention in the kidneys

Pathologically caused by kidney stones

107
Q

What is the GFR

A

Glomerular Filtration Rate

-the amount of blood filtered by the glomerulus into the capsular space per unit time

~90-140ml/ min in males
~80-125 ml/min in females

108
Q

What happens is GFR is too fast

A

Filtrate passes to quickly and required substances may not get reabsorbed

109
Q

What happens if GFR is too slow

A

Nearly all filtrate will be reabsorbed and certain wastes may not be secreted efficiently

110
Q

Constriction of the afferent Arteriole….

A

Decrease glomerular pressure

-decrease RBF and GFR

111
Q

Constriction of the efferent Arteriole

A

Increase glomerulus pressure

  • decrease RBF
  • increase GFR
112
Q

Dilation of the efferent Arteriole

A

Decreases glomerular pressure

  • increase RBF
  • decreases GFR
113
Q

Binational of the afferent Arteriole

A

increases glomerular pressure

-increases both RBF and GFR

114
Q

What product is used to estimate GFR

A

Creatine clearance

115
Q

What are mechanisms that regulate GFR

A

Renal Auto regulation (innate)
Neural Regulation (symp. NS)
Hormonal Regulation
(Angiotesin II and ANP)

116
Q

What is the myogenic mechanism

A

Acute increase in BP stretches the afferent Arteriole

Causes smooth muscle contraction of the afferent Arteriole (reducing RBF)
(reduces GFR) initially
-protects the nephron from rapid changes in BP

117
Q

When does myogenic mechanism occur naturally

A

In Systolic BP of 90-180

118
Q

Immediate increase in BP causes …

A

Myogenic vasoconstriction and then compensatory vasodilation

119
Q

What is tubuloglomerular feedback

A

Responds to changes in NaCL and H2O

Macula densa cells detect increase levels in the filtrate (GFR too fast)

  • release ATP and adenosine
  • causes both Afferent and Efferent Art to contract
  • Decreases the GFR
120
Q

What is the JGA

A

The juxtaglomerular apparatus

  • A complex structure that has the ability to affect systemic BP through auto regulation of the tubuloglomerular feedback system
  • one for every nephron
121
Q

What are the three components of the JGA

A

-juxtaglomerular cells
(granular cells)
-Macula densa cells
-Lacis Cells

122
Q

Where are Macula densa cells found

A

In the walls of the late thick ascending LoH

123
Q

Where are Lacis Cells found

A

Between the Afferent, efferent, and DCT

124
Q

What is another name from lacis cells

A

Extraglomerular mesangial cells

125
Q

What are the two functions of the juxtaglomerular cells

A 
Aka granular cells 
- Detect when BP is too low 
(Sensing stretch in the afferent arteriole) 
-Synth and secrete Renin 
(Helps to increases BP)
126
Q

What are the two functions of macula densa cells

A

-detect increase NaCL in the filtrate
-release ATP and Adenosine
(Triggers contraction of afferent arteriole and lacis cells)
(Reduces GFR)

127
Q

When a person is at rest

  • how is sympathetic stimulation of the kidney
  • how are the afferent and efferent Arteriole
A

Stimulation is low and the Arteriole are both dilated

128
Q

What happens to ECF during the flight or flight response

A

Begins to be reduced due to metabolism

  • triggers release of Epi/Norepi
  • causes constriction of Afferent arteriole
129
Q

What does Angiotensin II do

A 
Ultimately reduces GFR 
-very potent vasoconstrictor 
(Effects both afferent and efferent0 
(Effects efferent first)
Cause a brief increase in GFR and then a reduction.

increases systemic blood pressure

130
Q

What is the role of ANP/BNP

A 
Secreted by the atria 
Detects over stretching in the heart 
Causes a reduction in BP 
(Dilates afferent but constricts efferent arteriole) 
(Increases GFR)
131
Q

What role do prostaglandins play in hormonal regulation of GFR

A

Activated locally during hemorrhage or reduced ECF

  • attempts to counteract the effects of angiotesin II
  • helps prevent renal ischemia
132
Q

