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Schmidt’s World Of Anatomy > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

KIDNEY

1
Q

What is the first capillary bed blood encounters as it enters the kidney?

A

Glomerular Capillaries
Ball of veins
average pressure is twice as much as peripheral capillaries

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2
Q

Whats the cause of the decrease in blood pressure in the glomerular capillaries from the renal artery ?

A

The high vascular resistance from the afferent arteriole

renal artery pressure 100 mmHg
Glomerular capillary pressure 60 mmHg
pressure gradient 40 mmHg

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3
Q

What is the high pressure of the glomerular capillaries directly correlated with?

A

Driving filtration
maintaining GFR

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4
Q

What is normal GFR ?

A

125 mL/min
(180 L/day)

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5
Q

What are the four forces that determine filtration or reabsorption ?

A

Starlings forces
1. Capillary Hydrostatic Pressure (Pcap)
2. Interstitial Fluid Hydrostatic pressure ( Pisf)
3. Plasma Colloid Osmotic Pressure (𝜋cap)
4. Interstitial Colloid Osmotic Pressure (𝜋isf)

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6
Q

What are fenestrations and where are they?

A

numerous small openings in the endothelial cells of glomerular capillaries , where fluid and substances can be filtered.

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7
Q

Which is more permeable the renal glomerular membrane or muscle capillaries ?

A

Renal glomerular membrane
by about 500x
except for plasma proteins

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8
Q

What is filtration ? and what favors filtration ?

A

movement of fluid from the capillaries into the interstitial

Hydrostatic Pressure , Plasma Osmotic Pressure, and Interstitial Colloid pressure
Pcap/ 𝜫 cap / 𝜫 isf

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9
Q

What is reabsorption? And what favors it ?

A

the movement of fluid from the interstitial space back into the capillaries

Interstital Fluid Hydrostatic Pressure
Pisf

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10
Q

How is over-perfusion prevented in the kidney?

A

constriction or increased resistance at the Afferent Arteriole.

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11
Q

What is blood flow filtration a product of in the kidneys ?

A

Auto-regulation of renal blood flow through the kidneys

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12
Q

How do you calculate NFP in regular capillaries?

A

Pcap - Pisf - 𝜫 cap + 𝜫 isf = NFP

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13
Q

Can the kidney auto-regulate itself on its own ?

A

yes - without meds- via imperfect auto-regulation

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14
Q

What is the Plasma Oncotic-osmotic pressure in the afferent arteriole ?

A

28 mmHg
factors in the proteins dissolved in the plasma portion of blood

same as in the blood as at the systemic capillary

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15
Q

What should we not loose or filter if were healthy ?

A

Oncotic colloids
plasma proteins
glucose

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16
Q

What is Glomerular Plasma Colloid Osmotic pressure at the middle ? at the end ?

A

32 mmHg in the middle
36 mmHg at the end
further along more fluid is filtered and more proteins get concentrated

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17
Q

What is Ptube?

A

Hydrostatic pressure in the kidney tubule about 18 mmHg

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18
Q

What is the protein osmotic pressure in the early part of the tubule ?

A

should be 0 for healthy people.

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19
Q

How do you calculate NFP in the Kidney ?

A

60 mmHg - 32 mmHg - 18 mmHg = 10 mmHg

Glomerular pressure (60mmHg)
Colloid pressure in the capillaries (32mmHg) - Fluid pressure in the tubule (18mmHg)

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20
Q

How do you calculate filtration rate ? what is its units?

A

(K f) (NFP) = FR in mL/min

average = 12.5 mL/min

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21
Q

What is K f?

A

Filtration coefficient

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22
Q

What is the calculation of Filtration rate equate to ?

A

actual tissue flow

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23
Q

Whats the second arteriole blood encounters in the kidney ?

A

Efferent Arteriole

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24
Q

Which arteriole increases GFR the most ?

A

Efferent Arteriole
increased restriction at the efferent arteriole will increase upstream blood pressure that will increase filtration

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25
Q

What happens when the Efferent arteriole relaxes or dilates ?

A

decreases resistance in efferent arteriole - allows easier blood flow downstream , increased renal blood flow , and decreased GFR

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26
Q

What is the pressure after the efferent arteriole ?

A

18 mmHg

Pressure gradient from glomerular capillary = 42mmHg

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27
Q

what is the pressure gradient from the renal artery to the glomerular capillary ?

A

afferent arteriole pressure resistance caused pressure gradient of 40 mmHg

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28
Q

Which arteriole has the highest vascular resistance of any blood vessel segment in the kidney ?

A

the EFFERENT Arteriole

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29
Q

What is the second set of capillaries blood encounters in the kidneys ?

A

Peritubular capillaries

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30
Q

What happens in the Peritubular capillaries ?

A

Lots of reabsorption

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31
Q

What are the two capillary systems in the kidney ?

A

Glomerular capillaries and the peritubular capillaries

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32
Q

How much of filtration is reabsorbed?

A

about 99%

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33
Q

How much filtration is determined for excretion ?

A

about 1 %

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34
Q

What is the route of filtration in the GC
?

A

fenestrations - gaps in between the cells

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35
Q

What is the renal interstitium ?

A

an intermediary “matrix” place where proteins, ions, and electrolytes, other substances sit between the tubules and the blood vessels

anything reabsorbed from the tubule will end up here - to be reabsorbed will have to pass through peritubular capillaries

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36
Q

Where does the peritubular capillary send reabsorbed fluid to ?

A

the CV system via the renal vein

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37
Q

What is the oncotic pressure in the middle in of the peritubular capillary ?

A

32 mmHg
more diluted here

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38
Q

Pressure in the peritubualr capillaries ?

A

beginning = 18 mmHg
Middle = 13 mmHg

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39
Q

What is the interstitium fluid pressure at the pertiubular

A

𝜫 isf = 15 mmHg

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40
Q

What is the hydrostatic pressure of the renal interstitium fluid at the peritubular capillaries ?

A

Pisf = 6 mmHg

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41
Q

How is NRP calculated at the peritubular capillaries ?

A

𝜫 isf - Pisf - Ptube

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42
Q

How much of the plasma moving through the kidney’s is filtered ?

A

about 1/5 th.

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43
Q

What is the shape of the peritubular capillary ?

A

convoluted

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44
Q

Where does the tubule empty?

A

into the ureter then the bladder

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45
Q

What is the formula for excretion ?

A

Filtration - Reabsorption + secretion = Excretion

measured in volume (mL) or quantities of substances dissolved in the fluid (mol or mg) over time

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46
Q

Reabsorption pathway ?

A

Fluid waits in the renal interstitium until it moves back into the peritubular capillaries to be put back into the CV system via the renal vein

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47
Q

Secretion pathway ?

A

Opposite of reabsorption

compounds move from peritubular capillaries into the renal interstitium, through the cells , and into tubule
- specialized transport systems

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48
Q

Which capillary bed in the kidney is focused on re-absorption ?

A

Peritubular Capillaries

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49
Q

Which capillary bed in the kidney is focused on Filtration ?

A

Glomerular Capillaries

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50
Q

Increased GFR will increase what concentration ?

A

concentration of Colloids

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51
Q

Decreased GFR will decrease what concentration ?

A

concentration of colloids

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52
Q

Increased or decreased resistance at the efferent arteriole will increase or decrease GFR and what else?

A

concentration of colloids

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53
Q

What is normal Filtration fraction ?

A

20 % ( 0.195)

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54
Q

What is the Filtration fraction equation ?

A

GFR/RPF = FF

GFR / Renal Plasma Flow = filtration fraction

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55
Q

What is normal renal blood flow ?

A

1,100 mL/min

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56
Q

Normal Hct level?

A

0.40 (40% consist of RBC)

remaining 60% is plasma volume

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57
Q

Renal plasma flow equation ?

