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Phys 335 > Final Exam Renal > Flashcards

Final Exam Renal Flashcards

1
Q

Renal Functions (5)

A
  • Regulation of water, inorganic ion balance, and acid-base balance (in cooperation with lungs)
  • Removal of metabolic wastes
  • removal of foreign chemicals
  • gluconeogenesis
  • production of hormones/enzymes
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2
Q

Why is regulation of water important?

A

-vary amt of urine to keep water content same

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3
Q

examples of metabolic waste products in the blood

A
  • creatinine –> creatine
  • amino acids –> urea
  • nucleic acids –> uric acids
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4
Q

examples of foreign chemicals in blood

A
  • medications, pesticides, plant alkaloids
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5
Q

gluconeogenesis is mostly the ___ job

A
  • liver
  • kidneys do a little
  • A.A. and lactate to glucose
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6
Q

Renal Hormones

A
  • Erythropoietin
  • Renin
  • 1,25-dihydroxyvitamin D
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7
Q

Erythropoietin job

A
  • controls erythrocyte (RBC) production by stimulating bone marrow
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8
Q

Renin job

A
  • enzyme that controls the formation of angiotensin and influences blood pressure and sodium balance
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9
Q

1,25-dihydroxyvitamin D

A
  • influences calcium balance (bone growth, rickett’s)
  • activated by UV light
  • liver makes 25-dihydroxy.. kidney attaches OH group at alpha position
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10
Q

Structures of Urinary System

A
  • Kidney (retroperitoneal)
  • Ureter (smooth muscle)
  • Bladder
  • Urethra (internal & external sphincters)
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11
Q

Parts of Kidney

A
  • Cortex
  • Medulla (includes renal pelvis)
  • Pelvis
  • Artery
  • Vein
  • Pyramids
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12
Q

Functional unit of the kidney

A
  • nephron

- ~1 mil/kidney

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13
Q

types of nephrons

A
  • Juxtamedullary Nephron

- Corticol Nephron

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14
Q

Juxtamedullary Nephron

A
  • extends down into medulla from cortex
  • ~15 % of nephrons
  • has a vasa recta
  • interactions with peritubular capillaries at the tubules
  • evolutionarily: help conserve water
  • produce renal medullary gradient
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15
Q

Cortical Nephron

A
  • very little/no part of loop of henle reaches the medulla

- still interacts with peritubular capillaries at the tubules

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16
Q

Renal Artery (branched or na?)

A

branched

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17
Q

Renal Artery and Veins run where?

A
  • between the medulla and cortex
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18
Q

Bowman’s capsule consists of ______

A
  • glomerular capillaries

- bowman’s space

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19
Q

Bowman’s capsule is similar to what other structure in the body?

A
  • Pleural Sac in Lungs

- Fist in water balloon (fist is capillaries, water balloon is bowman’s space)

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20
Q

Juxtaglomerular apparatus

A
  • Macula Densa
  • Juxtaglomerular (JG) cells
  • consists of the distal tubule and the glomerular afferent arteriole
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21
Q

Macula Densa

A
  • in Juxtaglomerular Apparatus
  • Part of distal tubule
  • senses flow and sends paracrine signals to afferent arterioles
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22
Q

JG cells

A
  • part of juxtaglomerular apparatus
  • part of afferent arteriole
  • senses pressure and releases renin when it is low
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23
Q

How does vasoconstriction and renin secretion happen?

A
  • via NE to alpha-1 adrenergic receptors (from the VM)
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24
Q

Glomerular Filtrate

A
  • plasma without cells or proteins
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25
Q

What isn’t filtered?

A
  • proteins (too large)
  • some plasma Ca
  • most plasma fatty acids b/c they’re bound to proteins
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26
Q

% of plasma filtered?

