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2A Physiology Finals > EXCRETORY SYSTEM > Flashcards

EXCRETORY SYSTEM Flashcards

1
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS

Primary function:

A

Waste Removal
Fluid and Electrolyte Balance
filter blood plasma

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2
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS

Primary function:
Waste Removal - remove waste from the body via ______

A

urine

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3
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS

Primary function:
Fluid and Electrolyte Balance - homeostatic function of regulating ______ and ______

A

body fluid volume, electrolyte composition

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4
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS

Primary function:
Kidneys filter ______ by removing unwanted substances but essential substances are returned to the ______, while waste is excreted in ______.

A

blood plasma, blood, urine

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5
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS

Key Homeostatic Roles of the Kidneys:

A
  1. Excretion of metabolic waste products and foreign chemicals
  2. Regulation of water and electrolyte balances
  3. Regulation of body fluid osmolality and electrolyte concentrations
  4. Regulation of arterial pressure
  5. Regulation of acid-base balance
  6. Regulation of erythrocyte production
  7. Secretion, metabolism, and excretion of hormones
  8. Gluconeogenesis
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6
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Excretion of metabolic waste products and foreign chemicals

______ are the primary means by which the body eliminates metabolic waste products that the body no longer needs.

Waste products:
> ______ - from amino acid metabolism
> ______ -from muscles
> ______ - from nucleic acid breakdown
> ______ - ex. bilirubin.
> ______

Additionally, kidneys remove ______ and ______ (e.g., pesticides, drugs, food additives.

These waste and toxins are removed as ______ as they are produced.

A

Kidneys

Urea
Creatinine
Uric Acid
Hemoglobin Breakdown Products
Metabolites of Hormones

toxins, foreign substances

quickly

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7
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Regulation of Water and Electrolyte Balances

Excretion of water and electrolytes must ______ intake to maintain homeostasis.

______ Leads to an increase in the body’s substance levels.
______ Leads to a decrease in the body’s substance levels.

How kidney maintains homeostasis:
- Adjust ______ rates based on intake, which is influenced by eating and drinking habits.
- After a sudden increase in sodium intake, kidneys adapt in ______-______ days to restore balance between intake and excretion.
- Temporary sodium buildup triggers ______, increasing ______.

A

match

Excess Intake
Deficient Intake

excretion
2, 3
hormonal responses, sodium excretion

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8
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Regulation of body fluid osmolality and electrolyte concentrations
  • Sodium intake raised from ______ to ______ mEq/day.
  • Kidneys adjust to excrete ______ mEq/day within ______-______ days.
  • The kidney can handle sodium intake from ______ mEq/day to ______ mEq/day with minimal changes to extracellular fluid volume or plasma sodium
  • This adaptability extends to other electrolytes like ______, ______, ______, and more.
A

30, 300
300, 2, 3
10, 1500
chloride, potassium, calcium

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9
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Regulation of Arterial Pressure

______ Regulation: Adjust arterial pressure by varying sodium and water excretion.

______ Regulation: Secrete hormones and vasoactive substances (e.g., renin) to produce vasoactive compounds like angiotensin II, which affect blood vessel constriction and pressure.

A

Long-Term

Short-Term

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10
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Regulation of Acid-Base Balance
  • Work with ______ and body fluid ______ to regulate acid-base balance.
  • ______: Eliminate specific metabolic acids, like sulfuric and phosphoric acids, which result from protein metabolism.
  • ______: Adjust body fluid buffer stores to maintain pH balance.
A

lungs, buffers
Acid Excretion
Buffer Regulation

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11
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Regulation of Erythrocyte Production

Erythropoietin Secretion: Kidneys secrete ______ to stimulate ______ production in the ______.

Trigger: ______ (low oxygen levels) prompts increased erythropoietin secretion.

Impact of Kidney Disease: Severe kidney disease or removal can lead to ______ due to reduced erythropoietin production.

A

erythropoietin, red blood cell, bone marrow

Hypoxia

anemia

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12
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Secretion, metabolism, and excretion of hormones

The kidneys convert vitamin D into its active form, ______ (______), by hydroxylating it at the “number ______” position.
- Essential for calcium ______ in bones.
- Promotes calcium ______ from the gastrointestinal tract.
- Helps regulate both ______ and ______ levels in the body, contributing to bone health and mineral balance.

A

1,25-dihydroxyvitamin D3, calcitriol, 1, deposition, absorption, calcium, phosphate

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13
Q

MULTIPLE FUNCTIONS OF THE KIDNEYS
Key Homeostatic Roles of the Kidneys

  1. Gluconeogenesis / Glucose Synthesis

During prolonged fasting, kidneys perform ______, creating glucose from amino acids and other precursors.

Homeostatic Disruption: Chronic kidney disease or acute kidney failure disrupts ______ and ______ balance.

Accumulation of Toxins: Without functioning ______, potassium, acids, and fluids build up rapidly, leading to severe health issues.

Risk of Death: Complete renal failure can be fatal within days if not treated with interventions like ______, which helps restore fluid and electrolyte balance.

A

gluconeogenesis

fluid, electrolyte

kidneys

hemodialysis

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14
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

______ - Each one weighs about 150 g and is fist-sized.

A

KIDNEY

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15
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

______ - Enclosed by a fibrous capsule for protection

A

CAPSULE OF KIDNEY

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16
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

______ - Area where renal artery, vein, lymphatics, nerves, and ureter pass.

A

HILUM

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17
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

______ - Transports urine to the bladder.

A

URETER

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18
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

______ - Project into the renal pelvis, leading to the ureter.

A

PAPILLAE

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19
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

______ - Collect urine from renal tubules.

A

MAJOR AND MINOR CALYCES

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20
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

Urine is propelled by contractile elements in the walls of ______, ______, and ______ toward the bladder for storage

A

calyces, pelvis, ureter

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21
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

INTERNAL ANATOMY:
______ - outer

A

CORTEX

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22
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
General Organization

INTERNAL ANATOMY:
______ - inner; has 8-10 renal pyramids; each pyramid ends in the papilla

A

MEDULLA

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23
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Renal Blood Supply

Renal artery enters through the ______, branching into ______, ______, ______ (______) arteries, and then ______.

A

hilum, interlobar, arcuate, interlobular, radial, afferent arterioles

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24
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Renal Blood Supply

Two capillary beds in series: ______ (for filtration, high pressure) and ______ (for reabsorption, low pressure), separated by ______.

A

glomerular, peritubular, efferent arterioles

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25
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Renal Blood Supply

Afferent and efferent arterioles adjust resistance to control ______ in capillaries, affecting ______ and ______ rates.

A

hydrostatic pressure, glomerular filtration, tubular reabsorption

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26
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Renal Blood Supply

Blood from peritubular capillaries enters venous vessels: ______ vein, ______ vein, ______ vein, and finally ______ vein, exiting the kidney

A

interlobular, arcuate, interlobar, renal

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27
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

Each kidney has ______ to ______ nephrons, responsible for urine formation.

A

800,000, 1,000,000

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28
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

Nephrons cannot be ______; they ______ with aging, injury, or disease.

A

replaced, decrease

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29
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

By age ______, many have ______% fewer nephrons than at age ______, though the remaining nephrons adapt to maintain function.

A

80, 40, 40

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30
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

Structure of Nephron:
______: Network of capillaries with high pressure for filtering blood; enclosed in ______.

A

Glomerulus, Bowman’s capsule

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31
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

Structure of Nephron:
______: Converts filtered fluid into urine.

A

Renal Tubule

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32
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

Pathway of Filtered Fluid:
Filters at the ______ > flows into ______ > ______ (in cortex) > ______ > ______ (in cortex) > ______ > ______ > ______ > ______ (becomes the medullary collecting duct) > ______

A

Glomerular Capillaries, Bowman’s Capsule, Proximal Tubule, loop of Henle, distal tubule, connecting tubule, cortical collecting tubule, cortical collecting duct, renal medulla, renal papillae

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33
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

Pathway of Filtered Fluid:
Loop of Henle - contains a ______ (thin) and ______ (lower end is thin). Thin parts of the loop are called ______ and the rest of the ascending limb is called the ______

A

descending, ascending limb, thin segment of the loop of Henle, thick segment of the loop of Henle

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34
Q

PHYSIOLOGICAL ANATOMY OF THE KIDNEYS
Nephron - Functional Unit of the Kidney

______ - inside the end of thick ascending limb contains this specialized epithelial tissue

A

Macula Densa

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35
Q

MICROTURITION / URINATION PROCESS
Involves two main steps:

A
  1. Bladder Filling
  2. Micturition Reflex
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36
Q

MICROTURITION / URINATION PROCESS
Involves two main steps:

______: Bladder fills until wall tension reaches a threshold.

A

Bladder Filling

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37
Q

MICROTURITION / URINATION PROCESS
Involves two main steps:

______: A nervous reflex triggered by increased tension, causing bladder emptying or a desire to urinate. This is a spinal cord reflex “______”. This can be inhibited or enhanced by the cerebral cortex or brain stem.

