Exam 3 Review Flashcards
Name 4 things the kidneys excrete?
Urea
Creatinine
End products
Metabolites
Name 6 things the kidneys regulate?
waste
BP
acid/base
Electrolytes
Hormones
Water
Name the layers of the kidneys from superficial to deep
capsule
cortex
medulla
pelvis
Kidneys get ____ of your CO
22%
The renal artery splits into ____, ___ and _____
interlobar
arcuate
interlobULar
Where can you find the peritubular artery?
around the tubules
What are the two types of capillary arteries?
Glomerular and peritubular capillaries
In the glomerular artery, is the hydrostatic pressure high or low/
high hydrostatic pressure
If you increase flow into the afferent glomerular capillary, what happens?
GFR increases
What is the order of flow through the nephron
-Bowman’s capsule/glomerulus
-Proximal tubule
-Loop of Henle (thin, thin, thick)
-Macula Densa
-Distal Tubule
-Cortical collecting tubule
-Medullary collecting tubule
-Collecting duct
What are the two types of nephrons?
juxtamedullary and cortical nephrons
Cortical nephrons are ____
common
What is the responsibility of the juxtamedullary nephron?
concentration of urine
Which type of nephrons have vasa recta?
juxtamedullary nephrons
**What is the formula for urinary excretion
excretion = filtration - reabsorption + secretion
Define filtration
out of capillaries into bowman’s capsule
define reabsorption
from the Bowman’s capsule to the peritubular capillaries
Define secretion
out of the capillaries into the tubules
_____ is 100% filtered
creatinine
_____ are initially filtered but then get reabsorbed partially
electrolytes
What two substances should you remember together?
Amino acids and glucose
what 3 main end products are excreted?
urea
uric acid
creatinine
a high GFR will (increase/decrease) removal of waste
increase
how many liters of plasma in your body?
3 Liters
At a normal GFR how many liters can your body filter in one day?
180 Liters
Kidneys filter your plasma _____ in one day
60X
What two things does filtrate NOT contain?
proteins or RBCs
The GFR represents _____% of your renal plasma flow
20
The glomerular capillary membrane is (negatively/positively) charged. What layer?
negatively charged
endothelium
What is the job of the glomerular capillary membrane?
prevents proteins from crossing
What are the 3 layers of glomerular capillary membrane?
endothelium
basement membrane
epithelium
Which layer of the glomerular capillary membrane has the large holes in it?
basement membrane
Which layer of the glomerular capillary membrane has podocytes?
epithelium
What three substances have the same filterability as water?
sodium
glucose
insulin
What three components make up the GFR? What is the net filtration pressure?
Glomerular hydrostatic pressure (60)
Bowman’s Capsule Pressure (-18)
Glomerular colloid osmotic Pressure (-32)
10
The Glomerular hydrostatic pressure is ____
(60)
Bowman’s Capsule Pressure is ___
(-18)
Glomerular colloid osmotic Pressure ____
(-32)
When the filtration coefficient is low, the GFR (increase/decreases)
decreases
kidney stones are a result of an (increased/decreased) bowman’s capsule pressure, and GFR (increases/decreases)
increased bowman’s capsule pressure
so GFR decreases
When the afferent arteriole dilates, what happens in terms of blood flow and GFR
increased blood flow, and GFR increases
Decreased GFR can be a result of what conditions?
less blood flow
lower filtration coefficient
kidney stones
CKD
HTN
Less blood flow is due to afferent (dilation/constriction) and/or efferent (dilation/constriction)
afferent constriction
efferent dilation
What two hormones decrease GFR?
norepinephrine and epinephrine
Sympathetic stimulation (increases/decreases) GFR
decreases
Renal artery pressure is the same as ?
systemic arterial pressure
resistance is determined by what 3 arterioles?
interlobULar
afferent/efferent
T/F: Kidneys regulate their own renal blood flow
TRUE
Angiotensin II ____ both afferent and efferent arterioles. Which one does it exert the greatest effect?
