CV Biophysics & Kidney Flashcards
Major Functions of the Circulatory System
-Transporting nutrients to tissues
-Transporting waste products away from tissues
-Transporting hormones: signaling
Kidneys are an important part of this
Volume, Velocity, Pressure, Area
-Volume: Liters, ml, mcl
-Velocity: Distance/time (meters/sec)
-Pressure: Force; mmHg, cmH2O
-Area: Size, surface area (walls of a cyclinder)
Blood Flow Determinants
Blood Flow/ Vascular Resistance
-Blood Flow: Volume/time (ml/min, ml/sec, L/sec)
-Vascular Resistance: Typically determines what kind of BP we have. Increased resistance –> less flow
Blood Flow/Pressure & Resistance Example
The pressure will be highest between the source of blood flow and the area of resistance.
Immediately downstream from the area of resistance, the pressure should be much lower
Series vs Parallel
Blood vessels in a series: Blood vessels connected together end to end.
Ex: R1 + R2; will have double the resistance than just R1 or R2
Formula to determine resistance in series: Rtotal= R1 + R2 +R3…
Blood vessels in parallel: More pathways for the blood to flow through, stacked parallel to each other. Much lower resistance here
Cross Sectional Areas of Systemic Circulation
How does that affect velocity?
-Cross sectional area (cm2): Internal Diameter
-The lower the cross-sectional area, the faster the velocity of blood flow
-The higher the cross-sectional area, the slower the velocity of blood flow
Velocity of Blood Flow Formula
And cross-sectional diameters
Velocity= Blood flow/Cross-Sectional area
Small arteries- how do these influence blood pressure?
The further we get from the heart, blood pressure tends to decrease
-The small arteries and arterioles have a high resistance, and therefore are the determinants of our blood pressure.
If we look proximal to the small arteries, we should see a higher blood pressure
If we look distal to the small arteries, we should see a lower blood pressure
When giving phenylephrine, it increases the resistance of the small arteries, causing an increase in pressure upstream and a decrease in pressure downstream
Maintenance of pressure and resistance determines..
Circulatory Function
Blood flow is tightly controlled by..
-Blood flow is tightly controlled by tissue demands/ metabolic rate
-Maintenance of pressure and resistance determines what our blood pressure is going to be
Blood Flow Types
A) No flow
B) Laminar Blood Flow: The walls of the vessel are the resistance to movement. The blood closest to the walls of the vessel is flowing the slowest, whereas the blood in the middle in the vessel has less resistance and flows faster. Efficient. Doesn’t cause problems
C) Turbulent blood flow/disorderly: Blood is pushed into the walls of the blood vessels; slams Ca++ and cholesterol into the sides of the blood vessel causing it to be deposited into the wall. It usually caused from a blockage/narrowing in the blood vessel, causing blood to “shoot” through the narrow opening at a very fast velocity
Blood flow through the kidney? Why does it receive more than it needs?
-The kidney is one of the few organ systems that receives much more blood flow than it actually needs
-Kidneys receive about 1L/min of blood flow
-Without the extra blood flow, the kidney would not be an efficient filter
Ohm’s Law; Using it to solve for vascular resistance, delta P, or blood flow
-Solve for Delta P:
Delta P (change in pressure)= Flow (blood) x Resistance (Vasc.)
-Solve for Flow:
Flow= Delta P/ Resistance
-Solve for Resistance: Delta P/ Flow
Peripheral Vascular Resistance: How do we determine?
Aortic BP - R. Atrium BP / Total CO ml/min
R= Delta P/ Flow
How do we calculate this?
Vascular Conductance
If conductance is higher, what happens? If it’s lower?
-Conductance: The ease at which blood flows?
-If conductance is higher, resistance will be lower
-If conductance is lower, resistance will be higher
Conductance= 1 / Resistance
What are the functions of the capillary microcirculation?
How many capillaries do we have? Total surface area?
