FINAL EXAM Flashcards
KIDNEY
What is the first capillary bed blood encounters as it enters the kidney?
Glomerular Capillaries
Ball of veins
average pressure is twice as much as peripheral capillaries
Whats the cause of the decrease in blood pressure in the glomerular capillaries from the renal artery ?
The high vascular resistance from the afferent arteriole
renal artery pressure 100 mmHg
Glomerular capillary pressure 60 mmHg
pressure gradient 40 mmHg
What is the high pressure of the glomerular capillaries directly correlated with?
Driving filtration
maintaining GFR
What is normal GFR ?
125 mL/min
(180 L/day)
What are the four forces that determine filtration or reabsorption ?
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)
What are fenestrations and where are they?
numerous small openings in the endothelial cells of glomerular capillaries , where fluid and substances can be filtered.
Which is more permeable the renal glomerular membrane or muscle capillaries ?
Renal glomerular membrane
by about 500x
except for plasma proteins
What is filtration ? and what favors filtration ?
movement of fluid from the capillaries into the interstitial
Hydrostatic Pressure , Plasma Osmotic Pressure, and Interstitial Colloid pressure
Pcap/ 𝜫 cap / 𝜫 isf
What is reabsorption? And what favors it ?
the movement of fluid from the interstitial space back into the capillaries
Interstital Fluid Hydrostatic Pressure
Pisf
How is over-perfusion prevented in the kidney?
constriction or increased resistance at the Afferent Arteriole.
What is blood flow filtration a product of in the kidneys ?
Auto-regulation of renal blood flow through the kidneys
How do you calculate NFP in regular capillaries?
Pcap - Pisf - 𝜫 cap + 𝜫 isf = NFP
Can the kidney auto-regulate itself on its own ?
yes - without meds- via imperfect auto-regulation
What is the Plasma Oncotic-osmotic pressure in the afferent arteriole ?
28 mmHg
factors in the proteins dissolved in the plasma portion of blood
same as in the blood as at the systemic capillary
What should we not loose or filter if were healthy ?
Oncotic colloids
plasma proteins
glucose
What is Glomerular Plasma Colloid Osmotic pressure at the middle ? at the end ?
32 mmHg in the middle
36 mmHg at the end
further along more fluid is filtered and more proteins get concentrated
What is Ptube?
Hydrostatic pressure in the kidney tubule about 18 mmHg
What is the protein osmotic pressure in the early part of the tubule ?
should be 0 for healthy people.
How do you calculate NFP in the Kidney ?
60 mmHg - 32 mmHg - 18 mmHg = 10 mmHg
Glomerular pressure (60mmHg)
Colloid pressure in the capillaries (32mmHg) - Fluid pressure in the tubule (18mmHg)
How do you calculate filtration rate ? what is its units?
(K f) (NFP) = FR in mL/min
average = 12.5 mL/min
What is K f?
Filtration coefficient
What is the calculation of Filtration rate equate to ?
actual tissue flow
Whats the second arteriole blood encounters in the kidney ?
Efferent Arteriole
Which arteriole increases GFR the most ?
Efferent Arteriole
increased restriction at the efferent arteriole will increase upstream blood pressure that will increase filtration
What happens when the Efferent arteriole relaxes or dilates ?
decreases resistance in efferent arteriole - allows easier blood flow downstream , increased renal blood flow , and decreased GFR
What is the pressure after the efferent arteriole ?
18 mmHg
Pressure gradient from glomerular capillary = 42mmHg
what is the pressure gradient from the renal artery to the glomerular capillary ?
afferent arteriole pressure resistance caused pressure gradient of 40 mmHg
Which arteriole has the highest vascular resistance of any blood vessel segment in the kidney ?
the EFFERENT Arteriole
What is the second set of capillaries blood encounters in the kidneys ?
Peritubular capillaries
What happens in the Peritubular capillaries ?
Lots of reabsorption
What are the two capillary systems in the kidney ?
Glomerular capillaries and the peritubular capillaries
How much of filtration is reabsorbed?
about 99%
How much filtration is determined for excretion ?
about 1 %
What is the route of filtration in the GC
?
fenestrations - gaps in between the cells
What is the renal interstitium ?
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
Where does the peritubular capillary send reabsorbed fluid to ?
the CV system via the renal vein
What is the oncotic pressure in the middle in of the peritubular capillary ?
32 mmHg
more diluted here
Pressure in the peritubualr capillaries ?
beginning = 18 mmHg
Middle = 13 mmHg
What is the interstitium fluid pressure at the pertiubular
𝜫 isf = 15 mmHg
What is the hydrostatic pressure of the renal interstitium fluid at the peritubular capillaries ?
Pisf = 6 mmHg
How is NRP calculated at the peritubular capillaries ?
𝜫 isf - Pisf - Ptube
How much of the plasma moving through the kidney’s is filtered ?
about 1/5 th.
What is the shape of the peritubular capillary ?
convoluted
Where does the tubule empty?
into the ureter then the bladder
What is the formula for excretion ?
Filtration - Reabsorption + secretion = Excretion
measured in volume (mL) or quantities of substances dissolved in the fluid (mol or mg) over time
Reabsorption pathway ?
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
Secretion pathway ?
Opposite of reabsorption
compounds move from peritubular capillaries into the renal interstitium, through the cells , and into tubule
- specialized transport systems
Which capillary bed in the kidney is focused on re-absorption ?
Peritubular Capillaries
Which capillary bed in the kidney is focused on Filtration ?
Glomerular Capillaries
Increased GFR will increase what concentration ?
concentration of Colloids
Decreased GFR will decrease what concentration ?
concentration of colloids
Increased or decreased resistance at the efferent arteriole will increase or decrease GFR and what else?
concentration of colloids
What is normal Filtration fraction ?
20 % ( 0.195)
What is the Filtration fraction equation ?
GFR/RPF = FF
GFR / Renal Plasma Flow = filtration fraction
What is normal renal blood flow ?
1,100 mL/min
Normal Hct level?
0.40 (40% consist of RBC)
remaining 60% is plasma volume
Renal plasma flow equation ?
RPF = (0.60) x 1100 mL/min
about 660 mL
Renal Plasma Flow = Plasma x renal blood flow
where do changes of renal vascular resistance occur ?
front - afferent arteriole
back - efferent arteriole
or both
Auto-regulation or fine tuning of GFR come from which arteriole ?
