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AP Kidneys 2024 > Final > Flashcards

Final Flashcards

1
Q

Major functions of the circulatory System (3)

A
  1. Transport nutrients to tissues
  2. transporting waste products away form tissues
  3. transporting hormones: signaling
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2
Q

Physical characteristics of circulatory system (4)

A
  1. Volume (Ex liter)
  2. Velocity
  3. Pressure (mmHg)
  4. Area (size)
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3
Q

Blood flow determinants (5)

A
  1. Blood flow (ml/min)
  2. Vascular resistance
  3. blood pressures
  4. Vascular conductance
  5. Poiseulle’s law
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4
Q

High resistance causes ______ blood flow

A

poor

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5
Q

vascular resistance determines how much _______ we have

A

blood pressure

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6
Q

Pressure above a “choke point” is typically _______ and it is ______ below

A

higher
lower

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7
Q

inverse of vascular resistance

A

vascular conductance

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8
Q

what is conductance

A

How easy is it to drive flow through a conduit (blood vessel)

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9
Q

Vast majority of our blood is stored in our? what %?

A

veins
84%

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10
Q

The kidney controls how much _____ we have in our body? How is this related to blood volume?

A

fluid; if we reabsorb more fluid, this can increase our blood volume a little bit

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11
Q

What percent of our blood volume is in the heart?

A

7%

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12
Q

What is a system in series? How does this affect resistance?

A

Adding vessels end to end to find combined resistance;
increases resistance

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13
Q

what is system in parallel? How does this affect resistance?

A

Multiple pathways the blood can choose to flow through; decreases resistance

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14
Q

How is the circulatory system arranged? which system? What about the kidney?

A

BOTH
1. System in series
2. System in parallel

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15
Q

How to calculate system in series

A

R total = R1 + R2 + R3….

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16
Q

What is the cross sectional area of the aorta?

A

2.5 cm^2 OR
4.5 cm^2

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17
Q

What is the cross sectional area of the small arteries?

A

20 cm^2

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18
Q

What is the cross sectional area of the capillaries?

A

2500 cm^2 OR
4500 cm^2

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19
Q

What is the cross sectional area of the venae cavae

A

8 cm^2 OR
18 cm^2

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20
Q

Velocity of blood flow =

A

blood flow/cross sectional area

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21
Q

Phenylephrine works on the

A

small arteries and arterioles

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22
Q

Resistance vessels that determine blood pressure

A

small arteries and arterioles

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23
Q

How does kidney manage blood flow?

A

adjusting vascular resistance

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24
Q

Blood flow for tissue depends on

A

metabolic rate

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25
Q

What is Laminar flow? Describe the flow near the walls of the vessel.

A

Ideal efficient flow where blood is pushed forwards and orderly; the walls create resistance, therefore flow is reduced closest to the walls

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26
Q

what is turbulent flow?

A

inefficient movement of blood where it is not moving straight forward but in different directions

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27
Q

What happens to vessels with turbulent flow? What causes turbulent flow?

A

remodeling;
Clot or blockage leading to a narrow opening for blood to go through

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28
Q

How much cardiac output do kidneys receive?

A

1 L/ min
20 %

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29
Q

What is different about the kidneys in regards to how much they are perfused? (2)

A

They get more blood flow than they need in order to filter appropriately; they are only PARTIALLY controlled by the metabolic demands of the tissue

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30
Q

What are two blood flow determinants? (2 laws)

A
  1. Ohm’s Law (V=IR)
  2. Poiseulle’s law
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31
Q

Ohm’s Law rearranged

A

change in pressure = Flow x vascular resistance

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32
Q

A small change in blood vessel diameter has what effect? (Poiseulle’s law)

A

Very big difference in blood pressure

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33
Q

Conductance =

A

1/ Resistance

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34
Q

What are the long term roles of the kidney? (7)

A
  1. BP
  2. pH
  3. RBC
  4. electrolytes
  5. Vit D
  6. serum glucose
  7. metabolic waste disposal
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35
Q

If there is an issue with chronic BP, it is an indication that

A

There is an issue with the kidneys

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36
Q

uncontrolled diabetes can lead to increased _______

A

Nitrogen compounds (urea)

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37
Q

If the body is hypernatremic, how will the kidneys respond? Using what receptors?

A
  1. Get rid of excess sodium or reabsorb more water
  2. decrease ADH
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38
Q

Most kidney management is done via

A

autoregulation of GFR

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39
Q

Largest artery feeding into the kidney

A

Renal artery

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40
Q

Renal arteries split into

A

Segmental arteries

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41
Q

segmental arteries split into

A

interlobar arteries

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42
Q

Interlobar arteries split into

A

Artuate arteries

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43
Q

Arcuate arteries split into

A

interlobular arteries

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44
Q

What sits behind the afferent arteriole?

A

Glomerular capillaries

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45
Q

Bulk of reabsorption occurs at

A

Peritubular capillaries

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46
Q

List veins in order from smallest to largest

A
  1. Interlobular
  2. Arcuate veins
  3. Interlobar
  4. Segmental
  5. Renal
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47
Q

What are the vessels in the nephrons? (4)

A
  1. Afferent arterioles
  2. glomerular capillaries
  3. efferent arterioles
  4. peritubular capillaries
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48
Q

How many nephrons does a person under 40 have?

A

2 million

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49
Q

What are the two parts of nephrons

A
  1. Superficial (cortex)
  2. Deep (intermedulla)
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50
Q

What percent of our nephron are more cortical?

A

90%

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51
Q

What percent of our nephron are medullary?

A

5-10%

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52
Q

Where is the peritubular capillary network?