A

RPF = (0.60) x 1100 mL/min
about 660 mL
Renal Plasma Flow = Plasma x renal blood flow

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58
Q

where do changes of renal vascular resistance occur ?

A

front - afferent arteriole
back - efferent arteriole
or both

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59
Q

Auto-regulation or fine tuning of GFR come from which arteriole ?

A

Efferent Arteriole

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60
Q

Auto-regulation of blood flow through the kidney’s is whose responsibility ?

A

Afferent arteriole

will also indirectly manage GFR

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61
Q

Constriction of renal blood flow at the afferent arteriole will cause what ?

A

decreased Glomerular capillaries and decreased GFR
decreases renal blood flow

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62
Q

Constriction or increased resistance at the efferent arteriole will cause what ?

A

increased glomerular capillary pressure and increased GFR
decreases renal blood flow

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63
Q

Relaxation of Afferent arteriole will have what effect ?

A

Increased Glomerular capillary pressure and increased GFR

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64
Q

Relaxation of the Efferent arteriole will have what effect ?

A

Increased renal blood flow, decreased glomerular capillaries and decreased GFR.

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65
Q

Increased resistance at the efferent arteriole will have what effect on the peritubular capillaries ?

A

increased resistance at the efferent arteriole will decrease blood flow to the pertiubular capillary and decrease the pressure there

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66
Q

Range of blood pressure for renal auto-regulation ?

A

50 mmHg - 150 mmHg

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67
Q

Renal Auto-regulation prevents what ?

A

over-perfusion
under-perfusion
and GFR

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68
Q

Is the kidney really good at auto-regulating renal blood flow or GFR at low pressures ?

A

Renal blood flow is better auto-regulated than GFR at lower pressures

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69
Q

GFR is better auto-regulated at which end of the pressures?

A

GFR is better auto-regulated at HIGHER pressures than lower pressures.

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70
Q

What is normal urine output ?

A

1 mL/min

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71
Q

As blood pressure decreases what happens to urine output and why ?

A

urine output decreases at lower blood pressures to conserve fluid volume

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72
Q

the system usually favors what ?

A

fluid excretion and reduced pressures

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73
Q

what is glomerular filtration ?

A

movement of stuff from glomerular capillaries into the tubule

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74
Q

What is tubular secretion ?

A

Pumping things from the tubule into the peritubular capillary

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75
Q

What is tubular reabsorption ?

A

Re-absorption of stuff from tubule into the peritubular capillary

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76
Q

Different fates of filtration ?

A

Filtration only = 100%
Filtration and partial reabsorption - sodium
filtration and complete reabsorption = Glucose
Filtration and secretion = PAH

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77
Q

How much is re-absorbed at the PCT ?

A

2/3 of almost everything
65% H2O
50% Urea

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78
Q

How much of glucose is re-absorbed in the PCT in healthy person?

A

ALL of it

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79
Q

As you progress into the PCT what will happen to glucose concentration ?

A

it will decrease because its being re-absorbed - this makes the clearance of it 0

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80
Q

where does the bulk of plasma re-absorption occur ?

A

Proximal tubule

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81
Q

If a compound is freely filtered into the tubule and not re-absorbed what is its clearance ?

A

The compound will increase in concentration as fluid is re-absorbed and then excreted into the urine.

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82
Q

Concentration of mystery compounds going into kidney will be higher or lower than the concentration being excreted ?

A

Beginning concentration will be higher coming into kidney.

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83
Q

What is inulin?

A

exogenous compound used to properly estimate clearance

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84
Q

why is inulin more accurate than creatinenine?

A

Inulin cannot be secreted or absorbed as creatinene can be.

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85
Q

Most Famous guy to have prostate cancer ever ?

A

Linus Pauling

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86
Q

Sustained elevated hypertension indicates what ?

A

indicates something is wrong with the kidney’s

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87
Q

What is the short term regulator of CO 2? long term?

A

Lungs - short term to assist in blowing off CO 2
Kidney’s long term - produce HCO 3 - to balance pH and gets rid of excess protons

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88
Q

How do the kidney’s act as pH regulators ?

A

Production of HCO 3 -</sup
Decides how much HCO 3 - to reabsorb
Gets rid of excess protons

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89
Q

What things are filtered freely ?

A

Na, K, Cl, HCO3
Uncharged organic glucose,
Creatinine, Urea, Amino acids,
Peptides (Like Insulin & ADH)
(Vanders)

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90
Q

How do the kidney’s assist in Hct levels ?

A

RELEASES EPO -
they have sensors very deep in the medullary portions of the kidney that sense when oxygen levels are low. Releases EPO and stimulates bone marrow to produce more RBC that are in circulation

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91
Q

How do the kidneys’ manage electrolytes ?

A

Reabsorb most of the things we eat and the kidney will act to balance it out.

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92
Q

What vitamin do the kidney’s activate ?

A

VItamin D

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93
Q

How do the kidney’s help manage glucose ?

A

they reabsorb glucose to their capacity but cleave off the remaining excess in the urine

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94
Q

Do the kidney’s activate or inactivate drugs?

A

yes
by way of some selective transporters in the kidneys

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95
Q

How do the kidney’s help in severe diabetes ?

A

severe diabetes patients produce nitrogenous waste products like urea and the kidney will get rid of them

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96
Q

How does the kidney help manage Osmolarity ?

A

decides between salt and water reabsorption.
ex. in hypernatremia they can choose to get rid of salt and retain water. this includes ADH

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97
Q

Whats the biggest artery that feeds into the kidney’s?

A

RENAL ARTERY

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98
Q

what are they artery pathways of the kidney ?

A

Renal Artery
Segmental Arteries
Interlobar Arteries
Arcuate Arteries
Interlobular Arteries
Afferent Arteries.

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99
Q

What are the Venous pathways of the kidney’s ?

A

Glomerular Capillaries
Efferent Arterioles
Peritubular Capillaries
Interlobular Veins
Arcuate Veins
Interlobar Veins
Segmental Veins
Renal Veins

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100
Q

How many times does the renal artery split before reaching the afferent Artery ?

A

4 times

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101
Q

Whats larger the interlobar or interlobular arteries ?

A

INTERLOBAR - largest !

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102
Q

Where do we do the bulk of reabsorption ?

A

Peritubular capillaries

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103
Q

Where do the veins start to converge in the the kidney’s
?

A

just after the peritubular capillaries going forming into the interlobular veins

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104
Q

Interlobular veins converge to for what ?

A

Arcuate veins

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105
Q

Interlobar veins converge to form what ?

A

Segmental veins

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106
Q

Arcuate veins converge to form what ?

A

Interlobar veins

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107
Q

Segmental veins converge to form what ?

A

Renal veins

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108
Q

Which Renal blood vessels are most important ?

A

Afferent Arterioles
Glomerular Capillaries
Efferent Arterioles
Peritubular Capillaries

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109
Q

What is between the peritubular capillaries and the affernent arterioles ?

A

The tubular system that is in charge of reabsorbing things or actively secreting things into the urine

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110
Q

where are majority of nephrons?

A

CORTEX 90-95%

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111
Q

Where are the other nephrons?

A

INNER MEDULLA
5-10%

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112
Q

Where are most of the peritubular capillary networks?

A

OUTER MEDULLA

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113
Q

The peritubular capillaries descend deep into the medulla, as they ascend what happens?

A

As they ascend they split into two

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114
Q

Are there more ascending or descending peritubular capillaries ?

A

ASCENDING

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115
Q

How many descending peritubular capillaries do we have ?

A

ONE

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116
Q

we have more Ascending Peritubular blood vessels than descending, what does this do to blood velocity ?

A

this decreases the velocity of blood in the ascending capillaries
this helps us maintain solutes of the deep renal medulla

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117
Q

What are the deep descending peritubular capillaries called ?

A

Vasa recta capillaries

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118
Q

What would happen if the velocity was not slowed down as the peritubular capillaries ascend out of the inner medulla ?