Efferent Arteriole
Auto-regulation of blood flow through the kidney’s is whose responsibility ?
Afferent arteriole
will also indirectly manage GFR
Constriction of renal blood flow at the afferent arteriole will cause what ?
decreased Glomerular capillaries and decreased GFR
decreases renal blood flow
Constriction or increased resistance at the efferent arteriole will cause what ?
increased glomerular capillary pressure and increased GFR
decreases renal blood flow
Relaxation of Afferent arteriole will have what effect ?
Increased Glomerular capillary pressure and increased GFR
Relaxation of the Efferent arteriole will have what effect ?
Increased renal blood flow, decreased glomerular capillaries and decreased GFR.
Increased resistance at the efferent arteriole will have what effect on the peritubular capillaries ?
increased resistance at the efferent arteriole will decrease blood flow to the pertiubular capillary and decrease the pressure there
Range of blood pressure for renal auto-regulation ?
50 mmHg - 150 mmHg
Renal Auto-regulation prevents what ?
over-perfusion
under-perfusion
and GFR
Is the kidney really good at auto-regulating renal blood flow or GFR at low pressures ?
Renal blood flow is better auto-regulated than GFR at lower pressures
GFR is better auto-regulated at which end of the pressures?
GFR is better auto-regulated at HIGHER pressures than lower pressures.
What is normal urine output ?
1 mL/min
As blood pressure decreases what happens to urine output and why ?
urine output decreases at lower blood pressures to conserve fluid volume
the system usually favors what ?
fluid excretion and reduced pressures
what is glomerular filtration ?
movement of stuff from glomerular capillaries into the tubule
What is tubular secretion ?
Pumping things from the tubule into the peritubular capillary
What is tubular reabsorption ?
Re-absorption of stuff from tubule into the peritubular capillary
Different fates of filtration ?
Filtration only = 100%
Filtration and partial reabsorption - sodium
filtration and complete reabsorption = Glucose
Filtration and secretion = PAH
How much is re-absorbed at the PCT ?
2/3 of almost everything
65% H2O
50% Urea
How much of glucose is re-absorbed in the PCT in healthy person?
ALL of it
As you progress into the PCT what will happen to glucose concentration ?
it will decrease because its being re-absorbed - this makes the clearance of it 0
where does the bulk of plasma re-absorption occur ?
Proximal tubule
If a compound is freely filtered into the tubule and not re-absorbed what is its clearance ?
The compound will increase in concentration as fluid is re-absorbed and then excreted into the urine.
Concentration of mystery compounds going into kidney will be higher or lower than the concentration being excreted ?
Beginning concentration will be higher coming into kidney.
What is inulin?
exogenous compound used to properly estimate clearance
why is inulin more accurate than creatinenine?
Inulin cannot be secreted or absorbed as creatinene can be.
Most Famous guy to have prostate cancer ever ?
Linus Pauling
Sustained elevated hypertension indicates what ?
indicates something is wrong with the kidney’s
What is the short term regulator of CO 2? long term?
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
How do the kidney’s act as pH regulators ?
Production of HCO 3 -</sup
Decides how much HCO 3 - to reabsorb
Gets rid of excess protons
What things are filtered freely ?
Na, K, Cl, HCO3
Uncharged organic glucose,
Creatinine, Urea, Amino acids,
Peptides (Like Insulin & ADH)
(Vanders)
How do the kidney’s assist in Hct levels ?
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
How do the kidneys’ manage electrolytes ?
Reabsorb most of the things we eat and the kidney will act to balance it out.
What vitamin do the kidney’s activate ?
VItamin D
How do the kidney’s help manage glucose ?
they reabsorb glucose to their capacity but cleave off the remaining excess in the urine
Do the kidney’s activate or inactivate drugs?
yes
by way of some selective transporters in the kidneys
How do the kidney’s help in severe diabetes ?
severe diabetes patients produce nitrogenous waste products like urea and the kidney will get rid of them
How does the kidney help manage Osmolarity ?
decides between salt and water reabsorption.
ex. in hypernatremia they can choose to get rid of salt and retain water. this includes ADH
Whats the biggest artery that feeds into the kidney’s?
RENAL ARTERY
what are they artery pathways of the kidney ?
Renal Artery
Segmental Arteries
Interlobar Arteries
Arcuate Arteries
Interlobular Arteries
Afferent Arteries.
What are the Venous pathways of the kidney’s ?
Glomerular Capillaries
Efferent Arterioles
Peritubular Capillaries
Interlobular Veins
Arcuate Veins
Interlobar Veins
Segmental Veins
Renal Veins
How many times does the renal artery split before reaching the afferent Artery ?
4 times
Whats larger the interlobar or interlobular arteries ?
INTERLOBAR - largest !
Where do we do the bulk of reabsorption ?
Peritubular capillaries
Where do the veins start to converge in the the kidney’s
?
just after the peritubular capillaries going forming into the interlobular veins
Interlobular veins converge to for what ?
Arcuate veins
Interlobar veins converge to form what ?
Segmental veins
Arcuate veins converge to form what ?
Interlobar veins
Segmental veins converge to form what ?
Renal veins
Which Renal blood vessels are most important ?
Afferent Arterioles
Glomerular Capillaries
Efferent Arterioles
Peritubular Capillaries
What is between the peritubular capillaries and the affernent arterioles ?
The tubular system that is in charge of reabsorbing things or actively secreting things into the urine
where are majority of nephrons?
CORTEX 90-95%
Where are the other nephrons?
INNER MEDULLA
5-10%
Where are most of the peritubular capillary networks?
OUTER MEDULLA
The peritubular capillaries descend deep into the medulla, as they ascend what happens?
As they ascend they split into two
Are there more ascending or descending peritubular capillaries ?
ASCENDING
How many descending peritubular capillaries do we have ?
ONE
we have more Ascending Peritubular blood vessels than descending, what does this do to blood velocity ?
this decreases the velocity of blood in the ascending capillaries
this helps us maintain solutes of the deep renal medulla
What are the deep descending peritubular capillaries called ?
