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A & P > Final Exam Babyyy > Flashcards

Final Exam Babyyy Flashcards

1
Q

What does the CV system transport?

A
  • nutrients to tissue
  • waste products away from tissues
  • hormones
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2
Q

What is velocity?

A

Distance / time

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3
Q

What is blood flow?

A

Volume / time

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4
Q

How does high vascular resistance affect blood flow? & how does low vascular resistance affect blood flow?

A

High resistance – less blood flow
Low resistance – greater blood flow

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5
Q

If we had something causing high resistance in a vessel, what would the pressure measure upstream of the resistance? & what would it measure downstream?

A

Upstream – pressure would be high
Downstream – pressure would be low

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6
Q

What controls blood pressure?

A

Vascular resistance

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7
Q

What does the brain use to drive blood flow?

A

Cerebral perfusion pressure

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8
Q

What is the inverse of vascular resistance?

A

Vascular conductance
- how easy it is to drive blood flow

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9
Q

If vascular resistance is high what is vascular conductance is what?
If vascular resistance is low what is vascular conductance?

A

High resistance – low conductance
Low resistance – high conductance

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10
Q

Where is vast majority of blood stored?

A

veins
- (84%)

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11
Q

What percentage of blood is stored in the high pressure system of CV ?

A

17%
- heart, arteries, & arterioles/capillaries

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12
Q

What is the kidney in control of?

A

How much fluid we have in our body

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13
Q

Describe a system in series

A

Connecting 2 tubes together along with their resistance – over all resistance is now doubled as there is only one pathway

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14
Q

Describe a system in parallel

A

Connecting different tubes – not end to end – gives blood options on different pathways to take – decreases over resistance

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15
Q

Which organ contains both system in series & system in parallel?

A

Kidney

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16
Q

What blood vessel is a single tube with a cross sectional area of 2.5?

A

Aorta

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17
Q

The more total cross sectional area the less __ blood flow will have & vice versa

A

velocity

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18
Q

Why is the velocity in the Aorta greater than in the capillaries?

A

The aorta is one tube with a smaller cross sectional area than all the capillaries combined

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19
Q

What blood vessels in the circulatory system are the high resistance vessels?

A

Small arteries & arterioles

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20
Q

What blood vessels does phenylephrine work on?

A

small arteries & arterioles

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21
Q

blood flow to a tissue is determined by what?

A

its metabolic rate
- high metabolic rate – more blood flow
- low metabolic rate – less blood flow

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22
Q

Describe Laminal flow

A

organized blood flow, efficient & non problem causing
- blood in the middle of the vessel will travel the furthest
- walls of the vessel act as resistance causes blood near the wall not to travel as far

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23
Q

Describe Turbulent flow

A

Inefficient & disorderly
- blood is pushed against walls of vessels & causes remodeling & cause things to get stuck such as cholesterol & calcium
- Clots/blockage can cause turbulent flow

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24
Q

What percentage of CO per minute do kidneys get?

A

20% (1 Liter)

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25
Q

What is Ohm’s law>

A

Voltage = current x resistance

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26
Q

Movement out of the capillaries is called?

A

Filtration

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27
Q

Movement into the capillaries is called?

A

Reabsorption

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28
Q

Where is nutrient & gas exchange taken place?

A

Capillaries

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29
Q

When we are measuring blood pressure, which vessels are we measuring?

A

Large arteries

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30
Q

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

A

High Vascular resistance in the arterioles & small arteries – mast majority is arterioles

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31
Q

Blood flow to the capillaries is controlled by what?

A

Arterioles

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32
Q

Relaxation of arterioles has what affect on blood flow to capillaries?

A

increased blood flow

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33
Q

Constriction of arterioles has what affect on blood flow to capillaries?

A

reduced blood flow

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34
Q

about how much surface area in square meters do we have if we combine all the capillaries together?

A

500 - 700 square meters

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35
Q

How many layers do the capillaries have & what composes the capillaries?

A

1 layer & composed of endothelium cells

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36
Q

Do the capillaries contain smooth muscle?

A

No
- this is good as there is nothing to hinder nutrient/gas exchange

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37
Q

The typical MAP at the arterial end of a capillary is?

A

30mmHg

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38
Q

The typical MAP at the venous end of a capillary is?

A

10mmHg

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39
Q

What is the normal arterial MAP we are using for class?

A

100mmHg

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40
Q

Which end of the capillary favors filtration?

A

Arterial end

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41
Q

Which end of the capillary favors reabsorption?

A

Venous end

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42
Q

What are the 4 Capillary Starling forces?

A
  • Hydrostatic pressure in capillaries
  • Hydrostatic pressure in ISF
  • Capillary Colloid osmotic pressure (oncotic pressure
  • Interstitial fluid colloid osmotic pressure
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43
Q

What is Hydrostatic pressure in capillaries?

A

The blood pressure in the capillaries – also called the hydrostatic pressure – physical fluid pressure of the blood in the capillaries

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44
Q

What is Hydrostatic pressure in ISF?