A

Micturition Reflex, Autonomic Spinal Reflex

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38
Q

Physiologic Anatomy of the Bladder

______: Main part where urine collects.

A

Body

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39
Q

Physiologic Anatomy of the Bladder

______: Funnel-shaped, connects to the urethra

A

Neck / Posterior Urethra

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40
Q

Physiologic Anatomy of the Bladder

______: Smooth triangular area on the posterior bladder wall, where ureters enter at upper angles, and bladder neck opens into posterior urethra.

A

Trigone

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41
Q

Physiologic Anatomy of the Bladder

______: Smooth muscle that makes up bladder walls; contracts to increase bladder pressure. Muscle cells are interconnected, allowing a unified contraction (action potential) to empty the bladder.

A

Detrusor Muscle

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42
Q

Physiologic Anatomy of the Bladder

______: Found in the bladder neck, composed of detrusor muscle and elastic tissue. Prevents urine leakage by maintaining natural tone until bladder pressure rises to the threshold.

A

Internal Sphincter

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43
Q

Physiologic Anatomy of the Bladder

______: Located in the urogenital diaphragm, beyond the posterior urethra. Composed of voluntary skeletal muscle, allowing conscious control to prevent urination even when involuntary signals prompt bladder emptying.

A

External Sphincter

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44
Q

MICROTURITION / URINATION PROCESS
Transport of Urine from the Kidney Through the Ureters and Into the Bladder

No major changes in urine composition occur after it leaves the collecting ducts and travels through the ______, ______, and into the ______.

A

renal calyces, ureters, bladder

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45
Q

MICROTURITION / URINATION PROCESS
Transport of Urine from the Kidney Through the Ureters and Into the Bladder

______ and ______ Activity: Urine flow stretches the ______, initiating ______ that move urine from the renal pelvis down the ureter.

A

Calyces, Pacemaker, calyces, peristaltic contractions

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46
Q

MICROTURITION / URINATION PROCESS
Transport of Urine from the Kidney Through the Ureters and Into the Bladder

The ureter walls contain ______ innervated by ______, ______ nerves and an ______.

A

smooth muscle, sympathetic, parasympathetic, internal nerve plexus

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47
Q

MICROTURITION / URINATION PROCESS
Transport of Urine from the Kidney Through the Ureters and Into the Bladder

______: Inhibited by sympathetic stimulation and enhanced by parasympathetics

A

Peristalsis

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48
Q

MICROTURITION / URINATION PROCESS
Transport of Urine from the Kidney Through the Ureters and Into the Bladder

Ureters enter the bladder through the ______ in the ______, with the ______ compressing the ureters to prevent ______ (______) during contraction.

A

detrusor muscle, trigone, detrusor muscle, urine backflow, reflux

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49
Q

MICROTURITION / URINATION PROCESS
Transport of Urine from the Kidney Through the Ureters and Into the Bladder

______: Ureter does not travel far enough through the bladder wall, causing urine to flow back into the ureter. This can lead to ureter enlargement and potential damage to renal structures if severe.

A

Vesicoureteral Reflux

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50
Q

Pain Sensation in the Ureters and the Ureterorenal Reflex

Ureters are well-supplied with ______ nerves. A blocked ureter, such as by a ______, triggers intense reflex constriction and severe pain.

A

pain, stone

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51
Q

Pain Sensation in the Ureters and the Ureterorenal Reflex

Pain impulses initiate a ______ that constricts renal ______, reducing ______.

A

sympathetic reflex, arterioles, urine output

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52
Q

Pain Sensation in the Ureters and the Ureterorenal Reflex

______: This reflex helps prevent excessive fluid buildup in the kidney pelvis by decreasing urine flow from the affected kidney when a ureter is blocked.

A

Ureterorenal Reflex

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53
Q

MICROTURITION / URINATION PROCESS
The kidneys regulate the excretion of substances in the urine through three key processes:

A
  1. Glomerular Filtration
  2. Tubular Reabsorption
  3. Tubular Secretion
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54
Q

MICROTURITION / URINATION PROCESS
The kidneys regulate the excretion of substances in the urine through three key processes:

______: Blood flows through the glomerular capillaries, where a large amount of plasma, nearly free of protein, is filtered into Bowman’s capsule.

A

Glomerular Filtration

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55
Q

MICROTURITION / URINATION PROCESS
The kidneys regulate the excretion of substances in the urine through three key processes:

______: After filtration, the filtered fluid travels through the renal tubules, where specific solutes and water are reabsorbed back into the blood.

A

Tubular Reabsorption

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56
Q

MICROTURITION / URINATION PROCESS
The kidneys regulate the excretion of substances in the urine through three key processes:

______: Some substances are actively transported from the blood in the peritubular capillaries into the renal tubules. This enhances the excretion of certain waste products and toxins.

A

Tubular Secretion

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57
Q

Overall Urinary Excretion Rate (UER):

A

Filtration rate − Reabsorption rate + Secretion rate = UER

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58
Q

MICROTURITION / URINATION PROCESS
Renal Handling of Substances:

A
  1. No Reabsorption or Secretion
  2. Partial Reabsorption
  3. Complete Reabsorption
  4. Secretion in Addition to Filtration
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59
Q

MICROTURITION / URINATION PROCESS
Renal Handling of Substances:

______: Certain waste products like ______ are filtered and excreted without reabsorption or secretion, making their excretion rate ______ to the filtration rate.

A

No Reabsorption or Secretion, creatinine, equal

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60
Q

MICROTURITION / URINATION PROCESS
Renal Handling of Substances:

______: Substances like ______ and ______ ions are filtered, then partly reabsorbed, so the excretion rate is ______ than the filtration rate.

A

Partial Reabsorption, sodium, chloride, less

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61
Q

MICROTURITION / URINATION PROCESS
Renal Handling of Substances:

______: Nutrients such as ______ and ______ are completely reabsorbed from the tubules, ______ their excretion and ______ them.

A

Complete Reabsorption, glucose, amino acids, preventing, conserving

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62
Q

MICROTURITION / URINATION PROCESS
Renal Handling of Substances:

______: ______ and ______ are not only filtered but also actively secreted, which results in a ______ excretion rate, aiding in the efficient removal of these substances from the body.

A

Secretion in Addition to Filtration, Organic acids, bases, high

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63
Q

______—THE FIRST STEP IN URINE FORMATION

A

GLOMERULAR FILTRATION

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64
Q

______ is the function of the glomerulus

A

Filtration

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65
Q

______ and ______ are the functions of tubular portion of nephron

A

Reabsorption, secretion

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66
Q

______ is the first process of urine formation, “The process by which the blood that passes through glomerular capillaries is filtered through the filtration membrane”.

A

Glomerular Filtration

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67
Q

FILTRATION MEMBRANE
Formed by three layers:

A
  1. Glomerular Capillary Membrane
  2. Basement membrane
  3. Visceral Layer of Bowman’s Capsule
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68
Q

FILTRATION MEMBRANE
Formed by three layers:

Glomerular Capillary Membrane
- Single layer of ______ cells.

A

endothelial

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69
Q

FILTRATION MEMBRANE
Formed by three layers:

Glomerular Capillary Membrane
- It has many pores called ______ or ______.

A

Fenestra, Filteration pores

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70
Q

FILTRATION MEMBRANE
Formed by three layers:

Glomerular Capillary Membrane
- Diameter of about ______ micron.

A

0.1

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71
Q

FILTRATION MEMBRANE
Formed by three layers:

Glomerular Capillary Membrane
- Surrounding the endothelium is the ______.

