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Renal > First Aid Renal Physiology > Flashcards

First Aid Renal Physiology Flashcards

1
Q

Ureters pass under what structures?

A

Uterine artery (female) or vas deferens (males)

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2
Q

Potassium inside the cell?

A

High (HIKIN’ = HIgh K Intracellular)

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3
Q

60-40-20 rule

A

60% of body is water, 40% of body is ICF, 20% of body is ECF

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4
Q

How do you measure plasma volume?

A

radiolabeled albumin

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5
Q

How do you measure extracellular volume?

A

inulin

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6
Q

what is the osmalarity of plasma?

A

290

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7
Q

responsible for filtration of plasma according to size and net charge

A

glomerular filtration barrier

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8
Q

what is the size barrier of glomerular filtration?

A

fenestrated capillary endothelium

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9
Q

what is the negative charge barrier of glomerular filtration?

A

fused basement membrane with heparin sulfate

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10
Q

what does the epithelial layer of glomerular filtration barrier consist of?

A

podocyte foot processes

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11
Q

The charge barrier is lost in XXXX, resulting in albuminuria, hyporoteinuria, generalized edema, and hyperlipidemia

A

nephrotic syndrome

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12
Q

how do you calculate clearance?

A

(urine concentration x urine flow rate)/plasma concentration

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13
Q

when clearance is greater than GFR?

A

net secretion

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14
Q

when clearance is less than GFR?

A

net reabsorbtion

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15
Q

inulin clearance can be used to calculate GFR because it is

A

freely filtered and neither reabsorbed nor secreted

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16
Q

normal GFR =

A

100 ml/min

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17
Q

creatinine clearance slightly overestimates GFR because it is

A

moderately secreted by the renal tubules

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18
Q

ERPF can be estimated using PAH clearance because

A

it is both filtered and actively secreted in the proximal tubule (all PAH entering the kidney is excreted)

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19
Q

RBF =

A

RPF/(1-HCt)

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20
Q

EFPF underestimates true RPF by

A

~10%

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21
Q

FF =

A

GRF/RPF

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22
Q

What dilates afferent arterioles?

A

Prostaglandins

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23
Q

Prostaglandins dilate afferent arterioles –>

A

increased RPF, increased GFR, and no change in FF

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24
Q

NSAID effect on kidney

A

block prostaglandins –> constrict afferent artery –> decreased RPF, decreased GFR, and no change in FF

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25
Q

Angiotensin II preferentially constricts efferent arteriole –>

A

decreased RPF, increased GFR, increased FF

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26
Q

ACE inhibitors preferential vasodilates efferent arteriole –>

A

increased RPF, decreased GFR, decreased FF

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27
Q

what is the effect on RBF, GFR, and FF with increased plasma protein concentration

A

NC
Decreased
Decreased

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28
Q

what is the effect on RBF, GFR, and FF with decreased plasma protein concentration?

A

NC
Increased
Increased

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29
Q

what is the effect on RBF, GFR, and FF with ureter constriction?

A

NC
Decreased
Decreased

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30
Q

filtered load =

A

GFR x Plasma concentration

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31
Q

Excretion rate =

A

urine flow x urine concentration

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32
Q

reabsorption =

A

filtered - excreted

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33
Q

secretion =

A

excreted - filtered

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34
Q

Glucose at a normal plasma level is completely reabsorbed in PCT by

A

Na_/glucose cotransport

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35
Q

glucose threshold

A

160

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36
Q

glucose Tm

A

350

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37
Q

Normal pregnancy reduces absorption of what in the PCT?

A

amino acids and glucose

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38
Q

amino acid clearance

A

sodium dependent transporters in PCT

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39
Q

deficiency of neutral amino acid (tryptophan) transporter; results in pellagra

A

Hartup’s disease

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40
Q

PCT reabsorbs all glucose & AA, and most (5 things)

A 
bicarb
sodium
chloride
phosphate
water
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41
Q

PCT absorption does what to tonicity?