A

The blood pressure outside the capillaries & outside cells - ISF
- negative pressure d/t lymphatics pulling extra fluid

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45
Q

What is Capillary colloid osmotic pressure? (plasma osmotic pressure)

A

Proteins dissolved in blood in capillaries – creates a pulling force keeping fluid in CV
- normal capillary oncotic pressure is 28 mmHg

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46
Q

What is Interstitial fluid colloid osmotic pressure?

A

Proteins in the ISF – creates a pulling force into ISF

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47
Q

What can cause the Capillary plasmic oncotic pressure to decrease?

A

Hemorrhage, liver failure, sepsis & trauma

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48
Q

What happens to the osmotic pressure when the semi-permeable membrane becomes permeable?

A

Not only can proteins escape into ISF but the proteins in the capillaries lose their osmotic pressure – this is because osmotic pressure is based on a semi-permeable membrane where fluid can move but a dissolved substance cant

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49
Q

What kind of proteins can we find in the ISF & how much osmotic pressure do they produce in the ISF?

A

Proteoglycan filaments, Hyaluronic acid, & collagen
- osmotic pressure of 8mmHg

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50
Q

Which one has more proteins producing osmotic pressure the CV or the ISF?

A

CV
- osmotic pressure produced is 28mmHg

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51
Q

What happens to extra proteins that leak into ISF by sepsis? & what can affect the rate of this?

A

Lymphatic slowly removes extra proteins this takes time – this process is slowed even more in bedridden patients

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52
Q

What does the lymphatic system rely on for passive movement?

A

The contraction/relaxation of skeletal muscle – lymphatic uses this to move fluid forward

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53
Q

What is the capillary filtration coefficient?

A

How permeable the capillary is & how much surface area
- the more porous to water the more water will move
- the more surface area the more movement
(this is secondary to the other forces)

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54
Q

What are the three main proteins that make up the total oncotic pressure in the CV?

A

Albumin (Primary), Globulins (2nd most important – Abx) & Fibrinogen (clotting factor)
- total plasma oncotic pressure is 28mmHg

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55
Q

Where do the lymph vessels tie in?

A

Around capillaries

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56
Q

What is the purpose of lymph

A

Retrieving extra fluid from around the interstitial fluid around capillaries and returning it to the CV system

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57
Q

Where does the lymphatic system dump contents back into the CV system?

A

Lymphatic ducts at the top of the thorax dump into “very large veins.”

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58
Q

Do lymph vessels have valves? How goes blood return to the CV system?

A

Yes; one way valves, similar to veins. Need muscle contraction for lymph return. This is why bed bound people get swollen.

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59
Q

Lymph flow can be described as a

A

Passive one way pumping system

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60
Q

At rest, how fast is lymph flow?

A

Relatively slow

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61
Q

If we increase our activity, how much can we increase lymphatic flow?

A

20x; maybe even higher if our activity is enough

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62
Q

What is used in the hospital to prevent fluid backup in patients who are bed bound?

A

Sequential compression devices; helps get venous/lymphatic system moving, possibly more so for lymph

*requires intact path to top of thorax

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63
Q

What are capillaries most permeable to?

A

Water

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64
Q

What electrolyte is highly permeable in capillaries? Why?

A

NaCl - small

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65
Q

In regard to permeability to capillaries, the larger the electrolyte, the ___

A

less permeability we will have

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66
Q

On the arterial side of a capillary, the pressure is

A

30mmHg

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67
Q

On the venous side of a capillary, the pressure is

A

10mmHg

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68
Q

Oncotic pressure throughout the NON-RENAL capillary according the Schmidtty is

A

28mmHg

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69
Q

Interstitial fluid hydrostatic pressure around the capillaries in a healthy adult is typically ____. What does this create?

A

-3mmHg

A vacuum; favorable condition for filtration on the arterial side

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70
Q

Osmotic pressure of proteins in the interstitial fluid outside capillaries is typically

A

8mmHg

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71
Q

Oncotic pressure ______ filtration

A

Opposes

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72
Q

Capillary pressure, interstitial hydrostatic pressure, and interstitial protein oncotic pressure _____ filtration

A

Favor

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73
Q

In a healthy person, the total mmHg favoring filtration is

A

41mmHg

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74
Q

In a healthy person, the total mmHg opposing filtration is

A

28mmHg

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75
Q

In a healthy person, the net filtration pressure for filtration is

A

13mmHg

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76
Q

In a healthy person, the total pressure favoring reabsorption is

A

21mmHg

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77
Q

In a healthy person, the total pressure opposing reabsorption is

A

28mmHg

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78
Q

The a healthy person, the net filtration pressure for absorption is ____. Why is this important?

A

-7mmHg

Not completely favorable for reabsorption. Some fluid is left behind. This requires an intact lymph system to scavenge the remainder of fluid to prevent buildup provided there is not an extreme excess of fluid.

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79
Q

In the systemic system, the capillary is

A

short

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80
Q

What is the average capillary blood pressure in systemic circulation? (delta P between the arterial and venous side of capillary).