A

basement membrane

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72
Q

FILTRATION MEMBRANE
Formed by three layers:

Basement membrane
- Forms the separation between the ______ endothelium and the epithelium of ______.

A

glomerular capillary, visceral layer of Bowman’s capsule

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73
Q

FILTRATION MEMBRANE
Formed by three layers:

Visceral Layer of Bowman’s Capsule
- Single layer of flattened ______ cells resting on ______.

A

epithelial, basement membrane

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74
Q

FILTRATION MEMBRANE
Formed by three layers:

Visceral Layer of Bowman’s Capsule
- Cells are connected with ______ by cytoplasmic processes called ______ or ______.

A

basement membrane, Pedicles, Feet

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75
Q

FILTRATION MEMBRANE
Formed by three layers:

Visceral Layer of Bowman’s Capsule
- Arrangment of pedicles are ______ manner leaving small cleft like spaces in between called ______

A

interdigitating, Slit Pores

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76
Q

FILTRATION MEMBRANE
Formed by three layers:

Visceral Layer of Bowman’s Capsule
- The epithelial cells with pedicles are called ______.

A

Podocytes

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77
Q

FILTRATION MEMBRANE
Formed by three layers:

These three layers make up ______ that prevents filtration of ______.

A

filtration barrier, plasma proteins

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78
Q

GLOMERULAR (BOWMAN’S CAPSULE)

Bowman’s capsule surrounds glomerulus forming
capsular space
Two layers of capsule:

A

Visceral layer
Parietal layer

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79
Q

GLOMERULAR (BOWMAN’S CAPSULE)

Bowman’s capsule surrounds glomerulus forming
capsular space
Two layers of capsule:

______ layer - Podocytes (foot cells) modified simple squamous

A

Visceral

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80
Q

GLOMERULAR (BOWMAN’S CAPSULE)

Bowman’s capsule surrounds glomerulus forming
capsular space
Two layers of capsule:

______ layer - Simple squamous epithelium Think of it as a fist punched into an inflated bag

A

Parietal

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81
Q

PROCESS OF GLOMERULAR FILTRATION:

A
  1. Blood enters glomerular capillary
  2. Filters out of renal corpuscle
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82
Q

PROCESS OF GLOMERULAR FILTRATION:

Filters out of renal corpuscle
- ______ and ______ stay behind
- Everything else is filtered into ______
- The filtered fluid is called ______.

A

Large proteins, cells
nephron
glomerular filtrate

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83
Q

Glomerular filtration is called ______ because even the ______ are filtered. But the ______ are not filtered due to their larger molecular size.

A

Ultrafiltration, minute particles, plasma proteins

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84
Q

The glomerular filtrate contains all the substances present in plasma except the ______.

A

plasma proteins

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85
Q

GLOMERULAR FILTRATION RATE (GFR):

A

GFR = Kf x (PG - PB - piG + piB)

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86
Q

______: “The rate at which plasma is filtered into Bowman’s capsule.”

A

GLOMERULAR FILTRATION RATE (GFR)

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87
Q

GLOMERULAR FILTRATION RATE (GFR)

The units of filtration are a ______ filtered per ______, e.g. m/min or liters/day.

A

volume, unit time

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88
Q

GLOMERULAR FILTRATION RATE (GFR)

______% of filtrate is reabsorbed, ______ to ______L is excreted as urine.

A

99, 1, 2

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89
Q

FILTRATION FRACTION:

A

Filtration fraction = GFR/Renal plasma flow

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90
Q

______: “Fraction of the renal plasma which becomes the filtrate.”

A

FILTRATION FRACTION

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91
Q

______: It is the ratio between glomerular filtration rate and renal plasma flow.

A

FILTRATION FRACTION

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92
Q

FILTRATION FRACTION

It is expressed in Percentage between ______%-______%.

A

15, 20

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93
Q

FILTRATION FRACTION

GFR is about ______ ml/min, or ______ L/day, which means that about ______% of the plasma flowing through the kidney is filtered through the glomerular capillaries

A

125, 180, 20

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94
Q

FACTORS AFFECTING GFR:

A
  1. Renal Blood Flow
  2. Tubuloglomerular Feedback
  3. Glomerular Capillary Pressure
  4. Colloidal Osmotic Pressure
  5. Hydrostatic Pressure in Bowman’s Capsule
  6. Constriction of Afferent Arterioles
  7. Constriction of Efferent Arterioles
  8. Systemic Arterial Pressure
  9. Sympathetic Stimulation
  10. Surface Area of Capillary Membrane
  11. Permeability of Capillary Membrane
  12. Contraction of Glomerular Mesangial Cells
  13. Hormonal factors
  14. Angiotensin II
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95
Q

Norepinephrine
Effect on GFR:

A

down

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96
Q

Epinephrine
Effect on GFR:

A

down

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97
Q

Endothelin
Effect on GFR:

A

down

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98
Q

Angiotensin II
Effect on GFR:

A

mantains, prevents down

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99
Q

Endothelial-derived nitric oxide
Effect on GFR:

A

up

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100
Q

Prostaglandins
Effect on GFR:

A

up

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101
Q

FACTORS AFFECTING GFR
INCREASE GFR:

A

Increased renal blood flow
Increased glomerular pressure
Increased BP
Efferent arteriolar constriction
High Protein Intake
High Glucose Intake

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102
Q

FACTORS AFFECTING GFR
DECREASE GFR:

A

Increased plasma colloid osmotic pressure
Increased Bowman’s capsule pressure
Afferent arteriolar constriction
Sympathetic stimulation causing afferent arteriolar constriction

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103
Q

RENAL BLOOD FLOW

  • In a 70-kg man, kidney blood flow is around ______ ml/min, about ______% of cardiac output.
  • Despite making up only ______% of body weight, kidneys receive significantly high blood flow.
  • This high blood flow ensures enough plasma for ______, crucial for fluid and solute regulation.
A

1100, 22
0.4
glomerular filtration

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104
Q

CHARACTERISTICS OF THE RENAL BLOOD FLOW:

A
  1. High blood flow
  2. Two capillary beds
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105
Q

CHARACTERISTICS OF THE RENAL BLOOD FLOW:

High blood flow
______ ml/min, or ______ percent of the cardiac output. ______% to the cortex.

A

1100, 22, 94

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106
Q

CHARACTERISTICS OF THE RENAL BLOOD FLOW:

Two capillary beds
High hydrostatic pressure in ______ (about ______ mmHg) and low hydrostatic pressure in ______ (about ______ mmHg)

A

glomerular capillary, 60, peritubular capillaries, 13

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107
Q

BLOOD FLOW IN VASA RECTA

Blood flow to renal medulla is supplied by ______.

A

vasa recta

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108
Q

BLOOD FLOW IN VASA RECTA

Blood flow in vasa recta of medulla is very ______ as compared to blood flow in cortex.

A

low

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109
Q

BLOOD FLOW IN VASA RECTA

Blood flow in renal medulla is ______-______ % of total renal blood flow.

A

1, 2

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110
Q

BLOOD FLOW IN VASA RECTA

Vasa recta are important to form ______ urine.

A

concentrated

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111
Q

RENAL BLOOD FLOW AND OXYGEN CONSUMPTION

On a per gram weight basis, the kidneys normally consume oxygen at ______ the rate of the brain but have almost ______ times the blood flow of the brain.

A

twice, seven

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112
Q

RENAL BLOOD FLOW AND OXYGEN CONSUMPTION

A large part of 02 consumed by kidneys is related to high rate of active ______ by ______.

A

sodium ions re-absorption, renal tubules

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113
Q

RENAL BLOOD FLOW AND OXYGEN CONSUMPTION

If renal blood flow & GFR ______, ______ sodium ions is filtered and absorbed, consuming ______ 02.

A

decreases, less, less

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114
Q

RENAL BLOOD FLOW AND OXYGEN CONSUMPTION

Renal 02 consumption is ______ related to renal tubular sodium ions re-absorption.

A

directly

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115
Q

DETERMINANTS OF RENAL BLOOD FLOW: (formula)

A

RBF = (Renal artery pressure - Renal vein pressure)/Total renal vascular resistance

116
Q

MEASUREMENT OF RENAL BLOOD FLOW

The blood flow to kidney is measured by using ______ of ______.