A

majority in outer medulla

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53
Q

Are there more ascending or descending blood vessels in our inner medulla? Why?

A

ascending
There are split points to decrease the velocity to maintain a normal level of solutes in the renal interstitium

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54
Q

What would happen if there is increased rate of flow in the ascending vasa recta?

A

The renal interstitium will get washed out. Reabsorption will be affected

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55
Q

What are the ascending/ descending peritubular capillaries called?

A

Vasa recta

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56
Q

T/F: The medullary capillaries are the least sensitive to changes in blood pressure

A

False; very sensitive to low BP or inadequate perfusion

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57
Q

Where are the kidneys housed

A

right underneath the diaphragm

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58
Q

Where does the renal vein sit?

A

under the mesenteric arteries

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59
Q

What sits on top of the kidneys

A

Adrenal glands

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60
Q

What are ureters?

A

collection system of whatever is left in the tubules

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61
Q

The top of the right kidney comes into contact with the

A

liver

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62
Q

Top of left kidney comes into contact with the ______. Whats it called?

A

stomach
Gastric surface

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63
Q

Identify the gastric surface, splenic surface, pancreatic surface, and descending colic surface

A
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64
Q

Identify the hepatic surface and right colic flexure surface

A
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65
Q

T/F: The pancreas comes into contact with the left kidney

A

True

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66
Q

What comes together to form the ureter?

A

Minor and major calyx

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67
Q

Gland that surrounds the urethra in males

A

prostate

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68
Q

What system controls emptying of the bladder? Which nerve? What spinal nerves does it come off?

A

PNS and SNS
Pudendeal
S 2,3,4

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69
Q

The spinal nerves 2,3,4 are in charge of

A

Solid and urinary waste

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70
Q

Where does the pudendeal nerve run next to? besides continence what is it in charge of?

A

Prostate gland
Erection

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71
Q

What does the macula densa do

A

monitor filtration rate
(how much fluid is being filtered)

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72
Q

Where is the macula densa located

A

Thick ascending loop of Henle

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73
Q

The _____ collecting duct empties into the papillary duct

A

Medullary

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74
Q

The flow through the macula densa is measured by

A

juxtaglomerular cells

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75
Q

When is renin released? This will cause ?

A

When juxtaglomerular cells sense a decrease in BP
Increase Angiotensin II
Vasoconstriction of EA

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76
Q

Renal clearance describes

A

Quantity of plasma (ml) that is cleared of a substance per unit of time (min)

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77
Q

What are the units for renal clearance?

A

mL/min

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78
Q

Urinary flow rate

A

1ml/min

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79
Q

Excretion rate

A

volume x

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80
Q

Exogenous substance that is given as the gold standard to measure GFR

A

inulin

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81
Q

If inulin is the gold standard, why is it not used more often?

A

It requires more measurements, its difficult to do, and is more expensive

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82
Q

Where does most reabsorption take place?

A

Proximal convoluted tubule

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83
Q

T/F: All segments of the nephron reabsorb something

A

true

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84
Q

What portion of water is reabsorbed in the PCT?

A

water

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85
Q

T/F: creatitine is diluted more and more as we go along the nephron

A

false

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86
Q

What does the macula densa measure in regards to Na

A

How many Na pass per unit time

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87
Q

If we have a higher than normal filtration rate with a normal reabsorption rate, how will that affect the amount of Na and Cl near the macula densa?

A

Increased amount of Na and Cl; high GFR

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88
Q

How does the body respond to low GFR?

A

increase angiotensin II, constrict AA, reabsorb more Na at PCT

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89
Q

Increased reabsorption of Na at the PCT will cause a _________ at the macula densa. Is this considered a true low GFR? What is the effect?

A

deficit
No, GFR and BP are normal;
increased GFR

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90
Q

What causes PCT to increase Na absorption?

A

Elevated glucose levels, elevated amino acids

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91
Q

What is normally reabsorbed at the PCT?

A

Glucose and amino acids

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92
Q

T/F: Most glucose is reabsorbed at the PCT under normal conditions

A

False; all of it

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93
Q

for every glucose molecule, ______ Na molecules must be reabsorbed. What pump is utilized?

A

1; SGLT

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94
Q

What is the primary cause of degradation of the kidneys with uncontrolled DM?

A

hyperfiltration

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95
Q

Side of the tubular cell walls next to the lumen

A

Apical

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96
Q

Side of the tubular cell walls next to the interstitial fluid

A

Basolateral

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97
Q

What is the level of glucose at the end of the PCT?

A

practically Zero

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98
Q

How does glucose leave the tubular cells to through the basolateral side? Does it require energy?

A

Glut transporter
No

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99
Q

What are the 3 part of the PCT?

A

S1, S2, S3

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100
Q

What segment is responsible for the most glucose reabsorption? What percent? What transporters are there?

A

S1
90%
SGLT-2 AND Glut-2

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101
Q

T/F: Glut-2 transporters have a low affinity for glucose

A

True

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102
Q

What glucose transporters are at the S2 segment? Do they have a high or low affinity for glucose?

A

SGLT-1 and GLUT1
high

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103
Q

T/F: There are no SGLT transporters in the S3 segment of the PCT

A

False; just a few

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104
Q

What is the normal amount of glucose reabsorbed at the PCT

A

about 125 mg/min

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105
Q

What is a normal blood glucose

A

100 mg/dl

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106
Q

What is filtered load?

A

The amount of whatever is being dissolved in the fluid being filtered

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107
Q

At what point will we expect to see glucose in the urine? what is this point called?

A

200 mg/dL
threshold

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108
Q

What does the transport maximum refer to? What level of glucose is that?