A

17.3mmHg

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81
Q

Why is delta P of the capillary not 30-10=20mmHg?

A

It is 17.3mmHg because capillaries get larger as we go from the arterial side to the venous side, which increases cross sectional area and decreases pressure.

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82
Q

What is the net filtration pressure on average PER capillary?

A

0.3mmHg

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83
Q

What specialized capillary bed does NaCl have trouble getting through?

A

Blood Brain Barrier

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84
Q

The opening between endothelial cells at the capillary don’t have much barrier for what?

A

Water

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85
Q

The blood brain requires what for transport of glucose?

A

….glucose transporters

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86
Q

When blood comes into the kidney from the renal artery, it has a MAP of what?

A

100mmHg

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87
Q

When blood exits the kidney via the renal vein, it has a MAP of what? Why?

A

0mmHg

BP drops as it moves through areas of high resistance within the kidney. Energy is removed, so pressure drops

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88
Q

What is delta P between the renal artery and renal vein?

A

100mmHg

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89
Q

What blood vessel supplies the glomerulus capillary bed?

A

Afferent arteriole

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90
Q

What defines blood pressure of the glomerulus capillary bed?

A

Systemic BP (pressure coming in from renal artery)

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91
Q

Why does the pressure drop between the afferent arteriole and the glomerulus? capillary bed?

A

High resistance within the afferent arteriole

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92
Q

What is the typical pressure within the glomerulus capillary bed? How does this relate to the systemic capillary?

A

60mmHg

2x greater than systemic capillary, allowing for high filtration

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93
Q

What should we not be filtering out in the kidneys in a healthy individual?

A

RBC/Large proteins

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94
Q

If someone has proteinuria or RBC in the urine, what disease state could they have?

A

DM, lifetime HTN

It is okay to have a very low number filtered out per daddy

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95
Q

How many capillary beds does the kidney have?

A

2

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96
Q

The glomerulus capillary bed is the ____ renal capillary bed.

A

1st

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97
Q

In front of the afferent arteriole, what happens?

A

The renal artery splits into a bunch of smaller arteries, which eventually become the afferent arteriole for a given nephron.

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98
Q

What defines filtration in the glomerular capillaries?

A

Pressure

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99
Q

What is GFR?

A

Glomerular Filtration Rate - Amount of filtration sent into a compartment to process what has been filtered

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100
Q

Is increased or decreased GFR what we want?

A

Increased GFR is typically better

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101
Q

The total filtration of all glomerular capillaries is ____ mL/min; assuming they are all healthy and functional.

A

125mL/min

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102
Q

If renal blood flow is low, what will the afferent arteriole do?

A

It will relax (dilate) to increase blood flow to glomerulus

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103
Q

If renal blood flow is high, what will the afferent arteriole do?

A

It will constrict to decrease blood flow to glomerulus

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104
Q

What is the plasmic oncotic pressure at the end of the glomerular capillary?

A

36 mmHg

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105
Q

What is the plasmic oncotic pressure in the middle of the glomerular capillar?

A

32 mmHg

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106
Q

Why does the plasmic oncotic pressure increase from the beginning to the end of the glomerular capillary?

A

we lose a lot of fluid due to filtration leading to an increase in concentration in the plasma

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107
Q

What is the hydrostatic pressure in the tubule?

A

18 mmHg

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108
Q

What creates the hydrostatic pressure in the tubule?

A

The fluid filling up in the tubule generates a physical pressure

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109
Q

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

A

0
- if we are healthy we should not be filtering proteins

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110
Q

What is the net filtration pressure in glomerulus?

A

10 mmHg
(60 mmHg - 32 mmHg- 18 mmHg)

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111
Q

How can we determine the filtration rate? What is the normal filtration rate?

A

Filtration rate = Kf x NFP
125ml/min = 12.5 x 10 mmHg

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112
Q

What is Kf?

A

Filtration coefficient
- normal is 12.5

113
Q

Where does the efferent arteriole sit?

A

Behind the glomerular capillaries
- post glomerulus capillary

114
Q

How does the kidney fine tune the GFR?

A

constricts or dilates efferent arteriole

115
Q

What happens to GFR if the efferent arterioles constricts?

A

Upstream pressure increases –> increases blood pressure –> GFR is increased

116
Q

What happens to GFR if the efferent arteriole dilates?

A

Upstream pressure decreases –> decreases blood pressure –> GFR is decreased

117
Q

What is the blood pressure at the end of the efferent arteriole?

A

18 mmHg
(blood pressure drops from 60 to 18 – 42 mmHg difference)

118
Q

Which arteriole has a greater vascular resistance in the kidney?

A

The efferent arteriole has the highest vascular resistance
- efferent drops BP from 60 to 18 – 42 mmHg difference
- afferent drops BP from 100 to 60 – 40 mmHg difference

119
Q

Where does reabsorption happen? What is it?