-Primary place of nutrient exchange and waste product collection in our circulation
-Arterioles are encased in smooth muscle, which is how blood flow through our capillaries is controlled
-Constriction of the smooth muscle will reduce blood flow at the arteriole. This causes an increase in pressure above the site of constriction, and a decrease in pressure distal to the constriction ultimately reducing blood flow
-Relaxtion of the smooth muscle will increase blood flow
- 10+ billion capillaries
- 500-700 square meters of surface area
What is significant about this picture? (Four layers)
-Area of high vascular resistance because it has four layers of smooth muscle cells. This gives our arterioles a high wall-thickness to internal diameter ratio
-This is what allows our arterioles to contract, relax, and control blood flow downstream
What determines constriction or relaxation of arterioles upstream of capillaries?
-Metabolic byproducts and gases being removed from the capillaries determines whether the upstream arterioles need to constrict or relax
- Decreased O2 delivery or increased tissue metabolism –> leads to a decrease in tissue O2 –> arterioles and precapillary sphincters relax to increase blood flow to the tissue downstream
Determine the velocity of blood flow through these vessels
CO is 5L/min
-Aorta: 1.11 L/min/cm2
-Arterioles: 0.0125 L/min/cm2
-Capillaries: 0.00111 L/min/cm2
-Venae Cavae: 0.28 L/min/cm2
5L/min divided by total cross-sectional area
Pressure of the arteriole and venous ends?
Capillary Dynamics
What area is responsible for filtration? Reabsorption?
-30mmHg on the arteriole end
-10mmHg on the venous end
-Arteriole side has forces that favor filtration; which is the process that describes movement of fluid out of the capillary and into the tissue
-Venous side has forces that favor reabsoprtion; a process of fluid being reabsorbed into the capillary bed
Capillary Starling Forces: “Pcap”
-Hydrostatic pressure in the capillary: ~30mmHg at the arteriole end of the capillary and 10mmHg at the venous end
-Physical blood pressure within the capillary
-This determines how blood flows from the arterial end to the venous end, and also plays a huge role in determining how much fluid is going to be pushed out of the capillary (filtration)
Capillary Starling Forces: Pisf
-This is the pressure outside of our capillaries and surrounding our cells
-Pressure can oppose filtration on the arteriole end and promote reabsorption on the venous end if the pressure is positive
-Typically -3mmHg. This pulls fluid out of the capillary on the arteriole end, and opposes too much reabsorption on the venous end.
-This negative pressure is due to our lymphatic system creating a “vacuum” effect and taking up extra fluid
Capillary Starling Forces: Plasma Colloid Osmotic Pressure; Oncotic Pressure
-There are plasma proteins (albumin, fibrinogen, immunoglobulins) mostly within the capillary
-The cell walls are not permeable to these proteins; however, they are permeable to fluid. This creates an osmotic pressure associated with the proteins within the cell and outside the cell
-Because there is a large amount of colloids dissolved in the blood within the capillary, the oncotic pressure here is higher than outside the capillary –> causing the fluid to stay within the capillary/ cardiovascular syste,
28mmHg
What happens if plasma oncotic pressure is too low?
-Sepsis, liver failure, massive bleeding, or any condition that causes the cell to become more pourous than normal can cause these colloids to leak out of the capillary.
-The cell wall simply becoming permeable to the proteins causes a decrease in osmotic pressure (primary problem) and secondary is the proteins leaking out
-If we don’t have plasma proteins in the cardiovascular system, it becomes incredibly difficult to maintain a blood pressure
Capillary Starling Forces: Interstitial Fluid Colloid Osmotic Pressure
-Very large strings of proteins that stay in the interstitial fluid (matrix proteins, proteoglycan filaments, hyaluronic acid, collagen)
-Osmotic pressure of 8mmHg
-Favors fluid movement into the interstial fluid ~a little~ but is outweighed by the plasma osmotic pressure
Capillary Starling Forces: Capillary Filtration Coefficient (Kf)
How do we use this to determine filtration rate?
-Secondary to all other capillary starling forces
-Related to capillary permeability and surface area (the more surface area we have, the more area for movement)
Filtration Rate = Kf (NFP)
Normal Kf is 12.5
What happens if our capillary cells are damaged in an unorganized way?
-If capillaries are crushed from some sort of trauma, the plasma proteins leak out into the interstial space causing significant swelling
-Crush injury, sepsis or severe acidosis, a condition where cells are dying/ imploding in an unplanned manner
Primary function? What happens if someone is sick?
