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OLD "MBS 603" > Exam 4 Condensed > Flashcards

Exam 4 Condensed Flashcards

1
Q

What is the filtration fraction?

A

GFR/RPF

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2
Q

How do you calculate ECF?

A

20% x weight

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3
Q

How do you calculate ICF?

A

40% x weight

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4
Q

How do you calculate interstitial fluid?

A

75% x ECF

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5
Q

How do you calculate plasma volume?

A

25% x ECF

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6
Q

Intake of an isotonic NaCl solution…

type:
ECF volume:
ECF osmolarity:

A

type: isosmotic volume expansion
ECF volume: increase
ECF osmolarity: no change

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7
Q

Mild diarrhea…

type:
ECF volume:
ECF osmolarity:

A

type: isosmotic volume contraction
ECF volume: decrease
ECF osmolarity: no change

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8
Q

High NaCl intake…

type:
ECF volume:
ECF osmolarity:

A

type: hyperosmotic volume expansion
ECF volume: increase
ECF osmolarity: increase

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9
Q

Excessive sweating…

type:
ECF volume:
ECF osmolarity:

A

type: hyperosmotic volume contraction
ECF volume: decrease
ECF osmolarity: increase

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10
Q

Excessive water intake…

type:
ECF volume:
ECF osmolarity:

A

type: hyposmotic volume expansion
ECF volume: increase
ECF osmolarity: decrease

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11
Q

Adrenal insufficiency…

type:
ECF volume:
ECF osmolarity:

A

type: hyposomotic volume contraction
ECF volume: decrease
ECF osmolarity: decrease

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12
Q

How do you calculate filtered load of a solute?

A

UF x Us

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13
Q

During reabsorption, filtered load ____ excretion rate of solute

A

filtered load > excretion rate

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14
Q

During secretion, filtered load ____ excretion rate of solute

A

filtered load < excretion rate

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15
Q

Why is inulin a good marker for GFR?

A

it cannot be reabsorbed or secreted
* only filtered and excreted

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16
Q

How do you calculate clearance (GFR) of a solute?

A

UF x Us / Ps

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17
Q

For inulin, filtered load ____ excretion rate of solute

A

filtered load = excretion rate

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18
Q

[Creatinine] in plasma is ____________ proportional to GFR

A

inversely

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19
Q

Does hydrostatic pressure or osmotic pressure favor filtration?

A

hydrostatic pressure

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20
Q

Does hydrostatic pressure or osmotic pressure favor reabsorption?

A

osmotic pressure

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21
Q

Is hydrostatic pressure or osmotic pressure the driving force for GFR?

A

hydrostatic pressure

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22
Q

What happens to renal plasma flow if afferent arterioles are restricted?

A

decrease

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23
Q

What happens to hydrostatic pressure if afferent arterioles are restricted?

A

decrease

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24
Q

What happens to GFR if afferent arterioles are restricted?

A

decrease

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25
Q

What happens to renal plasma flow if efferent arterioles are restricted?

A

decrease

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26
Q

What happens to hydrostatic pressure if efferent arterioles are restricted?

A

increase

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27
Q

What happens to GFR if efferent arterioles are restricted?

A

increase then decrease

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28
Q

When you restrict efferent arterioles, why does hydrostatic pressure increase?

A

restriction downstream causes build up of pressure upstream cause increased filtration

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29
Q

When you restrict efferent arterioles, why does GFR increase then decrease?

A

INCREASE: restriction downstream causes build up of pressure upstream cause increased filtration

DECREASE: proteins build up causing osmotic pressure to overcome hydrostatic pressure

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30
Q

What 2 mechanisms auto-regulate renal function?

A
  1. myogenic mechanism
  2. tubuloglomerular feedback
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31
Q

How does auto-regulation of renal function via the myogenic mechanism work?

A
  1. increased stretch smooth muscle stretch is sensed in afferent arterioles
  2. increased intracellular Ca2+
  3. increased tension
  4. increase resistance (to counteract stretch)
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32
Q

How does auto-regulation of renal function via the tubuloglomerular feedback work?

A
  1. single nephron senses increase in lumenal NaCl (at macula densa)
  2. increased constriction of arterioles
  3. decreased GFR/RBF
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33
Q

What 2 things does Angiotensin II increase when secreted?

A
  1. increased contraction (increased R and BF)
  2. increased aldosterone (increase Na+ reabsorption & increased ECF)
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33
Q

What is aldosterone’s affect on Na+?