A

Reabsorb 98-99% of stuff that was filtered at the peritubular capillary

i.e., afferent arteriole –> Glomerular capillary –> Bowmans capsule –> PCT –> reabsorbed at peritubular capillary

120
Q

What is tubular secretion?

A

Cells in peritubular capillaries pump stuff out to the proximal convoluted tubule to be excreted

121
Q

What is excretion?

A

Urine; about 1-2% of what goes through the renal capillaries

Filtration - absorption + secretion = excretion

122
Q

What happens if stuff is filtered at the glomerular capillaries, but we have no specialized transport to reabsorb? (filtration only)

A

What is filtered is lost as urine, and some stays within the renal vein.

123
Q

What happens with filtration; partial reabsorption? What electrolyte mentioned in class follows this pathway?

A

Some filtrate is sent as urine, some stays in the renal vein, and some of the filtrate is reabsorbed back into the peritubular capillaries

Sodium; we eat way more than we need, the body chooses to not reabsorb all of this sodium

124
Q

What happens with filtration with complete reabsorption? What follows this pathway?

A

Will not go to urine - what is filtered gets completely reabsorbed at the peritubular capillaries from the PCT.

Glucose in a non-diabetic patient. If glucose is controlled and in normal limits, all glucose is reabsorbed by the PCT.

125
Q

What does it mean if glucose is found in the urine?

A

Elevated glucose (transporters can’t reabsorb fast enough; spill over)

Something may be wrong with the transport system for glucose reabsorption

126
Q

What happens with filtration with complete secretion?

A

A small portion is filtered at the glomerulus (near afferent arteriole), but then is secreted from peritubular capillaries to the PCT. None shows up in the urine.

127
Q

How much is filtered at the glomerulus?

A

1/5 or 20% of renal blood flow

128
Q

After filtration at the glomerulus, how much of the renal blood flow makes it to the efferent arteriole?

A

4/5, or 80%

129
Q

What is Para-aminohippuric acid (PAH)?

A

Diagnostic compound to estimate renal blood flow; removal from kidney is dependent on how much blood is moving through kidney. If we know how much of this we gave the patient, we can use it to estimate renal blood flow.

130
Q

How does Para-aminohippuric acid (PAH) work?

A

Assume all of the blood in the renal artery has Para-aminohippuric acid (PAH)

The more removed by the time it gets to the renal vein = higher renal blood flow

The less removed by the time it gets to the renal vein = lower renal blood flow

131
Q

Under normal circumstances, what is GFR rate in ml/min?
Reabsorption rate?
How about excretion rate?

A

GFR - 125ml/min
Reabsorption - 124mL/min
Excretion - 1ml/min

132
Q

What is normal renal plasma flow in ml/min?

A

660ml/min

133
Q

Why do we not factor in protein osmotic pressures within the PCT?

A

We don’t really filter proteins normally

134
Q

What are the layers of the glomerular capillaries?

A

Inner - endothelial cells
Middle - connective tissue called the basement membrane
Outside - epithelial cells

135
Q

What’s special about the inner layer of the glomerular capillaries?

A

Much more permeable than generic systemic capillaries

Have openings in wall called fenestrations

136
Q

What’s special about the middle layer of the glomerular capillaries?

A

Connective tissue called the basement membrane

137
Q

What’s special about the outside layer of the glomerular capillaries? What is the other name for these cells?

A

Specialized to provide structural support to the capillary bed

Podacytes

138
Q

What can podacytes be compared to in function?

A

Astrocytes within the blood brain barrier (support the capillaries of the brain)

139
Q

Why are podacytes important?

A

Pressure is very high within glomerular capillaries - provides structural support and prevents swelling. They also keep the surface area of the capillaries in check.

140
Q

What happens to the podacytes/glomerular capillaries if someone has longstanding HTN? (i.e. pressure is 200 instead of 100)

A

Glomerular capillaries swell, fall apart, and lose function

141
Q

Podacytes has processes on them. What are the spaces between these processes called? What is special about the processes?

A

Silt pores

Processes are negatively charged and help repel proteins, which are also usually negatively charged. Proteins can’t make it through fenestrations because of the charge.

142
Q

Which layer of the glomerular capillaries is negatively charged?

A

Epithelium (where podacytes are located; silt pores are here)

143
Q

What is the pressure within bowman’s capsule?

A

0mmHg per daddy

144
Q

What arteriole is in charge of auto regulation of blood flow through the kidneys?

A

Afferent arteriole

145
Q

What arteriole is in charge of autoregularion of fine tuning GFR?

A

Efferent arteriole

146
Q

What happens to downstream pressure when increasing resistance at the afferent arteriole? What happens to GFR?

A

Lower pressure; lower GFR

Renal blood flow DROPS

147
Q

What happens if you constrict the efferent capillary?

A

Pressure inside of the glomerular capillaries rise, GFR rises

Renal blood flow DROPS

148
Q

No matter if the afferent or efferent renal arteriole constricts, what is the similarity?

A

Renal blood flow DROPS

149
Q

If the afferent or efferent arteriole relax, what happens to renal blood flow?