A

plasma clearance, para-aminohippuric acid

117
Q

REGULATION OF RENAL BLOOD FLOW

The renal blood flow is regulated by means of ______.

A

auto regulation

118
Q

REGULATION OF RENAL BLOOD FLOW
Two mechanisms are involved in renal auto regulation:

A
  1. Myogenic response
  2. Tubuloglomerular feedback
119
Q

REGULATION OF RENAL BLOOD FLOW
Two mechanisms are involved in renal auto regulation:

Tubuloglomerular feedback
______ plays an important role in tubuloglomerular feedback which controls the renal blood flow and GFR. It acts as a sensor in detecting conc. of ______ in ______ and accordingly alters ______ and ______.

A

Macula densa, NaCl, tubular fluid, glom. blood flow, GFR

120
Q

MYOGENIC RESPONSE:

A
  1. The blood flow to kidney increases
  2. Stretches the elastic wall of afferent arteriole
  3. It increases the flow of calcium ions from ECF in to the cells
  4. Influx leads to the contraction of smooth muscles in afferent arteriole
  5. Causes constriction & increases in resistance in afferent arteriole
  6. Blood flow is controlled
121
Q

TUBULOGLOMERULAR FEEDBACK:

A
  1. Increase in GFR
  2. Increase in NaCl concentration
  3. in renal tubule
  4. Macula Densa releases
  5. Adenosine from ATP
  6. Constriction of afferent arteriole
  7. Decreases in Glomerular blood flow
  8. Decreases in GFR
  9. Decrease in GFR
  10. Decrease in NaCl concentration
  11. in renal tubule
  12. Macula Densa releases
  13. Prostaglandin E2, Bradykinin, Renin
  14. Dilatation of afferent arteriole
  15. Increases in Glomerular blood flow
  16. Increases in GFR
122
Q

Filtration, Reabsorption, and Secretion of Different Substances

In general, ______ is quantitatively more important than ______ in the formation of ______, but ______ plays an important role in determining the amounts of ______ and ______ ions and a few other substances that are excreted in the urine.

A

tubular reabsorption, tubular secretion, urine, secretion, potassium, hydrogen

123
Q

Filtration, Reabsorption, and Secretion of Different Substances

Certain foreign substances and drugs are also poorly reabsorbed but, in addition, are secreted from the blood into the ______, so their excretion rates are ______.

A

tubules, high

124
Q

Filtration, Reabsorption, and Secretion of Different Substances

______, such as ______ ions, ______ ions, and ______ ions, are ______ reabsorbed, so only small amounts appear in the urine.

A

electrolytes, sodium, chloride, bicarbonate, highly

125
Q

Filtration, Reabsorption, and Secretion of Different Substances

Each of the processeslomerular filtration tuular reabsorption, and tubular secretion—is regulated according to the ______ of the body

changes in glomerular filtration and tubular reabsorption usually act in a ______ manner to produce the necessary changes in ______

A

needs, coordinated, renal excretion

126
Q

______ can move a solute against an electro-chemical gradient and requires energy derived from metabolism. Transport that is coupled directly to an energy source, such as the hydrolysis of ______, is termed ______

A

Active transport, adenosine triphosphate (ATP), primary active transport

127
Q

Although solutes can be reabsorbed by ______ and/ or ______ mechanisms by the tubule, water is always reabsorbed by a ______ (______) physical mechanisms called ______, which means water diffusion from a region of low solute concentration (high water concentration) to one of high solute concentration (low water concentration)

A

active, passive, passive, nonactive, osmosis

128
Q

Regulation of Tubular Reabsorption

Because it is essential to maintain a precise balance between ______ and ______, there are multiple nervous, hormonal, and local control mechanisms that regulate tubular reabsorption, just as there are for control of glomerular filtration. An important feature of tubular reabsorption is that reabsorption of some solutes can be regulated ______ of others, especially through ______ control mechanismst

A

tubular reabsorption, glomerular filtration, independently, hormonal

129
Q

Reabsorption and Secretion Along Different Parts of the Nephron

Normally, about ______ percent of the filtered load of ______ and ______ and a slightly lower percentage of filtered ______ are reabsorbed by the ______ before the filtrate reaches the ______.

A

65, sodium, water, chloride, proximal tubule, loops of Henle

130
Q

Reabsorption and Secretion Along Different Parts of the Nephron

The ______ segment of the ______ of the ______ empties into the ______. The first portion of the ______ forms the ______, a group of closely packed epithelial cells that is part of the juxtaglo-merular complex and provides feedback control of GFR and blood flow in this same nephron

A

thick, ascending limb, loop of Henle, distal tubule, distal tubule, macula densa

131
Q

Reabsorption and Secretion Along Different Parts of the Nephron

The ______ of the ______ and the subsequent ______ have similar functional characteristics. Anatomically, they are composed of two distinct cell types, the ______ cells and ______ cells. The ______ cells reabsorb sodium and water from the lumen and secrete potassium ions into the lumen. The ______ cells reabsorb potassium ions and secrete hydrogen ions into the tubular lumen

A

second half, distal tubule, cortical collecting tubule, principal, intercalated, principal, intercalated

132
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING ______ URINE

A

DILUTE

133
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING DILUTE URINE

Normal kidneys can adjust urine ______ to manage body fluid levels. When there’s excess water, they can produce ______ urine with an osmolarity as low as ______ mOsm/L. Conversely, during water deficit, they can ______ urine up to ______-______ mOsm/L.

A

composition, dilute, 50, concentrate, 1200, 1400

134
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING DILUTE URINE

ANTIDIURETIC HORMONE CONTROLS URINE ______

A

CONCENTRATION

135
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING DILUTE URINE

A primary effector of this feedback is ______, also called ______. When body fluid osmolarity ______, the posterior pituitary secretes more ______, enhancing water ______ in the kidneys and reducing urine ______ without significantly affecting ______. Conversely, when there’s excess water and lower osmolarity, ______ secretion decreases, leading to more ______ urine. Thus, the level of ______ largely determines whether urine is ______ or ______.

A

antidiuretic hormone (ADH), vasopressin, increases, ADH, reabsorption, volume, solute excretion, ADH, dilute, ADH, concentrated, dilute

136
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING DILUTE URINE

RENAL MECHANISMS FOR EXCRETING DILUTE URINE
After consuming 1 liter of water, urine volume can increase to ______ times within ______ minutes. The urine osmolarity decreases from ______ to around ______ mOsm/L, allowing the kidneys to eliminate excess water without losing significant solutes.

A

six, 45, 600, 100

137
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING DILUTE URINE

Tubular Fluid Remains ______ in Proximal Tubules
- As fluid flows through the proximal tubule, solutes and water are reabsorbed in ______ proportions, so little change in osmolarity occurs. Thus, the proximal tubule fluid remains ______ to the plasma.

A

Isosmotic, equal, isosmotic

138
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING DILUTE URINE

Tubular Fluid Is ______ in the Ascending Loop of Henle
- In the ______ of the ______, sodium, potassium, and chloride are actively ______, while the segment remains ______, even with high ______. This makes the tubular fluid progressively ______, reducing its osmolarity to about ______ mOsm/L by the early ______. Thus, fluid exiting this segment is ______, about ______ that of plasma, regardless of ADH levels.

A

Diluted, thick ascending limb, loop of Henle, reabsorbed, water-impermeable, ADH, dilute, 100, distal tubule, hypo-osmotic, one-third

139
Q

KIDNEYS EXCRETE EXCESS WATER BY FORMING DILUTE URINE

Tubular Fluid in Distal and Collecting Tubules Is Further ______ in Absence of ______
- As fluid moves from the early distal tubule to the late distal tubule and collecting ducts, additional sodium chloride is reabsorbed. Without ______, these segments remain ______, diluting the tubular fluid to as low as ______ mOsm/L, resulting in a large volume of dilute urine due to solute reabsorption and minimal water reabsorption.