A

The point where there is a 1:1 relationship between filtered load and glucose excreted (no more glucose can be transported) ; 300 mg/DL

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109
Q

How much glucose is being reabsorbed once we hit transport maximum?

A

none

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110
Q

What ions are the macula densa sensitive to? Which is primary?

A

Na* and Cl

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111
Q

Where is angiotensinogen produced? What does it convert to and how?

A

liver;
angiotensin I via renin

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112
Q

Angiotensin I is converted to _______ by ________

A

Angtiotensin II
ACE

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113
Q

Dilation to the afferent arteriole will cause what effect to the glomerular capillaries?

A

Increased renal blood flow

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114
Q

An increase is efferent arteriolar resistance will cause what effect to glomerular capillaries?

A

increased renal blood flow

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115
Q

T/F: Angiotensin II only contracts the efferent arteriole

A

False; both. Efferent is primary

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116
Q

Medications that relax blood vessels primarily work at the _______ arteriole

A

afferent

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117
Q

What are AT1 receptors and where are they located?

A

angiotensin receptors
PCT

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118
Q

What effect does increasing activity of the NaK atpase pump have on sodium?

A

increase the amount of Na leaving the tubular cells, decreasing the amount of Na inside the cell, increasing the concentration gradient for the NHE transporter, moving more sodium from the tubular lumen into the cells

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119
Q

How does bicarb leave the tubular cells?

A

Na bicarb co transporter

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120
Q

Angiotensin II ________ the NaK atpase

A

speeds up

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121
Q

pathway between the cells

A

paracellular pathway
“tight junctions”

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122
Q

What ions goes through the paracellular route of PCT?

A

Cl, Ca

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123
Q

What does transcellular reabsorption refer to?

A

movement through the cell wall usually by transporter

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124
Q

Water moves transcellularly through

A

aquaporin channels

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125
Q

Any water thats reabsorbed is does so how?

A

osmosis; follows ions

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126
Q

Are there any water pumps in the kidneys to reabsorb water from the tubules?

A

no

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127
Q

What does the body utilize to reabsorb water?

A

urea

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128
Q

The luminal side of the the PCT looks like? why?

A

brush border
to increase surface area for transporters

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129
Q

T/F: tubular epithelial cells have a membrane potential

A

true; -70 mV

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130
Q

What is the charge associated with the tubular lumen of the PCT? this is due to what?

A

-3 mV
net charge of ions

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131
Q

T/F: sodium gets concentrated in the PCT

A

false; chloride does a little bit

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132
Q

Where can we find carbonic anhydrase and its function

A

PCT;
acid base management

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133
Q

Primary reabsorption process for Na

A

Na K atpase

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134
Q

How does the PCT regulate bicarb?

A

HCO3 combines with protons pumped into the tubule from the Na H pump to form carbonic acid (H2CO3). Carbonic anhydrase helps it disassociate to CO2 and H2O which can be reabsorbed into the tubular cells.
once inside the tubular cells, carbonic anhydrase helps combine CO2 and H2O to form carbonic acid which then disassociates back into bicarb and protons. Bicarb can then leave the tubular cells and be reabsorbed

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135
Q

Where is carbonic anhydrase stored?

A

Some are tethered to cell wall, some is inside the cell wall, and some is wedged in the cell wall

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136
Q

Biggest issue with carbonic anhydrase inhibitors

A

acidoses

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137
Q

Where is glutamine produced

A

liver, skeletal muscle

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138
Q

Glutamine can be broken down into

A
  1. 2 molecules bicarb
  2. 2 molecules ammonium
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139
Q

Important Urinary buffers (2)

A

ammonium, phosphates

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140
Q

Where is Ca reabsorbed in the tubule?

A

PCT- paracellularly and transcellularly

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141
Q

How does calcium enter the PCT transcellularly? Leave the PCT ?

A
  1. Ca pumps
  2. Ca ATPase pump and NCX
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142
Q

Why doesnt all our calcium get filtered

A

It aggregates with albumin

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143
Q

What glands are responsible for monitoring Ca levels? what does it release when levels are low

A

Parathyroid gland
parathyroid hormone

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144
Q

What does PTH do?

A

increase Vitamin D3 activation
increase intestinal Ca reabsorption
stimulates bone breakdown (osteoclasts)
decrease osteoblast activity

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145
Q

bones are formed from

A

Ca and Phosphate

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146
Q

Long term Ca stores? when do they become porous?

A

bones
chronic low plasma Ca levels

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147
Q

Role of osteoblasts

A

Build bones by combining Ca and phosphate

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148
Q

What endogenous organic cations are secreted by the PCT

A

creatinine
Ach
choline
Setoronin
Dopamine
NE
Epi
Histamine

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149
Q

What endogenous organic anions are secreted by the PCT

A

hippuric acid (hippurates)
bile salts
prostaglandins
urate
oxalate

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150
Q

What exdogenous organic anions are secreted by the PCT

A

penicillin
furosemide
salicylates

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151
Q

What exdogenous organic cations are secreted by the PCT

A

atropine
isoprel
morphine
procaine
quinine
tetraethlylammonium

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152
Q

organic cations are secreted via

A

H dependent antiporter

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153
Q

organic anions are secreted via

A

Na dependent antiporter and mediary compound alpha ketoglutarate

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154
Q

In general, what portion of pretty much everything gets reabsorbed at the PCT

A

2/3

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155
Q

Downward portion of LOH? is it more or less concentrated?