Lymphatic system;
-Responsible for absorbing extra fluid and dumping it back into the top of the thorax, allowing it to be reabsorbed back into the cardiovascular system
-In a healthy person, the lymphatic system can increase it’s rate of work by 20-40x in terms of managing extra fluid
-After an injury where cell walls are damaged, the lymphatic system can absorb some of the extra fluid in the interstitial space but it is not specialied to pick up extra proteins.
-The lymphatic system typically increases its rate of action with increased muscle movement. If someone is immobile and in a hospital bed, the lymphatic system is not going to be able to do it’s job effectively
Capillary Oncotic Pressure: Components
Albumin: 4.5g/dl –> 21.8 mmHg
Globulins: 2.5g/dL –> 6.0mmHg
Fibrinogen: 0.3g/dL –> 0.2mmHg
Venous blood is returned back to the heart…
Via a one-way valve system that relies on our skeletal muscles compressing and relaxing against the lymphatic system
Without movement, fluid will accumulate in the legs and we are more prone to blood clots in the lower extremities.
Capillary Net Filtration Pressure: Arteriole End
Forces that favor filtration:
30mmHg
-3mmHg
8mmHg
Forces that oppose filtration:
28mmHg
NFP = Pcap - Pisf - Plasma Oncotic Pressure + Interstitial Oncotic Pressure
Gives us a NFP of 13mmHg
Favors filtration
Capillary Net Filtration Pressure: Venous End
Which pressure is the opposing force for both venous & arteriole ends?
Forces that favor filtration:
10mmHg
-3mmHg
8mmHg
Oppose Filtration:
28mmHg
NFP = Pcap - Pisf - Plasma Oncotic Pressure + Interstitial Oncotic Pressure
NFP: -7mmHg, favors reabsorption
Plasma oncotic pressure is the opposing pressure in both venous and arteriole ends
Average Capillary Blood Pressure in Systemic Circulation & Avg NFP
17.3mmHg
Capillaries get larger as we move from the arteriole end to the venous end
If we use this number in our NFP equation, we end up with an average NFP of 0.3mmHg throughout each capillary
General Capillary Permeability
What is the exception for NaCl?
The smaller the molecular weight, the more likely the membrane is permeable to that substane.
The exception for NaCl is the BBB.
Resistance & Blood Flow (Kidney Example)
Why does pressure decrease as blood flows past resistance?
-Renal artery pressure if ~100mmHg
-Blood encounters vascular resistance when traveling through the kidney, and by the time it reaches the renal vein, the pressure is around 0mmHg
-Energy/ATP is removed from the blood as it moves through resistance, causing a decrease in pressure as it continues to encounter resistance
Afferent Arteriole?
Glomerular Capillaries
Pressure here determines what? GFR?
-First set of capillaries in the kidneys
-Afferent arteriole is immediately upstream to the glomerular capillaries–> very important in determining how much pressure the glomerular capillaries have
-The pressure in the glomerular capillaries determines the glomerular filtration rate
-Normal pressure in the glomerular capillaries is around 60mmHg. This high pressure is used to push fluid out of the capillaries at a rate of about 125ml/min
Plasma Oncotic Pressure in the Glomerular Capillaries
-Plasma oncotic pressure is 28mmHg at the beginning of the glomerular capillaries
-As we move through the glomerular capillary, the plasma oncotic pressure increases ( 28mmHg –> 32mmHg–>36mmHg)
due to the fact that the glomerulus is filtering fluid, but the amount of colloids remains the same
What happens if someone is sick?
Autoregulation in the Kidney; Afferent Arteriole
How does this affect filtration? Autoregulation limits?
-If blood flow is too low, the afferent arteriole will relax to increase blood flow to the glomerulus
-Increasing renal blood flow increases GFR
-If renal blood flow is too high, the afferent arteriole constricts to reduce overperfusion
-Decreasing renal blood flow decreases GFR
Autoregulation typically occurs between 50mmHg and 150mmHg. The afferent arteriole is able to regulate RBF fairly well if BP is too high, but RBF and GFR starts to steeply drop off well before 50mmHg. If someone has had chronic HTN, the afferent arteriole will not be able to relax as well
Where does PCT empty? Filtration, secretion, excretion
Promixal Convoluted Tubule
Starling forces?
Ptubule- 18mmHg
-The fluid from filtration fills the PCT until it reaches a P of 18mmHg –> empties into ureters and bladder to be excreted or leaves the PCT –> renal interstitium –> reabsorbed PT capillaries
The body can physically pump things into the tubule (secretion). Leaves the PT capillaries –> renal interstitium –> P tubule
Ex: Toxins, K+, Na+
Oncotic pressure in the tubule should be 0mmHg because in a healthy person, we are not filtering protein
Filtration Fraction vs Osmotic Pressure
Efferent arteriole constriction or relaxation determines how much fluid is being filtered
-The more fluid we filter (higher filtration fraction), the higher the osmotic pressure will be on the efferent end
-The less fluid we filter (lower filtration fraction), the lower the osmotic pressure will be on the efferent end
This represents the change in osmotic pressure that we see along the glomerular capillary
A) Filtration Only: Happens when we don’t have any specialized transporters designed to retain or reabsorb whatever is being filtered
B) Filtration, Partial Reabsorption: Na+ is a good example. We typically eat more Na+ that we need. Reabsorb what we need, filter the rest
C) Filtration w/ complete reabsorption: Glucose in a non-diabetic patient. If glucose is present in the urine, BG is way too high or there is an issue with the transport system.
D) Filtration w/ secretion: A small portion of this was filtered, and the remainder of this was secreted. Paraminohippuric acid (PAH); a diagnostic compound that gives us an idea of what the renal blood flow is.
The higher the amount of PAH removed, the better the RBF
The lower the amount of PAH removed, the lower the RBF is
What is it? And function?
- Fenestrations: Specialized openings in the renal glomerular endothelium that allow the cell to be more permeable
- Epithelium/ Epithelial Cells: Specialized to provide support to the glomerular capillary bed. Pressure is high in the glomerulus, so this is important
- Baesment Membrane: Thick layer of connective tissue that is littered with negative charges in order to prevent other negatively charged particles from exiting through the slit pores (proteins)
- Endothelium
- Podocytes: What makes up the epithelium and provides structural support under the high pressure system in the glomerulus. Keeps the glomerular capillary from swelling due to chronic HTN (tries to). If you have chronic HTN and the pressure at the renal artery is 200mmHg instead of 100mmHg, this significantly increases the pressure within the glomerulus
- Slit Pores: “Foot processes” that are openings between podocytes.
How do size and charge affect filterability?
- Polycationic dextran: The charge on the sugar compound is positive, so the filtration rate will be higher
- Polyanionic dextran: The negative charged will be repelled by the basement membrane of the glomerulus, so it’s filterability is reduced
If the compound is larger, it’s less filterable
If the compound is smaller, it’s more filterable
Renal Blood Vessels
Renal artery –> Segmental arteries –> interlobar arteries –> arcuate arteries –> interlobular arteries –> afferent arterioles ->
Glomerular capillaries –> Efferent Arteriole–> peritubular capillaries
These are all located behind the PT capillaries:
–> Interlobular veins –> Arcuate veins –> Interlobar veins –> Segmental veins –> Renal veins
Arteries split into smaller arteries
Veins converge into larger veins
- Arcuate Artery
- Arcuate Vein
- Afferent Arteriole
- JG apparatus
- Efferent Arteriole
- Glomerulus
- Bowman’s Capsule
- Proximal Tubule
- Cortical collecting tubule
- Collecting Duct
- Loop of Henle
- Peritubular Capillaries
- Distal Tubule
Renal Blood Vessels; Two types of nephrons
Superficial vs Deep, difference between the vessels
90-95% of our nephrons are very superficial and are located in the cortex
-PT capillaries and renal vessels are in the outer medulla
5-10% of our nephrons are deep medullary nephrons
-Unequal number of descending and ascending PT capillaries here.
-Called descending and ascending Vasa Recta
-We have more ascending vasa recta than descending; causing the velocity of blood flow to slow as it ascends. This is important in maintaining a normal level of solutes in the deep interstitium; if the blood flow was too fast, it would “wash out” the solutes traveling through the renal interstitium
-Receive a limited supply of blood, so if BP is low, the deep medullary PT capillaries will be the most sensitive to those changes
Why is this important?
Renal Surface Anatomy
- R. Adrenal Gland
- L. Adrenal Gland
- Gastric surface of L kidney
- Splenic surface
- Pancreatic surface
- Descending colic (colon) surface
- Duodenal surface
- R colic flexure surface (colon)
- Hepatic Surface
Cancer in these other organs are likely to spread to the “surface” of the kidney that it touches
- Proximal convoluted tubule
- Afferent & Efferent Arterioles
- Straight Proximal tubule
- Descending Thin Loop of Henle
- Ascending thin Loop of Henle
- Thick ascending limb of Loop of Henle
- Macula Densa (Located in the TAL Loop of Henle)
- Glomerulus
- Bowman’s Capsule
- Distal convoluted tubule
- Cortical Collecting Duct
- Medullar Collecting Duct
-Outer MCD and Inner MCD - Papillary Duct
Function of the Macula Densa? Exact location?
-TAL of Loop of Henle
-Sits on top of the afferent and efferent arterioles entering the glomerulus
-Measures flow through the kidney.
-When flow is low, renin is released
-Increased Renin leads to increased Angiotensin II –> constricts the efferent arteriole, occluding outflow–> increases Pg
-Flow is too high –> decreased amounts of Renin released –> decreased Angiotensin II –> relaxation of the efferent arteriole
What is going on in this graph?
Concentration compared to location in tubule
-Creatinine is freely filtered, but not reabsorbed. The further along the tubule we go, the higher the concentration of creatinine becomes because water continues to be absorbed but creatinine is not
-All glucose reabsorption happens at the PCT. Concentration should be the same as plasma glucose once it’s filtered, but should completely be reabsorbed steeply decreasing the glucose concentration throughout the remained of the tubule
-Same for AA ^
-Na+ concentration is fairly consistent throughout the proximal tubule because as Na+ is being absorbed, water is also being absorbed
-Cl- tends to become slightly more concentrated than Na+ as we move through the proximal tubule. In the second half of the proximal tubule, Cl- is most concentrated, and this favors reabsorption
SGLT- Function? What happens if glucose is too high?
Glut transporter on basolateral side? Hyperfiltration of glucose does..?
-All filtered glucose should be reabsorbed in the PCT.
-The SGLT transporter brings 1 Na+ from the tubular lumen down it’s concentration gradient, into the tubular cells, and 1 glucose with it
-What happens if glucose is too high?
Hyperfiltration of glucose causes increased reabsorption of Na+. This causes increased renin release by the macula densa, increasing GFR. This increases the workload on the nephron and can destroy nephrons if hyperglycemia is chronically uncontrolled
-Because glucose is being packed into the tubular cells, the GLUT transporter on the basolateral side does not need ATP. Glucose moves down its concentration gradient
How are amino acids reabsorbed? What happens if plasma AA is too high?
-Small, filtered easily, and the body reabsorbs 100% of the AA that are filtered
-Sodium/Amino Acid transporter works the same way that the SGLT transporter does. 1 Na+ moves across it’s concentration gradient from the tubular lumen into the tubular cells, bringing one AA with it
-Hyperfiltration of AA is the same as glucose.
-AA are passively allowed out of the basolateral side of the cell in the same way as glucose
-Filtered load of glucose depends on GFR and plasma concentration of glucose
-Vertical axis is showing glucose filtered load, reabsorption, or excretion
-Horizontal axis is showing up plasma glucose concentration
-Threshold (Graph shows 200, Schmidt says <200mg/dL); the point where the PCT can no longer reabsorb 100% of the glucose, and some glucose will start to be excreted. As BG increases, excretion rate also increases
-Transport maximum is ~ 300mg/dL; at this point, there will be a rapid increase in the amount of glucose excrese
Primary effect & secondary affect
AT I Receptors
-Main effect: When Ang II binds to the AT I receptor, the speed of the Na+/K+/ATPase pump increases
1. Causing an increase in Na+ leaving the cell–> causing an increase in the concentration gradient –> Na+ will flow in faster at the NHE exchanger
2. Speeds the rate of reabsorption for HCO3- via the Na+/HCO3- cotransporter (secondary active transporter)
-HCO3- drives this pump, not Na+
Paraceullar vs Transcellular. What is reabsorbed via paracellular?