A

The increased blood flow velocity would wash out the solutes of the renal interstitium - disturbing the osmolarity of the deep medulla
slower flow rates allow for solutes to go back into intersitium instead of leaving.

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119
Q

Vasa Recta capillaries comprise how much of the peritubular capillaries?

A

5-10%

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120
Q

How much blood supply do the deep inner medulla have ?

A

5-10%
from the descending peritubular capillaries called the vesa recta

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121
Q

Where would would expect to have ischemia in the kidneys ?

A

INNER MEDULLA - deepest part that only gets 5-10% of blood supply

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122
Q

Where are the kidneys housed ?

A

inferior to the diaphragm

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123
Q

Where are the renal arteries and veins located ?

A

inferior to the mesenteric arteries

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124
Q

Where are the adrenal glands ?

A

each one sits superior to each kidney
“Suprarenal gland”

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125
Q

Each kidney has a ____ that connect to the _____

A

Ureter ; bladder

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126
Q

What is the first part of the urine emptying system called ? ( Inside the kidney )

A

Renal Papilla

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127
Q

Where do the renal papilla empty into ?

A

the minor then the Major Calyx

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128
Q

What do the major Calyx converge to form ?

A

renal pelvis (just before the ureter)

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129
Q

The right kidney comes into contact with what other anatomical structure ?

A

Liver - top (superior) lateral side
and COLON

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130
Q

The left kidney comes into contact with what other anatomical structure ?

A

Stomach - Gastric surface
SPLEEN - top lateral portion
Pancreatic Surface - Middle
COLON - descending surface

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131
Q

What anatomical structure do both kidneys come into contact with ?

A

COLON

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132
Q

Why is kidney cancer more rare ?

A

Kidney’s do not replicate as much

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133
Q

If we have kidney cancer where would it come from ?

A

metastasis from the other anatomical structures that they come into contact with

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134
Q

What quadrant are the kidneys in ?

A

Right - RUQ
Left - LUQ

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135
Q

Kidney stones would increase what in the kidney ?

A

Increased pressure

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136
Q

Because kidney stones can cause increase in upstream pressures, which starling force could this impact ?

A

Hydrostatic filtrate pressure in the Bowman’s space - this would in turn cause decreased GFR

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137
Q

Where are kidney stone pains referred to ?

A

back pain

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138
Q

Increase in ANG2 will cause constriction at which arteriole the MOST?

A

Efferent Arteriole
- will constrict both but mostly EA

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139
Q

What is normal renal artery pressure ?

A

100 mmHg

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140
Q

Which part of the kidney has the highest pressure gradient ?

A

Peritubular capillaries.

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141
Q

What has the most dramatic influence on velocity ?

A

change in diameter

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142
Q

Systemic veins store what percentage of blood ?

A

64%

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143
Q

What kind of circulatory system decreases overall resistance and velocity ?

A

parallel system

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144
Q

what is cross sectional area?

A

the internal diameter
dictates the speed at which blood flows

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145
Q

What is the most important cross sectional ?

A

AORTA

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146
Q

Blood flow velocity (or vascular conductance) is ___________ (directly/inversely) proportional to cross sectional area?

A

Inversely
Lower cross sectional area = higher velocity flow

higher cross sectional area = lower velocity

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147
Q

Blood flow through any tissue is dictated by what ?

A

Its metabolic rate

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148
Q

The kidneys receive about how much blood flow from the overall cardiac output ?

A

about 20 %
1L/min

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149
Q

Is the blood flow to kidney’s controlled by its metabolic rate?

A

NO - kidneys are the one exception to this

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150
Q

What is conductance ?

A

The inverse of resistance

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151
Q

High conductance equates to _____ Resistance ?

A

Lower resistance

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152
Q

High resistance equates to _______ conductance ?

A

LOWER conductance

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153
Q

Blood flow is _____ (directly/indirectly) proportional to pressure ?

A

DIRECTLY

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154
Q

Blood flow is _____ (directly/indirectly) related to resistance ?

A

INDIRECTLY

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155
Q

how many capillaries do we have ?

A

10 + billion

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156
Q

What is the functional unit of the kidney ?

A

Nephron

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157
Q

What makes up the renal tubule ?

A

Renal Corpuscle
PCT
Loop of Henle
(ascending and descending)
DCT

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158
Q

What two key hormones work to decrease renal blood flow ?

A

Adrenaline (epinephrine)
angiotensin

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159
Q

Substances with high renal clearance mean wha t?

A

determine how much of that substance will be removed from the plasma and kidney

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160
Q

what cells at the PCT handle the filtered proteins ?

A

proximal tubule cells

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161
Q

Whats the healthy amount of protein filtered by the kidneys?

A

1.8g of protein

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162
Q

How much of the filtered protein does the PCT reabsorb ?

A

1.7g of protein

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163
Q

How much protein would show up in the urine in a healthy person ?

A

100mg protein urea

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164
Q

What process do cells use to reabsorb proteins from the tubule ?

A

Endocytosis or pinocytosis

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165
Q

What do PCT cells turn filtered protein into ?

A

amino acids

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166
Q

Can PCT cells reabsorb excessive amounts of filtered protein ?

A

NO

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167
Q

What situations would overwhelm the endocytosis of the PCT cells ?

A

Sepsis
swiss cheese …

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168
Q

Where does the pinocytotic process exist ?

A

ONLY in the PCT

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169
Q

What proteins can the PCT reabsorb via pinocytosis ?

A

Albumin
peptides (small string of amino acids)
growth hormone

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170
Q

Tubular Cell resting membrane potential in PCT ?

A
  • 70 mV
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171
Q

Apical side (tubular lumen) resting membrane potential in PCT ?

A
  • 3 mV
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172
Q

Apical side resting charge at TAL ?

A

+ 8 mV

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173
Q

Principal cells are sensitive to what ?

A

Aldosterone
and ADH

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174
Q

Intercalated cells are Sensitive to what ?

A

ADH

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175
Q

What makes it possible for our Principle cells to have internal receptors ?

A

Aldosterone is a cholesterol derivative so it can easily cross into the cell and bind to the receptor.

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176
Q

Aldosterone speeds up which pump in the DCT ?

A

Na + /K + ATPase pump
also increases Na Reabsorption from tubule

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177
Q

What does alcohol reduce the release of ?

A

ADH from the brain
thats why you gotta pee alot when you getting lit (CRAZY )

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178
Q

If we need to conserve water what happens to our ADH levels ?

A

Vasopressin levels will be very very high

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179
Q

ADH can help correct what things ?

A

Blood volume - via water control
Blood pressure

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180
Q

What is the primary controller, in the brain, that senses changes in osmolarity ?

A

Osmoreceptors in the hypothalamus

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181
Q

Osmoreceptors send signals to where ?

A

to two nuclei in the brain
Supraoptic or Paraventricular neurons

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182
Q

cell bodies in the CNS

A

nuclei/nucleous

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183
Q

5/6th of ADH comes from where ?

A

Supraoptic Neuron

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184
Q

1/6 of ADH is produced where ?

A

Periventricular Nucleus

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185
Q

Where is the periventricular Nucleus ?

A

opposite sides of the third ventricle

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186
Q

Supraoptic and Paraventricular nuclei delivery ADH to where ?

A

POSTERIOR Pituitary gland
Neurohypophyis

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187
Q

Posterior Pituitary gland is called ?

A

Neuro Hypophysis

188
Q

Anterior (front) lobe of pituitary is called what ?

A

Adeno hypophysis

189
Q

what is the EPI to NE ratio released from the adrenal gland ?

A

4 to 1

190
Q

Isotonic

A

no change in osmolarity would be equal on all side
0.9& NS and d5

191
Q

Hypotonic

A

Hypotonic = Dilute solution = 0.45% NS
water will move into the cell until the osmolarity on both sides is equal . results in swelling and reduced ADH

192
Q

Hypertonic

A

Hypertonic = Extra Salty = 3% saline
water would leave the cell until salt concentration inside is equal to outside.
Cell shrinks and increase in ADH release to conserve water.

