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Year2 Renal > Exam2 Michelsintro > Flashcards

Exam2 Michelsintro Flashcards

1
Q

what percentage of body is water? intracell portion? extra cell?

A

60% body is water
40% intracell
20% extracell

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2
Q

Where is sodium higher?

A

extra cell

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3
Q

where is K higher?

A

inside cell

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4
Q

Where is Cl higher

A

extracell

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5
Q

What controls fluid movement primarily between ECF and ICF

A

Na, so NaK ATPase

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6
Q

what controls fluid within ECF i.e. plasma and interstilium

A

the oncotic and hydrostatic pressures

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7
Q

what is non-pitting edema

A

swollen cell sdue to increased ICF volume

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8
Q

what is pitting edema

A

increased interstitial fluid volume

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9
Q

which type of edema does not respond to diuretics

A

non pitting edema

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10
Q

What is isoosmotic volume contraction. give examples

A

osmolarity is same
change in volume of ECF only
diarrhea, vomiting, hemorrhage

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11
Q

give example of isometric expansion

A

giving saline

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12
Q

What is hyperosmotic volume expansion and give examples

A

osmolarity and volume of ECF increases
ICF volume decreases to keep equilibrium(water)
excess NaCl intake, mannitol infusion

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13
Q

what is hyoosmotic volume expansion and give examples

A

addition of pure water will decreased ECF osmolarity and the water increases in both ECF and ICF
SIADH, psychogenic polydipsia

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14
Q

what is the renal response to volume expansion

A 
decreased SAN
causes nephron to vasodilate, increasing GFR
Heart increases BNP and ANP
brain decreases ADH release
dec renin. dec Ang I II and aldosteron
leads to water loss overall
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15
Q

What is a hypoosmotic volume contraction and give example

A

osmolarity of ECF decreases and volume
ICF volume increases
examples
hypoaldosteronism and adrenal insufficiency

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16
Q

what is hyperosmotic volume contraction

A

lost water
osmolarity of ECF increases and volume
ICF volume decreases and water shiffts from ICF to ECF to equilibrate
dehydration and diabetes inspidus

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17
Q

what are the bodies response to volume contraction

A 
increased SAN
vasoconstriction of renal vasc (afferent and efferent)
GFR decreases
Heart dec ANP and BNP
increase in ADH
increase renin, ANG I II and aldosterone
to decrease Na and water secretion
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18
Q

what happens to a cell in a hypotonic(hypoosmotic) environment

A

the cell swells

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19
Q

what happens to the cell in a hypertonic solution

A

cell shrinks

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20
Q

where is the cortex and medulla of kidney? where are the nephrons

A

cortex is the outside
medulla inside
nephrons–> juxtamedullary loop of henle extend into medulla
cortical nephron stays in Cx

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21
Q

Which type of nephron is important in concentrating urine

A

juxtamedullary

osmolarity of renal medulla increases during the center

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22
Q

which cells release renin

A

juxtaglomerular cells

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23
Q

what cells autoregulate vasculature of renal system

A

macula densa cells

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24
Q

describe glomerular capillaries

A

high hydrostatic pressure filter into bowmans capsule

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25
Q

describe peritubular capillaries

A

low hydrostatic pressure so water and solute are reabsorbed here

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26
Q

what inn affects renal blood flow, GFR and filtration fraction

A

symapthetic system

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27
Q

what stimulates renin release

A

signals from sympathetic cells working on glomerular cells

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28
Q

what are the layers of the glomerulus

A

fenestrated endothelium
glomerular BM has negative charge( prevent proteins)
Podocyte epithelium slit pores between podocytes(prevent large molecules)

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29
Q

what is normal GFR

A

125 ml/min or 180L/day

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30
Q

What are the 3 physical factors of GFR

A

hydraulic conductivity
SA for filtration
capillary ultrafiltration pressure

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31
Q

high oncotic pressure does what

A

pulls water towards it

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32
Q

where does fluid enter after glomerular capillaries

A

peritubular capillaries

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33
Q

What is the filtration fraction

A

part of renal plasma flkow that is diverted into proximal convoluted tubule

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34
Q

how do we calculate FF

A

GFR/RPF renal plasma flow

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35
Q

what dictates FF

A

ultrafiltration pressure

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36
Q

What happens with and increased FF

A

oncotic pressure of efferent arteriole increases leading to greater reabsorption

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37
Q

what is normal FF

A

20%

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38
Q

what happens to oncotic P and hydrostatic pressure of capillary during volume contraction