Vasa recta capillaries
What would happen if the velocity was not slowed down as the peritubular capillaries ascend out of the inner medulla ?
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.
Vasa Recta capillaries comprise how much of the peritubular capillaries?
5-10%
How much blood supply do the deep inner medulla have ?
5-10%
from the descending peritubular capillaries called the vesa recta
Where would would expect to have ischemia in the kidneys ?
INNER MEDULLA - deepest part that only gets 5-10% of blood supply
Where are the kidneys housed ?
inferior to the diaphragm
Where are the renal arteries and veins located ?
inferior to the mesenteric arteries
Where are the adrenal glands ?
each one sits superior to each kidney
“Suprarenal gland”
Each kidney has a ____ that connect to the _____
Ureter ; bladder
What is the first part of the urine emptying system called ? ( Inside the kidney )
Renal Papilla
Where do the renal papilla empty into ?
the minor then the Major Calyx
What do the major Calyx converge to form ?
renal pelvis (just before the ureter)
The right kidney comes into contact with what other anatomical structure ?
Liver - top (superior) lateral side
and COLON
The left kidney comes into contact with what other anatomical structure ?
Stomach - Gastric surface
SPLEEN - top lateral portion
Pancreatic Surface - Middle
COLON - descending surface
What anatomical structure do both kidneys come into contact with ?
COLON
Why is kidney cancer more rare ?
Kidney’s do not replicate as much
If we have kidney cancer where would it come from ?
metastasis from the other anatomical structures that they come into contact with
What quadrant are the kidneys in ?
Right - RUQ
Left - LUQ
Kidney stones would increase what in the kidney ?
Increased pressure
Because kidney stones can cause increase in upstream pressures, which starling force could this impact ?
Hydrostatic filtrate pressure in the Bowman’s space - this would in turn cause decreased GFR
Where are kidney stone pains referred to ?
back pain
Increase in ANG2 will cause constriction at which arteriole the MOST?
Efferent Arteriole
- will constrict both but mostly EA
What is normal renal artery pressure ?
100 mmHg
Which part of the kidney has the highest pressure gradient ?
Peritubular capillaries.
What has the most dramatic influence on velocity ?
change in diameter
Systemic veins store what percentage of blood ?
64%
What kind of circulatory system decreases overall resistance and velocity ?
parallel system
what is cross sectional area?
the internal diameter
dictates the speed at which blood flows
What is the most important cross sectional ?
AORTA
Blood flow velocity (or vascular conductance) is ___________ (directly/inversely) proportional to cross sectional area?
Inversely
Lower cross sectional area = higher velocity flow
higher cross sectional area = lower velocity
Blood flow through any tissue is dictated by what ?
Its metabolic rate
The kidneys receive about how much blood flow from the overall cardiac output ?
about 20 %
1L/min
Is the blood flow to kidney’s controlled by its metabolic rate?
NO - kidneys are the one exception to this
What is conductance ?
The inverse of resistance
High conductance equates to _____ Resistance ?
Lower resistance
High resistance equates to _______ conductance ?
LOWER conductance
Blood flow is _____ (directly/indirectly) proportional to pressure ?
DIRECTLY
Blood flow is _____ (directly/indirectly) related to resistance ?
INDIRECTLY
how many capillaries do we have ?
10 + billion
What is the functional unit of the kidney ?
Nephron
What makes up the renal tubule ?
Renal Corpuscle
PCT
Loop of Henle
(ascending and descending)
DCT
What two key hormones work to decrease renal blood flow ?
Adrenaline (epinephrine)
angiotensin
Substances with high renal clearance mean wha t?
determine how much of that substance will be removed from the plasma and kidney
what cells at the PCT handle the filtered proteins ?
proximal tubule cells
Whats the healthy amount of protein filtered by the kidneys?
1.8g of protein
How much of the filtered protein does the PCT reabsorb ?
1.7g of protein
How much protein would show up in the urine in a healthy person ?
100mg protein urea
What process do cells use to reabsorb proteins from the tubule ?
Endocytosis or pinocytosis
What do PCT cells turn filtered protein into ?
amino acids
Can PCT cells reabsorb excessive amounts of filtered protein ?
NO
What situations would overwhelm the endocytosis of the PCT cells ?
Sepsis
swiss cheese …
Where does the pinocytotic process exist ?
ONLY in the PCT
What proteins can the PCT reabsorb via pinocytosis ?
Albumin
peptides (small string of amino acids)
growth hormone
Tubular Cell resting membrane potential in PCT ?
- 70 mV
Apical side (tubular lumen) resting membrane potential in PCT ?
- 3 mV
Apical side resting charge at TAL ?
+ 8 mV
Principal cells are sensitive to what ?
Aldosterone
and ADH
Intercalated cells are Sensitive to what ?
ADH
What makes it possible for our Principle cells to have internal receptors ?
Aldosterone is a cholesterol derivative so it can easily cross into the cell and bind to the receptor.
Aldosterone speeds up which pump in the DCT ?
Na + /K + ATPase pump
also increases Na Reabsorption from tubule
What does alcohol reduce the release of ?
ADH from the brain
thats why you gotta pee alot when you getting lit (CRAZY )
If we need to conserve water what happens to our ADH levels ?
Vasopressin levels will be very very high
ADH can help correct what things ?
Blood volume - via water control
Blood pressure
What is the primary controller, in the brain, that senses changes in osmolarity ?
Osmoreceptors in the hypothalamus
Osmoreceptors send signals to where ?
to two nuclei in the brain
Supraoptic or Paraventricular neurons
cell bodies in the CNS
nuclei/nucleous
5/6th of ADH comes from where ?
Supraoptic Neuron
1/6 of ADH is produced where ?
Periventricular Nucleus
Where is the periventricular Nucleus ?
opposite sides of the third ventricle
Supraoptic and Paraventricular nuclei delivery ADH to where ?
POSTERIOR Pituitary gland
Neurohypophyis
Posterior Pituitary gland is called ?
Neuro Hypophysis
Anterior (front) lobe of pituitary is called what ?
Adeno hypophysis
what is the EPI to NE ratio released from the adrenal gland ?
4 to 1
Isotonic
no change in osmolarity would be equal on all side
0.9& NS and d5
Hypotonic
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
Hypertonic
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.
to conserve water we would _______ ADH ?
