Final: Renal Flashcards
1
Q
Total body water ___ of body weight
A
60%
2
Q
2-3 of 60% is in
A
ICF
3
Q
1/3 of 60% is
A
ECF
4
Q
3/4 of ECF is
A
ECF in interstitial fluid
5
Q
1/4 of ECF is
A
ECF in plasma
6
Q
Presence of excess fluid in body tissues
A
Edema
7
Q
Intracellular edema due to
A
Hyponatremia
Metabolic depression
Lack of adequate nutrition
8
Q
Extracellular edema due to
A
Fluid leakage Lymphatic failure (lymphedema)
9
Q
Hypernatremia can be due to
A
Dehydration (water loss)
Over hydration (excess NaCl)
10
Q
Effects of hypernatremia tend to be
A
Less severe
Cells resist damage from shrinkage
11
Q
Dehydration causing hypernatremia can be due to
A
Excessive sweating
Lack ADH production (diabetes insipidus)
12
Q
Over hydration resulting in hypernatremia can be due to
A
Abnormally high secretion of aldosterone
13
Q
MC electrolyte disorder
A
Low Na
Hyponatremia
14
Q
Hyponatremia can result in
A
Edema
Brain swelling and damage
Death
15
Q
Normal levels of Na
A
135-145 meq/L
16
Q
Hyponatremia can be due to
A
Dehydration (loss of NaCl)
Overhydration (over retention of water)
17
Q
Over retention of water due to
A
Abnormally high secretion of ADH
18
Q
Dehydration causing hyponatremia due to
A
Diarrhea
Vomiting
19
Q
Cell in hypertonic fluid
A
Shrink (water moves out of cell)
More than .9% NaCl solution
More than 5% glucose solution
20
Q
Cell in hypotonic solution
A
Cell swells (water moves in)
Less than .9% NaCl
Less than 5% glucose solution
21
Q
Isotonic solution means impermeable solutes have osmolarity of about
A
290 mOsm/L
22
Q
Osmolarity
A
Osmoles per L of water
23
Q
Osmolality
A
Osmoles per kg of water
24
Q
Osmoles
A
Number of particles in solution
25
Equilibrium pressure between hydrostatic pressure and
Osmotic forces generated by addition of solute
26
Osmotic pressure is proportional to
Number of active or dissociable solutes in solution
27
Kidney synthesizes and secretes what 3 major hormones
1. Renin
2. EPO
3. 1,25 dihydroxycholecalciferol
28
Renin
Stimulates angiotensin 2 formation and aldosterone secretion
29
EPO
Stimulates RBC production
30
Activated Vit. D
Widespread effects including Ca absorption from GI tract
31
Kidneys excrete
Harmful substances
| Things in excess
32
Kidneys regulate
Volume
Composition
PH
33
Role of renal system
```
Filtration
Reabsorption
Secretion
Excretion
Water/electrolyte balance
PH regulation
Control circulating volume
Hormone secretion
Site of hormone action
Gluconeogenesis
```
34
Examples of water soluble wastes excreted by renal system
Urea
Creatinine
Uric acid
35
Function of ADH
Concentrate urine
36
Activated Vit D also enhances ___
Immune function
37
Activated Vit D aka
Calcitriol
38
Gluconeogenesis uses what 3 things
AA (alanine)
Glycerol
Lactate
39
Renal functions to reabsorb virtually all filtered glucose in
PCT
40
2 kidneys, ___ each
150 grams
41
Standing, kidneys located
L1-L4
42
T/F
| Kidneys retroperitoneal
True
43
Calyces, renal pelvis, and ureter contract to
Propel urine to bladder
44
Sym. Pre fibers from
T10 to L2
45
Symp Post SNS fibers to kidney via
Renal plexus
46
Symp post fibers project to
Individual nephrons
47
SNS stimulation
Constriction of arterioles
Decrease urinary output
48
SNS can also signal kidneys to
Increase sodium reabsorption
Increased renin release
49
Unique blood flow of kidneys
2 sets capillary beds
| 2 sets arterioles in series
50
Afferent arterioles give rise to ___ which are drained by ____ which give rise to ___
Glomerular capillaries
Efferent arterioles
Peritubular capillaries
51
All filtration takes place in
Glomerular capillaries
52
All reabsorption takes place in
Peritubular capillaries
53
Glomerular capillaries have ___ hydrostatic pressure
High
| Kept constant by efferent arterioles
54
Peritubular capillaries have ___ hydrostatic pressure
Lower
55
Functional unit of kidney
Nephron
56
Each kidney has ___ nephrons
800,000 to 1 million nephrons
57
85% of nephron
Cortical nephron
58
In cortical nephron, glomerulus is
Higher to cortex
59
15% of nephrons
Juxtamedullary nephron
60
Juxtamedullary nephron glomerulus closer to
Medulla
61
___ capable of concentrating urine
Juxtamedullary nephron
62
T/F
| Kidney able to regenerate nephrons
False
63
Approximate loss of nephrons
10% loss every 10 years
64
Can live with ____ of original number of nephrons
25%
65
Major step in emptying bladder
Contraction of detrusor muscle
| Increase pressure by 40-60 mmHg
66
Ureters enter bladder at
Upper trigone
67
Surface of trigone
Smooth mucosa
68
Surface of bladder mucosa
Folded rugae
69
Tone of ___ shuts down ureters
Detrusor
70
Bladder neck composed of
Detrusor muscle
| Elastic tissue
71
Muscle at bladder neck is
Internal sphincter (only in males)
72
External sphincter muscle is ___ and under
Skeletal muscle
Voluntary control
73
Pudendal N innervates
External bladder sphincter
Under voluntary control
74
Sympathetic innervation to bladder through _____ and stimulates ____
Hypogastic Nerves (L2)
Blood supply to bladder
75
Pelvic nerves supplying bladder
Through sacral plexus
S2, S3
76
Sensory fibers in bladder detect
Stretch of bladder wall
77
Para motor fibers in bladder innervate
Detrusor muscle
78
Order of urine flow
```
Nephron
Collecting ducts
Renal calyces
Ureters
Bladder
```
79
Urine flow from collecting ducts to renal calyces causes
Peristaltic contractions
80
Peristaltic contractions occur in
Renal pelvis and ureters
Forces urine from kidneys to bladder
81
Ureterorenal reflex
Severe pain (kidney stone)
Reflex constriction of renal arterioles
Decrease flow of fluid to kidney with blocked ureter
82
Micturition reflex causes a nervous reflex to cause
An urge to urinate
83
Micturition reflex controlled by
ANS (coordinated by Centers in midbrain)
84
When bladder is filling ___ Control predominates
SNS
85
Filling of bladder, SNS causes
Relaxation of detrusor (beta)
| Contraction of internal sphincter (alpha)
86
Full bladder sensed by ____ in bladder wall
Mechanoreceptors
87
To empty bladder, PSNS does what?