A

dec hydrostatic
increased oncotic
to increases absorption

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39
Q

what changes the hydrostatic pressure of glomerular capillaries

A

renal arteriole BP
afferent arteriole R
efferent arteriolar R

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40
Q

what happens to GFR when mesangial cells contract

A

shorten loops and decrease GFR

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41
Q

what happens with afferent arteriole constriction

A

pressure drop so decreased GFR

renal blood flow falls because increased R

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42
Q

what happens with efferent arteriolar constriction

A

pooling of blood in glomerular capillaries
icnreased hydrostatic of glomerular capillaries increases GFR
renal blood flow dec

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43
Q

What happens in the arterioles with increased systemic BP

A

increased GFR, increased RBF

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44
Q

what happens with moderate efferent arterole constriction

A

dec RBF renal blood flow

increased GFR and increased P built up in the hydrostatic glomerular capillary

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45
Q

What affects of SAN has on efferent and afferent arterioles

A

constrict afferent
less constriction efferent
dec RBF and dec GFR

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46
Q

What effects of SAN on renin system

A

increased renin by grnaular cells

so Ang II helps BP

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47
Q

how does ANG II work on renal system

A

contricts efferents more so the BP will increase and stabilize GFR

48
Q

What effect on Na does the SAN do

A

stimulates reabsorption in proximal tubules, Thick ascending lopps, distal convoluted and collectin duct

49
Q

Where is ACE located

A

endothelial cells in lung

50
Q

does ADH go up or down in hypotension

A

increase because want to conserve water. increase blood volume

51
Q

What do PGI2 and PGE2 do on renal system

A

increase renal blood flow, vasodilatory

52
Q

What is Clearance

A

volume of plasma from which substance is completely removed by kidneys in given period of time
ml/min or L/hr

53
Q

what does clearance of kidneys tell you

A

how effectively kidneys are removing substance from blood

54
Q

how do you calculate clearance

A

concentration of substance in urine times the volume

all over the concentration of substance in plasma

55
Q

the plasma clearance of creatnine is used for what

A

Inverse indicator of GFR

inulin too

56
Q

if GFR has fallen 25% what will Pcreatnine look like

A

increased 4X

57
Q

what is P creatnine used for clinically

A

chronic long term monitoring of GFR

58
Q

what is glomerular filtration

A

filtration of plasma from gc into bowmans

59
Q

what is tubular reabsorption

A

transferral of substances from tubular lumen to peritubular capillaries

60
Q

what is tubular secretion

A

transferral of substances from peritubular capillaries to tubular lumen
organic cations and anions
breakdowns from drugs

61
Q

what is kidney excretion

A

voiding of substances in urine

62
Q

how do you calculate tubular reabsorption

A

glomerular filtration - urinary excretion

63
Q

if excretion is less then filtration what was net result

A

net reabsorption

64
Q

how do you calculate urinary excretion rate

A

the concentration in urine and the volume or urine

65
Q

what are types of secondary active transport

A

co and counter transport

66
Q

what is reabsorbed in proximal tubule

A

most filtered substances: Na K Cl Ca HCO3 and PO4

all glucose and aa

67
Q

what are secreted in proximal tubule

A

organic anions and cations (drug metabolites, cretnin and irate)

68
Q

What controls moevement in proximal tubule

A

the ATPase on the basolateral membrane

69
Q

Na co transports what molecules into cell from tubule lumen

A

glucose and K and Cl

70
Q

what is Na exchanged for on luminal membrane in proximal tubule

A

H+

countertransporter

71
Q

Where do loop diuretics work

A

co transport of Na K 2Cl in the thick ascending limb

72
Q

where is there Na Cl co transport

A

early distal convoluted tubule

73
Q

what exchange d occurs in proximal tubule

A

co transport glucose aa and PO4

countertransport of Na H

74
Q

what channels are present in the late distal convoluted tubule/collecting duct

A

luminal membrane channels

75
Q

How does water move between cells

A

transcell and paracell

76
Q

What is PAH

A

para-amino-hippurate acid

77
Q

if the tubular lumen has lower pH what happens

A

favors reabsorption of organic acids

traps organic bases in lumen

78
Q

how do you help a patient who overdosed on aspirin

A

decrease acidity of lumen
give bicarb
Increase pH(traps acid in lumen)