193
Q

to conserve water we would _______ ADH ?

A

Release ADH

194
Q

to excrete water we would ________ ADH ?

A

decrease release of ADH

195
Q

Swollen osmoreceptors cells would induce what change in ADH ?

A

decreased rate of action potentials sent to ADH production centers.

196
Q

How much does the PCT reabsorb?

A

2/3rd

197
Q

What portion of the nephron has highest metabolic rate and why?

A

PCT
then DCT
maximum reabsorption here

198
Q

What is the osmolarity of the PCT ?

A

probably the same as the blood - 300

199
Q

Osmolarity of urine becomes completely dependent on ADH after what section of the nephron?

A

After the diluting segment of the distal tubule

200
Q

What is the osmolarity of the Interstitium ?

A

closer to 1200 as its deep and concentrated there

201
Q

What is the osmolarity of the Ascending loop of Henle ?

A

1200 ascending out to cortex to 100

202
Q

which portion of the nephron is completely reliant on ADH for dilution ?

A

Collecting Tubule

203
Q

Without ADH what is urine osmolarity ?

A

50 mOsm

204
Q

With alot of ADH what is the urine osmolarity ?

A

1200

205
Q

How does ADH affect the osmolarity in the loop of henle?

A

ADH determines how much urea we reabsorb

206
Q

Why does the kidney hang onto urea ?

A

to use it for water reabsorption

207
Q

After the PCT how much urea is left ?

A

about 1/2

208
Q

The collecting duct has alot of aquaporins and what else ?

A

urea transporters

209
Q

What are the Urea Transporters called ?

A

UT-A1
UT-A3

210
Q

anti-diuresis is what ‘?

A

the states of holding on to as much electrolytes as we can.
usually via urea transporters.

211
Q

ADH is the only regulator that can do what ?

A

selectively reabsorb water or salt
primary regulator of our plasma osmolarity

212
Q

Decrease Thirst can be regulated by what ?

A

decreased plasma osmolarity and ANG2
and
And gastric distention increased Blood volume and Blood pressure

213
Q

What can increase thirst ?

A

Increased plasma osmolarity and ANG 2
and dryness of the mouth
Decreased Blood Volume and Pressure

214
Q

What can reduce ADH ?

A

Decreased Plasma osmolarity
increased BP and volume

Alcohol , and Haloperidol

215
Q

What can increase ADH ?

A

Increased plasma osmolarity
Decreased BP and volume

Nausea, hypoxia
morphine and
Nicotine

216
Q

Increased water intake will ______ ADH and ______ urine flow .

A

DECREASES ADH
INCREASE URINE FLOW

217
Q

ADH can manage water with ______ effect on electrolytes

A

NO

218
Q

Urine osmolarity in healthy patient is what ?

A

600 mOsm/L

219
Q

How much is reabsorbed at the TAL ?

A

25%

220
Q

What is the diluting segment of the nephron ?

A

early DCT
and late ascending TAL
usually hypotonic

221
Q

Which parts of the nephron are permeable to water ?

A

PCT, thin DL, DCT

222
Q

What area is responsible for final reabsorption of additional electrolytes?

A

the collecting duct

223
Q

Decreased Renal creatinine excretion will have what effect on creatinine production ?

A

this will increase blood creatinine production and plasma levels two fold

224
Q

Post unilateral nephrectomy will have what effect on the remaining kidney ?

A

physiologic hypertrophy that makes it able to do more work

225
Q

what is an example of bad kidney hypertrophy ?

A

diabetes induced kidney hypertrophy

226
Q

How much can a single kidney increase its workload ?

A

one working kidney can increase its work load by 50%

227
Q

With one kidney will the kidney pressures change?

A

no , they work out to stay the same.

228
Q

What is the filtered load of creatinine ?

A

1.25 mg / min

creatinine clearance = 1mL/mg x 1.25 mg/mL / 1mg/100 mL
Ux x V / Px

229
Q

what is the normal secretion of creatinine into the tubule ?

A

0.15 mg/min

230
Q

what is the normal excretion of creatinine ?

A

1.40 mg/min

231
Q

with one kidney what would the plasma level of creatinine increase to ?

A

2mg/dL
or double baseline

232
Q

how many nephrons do we have total?

A

born with 2 Million

233
Q

How much does each nephron filter ?

A

62.5 nl/min
nanoliters / minute

234
Q

How much volume is excreted for all nephrons total ?

A

1 ml/minute

235
Q

how much is each nephron excreting ?

A

0.50 nl.min
nanoliters per minute
Per Schmidt - went and asked him for the specific #

236
Q

With loss of nephrons what would total GFR be ?

A

40 ml/min
GFR
with 75% loss of nephron

237
Q

With loss of nephrons what would single total GFR be ? ?

A

80 nl/min

238
Q

With loss of nephrons what would total excretion be ?

A

1.0 ml/min

239
Q

With loss of nephrons what would total excretion be per nephron?

A

3.0 nl/min

240
Q

At what age do our nephrons start to tap out ?

A

around 40 years old

241
Q

What problems increase risk on kidney health ?

A

Hypernatremia
Hypervolemia
Hyperkalemia
Hypertension
Acidosis

242
Q

How do we change the make up of our body compartment fluids w solutions ?

A

isotonic solutions = Expanded ECF

Hypertonic =
will pull preexisting water into cells until equilibrium.

Hypotonic Saline = decreases overall osmolarity - will shift from ECF to ICF

243
Q

what kind of solutions have more water than salt ?

A

Hypotonic
(0.45 % NaCl)

244
Q

What kind of solution has more salt than water ?

A

Hypertonic
(3% saline)

245
Q

What type of solution has equal amounts of water and sodium ?

A

Isotonic
(0.9% saline)

246
Q

What are the primary sites for nutrient exchange and waste removal ?

A

the capillaries

247
Q

Determine the thickest walls to the thinnest of the vascular system

A

Aorta - 2 mm
Vena cava - 1.5 mm
Arteries - 1 mm
Veins - 0.5 mm
Arterioles - 20 um
Venules - 7 um
Capillaries - 1 um

248
Q

If capillary Colloid Osmotic pressure is lower than normal what effect can happen ?

A

This will decrease reabsorption, making it hard to keep fluid in CV circulation.

249
Q

What conditions can increase Interstitial Fluid Colloid Osmotic Pressure ?

A

Damage/trauma
Bacterial or Viral Infections
Capillaries turning into swiss cheese

250
Q

What factors can turn capillaries into swiss cheese ?

A

Sepsis, Liver disease, nephritis

251
Q

Hypertonic IV administration will cause what effect on ICF, ECF, and TBW ?

A

DECREASE ICF volume and increase ICF osmolarity

INCREASE ECF volume and osmolarity

INCREASE TBW

252
Q

HYPOTONIC IV administration will cause what effect on ICF, ECF, and TBW ?

A

INCREASE ICF volume
decreasing osmolarity

INCREASE ECF volume
decreasing osmolarity

INCREASE TBW

253
Q

ISOTONIC IV administration will cause what effect on ICF, ECF, and TBW ?

A

ECF volume will increase, TBW will increase. No change in Osmo of either compartment.

254
Q

What is the NFP of any individual systemic capillary ?

A

0.3 mmHg

255
Q

Capillary Permability ranking (most permeable to least.)

A

water > NaCl > Urea > Glucose > Inulin > Myoglobin > Hemoglobin > Albumin

256
Q

If Pcap Increases what effects will this have in systemic capillary system?

A

⬆︎Pcap =
⇧ Pisf
⇧ interstitial volume
⇧ Lymph flow

257
Q

If 𝜋cap decreases what effects will this have in the systemic capillary system ?