A

descending loop of henle
more

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156
Q

T/F: There are many ion transporters and ion reabsorption occurring at the descending loop of henle

A

false

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157
Q

The thin ascending loop of henle is impermeable to ____

A

water

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158
Q

which ion transporter is in the thin ascending loop? Categorize the transporter

A

Na and Cl atpase transporter
Primary active transporter

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159
Q

Ions that get reabsobed via paracellular route of thick ascending loop of henle

A

Na, K, Mg, Ca

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160
Q

What is the charge of the tubular lumen of the thick ascending loop of henle

A

+8 mV

161
Q

NKCC

A

Moves 1 Na, 1 K, 2 Cl from tubular fluid into the tubular cells

162
Q

target of loop diuretics

A

NKCC transporter

163
Q

Why are loop diuretics so potent?

A

without the action of the NKCC, the renal interstitium becomes less concentrated

164
Q

What does the concentration of the renal interstitium depend on?

A

NKCC

165
Q

What is the maximum osmolarity of the renal interstitium

A

1200

166
Q

T/F: Renal insterstitium osmolarity in loop of Henle is equivalent to the osmlolarity of the urine

A

true

167
Q

Target of thiazides?

A

NaCl transporter and the distal tubule

168
Q

The distal tubule is sensitive to

A

ADH and aldosterone

169
Q

Which cells in the distal tubule are sensitive to aldosterone? Which is sensitive to both adh and aldo?

A

principal cells
cells

170
Q

Aldo is a derivative of _________ which means the receptors are ________

A

cholesterol
inside the cell

171
Q

T/F The PCT has a high metabolic rate

A

true

172
Q

What portion of filtered water makes it past the ascending loop of henle?

A

15%

173
Q

What percent of filtered ions are reabsorbed in the thick ascending loop of henle

A

25%

174
Q

Cells found in the late portion of the distal tubule that determine the last of the electrolyte reabsorption?

A

principal cells

175
Q

How does the calcium move from the lumen to the interstitium in the distal tubule

A

NCX

176
Q

How can we increase the amount of Ca being reabsorbed in the distal tubule?

A

Block Na coming into the cell; Thiazide diuretic

177
Q

What is the target of thiazide diuretics

A

NaCL transporter

178
Q

A patient with osteoporosis OR prevention of kidney stones may benefit from

A

thiazides

179
Q

If a patient is on thiazides, they must be wary of

A

calcium supplements

180
Q

aldosterone sensitive cells

A

principal

181
Q

The more aldosterone we have the more ______ absorbed and the more ______ secretion

A

na
K

182
Q

Name 2 aldosterone antagonists? also known as?

A

spironolocatone and epleronone;
K sparing diuretics

183
Q

ROMK are typically where when there are low K levels?

A

renal outer medullary k channels are sequestered

184
Q

BK channels are typically where in the cell?

A

cell wall

185
Q

What moves ROMK channels and open BK channels?

A

aldosterone

186
Q

potassium maintenance is typically done in the _______

A

principal cells

187
Q

ENaC are sensitive to

A

aldosterone

188
Q

Na channel blockers (2)

A

amiloride
triamterene

189
Q

anything that increases Na in the principal cells will ultimately?

A

be a K wasting diuretic

190
Q

Triamterene is almost always given with

A

hydrochlorothiazide

191
Q

A small amount of estrogen is produced

A

zona fasciculata

192
Q

Catecholamines come from which part of the adrenal glands?

A

Medulla

193
Q

What is the ratio of epi/NE released from the adrenal medulla?

A

4:1

194
Q

Where are AT-1 receptors

A

zona glomerulosa

195
Q

enzyme that produces aldosterone

A

aldosterone synthase

196
Q

Cortisol is a _______ so it helps manage our ________

A

glucocorticoid
glucose

197
Q

Aldosterone is a _______

A

mineralecorticoid

198
Q

Cells in the distal tubule that maintains acid base balance? How do they do this?

A

intercalated cells
secrete protons (type A), reabsorb protons (B), or secrete HCO3 (B)

199
Q

What is the function of the Hydrogen ATPase pump

A

move H from the tubular cells to the tubular lumen

200
Q

How do type A intercalated cells secrete protons? (2)

A

hydrogen-potasisum
hydrogen atpase pump

201
Q

Both intercalated and principal cells are sensitive to________

A

vasopressin

202
Q

Where are V2 receptors found

A

late distal tubule and collecting ducts

203
Q

in the distal tubule, protein kinase A will phosphorylate ________ which will cause them to move to the cell wall. This process is dependent on _______

A

aqua porin-2 channels
ADH

204
Q

Nephrogenic DI? What can induce this? What would be an estimated urine osmolarity?

A
  1. There is a problem with the kidney and how it responds to ADH
  2. Lithium therapy
  3. 50 mmosm
205
Q

Central DI

A

Problem with the release of ADH

206
Q

How does alcohol affect ADH?

A

decreases ADH release from the brain
affects how the kidney responds to ADH

207
Q

High blood pressure monitors

A

Baroreceptors

208
Q

Low blood pressure monitors

A

veins and atria

209
Q

Where are osmoreceptors located?

A

hypothalamus

210
Q

ADH production centers

A
  1. Supraoptic nuceli (nuclei=cell bodies)
  2. Paraventricular nuclei
211
Q

What portion of ADH is produced in the supraoptic nuclei?

A

5/6

212
Q

Where are the paraventricular nuclei located

A

opposite sides of the 3rd ventricle

213
Q

Which lobe of the pituitary is ADH secreted to? Whats another name for it?

A

posterior lobe
neurohypothesis

214
Q

another name for anterior lobe of the pituitary gland?

A

adenohypothesis

215
Q

Cells in a hypotonic solution will
Cells in a hypertonic solution will
why does this happen?