A

isotonic

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42
Q

generated and secreted by PCT to act as a buffer for secreted H+

A

Ammonia

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43
Q

Inhibits Na+/phosphate cotransport –> phosphate excretion

A

PTH

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44
Q

PTH –> decreased phosphate by

A

increased excretion by decreasing reabsorption in PCT

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45
Q

ATII stimulates NA+/H+ exchange –>

A

increased sodium, water, and bicarb reabsorption, permitting contraction alkalosis

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46
Q

what percent of Na+ is reabsorbed in the PCT?

A

65-80%

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47
Q

thin descending loop of Henle is impermeable to

A

sodium (concentrating sdemgnet0

48
Q

actively reabsorbs sodium, potassium, and chloride

A

TAL

49
Q

TAL indirectly induces the paracellular reabsorption of [2 things] through (+) lumen potential generation by K+ backleak

A

magnesium and calcium

50
Q

what percent of sodium is reabsorbed in the TAL

A

10-20%

51
Q

what drugs work at the PCT?

A

ACE inhibitors,

Carbonic anhydrase inhibitors

52
Q

what drugs work at the TAL?

A

loop diuretics

53
Q

TAL is impermeable to

A

water

54
Q

actively reabsorbs sodium and potassium –> makes urine hypotonic

A

early DCT

55
Q

what drugs work at the early DCT?

A

thiazide

56
Q

Effect of PTH on early DCT?

A

increases calcium/sodium exchange –> increased calcium reabsorption

57
Q

what percent of sodium is reabsorbed in the early DCT?

A

5-10%

58
Q

what drugs work on the collecting tubule?

A

K+ sparing diuretics (amiloride, triamterene, spirolactone, eplerenone)

59
Q

Collecting tubules reabsorb Na+ in exchange for secreting

A

K+ and H+

60
Q

regulates collecting tubule reabsorption of Na+ in exchange for K+ and H+ secretion

A

aldosterone

61
Q

acts on mineralocorticoid receptor in collecting tuble–> insertion of Na+ channel on luminal side

A

aldosterone

62
Q

acts at V2 receptor in principal cell in collecting tubule

A

ADH

63
Q

ADH –> insertion of

A

aquaporin H2 channels on luminal side of principal cell in collecting tubule

64
Q

percent of Na+ reabsorbed in collecting tubule

A

3-5%

65
Q

TF/P > 1 when

A

solute is reabsorbed less quickly than water

66
Q

TF/P = 1 when

A

solute and water are reabsorbed at the same rate

67
Q

TF/P <1 when

A

solute is reabsorbed more quickly than water

68
Q

tubulan inulin increases in concentration along the PCT as a result of

A

water reabsorption

69
Q

Renin responds to three things

A

decreased BP, decreased Na+ delivery, increased sympathetic tone

70
Q

JG cells secrete renin in response to

A

low BP

71
Q

macula densa tells JG cells to secrete renin in response to

A

low Na+ (Cl-) delivery

72
Q

what receptors tell JG cells to secrete renin in response to increased sympathetic tone?

A

beta-1

73
Q

AT II has six effects

A
  1. vasoconstriction of vascular smooth muscle
  2. vasoconstriction of efferent arteriole
  3. ldosterone
  4. ADH
  5. Increased proximal tubule Na+/H+ activity
  6. Stimulates hypothalamus
74
Q

What is the rationale of AT II preferential constriction of efferent arteriole

A

increase FF to preserve GFR in low-volume sttes

75
Q

aldosterone is produced by

A

adrenal gland

76
Q

aldosterone effects

A
  1. increased Na+ and Na+K+ pump insertion in principal cells

2. enhanced K+ and H_ excretion

77
Q

aldosterone –> enhanced K+ secretion where?

A

principal cell K+ channels

78
Q

aldosterone –> inc H+ secretion where

A

intercalated cell H+ channels

79
Q

net effect of aldosterone

A

creats favorable Na+ gradient for Na+ and H20 reabsorption

80
Q

what produces ADH?