A

Increases renal blood flow

150
Q

What happens if you relax the afferent arteriole?

A

Increase GFR, increase glomerular pressure

Increase renal blood flow

151
Q

What happens if you relax the efferent arteriole?

A

Decrease GFR, decrease glomerular pressure

Increase renal blood flow

152
Q

What is dextran? Is a positive or negative dextran more likely to be filtered?

A

A synthetic sugar; can be larger or smaller based on how many chains are linked together. Used to test filterability in the kidney

A positive dextran is more permeable than a negative dextran due to the negative charge of the epithelial layer or the glomerular capillaries.

Larger + negative charge = less filterable

Smaller + positive charge = more filterable

153
Q

What percentage of everything that is filtered is reabsorbed?

A

99%

154
Q

What is the filterability of water, sodium, and glucose?

A

1.0 - very filterable because they are all small

155
Q

What is inulin? What is its filterability?

A

Can be used to figure out GFR - synthetic, more sensitive than creatinine. Can inject into the patient to determine clearance. Creatinine clearance is variable, and doesn’t follow the same kinetics as inulin.

Filterability is 1.0, just as filterable as water, sodium, and glucose.

156
Q

Is inulin better than creatinine clearance to determine GFR?

A

Yes; but we’re lazy and use creatinine clearance

157
Q

Should myoglobin normally be floating around in our blood? What is the filterability of it?

A

no

Filterability 0.75

158
Q

What is the filterability of albumin? Why don’t we want to filter it?

A

0.005
Very large
If we filter it, it adds to oncotic pressure which changes tendency for reabsorption

159
Q

What pressures can the kidney autoregulate well with in a healthy person? What about someone unhealthy i.e. in the ICU?

A

50mmHg-150mmHg

ICU patients will not fare well with a map of 50mmHg in terms of autoregulation

160
Q

The ability to autoregulate is dependent on what?

A

Afferent arterioles ability to dilate

161
Q

What disease process(s) might lead the afferent arterioles to not be able to dilate as well? How can these patients autoregulate?

A

HTN for years
Uncontrolled DM

Need a higher BP to autoregulate for kidneys to be happy

162
Q

Autoregulation prevents ______ which gives us a relatively constant ____.

A

Over/underperfusion; GFR

163
Q

What percentage of everything that is filtered is excreted?

A

1%

164
Q

How is autoregulation past 150mmHg between renal blood flow and glomerular filtration rate?

A

GFR fares well - line stays pretty flat, the GFR stays more or less the same with a slight rise.

Renal blood flow increases sharply past 150mmHg

165
Q

What is the process reabsorption in the kidney from the tubule back to the per-tubular capillaries?

A

Reabsorption goes through the cells or in between the cells that make up the lining of the tubule –> through the renal interstitium–> then cross the wall of the peri-tubular capillaries

166
Q

If BP is above 150mmHg and renal blood flow is increasing, do we produce a lot more urine?

A

In a healthy person, no. GFR is able to hold onto fluid and not let too much go.

167
Q

If BP is above 150mmHg in someone who did not have good autoregulation, who was unhealthy, what happens to urine output?

A

Someone without good GFR autoregulation at high BP will have a dramatically increased urine output which could be problematic.

Example: CVA resulting in high BP –> Don’t want to lose a liter of fluid per hour, this would be bad

168
Q

What is a normal urine output for a perfectly healthy patient?

A

1ml/min

169
Q

While near autoregulation was a straight line, what is different in the kidneys? What does this mean?

A

Autoregulation in the kidneys is more of a slanted line.

As BP goes up, UOP increases
As BP goes down, UOP decreases

170
Q

Does autoregulation of the kidneys require aldosterone, vasopressin, transporters, etc?

A

No - completely independent. Autoregulation is based on pressure. If pressure goes up, favors fluid reduction and reduced pressures.

171
Q

What is filtration fraction? What is the normal amount for filtration fraction? How is it calculated?

A

How much is filtered vs how much makes it through the kidney

20% is normal

GFR (125ml/min) divided by renal plasma flow (660ml plasma/min)
125/660 = 0.19

172
Q

In the middle of the peritubular capillaries, what is the plasmic oncotic pressure?

A

32 mmHg
- plasma gets diluted which drops pressure from 36 to 32

173
Q

For our class, what is the normal renal blood flow?

A

1100ml/min

174
Q

How is RBC volume calculated in relation to renal blood flow?

A

Renal blood flow is 1100ml/min
If hct is 0.4, take 40% of 1100ml/min. That will give you RBC volume.

175
Q

How do you find renal plasma flow if given renal blood flow?

A

Assuming hct is 0.4.

1-0.4 = 0.6
or
60%

Renal blood flow is 1100ml/min
60% of 1100ml/min = 660ml/min renal plasma flow

176
Q

As filtration fraction was increased, what would happen to blood colloid osmotic pressure? When does this usually occur?

A

Proteins would be more concentrated, which would lead to a higher blood colloid osmotic pressure at the end of the glomerulus.