A

absorb water and swell
secrete water and shrink
The cell is trying to match the osmolarity

216
Q

ADH plays a role in water reabsorption and ?

A

How much urea is reabsorbed from the tubular fluids

217
Q

How much urea is reabsorbed at the PCT?

A

50%

218
Q

Where would we find a lot of urea transporters? Name them

A

collecting duct
UT-A1 and UT-A3

219
Q

What is the singular compound that can control water absorption without affecting electrolyte absorption

A

ADH

220
Q

Name 5 things that decrease thirst

A
  1. decrease plasma osmolarity
  2. decrease antiotensin II
  3. Increase BP
  4. Increase blood volume
  5. gastric distention
221
Q

Name 5 things that increase thirst

A
  1. increase plasma osmolarity
  2. increased angiotensin II
  3. dec BP
  4. Dec blood volume
  5. dryness of mouth
222
Q

Name 3 things that decrease ADH and 2 drugs

A
  1. decreased osmolarity
  2. increased BP
  3. increased blood volume
  4. alchohol
  5. Haldol
223
Q

Name 5 things that increase ADH and 2 drugs

A
  1. inc osmolarity
  2. dec blood volume
  3. dec BP
  4. Nausea
  5. hypoxia
  6. morphine
  7. nicotine
224
Q

T/F: our body can start to have difficulty secreting potassium if we intake a large amount

A

false

225
Q

ideal urine osmolarity

A

600 mOsm/L

226
Q

If it is easy to drive blood flow through a vessel, how would you describe vascular conductance?

A

high conductance

227
Q

relate total cross sectional area and velocity

A

A small cross sectional area will have a high velocity; the larger the total cross sectional area (as we move away from the heart), the lower the velocity of blood flow through each individual vessels

228
Q

Most accurate renal blood flow

A

1100 ml/min

229
Q

Blood pressure at the beginning of a systemic capillary? End? delta P?

A

30mmHg
10 mmHg
17.3 mmHg

230
Q

define filtration and absorption

A

Filtration describes the movement of fluid out of the capillary. Absorption is the fluid being absorbed by the capillaries

231
Q

The drop in blood pressure between the large arteries capillaries is due to?

a. the fact that it has multiple pathways to take through

b. vascular resistance that the blood is encountering

A

b

232
Q

As resistance in a tubule increases, blood flow ________.
As delta P increases, blood flow _______

A

decreases
increases

233
Q

The primary place where nutrient exchange or waste product collection goes into the circulation

A

capillaries

234
Q

What controls blood flow through the capillaries? How?

A

arterioles; they have smooth muscle associated with them and can contract or relax as needed

235
Q

Why is there a high osmolarity in the loop of henle? What is the level?

A

water has been reabsorbed
1200 mmOsm

236
Q

What is the osmolarity after the ascending loop of Henle? why?

A

100 mmOsm
solutes were reabsorbed but water was not permeable

237
Q

In what circumstance would the osmolarity in the loop of henle be 600 mmOsm?

A

No ADH being secreted

238
Q

What ions are reabsorbed at the ascending loop of henle

A

K, Na, Cl

239
Q

What follows the same filtration/ absorption pattern as PAH in the loop of henle? Whats the difference?

A

creatinine; PAH is a higher number

240
Q

diuresis indicates an excretion of

A

electrolytes and water

241
Q

Initital exposure of a diuretic causes

A

very large excretion of sodium

242
Q

With a urine loss of 1 L, we can assume that how much comes from the plasma? Where does the rest come from?

A

1/5 or 200ml
interstitial fluid

243
Q

Hypertension is usually due to

A

increased vascular resistance

244
Q

Why are diuretics used primarily to lower blood pressure?

A

the body figures out a way around mediations that relax blood vessels

245
Q

How does eating excess sodium affect angiotensin II? What does this mimic?

A

suppresses it
ACE inhibitors

246
Q

Chronically high angiontensin II with increased Na intake will cause?

A

significant hypertension

247
Q

Over expression of the RAA system leads to?

A

salt sensitive essential hypertension

248
Q

Mannitol is an examples of what kind of drug? Can it be reabsorbed?

A

osmotic diuretic
no

249
Q

ARBS affect which arteriole? Where is electrolyte reabsorption affected?

A

efferent
PCT

250
Q

T/F: Angiotensin II is a pressor

A

true

251
Q

Excretion rate should always equal ___________

A

production

252
Q

What will be the immediate effect on plasma creatinine after a unilateral nephrectomy?

A

it will double; the same amount of creatinine is being produced but half the creatinine is being excreted

253
Q

GFR can increase by how much if one donates a kidney?

A

50%

254
Q

creatinine clearance

A

1.25 mg/dl

255
Q

how many nephrons does a healthy person have

A

2 million

256
Q

Single nephron GFR

A

62.5 nl/min

257
Q

volume excreted for all nephrons in ml/min

A

1.0 ml/min

258
Q

volume excreted per nephron

A

0.75 nl/min

259
Q

if someone lost 75% of their nephrons, would the single nephron GFR go up or down? what about volume excreted per nephron?

A

increase
increase substantially

260
Q

At what age do people start losing nephrons

A

40

261
Q

Treatments for renal failure in regards to restriction

A
  1. Na restriction
  2. K restriction
  3. Protein restriction
  4. Fluid restriction
262
Q

T/F: Acidosis is a short term problem with chronic renal failure

A

False; long term

263
Q

How does administering isotonic Nacl affect intracellular fluid, extracellular fluid, and osmolarity?

A

increase extracellular fluid
intracellular stays constant

264
Q

How does administering hypotonic NaCl affect intracellular fluid, extracellular fluid, and osmolarity?