constricts
mainly EFFERENTS
Angiotensin II (increases/decreases) GFR and (increases/decreases) renal blood flow
increases GFR
decreases renal blood flow
what is the MOA for Ace inhibitors? What is the end result on BP and GFR?
prevent AT1 from converting to AT2
lowers BP and lowers GFR
The macula densa is most receptive to ____ concentration
sodium chloride
the macula densa controls ______ and _____
renal blood flow and GFR
Macula densa affects the (afferent/efferent/both) arterioles
both
If the macula densa senses low sodium, what happens?
it will dilate the afferent arterioles and release renin
if the afferant arterioles is dilated the GFR will be (higher/lower)
higher GFR
In a higher GFR, (more/less) sodium filtered so that you can reabsorbed (more/less) later
more sodium
more
What effect does renin have? Does the GFR increase or decrease
constricts Efferent arterioles
GFR increases
What is the flow chart look like for GFR regulation. Draw it
Which is more important, reabsorption or secretion?
reabsorption is more important
____ and ____ are poorly absorbed, so they will be present in urine
urea and creatinine
What are the top two electrolytes that are reabsorbed?
glucose and bicarb
What does transcellular mean?
across the cell, aka through it
What does paracellular mean?
next to cell, aka between two cells
This is going through “tight junctions”
where does ultrafiltration/bulk flow occur?
out of the lumen of the nephron and in between the capillaries and tubules
active transport requires ____
ATP
Secondary active transport requires ____
glucose
What is the most important ATPase pump?
sodium/potassium ATPase pump
what are the two glucose co-transporters?
SGLT2 and SGLT1.
Which glucose co-transporter does the bulk of the glucose? where is it located?
SGLT2
proximal convoluted tubule
the SGLT co-transport system is what kind of transport? What is the primary part?
secondary transport
sodium is the primary part
Counter transport helps to ???
preserve energy
Sodium passively diffuses from _____ into _____
lumen
tubular cell
sodium is actively transported from _____ to _____
tubule cell to blood.
When sodium is coming in via counter transport, it can spin the door so ____ ions can leave. no energy required
Hydrogen
Once you hit your reabsorption max, you ____ the rest
excrete
_____ is the max reabsorbable load for glucose
375 mg/min
T/F: If substances are passively absorbed, they have a transport maximum.
False!
passively absorbed substances are time dependent
What is another name for time dependent transport?
gradient-time transport
What is the exception for passive absorption?
sodium reabsorption
Bulk of Na and water is reabsorbed in the _____
proximal convoluted tubule
Besides water and sodium, ___, ____ and ____ are also reabsorbed in the PCT
bicarb, glucose and amino acids
In the PCT ______ and _____ increase in concentration
urea and creatinine
NOT reabsorbed at all in the PCT
What is important about the descending LOH reabsorption?
EXTREMELY permeable to water
aka the water is leaving
The ascending LOH is (highly/not at all) permeable to water
0% permeability to water
_____ leaves at the ascending LOH. What does this result in?
sodium
concentrated urine, LOTS of reabsorption happens here
Where do loop diuretics work? What transporter is involved?
Ascending LOH
1Na-2Cl-1K transporter.
The macula densa is located where?
first part of the distal tubule
What is happening at the distal tubule?
Dilutes urine, aka reabsorbing the rest of the ions like Sodium-Chloride, Bicarb, and Calcium
The distal tubule is impermeable to ____ and ____
water and urea
Where do thiazide diuretics work?
distal tubule
principal cell are responsible for ___ and ____ into the blood, and ____ out
sodium and water
potassium out
intercalated cells are responsible for ____ in and ____ out
K and bicarbonate are reabsorbed
Hydrogen excreted out
Principal cells are where _____ and ______ work (types of medication)
aldosterone antagonists and sodium channel blockers
_____ is the final determinant of urine concentration
Medullary collecting duct
____ is the only site where ADH works
Medullary collecting duct
_____ is the only place urea is permeable
Medullary collecting duct
The higher the ADH, the more ____ reabsorbed
water
_____ + ____ = concentrated urine
High ADH + Hyperosmotic renal medulla
Describe the process of the countercurrent mechanism
- There is only one place in the loop of Henle that is permeable to water: descending loop.
