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Renal Exam 1 > Body Fluids, Clearance and Glomerular Hemodynamics > Flashcards

Body Fluids, Clearance and Glomerular Hemodynamics Flashcards

1
Q

what contains the ICF

A
  • blood cells

- cells

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2
Q

what comprises the ECF

A
  • interstitial fluid

- plasma (serum)

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3
Q

adult male is composed of what percent water

A
  • 60%
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4
Q

adult female is composed of what percent water

A
  • 50%
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5
Q

formula for total body water

A
  • body weight x fraction of body water
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6
Q

how much of the total body water is extracellular fluid

A
  • 1/3
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7
Q

how much of the total body water is intracellular fluid

A
  • 2/3
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8
Q

how much of the extracellular fluid is interstitial fluid

A
  • 3/4
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9
Q

how much of the extracellular fluid is plasma

A
  • 1/4
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10
Q

how much of the blood volume is hematocrit

A
  • 45%
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11
Q

what are the major ions in ECF

A
  • Na+ and Cl-
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12
Q

is the major intracellular cation

A
  • K+
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13
Q

what are the major intracellular anions

A
  • organic ions

- Pi

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14
Q

protein concentration of plasma versus ECF

A
  • plasma has higher protein
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15
Q

concentration of osmolarity

A
  • mOsm/L
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16
Q

concentration of osmolality

A
  • mOsm/kg
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17
Q

what is tonicity (effective osmolality)

A
  • osmolality of solutes that do not freely cross the cell membrane
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18
Q

osmolality of ICF and ECF

A
  • 275-295 mOsm
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19
Q

ECF shows transient changes in osmolality and tonicity due to

A
  • alterations in salt and water intake
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20
Q

calculation of total osmolality

A
  • total osm = 2 x Na + glucose/18 + BUN/2.8 + EtOH/3.7
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21
Q

calculation of toxicity or effective osmolality

A
  • 2 x Na + glucose/18
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22
Q

formula for net excretion

A

excretion = filtration + secretion - reabsorption

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23
Q

normal GFR for males

A

120 +/- 25 ml/min

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24
Q

what is GFR

A
  • rate at which plasma is filtered at glomerulus
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25
Q

normal GFR for females

A

95 +/- 25 ml/min

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26
Q

GFR is approximately what percent of renal plasma flow

A
  • 20%
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27
Q

GFR with age

A
  • declines
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28
Q

GFR with disease

A
  • increases or decreases
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29
Q

average renal blood flow

A
  • 1000 ml/min
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30
Q

formula for renal plasma flow

A

RPF= RBF (renal blood flow) x (1-hematocrit)

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31
Q

definition of urine flow (V)

units

A
  • volume of urine excreted per unit time

- ml/min or L/24 hr

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32
Q

average amount of urine flow

A

500 mL

18L/day

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33
Q

formula for filtered load

A

filtered load =GFR x P

GFR x plasma concentration

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34
Q

formula for excreted load

A

excreted load =V x U

urine flow x urine concentration

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35
Q

formula for reabsorption

A

filtered load - excreted load

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36
Q

formula for secretion

A

excreted load - filtered load

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37
Q

what is clearance

units

A
  • volume of plasma completely cleared of a substance per unit time
  • ml/min
38
Q

clearance formula

A

(VxU)/P

excreted load/plasma concentration

39
Q

clearance formula requires

A
  • steady state concentration
40
Q

what does it mean when the clearance rate is 0

A
  • substance is not filtered or secreted so none appears in the urine
  • substance is freely filtered but is completely reabsorbed so none appears in the urine
41
Q

when does clearance = GFR

A
  • if everything that is filtered gets excreted, then mLs of plasma cleared = mLs filtered (GFR)
42
Q

when does clearance = GFR

A
  • solute is freely filtered
  • solute is not reabsorbed
  • solute is not secreted
  • solute is not metabolized
43
Q

formula for when filtered load = excreted load

A

GFR x P = V x U

GFR x plasma concentration = excreted load

44
Q

creatinine clearance requires what for collection

A
  • one or two samples

- 24h urine collection

45
Q

formula for creatinine clearance

A

Cl_Cr = (UxV)/P

46
Q

plasma creatinine _________ in proportion to the decline in GFR

A
  • increases
47
Q

plasma creatinine when GFR decreases to half value - on first day

A
  • no change in plasma creatinine
48
Q

filtered load of creatinine (GFRxP_Cr) when GFR decreases to half value - on first day

A
  • declines to half starting value because plasma creatinine is still the same
49
Q

creatinine clearance when GFR decreases to half value - on first day

A
  • decreased because excreted load is half normal
50
Q

plasma creatinine when GFR decreases to half value - on day 4

A
  • doubled due to initial fall in filtered and excreted load
51
Q

filtered load of when GFR decreases to half value - on day 4

A
  • now back to normal
52
Q

what is renal plasma flow?

renal plasma flow is estimated using

A
  • plasma cleared of solute in one pass through the kidney

- para-amino hippuric acid (PAH)

53
Q

how much of the para-amino hippuric acid is excreted

what is the maximum clearance you can have?