A

intracellular fluid goes up
extracellular goes up
osmolarity goes down

265
Q

How does administering hypertonic NaCl affect intracellular fluid, extracellular fluid, and osmolarity?

A

intracellular fluid goes down
extracellular goes up
osmolarity goes up

266
Q

How many layers of smooth muscle cells do small arteries have?

A

4

267
Q

How much volume per min moves through the aorta

A

5L

268
Q

Where would we expect velocity to be higher? The vena cavae or the aorta? why?

A

aorta
the total cross sectional area is less for the aorta

269
Q

Compare cell wall thickness of arterioles to capillaries

A

capillaries are much thinner with only 1 cell layer thickness

270
Q

Why is it a good thing that capillaries do not have smooth muscle?

A

less in the way for nutrient exchange

271
Q

Why is there a drop in the average blood pressure of the aorta to the start of the capillaries?

A

We went from an area of high vascular resistance to low vascular resistance

272
Q

Normal MAP

A

100mmhg

273
Q

Capillary Starling forces favor _______ at the arterial end and ______ at the venous end

A

filtration; reabsorption

274
Q

What are the 4 components of Starling Forces?

A
  1. Pcap: hydrostatic pressure in capillary
  2. Pisf: hydrostatic pressure in ISF
  3. Capillary colloid osmostic pressure (oncotic pressure)
  4. Interstitial fluid oncotic pressure
275
Q

What is capillary pressure?

A

pressure within the capillary

276
Q

What spinal nerves are the phrenic

A

C3,4,5

277
Q

High pressure in the interstitial fluid should _______ filtration

A

oppose

278
Q

What is the interstitial fluid pressure on the arterial side of the capillary? venous side?

A

-3 mmOsm
-3 mmOsm

279
Q

Why is the interstitial fluid pressure of the isf negative?

A

Because the lympatic system pulls excess fluids out of the interstitium

280
Q

What is oncotic pressure?

A

colloid osmotic pressure

281
Q

What is normal plasma oncotic pressure?

A

28 mmHg

282
Q

Osmostic pressure depends on

A

a semi permeable membrane where fluid can move but some dissolved substances cant

283
Q

What would happen if a capillary became permeable to proteins?

A

The proteins will not have an osmotic pressure associated with them and then secondary, they could leak out

284
Q

Name 3 compounds that are in the insterstitial space

A
  1. proteoglycan filaments
  2. hyaluronic acid
  3. collagen
285
Q

T/F: There are more proteins outside the cardiovascular system than inside

A

false

286
Q

What is the osmotic pressure of interstital fluid?

A

8 mmhg

287
Q

Why is there swelling with trauma?

A

Protein from inside the cell escaped, drawing fluid to the capillary

288
Q

Are lympathics specialized to get rid of extra proteins?

A

no; its specialized to get rid of excess fluid in the insterstitium but it can help slowly

289
Q

The function of the lympathic system is dependent on. By how much can it increase?

A

How much movement the body is doing
20-40?

290
Q

The 3 main proteins that make up our total oncotic pressure? Which is primary?

A

albumin*, globulins, fibrinogen

291
Q

areas of collection for our lymphatic system

A

lymph nodes

292
Q

Where are the lymphatic ducts? where do they connect and go to?

A

top of the thorax
two large veins to the cardiovascular system

293
Q

T/F: Lymph moves bidirectionally

A

false; goes through one way valves

294
Q

A positive interstitial fluid pressure would favor filtration or reabsorption?

A

reabsorption

295
Q

The arterial end of the capillary favors ________ while the venous favors _______ but they are not equal. Which is in excess?

A

filtration
absorption
filtration

296
Q

If filtration is in excess at the arterial end of the capillary, why dont we have excess fluid in our tissues?

A

its scavenged by the lymphatics

297
Q

If the arterial pressure is 30, and the venous end is 10, what is the average capillary pressure if not 20? and why is that?

A

17.3; in alot of capillaries, the venous end gets larger and larger

298
Q

What is the net filtration pressure throughout the ENTIRE capillary?

A

0.3 mmHg

299
Q

In general, capillaries are most permeable to (2)

A

water
NaCl

300
Q

What is one specialized capillary bed where sodium and chloride have a hard time going through?

A

BBB

301
Q

List in order of least permeable to most:
glucose, albumin, water, urea, NaCl, inulin, myoglobin, sucrose

A

Albumin
Myoglobin
Inulin
Sucrose
Glucose
Urea
Na+
Water

302
Q

Capillary set that provides the kidney with a lot of filtration. its first in a set of 2

A

glomerular capillaries

303
Q

Which artery determines the blood pressure in the glomerular capillaires

A

afferent arteriole

304
Q

What is GFR?

A

The rate of fluid moving from the glomerular capillary bed into the nephron

305
Q

What is the average blood pressure in the glomerular capillaries?

A

60 mmHg

306
Q

The blood pressure in a typical capillary is about ________ the blood pressure in the glomerular capillaries

A

half

307
Q

Autoregulation of renal blood flow is a factor in determining?

A

GFR

308
Q

What is the significance of the slightly slanted line in regards to renal autoregulation

A

its a large part of how the kidney is able to get rid of fluid when pressure is high and retain when it is low. A little bit of imperfect regulation helps the kidney manage BP long term

309
Q

What is the oncotic pressure right before the glomerular capillaries? after? why?

A

28 mmHg
36 mmHg
because the plasma colloids are not filtered and we have reabsorbed water

310
Q

What is the hydrostatic pressure and the oncotic pressure in the beginning of the tubule?