Normally occurs if the efferent arteriole constricts. When it constricts, more fluid is filtered.

177
Q

What is the blood pressure at the beginning of the Peri-tubular capillaries?

A

18 mmHg

178
Q

What is the average blood pressure in the peri-tubular capillaries?

A

13 mmHg

(end of the peri-tubular capillaries should be lower – he didnt give a number)

179
Q

If we were filtering less fluid, what would happen to the blood colloid osmotic pressure at the end of the glomerulus? When does this normally happen?

A

Would not be as high as normal.

Normally occurs if the efferent arteriole relaxes, which makes it easier for blood to get by. This decreases the amount of fluid filtered.

180
Q
A
181
Q

What is the oncotic pressure in the renal intersitium?

A

15 mmHg

182
Q

What is the hydrostatic pressure in the renal interstitium?

A

6 mmHg

183
Q

What is the Net filtration pressure or the Net reabsorption pressure?

A

Net filtration pressure = - 10mmHg
Net reabsorption pressure = 10 mmHg

184
Q

What percentage of the blood plasma gets filtered?

A

10% or 1/5th

185
Q

where does the tubule empty into?

A

Ureters & fills into bladder

186
Q

What is the process by which we remove things from the body via urine?

A

Excretion?

187
Q

How can we determine excretion?

A

Excretion = filtration - reabsorption + secretion

188
Q

How does secretion work into the tubule?

A

The body can actively pump things it doesn’t want into the tubule – works the opposite of reabsorption – things are pumped out of the peri-tubular capillaries into the renal intersitium –> then cross the cells that make up the walls of the tubule & gets dumped into tubule

189
Q

Excretion can be thought of in terms of in units of ___ or ___

A

Volume or Quantities (quantity of substance dissolved in a volume)

190
Q

What are the several roles of the kidney discussed in lecture?

A
  • long term BP regulator
  • long term pH regulator
  • Long term RBC regulator
  • long term electrolyte regulator
  • long term vitamin D regulator
  • long term glucose regulator
  • Drug clearance
  • long term metabolic waste disposal
  • Osmolarity regulator
191
Q

How does the kidney manage BP?

A

Determines how much volume we have in the CV system

192
Q

How does the kidney manage pH?

A

Regulates acid/base balance
- dictates how much bicarb we reabsorb & can produce its own bicarb
- gets rid of excess protons

193
Q

What is the short term regulator of pH & what is the long term regulator?

A

short term - lungs – can get rid of excess CO2 but not protons
Long term - kidneys – through getting rid of protons & keeping/producing bicarb

194
Q

How does the kidney control RBCs?

A

In the deep medullary kidney, there are sensors that measure blood oxygen levels – if oxygen is low the kidney releases erythropoietin which stimulates the bone marrow to produce more RBCs

195
Q

How does the kidney regulate calcium levels?

A

determines how much we reabsorb & can determine how much we absorb through Vitamin D
– Activation of Vitamin D is controlled by kidney –

196
Q

How does the kidney regulate glucose levels?

A

Normally the more we filter the more we reabsorb
- once reabsorption max is reached glucose will be excreted via in high blood glucose levels (blow off valve)

197
Q

How can kidneys clear drugs?

A

it can transport drugs from the blood stream to the tubule to be excreted via urine (secretory process)

198
Q

How does the kidney control blood osmolarity?

A

Determines how much water we reabsorb second to salt reabsorption – kidney can choose to get rid of salts or be selective of how much water we reabsorb –> the kidney can differentiate between the two & choose what to keep or get rid of

199
Q

How is water retention accomplished in the kidney?

A

ADH
(by osmoreceptors in brain)

200
Q

How does the kidney control most of its roles?

A

Maintaining GFR - auto regulation is important

201
Q

What is the pathway blood flows through starting from the renal artery out to the renal vein?

A

Renal artery –> Segmental arteries –> Interlobar arteries –> arcuate arteries –> interlobular arteries –> afferent arterioles –> Glomerular capillaries –> efferent arterioles –> Peri-tubular capillaries –> interlobular veins –> arcuate veins –> interlobar veins –> segmental veins –> renal veins

202
Q

What is a nephron & what makes up a nephron?

A

The basic functional unit of the kidney
- a nephron consists of the Afferent/efferent arteriole, the glomerular/peri-tubular capillary, & the tubule/collecting duct

203
Q

How many nephrons do we have at birth & when do we begin to lose nephrons?

A

1 million per kidney (2 milli total)
- at age 40

204
Q

What are the two types of nephrons? & what percentage do each take up?

A

Superficial cortical - make up 90-95% of nephrons
Deep medullary nephrons – make up 5-10%

205
Q

A descending splits into more ascending blood vessels, why does this happen & what does this aid in?

A

This slows blood velocity going up the ascending limb
- this helps prevent the washing out of the renal interstitium by maintaining a normal level of solutes in the deep medulla

206
Q

what is the term used to describe the deep peri-tubular capillaries?