A

increased Na+ reabsorption

(to increase ECF volume)

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34
Q

What environment is aldosterone secreted in?

A

low blood pressure

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35
Q

What are 3 stimulators of aldosterone secretion?

A
  1. AT II
  2. volume contraction
  3. hyperkalemia
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36
Q

What medication blocks aldosterone and competes for binding of its receptor?

A

spironolactone

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37
Q

What is the purpose of diuretics?

A

prevent salt reabsorption to draw fluid into tubules = increased urine production

  • prevents fluid build up in body & lowers BP
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38
Q

How do prostaglandins (PGE2) affect kidney function?

A

local vasodilator allowing for increased blood flow

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39
Q

What affects paracellular movement?

A

voltage

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40
Q

What affect transcellular movement?

A

saturation of transporters

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41
Q

Molecules that need to be actively transported can have their transporters saturated, how does that affect…

excretion
reabsorption
filtration

A

excretion: none
reabsorption: Tm limited
filtration: none

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42
Q

What happens when an active transporter reaches Tm?

A

transporter becomes saturated

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43
Q

Why is there no glucose excreted at the beginning of the glucose Tm graph?

A

its all being filtered and reabsorbed

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44
Q

What does the threshold on the glucose Tm graph represent?

A

plasma concentration at which solute first appears in urine

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45
Q

What segment of the nephron reabsorbs the most water?

A

proximal tubule

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46
Q

Fluid reabsorption in the proximal tubule is ____osmotic

A

isosmotic

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47
Q

_____% of Na+ is reabsorbed in the proximal tubule

A

67%

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48
Q

What is the Vte charge in the early proximal tubule and why?

A

-4 mV
Na+ is leaving paracellularly making lumen more negative

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49
Q

What drives the reabsorption of Na+ in the early proximal tubule?

A

negative Vte

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50
Q

What is the Vte charge in the late proximal tubule and why?

A

+4 mV
Cl- is paracellularly leaving lumen making it more positive

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51
Q

What is GT balance?

A

67% of Na+ is always reabsorbed in the proximal tubule, regardless of the change in filtered load

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52
Q

What are the 2 factors that affect GT balance?

A
  1. peritubular factors (change in starling forces)
  2. luminal factors (tubule flow)
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53
Q

If you increase the filtration fraction does the osmotic pressure of the peritubular capillary increase or decrease?

How does this aid in GT balance?

A

increase osmotic pressure

*increased Na+ reabsorption

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54
Q

If you increase the filtration fraction does the hydrostatic pressure of the peritubular capillary increase or decrease?

How does this aid in GT balance?

A

decrease hydrostatic pressure

more filtration means more solutes need to be absorbed whcich favors osmotic pressure

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55
Q

If you increase filtration fraction, the tubule flow ___________, so what is the affect on solute reabsorption?

A

increase tubule flow

increased solute reabsorption (spends more time in tubule)

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56
Q

How much glucose, amino acids, and carboxylates are reabsorbed in proximal tubule?

A

almost 100%

57
Q

How much potassium and calcium is reabsorbed in proximal tubule?

A

2/3

58
Q

What ion closely follows fluid reabsorption?

A

K+

59
Q

Where is most of the Ca2+ reabsorbed?

A

thick ascending limb

60
Q

How much Mg2+ is reabsorbed in proximal tubule?

A

15%

61
Q

What ion is excreted the most and why?

A

phosphate (aids in excretion of non-volatile acids)

62
Q

How much phosphate is reabsorbed in proximal tubule?

A

80%

63
Q

Reabsorption of phosphate is ____-limited causing it to be excreted in urine

A

Tm

64
Q

How much HCO3- is reabsorbed in proximal tubule?

A

80%

65
Q

What is an example of an organic/synthetic anion?

A

PAH

66
Q

PAH __________ is Tm limited because active transporter is located on _________ side

A

secretion

basolateral side

67
Q

The fluid at the end of the loop of henle is ______osmotic

A

hypotonic

68
Q

The thin descending limb reabsorbs ______ while the thin/thick ascending limb reabsorbs ________

A

H2O

NaCl

69
Q

Fluid movement down the thin descending limb becomes more __________

A

concentrated

70
Q

Fluid movement up the thick/thin descending limb becomes more __________

A

diluted

71
Q

What transporter reabsorbs NaCl in thick ascending limb?