A

Diluted, ADH, ADH, water-impermeable, 50

140
Q

KIDNEYS CONSERVE WATER BY EXCRETING ______ URINE

A

CONCENTRATED

141
Q

______ Function: Essential for forming concentrated urine, essential for the survival of land mammals, including humans.

A

Kidney

142
Q

Water Loss: Continuous loss occurs via:
______ (evaporation into the expired air)
______ (feces)
______ (evaporation and perspiration)
______ (urine excretion)

A

Lungs
Gastrointestinal tract
Skin
Kidneys

143
Q

______ Intake: Must match water loss, but the ability of the kidneys to form a small volume of concentrated urine ______ the fluid intake required to maintain ______, an important function when water is in short supply.

A

Fluid, minimizes, homeostasis

144
Q

Water Deficit Response:
- Kidneys excrete ______ while increasing ______.
- Decreases ______, forming ______.

A

solutes, water reabsorption, urine volume, concentrated urine

145
Q

Maximal Concentration: Human kidneys can achieve a urine concentration of ______ to ______ mOsm/L (______-______ times plasma osmolarity).

A

1200, 1400, 4, 5

146
Q

Calculation of the obligatory urine volume:

A

600 mOsm/day / 1200 mOsm/L = 0.5 L/day

147
Q

______
- Provides a rapid estimate of urine solute concentration.

A

Urine Specific Gravity

148
Q

Urine Specific Gravity
- Increases with urine ______ and typically increases ______ with ______.

A

concentration, linearly, osmolarity

149
Q

______
- Reflects the weight of solutes in a given urine volume.

A

Urine Specific Gravity

150
Q

Urine Specific Gravity
- Normal range in humans: ______ to ______ g/ml.

A

1.002, 1.028

151
Q

Urine Specific Gravity
- ______ offer approximate measurements; laboratories usually use ______ for accuracy.

A

Dipsticks, refractometers

152
Q

Basic requirements for forming a concentrated urine:

A
  • high level of ADH
  • high osmolarity of the renal medullary interstitial fluid
153
Q

Basic requirements for forming a concentrated urine:

a ______, increases the permeability of distal tubules and collecting ducts to water, enhancing water reabsorption

A

high level of ADH

154
Q

Basic requirements for forming a concentrated urine:

a ______, which provides the osmotic gradient necessary for water reabsorption to occur in the presence of high levels of ADH.

A

high osmolarity of the renal medullary interstitial fluid

155
Q

The renal medullary interstitium around the collecting ducts is typically ______. High ______ levels allow water to osmotically move into the interstitium, where it is carried away by the ______. Thus, urine concentration depends on ______ levels and the renal medulla’s ______, which is established by the ______.

A

hyperosmotic, ADH, vasa recta, ADH, hyperosmolarity, countercurrent multiplier mechanism

156
Q

The ______ depends on the special anatomical arrangement of the loops of Henle and vasa recta, the specialized peritubular capillaries of the renal medulla.

A

countercurrent multiplier mechanism

157
Q

COUNTERCURRENT MULTIPLIER MECHANISM PRODUCES ______ RENAL MEDULLARY INTERSTITIUM

A

HYPEROSMOTIC

158
Q

COUNTERCURRENT MULTIPLIER MECHANISM PRODUCES HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM

The osmolarity of interstitial fluid is about ______ mOsm/L in most body parts, but in the kidney medulla, it can rise to ______ to ______ mOsm/L in the pelvic tip of the medulla. . This means that the renal medullary interstitium has accumulated solutes in great excess of water. A high concentration of solutes is maintained by a balanced inflow and outflow of solutes and water in the medulla.

A

300, 1200, 1400

159
Q

Major factors that contribute to the buildup of solute concentration into the renal medulla:

A
  • Active transport of sodium and co-transport of potassium, chloride, and other ions from the thick ascending limb of the loop of Henle into the medullary interstitium
  • Active transport of ions from the collecting ducts into the medullary interstitium
  • Facilitated diffusion of urea from the inner medullary collecting ducts into the medullary interstitium
  • Small amounts of water diffuse from the medullary tubules into the interstitium, much less than solute reabsorption.
160
Q

LOOP OF HENLE CHARACTERISTICS THAT CAUSE SOLUTES TO BE TRAPPED IN THE RENAL MEDULLA

High medullary osmolarity results from ______ of sodium and ______ of potassium, chloride, and other ions from the thick ascending loop of Henle into the interstitium.

A

active transport, co-transport

161
Q

LOOP OF HENLE CHARACTERISTICS THAT CAUSE SOLUTES TO BE TRAPPED IN THE RENAL MEDULLA

The thick ascending limb is nearly ______, preventing ______.

A

water-impermeable, osmotic flow

162
Q

LOOP OF HENLE CHARACTERISTICS THAT CAUSE SOLUTES TO BE TRAPPED IN THE RENAL MEDULLA

Active transport results in more ______ than ______ in the medullary interstitium.

A

solutes, water

163
Q

LOOP OF HENLE CHARACTERISTICS THAT CAUSE SOLUTES TO BE TRAPPED IN THE RENAL MEDULLA

______ of sodium chloride from the thin ascending limb further increases solute concentration.

A

Passive reabsorption

164
Q

Steps Involved in Causing Hyperosmotic Renal Medullary Interstitium:

A

STEP 1: Assume the loop of Henle has fluid with a concentration of 300 mOsm/L, equal to that from the proximal tubule.
STEP 2: The active ion pump in the thick ascending limb lowers tubular concentration and raises interstitial concentration, creating a 200-mOsm/L gradient.
STEP 3: The descending limb and interstitial fluid reach osmotic equilibrium as water osmoses out, maintaining interstitial osmolarity at 400 mOsm/L and creating a 200-mOsm/L sodium chloride gradient.
STEP 4: Fluid from the proximal tubule enters the loop, causing hyperosmotic fluid from the descending limb to flow into the ascending limb, where ions are pumped out, raising interstitial osmolarity to 500 mOsm/L.

165
Q

ROLE OF DISTAL TUBULE AND COLLECTING DUCTS IN EXCRETING CONCENTRATED URINE

ROLE OF DISTAL TUBULE:
- Tubular fluid entering the distal convoluted tubule is ______ and the early distal tubule further ______ the fluid

A

dilute, dilutes

166
Q

ROLE OF DISTAL TUBULE AND COLLECTING DUCTS IN EXCRETING CONCENTRATED URINE

ROLE OF COLLECTING DUCTS:
- Water reabsorption depends on ______; without ______, it’s nearly ______, further ______ urine while ______ solutes

A

ADH, ADH, impermeable, diluting, reabsorbing

167
Q

ROLE OF DISTAL TUBULE AND COLLECTING DUCTS IN EXCRETING CONCENTRATED URINE

ROLE OF COLLECTING DUCTS:
- With high ______, the tubule becomes ______, allowing ______

A

ADH, water-permeable, reabsorption

168
Q

ROLE OF DISTAL TUBULE AND COLLECTING DUCTS IN EXCRETING CONCENTRATED URINE

ROLE OF COLLECTING DUCTS:
- More water is ______ in the medullary collecting ducts, carried away by the ______

A

reabsorbed, vasa recta

169
Q

ROLE OF DISTAL TUBULE AND COLLECTING DUCTS IN EXCRETING CONCENTRATED URINE

ROLE OF COLLECTING DUCTS:
- High ADH levels increase water ______, enabling ______ urine formation while excreting normal ______ amounts

A

permeability, concentrated, solute

170
Q

UREA CONTRIBUTES TO HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM AND FORMATION OF CONCENTRATED URINE

Urea contributes ______% to ______% of the osmolarity (______–______ mOsm/L) of the renal medullary interstitium in maximally concentrated urine.

A

40, 50, 500, 600

171
Q

UREA CONTRIBUTES TO HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM AND FORMATION OF CONCENTRATED URINE

Unlike sodium chloride, urea is ______ reabsorbed from the tubule.

A

passively

172
Q

UREA CONTRIBUTES TO HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM AND FORMATION OF CONCENTRATED URINE

During water ______ and ______ ADH levels, large amounts of urea are reabsorbed from the inner medullary collecting ducts into the interstitium.

A

deficits, high

173
Q

UREA CONTRIBUTES TO HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM AND FORMATION OF CONCENTRATED URINE

The ______ and ______ are impermeable to urea, leading to minimal reabsorption.