A

Vesa Recta

207
Q

Which nephrons are the most sensitive to hypotension/inadequate perfusion?

A

The deep medullary nephrons as there are so few (5-10%) ischemia would most affect here

208
Q

The kidneys are housed underneath what muscle?

A

Diaphragm

209
Q

The renal artery/vein sit beneath what major artery?

A

Mesenteric artery

210
Q

What sits right on top of the kidneys?

A

Adrenal glands

211
Q

The upper part of the right kidney comes into contact with what organ?

A

Liver

212
Q

The middle lateral part of the right kidney come into contact with what?

A

Colon

213
Q

The upper proximal part of the left kidney comes into contact with what organ?

A

Gastric surface (stomach)

214
Q

The upper distal part of the left kidney comes into contact with what organ?

A

Spleen

215
Q

The middle part of the left kidney comes into contact with what organ?

A

Pancreas

216
Q

The lower lateral part of the left kidney comes into contact with what organ?

A

Colon

217
Q

Why is know what comes into what part of the kidney important?

A

Cancer spreading
- Cancer of the kidney itself is very rare as it doesnt really generate new nephrons – most cancer of kidney is due to infiltration

218
Q

Where is kidney stone pain referred to ?

A

Back

219
Q

As men age the prostate gland enlarges, what issue does this cause?

A

The larger the prostate the more is squeezes the urethra & makes it difficult to empty the bladder
(us men have it so difficult :( )

220
Q

What controls emptying of the bladder?

A

SNS & PNS
- example – if we are nervous we may lose control of bladder or have inability to empty bladder

221
Q

Which nerve is in control of the bladder & solid waste? & what does it come off from?

A

Pudendal nerve
- comes from S2,S3, & S4

222
Q

What is the pudendal nerve also in charge of?

A

ERECTIONS

223
Q

What is the pathway from the beginning of the tubule to the end

A

Bowman’s capsule (Corpuscle) –> Proximal tubule –> proximal straight tubule –> Descending thin limb –> Ascending thin limb –> Ascending thick limb –> Distal convoluted tubule –> Cortical collecting duct –> Medullary collecting duct –> empties into papillary duct

224
Q

What makes up the Loop of Henle?

A

Descending thin limb, Ascending thin limb & Ascending thick limb

225
Q

Where are the Macula Densa found per lecture?

A

Thick Ascending limb

226
Q

What is the role of the Macula Densa? & what does it come into contact with?

A

Tells the kidney how much is being filtered - monitors filtration rate by acting like a speedometer
- is in contact with Afferent & Efferent Arterioles

227
Q

If the Macula Densa senses flow is low, what happens?

A

The Juxtaglomerular cells connected to the afferent/efferent arterioles release renin –> renin eventually gets converted to Angiotensin II –> this constricts the Efferent Arteriole –> increases pressure in glomerulus –> filtration is increased

228
Q

If Macula Densa senses flow is too low what happens?

A

Renin production is reduced –> leads to dilation of efferent arterioles

229
Q

Who was Linus Pauline? Why was he important?

A

Chemist who had prostate cancer for 25years

  • there is a correlation between cancer and antioxidants, such as vitamin C

-Antioxidants help prevent free radical oxidative stress

230
Q

What does renal clearance describe?

A

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

231
Q

If the kidney reabsorbs lots of fluid, but not the substance that is in the fluid, clearance is what?

A

High

232
Q

If the kidney reabsorbs all of the fluid and substance that it is filtering, clearance is what

A

Low

233
Q

in regard to clearance, what unit does the following use?

Plasma
Time

A

ml

Minute

234
Q

Will clearance ever be L/min?

A

No - it will only ever be mL/min

235
Q

Where can clearance be something other than mL/min?

A

Hepatic clearance

236
Q

If our body wants to keep a substance in the body and reabsorbs a lot of it, clearance is what?

A

Low

237
Q

How is excretion rate calculated?

A

Urinary flow rate (1ml/min) x urinary concentration of the compound = excretion rate

238
Q

How do you calculate renal clearance?

A

(Urinary flow rate x concentration of the compound)/Plasma = Renal clearance

239
Q

How many nephrons do we have per kidney in a healthy person?

A

1,000,000 (one million PER kidney)

240
Q

How many nephrons collectively filter 125mL/min?

A

2,000,000 (two million)

241
Q

How much do we reabsorb at the peritubular capillaries per minute?

A

124ml/min (99% of what is filtered, leaving 1ml/min of urine)

242
Q

What is the symbol in equations for urine output?

A

v̇

Note: can also be v̇u̇, but not commonly

243
Q

What does the dot mean with v̇?

A

volume per unit of time

244
Q

If something is small and positively charged, would it be hard or easy to filter? Would this fluid have the same or different composition in Bowmans capsule vs the glomerulus?

A

Easy

Roughly the same composition EARLY in Bowmans capsule

245
Q

How much stuff is reabsorbed at the proximal convoluted tubule?

A

2/3 of everything

246
Q

If we have normal glucose levels, how much is reabsorbed at the proximal tubule?