A

⬇︎𝜋cap =
⇧ Pisf
⇧ interstitial volume
⇧ Lymph flow

258
Q

If arteriole resistance increase what effects will this have on systemic capillary system ?

A

⬆︎Arteriole Resistance =
⇩Vascular conductance
⇩Pcap
⇩Capillary filtration
⇩Interstitial volume and pressure
⇩Lymph flow.

259
Q

What is the filtration fraction and what is the equation for it ?

A

FF = GFR / RPF

This is the fraction of renal plasma flow that is filtered. Average is 0.2 or 20%

260
Q

Which catecholamines or peptides , if increased, will decrease GFR ?

A

Norepinephrine
Epinephrine
Endothilien

261
Q

Which natural gas or autocoids , if increased, will increase GFR ?

A

Nitric Oxide
Prostaglandins

262
Q

What Reabsorption pathway does sodium follow ?

A

Partial reabsorption

263
Q

what is dextran and what can we use it for ?

A

Dextran is a synthetic sugar
we can use it to help depict the filterability between different sized sugar compounds

264
Q

polycationic dextran that is the same size as neutral dextran is relatively _______(more or less) filterable ?

A

polycationic dextran is much MORE filterable than neutral dextran due to no negative charges on it

265
Q

Polyanionic dextran that is the same size as neutral dextran is relatively _____(more or less) filterable ?

A

polyanionic dextran is much LESS filterable due to so many negative charges on it

266
Q

what are the 8 main things that can be achieved through proper auto-regulation of GFR ?

A

pH
Hematocrit
Osmolarity
Metabolic waste
Electrolyte Balance
BP
Drug clearance
Glucose

267
Q

Renal blood vessels (arteries to veins)

A

Renal Artery
Segmental Arteries
Interlobar Arteries
Arcuate Arteries
Interlobular Arteries
Afferent Arteriole
Glomerular Capillary
Peritubular Capillaries
Efferent Arteriole
Interlobular Veins
Arcuate Veins
Interlobar Veins
Segmental Veins
Renal Vein.

268
Q

What are the two type of nephrons?

A

Superficial (90-95%) and Deep Nephron ( 2-10% medullary nephron)

269
Q

what is the pudenal nerve ?

A

S2, S3, & S4
controls bladder , bowel emptying , and overall continence
and erections

270
Q

why is prostate removal tricky ?

A

prostate is very close to pudendal and hard to not damage pudenal nerve with this procedure.

271
Q

Where is the macula densa located ?

A

TAL - thick Ascending limb of henle is the best answer option - per schmidt

272
Q

What are the parts of the collecting duct ?

A

Cortical Collecting duct - initial segment in the cortex
Medullary collecting duct - splits into two parts - superficial is OUTER CD and deeper is he INNER CD
Papillary Ducts - terminal ducts that drain urine into the calyx then ureters then bladder.

273
Q

Release of renin leads to what ?

A

increased ANG 2
-preferentially constricts EA

274
Q

Where is renin released from ?

A

from the juxtaglomerular cells at the AA and EA

275
Q

What does renal clearance describe ?

A

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

276
Q

Ů or a V with a dot means what ?

A

per unit of time
(this unit urine flow per unit of time)

277
Q

At the tip of bowman’s capsule we would expect its osmolarity to be (same or different) ________ from serum osmolarity ?

A

SAME for freely filtered things

278
Q

What is PAH used for ?

A

PAH ( para Aminohippuric) clearance
is used to estimate renal plasma flow
can be divided by (1-HCT ) for renal blood flow.

279
Q

a dL is how many mL’s?

A

100 mL’s

280
Q

urinary flow rate x urinary concentration = what?

A

excretion rate

281
Q

what is clearance equation ?

A

[Us]x(Urinaryflowrate) / [Plasma concentration of compound]

282
Q

What factors can be used to find renal blood flow (RBF) ?

A

Renal Plasma Flow and Hct

283
Q

How can you find RBC ?

A

1- Hct

284
Q

Clearance of inulin = what ?

A

clearance of inulin = GFR

285
Q

what are the units for renal clearance, RPF, ERPF, and RBF?

A

mL/min

286
Q

what are the units for excretion rate , reabsorption rate, and secretion rate ?

A

mg/min, mmol/min, or mEq/min

287
Q

prolonged HTN will cause most damage to what part of the kidneys?

A

glomerular capillaries will have the most damage from increased pressures that cause inefficient podocytes, fenestrations may widen, may have scarring of the capillary bed.

288
Q

Prolonged HTN can damage Afferent Arterioles how ?

A

Afferent arterioles will also stiffen over time from prolonged constriction.

289
Q

increased time in the tubule can increase what ?

A

the overal percentage reabsorbed

290
Q

Prostaglandins preferentially ________(dilate/constrict) the ________. arteriole under normal conditions?

A

PG’s DILATE the AFFERENT arterioles normally

291
Q

ANG2 preferentially ________(dilate/constrict) the ________. arteriole under normal conditions?

A

ANG2 CONSTRICTS the EFFERENT arterioles under normal conditons

292
Q

NSAID’s cause _________(constriction/dilation) at the Afferent arteriole

A

CONSTRICTION

293
Q

ACE inhibitors cause _________ (constriction/dilation) at the efferent arterioles?

A

DILATION

294
Q

NSAIDs usually constrict afferent arterioles and ACE inhibitors dilate efferent arterioles, this has was effect on filtration ?

A

DECRESED EFFECTIVE FILTRATION PRESSURE

295
Q

If less Na+ or Cl- reaches the Macula densa, this would indicate what ?

A

low GFR
inducing renin release –> ANG2 released –>increased EA resistance or decreased AA to increase GFR

296
Q

how much Na+ or Cl- is reabsorbed at the PCT ?

A

2/3 rds

297
Q

What situations can increase Na+ or Cl- reabsorption in the PCT ?

A

Increased Glucose reabsorption

298
Q

What is the primary way kidneys are destroyed in diabetes ?

A

HYPERFILTRATION
initiated by the feedback mechanism in the kidneys of reabsorbing glucose and more Na which tells macula densa GFR is low

299
Q

for every glucose reabsorbed in the PCT , how many Na are reabsorbed ?

A

S1 = 1 glucose for 1 Na+
S2&3 = 1 glucose for 2 Na+

300
Q

How many amino acids are reabsorbed with each Na+ in the PCT ?

A

1 Na+ for 1 Amino Acid

301
Q

Which segments of the PCT have HIGH affinity glucose transporters ? what are the ratios there ?

A

S2 and S3 - 10% of glucose transport
2Na+ : 1 Glucose
HIGH affinity

302
Q

How many segments are in the PCT ? what are their names ?

A

S1 - early PCT
S2 & S3

303
Q

Where are all the glucose transporters found ?

A

in the PCT
SGLT2 with GLUT2 at S1 of PCT

SGLT1 with GLUT1 at S2&3 of PCT
both are on the

304
Q

SGLT 1_________ (primary/secondary) active transporter with (high/low) __________ affinity and low capacity, located on the __________ (apical/basolateral) side of the S2&3 segments of the _____ its respective GLUT 1 transporter is a ________(active/passive) transporter located on the __________ (apical/basolateral) side.

A

SECONDARY ACTIVE HIGH AFFINITY
APICAL
PCT
PASSIVE
BASOLATERAL

305
Q

SGLT2 and GLUT2

A

LOW AFFINITY glucose transporters of S1 segment of PCT

306
Q

SGLT 2_________ (primary/secondary) active transporter with (high/low) __________ affinity and high efficacy , located on the __________ (apical/basolateral) side of the S1 segments of the _____ its respective GLUT 2 transporter is a ________(active/passive) transporter located on the __________ (apical/basolateral) side.