A

posterior pituitary

81
Q

ADH –> increased H2O channel insertion in

A

principal cells

82
Q

net effect of ADH

A

increased H2O reabsorption

83
Q

affects baroreceptor function; limits reflex bradycardia; helps maintain blood volume and BP

A

angiotensin II

84
Q

angiotensinogen is produced by the

A

liver

85
Q

angiotensinogen –> angiotensin I

A

Renin

86
Q

angiotensin I –> angiotensin II

A

ACE

87
Q

ACE inhibits

A

bradykinin

88
Q

ACE is produced by the

A

lungs

89
Q

Released from atria in response to increased volume; may act as a check on RAA system; relaxes vascular smooth muscle via cGMP, causing increased GFR and decreased renin

A

ANP

90
Q

primarily regulates osmolarity but also responds to low blood volume, which takes precedence over osmolarity

A

ADH

91
Q

primarily regulates blood volume;

A

Aldosterone

92
Q

in low-volume states, what acts to protect blood volume

A

BOTH aldosterone and ADH

93
Q

beta blocker effect on kidney

A

inhibit beta-1 receptors of the JGA, causing decreased renin release

94
Q

released by interstitial cells in the peritubular capillary bed in response to hypoxia

A

EPO

95
Q

what cells produce epo

A

renal peritubular intersitial cells

96
Q

what cells convert 25-OH vitamin D to its active form

A

proximal tubule cells

97
Q

what enzyme converts vitamin D to its active form?

A

1alpha hydroxylase

98
Q

what stimulates 1-alpha-hydroylase production?

A

PTH

99
Q

secreted by JG cells in response to decreased renal arterial pressure and increased renal sympathetic discharge (beta1 effect)

A

renin

100
Q

paracrine secretion vasodilates the afferent arterioles to increase GFR

A

prostaglandins

101
Q

NSAIDs can cause acute renal failure by inhibiting the renal production of

A

prostaglandins

102
Q

4 kidney endocrine functions

A
  1. epo
  2. 1,25-(OH)2 vitamin D
  3. Renin
  4. Prostaglandins
103
Q

6 hormones act on kidney

A

ANP, PTH, Renin, AT II, Aldosterone, ADH

104
Q

Secreted in response to increased atrial pressure.

A

Atrial natriuretic peptide (ANP)

105
Q

Causes increased GFR and increased sodium filtration with no compensatory Na+ reabsorption in distal nephron –> Na+ loss and volume loss

A

ANP

106
Q

PTH is secreted in response to three things

A

decreased plasma calcium
increased plasma phosphate
decreased plasma 1.25-(OH)2 vitamin D

107
Q

PTH causes increased calcium reabsorption where?

A

DCT

108
Q

PTH causes decreased phosphate reabsorption where?

A

PCT?

109
Q

PTH has 4 effects:

A

increased calcium reabsorption (DCT)
decreased phosphate reabsorption (PCT)
increased 1,25-(OH)2 vitamin D production
increased calcium and phosphate absorption from gut

110
Q

Angiotensin II is synthesized in response to:

A

decreased BP

111
Q

Renin is synthesized in response to:

A

decreased blood volume

112
Q

Aldosterone is synthesize in response to:

A

decreased blood volume (via AT II)

increased [K+]

113
Q

Aldosterone causes three effects

A
  1. Increased sodium reabsorption
  2. Increased K+ secretion
  3. Increased H+ secretion
114
Q

Causes efferent arteriole constriction (–> inc GFR and FF) but with compensatory Na+ reabsorption in proximal and distal nephron

A

AT II

115
Q

Preservation of renal function in low-volume state (increased FF) with simultaneous NA+ reabsorption (both proximal and distal) to decreased additional volume loss

A

AT II

116
Q

Secreted in response to increased plasma osmolarity and decreased blood volume

A

ADH

117
Q

Binds to receptors on principal cells –> increased number of water channel channels –> increased H2O reabsorption

A

ADH

Renal (22 decks)

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