A

18 mmhg
0 mmhg

311
Q

Why don’t the proteins necessary for the cell that make up the tubule accounted for with protein oncotic pressure?

A

The proteins are tethered and not free floating

312
Q

How do you calculate filtration rate?

A

Filtration rate = Kf (Nfp)

Kf (filtration coefficient)

313
Q

How does the body respond when our GFR is too low?

A

constrict the efferent arteriole

314
Q

Which segment of the kidney has the highest vascular resistance?

A

Efferent arteriole

315
Q

The second set of capillaries after the efferent arteriole? what occurs here?

A

peritubular capillaries; reabsorption

316
Q

what is dissolved in the renal interstitium?

A

proteins, ions, electrolytes, energy compounds

317
Q

T/F: anything that is reabsorbed from the tubule will pass through the interstitium

A

true

318
Q

Anything reabsorbed at the peritubular capillaries is going to go to?

A

cardiovascular system

319
Q

do we expect the filtration pressure at the peritubular capillaries to be higher, equal, or lower than at the glomerular capillaries

A

lower; this is where reabsorption occurs

320
Q

About what percent of renal blood flow is filtered?

A

10%

321
Q

Everything that is reabsorbed in the peritubular capillaries makes its way back to the cardiovascular system via the

A

renal vein

322
Q

What portion of the plasma that moves through the kidneys is filtered

A

1/5; 20%

323
Q

How to calculate excretion

A

excretion = filtration -reabsorption + secretion

324
Q

The process of secretion is compounds moving from the ________ to the _______

A

peritubular capillaries
renal interstium

325
Q

What is an example of two electrolytes our body secretes?

A

k and na

326
Q

Describe what is happening with the blue and green line:

A. blue- afferent arteriole is relaxing
green- efferent arteriole is contracting

B. blue- efferent arteriole is contracting
green- efferent arteriole is relaxing

C. blue- efferent arteriole is relaxing
green- afferent arteriole is contracting

D. blue- afferent arteriole is relaxing
green- afferent arteriole is contracting

A

B

327
Q

What is filtration fraction? What is a normal amount?

A

GFR (how much fluid is being filtered)/RPF (renal plasma flow)
20%

328
Q

What is renal plasma flow and how do we calculate that?

A

660 ml/min
1100 * 0.6 = 660ml/min
(40% is hct)

329
Q

How will lower pressure in the glomerular capillary affect GFR?

A

lower

330
Q

Which is easier for the afferent arteriole to auto regulate? blood pressure past 150 or BP lower than 50? if we couldnt, what would happen

A

BP past 150
high blood pressure would lead to urine dumping

331
Q

Normal urine output

A

1ml/min

332
Q

T/F: autoregulation by the kidney is dependent on renin and ADH

A

false; its independent

333
Q

Match the letter with the ion that follows this system
glucose, sodium, PAH

A
  • A- Mannitol
  • B- sodium
  • C- glucose
  • D- PAH
334
Q

What is the MAX amount of a substance that can be filtered at the glomerular capillaries?

A

1/5

335
Q

Paraamino hippuric acid is used to? how?

A

measure renal blood flow; the removal is highly dependent on renal blood flow since all of it is removed from the circulation, it is an indication of high renal blood flow

336
Q

What are fenestrations?

A

the openings in the endothelium of the glomerular capillaries

337
Q

Identify the structures

A

a. epithelium
b. basement membrane
c. endothelium
d. fenestrations
e. slit pores

338
Q

structural reinforcement of the glomerular capillary bed? foot processes of said structure?

A

podocytes
slit pores

339
Q

Proteins have a net _______charge and the basement endothelium has a net ______ charge. What does this do?

A

negative
negative
prevent proteins from slipping through the fenestrations

340
Q

What starts to deteriorate in the glomerular capillaries after exposure to continuous high bp

A

podocytes

341
Q

Compare the filterability of a polycationic dextran to a polyanioic dextran

A

a polycationic will be more readily filterable due to the positive charge

342
Q

Pressure in the right atrium

A

10 mmHg

343
Q

cross sectional area of arterioles

A

400 cm ^ 2

344
Q

Describe the process of shear force causing NO release

A

shear stress leads to release of eNOS which binds to O2 to L-arginine to create NO. NO binds with L-citrulline which activates soluble guanylylcyclase in the smooth muscle. it activates cGTP to cGMP and that leads to relaxation of the smooth muscle

345
Q

How much oncotic pressure in a standard capillary is due to albumin? how much is in our plasma?

A

21.8 mmHg
4.5 g/dl

346
Q

How much oncotic pressure in a standard capillary is due to globulins? how much is in our plasma?

A

6 mmHg
2.5 g/dl

347
Q

How much oncotic pressure in a standard capillary is due to fibrinogen? how much is in our plasma?

A

0.2 mmHg
0.3 g/dl

348
Q

The kidneys are long term regulators of

A

blood pressure
acid base balance
electrolyte balance
blood glucose

349
Q

Describe how the kidney manages acid base balance

A

Can reabsorb bicarb as needed or produce bicarb if more is needed. It can also get rid of excess protons

350
Q

How does the kidney manage hct levels?

A

There are oxygen sensors deep in the kidney. If oxygen is low, the kidney release erythropoietin which increases the number of RBC

351
Q

Which vitamin is activated in the kidney?

A

Vit D

352
Q

What waste products would someone with DM be expected to have in the plasma

A

nitrogenous compounds such as urea

353
Q

T/F: the kidney has the ability to absorb extra NA without absorbing extra water

A

true

354
Q

Where are the peritubular capillaries located?

A

in the outer parts of the medulla

355
Q

What is a unique feature of peritubular capillaries found on nephrons in the deep medulla? why? what percentage of capillaries are these? what are they called?