A

ascending loop of Henle, distal tubules

174
Q

UREA CONTRIBUTES TO HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM AND FORMATION OF CONCENTRATED URINE

______ ADH increases water reabsorption in the cortical collecting tubule, raising urea ______ due to low ______.

A

High, concentration, permeability

175
Q

UREA CONTRIBUTES TO HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM AND FORMATION OF CONCENTRATED URINE

In the inner medullary collecting ducts, further water ______ raises urea concentration, causing ______ into the renal interstitial fluid.
Urea transporters ______ and ______, activated by ______, enhance this diffusion and reabsorption.

A

reabsorption, diffusion, UT-A1, UT-A3, ADH

176
Q

UREA CONTRIBUTES TO HYPEROSMOTIC RENAL MEDULLARY INTERSTITIUM AND FORMATION OF CONCENTRATED URINE

The combined movement of water and urea maintains ______ urea concentrations in the tubular fluid and urine.

A

high

177
Q

Recirculation of Urea from Collecting Duct to Loop of Henle Contributes to Hyperosmotic Renal Medulla

Rate of urea excretion is determined mainly by the following:

A

concentration of urea in the plasma
glomerular filtration rate (GFR)
renal tubular urea reabsorption

178
Q

COUNTERCURRENT EXCHANGE IN ______ PRESERVES HYPEROSMOLARITY OF RENAL MEDULLA

A

VASA RECTA

179
Q

COUNTERCURRENT EXCHANGE IN VASA RECTA PRESERVES HYPEROSMOLARITY OF RENAL MEDULLA

Special features of the renal medullary blood flow contribute to the preservation of the high solute concentrations:
- The medullary blood flow is ______, accounting for ______ than Medullary blood flow is low, making up less than ______% of total renal blood flow. This sluggish flow meets metabolic needs while minimizing solute ______ from the medullary interstitium.

A

low, less, 5, loss

180
Q

COUNTERCURRENT EXCHANGE IN VASA RECTA PRESERVES HYPEROSMOLARITY OF RENAL MEDULLA

Special features of the renal medullary blood flow contribute to the preservation of the high solute concentrations:
- The ______ serve as countercurrent exchangers, minimizing the ______ of solutes from the medullary interstitium.

A

vasa recta, washout

181
Q

SUMMARY OF URINE-CONCENTRATING MECHANISM AND CHANGES IN OSMOLARITY IN DIFFERENT TUBULAR SEGMENTS

Proximal Tubule:
- About ______% of filtered electrolytes are reabsorbed in the proximal tubule
- Aided by ______
- Osmolarity of the fluid around ______ mOsm/L, similar to ______

A

65, aquaporin 1 (AQP-1), 300, glomerular filtrate

182
Q

SUMMARY OF URINE-CONCENTRATING MECHANISM AND CHANGES IN OSMOLARITY IN DIFFERENT TUBULAR SEGMENTS

Descending Loop of Henle:
- As fluid flows down the descending loop of Henle, water is absorbed into the ______
- Increasing the osmolarity of the tubular fluid to nearly ______ mOsm/L in the presence of ______

A

medulla, 1200, high ADH

183
Q

SUMMARY OF URINE-CONCENTRATING MECHANISM AND CHANGES IN OSMOLARITY IN DIFFERENT TUBULAR SEGMENTS

Thin Ascending Loop of Henle:
- The thin ascending limb is ______ to water but reabsorbs ______
- ______ of sodium chloride into the medullary interstitium; ______ the tubular fluid
- Urea from the medullary interstitium diffuses back into the ascending limb, contributing to ______

A

impermeable, sodium chloride, Passive diffusion, dilutes, urea recycling

184
Q

SUMMARY OF URINE-CONCENTRATING MECHANISM AND CHANGES IN OSMOLARITY IN DIFFERENT TUBULAR SEGMENTS

Thick Ascending Loop of Henle:
- The thick part of the ascending loop of Henle is also virtually ______ to water
- Large amounts of sodium, chloride, potassium, and other ions are ______ from the tubule into the medullary interstitium
- Fluid becomes very dilute, falling to a concentration of about ______ mOsm/L

A

impermeable, actively transported, 140

185
Q

SUMMARY OF URINE-CONCENTRATING MECHANISM AND CHANGES IN OSMOLARITY IN DIFFERENT TUBULAR SEGMENTS

Early Distal Tubule:
- Has properties similar to those of the ______
- Further dilution of the tubular fluid to about ______ mOsm/L occurs as ______ are reabsorbed while ______ remains in the tubule

A

thick ascending loop of Henle, 100, solutes, water

186
Q

SUMMARY OF URINE-CONCENTRATING MECHANISM AND CHANGES IN OSMOLARITY IN DIFFERENT TUBULAR SEGMENTS

Late Distal Tubule and Cortical Collecting Tubules:
- Osmolarity of the fluid depends on the level of ______
- High ______, tubules are highly ______ to water; water are ______
- Absence of ______, little water is reabsorbed in the late distal tubule and cortical collecting tubule; osmolarity ______ even further

A

ADH, ADH levels, permeable, reabsorbed, ADH, decreases

187
Q

SUMMARY OF URINE-CONCENTRATING MECHANISM AND CHANGES IN OSMOLARITY IN DIFFERENT TUBULAR SEGMENTS

Inner Medullary Collecting Ducts:
- The concentration of fluid in the inner medullary collecting ducts also depends on ______ and the surrounding ______ established by the ______

A

ADH, medullary interstitium osmolarity, countercurrent mechanism

188
Q

Disorders of Urinary Concentrating Ability
Abnomalities:

A
  • Inappropriate secretion of ADH
  • Impairment of the countercurrent mechanism
  • Inability of the distal tubules, collecting tubules, and collecting ducts to respond to ADH
189
Q

Failure to Produce ADH: ______

A

Central Diabetes Insipidus

190
Q

Failure to Produce ADH: Central Diabetes Insipidus

  • Inability to produce or release ______ from the ______
  • Caused by ______ or ______, or it can be ______
  • Results in the formation of a large volume of ______ urine (>15 L/day)
A

ADH, posterior pituitary, head injuries, infections, congenital, dilute

191
Q

Inability of Kidneys to Respond to ADH: ______

A

Nephrogenic Diabetes Insipidus

192
Q

Inability of Kidneys to Respond to ADH: Nephrogenic Diabetes Insipidus

  • ______ cannot respond appropriately
  • Due to failure of the ______ to form a hyperosmotic renal medullary interstitium or failure of the ______ to respond to ADH
  • Large volumes of ______ urine are formed; causes ______
A

Renal tubular segments, countercurrent mechanism, distal and collecting tubules and ducts, dilute, dehydration

193
Q

CONTROL OF EXTRACELLULAR FLUID OSMOLARITY AND SODIUM CONCENTRATION

Estimating Plasma Osmolarity From Plasma Sodium Concentration
- Sodium ions and associated anions (mainly ______ and ______) account for about ______% of extracellular osmoles, while glucose and urea contribute around ______% to ______%. ______ easily permeates cell membranes and exerts little effective osmotic pressure under steady-state conditions. Thus, sodium ions and associated anions are the main determinants of fluid ______ across cell membranes. This allows for simultaneous discussion of osmolarity control and sodium ion concentration control.

A

bicarbonate, chloride, 94, 3, 5, Urea, movement

194
Q

Two primary systems involved in regulating the concentration of sodium and osmolarity of extracellular fluid:

A

the osmoreceptor-ADH system
the thirst mechanism.

195
Q

OSMORECEPTOR-ADH FEEDBACK SYSTEM

Osmoreceptor-ADH feedback system operation:

A

Water deficit
(up) Extracellular osmolarity
(up) ADH secretion
(up) Plasma ADH
(up) H2O permeability in distal tubules, collecting ducts
(up) H2O reabsorption
(down) H2O excreted

196
Q

ADH SYNTHESIS IN SUPRAOPTIC AND PARAVENTRICULAR NUCLEI OF HYPOTHALAMUS AND ADH RELEASE FROM POSTERIOR PITUITARY

  • ADH is synthesized in the ______ (five-sixths) and ______ (one-sixth) nuclei of the ______.
  • These nuclei send ______ to the posterior pituitary for ADH transport.
  • ______ osmolarity triggers nerve impulses that lead to ______ and ______ from secretory granules in the posterior pituitary.
  • Released ADH enters ______, rapidly increasing ______ levels to alter renal water excretion.
A

supraoptic, paraventricular, hypothalamus

axonal extensions

Increased, calcium entry, ADH release

circulation, plasma

197
Q

STIMULATION OF ADH RELEASE BY DECREASED ARTERIAL PRESSURE AND/ OR DECREASED BLOOD VOLUME

Cardiovascular reflexes:

A
  • the arterial baroreceptor reflexes
  • the cardiopulmonary reflexes
198
Q

STIMULATION OF ADH RELEASE BY DECREASED ARTERIAL PRESSURE AND/ OR DECREASED BLOOD VOLUME

Stimuli increase ADH secretion:

A
  • decreased arterial pressure
  • decreased blood volume.
199
Q

CENTRAL NERVOUS SYSTEM CENTERS FOR THIRST

The anteroventral wall of the third ventricle promotes ______ and stimulates ______.