How does N.O. Effect hormonal regulation of GFR

A

Endothelium derived relaxing factor

  • helps conteract Angiotensin II
  • Increases GFR

Causes vasodilation at aff and efferent Arteriole
( much more at aff)

133
Q

What is the role of bradykinin

A

vasodilator that stimulates the release of NO and prostaglandins

-increases GFR

134
Q

What is the role of adenosine

A

Produced within the kidneys
Causes vasoconstriction in tubuloglomerular feedback at the afferent arteriole

-reduces GFR

135
Q

What is ACE

A

Angiotensin Converting Enzyme

  • Located on the surface of afferent arteriole, glomerular capillaries, and lungs
  • Converts Angiotensin I to II
  • Reduces GFR
136
Q

How is the RAAS activated

A
  • In response to low afferent arteriole pressure, renin gets released
  • stimulation of beta-1 In juxtaglomerular cells, renin gets released
  • by decrease in NaCL detected by macula densa cells, renin gets released
137
Q

What does renin interact with

A

Angiotensinogen, released by hepatocytes (liver)

Renin cleaves of a 10-amino acid peptid and creates Angiotensin I

138
Q

Where is angiotensin I converted to II

A

Lung endothelium containing ACE

Kidney endothelium containing ACE

139
Q

What are the specific functions of Angiotensin II

A

Decreases GFR
Enhances Na and Cl and H20 reabsoption in the PCT
(Increases blood pressure and volume)

-stimulates the adrenal cortex to secrete aldosterone
(Increases reabosption of Na and CL and to secrete more K* in the collecting ducts)
(Action on principle cells of the Collecting duct)

-Stimulates Post. Pituitary to release ADH
(Causes more H20 retention in the DCT and collecting ducts)

140
Q

What structures are responsible for the plasma osmolartiy and volume

A

LoH
DCT
Collecting Ducts

141
Q

where is the filtrate first “concentrated”

A

In the descending LoH

Permeable to water

142
Q

Where is the filtrate initially “diluted”

A

The Ascending LoH

Impermeable to water

143
Q

Where does final dilation/concentration occur

A

In the DCT and Collecting Duct

Where ADH as its actions

144
Q

In the absence of ADH urine should be

A

Diluted

145
Q

In the presence of ADH urine should be..

A

Concentrated

146
Q

What are 6 characteristics of Urinalysis

A 
Volume 
Color 
Turbidity 
Odor 
pH 
Spec. Gravity
147
Q

What is normal urine production in a 24 hr period

A

1-2 liters

148
Q

What is turbidity

A

When urine is clear when voided, becomes cloudy with time

149
Q

What is the normal pH of Urine

A

4.6-8.0

Average~6.0

150
Q

What does pyridium do to urine

A

Change its color (RED)

151
Q

What is the specific gravity of urine

A

Density of urine
~1.001 to 1.035

The high the solutes the higher the value

152
Q

What is a marker for bacterial pathogens in a UA

A

Nitrite

153
Q

What is a marker for WBC in a UA

A

Leukocyte Esterase

154
Q

What is the protein concentration in urine ?

A

Should be zero

155
Q

What is a normal BUN

A

7-20 mg/dL

156
Q

What does a BUN measure

A

Urea/ Uremia

Catabolism of proteins in the liver

157
Q

When GFR reduces in renal disease, the BUN,,..

A

Increases

158
Q

What are the two blood tests to test kidney function

A

Plasma Creatine

BUN

159
Q

What does plasma creatinine measure

A

Catabolism of creatine phosphate

160
Q

What is a normal SERUM creatinine level

A

Anything below 1.6 mg/dL

161
Q

What is renal plasma clearance and why is it important

A

The volume of plasma (ml) that can be completely cleared of a substance per unit time (min)

Drugs like penicillin have high clearance rates, which means dosages must be high to be effective

162
Q

What is a great measure of True GFR

A

Inulin Clearance

163
Q

What are the lab values needed for complete UA

A

24hr urine collection
Urinary Creatinine
Plasma Creatinine

164
Q

What is the path of urine from the Collecting Ducts to the toilet

A 
Collecting Ducts 
Papilla 
Papillary Ducts 
Minor Calyces 
Major Calyces Renal Pelvis 
Ureters 
Urinary Bladder 
Urethra 
Toilet
165
Q