A

Na+/K+/Cl- co-transporter

72
Q

What is the Vte of the thick ascending limb and why?

A

+10 mV

lots of K+ channels pump K+ into lumen

73
Q

What is Bartter Syndrome?

A

defective Na/K/Cl co-transporter

less K+ movement = less ion reabsorption

74
Q

What is a loop diuretic?

A

inhibits Na/K/Cl co-transporter

targets thick ascending limb

75
Q

What 2 ions are mainly transported paracellularly in the thick ascending limb?

A

Mg2+
Ca2+

76
Q

Where is most of the Mg2+ reabsorbed?

A

thick ascending limb

77
Q

What aid in the diffusion of Mg2+ through tight junctions in the TAL?

A

paracellin-1

78
Q

What are the 2 cell types in the distal tubule and collecting duct?

A

intercalated cells
principle cells

79
Q

What is special about principle cells in the distal tubule?

A

Na+ reabsorption stimulated by aldosterone

80
Q

What transporter reabsorbs NaCl in the distal tubule?

A

thiazide-sensitive NaCl co-transporter

81
Q

What is Gitelman Syndrome?

A

defective thiazide-sensitive NaCl co-transporter

less NaCl reabsorption = more concentrated urine

82
Q

What is the Vte of principle cells in the collecting ducts and why?

A

-40 mV

ENac is pulling Na+ out of lumen

83
Q

What transporter reabsorbs Na+ in principle cells of the collecting duct?

A

ENac (K+/Na+ channel)

84
Q

How does Cl- get reabsorbs in principle cells of the collecting ducts?

A

paracellularly

  • does not use ENac (K+/Na+ channel)
85
Q

What is Liddle Syndrome?

A

increases ENac activity

causes more Na+ reabsorption and high BP

86
Q

What is the Vte of beta-intercalated cells in the collecting duct and why?

A

-40 mV

HCO3- is being pumped into lumen via HCO3-/Cl- exchanger

87
Q

What transporter do beta-intercalated cells use to transport Cl-?

A

HCO3-/Cl- exchanger

  • aids in HCO3- secretion
88
Q

Do beta-intercalated cells transport Na+?

A

no

only Cl-, HCO3-, H+

89
Q

What is aldosterone’s affect on NaCl reabsorption?

A

increases

90
Q

What cell type does K+ secretion in collecting duct?

A

principle cells (via ENac)

91
Q

What cell type does K+ reabsorption in collecting duct/distal tubule?

A

alpha-intercalated cells (H+/K+ pump)

92
Q

Why does hypokalemia induce acidosis?

A

K+ is reabsorbed by alpha-intercalated cell’s H+/K+ pump

If K+ is not being reabsorbed H+ is building up in blood

93
Q

What cell type performs H+ secretion in the collecting duct/distal tubule?

A

alpha-intercalated cells (H+/K+ pump)

94
Q

What cell type performs HCO3- secretion in the distal tubule?

A

beta-intercalated cells (HCO3-/Cl- exchanger)

95
Q

What is the HCO3- pump and the H+ pump located on alpha-intercalated cells?

A

HCO3-: basolateral side
H+: apical side

96
Q

What is the HCO3- pump and the H+ pump located on beta-intercalated cells?

A

HCO3-: apical side
H+: basolateral side

97
Q

Ca2+ reabsorption is tightly regulated in the __________________ compared to the proximal tubule

A

distal convoluted tubule

98
Q

What are 2 reasons kidneys excrete H+ into lumen?

A
  1. reabsorb filtered HCO3-
  2. excrete non-volatile acids
99
Q

What’s the net uptake of acid in a day:
What’s the net metabolic acid produced in a day:
How much H+ is excreted in a day:
How much HCO3- is reabsorbed in a day:

A

30
55
70
4320

100
Q

What are the 2 fates of H+ secreted in the lumen?

A
  1. make new HCO3- (combines with OH- to make water)
  2. secreted as a titratable acid
101
Q

Is the HCO3 made in H+ excretion or HCO3- absorption considered “new”?

A

H+ excretion

102
Q

Where is the most HCO3- reabsorbed?

A

proximal tubule

103
Q

What 3 segments of the nephron participate in acid secretion?

A
  1. proximal tubule
  2. thick ascending limb
  3. cortical collecting duct
104
Q

How does the early proximal tubule play a role in acid secretion?