A

ADH release, thirst

200
Q

CENTRAL NERVOUS SYSTEM CENTERS FOR THIRST

______ stimulation of the ______ triggers immediate drinking.

A

Electrical, preoptic nucleus

201
Q

CENTRAL NERVOUS SYSTEM CENTERS FOR THIRST

Neurons in the thirst center act as ______, responding to ______ salt solutions initiating drinking behavior.

A

osmoreceptors, hypertonic

202
Q

CENTRAL NERVOUS SYSTEM CENTERS FOR THIRST

Increased ______ in the third ventricle encourages drinking

A

cerebrospinal fluid osmolarity

203
Q

STIMULI FOR THIRST

Increased ______ causes intracellular dehydration in thirst centers.

A

extracellular fluid osmolarity

204
Q

STIMULI FOR THIRST

Decreased ______ and ______ stimulate thirst.

A

extracellular fluid volume, arterial pressure

205
Q

STIMULI FOR THIRST

______ is a key stimulus for thirst.

A

Angiotensin II

206
Q

STIMULI FOR THIRST

Dryness of the ______ and ______ elicits thirst.

A

mouth, esophagus

207
Q

STIMULI FOR THIRST

______ and ______ stimuli also influence thirst.

A

Gastrointestinal, pharyngeal

208
Q

THRESHOLD FOR OSMOLAR STIMULUS OF DRINKING

The kidneys excrete water to remove excess ______, even in ______.

A

solutes, dehydration

209
Q

THRESHOLD FOR OSMOLAR STIMULUS OF DRINKING

______ increases extracellular sodium concentration and osmolarity.

A

Evaporation

210
Q

THRESHOLD FOR OSMOLAR STIMULUS OF DRINKING

Thirst is activated when sodium rises about ______ mEq/L above normal.

A

2

211
Q

Disorders of Thirst and Water Intake

______: Excessive thirst; occasionally occurs in the absence of known physiological stimuli for thirst

A

Polydipsia

212
Q

Disorders of Thirst and Water Intake

______: May be caused by mental illnesses (schizophrenia or obsessive-compulsive disorders) and can lead to hyponatremia

A

Psychogenic polydipsia

213
Q

Disorders of Thirst and Water Intake

______: Rare but usually results from lesions to the hypothalamic thirst centers caused by trauma, infection, or surgery.

A

Adipsia

214
Q

INTEGRATED RESPONSES OF OSMORECEPTOR-ADH AND THIRST MECHANISMS

  • Osmoreceptor-ADH and thirst mechanisms manage ______ and ______ during dehydration.
  • High ______ has minimal impact if both mechanisms are working.
  • If one mechanism fails, the other can help if fluid intake is ______.
  • Both mechanisms failing leads to poor ______ and ______ control.
  • No other system effectively regulates ______ without these mechanisms.
A

osmolarity, sodium, salt intake, adequate, sodium, osmolarity, plasma sodium

215
Q

Role of Angiotensin II and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration

  • Regulates ______: prevents ______ at low intake, allows ______ at high intake.
A

sodium reabsorption, loss, excretion

216
Q

Role of Angiotensin II and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration

Increases ______ with minimal effect on sodium concentration, except in extremes.

A

extracellular fluid volume

217
Q

Role of Angiotensin II and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration

______ remains stable without ______, despite sodium intake changes.

A

Plasma sodium, aldosterone

218
Q

Role of Angiotensin II and Aldosterone in Controlling Extracellular Fluid Osmolarity and Sodium Concentration

______ is more crucial than angiotensin II and aldosterone for plasma sodium regulation.

A

ADH-thirst mechanism

219
Q

Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume

______ to obtain salt during ______, crucial for herbivores on low-sodium diets.

A

Regulatory drive, sodium deficiency

220
Q

Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume

Main stimuli for salt appetite: ______ and ______.

A

sodium deficits, decreased blood volume/pressure

221
Q

Salt-Appetite Mechanism for Controlling Extracellular Fluid Sodium Concentration and Volume

Neuronal mechanism for salt appetite is similar to ______, involving the ______ region; ______ affect both.

A

thirst, AV3V, lesions

222
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

The ECF potassium concentration normally is regulated at about ______ mEq/L, seldom rising or falling more than ±______ mEq/L

A

4.2, 0.3

223
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

Increase in plasma potassium concentration of only 3 to 4 mEq/L can cause ______

A

cardiac arrhythmias

224
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

Higher concentrations can lead to ______ or ______

A

cardiac arrest, fibrillation

225
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

More than ______% of total body potassium is contained in the cells, and only ______% in ECF

A

98, 2

226
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

70-kg adult: ______ mEq of potassium are in the cells, only about ______ mEq in the ECF

A

3920, 59

227
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

Potassium in a single meal may be as high as ______ mEq

A

50

228
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

Daily potassium intake ranges between ______ and ______ mEq/day

A

50, 200

229
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

Only ______% to ______% of potassium intake is excreted in feces; ______ are primarily responsible for the excretion

A

5, 10, kidneys

230
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

______ can serve as an overflow site for excess ECF during ______ or source of potassium during ______

A

Cells, hyperkalemia, hypokalemia

231
Q

REGULATION OF EXTRACELLULAR FLUID POTASSIUM CONCENTRATION AND POTASSIUM EXCRETION

Redistribution of potassium between ______ and ______ compartments provides a first line of defense against changes in ______

A

ICF, ECF, extracellular fluid concentration

232
Q

REGULATION OF INTERNAL POTASSIUM DISTRIBUTION

After ingestion of a potassium-rich meal, ______ would rise to a dangerous level if the ingested potassium did not move into the cells ______

A

extracellular fluid potassium concentration, rapidly

233
Q

REGULATION OF INTERNAL POTASSIUM DISTRIBUTION

Most ingested potassium rapidly moves into cells until ______ can eliminate ______

A

kidneys, excess

234
Q

REGULATION OF INTERNAL POTASSIUM DISTRIBUTION

Between meals, ______ stays constant as cells release potassium to balance kidney ______

A

plasma potassium, excretion

235
Q

OVERVIEW OF RENAL POTASSIUM EXCRETION

Renal potassium excretion is determined
by:

A
  • Rate of potassium filtration (GFR × plasma potassium concentration)
  • Rate of potassium reabsorption by tubules
  • Rate of potassium secretion by tubules
236
Q

OVERVIEW OF RENAL POTASSIUM EXCRETION

Normal rate of potassium filtration: ______ mEq/day (GFR, 180 L/day × plasma potassium concentration, 4.2 mEq/L)

A

756

237
Q

OVERVIEW OF RENAL POTASSIUM EXCRETION

Severe decreases in GFR can cause ______ and ______

A

potassium accumulation, hyperkalemia

238
Q

OVERVIEW OF RENAL POTASSIUM EXCRETION

Potassium reabsorption:
- ______% in proximal tubule
- ______% to ______% in loop of Henle
- ______ rates in collecting tubules and collecting ducts

A

65, 25, 30, Variable

239
Q

OVERVIEW OF RENAL POTASSIUM EXCRETION

In proximal tubule and loop of Henle, relatively ______ is reabsorbed

A

constant fraction

240
Q

OVERVIEW OF RENAL POTASSIUM EXCRETION

Daily variation of potassium excretion is not due to changes in ______ or ______ reabsorption

A

proximal tubule, loop of Henle

241
Q

OVERVIEW OF RENAL POTASSIUM EXCRETION

Collecting tubules and collecting ducts reabsorb ______ at ______ rates, depending on ______