Release ADH
to excrete water we would ________ ADH ?
decrease release of ADH
Swollen osmoreceptors cells would induce what change in ADH ?
decreased rate of action potentials sent to ADH production centers.
How much does the PCT reabsorb?
2/3rd
What portion of the nephron has highest metabolic rate and why?
PCT
then DCT
maximum reabsorption here
What is the osmolarity of the PCT ?
probably the same as the blood - 300
Osmolarity of urine becomes completely dependent on ADH after what section of the nephron?
After the diluting segment of the distal tubule
What is the osmolarity of the Interstitium ?
closer to 1200 as its deep and concentrated there
What is the osmolarity of the Ascending loop of Henle ?
1200 ascending out to cortex to 100
which portion of the nephron is completely reliant on ADH for dilution ?
Collecting Tubule
Without ADH what is urine osmolarity ?
50 mOsm
With alot of ADH what is the urine osmolarity ?
1200
How does ADH affect the osmolarity in the loop of henle?
ADH determines how much urea we reabsorb
Why does the kidney hang onto urea ?
to use it for water reabsorption
After the PCT how much urea is left ?
about 1/2
The collecting duct has alot of aquaporins and what else ?
urea transporters
What are the Urea Transporters called ?
UT-A1
UT-A3
anti-diuresis is what ‘?
the states of holding on to as much electrolytes as we can.
usually via urea transporters.
ADH is the only regulator that can do what ?
selectively reabsorb water or salt
primary regulator of our plasma osmolarity
Decrease Thirst can be regulated by what ?
decreased plasma osmolarity and ANG2
and
And gastric distention increased Blood volume and Blood pressure
What can increase thirst ?
Increased plasma osmolarity and ANG 2
and dryness of the mouth
Decreased Blood Volume and Pressure
What can reduce ADH ?
Decreased Plasma osmolarity
increased BP and volume
Alcohol , and Haloperidol
What can increase ADH ?
Increased plasma osmolarity
Decreased BP and volume
Nausea, hypoxia
morphine and
Nicotine
Increased water intake will ______ ADH and ______ urine flow .
DECREASES ADH
INCREASE URINE FLOW
ADH can manage water with ______ effect on electrolytes
NO
Urine osmolarity in healthy patient is what ?
600 mOsm/L
How much is reabsorbed at the TAL ?
25%
What is the diluting segment of the nephron ?
early DCT
and late ascending TAL
usually hypotonic
Which parts of the nephron are permeable to water ?
PCT, thin DL, DCT
What area is responsible for final reabsorption of additional electrolytes?
the collecting duct
Decreased Renal creatinine excretion will have what effect on creatinine production ?
this will increase blood creatinine production and plasma levels two fold
Post unilateral nephrectomy will have what effect on the remaining kidney ?
physiologic hypertrophy that makes it able to do more work
what is an example of bad kidney hypertrophy ?
diabetes induced kidney hypertrophy
How much can a single kidney increase its workload ?
one working kidney can increase its work load by 50%
With one kidney will the kidney pressures change?
no , they work out to stay the same.
What is the filtered load of creatinine ?
1.25 mg / min
creatinine clearance = 1mL/mg x 1.25 mg/mL / 1mg/100 mL
Ux x V / Px
what is the normal secretion of creatinine into the tubule ?
0.15 mg/min
what is the normal excretion of creatinine ?
1.40 mg/min
with one kidney what would the plasma level of creatinine increase to ?
2mg/dL
or double baseline
how many nephrons do we have total?
born with 2 Million
How much does each nephron filter ?
62.5 nl/min
nanoliters / minute
How much volume is excreted for all nephrons total ?
1 ml/minute
how much is each nephron excreting ?
0.50 nl.min
nanoliters per minute
Per Schmidt - went and asked him for the specific #
With loss of nephrons what would total GFR be ?
40 ml/min
GFR
with 75% loss of nephron
With loss of nephrons what would single total GFR be ? ?
80 nl/min
With loss of nephrons what would total excretion be ?
1.0 ml/min
With loss of nephrons what would total excretion be per nephron?
3.0 nl/min
At what age do our nephrons start to tap out ?
around 40 years old
What problems increase risk on kidney health ?
Hypernatremia
Hypervolemia
Hyperkalemia
Hypertension
Acidosis
How do we change the make up of our body compartment fluids w solutions ?
isotonic solutions = Expanded ECF
Hypertonic =
will pull preexisting water into cells until equilibrium.
Hypotonic Saline = decreases overall osmolarity - will shift from ECF to ICF
what kind of solutions have more water than salt ?
Hypotonic
(0.45 % NaCl)
What kind of solution has more salt than water ?
Hypertonic
(3% saline)
What type of solution has equal amounts of water and sodium ?
Isotonic
(0.9% saline)
What are the primary sites for nutrient exchange and waste removal ?
the capillaries
Determine the thickest walls to the thinnest of the vascular system
Aorta - 2 mm
Vena cava - 1.5 mm
Arteries - 1 mm
Veins - 0.5 mm
Arterioles - 20 um
Venules - 7 um
Capillaries - 1 um
If capillary Colloid Osmotic pressure is lower than normal what effect can happen ?
This will decrease reabsorption, making it hard to keep fluid in CV circulation.
What conditions can increase Interstitial Fluid Colloid Osmotic Pressure ?
Damage/trauma
Bacterial or Viral Infections
Capillaries turning into swiss cheese
What factors can turn capillaries into swiss cheese ?
Sepsis, Liver disease, nephritis
Hypertonic IV administration will cause what effect on ICF, ECF, and TBW ?
DECREASE ICF volume and increase ICF osmolarity
INCREASE ECF volume and osmolarity
INCREASE TBW
HYPOTONIC IV administration will cause what effect on ICF, ECF, and TBW ?
INCREASE ICF volume
decreasing osmolarity
INCREASE ECF volume
decreasing osmolarity
INCREASE TBW
ISOTONIC IV administration will cause what effect on ICF, ECF, and TBW ?
ECF volume will increase, TBW will increase. No change in Osmo of either compartment.
What is the NFP of any individual systemic capillary ?
0.3 mmHg
Capillary Permability ranking (most permeable to least.)
water > NaCl > Urea > Glucose > Inulin > Myoglobin > Hemoglobin > Albumin
If Pcap Increases what effects will this have in systemic capillary system?
