Flow and filtration Flashcards

1
Q

What percentage of the cardiac output goes to the kidney? Why? What else contributes to this?

A

Receives 20-25% - in order to generate the high pressure needed for ultrafiltration. Achieved also with direct aortic branching.

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2
Q

What is glomerular filtration?

A

Formation of an ULTRAFILTRATE in glomerulus.

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3
Q

What proportion of plasma is generally filtered in glomerular filtration?

A

20%. While 80% is retained in the plasma.

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4
Q

How is the glomerular filtrate produced?

A

Passive process – as fluid is driven through semi-permeable walls of glomerular capillaries into Bowman’s capsule by (very high) cardiac hydrostatic pressure. Capillary walls (which are fenestrated) = highly permeable to fluids and small solutes, but not cells; proteins and drugs are carried by proteins. Filtration barrier = fenestrated CAPILLARY ENDOTHELIUM, modified BASAL MEMBRANE and PODOCYTES found outside the capillaries with feet that interdigitate.

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5
Q

How does the afferent and efferent glomerulus arterioles differ?

A

Afferent is much larger in diameter. This helps with maintaining pressure in the glomerulus, so keeping gradient high enough for ultrafiltration. NOTE, the afferent arteriole emerges from above, and the efferent leaves below. [PHOTO 2].

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6
Q

What is primary urine?

A

Clear ultrafiltrate fluid free from blood and proteins.

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7
Q

What is the renal corpuscle?

A

Made up of the Bowman’s capsule, glomerulus and podocytes.

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8
Q

How is the body’s level of excretion through the kidneys calculated?

A

Amount FILTERED + amount SECRETED – amount ABSORBED.

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9
Q

What is the glomerular filtration rate?

A

Amount of fluid filtered from the glomeruli into the Bowman’s capsule per unit time (ml/min) – sum of rate of all functioning nephrons.

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10
Q

What is Pgc, Pt and πgc?

A

Pgc = hydrostatic pressure in the glomerular capillaries. Pt = hydrostatic pressure in tubules. Other one = osmotic pressure in the glomerular capillaries.

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11
Q

What is the normal value for GFR?

A

120 ml min-1 per 1.73m^2. 1.73m^2 is a typical value for the body surface area of an adult.

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12
Q

What happens to GFR with age?

A

Decreases about 10 ml min-1 per decade after 40.

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13
Q

What is the filtration fraction?

A

Ratio of renal plasma flow to amount of filtrate filtered by the glomeruli.

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14
Q

What is the normal value for filtration fraction?

A

0.2.

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15
Q

What is meant by ‘freely filtered’?

A

Concentration in the glomerular filtrate is the same as in the plasma.

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16
Q

What factors affect GFR? (x4)

A

Pgc, πgc, Pt, Kf (number of functioning nephrons). Can be hormonally or neutrally controlled.

17
Q

What is myogenic autoregulation? Importance?

A

Vascular smooth muscle cells stretched when arterial pressures rise in vessels of the kidneys, Resistance therefore increases too. IMPORTANCE: this reduces blood flow to keep GFR constant.

18
Q

What events can affect GFR? (x4) How – for each?

A
  1. Severe haemorrhage: decreases Pgc so will decrease GFR. 2. