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Renal Midterm > Elements of Renal Function > Flashcards

Elements of Renal Function Flashcards

1
Q

what are some waste products that the kidneys remove

A

urea, creatinine, acid, bilirubin, other stuff

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2
Q

where is EPO made

A

kidneys

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3
Q

what is EPO made in response to

A

low PO2

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4
Q

what causes drops in PO2

A

anemia caused by blood loss, arterial hypoxia, inadequate renal flow

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5
Q

what is calcitriol and where is it made

A

active Vit D; kidneys

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6
Q

where does gluconeogenesis occur

A

mostly liver but a substantial amount can happen in kidneys

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7
Q

the cortex contains what

A

renal corpuscles, coiled blood vessels, and coiled tubules

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8
Q

the medulla contains

A

straight blood vessels and straight tubules

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9
Q

the microcirculation of the kidneys is comprised of how many capillary networks and how are they arranged

A

2; in series

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10
Q

what are the capillaries of the kidney

A

glomerular and peritubular

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11
Q

what does the glomerular capsule prefer

A

filtration

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12
Q

what does the peritubular capillary prefer

A

absorption

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13
Q

what are the Pc of the glomerular and peritubular capillaries

A

~60 mm Hg; ~13 mm Hg

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14
Q

long medullary peritubular capillaries are often called

A

vasa recta

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15
Q

where is renal blood flow highest

A

cortex then outer medulla then inner medulla

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16
Q

when do we start losing nephrons

A

10% each decade beyond 40

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17
Q

what is the main process of the glomerulus

A

filtration via starling forces

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18
Q

what is the main process of the proximal tubule

A

reabsorption of the largest fraction of glomerular filtrate

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19
Q

what is the main process of the loop of henle

A

controlling urine concentration and secreting Tamm-Horsfall glycoproteins

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20
Q

what is the main process of the distal tubule/collecting ducts

A

fine control of salt and water secretion

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21
Q

How do you calculate renal clearance C_x

A

C_x=Urine concentration of X * urine volume/ concentration of X in plasma

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22
Q

How do you calculate glomerular flow rate

A

GFR = urine concentration of inulin*urine volume/plasma concentration of inulin

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23
Q

How do calculate clearance ratio

A

Clearance of X / clearance of inulin

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24
Q

How do you calculate renal plasma flow

A

RPF = (urine concentration of PAH * urine volume)/ (renal artery PAH concentration - renal vein concentration of PAH)

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25
Q

What is the issue with effective renal plasma flow

A

Underestimates RPF by 10%

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26
Q

What is effective renal plasma flow also equal to

A

Clearance of PAH

27
Q

How do you calculate the Glomerular Filtration Rate

A

GFR = urine concentration of inulin * urine volume / plasma concentration of inulin

28
Q

What does glomerular filtration rate also equal

A

Clearance of inulin

29
Q

How do you calculate filtration fraction

A

FF - GFR / RPF

30
Q

How do you calculate filtered load

A

Filtered load = GFR * plasma concentration of X

31
Q

How do you calculate excretion rate

A

Excretion = urine volume * urine concentration of x

32
Q

How do you calculate reabsorption or secretion rate

A

Filtered load - excretion

If > 0 then net reabsorption

If < 0 then net secretion

33
Q

What are the 3 ways that sympathetic can increase BP

A
  1. α1 activation with more constriction on afferent arterioeles
  2. Stimulating juxtaglomerular cells to release renin through β1 receptors
  3. Na-K ATPase incereasing reabsorption of Na from α1 activation on tubular epithelial cells
34
Q

How do you calclulate urinary excretion

A

Urinary excretion = amount filtered - amount reabsorbed + amount secreted

35
Q

How do you calculate tubular reabsorption

A

Tubular reabsorption = glomerular filtration - urinary excretion + amount secreted

36
Q

If excretion > filtration then what has happened

A

Tubular excretion

37
Q

How do you calculate V

A

Urine volume/time

Generally in mL/min

38
Q

What is renal clearance

A

The rate at which substances are removed from plasma

It is measure as the volume of plasma cleared of a substance by the kidneys per unit of time

39
Q

Clearance is a ___________ rate

A

Flow

40
Q

What is the glomerular filtrate

A

Volume of plasma filtered into the combined nephrons of both kidneys per unit time

Also the fluid that goes into Bowman’s space

41
Q

When would we expect protein and cells in glomerular filtrate

A

In the event of damage

42
Q

How do you calculate filtration fraction

A

GFR/RPF

43
Q

What does Kf depend on

A

Permeability and surface area

44
Q

What is the main influence of filtration fraction

A

Influenced by blood pressure

45
Q

How does the filtration fraction relate to the oncotic pressure in the peritubular capillaries

A

As it increases there is less water in the capillaries so the oncotic pressure increases

46
Q

How does renal artery stenosis or severe hemorrhage affect FF

A

Decreased RBF so GFR must increase to maintain homeostasis

GFR/RBF where GFR goes up and RBF goes down

47
Q

What is the difference between filtered load and filtration fraction

A

Filtered load is the amount of substance in the blood filtered in unit time

Filtration fraction relates to blood flow

48
Q

How do you calculate filtered load

A

GFR X PNa

49
Q

What is normal GFR

A

125 mL/min

50
Q

When can renal clearance be used to estimate GFR

A
  1. Substance can be freely filtered
  2. Substance can’t go out of or into the tubules
  3. Can’t be synthesized, metabolized, or accumulated in the kidney
  4. Physiologically inert
51
Q

What do we normally use to look at GFR

A

Inulin or creatinine

52
Q

What is the issue with using inulin

A

We have to infuse it

53
Q

Why do we normally use creatinine clearance for GFR

A

Body makes it naturally and production = excretion

54
Q

What is an issue with creatinine and GFR

A

Some (10%) is secreted in the tubules

55
Q

What is the relationship between plasma creatinine concentration and GFR

A

Inversely proportional

56
Q

What do we use to isolate renal issue location

A

BUN/creatinine

57
Q

How do we determine pre-renal, post-renal, or intrarenal diseases

A

> 20:1

10-20:1

<10:1

58
Q

What are some pre-renal diseases

A

Hypovolemia, dehydration, reduced renal perfusion, and high protein

59
Q

What are post-renal issues

A

Ureter backup

60
Q

What are some intrarenal issues

A

Liver disease and low protein diet

61
Q

The normal formula over/under-estimates creatinine clearance

A

Over

62
Q

What is used to estimate renal plasma flow

A

PAH

63
Q

Where is most PAH filtered out of the blood

A

Peritubular capillary which is why it is used to estimate RBF

Renal Midterm (8 decks)

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