Contract detrusor muscle
Relax internal sphincters
88
Micturition contractions vary in length of ___ and ___ and generally ___ as more urine added
Contraction and intensity
Increases
89
As micturition reflex increases, reflex passes through ____ to external sphincter
Pudendal N
90
Urination can be facilitated or inhibited by Centers in ___ and ___
Pons
Cerebral cortex
91
Voluntary urination involves
Contraction of abdominal muscles
Increase pressure in bladder
Increase urine that enters bladder neck
Empties all urine from bladder
92
Input and output of fluid must be adjusted to
Maintain ECF
Maintain osmolality
93
Typical daily fluid intake
2300 ml/day
94
Insensible water loss includes
Breathing
Through skin
95
Loss of body water includes
Insensible loss
Sweating
Feces
Excreted via kidneys
96
40% of total body weight
Intracellular fluid
97
Intracellular fluid low in
Sodium
Calcium
Chloride
98
Intracellular fluid high in
Potassium
| Phosphate ions
99
20% of total body weight
Extracellular fluid
100
Plasma and intestinal fluid make up
Extracellular fluid
101
ECF low in
Potassium
Phosphates
Protein
102
ECF high in
Sodium
Chloride
Bicarbonate
103
Volume of body fluid compartment depends on amount of
Solute in contains
104
Major cation in ECF
Na
105
Major anions in ECF
Cl
| HCO3
106
Diarrhea
Loss if sig amount of isosmotic fluid from GI tract
Results in decrease in ECF volume
107
Water deprivation (sweating) results in
Hyperosmotic volume contraction
108
In hyperosmotic state, ECF osmolarity ___ ICF osmolarity
>
109
In hyperosmotic situation, fluid shift from
ICF —> ECF
110
Adrenal insufficiency (Addison’s disease) results in
Hyposmotic volume contraction
111
Low aldosterone results in
High excretion of NaCl in urine
112
In hyposmotic volume contraction, ECF osmolarity ___ ICF osmolarity
<
113
Isosmotic volume expansion, all fluid infused up in
ECF
114
High NaCl intake results in
Hyperosmotic volume expansion
115
Syndrome of inappropriate ADH results in
Hyposmotic volume expansion
116
Secrete excess ADH results in
Too much water reabsorbed by kidney
117
Measure of renal function
Glomerular filtration rate
118
Normal GFR
> 90ml/min
119
Chronic kidney disease, GRF ___
Reduced
120
If GFR < 15 ml/min
Kidney failure
121
Renal clearance
Describes rate at which substances removed from plasma
122
Inulin clearance =
GFR
123
Inulin is neither ___ or ___
Reabsorbed
Secreted
124
Para-aminohippuric acid (PAH)
Organic acid both filtered and secreted
Highest clearances
125
Used to estimate GFR in clinical practice
Creatinine
126
Kidneys receive about ____ of resting CO
1/4
127
More alpha 1 receptors are
Afferent arterioles
128
Angiotensin 2 potent vasoconstrictor of both
Afferent arterioles
| Efferent arterioles
129
__ more sensitive to angiotensin 2
EA
130
Low levels angiotensin 2
Increase GFR by constricting EA
131
High levels angiotensin 2
Lower GFR by constricting both AA and EA
132
SNS stimulates low
GFR and RBF
133
SNS stimulates release of
Renin from Juxtaglomerular cells
134
Prostaglandins are produced locally and cause
Vasodilation of both AA and EA
135
NSAIDS inhibit
PG synthesis
136
Low levels of dopamine
Dilate renal arterioles and cerebral, cardiac, splanchnic arterioles
Constrict skeletal muscle and cutaneous arterioles
137
Proximal tubules produce
Dopamine
138
Dopamine ___ renin secretion
Inhibits
139
Myogenic hypothesis
Increase arterial BP stretches blood vessels —> cause reflex constriction
140
Tubuloglomerular feedback
High RBF —> high GFR
Increase delivery of solute and water to macula densa
Increase resistance of AA by release of local constrictor
141
Charge on glomerular capillary
Negative
