FINAL Flashcards
renin, erythropoietin comes from?
kidney
Pressure =?
flow x resistance
velocity of blood flow = ?
blood flow/cross sectional area
vascular conductance =
1/resistance
high conductance = low resistance
cross sectional area of aorta
2.5 cm^2
vena cavae cross sectional area
8 cm^2
ventricles pressure range
2-120mmHg
atria pressure?
2mmHg
Aorta pressure range
80-120mmHg
aorta or large arteries have wider pulse pressure?
large arteries
from heart to capillary how much pressure is lost
100-30
70mmHg is lost
delta P increases = ?
delta P decreases=?
delta P increases = more blood flow
doubling diameter of vessel increases flow by?
16x
Poiseuille’s law
F=pi * deltaP * r^4/ 8nl
nu= blood viscosity
L= length of tube
r= radius of tube
F, I, Q = flow
increasing resistance does what to flow?
decreases flow
Resistance equation
R= delta P/ F
conductance is proportional to ?
diameter^4
total surface area of capillaries
500-700 m^2
cross sectional area of all capillaries
2500 cm^2
capillary pressure (hydrostatic pressure) within capillary vasculature
30mmHg
pushing fluid out
Hydrostatic pressure in ISF , vasculature vessel
-3 pushing fluid in
plasma colloid osmotic pressure within vasculature vessel
28mmHg
keeping fluid in
interstitial fluid colloid osmotic pressure ISF vasculature vessel
8 pulling fluid out
at arteriolar end of capillary what movemet is favored?
filtration
at venular end of capillary what movement is favored?
reabsorption
extra fluid from net filtration pressure on average adds up to ___ per day
2L
scavenged by lymphatic system
mean capillary pressure?
17.3mmHg
net filtration pressure across entire average capillary
+0.3mmHg
NFP positive vs negative
If positive: net loss of fluid, filtration
If negative: net pulling of fluid into capillary, reabsorption
makes up 21.8 of total 28 protein oncotic pressure within capillary
albumin
2nd largest contributor to capillary oncotic pressure
globulins
3rd largest contributor to capillary oncotic pressure?
fibrinogen
lymphatic system is able to increase output by ___ due to disease process
20 fold
peritubular capillary functions
1) reabsorb fluids
2)provide metabolic requirements for kidney
outer part of kidney
cortex
next inner layer after cortex
medulla
blood vessels that are the peritubular capillaries that descend really deep into the kidney,
those are called vasa recta VR.
About 5% of our peritubular capillaries end up being ?
The other 95% are in?
AVR and DVR
The other 95% are in the outer medulla and that’s where the bulk of our reabsorption happens.
kidneys tucked underneath?
diaphragm
if we
if we increase amount of blood going through kidney?
Will drive up pressure in other arteries and capillary bed as well
higher pressure is reflected every where
adrenal glands where?
on top of kidneys
left kidney is ___ than right kidney
higher
emptying of bladder is contolled by?
pudendal nerve
pudendal nerve sits next to?
prostate in men
another name for bowmands capsule
corpuscle
after PCT is ?
proximal straight tubule
located at first part of DCT
macula densa
collecting duct portions
cortical collecting duct
outer medullary collecting duct
inner medullary collecting duct
macula densa comes into contact with?
afferent and efferent arteriol
For GFR to increase, macula densa has to what?
dilate afferent arterial
angiotensin II has what 2 effects
increase resistance on efferent arteriole preferentially and afferent
juxtaglomerular cells in response to low Na count from macula densa will do what?
causes renin release
if macula densa sees low Na, it will?
think GFR is low
dilate afferent arteriol
cause renin release
renal blood flow
1100 ml/min
renal plasma flow
660 ml/min
filtration fraction
125/660
19%
GFR mls and dls
125ml/min = 1.25 dL/min
where does body choose to fine-tune the GFR
efferent arterioles
glomerular cap hydrostatic BP vs peritubular cap BP
60 in glomer vs 13 in peritubular
filtered load equation and units?
plasma concentration x GFR (convert to dL/min)
answer in mg/min
renal clearance
(urine flow rate x urinary conc)/ plasma conc
excretion = ?
filtration - reabsorption + secretion
secretion of organic compounds happens where?
proximal tubule
how much creatinine is being actively secreted?
0.10 - 0.15mg
most accurate guess of creatinine clearance
1.35 - 1.4mg/min but 1.25mg/min is close enough
inulin
A compound that is more accurate than creatinine
o Synthetic compound, can be injected IV,
Advantage: inulin is not secreted at all by peritubular capillaries and tubules
PAH stands for and used for?
para amino hippuric acid
estimating renal plasma flow
urinary conc after nephrectomy at steady state
0.625mg/ml
3 weeks out: 1.25mg/ml
Podocytes
similar structure to astrocytes in brain
outermost strucutre of glomerular capillaries
part of epithelial cells
slit pores do what?
keep proteins out of area
has lots of negative charges to repel, but doesnt repel ions
layers of glomerular capillary
epithelium
basement membrane
endothelium
normal urine output
1 mL/min
net filtration pressure equation
glomerular hydrostatic pressure - bowmans capsule pressure - glomerular oncotic pressure
bowmans capsule pressure
18 mmHg
glomerular colloid osmotic pressure
32
capillary colloid osmotic pressure beginning of glomerular capillary vs end
28 to 32 to 26
filtration coefficient unit
Kf (ml/min/mmHg)
12.5 ml/min/mmHg
factors that affect the filtration coefficient
extreme infection (swiss cheese)
2nd: capillaries become larger, more surface area
polycationic dextran filterability
positive charges on the dextran make it easier for that dextran to be filtered
filtration rate is____ to urine output
directly proportional
most BP drugs affect resistance of?
afferent arteriole
constricting afferent arteriole does what to renal blood flow
decreases renal blood flow
cardiac bp meds that dilate will do what to urine output?
increase urine output, dilates afferent arteriole
clearance rate units
ml/min
dl/min
organic anions and cations filtered where?