A

SECONDARY ACTIVE
LOW AFFINITY
APICAL
PCT
PASSIVE
BASOLATERAL

307
Q

mL to dL math

A

mL / 100

308
Q

dL to mL math

A

dL x 100

309
Q

what ways can Bicarb be managed in the PCT ?

A

Selective Reabsorption of HCO3-
Production of HCO3-

310
Q

How is HCO3- produced in the PCT ?

A

1 Glutamine is reabsorbed from either side of the cell –> combined inside the cell produce 2HCO3- and 2NH4+

HCO3- is produced other places in the nephron- schmidt only cares about here

311
Q

where is glutamine produced?

A

mainly by the liver

312
Q

which disease is there a lack of glutamine ?

A

liver failure patients
this is why they have a hard time balancing acids, can be supplemented

313
Q

Where can Carbonic Anhydrase be found ?

A

in the PCT
usually luminal side
can be tethered to cell or wedged in cell wall also

314
Q

what does Carbonic Anhydrase do in the PCT ?

A

Facilitates the breaking down of Carbonic acid into CO2 and H20

315
Q

Carbonic Anhydrase ___________(breaks down/builds) Carbonic acid in the lumen and _________(Breaks down/builds) it inside the cell

A

BREAKS DOWN in lumen

BUILDS inside the cell.

316
Q

What are our urinary buffers ?

A

Ammonium (NH4+)
Phosphate (PO4-)
Sodium Phosphate (Na3PO4)

317
Q

What are brush boarders ?

A

boarder luminal side of PCT cells, increase surface area by about 20 fold.

318
Q

What are paracellular Pathways?

A

these are reabsorption routes in between cells at the tight junctions.

these Junctions are wider at the PCT.

319
Q

What are Trans-cellular Pathways?

A

transport of substances through the cell via a channel or transporter.

320
Q

Cl- travels mostly via which route ?

A

Cl- travels paracellular route

321
Q

Na+ travels via which route in the PCT ?

A

Majority Trans-cellular pathways.
Some paracellular routes too

322
Q

Aquaporins (AQP) allows for water reabosorption via _________ (transcellular/paracelluar), while other water is reabsorbed along the _________(Paracellular/transcellular)

A

TRANSCELLULAR pathways

PARACELLULAR pathways

323
Q

what is bulk flow?

A

ultrafiltration or mass transfer of water and substances mediated by hydrostatic and colloid osmotic forces.

324
Q

where are the water pumps in the body ?

A

NOWHERE
body does not have ANY water pumps.

325
Q

How must we reabsorb water?

A

we have to provide an environment concentrated enough to facilitate osmosis

326
Q

Na+/K+ ATPease maintain ion gradients and contribute to the cellular membrane potential of what in the PCT?

A

-70 mV

327
Q

where is Cl- concentration highest, early or late PCT?

A

late PCT
Cl- lags a bit until ti becomes more positive

328
Q

How do proteins make it past the PCT ?

A

pinocytosis process is overloaded and they will be excreted in the urine if they don’t cause damage.
Conditions that over loaded pinocytosis : diabetes, sepsis, liver failure

329
Q

How is the NHE pump a form of secretion ?

A

it is pumping protons INTO the tubule .

330
Q

NHE pump ratio

A

1 Na+ / 1 H+

331
Q

Creation of bicarb at PCT ratios

A

1 Glutamine –>
2 HCO3 -
2NH4+

332
Q

SLGT 2 ratios

A

1 Na+ /1 Glucose

333
Q

SLGT 1 Ratios

A

2 Na+ / 1 Glucose
due to more dilute area.

334
Q

Na+ /HCO3- ratios

A

1 Na+ / 1 HCO3-
basolateral side

335
Q

Na2PO4 is a good buffer of what ?

A

protons especially in the urine

336
Q

Calcium can be reabsorbed in the PCT via which pathways?

A

Transcellular and Paracellular pathways

337
Q

Calcium Reabsorption rate will increase if what is increased?

A

increased reabsorption of salt and water

338
Q

what are Ca++ removal routes ?

A

Ca++ ATPease pump
Na+ / Ca++ Exchanger

339
Q

What gland moniotrs Ca ++ levels in our blood ?

A

Parathyroid gland

340
Q

When PTH is released what happens?

A
  1. Encourages Vitamin D3 activation = increased Ca++
  2. Increases Ca++ reabsorption via Ca++ channels
  3. Stimulates bone break down (osteoclast)
  4. Decreases building of bone ( Osteoblast)
341
Q

cells that break down bone care called what?

A

Osteoclast

342
Q

What is bone made of ?

A

Ca++ and PO4-

343
Q

High Ca++ levels indicate _______ (low/High) PTH levels and Osteoclast activity will be _____(low/high) and Osteoblast activity will be _____ (high/Low)

A

High Ca++ = LOW PTH = LOW Osteoclast = HIGH Osteoblast

344
Q

Osteoblast does what ?

A

builds bones

345
Q

We get porous weak bones from what ?

A

long term calcium deficit.

346
Q

OCT vs OAT

A

Organic Cations Transporters
Organic Anion Transporters

347
Q

Organic Cation Transporters are dependent on what ?

A

H+ dependent transporters
two substances in opposite directions

348
Q

Organic anion Transporters are dependent on what ?

A

Na + dependent process
and 𝛼KG

349
Q

Steps of Cation transportation

A

probably leaked out of porous PT capillaries and end up in renal interstitial area
1. movement of C<sup +</sup> into the cell
2. Removed from cell via Proton/Cation
( 1 Proton in and 1 Cation out)

350
Q

𝛼KG

A

𝛼 - Ketoglutarate

351
Q

Steps of Anion transportation

A
  1. 3 Na+ : 1 𝛼KG
    increases in 𝛼KG concentration in the cell
  2. 𝛼KG is then exchanged for A-
  3. A- is then secreted via facilitated transporter into proximal tubule
352
Q

How did PCN come about ?

A

during WW2 petri dish grew PCN and first dose was in 1942 .

353
Q

_______(synthetic/natural) hippurate substances can ____________ (competitively/non-competitively) inhibit the removal of PCN?

A

SYNTHETIC
COMPETITIVELY

354
Q

what kind of transporters are in the THIN Descending loop of Henle ?

A

NONE
only water absorption

355
Q

by the time fluid makes it out the the Thin Descedning Loop of Henle , how much water has been reabsorbed?

A

85%
65% in PCT
20 % in Thin descending limb

356
Q

PCT ion reabsorption plus TAL ion reabsorption equals what ?

A

2/3 solutes reabsorbed in PCT
25% (1/4) reabsorbed by end of TAL

357
Q

ADH allows kidneys to fine tune what ?

A

water reabsorption usually in the DCT and collecting duct

358
Q

Which portions of the nephron have the highest metabolic rates ?

A

PCT and TAL

359
Q

Thiazide diuretics are used for treatment with osteoporosis patients and frequent kidney stones why ?

A

Thiazide diuretics target the Na+ / Cl - transporter on the apical lumen side in the DCT . Inhibition of this pump will decrease the Na+ concentration inside the cell —> increasing the drive of the Ca++ / Na+ on the basolateral cell increased Ca++ reabsorption .
increased Ca++ can increase bone building and decrease free floating Ca++ from making more kidney stones.

360
Q

What is a mineralocorticoid ?

A

ALDOSTERONE

361
Q

Aldosterone promotes what ? and gets rid of what ?

A

Aldosterone promotes Na+ and H2O reabsorption
and gets rid of K+

362
Q

How many K+ sequestration channels do principle cells have ?

A

2
ROMK and BK

363
Q

ROMK

A

ALDO mediated - primary potassium channels in principle cells

364
Q

BK

A

BIG K+
ALDO Mediated - Secondary potassium channels in principle cells- usually open when there is alot of potassium

365
Q

Amiloride and Triamterene work and by what action ?

A

Na+ channel blocker at the DCT
will decrease amount of potassium secreted

366
Q

Aldosterone antagonist work where ?