A
  • 90% excreted in one pass

- plasma flow

54
Q

clearance of PAH is equal to

A

90% of renal plasma flow

55
Q

the extraction ratio of PAH is equal to

A

0.9

56
Q

formula for filtration fraction

A

FF = GFR/RPF

glomerular filtration rate/renal plasma flow

what is being filtered versus what is continuing on into the rest of the kidney

57
Q

what is the usual value of filtration fraction

A
  • 20%
58
Q

glomerular ultrafiltration depends upon

A
  • special anatomic properties of filtration barrier

- high hydrostatic pressure in glomerular capillaries

59
Q

glomerular filtration filters based on

A
  • size and charge
60
Q

are blood cells filtered in glomerulus

why

A
  • no

- they are too big

61
Q

what is the size of molecules that can pass through the filtration barrier?

A

<40 angstroms

62
Q

what charge of molecules can pass through filtration barrier

why

A
  • positively and neutrally charged

- basement membrane is negatively charged

63
Q

are albumin and other plasma proteins filtered by the healthy kidney

A
  • no
64
Q

GFR starling forces

A

GFR = Kf (PGC-PBS)-(πGC-πBS)

PGC = hydrostatic pressure in glomerular capillaries
PBS= hydrostatic pressure in interstitium (bowman's space)
Kf = filtration coefficient
πGC = osmotic pressure in plasma
πBS = osmotic pressure in interstitium

GOOD COCK WITHOUT THE BULLSHIT

65
Q

what is the normal value of πBS

A
  • 0
66
Q

which reins higher in glomerular capillaries - PGC or oncotic pressure?

why?

A
  • PGC

- favors filtration

67
Q

effect on COP due to loss of protein free fluid

A
  • COP increases
68
Q

angiotensin II release in hypovolemia

result

A
  • increases

- efferent arteriole constriction

69
Q

filtration rate in hypovolemia

A
  • increases

THIS IS COUNTERINTUITIVE

70
Q

colloid oncotic pressure in hypovolemia

result

A
  • increases

- drives reabsorption of what you have filtered

71
Q

proximal reabsorption in hypovolemia

A
  • increases
72
Q

angiotensin II release in hypervolemia

result

A
  • decreases

- efferent arteriole dilation

73
Q

filtration rate in hypervolemia

A
  • decreases
74
Q

colloid oncotic pressure in hypervolemia

A
  • decreases
75
Q

proximal reabsorption in hypervolemia

A
  • decreases
76
Q

diabetes insipidus is a disorder of

A
  • ADH
77
Q

result of diabetes insipidus

A
  • unable to concentrate urine

- large volume of dilute urine

78
Q

renal plasma flow in regard to PAH formula

A

clearance PAH/extraction ratio

79
Q

if Cx < GFR

A
  • net tubular absorption of X
80
Q

if Cx>GFR

A
  • net tubular secretion of X
81
Q

RPF of para-amino hippuric acid (PHA) formula

A

RPF=(UxV)/(P) / extraction ratio

extraction ratio = 0.9

82
Q

GFR over differences in mean arterial pressure

A
  • doesn’t change
83
Q

RAAS process in response to low BP

A
  • BP drops so hydrostatic pressure goes down
  • stretch on afferent arteriole goes down which releases renin
  • sympathetic system releases renin
  • deliver low Na+ and Cl- distally and that causes renin release
  • increases angiotensin II production and aldosterone production
  • angiotensin II causes efferent arteriole vasoconstriction
  • fluid will back up in the glomerular capillary
84
Q

what releases renin

A
  • smooth muscle cells in afferent arteriole of JG apparatus
85
Q

Afferent Constriction:

predict
GFR, RPF, FF

A

GFR: decreased
RPF: decreased
FF: same

86
Q

Efferent constriction

predict
GFR, RPF, FF

A

GFR: increases
RPF: decreases
FF: increases

87
Q

Afferent dilation

predict
GFR, RPF, FF

A

GFR: increases
RPF: increases
FF: same

88
Q

Efferent dilation

predict
GFR, RPF, FF

A

GFR: decreases
RPF: increases
FF: decreases

89
Q

Increased serum protein

predict
GFR, RPF, FF

A

GFR: decreases
RPF: same
FF: decreases

90
Q

Urinary obstruction

predict
GFR, RPF, FF

A

GFR: decreases
RPF: same
FF: decreases

91
Q

Angiotensin blockade

predict
GFR, RPF, FF

A

GFR: decreases
RPF: increases
FF: decreases

Angiotensin blockade same as efferent dilation

92
Q

NSAIDs

predict
GFR, RPF, FF

A

GFR: decreases
RPF: decreases
FF: same

NSAIDs effect same as afferent constriction

Renal Exam 1 (24 decks)

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