PT
proteins are not filterable bc of 2 things
size and negative charge
which is more efficient: autoregulation of GFR or renal blood flow
GFR
at higher pressures
all fluid filtered by 2 million nephrons
125ml/min
massive reabsorption in proximal tubule
bulk flow
sodium and chloride concentration across length of proximal tubule
doesnt change
n the tubular lumen side of proximal tubules, they have these infoldings here that increase the surface area that the proximal tubule has to use as a reabsorption point or a pumping area
brush border
by end of proximal tubule we’ve reabsorbed how much water
65%
anhydrase enzyme is pulling?
water out of something
glucose and amino acid reabsorbed where?
PT
carbonic anhydrase active where? and associated with?
everywhere, but mostly in PT
associated with brush border
transporter for amino acids located where?
PT on tubular side
co transported with Na
SGLT 2 transporters reabsorb how much of filter load of glucose?
ratio?
capactiy?
90%
1:1 reabsorption ratio
high capacity, low affinity
SGLT 1 transporters reabsorb how much of filter load of glucose?
ratio?
capactiy?
10 to 35%
2:1
low capacity, high affinity
glutamine splits into?
2 bicarb and 2 ammonium
ammonia
Nh3
ammonium
NH4
angiotensin II effects on proximal tubule
speeds up
NaK pump
sodium proton exchanger
-bicarb sodium pump
buffers in proximal tubule
phosphate, ammonium, bicarb
aniotensin II increases amount of ______ reabsorbing at proximal tubules
salt and water
when Ang II receptors on adrenal gland get hit…
aldo is released from adrenal glands
PTH 3 things:
increase Ca intestinal absorption through vitamin D activation
increase renal Ca reabsorption
increase Ca release from bones
bicarb 3 main places
mainly PT, TAL, DT
PTH 3 main places
PT, TAL, DT
how much water is filtered in a descending loop of Henle
20%
PTH on osteoblast/clast
stimulates osteoclasts
inhibits osteoblasts
which segment requires the most energy, 2nd?
PT
second most: TAL
which pump and where does lasix work, what ions are transported thru pump
sodium K 2 Cl transporter
4 ions
Na exits through NaK pump
Cl exits through simple Cl channel
on tubular side
on TAL
which segment has K channels on both sides
TAL, makes tubule section +8mV
drives reabsorption of other cations (mg, ca, na, K) through tight junctions
glutamine needs to have __________ to produce bicarb
sodium proton exchanger
lasix does what to renal interstitium
dilutes it
source for renal inst concentration
TAL
thought of as diluting segment
distal tubule
dilution comes from sodium and chloride pumping
thin ascending limb has which pump
Na Cl co transporter
from tubule to interstitum
40-50% of dissolved stuff in interstitium
urea
urea tends to be reabsorbed from __________ via stimulation of ____
medullary collecting duct via ADH/AVP
regulation of body fluid osmolarity is via ___
ADH
ADH is released from posterior pituitary gland which effects _____ in the _______
efects principal and intercalated cells in the late DCT, but primarily in collecting duct
2 urea transporters in distal tubule and cortical medullary duct
UT -A1 and UT-A3
decreased GFR or RBF results in?
decreased UO
which calcium pump ensures bulk of calcium reabsorption
Na Ca exchanger
where are calcium pumps in distal tubule
interstitial side
simple Calcium channel on tubule side
which channels do PTH stimulate
calcium channels on tubular side
2 actions of thiazide diuretics
inhibit Na Cl pump (tubular side)
speed up sodium calcium exchanger (on interstitial side)
in distal tubule
chronically low calcium and chronically high PTH?
osteroporosis
when aldo is high?
sodium is reabsorbed and Potassium is excreted
aldosterone antagonist
spironolactone
Na channel blockers
Amiloride
Triamterene
2 parts that ar aldo sensitive
are the sodium/potassium pump speed
- ALDO also determines how many sodium channels we have on the tubular side of the cell wall.
aldo needs sufficient supply of ___
cholesterol
adrenal medulla produces?
catecholamines
fasciulata and reticularis produces?
cortisol and androgens
potassium wasting effect comes from which cell
principal cell in distal tubule
through sodium channels in tubular lumen
that’s a compound that specifically destroys cortisol or cortisol like steroids, but tends to not act at all on the Aldo
11 beta-HSD. So 11 beta hydroxy steroid dehydrogenase,
dont give potassium sparing diuretic to ?
massive hearat failure with tons of arrhythmias
as K increase, aldo__
increases
too high cortisol effects include?
HTN and problem maintaining potassium balance
ADH acts on what receptor?
V2 receptor
V2 receptor type?
GPCR
increase cAMP, increases PKA, phosphorylates AQP-2, moves to tubular side of cell
AQP 3 and 4
water is allowed out back of cell
final determinant of urinary osmolarity
cortical & medullary collecting duct
produces 5/6 ADH
supraoptic neuron
produces 1/6 ADH
periventricular nuclei
lack of release of ADH disease
central DI
failure of kidney to repond normally to ADH
nephrogenic DI
nephrogenic DI cause
high dose lithium
infection, drugs, genetics
ADH half life
20 min
high free water clearance is from?
no adh
low free water clearance is from?
ADH around
decreasing thirst (decrease ADH)
alcohol clonidine
haldol
range of K intake
30-120 mEq/day
increasing thirst drugs (increase adh)
nausea
morphin
nicotine
blocking aldo has not that much effect on?
plasma Na concentrations
common cause for essential HTN
stenotic renal artery