A

They have an unequal number of descending and ascending capillaries; to maintain normal levels of solutes deep in the interstitium; 5-10%; vasa recta

356
Q

Label the structures

A

a. left suprarenal gland
b. gastric surface
c. splenic surface
d. pancreatic surface
e. descending colic surface
f. left renal hilium
g. left ureter
h. right ureter
i. duodenal surface
j. right colonic flexture surface
k. right renal hilium
l. hepatic surface
m. right suprarenal gland

357
Q

Which two structures come together to form the ureter?

A

major and minor calyxes

358
Q

First part of the urine emptying system

A

papilla

359
Q

Corpuscle is another term to describe

A

Bowman’s capsule

360
Q

The medullary collecting duct follows the __________ and empties into the ________

A

cortical collecting duct
papillary duct

361
Q

Renin is released from the

A

juxtaglomerular cells

362
Q

Which arteriole is primarily affected by angiotensin II?

A

efferent

363
Q

Define renal clearance

A

the amount of plasma thats been cleared of a substance per unit of time

364
Q

V or U with a dot over it stands for

A

Vol per unit time

365
Q

About 2/3 of what is reabsorbed in the PCT?

A

almost everything

366
Q

What charge is more likely to be filtered?

A

positive

367
Q

What is the renal clearance of glucose?

A

Zero

368
Q

How much plasma is reabsorbed per minute at the peritubular capillaries?

A

about 124 ml/min

369
Q

If inulin is freely filterable but cannot be reabsorbed by the peritubular capillaries, compare the concentration of inulin at the renal artery to renal vein

A

There should be less inulin concentration in the renal vein, because 124ml/min of plasma was cleared of inulin

370
Q

How do you calculate clearance of a compound?

A

multiply the urinary flow rate times the urinary concentration of the compound divided by the plasma concentration of the compound

371
Q

Why is creatinine less accurate than inulin? (2)

A

the kidneys secrete some creatinine and levels are dependent on muscle mass

372
Q

What percent of TBW is ECF vs ICF?
What percent of ECF is plasma vs ISF

A
  1. ECF 33%/ ICF 66%
  2. plasma 20 % / ISF 80%
373
Q

How to calculate renal blood flow

A

Renal plasma flow / (1- Hct)

374
Q

Reabsorption depends on ___________. The more _______ we have, the greater percentage gets reabsorbed
(same word)

A

time

375
Q

What happens to the slit pores and fenestrations of podocytes after long term hypertension?

A

They widen and can potentially have scarring

376
Q

T/F: Ang II only constricts the efferent arteriole

A

False; constricts both but more so the efferent

377
Q

Why is Cr concentration increasing the further along the proximal tubule?

A

It it freely filterable but not reabsorbed while water is

378
Q

A higher than normal concentration of NaCl at the macula densa means there is a higher than normal concentration of NaCl at what part of the tubule?

A

thick ascending limb

379
Q

If there is a high level of NaCl but a normal amount being reabsorbed, this will be interpreted by the macula densa as?

A

high GFR

380
Q

Other than constricting the efferent arteriole, what is another function of ang II

A

increases the amount of salt that the proximal tubule rate absorbs

381
Q

What is the “actual” reason for deterioration of the kidneys in regards to uncontrolled diabetes?

A

hyperfiltration

382
Q

How can increased plasma amino acid level lead to increased GFR?

A

increased amino acids will cause the sodium amino acid pump to increase in rate, leading to increased Na reabsorption. The macula densa will sense this as decreased GFR and constrict the efferent arteriole

383
Q

Why do SGLT1 transporters require 2 Na?

A

Its harder to pump the remaining dilute glucose into the cell

384
Q

what is the renal threshold for glucose?

A

under 200 mg/dl

385
Q

What is transport maximum? What is about the transport maximum for glucose?

A

When the maximum amount of filtration is happening because the transporters have a finite time when they can undergo confirmation change to reabsorb. At this point there will be a 1:1 excretion rate per ion filtered;
about 300 mg/dl

386
Q

Are the juxtaglomerular cells found in the macula densa or the afferent and efferent arteriole

A

the afferent and efferent arteriole

387
Q

What is the rate limiting step in the production of angiotensin II?

A

renin release

388
Q

What is the primary response and secondary response of the nephron once decreased GFR is sensed?

A
  1. Constrict efferent arteriole via angiotensin II
  2. Dilate the afferent arteriole via nitric oxide
389
Q

T/F: constricting the efferent arteriole helps increase renal blood flow

A

false

390
Q

What effect does ang II have on Na and water

A

increase reabsorption at the PCT

391
Q

What is the renal clearance of PAH?

A

90%

392
Q

T/F: constricting the efferent and afferent arteriole will increase GFR

A

False, only works if efferent arteriole is constricted

393
Q

Primary way that Cl gets reabsorbed in the PCT? why?

A

paracellularly; it is negatively charged and -3mV in the tubule due to positively charged Na+ being reabsorbed.

394
Q

The process of having high amounts of reabsorption

A

bulk flow

395
Q

waste product that is stored in the renal insterstitium? why is it stored?

A

urea; to help reabsorb water if we need it

396
Q

T/F: There is a significant buildup of chloride along the proximal tubule

A

False; slight build up

397
Q

How much protein is filtered per day? How much do we excrete per day?

A

1.8 g
100 mg

398
Q

How to calculate vascular resistance of the kidney?

A

R = delta P / F

R= 100mmhg - 0 mmhg/ 1100ml/min
R= 0.09 mmhg/ml/min

AP Kidneys 2024 (9 decks)

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