⬆︎Pcap =
⇧ Pisf
⇧ interstitial volume
⇧ Lymph flow
If 𝜋cap decreases what effects will this have in the systemic capillary system ?
⬇︎𝜋cap =
⇧ Pisf
⇧ interstitial volume
⇧ Lymph flow
If arteriole resistance increase what effects will this have on systemic capillary system ?
⬆︎Arteriole Resistance =
⇩Vascular conductance
⇩Pcap
⇩Capillary filtration
⇩Interstitial volume and pressure
⇩Lymph flow.
What is the filtration fraction and what is the equation for it ?
FF = GFR / RPF
This is the fraction of renal plasma flow that is filtered. Average is 0.2 or 20%
Which catecholamines or peptides , if increased, will decrease GFR ?
Norepinephrine
Epinephrine
Endothilien
Which natural gas or autocoids , if increased, will increase GFR ?
Nitric Oxide
Prostaglandins
What Reabsorption pathway does sodium follow ?
Partial reabsorption
what is dextran and what can we use it for ?
Dextran is a synthetic sugar
we can use it to help depict the filterability between different sized sugar compounds
polycationic dextran that is the same size as neutral dextran is relatively _______(more or less) filterable ?
polycationic dextran is much MORE filterable than neutral dextran due to no negative charges on it
Polyanionic dextran that is the same size as neutral dextran is relatively _____(more or less) filterable ?
polyanionic dextran is much LESS filterable due to so many negative charges on it
what are the 8 main things that can be achieved through proper auto-regulation of GFR ?
pH
Hematocrit
Osmolarity
Metabolic waste
Electrolyte Balance
BP
Drug clearance
Glucose
Renal blood vessels (arteries to veins)
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.
What are the two type of nephrons?
Superficial (90-95%) and Deep Nephron ( 2-10% medullary nephron)
what is the pudenal nerve ?
S2, S3, & S4
controls bladder , bowel emptying , and overall continence
and erections
why is prostate removal tricky ?
prostate is very close to pudendal and hard to not damage pudenal nerve with this procedure.
Where is the macula densa located ?
TAL - thick Ascending limb of henle is the best answer option - per schmidt
What are the parts of the collecting duct ?
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.
Release of renin leads to what ?
increased ANG 2
-preferentially constricts EA
Where is renin released from ?
from the juxtaglomerular cells at the AA and EA
What does renal clearance describe ?
the amount of a substance thats been cleared from plasma per unit of time
Ů or a V with a dot means what ?
per unit of time
(this unit urine flow per unit of time)
At the tip of bowman’s capsule we would expect its osmolarity to be (same or different) ________ from serum osmolarity ?
SAME for freely filtered things
What is PAH used for ?
PAH ( para Aminohippuric) clearance
is used to estimate renal plasma flow
can be divided by (1-HCT ) for renal blood flow.
a dL is how many mL’s?
100 mL’s
urinary flow rate x urinary concentration = what?
excretion rate
what is clearance equation ?
[Us]x(Urinaryflowrate) / [Plasma concentration of compound]
What factors can be used to find renal blood flow (RBF) ?
Renal Plasma Flow and Hct
How can you find RBC ?
1- Hct
Clearance of inulin = what ?
clearance of inulin = GFR
what are the units for renal clearance, RPF, ERPF, and RBF?
mL/min
what are the units for excretion rate , reabsorption rate, and secretion rate ?
mg/min, mmol/min, or mEq/min
prolonged HTN will cause most damage to what part of the kidneys?
glomerular capillaries will have the most damage from increased pressures that cause inefficient podocytes, fenestrations may widen, may have scarring of the capillary bed.
Prolonged HTN can damage Afferent Arterioles how ?
Afferent arterioles will also stiffen over time from prolonged constriction.
increased time in the tubule can increase what ?
the overal percentage reabsorbed
Prostaglandins preferentially ________(dilate/constrict) the ________. arteriole under normal conditions?
PG’s DILATE the AFFERENT arterioles normally
ANG2 preferentially ________(dilate/constrict) the ________. arteriole under normal conditions?
ANG2 CONSTRICTS the EFFERENT arterioles under normal conditons
NSAID’s cause _________(constriction/dilation) at the Afferent arteriole
CONSTRICTION
ACE inhibitors cause _________ (constriction/dilation) at the efferent arterioles?
DILATION
NSAIDs usually constrict afferent arterioles and ACE inhibitors dilate efferent arterioles, this has was effect on filtration ?
DECRESED EFFECTIVE FILTRATION PRESSURE
If less Na+ or Cl- reaches the Macula densa, this would indicate what ?
low GFR
inducing renin release –> ANG2 released –>increased EA resistance or decreased AA to increase GFR
how much Na+ or Cl- is reabsorbed at the PCT ?
2/3 rds
What situations can increase Na+ or Cl- reabsorption in the PCT ?
Increased Glucose reabsorption
What is the primary way kidneys are destroyed in diabetes ?
HYPERFILTRATION
initiated by the feedback mechanism in the kidneys of reabsorbing glucose and more Na which tells macula densa GFR is low
for every glucose reabsorbed in the PCT , how many Na are reabsorbed ?
S1 = 1 glucose for 1 Na+
S2&3 = 1 glucose for 2 Na+
How many amino acids are reabsorbed with each Na+ in the PCT ?
1 Na+ for 1 Amino Acid
Which segments of the PCT have HIGH affinity glucose transporters ? what are the ratios there ?
S2 and S3 - 10% of glucose transport
2Na+ : 1 Glucose
HIGH affinity
How many segments are in the PCT ? what are their names ?
S1 - early PCT
S2 & S3
Where are all the glucose transporters found ?
in the PCT
SGLT2 with GLUT2 at S1 of PCT
SGLT1 with GLUT1 at S2&3 of PCT
both are on the
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.
SECONDARY ACTIVE HIGH AFFINITY
APICAL
PCT
PASSIVE
BASOLATERAL
SGLT2 and GLUT2
LOW AFFINITY glucose transporters of S1 segment of PCT
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.