- Essentially, in the ascending loop, you just keep pumping solutes into the medulla (outside)
- When new filtrate flows into the descending loop, it pushes water out to dilute the medulla (outside)
- As this process repeats you are left with a hyperosmotic medulla, since water can only flow into the medulla at the descending loop.
- The entire time, the medulla cannot send solutes back into the loop. It is a one way street.
- The main solute that makes the medulla hyperosmotic is urea. (requires ADH)
Medullary blood flow is very (fast/slow) so the solutes don’t flow away via ____
slow
blood
Describe the role of the Vasa Recta in countercurrent multiplier
Because the medulla is so concentrated with solutes, some it flows into the Vasa Recta.
However, this makes it hyperosmotic as it continues to gain solute but lose water.
As it goes up the loop, the Vasa Recta is permeable to water unlike the loop of Henle, so it reabsorbs water and gets rid of solute (aka undoing what happened in the beginning).
This ensures that all the hard work of concentrating the medulla via the loop of Henle is not lost.
Blood gets hyperosmotic as it descends, but it is reversed as it ascends, so pretty much nothing changed and no solute is lost.
What is the main cause of prerenal acute renal failure?
hypoperfusion
What is the main common cause of intrarenal acute renal failure?
abnormalities of vessls or glomeruli
what is the main common cause of postrenal acute renal failure?
Kidney stones
Acute renal failure can lead to _____ and _____
hyperkalemia and metabolic acidosis
What are the top 3 main causes of prerenal acut renal failure?
- Volume depletion
- Cardiac Failure
- Peripheral vasodilation/shock
anything that causes not enough blood flow to kidneys or not enough pressure to get blood to the kidneys
is prerenal acute renal failure reversible?
Reversible, unless renal blood flow is < 25%
How do the kidneys adjust in prerenal acute renal failure?
temporarily slowing GFR
Give some examples of glomerular capillary/vessel damage
What type of acute renal failure?
Vasculitis, cholesterol, acute glomerulonephritis (GN)
intrarenal
Give an example of renal tubular epithelium damage
What type of acute renal failure?
Acute tubular necrosis (ATN)
intrarenal
Give two examples of renal interstitium damage
What type of acute renal failure?
Acute pyelo (UTI going up to the kidneys themselves)
Acute interstitial nephritis (drugs or immune)
intrarenal
What are three examples of postrenal acute renal failure?
Bilateral obstruction of ureters/renal pelvis due to clots or stones
Bladder obstruction
Obstruction of Urethra
In a male patient, what are two examples of postrenal acute renal failure?
Some sort of stone
prostate
At what point does it become visible that your nephrons are dying?
start showing signs of renal failure once you have lost 25% of them
What are the top 5 causes of ESRD?
DM
HTN
Infections
Vascular diseases
(Obesity plays a role in both DM and HTN)
As you start to lose nephrons, your kidney become _____
scarred
What is the most common form of kidney disease?
Nephrosclerosis
its is benign but irreversible
What chronic renal disease is immune complex mediated?
glomerulonephritis
What kind of nephrons have vasa recta?
juxtamedullary
What is the MCC of nephrotic syndrome in children?
minimal change disease
what is minimal change disease caused by? What is an obvious factor?
caused by damage to your glomeruli
protein will be present in the urine
Chronic renal failure is amplified by ____ and ______
HTM and DM
What is chronic glomerulonephritis?
It’s characterized by irreversible and progressive glomerular and tubulointerstitial fibrosis, which can lead to a reduction in the glomerular filtration rate (GFR) and retention of uremic toxins
Myenteric plexus is also know as _____ plexus
Auerbach’s plexus
Myenteric/Auerbach’s plexus is responsible for ????
GI movement/peristalsis
Submucosal plexus is also known as ____ plexus
Meissner’s plexus
Submucosal/Meissner’s plexus is responsible for ???
Secretions/blood flow
Where is the primary parasympathetic cut off point?
transverse colon
Sacral parasympathetic is _____ to ____
transverse colon to anus
What transmitter excites the GI tract?