A
  • 20%, 80% continues in efferent arteriole
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27
Q

Filterable substances that are drugs and toxins (what happens to them)

A
  • removed by both filtration and secretion (virtually 100%)
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28
Q

Filterable substances necessary for body function (what happens to them)

A
  • undergo regulated reabsorption
  • varies in amount depending on amount ingested or produced in the body
  • ex.) Na, Cl
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29
Q

valuable filterable substances (what happens to them)

A
  • virtually all reabsorbed

- ex.) glucose, needed for energy

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30
Q

Three layers to filtration

A
  • enDOthelium (w/ leaky pores) on capillaries
  • basement membrane
  • Bowman’s EPIthelium
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31
Q

Fact about basement membrane

A
  • negative charge repels plasma proteins, cells are too big for filtration
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32
Q

Normal GFR

A
  • Glomerular Filtration Rate
  • 125 ml/min
    180 L/day
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33
Q

Filtration facts

A
  • leaky barrier

- high pressure favoring filtration

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34
Q

Podocyte

A
  • foot processes attached to bowman’s space
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35
Q

Starling Forces

A
  • Favoring filtration: P(gc) (60)
  • Opposing filtration: P(bs) (15)
  • pi(gc) (29)
  • total: 16mmHg favoring filtration
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36
Q

Starling Forces equation

A
  • Net glomerular filtration pressure= P(gc)-P(bs)-pi(gc)
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37
Q

why is pi(bs) not in equation?

A
  • because proteins aren’t in bowman’s space
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38
Q

What regulates P(gc)

A
  • renal arterioles
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39
Q

what determines pi(gc)

A
  • plasma protein concentration
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40
Q

how can P(bs) increase?

A

-if urinary tract is blocked

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41
Q

How is P(gc) regulated?

A
  • renal arterioles increase/decrease GFR
42
Q

Decreased GFR (2 ways)

A
  • constrict AA

- dilate EA

43
Q

Increased GFR (2 ways)

A
  • constrict EA (overhydrated, forces filtration)

- dilate AA (caffeine does this)

44
Q

equal dilation or constriction of AA and EE

A
  • doesn’t change GFR much, but changes blood flow

- change independently

45
Q

Load

A
  • rate of solute (mg/min)
46
Q

Filtered Load Equation

A

FL=GFRxP([s]) –> plasma [] of substance

47
Q

Excreted Load (2 equations)

A 
EL= VxU([s])
EL= filtered load+secreted load-reabsorbed load
V= rate of urine formation
U([s]) = urine [] of substance
48
Q

Tubular Reabsorption

A
  • either by diffusion through gap juncts or mediated transport
  • from interstitial to peritubular capillary: combo of diffusion and bulk flow
  • normally hydrated person, 99% of filtrate volume is reabsorbed
  • tight juncts vary by region
49
Q

Is filtration diffusion or bulk flow?

A
  • bulk flow
50
Q

barriers to reabsorption (pathway taken)

A
  • Luminal (=apical) membrane
  • basolateral membrane (on epithelial cells of tubule)
  • renal interstitum
  • peritubular capillary wall
51
Q

Majority of reabsorption

A
  • happens at the proximal tubule

- but also at loop of henle, distal tubule, and collecting duct

52
Q

Luminal Membrane

A
  • between tubule and epithelial cells
53
Q

Basolateral membrane

A
  • between epithelial cell and peritubular fluid
54
Q

Renal Interstitum

A
  • interstitial fluid between epithelial cells and capillary
55
Q

Peritubular capillary wall

A
  • between renal interstitum and capillary
56
Q

Types of molecs that are reabsorbed by diffusion

A
  • molec like urea and lipid soluble subustances (nonpolar)
57
Q

Reabsorption by mediated transport proteins

A
  • slower
  • can be saturated
  • large/charged substances
58
Q

Transport Maximum

A
  • rate or reabsorption of substances that need transport proteins
59
Q

Plasma concentrations and reabsorption

A
  • low plasma concentration, filtration will probs equal reabsorption
  • high plasma concentrations, filtration will probably exceed reabsorption
60
Q

Glucose

A
  • important for energy, virtually all will be reabsorbed
  • cannot be secreted, only filtered and reabsorbed
  • no more transporters past the proximal tubule, will be excreted if missed
61
Q

Tubular Secretion

A
  • Foreign chems, drugs, toxins, hormones. K and H are all secreted
  • usually by active transport mechanisms
  • mostly secretion into proximal tubules
62
Q

Where are K and H secreted

A
  • cortical collecting duct (H also into proximal)
63
Q

Renal Clearance

A
  • how “good” the kidney is at cleaning the blood
  • volume plasma cleaned OF substance per unit time
    • aka ml of plasma no longer containing S
64
Q

units of renal plasma clearance

A
  • ml plasma/min
65
Q

RPC=GFR when?

A
  • substances that filter but are not secreted or reabsorbed

- inulin

66
Q

RPC=Renal Plasma Flow when?