SECONDARY ACTIVE
LOW AFFINITY
APICAL
PCT
PASSIVE
BASOLATERAL
mL to dL math
mL / 100
dL to mL math
dL x 100
what ways can Bicarb be managed in the PCT ?
Selective Reabsorption of HCO3-
Production of HCO3-
How is HCO3- produced in the PCT ?
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
where is glutamine produced?
mainly by the liver
which disease is there a lack of glutamine ?
liver failure patients
this is why they have a hard time balancing acids, can be supplemented
Where can Carbonic Anhydrase be found ?
in the PCT
usually luminal side
can be tethered to cell or wedged in cell wall also
what does Carbonic Anhydrase do in the PCT ?
Facilitates the breaking down of Carbonic acid into CO2 and H20
Carbonic Anhydrase ___________(breaks down/builds) Carbonic acid in the lumen and _________(Breaks down/builds) it inside the cell
BREAKS DOWN in lumen
BUILDS inside the cell.
What are our urinary buffers ?
Ammonium (NH4+)
Phosphate (PO4-)
Sodium Phosphate (Na3PO4)
What are brush boarders ?
boarder luminal side of PCT cells, increase surface area by about 20 fold.
What are paracellular Pathways?
these are reabsorption routes in between cells at the tight junctions.
these Junctions are wider at the PCT.
What are Trans-cellular Pathways?
transport of substances through the cell via a channel or transporter.
Cl- travels mostly via which route ?
Cl- travels paracellular route
Na+ travels via which route in the PCT ?
Majority Trans-cellular pathways.
Some paracellular routes too
Aquaporins (AQP) allows for water reabosorption via _________ (transcellular/paracelluar), while other water is reabsorbed along the _________(Paracellular/transcellular)
TRANSCELLULAR pathways
PARACELLULAR pathways
what is bulk flow?
ultrafiltration or mass transfer of water and substances mediated by hydrostatic and colloid osmotic forces.
where are the water pumps in the body ?
NOWHERE
body does not have ANY water pumps.
How must we reabsorb water?
we have to provide an environment concentrated enough to facilitate osmosis
Na+/K+ ATPease maintain ion gradients and contribute to the cellular membrane potential of what in the PCT?
-70 mV
where is Cl- concentration highest, early or late PCT?
late PCT
Cl- lags a bit until ti becomes more positive
How do proteins make it past the PCT ?
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
How is the NHE pump a form of secretion ?
it is pumping protons INTO the tubule .
NHE pump ratio
1 Na+ / 1 H+
Creation of bicarb at PCT ratios
1 Glutamine –>
2 HCO3 -
2NH4+
SLGT 2 ratios
1 Na+ /1 Glucose
SLGT 1 Ratios
2 Na+ / 1 Glucose
due to more dilute area.
Na+ /HCO3- ratios
1 Na+ / 1 HCO3-
basolateral side
Na2PO4 is a good buffer of what ?
protons especially in the urine
Calcium can be reabsorbed in the PCT via which pathways?
Transcellular and Paracellular pathways
Calcium Reabsorption rate will increase if what is increased?
increased reabsorption of salt and water
what are Ca++ removal routes ?
Ca++ ATPease pump
Na+ / Ca++ Exchanger
What gland moniotrs Ca ++ levels in our blood ?
Parathyroid gland
When PTH is released what happens?
- Encourages Vitamin D3 activation = increased Ca++
- Increases Ca++ reabsorption via Ca++ channels
- Stimulates bone break down (osteoclast)
- Decreases building of bone ( Osteoblast)
cells that break down bone care called what?
Osteoclast
What is bone made of ?
Ca++ and PO4-
High Ca++ levels indicate _______ (low/High) PTH levels and Osteoclast activity will be _____(low/high) and Osteoblast activity will be _____ (high/Low)
High Ca++ = LOW PTH = LOW Osteoclast = HIGH Osteoblast
Osteoblast does what ?
builds bones
We get porous weak bones from what ?
long term calcium deficit.
OCT vs OAT
Organic Cations Transporters
Organic Anion Transporters
Organic Cation Transporters are dependent on what ?
H+ dependent transporters
two substances in opposite directions
Organic anion Transporters are dependent on what ?
Na + dependent process
and 𝛼KG
Steps of Cation transportation
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)
𝛼KG
𝛼 - Ketoglutarate
Steps of Anion transportation
- 3 Na+ : 1 𝛼KG
increases in 𝛼KG concentration in the cell - 𝛼KG is then exchanged for A-
- A- is then secreted via facilitated transporter into proximal tubule
How did PCN come about ?
during WW2 petri dish grew PCN and first dose was in 1942 .
_______(synthetic/natural) hippurate substances can ____________ (competitively/non-competitively) inhibit the removal of PCN?
SYNTHETIC
COMPETITIVELY
what kind of transporters are in the THIN Descending loop of Henle ?
NONE
only water absorption
by the time fluid makes it out the the Thin Descedning Loop of Henle , how much water has been reabsorbed?
85%
65% in PCT
20 % in Thin descending limb
PCT ion reabsorption plus TAL ion reabsorption equals what ?
2/3 solutes reabsorbed in PCT
25% (1/4) reabsorbed by end of TAL
ADH allows kidneys to fine tune what ?
water reabsorption usually in the DCT and collecting duct
Which portions of the nephron have the highest metabolic rates ?
PCT and TAL
Thiazide diuretics are used for treatment with osteoporosis patients and frequent kidney stones why ?
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.
What is a mineralocorticoid ?
ALDOSTERONE
Aldosterone promotes what ? and gets rid of what ?
Aldosterone promotes Na+ and H2O reabsorption
and gets rid of K+
How many K+ sequestration channels do principle cells have ?
2
ROMK and BK
ROMK
ALDO mediated - primary potassium channels in principle cells
BK
BIG K+
ALDO Mediated - Secondary potassium channels in principle cells- usually open when there is alot of potassium
Amiloride and Triamterene work and by what action ?
Na+ channel blocker at the DCT
will decrease amount of potassium secreted
Aldosterone antagonist work where ?
K+ / Na + ATPease pump in Principle cells of the DCT and collecting tubule.
will decrease amount of potassium secreted
Anything that limits sodium reabsorption will have what effect on water and downstream sodium concentration?
this will indirectly limit the amount of water we reabsorb upstream and more sodium traveling downstream
increased Na+ at the principle cells will have what effect ?