A

K+ / Na + ATPease pump in Principle cells of the DCT and collecting tubule.
will decrease amount of potassium secreted

367
Q

Anything that limits sodium reabsorption will have what effect on water and downstream sodium concentration?

A

this will indirectly limit the amount of water we reabsorb upstream and more sodium traveling downstream

368
Q

increased Na+ at the principle cells will have what effect ?

A

More sodium reabsorbed via the sodium potassium pump , and increases secretion of potassium faster. ( Potassium wasting)

369
Q

What is the outer most part of the adrenal gland ?

A

ZONA GLOMERULOSA

370
Q

The zona glomerulosa makes what ?

A

Aldosterone

371
Q

Adenal gland layers

A

Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
Medulla in the deepest middle

372
Q

Catecholamines come from what part of the adrenal glad ?

A

Medulla
Epi 4 / NE 1

373
Q

Cortisol, Androgen, and some Estrogen is secreted from what part of the adrenal glands ?

A

Zona Fasiculata and reticularis.

374
Q

at low potassium levels what will the adrenal gland do ?

A

reduce aldosterone produced

375
Q

Aldosterone can be released from adrenal glands how?

A

Increased potassium levels and ANG2 binding

376
Q

How does smoking cause HTN ?

A

Licorice is used to flavor tobacco. Licorice is a natural inhibitor of 11𝛽 - HSD- Type 2.
11𝛽 - HSD- Type 2 usually prevents cross reactivity of increased cortisol levels.
smoking inhibits the inhibitor.

377
Q

what is 11𝛽 - HSD- Type 2, where are they? are they specific ??

A

11𝛽 - HSD- Type 2 - Hydroxysteroid Dehydrogenase Enzyme are a specific type of steroid enzyme located in principle cells that target cortisol specifically.

378
Q

Lithium can cause loss of how much water a day ?

A

20 L/day
lower limit of urine osmolarity of 50

379
Q

Nephrogenic Diabetes Insipidus means theres a problem where?

A

problem with kidneys and how it responds to ADH

380
Q

A condition in which there is a problem with the release of ADH is what ?

A

Central Diabetes Insipidus

381
Q

AQP 3 & 4 are where ?

A

Basolateral side of Intercalated cells in the late DCT and Collecting duct

382
Q

AQP - 2 are where ?

A

usually segregated until phosphorylated by PKA , then they migrate to apical tubular lumen side of cell.

383
Q

Type A Intercalated cells

A

Responsible for acid/base balance
located in the late DCT and collecting duct
secrete H+ (protons) via H+ ATPease of H+ / K+ ATPease

384
Q

Type B intercalated cells are in charge of what ?

A

Type B intercalated cells in the late DCT and collecting tubule
reabsorb H+

385
Q

How do you find Intracellular volume ?

A

total body fluid - ECF volume
(2/3% 0f total body water)

386
Q

How do you find the interstitial fluid volume

A

ECF - Plasma Volume

387
Q

How do you find the Plasma Volume ?

A

(Blood volume) (1.0-Hct)

388
Q

Extracellular fluid compartment is comprised of what?

A

Interstitial fluid and plasma
(1/3 of total body water)

389
Q

Whats the equation for Reabsorption rate ?

A

RR = FL - ER
reabsorption rate = filtered load - excretion rate
FL = (GFR)(P[])
ER = (U[])(UFLOW

390
Q

Renal Clearance greater than GFR is indicative of what ?

A

Secretion somewhere

391
Q

Extracellular fluid volume expansion or increased blood pressure will increase urine excretion of what ions ?

A

Ca++
decreases Na+ and H2O which calcium is usually reabsorbed with

392
Q

metabolic acidosis will have what effect on intracellular K+ and excretion ?

A

DECREASED
acidosis decreases potassium in the cells due to increased H+ in the blood this will slow down the Na+ / K+ ATPease pump which decreases principle cell excretion of potassium.

393
Q

how do you calculate filtered load ?

A

(GFR)(P[])

394
Q

A 50% reduction in GFR will result in what lab changes at steady state?

A

a 50% increase in Plasma Creatinine concentration with a 50% reduction in creatinine clearance.
No change to Na+ or creatinine excretion, or filtered load UNDER STEADY STATE conditions.

395
Q

INcreased INsulin will have what effect on K+ ?

A

shift K + into the cells = decreased plasma K + levels.

396
Q

How do you calculate urine flow rate ?

A

GFR - Tubular Fluid Reabsorption

397
Q

Concentration of which Ions will be higher at excretion versus coming into a normal kidney ?

A

Creatinine - not reabsorbed
Inulin
Urea
K+
PAH - will be the highest

398
Q

Concentrations of these substances will be significantly lower (if not obsolete) at excretion versus their concentration when entering a normal kidney (four big ones)

A

GLUCOSE
PROTEIN
AMINO ACIDS
HCO3-
Cl - and Na+ will be slightly less then their initial concentrations.

399
Q

Dehydration caused by decreased fluid intake will have increases in which lab values?

A

Renin –> ADH—> Aldosterone

400
Q

In Conn’s Syndrome you would expect to see _______ (Hyponatremia/Hypernatremia) and _______(Alkalosis/Acidosis)

A

Conn’s = HYPERnatremia and ALKALOSIS
Conn’s is an adrenal adenoma secreting excessive aldosterone = increases Na+ and H2O reabsorption.

401
Q

In Addisons syndrome you would expect to see _______ (Hyponatremia/Hypernatremia) and _______(Alkalosis/Acidosis)

A

Addison’s = HYPOnatremia and ACIDOSIS

402
Q

What comprises the Capillary plasma colloid osmotic pressure of 28 mmHg in the systemic capillary (𝛑cap?

A

Fibrinogen = 0.2
Albumin = 21.8
Globulins = 6

403
Q

What cells sense blood pressure in the kidneys and where are they found ?

A

Juxtaglomerulous cells located at the Afferent and Efferent Arterioles

404
Q

Where is renin released?

A

Juxtaglomerulous cells

405
Q

What are three main effects of Angiotensin 2 in the kidneys ?

A

Vasoconstriction - preferentially at the Efferent arteriole Aldosterone release from adrenal glands
ADH release

406
Q

What effects does aldosterone have on the kidneys and where ?

A

increased Na+ reabsorption at DCT
increased K+ secretion from DCT
and increased H+ secretion from collecting duct.

407
Q

What happens if more sodium is reabsorbed from filtrate?

A

Increased fluid reabsorption
increased blood pressure
increased intravascular volume

408
Q

main presenting feature of hyper-aldosteronisim ?

A

HTN
Renin will be low and aldosterone will be high

409
Q

Causes of hyper aldosteronism

A

adrenal adenoma secreting Aldosterone
or bilateral enlargement (hyperplasia) and over functioning of adrenal glands.

410
Q

How does renal artery stenosis cause increased aldosterone ?

A

Narrowing of Afferent arteriole will decrease renal blood flow and pressure at the glomerular capillaries and JXA cell secrete renin and increase aldosterone release despite systemic hypertension

411
Q

What classes of medications inhibit the RAAS system?

A

ACEi ( lisinopril)
AT2-R Blockers (Losartan)
Aldosterone antagonist (spironolactone)

412
Q

indications to inhibit RAAS ?

A

HTN
Heart failure
CKD

413
Q

What is the primary stimulus of PTH release ?

A

LOW Ca++

414
Q

ideal serum Ca++?

A

2.2

415
Q

PTH release effects the kidneys how ?

A

increases Ca++ reabsorption
increases PH4+ excretion

416
Q

Where is ADH made and secreted ?

A

Made in the hypothalamus
- supraoptic nuclei
- Paraventricular nuclei
secreted from pituitary gland

417
Q

What are osmoreceptors ?

A

located in the hypothalamus are specialized cells that sense blood osmolarity

418
Q

How do baroreceptors regulate ADH release ?