Acetylcholine
What transmitter inhibits the GI tract? What levels?
Norepinephrine
L5-T2??? need to double check this fact
Gastrin is secreted to break down ____
proteins
Where is gastrin found?
at the bottom of the stomach, G cells
What is the inhibitor of gastric emptying?
CCK
CCK is released in response to _____. What does it release?
fat
releases bile
______ secretes everything except gastric acid
secretin
______ inhibits gastric acid
gastric inhibitor peptide (GIP)
GI blood flow uses ____ circulation
splanchnic
GI blood flow flows through the ______ on return
portal vein
_____ and _____ get absorbed earlier than fats
carbs and proteins
What are the two main arteries off the aorta?
Which one is most important?
**Superior mesenteric artery and Inferior mesenteric artery
_____ are the functional unit of the liver
lobules
What is the order of liver blood flow?
- Portal veins
- Sinusoids
- Central veins
- Hepatic veins
- IVC
_____ cells eat toxins/bacteria as the blood flows through them. (aka the detox part of your liver.
Kupffer cells
food + gastric secretions =
chyme
The _____ is the end of the stomach, and it prevents you from dumping your entire meal into your intestines immediately.
pylorus
What are the two different types of gastric glands?
Chief cells
parietal cells
____ cells are associated with pepsin
chief cells
parietal cells are associated with ____ and _____
HCl and intrinsic factor
pyloric glands mainly just secrete ____
gastrin
The presence of _____ specifically is one of the indicators for your duodenum to slow gastric emptying. What two hormones are associated with it?
fats
CCK and GIP
The pancreas functions as both ????
an endocrine and exocrine gland
acini cells are associated with ____
bicarb
The pancreas is associated with _____, ____ and _____ that break down proteins
trypsin + chymotrypsin + carboxypolypeptides
trypsin + chymotrypsin + carboxypolypeptides all start out as _______. What changes that?
inactivated
are activated by the HCl in the stomach acid
What enzyme is associated with breaking down carbs?
pancreatic amylase
What 3 pancreatic enzymes are responsible for breaking down fats?
Pancreatic lipase + Esterase + Phospholipase
How does the SI increase surface area?
Valvulae Conniventes (3x)
Villi (10x)
Brush border Microvilli (20x)
total: 1000X increase in surface area
What are the three monosaccharides?
Glucose
Fructose
Galactose
Which simple sugar is the sweetest?
fructose
Which simple sugar is not found solo in nature? What is it always a part of?
galactose
lactose
What are the two components of sucrose?
glucose + fructose
What are the two components of lactose?
galactose + glucose
What are the two components of maltose? Where is it commonly found?
glucose + glucose
beer, cereals, germinating seeds
Which disaccharide is the least sweet?
Lactose
Which disaccharide is the most common?
sucrose
What are two common polysaccharides?
starch and glycogen
What are the TWO sources of amylase?
salivary amylase and pancreatic amylase
Hydrolysis is used for the breakdown of ______, _____ and ______.
COMPLEX carbs
polysaccharides
triglycerides to 3 FAs and glycerol
how are triglycerides broken down? what are the components? via what enzyme?
triglycerides to 3 FAs + glycerol
pancreatic LIPASE
emulsification happens via _____
bile acids
_____ + _____ = emulsified fat droplets
bile acids + agitation
emulsified fat + _____ = fatty acids and 2-monoglycerides
pancreatic lipase
once triglycerides are broken down, _____ are formed
micelles
Draw the diagram for protein digestion
When talking about lipoproteins, the density refers to ____
how much PROTEIN is in it
Which type of cholesterol is considered “bad”
LDL (has a low density of protein aka a high density of fats)
Which type of cholesterol is considered “good”
HDL
Where are most triglycerides stored?
as adipose cells or in the liver
What is achalasia?
hypercontractile lower esophageal sphincter
Name two causes of the peptic ulcer disease?
H. pylori infection
excess NSAID use
What are the two main causes of pancreatitis?
gallstones
binge drinking alcohol
non-tropical sprues = ______ disease. How does it work? How is it mostly commonly transmitted?
celiac disease
gluten kills the villi in the your SI
familial inheritance
tropical sprues is caused by ???? How is it treated?
bacteria
treat with abx
UC is a subtype of _____. Where does it most commonly affect?