More sodium reabsorbed via the sodium potassium pump , and increases secretion of potassium faster. ( Potassium wasting)
What is the outer most part of the adrenal gland ?
ZONA GLOMERULOSA
The zona glomerulosa makes what ?
Aldosterone
Adenal gland layers
Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
Medulla in the deepest middle
Catecholamines come from what part of the adrenal glad ?
Medulla
Epi 4 / NE 1
Cortisol, Androgen, and some Estrogen is secreted from what part of the adrenal glands ?
Zona Fasiculata and reticularis.
at low potassium levels what will the adrenal gland do ?
reduce aldosterone produced
Aldosterone can be released from adrenal glands how?
Increased potassium levels and ANG2 binding
How does smoking cause HTN ?
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.
what is 11𝛽 - HSD- Type 2, where are they? are they specific ??
11𝛽 - HSD- Type 2 - Hydroxysteroid Dehydrogenase Enzyme are a specific type of steroid enzyme located in principle cells that target cortisol specifically.
Lithium can cause loss of how much water a day ?
20 L/day
lower limit of urine osmolarity of 50
Nephrogenic Diabetes Insipidus means theres a problem where?
problem with kidneys and how it responds to ADH
A condition in which there is a problem with the release of ADH is what ?
Central Diabetes Insipidus
AQP 3 & 4 are where ?
Basolateral side of Intercalated cells in the late DCT and Collecting duct
AQP - 2 are where ?
usually segregated until phosphorylated by PKA , then they migrate to apical tubular lumen side of cell.
Type A Intercalated cells
Responsible for acid/base balance
located in the late DCT and collecting duct
secrete H+ (protons) via H+ ATPease of H+ / K+ ATPease
Type B intercalated cells are in charge of what ?
Type B intercalated cells in the late DCT and collecting tubule
reabsorb H+
How do you find Intracellular volume ?
total body fluid - ECF volume
(2/3% 0f total body water)
How do you find the interstitial fluid volume
ECF - Plasma Volume
How do you find the Plasma Volume ?
(Blood volume) (1.0-Hct)
Extracellular fluid compartment is comprised of what?
Interstitial fluid and plasma
(1/3 of total body water)
Whats the equation for Reabsorption rate ?
RR = FL - ER
reabsorption rate = filtered load - excretion rate
FL = (GFR)(P[])
ER = (U[])(UFLOW
Renal Clearance greater than GFR is indicative of what ?
Secretion somewhere
Extracellular fluid volume expansion or increased blood pressure will increase urine excretion of what ions ?
Ca++
decreases Na+ and H2O which calcium is usually reabsorbed with
metabolic acidosis will have what effect on intracellular K+ and excretion ?
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.
how do you calculate filtered load ?
(GFR)(P[])
A 50% reduction in GFR will result in what lab changes at steady state?
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.
INcreased INsulin will have what effect on K+ ?
shift K + into the cells = decreased plasma K + levels.
How do you calculate urine flow rate ?
GFR - Tubular Fluid Reabsorption
Concentration of which Ions will be higher at excretion versus coming into a normal kidney ?
Creatinine - not reabsorbed
Inulin
Urea
K+
PAH - will be the highest
Concentrations of these substances will be significantly lower (if not obsolete) at excretion versus their concentration when entering a normal kidney (four big ones)
GLUCOSE
PROTEIN
AMINO ACIDS
HCO3-
Cl - and Na+ will be slightly less then their initial concentrations.
Dehydration caused by decreased fluid intake will have increases in which lab values?
Renin –> ADH—> Aldosterone
In Conn’s Syndrome you would expect to see _______ (Hyponatremia/Hypernatremia) and _______(Alkalosis/Acidosis)
Conn’s = HYPERnatremia and ALKALOSIS
Conn’s is an adrenal adenoma secreting excessive aldosterone = increases Na+ and H2O reabsorption.
In Addisons syndrome you would expect to see _______ (Hyponatremia/Hypernatremia) and _______(Alkalosis/Acidosis)
Addison’s = HYPOnatremia and ACIDOSIS
What comprises the Capillary plasma colloid osmotic pressure of 28 mmHg in the systemic capillary (𝛑cap?
Fibrinogen = 0.2
Albumin = 21.8
Globulins = 6
What cells sense blood pressure in the kidneys and where are they found ?
Juxtaglomerulous cells located at the Afferent and Efferent Arterioles
Where is renin released?
Juxtaglomerulous cells
What are three main effects of Angiotensin 2 in the kidneys ?
Vasoconstriction - preferentially at the Efferent arteriole Aldosterone release from adrenal glands
ADH release
What effects does aldosterone have on the kidneys and where ?
increased Na+ reabsorption at DCT
increased K+ secretion from DCT
and increased H+ secretion from collecting duct.
What happens if more sodium is reabsorbed from filtrate?
Increased fluid reabsorption
increased blood pressure
increased intravascular volume
main presenting feature of hyper-aldosteronisim ?
HTN
Renin will be low and aldosterone will be high
Causes of hyper aldosteronism
adrenal adenoma secreting Aldosterone
or bilateral enlargement (hyperplasia) and over functioning of adrenal glands.
How does renal artery stenosis cause increased aldosterone ?
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
What classes of medications inhibit the RAAS system?
ACEi ( lisinopril)
AT2-R Blockers (Losartan)
Aldosterone antagonist (spironolactone)
indications to inhibit RAAS ?
HTN
Heart failure
CKD
What is the primary stimulus of PTH release ?
LOW Ca++
ideal serum Ca++?
2.2
PTH release effects the kidneys how ?
increases Ca++ reabsorption
increases PH4+ excretion
Where is ADH made and secreted ?
Made in the hypothalamus
- supraoptic nuclei
- Paraventricular nuclei
secreted from pituitary gland
What are osmoreceptors ?
located in the hypothalamus are specialized cells that sense blood osmolarity
How do baroreceptors regulate ADH release ?
Baroreceptors sense blood pressure in artery walls
HIGH BP = INHIBITS ADH release
LOW BP = STIMULATES ADH release
What receptors do ADH bind to in the kidneys and where ?
V2 on the basolateral side of the collecting duct and DCT
What happens to urine osmolarity during water deprivation ?