A

Baroreceptors sense blood pressure in artery walls
HIGH BP = INHIBITS ADH release
LOW BP = STIMULATES ADH release

419
Q

What receptors do ADH bind to in the kidneys and where ?

A

V2 on the basolateral side of the collecting duct and DCT

420
Q

What happens to urine osmolarity during water deprivation ?

A

Osmo will increase ( be more concentrated)

421
Q

What classes of medications can cause hyperkalemia ?

A

chronic treatments with Aldosterone antagonist , ACE-inhibitors, and AT-2 Recptor blockers

422
Q

What effect does insulin have on the Na+/ K + ATP pump ?

A

Insulin increased the sodium potassium pump.
Driving Potassium into the cell and Sodium out of the cells

423
Q

What are three key features of DKA ?

A

Ketoacidosis
dehydration and potasium imbalance

424
Q

Why do DKA patients become dehydrated ?

A

Hyperglycemia exceeds transport maximum in kidneys, increasing glucose excretion in the urine , water will also follow the glucose causing dehydration and polydipsia

425
Q

what electrolyte will likely be imbalanced in DKA ?

A

K+ = hypokalemia

426
Q

How do SGLT2 inhibitors work ?

A

inhibit glucose reabsorption in the S1 segment of PCT which increases glucose excretion and decreasing serum glucose levels

427
Q

Nephron death is what kind of feed back ?

A

Positive feedback

428
Q

Phosphatidyalserine does what ?

A

Marks bad cells for immune destruction

429
Q

What enzyme can fix a bad cell before the immune system destroys it?

A

FLIPPASE

430
Q

what is the Foramen of luschka?

A

in between third and fourth ventricle
Paraventricular nuclei would be Superior to the foramen of Luschka

431
Q

How much K+ is stored in the ICF ?

A

98%

432
Q

Cross sectional area of capillaries ?

A

4500 cm2

433
Q

Cross Sectional area of Aorta ?

A

2.5 - 4.5 cm2
Schmidt says focus on trend/relationships instead of obviously different numbers between Lange and Guyton

434
Q

In which vessels does phenylephrine work ?

A

Small Arterioles and Arterioles
highest resistance blood vessels

435
Q

increasing the pressure at the small arterioles and arterioles with phenylephrine will have what upstream and down stream effect?

A

increased pressure upstream (large arteries towards aorta)
decreased blood pressure downstream ( capillaries toward pulmonary )

436
Q

Blood flow through capillaries is controlled by what ?

A

pre-capillary sphincters of arterioles

437
Q

three layers of Small Arteries ?

A

Endothelial Layer - thin layer inside
Medial muscle fibers - middle
Adventitia - outside

438
Q

What conditions can cause a decrease in capillary colloid osmotic pressure (𝛑cap ?

A

Hemorrhage or liver failure or sepsis
will have a hard time keeping fluid in the cv system

439
Q

What comprises the Interstitial Oncotic Pressure of 8 mmHg in the systemic capillaries (𝛑isf)?

A

Collagen
Hyaluronic Acid
Proteoglycans

440
Q

Net Capillary pressure of all systemic capillaries ?

A

17.3 mmHg

not equal to the △P of 20 mmHg because of the increase in diameters of the capillaries.

441
Q

What does Filtration coefficient tell us ?

A

Filtration Rate inclusive of surface area

442
Q

What kind of pain is kidney pain ?

A

visceral

443
Q

Renin secretion is stimulated by which autonomic system ?

A

SNS
Sympathetic nervous system stimulates the JXA cells on Afferent and Efferent Arteioles via Baroreceptors

444
Q

How is anion gap calculated?

A

(Cl- + HCO3-) - Na+

445
Q

Urea is mostly secreted in which segment of the nephron?

A

PCT - reabsorbed thn

446
Q

How can you increase RPF ?

A

Decrease resistance in the efferant arteriole or the afferent arteriole.
OR
Decreasing the resistance of one vessel more than the other ( between efferent or afferent arteriole)

447
Q

Excessive ALDOSTERONE diseases

A

Primary Aldosertonism - Conn’s = ↑ALDO ↑Na+ ↑pH (alkalosis) ↓RENIN ↓K+

448
Q

ALDOSTERONE Defficient conditions?

A

ADDISONS = ↓ Aldo , ↓Na+, ↓ Glucose , ↑K+

449
Q

ADH conditions

A

Central DI
Nephrogenic DI
SIADH

450
Q

SIADH definiton and expected labs

A

too much↑ ADH floating around.
- Increases BP
- Increases Urea in interstitum
- usually indicitive of lung cancer.
↓PNa+
↓PRenin
↓PAldo
↓Urine output
↑Urine osmo

451
Q

Central DI and Nephrogenic DI labs and differences

A

Central DI - Brian is not properly secreting ADH (↓)
Nephrogenic DI - Kidneys are not responding to secreted ADH (normal/↑) - not phosphorylating AQP channels.

↑PNa+
↑Posmo
↑Urine Output
↓Urine Osmo

452
Q

Dehydration due to decreased Water intake labs

A

↑ADH
↑Aldo
↑Plasma Na+
↑Urineosmo
⇔UrineNa+

453
Q

What will increase K+ movement from ICF to ECF , increasing Plasma K+?

A

𝛃- Blockers ( -lol)
Insulin Resistance (Hyperglycemia)
Acidosis (metabolic)
Addison’s
Strenous excercise
↓ECF Osmo

454
Q

What will increase K+ movement from ECF to ICF , decreasing Plasma K+?

A

↑ECF Osmo
Alkalosis ↑pH
Hypoglycemia ↓BG
β-Agonist (isoproteronal)
Cushing’s

455
Q

Renal Clearance greater than GFR indicates what ?

A

SECRETION

456
Q

Diabetes Milliteus labs to be aware of

A

↑Thirst
↑Urine Volume
↑Titratable Acid
↑GFR
↑NH+ Production & Excretion
↓pH ( when high enough)
↓HCO3-
↓PCO2
↓Afferent Arteriole Resistance

457
Q

% H2O filtered is the inverse of what ?

A

creatinine

458
Q

Things the ↓GFR

A

↑Afferent Arteriole Resistance
↑Bowman’s Hydro pressure
↓Efferent Arteriole Resistance
↓GC Hydro pressure (PGC-CAP>)
↓GC Kf

459
Q

Things that ↑GFR

A

↑Efferent Arteriole Resistance
↑GC Hydro pressure (PGC-CAP> 60mmHG)
↑GC Kf
↓Afferent Arteriole Resistance
↓Bowman’s Hydro pressure (PBC-CAP>18mmHg)

460
Q

↓Plasma Protein, without proteinuria results in what changes to starling forces ?

A

↑Capillary Filtration Rate
↑Interstitial Fluid volume
↑Interstitial fluid Hydrostatic pressure = ↑Lymph Flow
↓Interstitial protein concentration (“wash out”)
↓Plasma Colloid Pressure

461
Q

Amiloride is K+ sparing , what else can it spare ?

A

H+
( protons follow potassium)

462
Q

Creatinine follows what ?

A

GFR

463
Q

Urine specific gravity of <1.005

A

LOW = DI

HIGH = DRY

464
Q

PAH is freely filtered and what else….?

A

filtered , kinda
10% reabsorbed and 100% secreted
used for Renal Plasma flow estimate
always higher concentration at excretion than begining of renal artery

465
Q

Inulin is freely filtered and what else….?

A

freely filtered
NOT reabsorbed
NOT secreted
golden standard for GFR

466
Q

UREA is freely filtered and what else….?

A

REABSORBED
SECRETED
and Excreted
usually higher concentration of urea in urine …

467
Q

Creatinine is freely filtered and what else….?

A

REABSORBED
SECRETED
Clinical standard for GFR

Schmidt’s World Of Anatomy (3 decks)

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