A

All of it

247
Q

Does glucose have a low or high clearance normally?

A

No clearance at all at normal glucose levels

248
Q

If glucose is 900, will our clearance be zero?

A

No - will have some spill over into the urine which would result in a non-zero clearance.

249
Q

If you have a compound that is freely filtered, does not have reabsorption pump/process, how much plasma would be reabsorbed?

A

124ml, and none of the compound.

250
Q

If you have a compound that is freely filtered, does not have reabsorption pump/process, where would the compound be?

A

It would stay within the proximal convoluted tubule and make its way to the bladder.

251
Q

If you have a compound that is freely filtered, does not have reabsorption pump/process, how would the concentration of said substance change throughout the tubule system?

A

Early on in the PCT the concentration would be the same as it was in the glomerulus.

Later in the PCT, after 124ml plasma is reabsorbed at the peritubular capillaries, the 1ml of urine will become more concentrated with the substance as it flows to the bladder.

252
Q

What should clearance be close to? What is the typical number we use?

A

GFR; 124ml/min

253
Q

What happens to concentration of fluid within the peritubular capillaries?

A

It becomes dilute as it heads to the renal vein. This is due to reabsorption of 124ml/min of fluid. The fluid dilutes what fluid is there.

254
Q

Is the renal vein more concentrated than the peritubular capillaries?

A

No

Peritubular capillaries are more concentrated than the renal vein.

255
Q

If you are dividing two fractions, how can you make it easier?

A

Multiply by the reciprocal of the denominator

256
Q

How many ml are in one dL?

A

100

257
Q

How many dL are in 500ml?

A

5

258
Q

If something is freely filtered, how does it compare to what is sent to the urine if it doesn’t reabsorb?

A

The amount filtered is the same amount that goes to the urine.

259
Q

How is concentration in plasma typically described?

A

1mg/dL

260
Q

If the concentration of a substance is 1mg/dL, and we freely filtered 125ml/min, how much of the substance are we filtering per minute?

A

125mL –> 1.25dL
1.25dL/min x 1mg = 1.25mg/min

261
Q

If the concentration of a substance is 1mg/dL, and we freely filtered 125ml/min, we are clearing 1.25mg/min of the substance. What would the concentration be? How about the excretion rate?

A

1.25mg/ml of urine

Excretion is 1.25mg/min

262
Q

What is excretion rate?

A

Quantity of stuff lost in the urine over a minute

263
Q

What is the gold standard for finding GFR? How many readings to we take?

A

Inulin

Two (measure two minutes after administration, then another time after another two minutes)

264
Q

What are the renal characteristics of inulin?

A

Freely filtered, not reabsorbed or secreted. Great to find GFR. Exogenous.

265
Q

What is typically used to measure GFR? Why is this variable?

A

Creatinine clearance.

Creatinine is endogenously produced, some is released continuously as it is a byproduct of skeletal muscle. This leads to artificially high GFR readings.

266
Q

Would a frail person have a high or low creatinine level? How does this relate to GFR/creatinine clearance?

A

Low

GFR/creatinine clearance would be low due to lack of creatinine. Use inulin to get accurate measure of kidney function.

267
Q

If we have a compound that is fully secreted/pumped into the PCT, what is the clearance rate? What would this be equal to? Would any of the substance be in the renal vein?

A

Very high

Renal plasma flow

None in the renal vein

268
Q

How does the kidney get rid of Para-aminohippuric acid (PAH)? What does this mean for clearance rate and renal plasma flow?

A

It has massive amounts of transporters at the peritubular capillaries that secrete it back into the PCT. The clearance rate is very high, and the renal plasma flow is equal to the clearance rate.

269
Q

Does Para-aminohippuric acid (PAH) make it to the renal vein?

A

No; heavily/totally secreted into the PCT.

270
Q

Review renal formulas in Guyton chapter 28

A

Daddy said please

271
Q

How can we use Para-aminohippuric acid (PAH) to calculate renal blood flow?

A

Clearance rate of Para-aminohippuric acid (PAH) is equal to the renal plasma flow.

Divide renal plasma flow (RPF) by (1 minus HCT level) –> will give renal blood flow

272
Q

The Guyton textbook makes an adjustment to the % of Para-aminohippuric acid (PAH) removed from the kidney. How much is actually removed from the kidney?

A

90% of Para-aminohippuric acid (PAH) is removed from the kidney.

273
Q

According to Guyton, how much Para-aminohippuric acid (PAH) did Daddy say makes it into the renal vein?

A

10%

274
Q

Formula for excretion rate is

A

Concentration x amount (how long we took the urine sample were direct words)

***review the book please

275
Q

What is the formula for secretion rate?

A

Excretion rate - filtered load

276
Q

What is the formula for reabsorption rate?

A

Filtered load - excretion rate

277
Q

What should we know how to do with all of the formulas?

A

Rearrange them to solve for each part of the equation; keep your eyes on units

278
Q
A

A & P (6 decks)

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