Osmo will increase ( be more concentrated)
What classes of medications can cause hyperkalemia ?
chronic treatments with Aldosterone antagonist , ACE-inhibitors, and AT-2 Recptor blockers
What effect does insulin have on the Na+/ K + ATP pump ?
Insulin increased the sodium potassium pump.
Driving Potassium into the cell and Sodium out of the cells
What are three key features of DKA ?
Ketoacidosis
dehydration and potasium imbalance
Why do DKA patients become dehydrated ?
Hyperglycemia exceeds transport maximum in kidneys, increasing glucose excretion in the urine , water will also follow the glucose causing dehydration and polydipsia
what electrolyte will likely be imbalanced in DKA ?
K+ = hypokalemia
How do SGLT2 inhibitors work ?
inhibit glucose reabsorption in the S1 segment of PCT which increases glucose excretion and decreasing serum glucose levels
Nephron death is what kind of feed back ?
Positive feedback
Phosphatidyalserine does what ?
Marks bad cells for immune destruction
What enzyme can fix a bad cell before the immune system destroys it?
FLIPPASE
what is the Foramen of luschka?
in between third and fourth ventricle
Paraventricular nuclei would be Superior to the foramen of Luschka
How much K+ is stored in the ICF ?
98%
Cross sectional area of capillaries ?
4500 cm2
Cross Sectional area of Aorta ?
2.5 - 4.5 cm2
Schmidt says focus on trend/relationships instead of obviously different numbers between Lange and Guyton
In which vessels does phenylephrine work ?
Small Arterioles and Arterioles
highest resistance blood vessels
increasing the pressure at the small arterioles and arterioles with phenylephrine will have what upstream and down stream effect?
increased pressure upstream (large arteries towards aorta)
decreased blood pressure downstream ( capillaries toward pulmonary )
Blood flow through capillaries is controlled by what ?
pre-capillary sphincters of arterioles
three layers of Small Arteries ?
Endothelial Layer - thin layer inside
Medial muscle fibers - middle
Adventitia - outside
What conditions can cause a decrease in capillary colloid osmotic pressure (𝛑cap ?
Hemorrhage or liver failure or sepsis
will have a hard time keeping fluid in the cv system
What comprises the Interstitial Oncotic Pressure of 8 mmHg in the systemic capillaries (𝛑isf)?
Collagen
Hyaluronic Acid
Proteoglycans
Net Capillary pressure of all systemic capillaries ?
17.3 mmHg
not equal to the △P of 20 mmHg because of the increase in diameters of the capillaries.
What does Filtration coefficient tell us ?
Filtration Rate inclusive of surface area
What kind of pain is kidney pain ?
visceral
Renin secretion is stimulated by which autonomic system ?
SNS
Sympathetic nervous system stimulates the JXA cells on Afferent and Efferent Arteioles via Baroreceptors
How is anion gap calculated?
(Cl- + HCO3-) - Na+
Urea is mostly secreted in which segment of the nephron?
PCT - reabsorbed thn
How can you increase RPF ?
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)
Excessive ALDOSTERONE diseases
Primary Aldosertonism - Conn’s = ↑ALDO ↑Na+ ↑pH (alkalosis) ↓RENIN ↓K+
ALDOSTERONE Defficient conditions?
ADDISONS = ↓ Aldo , ↓Na+, ↓ Glucose , ↑K+
ADH conditions
Central DI
Nephrogenic DI
SIADH
SIADH definiton and expected labs
too much↑ ADH floating around.
- Increases BP
- Increases Urea in interstitum
- usually indicitive of lung cancer.
↓PNa+
↓PRenin
↓PAldo
↓Urine output
↑Urine osmo
Central DI and Nephrogenic DI labs and differences
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
Dehydration due to decreased Water intake labs
↑ADH
↑Aldo
↑Plasma Na+
↑Urineosmo
⇔UrineNa+
What will increase K+ movement from ICF to ECF , increasing Plasma K+?
𝛃- Blockers ( -lol)
Insulin Resistance (Hyperglycemia)
Acidosis (metabolic)
Addison’s
Strenous excercise
↓ECF Osmo
What will increase K+ movement from ECF to ICF , decreasing Plasma K+?
↑ECF Osmo
Alkalosis ↑pH
Hypoglycemia ↓BG
β-Agonist (isoproteronal)
Cushing’s
Renal Clearance greater than GFR indicates what ?
SECRETION
Diabetes Milliteus labs to be aware of
↑Thirst
↑Urine Volume
↑Titratable Acid
↑GFR
↑NH+ Production & Excretion
↓pH ( when high enough)
↓HCO3-
↓PCO2
↓Afferent Arteriole Resistance
% H2O filtered is the inverse of what ?
creatinine
Things the ↓GFR
↑Afferent Arteriole Resistance
↑Bowman’s Hydro pressure
↓Efferent Arteriole Resistance
↓GC Hydro pressure (PGC-CAP>)
↓GC Kf
Things that ↑GFR
↑Efferent Arteriole Resistance
↑GC Hydro pressure (PGC-CAP> 60mmHG)
↑GC Kf
↓Afferent Arteriole Resistance
↓Bowman’s Hydro pressure (PBC-CAP>18mmHg)
↓Plasma Protein, without proteinuria results in what changes to starling forces ?
↑Capillary Filtration Rate
↑Interstitial Fluid volume
↑Interstitial fluid Hydrostatic pressure = ↑Lymph Flow
↓Interstitial protein concentration (“wash out”)
↓Plasma Colloid Pressure
Amiloride is K+ sparing , what else can it spare ?
H+
( protons follow potassium)
Creatinine follows what ?
GFR
Urine specific gravity of <1.005
LOW = DI
HIGH = DRY
PAH is freely filtered and what else….?
filtered , kinda
10% reabsorbed and 100% secreted
used for Renal Plasma flow estimate
always higher concentration at excretion than begining of renal artery
Inulin is freely filtered and what else….?
freely filtered
NOT reabsorbed
NOT secreted
golden standard for GFR
UREA is freely filtered and what else….?
REABSORBED
SECRETED
and Excreted
usually higher concentration of urea in urine …
Creatinine is freely filtered and what else….?
REABSORBED
SECRETED
Clinical standard for GFR