A
  • substances that are filtered and COMPLETELY secreted
67
Q

Clinical test of GFR

A
  • creatinine clearance

- b/c creatinine is cleared entirely from the kidneys so RPC=GFR

68
Q

How much of total CO do kidneys receive?

A

20%

69
Q

Glucose RPC

A

should be 0% (all glucose reabsorbed.. no plasma no longer containing glucose)

70
Q

Micturition

A
  • mech that allows urine to be excreted
71
Q

Detrusor

A
  • walls of bladder
  • smooth muscle
  • parasymp acts to contract
72
Q

Internal Sphincter

A
  • autonomic
  • sm. muscle
  • symp causes contraction
73
Q

External sphincter

A
  • conscious opening and closing
  • skel. muscle
  • somatic motor causes contraction
74
Q

Bladder Filling

A
  • detrusor relaxed, low parasymp tone
  • internal sphincter contracted
  • external sphincter contracted
75
Q

Bladder emptying

A
  • high parasymp tone
  • contracts detrusor muscle
  • relaxes internal sphincter
  • relaxes external sphincter (inhibition of somatic)
76
Q

Neonates Micturition

A
  • reflexive, integrated in lumbar and sacral cord
77
Q

Older Micturition

A
  • controlled, integrated in brain
78
Q

Where sodium goes _____ goes

A

Chloride

79
Q

water gain/water loss per day in adults

A
  • input = output

- 2850ml

80
Q

water outputs

A
  • insensible loss
  • sweat
  • feces
  • urine
81
Q

daily NaCl intake

A
  • 8.5 g
  • 0.25 lost in sweat, 0.25 lost in feces
  • rest lost in urine
  • if take in >8.5 g, more will be excreted in urine
82
Q

Fluid compartments: volume in ICF

A

28L

83
Q

Plasma volume

A

3L

84
Q

ISF volume

A

11L

85
Q

total body NaCl is proportional to ECF volume

A
  • high sodium content in plasma, water out of ICF to balance it
86
Q

Where is most Na reabsorbed?

A
  • proximal tubules

- look at chart on page 101

87
Q

When MABP is normal, what is going on in proximal tubule and loop of henle?

A
  • Na reabsorption is high and constant
  • water permeability is high
  • reabsorption of Na and H2O are coupled
88
Q

When MABP is normal, what is going on in the distal tubule and collecting duct?

A
  • Na reabsorption is regulated by aldosterone and NOT directly coupled with water
  • water permeability regulated by ADH and requires the renal medullary gradient
89
Q

if we filter 100% of nacl and h2o, how much nacl and h2o is reabsorbed at the proximal tubule?

A
  • 67%
90
Q

if we filter 100% of nacl and h20, how much nacl and h20 is reabsorbed at the descending loop of henle?

A
  • h20= 20%

- nacl= 0%

91
Q

if we filter 100% of nacl and h2o, how much nacl and h2o is reabsorbed at the ascending loop of henle?

A
  • h2o= 0%

- nacl= 25%

92
Q

if we filter 100% of nacl and h2o, how much nacl and h2o is reabsorbed at the corticol collecting duct?

A
  • nacl= 0-2%, (0 if too much salt in body, 2% normal)

- h2o= 0%

93
Q

if we filter 100% of nacl and h2o, how much nacl and h2o is reabsorbed at the medullary collecting duct?

A
  • nacl = 0
    =h2o = 1-13% (1% over hydrated, 13% dehydrated)
    • ADH works towards the 13%
94
Q

ADH causes what in collecting ducts?

A
  • aquaporin insertion
95
Q

low ADH, what happens at the cellular level?

A
  • aquaporins pulled back in from membrane
96
Q

mechanism for aquaporin insertion?

A
  • ADH binds to GPCR
  • activates adenylate cyclase
  • ATP to cAMP
  • vesicles with aquaporins fuse to luminal membrane
97
Q

what side of collecting duct cells always has aquaporins?

A
  • basolateral membrane
98
Q

what nephrons create renal medullary gradient and what nephrons use it?

A
  • juxtamedullary nephrons make it

- all nephrons flow through and use it

99
Q

how much of a difference can the osmolarity of the ascending limb be from the interstitial?

A
  • 200mOsm
100
Q

what comes out of the descending limb and what comes out of the ascending limb? What type of transport for both?

A

-H2O out of descending (diffusion), NaCl out of ascending (active transport)

Phys 335 (3 decks)

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