A

Na/HCO3- exchanger

  • HCO3- reabsorption

H+ secretion

105
Q

How does the thick ascending limb play a role in acid secretion?

A

Na+/HCO3- exchanger

  • HCO3- reabsorption
106
Q

How does the cortical collecting duct play a role in acid secretion?

A

alpha/beta-intercalated cells

*H+/HCO3- secretion

107
Q

Does glutamine breakdown or urea formation make new HCO3-?

A

glutamine breakdown

108
Q

What 2 things are needed to make a concentrated urine?

A
  1. H2O permeable nephron segments
  2. hyper-osmotic medullary interstitum
109
Q

What is the role of ADH?

A

increase water reabsorption by inserting more aquaporins

  • more concentrated urine
110
Q

What are 2 stimulators of ADH?

A

** 1. increased plasma osmolarity
2. decreased ECF

111
Q

What 2 segments of the nephron are the most water permeable?

A

PT
tDLH

112
Q

Where is ADH the most active?

A

inner medullary collecting duct

113
Q

Where does ADH first appear?

A

distal tubule

114
Q

What are the 2 steps to generating a hyperosmotic medullary interstitum?

A
  1. reabsorb H2O in tDLH
  2. reabsorb NaCl in TAL
115
Q

What is the single effect of the counter-current loop?

A

movement of NaCl out of ascending limb increases the osmolarity of interstitum

116
Q

What is the osmotic equillibrium of the counter-current loop?

A

entering fluid is isosmotic but turns hyperosmotic as water is reabsorbed in tDLH

117
Q

What is the tubule flow of the counter-current loop?

A

concentrated fluid moves the LH tip which drives more NaCl into interstitum

118
Q

What does the vasta cava do?

A

picks up NaCl from interstitum and drops it back off

119
Q

urea concentration increases/decreases as you get deeper into the medulla

A

increases

120
Q

Where is 50% of urea secretion?

A

tip of LH

121
Q

Urea is reabsorbed in the presence of ________

A

ADH

122
Q

ADH is release when water intake is high or low?

A

low

123
Q

Why does urea build up in interstitum when ADH is present?

A

provides driving force for water reabsorption to hydrate body

124
Q

In respiratory alkalosis compensation, which is larger…[HCO3]/[CO2]?

A

small/large
* needs to decrease CO2

125
Q

In respiratory acidosis compensation, which is larger…[HCO3]/[CO2]?

A

large/small
* needs to increase CO2

126
Q

In metabolic alkalosis compensation, which is larger…[HCO3]/[CO2]?

A

large/small
* needs to increase CO2

127
Q

In metabolic acidosis compensation, which is larger…[HCO3]/[CO2]?

A

small/large
* needs to decrease CO2

128
Q

Metabolic alkalosis…
pH:
[HCO3-]:
PCO2:
equation:

A

pH: increase
[HCO3-]: increase
PCO2: NA
equation: right

129
Q

Metabolic acidosis…
pH:
[HCO3-]:
PCO2:
equation:

A

pH: decrease
[HCO3-]: decrease
PCO2: NA
equation: left

130
Q

Respiratory alkalosis…
pH:
[HCO3-]:
PCO2:
equation:

A

pH: increase
[HCO3-]: decrease
PCO2: decrease
equation: left

131
Q

Respiratory acidosis…
pH:
[HCO3-]:
PCO2:
equation:

A

pH: decrease
[HCO3-]: increase
PCO2: increase
equation: right

132
Q

What’s the normal pH?

A

7.4

133
Q

What’s the normal PCO2?

A

40

134
Q

What’s the normal HCO3-?

A

24

135
Q

What cells are affected by ADH?

A

principle cells

136
Q

What is the difference between Cl- transport in the early vs late proximal tubule?

A

early: only paracellular
late: trans and paracellular

137
Q

Is there water transport at the distal convoluted tubule?
What is reabsorbed there?

A

No

only Na, Cl, K+

138
Q

Intercalated cells in the CCT only transport…

A

Cl-
HCO3-
H+
K+

139
Q

What’s the role of the juxtaglomerular apparatus in kidney function?

A

contains masala dense and aids in tubuloglomerulus feedback (autoregulation)

140
Q

What’s the effect of atrial natriuretic peptide (ANP) on the kidneys?

A

promotes sodium and water excretion, reducing blood volume and pressure

OLD "MBS 603" (22 decks)

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