IBD
sigmoid colon and rectum
What is the normal body temp?
98.6
a person commonly gains heat from _____ and _____
metabolic processes
environment
what are the four main ways you lose heat?
**radiation, convection, conduction, evaporation
_____ can boost how much heat you lose
Sympathetics
The majority of heat loss is through _____
radiation: 60%
convection heat loss, lose heat through _____
air currents
think like an over
conduction heat loss, lose heat through _____
touching an object or air
think like elctricity
evaporation heat loss, lose heat through _____
sweat
What is the main method of losing heat when it is too hot outside?
evaporation aka sweating
____ is responsible for overall temperature regulation
hypothalamus
When you sweat slowly (like after a jog), you (can/cannot) reabsorb the sodium you normally lose.
can reabsorb the sweat you lose
When you sweat profusely, you lose a lot of sodium. What is a common way to replenish?
pedialyte/gatorade help with people who are sweating A LOT
When you are too hot, the body adapts in what 3 ways?
Vasodilation
Sweat
Slowing metabolic processes
When you are too cold, the body adapts in what 3 ways?
Shivering
Piloerection (goosebumps/hair)
Increased metabolic processes
Overall, you are more sensitive to ____ than ____. 10x more receptors.
cold: 10x more receptors.
hot
What is a fever due to?
Increased set point within the hypothalamus due to endogenous pyrogens, like IL-1 and IL-6.
What two endogenous pyrogens are responsible for a fever?
IL-1 and IL-6.
Do platelets have a nucleus?
NO!
What is normal platelet count?
150K-450K
What is a low platelet count called?
Thrombocytopenia
What is a high platelet count called?
thrombocytosis
What is the 1/2 life of a platelet?
8-12 days
How are the majority of platelets removed?
by the spleen
What is the triggering factor for platelet plugs?
exposed collagen from damaged vascular wall
Collagen makes plts sticky and causes them to leak ____, ____ and _____
vWF, ADP, and thromboxane A2.
How long does it take to make a platelet plug?
15-20 seconds
platelet plug transitions into a clot when ???
you start activating fibrin
generally your body in in an _____
anticoagulant state
A ruptured vessel/damaged blood cells trigger ______
prothrombin activator
What is the rate-limiting step in clotting?
Availability of activator
Prothrombin activator activates ???? What does it need for this process?
prothrombin into thrombin
presence of sufficient Calcium ions
Where is prothrombin made?
in the liver
Thrombin converts ????
fibrinogen to fibrin
Where is fibrinogen made?
in the liver
Extrinsic pathway thinking ????? what is the lab measuring?
triggered by damage to walls
PT
Intrinsic pathway thinking ????? What lab measurement?
damage to the RBCs themselves
aPTT
What is the helpful analogy for extrinsic vs intrinsic?
Draw the diagram for extrinsic and intrinsic factors
Which factors does PT measure?
Measures 1, 2, 5, 7, 10 (AKA common pathway + extrinsic)
Which factors does aPTT measure?
Measures 1, 2, 5, 8, 9, 11, 12 (AKA common pathway + intrinsic)
How does heparin work?
it amplify Antithrombin 3 by 100x
What is the role of antithrombin 3
blocking and inactivation of thrombin. (Factor 2)
Plasmin came from _____.
plasminogen
____ can eat fibrin
plasmin
What is hemophilia related to? What can it cause?
eficiency of factor VIII (8) and causes large vessel bleeding
What does DIC stand for? Describe what happens.
DIC = disseminated intravascular coagulation
A trigger causes you to clot everywhere
You clot too much, you run out
Now you bleed everywhere.
a venous emboli will go to the _____
lungs
arteriole emboli tend to go the ___ and ____
brain and kidneys
Factor 1 is ____
fibrinogen
Factor 2 is _____
prothombin
Factor 3 is _____
tissue factor
Which clotting factor is vit K dependent?
factor 10
(Stuart-Prower factor)