What mechanical mechanism move urine out of the body

A

Peristalsis along with hydro-static pressure and gravity

166
Q

Are ureters intro or retro peritoneal

A

RETRO

167
Q

What is the anti-reflux mechanism of the bladder

A

When bladder fills with urine, it pulls the bladder down which closes the ureters and stops urine back flow

168
Q

What are the three layers of the ureter

A

The adventitia
Muscularis
Mucosa

169
Q

What is the Ureter Adventitia

A

Anchors the ureters to the surrounding tissues, contains the blood vessels, nerves, and lymphatic vessels

170
Q

What is the muscularis of the ureter

A

Provides peristalsis

-outer circular, inner longitudinal smooth muscle

171
Q

What is the ureter mucosa

A

Transitional epithelium with goblet cells that secrete mucus
(To protect from acidity of urine)

172
Q

What is the capacity of the Urinary Bladder

A

700-800 ml

173
Q

Where is the anatomical location of the Urinary Bladder

A

Posterior to the pues symphysis
Immediately anterior to the rectum in males

Inferior and slightly anterior to the uterus in females

HELD IN PLACE BY PERITONEAL FOLDS

174
Q

What is the serosa

A

Visceral peritoneum

Covers superior surface of the bladder

175
Q

What are the three layers of the

Muscularis

A

Inner longitudinal
Middle Circular
Outer Longitudinal

176
Q

What is the detrusor muscle

A

The muscularis of the urinary bladder.

When contracts it forces urine into the urethra

177
Q

What are the two parts of the mucosa of mucosa

A

Rugae- Folds which allow filing/ stretching

Trigone- Smooth triangular area of the bladder floor

The posterior corners is the uretal openings
The anterior corner feeds to the urethral sphincter

178
Q

Describe the urethral sphincter

A

Smooth muscle (Circular)
(Extension of the detrusor muscle)
Involuntary

just above the prostate in males

179
Q

Describe the external urethral sphincter

A

Skeletal muslce,

Deep perineal muscles/ pelvic floor

180
Q

What are the three sections of the male urethra

A
  1. Prostatic
  2. Membranous
  3. Spongy
181
Q

What is the shortest portion of the male urethra

A

Membranous portion

forms the urethral sphincter

182
Q

What are cowpers glands

A

Bulbourethral Glands that help neutralize the acidity of the urine

183
Q

What is the micturition reflex

A

Parasympathetic reflex initiatives mechanism for urination which causes

  • involuntary contractions of the detrusor muscle
  • internal sphincter to open
184
Q

What stimulates the pituitary gland to release ADH

A

Angiotensin II

185
Q

What are ACE inhibitors used to treat

A

Primary Hypertension

186
Q

What does ACE inhibitors do

A

Inhibit conversion of angiotensin I to angio II

Also increase bradykinin, Increase RBF and GFR

187
Q

Why do people on ACE inhibitor cough often

A

Bradykinin

188
Q

What are ARBs

A

Angiotensin II receptor blockers

Block Angio II at the afferent arteriole

Increases RBF and GFR

189
Q

What is the apical membrane of the tubules

A

The lumen side of the cell

190
Q

What is the basolateral membrane of the tubules

A

The interstitial side of the cell

191
Q

What segments of the Tubule is always permeable to water

A

The PCT and th descending LoH

192
Q

What type of cells make up the PCT

A

Simple cubodial cells with microvilli

193
Q

What type of cells make up the LoH thin descending and thin ascending

A

Simple squamous cells

194
Q

What type of cells make up the thick walls of the LoH

A

Subodial to low columnar

195
Q

What type of cells make up the DCT

A

Most of the DCT is simple cubodial cells

The last part of the DCT is contain principle cells and tntercalated disks

196
Q

What do principle cells do

A

Have receptors for ADH and aldosterone

197
Q

What do intercalated disks do

A

Play a role in blood pH

198
Q

What kind of cells are in the Collecting Duct

A

Simple cuboidal cells

Also contain principle cells and intercalated disks

IPAP 21-2 Freshman Semester (22 decks)

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