79
Q

why does inulin increase as you move down proximal tubule

A

as you go through tube more water reabsorption is taking lpace. concentratin the inulin

80
Q

how do [ ] Na and K change in proximal tubule

A

no change

81
Q

what substances are reabsorbed in proximal tubule more than water

A

HCO3, aa and glucose

82
Q

which part of the loop of henle is impermeable to water

A

ascending limb

83
Q

If K levels are messed up, what other ion may have issues in thick ascending limb

A

Mg

84
Q

where is the major site of physiological control of Na water balance

A

late DCT and collecting duct

85
Q

What does ANP do

A

inhibits Na reabsorption and medullary collecting duct

86
Q

majority of K is reabsorbed wehre

A

in proximal tubule mostly

then TAL of loop

87
Q

what cells in collecting duct secrete K

A

principal cells

88
Q

What are the 5 factors that affect K secretion in collecting duct

A 
extracell K cocnentration
Na reabsorption, negative luminal voltage, attracts K
luminal fluid flow rate
extracell pH
aldosterone
89
Q

what does aldosterone do

A

stimulate K secretion in collectin gduct

90
Q

how does extracell pH affect K

A

K and H exchange across cell membranes

91
Q

how does luminal fluid flow rate affect K lvels

A

dilution of secreted K

92
Q

how does Na reabsorption affect K levels

A

negative luminal voltage, attracts K

93
Q

how can a low Na diet lead to hyperkalemia

A

less Na delivery to date distal tubule and collecting duct causing less K secretion/excretion

94
Q

How is hyperkalemia treated

A

increasing downstream delivery Na to distal tubule and collecting ducts

95
Q

what is the countercurrent multiplier mechanisms

A

increased osmolarity in medulla that concentrates urine

recycling of Na and K in region to keep high osmolarity

96
Q

increased blood flow affects countercurrent how?

A

decreases the concentration

97
Q

what are the levels of ADH in dehydrated individuals

A

high because want to save water

98
Q

how does ADH help reabsorb water

A

second messengers leading to increase aquaporins on tubular side of cell

99
Q

What is free water Clearance

A

amount of water excreted by kidneys without solute

100
Q

if the urine osm is less than the P osm or Clearance of water then?

A

pure water is cleared. hypotonic urine

101
Q

How does ADH affect clearance water

A

changing permeability of collecting duct

102
Q

What are the effects of ANP on Na and water excretion

A

increase GFR via efferent constriction afferent dilation
inhibits Na reabsorption in medullary collecting duct
suppress renin
suppress aldosterone
systemic vasodilator
suprresses ADH secretion and actions

103
Q

what is normal blood pH

A

7.4

104
Q

what are the kidneys defense for pH changes

A

chemical buffers, intracell(proteins) and respiration(CO2)

kidneys(urinary buffers)

105
Q

what factors control renal H secretion

A

intracell pH, plasma PCO2, carbonic anhydrase, Na reabsorption, ECF K levels, aldosterone

106
Q

What is anion gap informative for

A

metabolic acidosis Dx

107
Q

What is chronic reparatory acidosis and alkalosis

A

changes in repiration in the presence of renal compensation

takes 2-3 days for kidneys to compensate for initial disturbance

108
Q

what can cause metabolic acidosis

A

gain of fixed acid
loss HCO3
(HCO3 falls)

109
Q

how do we measure anion gap

A

cations(Na)- anions (Cl and HCO3)

110
Q

what is normal anion gap range

A

8-11 mEg/L

111
Q

if there is metabolic acidosis what happens to anion gap

A

increased

112
Q

by is Anion gap unchanged with hyperchloremic acidosis

A

loss of HCO3 matched by Cl

113
Q

know anion gap equation

A

cations Na minus anions Cl and HCO3

114
Q

what are causes of high anion gap acidosis

A

Mudpiles

methanol, uremia, diabetic ketoacidosis, propylene glycol, isoniazid lactic acidosis, ethylene glycol, salicylates

115
Q

what is metabolit alkalosis

A

gain of strong base

loss of fixed acid

116
Q

review extra slides of graphs with lots of detail

A

second half of ppt and video has most

Year2 Renal (20 decks)

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