A

potassium, variable, potassium intake

242
Q

Variable Potassium Secretion in Distal and Collecting Tubules Mediates Most Daily Changes in Potassium

Principal cells of ______ and cortical ______ are most important sites for regulating potassium excretion

A

late distal tubules, collecting tubules

243
Q

Variable Potassium Secretion in Distal and Collecting Tubules Mediates Most Daily Changes in Potassium

With normal potassium intake (______ mEq/day):
- Kidneys must excrete ______ mEq/day
- ______ mEq lost in feces
- ______ mEq/day secreted into distal and collecting tubules

A

100, 92, 8, 60

244
Q

Variable Potassium Secretion in Distal and Collecting Tubules Mediates Most Daily Changes in Potassium

With high potassium intake:
- Extra excretion achieved by ______ secretion into distal and collecting tubules
- Can exceed amount in ______

A

increased, glomerular filtrate

245
Q

Variable Potassium Secretion in Distal and Collecting Tubules Mediates Most Daily Changes in Potassium

With low potassium intake:
- ______ secretion in distal and collecting tubules
- ______ reabsorption by intercalated cells
- Excretion can fall to <______% of glomerular filtrate (<10 mEq/day)
- Severe ______ possible below this level

A

Decreased, Increased, 1, hypokalemia

246
Q

Variable Potassium Secretion in Distal and Collecting Tubules Mediates Most Daily Changes in Potassium

Daily regulation occurs mainly in ______ and ______ tubules
- Potassium can be ______ or ______ depending on the body’s needs

A

late distal, cortical collecting, reabsorbed, secreted

247
Q

PRINCIPAL CELLS OF LATE DISTAL AND CORTICAL COLLECTING TUBULES SECRETE ______

A

POTASSIUM

248
Q

PRINCIPAL CELLS OF LATE DISTAL AND CORTICAL COLLECTING TUBULES SECRETE POTASSIUM

Make up most cells in ______ and ______ tubules

A

late distal, cortical collecting

249
Q

PRINCIPAL CELLS OF LATE DISTAL AND CORTICAL COLLECTING TUBULES SECRETE POTASSIUM

Two-step potassium secretion:

A
  • Na+-K+ ATPase pump moves K+ from interstitium into cell
  • Passive diffusion of K+ into tubular fluid
250
Q

PRINCIPAL CELLS OF LATE DISTAL AND CORTICAL COLLECTING TUBULES SECRETE POTASSIUM

Two types of K+ channels in luminal membrane:

A
  • Renal outer medullary potassium (ROMK) channels
  • “Big” potassium BK channels
251
Q

PRINCIPAL CELLS OF LATE DISTAL AND CORTICAL COLLECTING TUBULES SECRETE POTASSIUM

Control of Potassium Secretion by Principal Cells:

A

Na+-K+ ATPase pump activity
Electrochemical gradient
Luminal membrane permeability

252
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

A

Type A cells
Type B cells

253
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Reabsorb K+ during severe depletion

A

Type A cells

254
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Use hydrogen-potassium ATPase in luminal membrane

A

Type A cells

255
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Exchange K+ for H+ ions

A

Type A cells

256
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Enhanced during hypokalemia

A

Type A cells

257
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Causes alkalosis

A

Type A cells

258
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Active during excess K+

A

Type B cells

259
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Opposite function to Type A

A

Type B cells

260
Q

Intercalated Cells Can Reabsorb or Secrete Potassium:

______
- Use hydrogen-potassium ATPase on basolateral membrane

A

Type B cells

261
Q

SUMMARY OF MAJOR FACTORS THAT REGULATE POTASSIUM SECRETION

Factors that stimulate potassium secretion:

A
  • Increased extracellular fluid potassium concentration
  • Increased aldosterone
  • Increased tubular flow rate
262
Q

SUMMARY OF MAJOR FACTORS THAT REGULATE POTASSIUM SECRETION

Factor that decreases potassium secretion:

A

Increased hydrogen ion concentration (acidosis)

263
Q

______ Extracellular Fluid Potassium Concentration Stimulates Potassium Secretion

A

Increased

264
Q

Aldosterone ______ Potassium Secretion

A

Stimulates

265
Q

______ Extracellular Potassium Ion Concentration Stimulates Aldosterone Secretion

A

Increased

266
Q

Blockade of Aldosterone Feedback System Greatly ______ Potassium Regulation

A

Impairs

267
Q

______ Distal Tubular Flow Rate Stimulates Potassium Secretion

A

Increased

268
Q

Acute Acidosis ______ Potassium Secretion

A

Decreases

269
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

Normal extracellular calcium: ______ mEq/L

A

2.4

270
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

Plasma calcium distribution (total ______ mEq/L):
- ______% ionized (biologically active)
- ______% protein-bound
- ______% complexed with anions

A

5, 50, 40, 10

271
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

pH Effects on Calcium:
______: Decreases protein-bound calcium

A

Acidosis

272
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

pH Effects on Calcium:
______:
- Increases protein-bound calcium
- Higher risk of hypocalcemic tetany

A

Alkalosis

273
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

Calcium Balance:
- Daily intake: ~______ mg/day
- Fecal excretion: ~______ mg/day
- Body distribution:
______% in bone
______% in ECF
______% in ICF

A

1000, 900, 99, 0.1, 1.0

274
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

PTH Regulation:
Triggered by ______ calcium via ______

A

low, calcium-sensing receptors (CSRs)

275
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

PTH Regulation:
Three main effects:

A
  • Stimulates bone resorption
  • Activates vitamin D for intestinal absorption
  • Increases renal tubular reabsorption
276
Q

REGULATION OF RENAL CALCIUM EXCRETION AND EXTRACELLULAR CALCIUM ION CONCENTRATION

Functions in both ______ and ______ calcium regulation

A

short-term, long-term

277
Q

Renal Calcium Excretion Formula:

A

Renal calcium excretion = calcium filtered - calcium reabsorbed

278
Q

CONTROL OF CALCIUM EXCRETION BY THE KIDNEYS

Only ______% of plasma calcium is filtered

A

60

279
Q

CONTROL OF CALCIUM EXCRETION BY THE KIDNEYS

Total reabsorption: ______% of filtered calcium

A

99

280
Q

CONTROL OF CALCIUM EXCRETION BY THE KIDNEYS

Distribution of reabsorption:
- Proximal tubule: ______%
- Loop of Henle: ______-______%
- Distal/collecting tubules: ______-______%

A

65, 25, 30, 4, 9

281
Q

CONTROL OF CALCIUM EXCRETION BY THE KIDNEYS

Proximal Tubular Calcium Reabsorption.
- Mainly ______ pathway
- ______% transcellular pathway via:
______ through electrochemical gradient
______ via calcium ATPase and Na-Ca counter-transport

A

paracellular, 20, Luminal entry, Basolateral exit

282
Q

CONTROL OF CALCIUM EXCRETION BY THE KIDNEYS

Loop of Henle and Distal Tubule Calcium Reabsorption

Loop of Henle (______):
- ______% paracellular (______)
- ______% transcellular (______)

A

Thick Ascending Limb, 50, passive diffusion, 50, PTH-stimulated

283
Q

CONTROL OF CALCIUM EXCRETION BY THE KIDNEYS

Loop of Henle and Distal Tubule Calcium Reabsorption

Distal Tubule:
- Mainly active ______ transport
- Uses ______, ______, and ______
- Regulated by ______, ______, and ______

A

transcellular, calcium channels, calcium- ATPase pump, Na-Ca counter-transport, PTH, vitamin D, calcitonin

284
Q

Regulation of Tubular Calcium Reabsorption.

PTH:
- ______ controller
- Stimulates reabsorption in ______ and ______
- No effect on ______

A

Primary, loop of Henle, distal tubule, proximal tubule

285
Q

Regulation of Tubular Calcium Reabsorption.

Volume Status:
- Volume expansion ______ reabsorption
- Volume depletion ______ reabsorption

A

decreases, increases

286
Q

Regulation of Tubular Calcium Reabsorption.

Other Factors:
______ levels affect PTH secretion
pH effects:
- Acidosis ______ excretion
- Alkalosis ______ excretion

______ respond to calcium levels
______ influences excretion

A

Phosphate, increases, decreases, CSRs, Dietary calcium intake

2A Physiology Finals (4 decks)

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