Tubular Reabsorption
-Paracellular reabsorptionm (passive) originates at the tight junction of the apical membrane of the tubular lumen. This pathway goes between cells
1. Cl- is reabsorbed this way –> moves into the renal interstitium because of the electrical gradient created by Na+
2. Areas of the kidney that are impermeable to water (Thin Ascending Loop) will have very tight junctions and will lack aquaporins
-Transcellular reabsorption happens via a transporter or channel within the cell wall
1. Water moves through aquaporins via the transcellular route. Follows solute traveling to the renal interstitium via osmosis
What is bulk flow? What is largely present in the renal interstitium?
-Bulk flow: Happens at the area of the tubule where filtration is very heavy, and reabsorption is also very heavy. NFP at the glomerular capillaries is about 10mmHg, and NRP at the peritubular capillaries is also 10mmHg
-Urea, a metabolic waste product, is somewhere stored within the renal interstitium and is used to help reabsorb water via osmosis
-Brush border on the apical side of the proximal tubule cells; increases the surface area of the cells lining the apical border of the tubule by ~20x. This allows for a large amount of the cell to be exposed to the fluid in the proximal tubule as well as a large area for the kidney to place transporters
Vrm in the tubular cells is -70mV
Vrm in the tubular lumen is -3mV (due to a combination of K+, Na+ and Cl-)
Function of the NHE pump? H+ combines with what?
Acid-Base Management at the PCT
Carbonic anhydrase is located where? Walk thru the steps of the image
NHE: A form of secretion; secreting H+ ions at the PCT. This exchanger is also the primary reabsorption process for Na+ in the PCT
-H+ secreted into PCT, combines with HCO3- to form H2CO3
-Carbonic anhydrase dissociates H2CO3 into H2O and CO2
-H2O is easily reabsorbed via osmosis. CO2 easily diffuses across the membrane
-Carbonic anhydrase can be:
1. Tethered to the cell wall
2. Floating freely in the proximal tubule
3. Inside of the tubular cell
-Carbonic anhydrase then drives the reaction in the opposite direction once in the cell; CO2 + H2O = H2CO3
-Dissociates again into H+, HCO3-
-H+ is secreted into tubule, joins with HCO3-, or combines with NH4 (buffer for the urine)
-HCO3- is reabsorbed into the renal interstitium –> PT capillaries
What happens in the patient is in liver failure?
Production of new HCO3- in the PCT
-Glutamine produced in the liver can be converted into two different compounds in the PCT:
1. HCO3-
2. NH4+
1 Glutamine is turned into 1 glucose –> turned into 2HCO3-, which is then turned into NH4+
The NH4+/ Na+ secretes NH4+ out into the tubular lumen, where H+ can attach to be excreted through the urine
This is another method for the body to buffer our blood by getting rid of extra protons. Liver failure means the person will not be able to produce glutamine as effectively
Other Buffers in the PCT
-NaHPO4- is a urinary buffer in addition to NH4+ and HCO3-
Ca++ Regulation in the tubule
-Ca++ is reabsorbed in multiple areas of the tubule
-Follows both pathways of reabsorption;
- Paracellular: Ca++ is “dragged” along with water and other solutes via the paracellular route. If the reabsorption rate in the PCT increases for any reason, thats typically means that the reabsorption rate of Ca++ will also increase
- Transcellular:
-Ca++ channel on the apical side that allows Ca++ into the tubular cells (concentration gradient)
-Ca++ ATPase pump that directly pumps Ca++ out into the renal interstitium
-Ca++/Na+ exchanger (3 Na+ in, 1 Ca++ out)
Ca++ filtration heavily depends on acid/base balance. If Ca++ is bound to albumin (or something else that’s negatively charged), it’s not going to be filtered
H+ & Na+ Dependent Antiporters
Cation Secretion:
H+ Dependent antiporters bring one H+ ion into the cell in exchange for secreting a cation into the tubule
Anion Secretion:
This pathway uses an intermediary called alpha-ketogluterate
(a-kb). A transport system brings 3 Na+ with each 1 a-kb into the tubular cell. The increased concentration of a-kb in the tubular cells causes organic anions to be secreted into the tubular cells from the renal interstitium. Once in the tubular cell, the organic anion is secreted into the tubular lumen via a facilitated transporter
If two compounds are using the same transporter system, we can increase the levels of the one we do not want to keep around so that the transporter system secretes the compound in higher concentration
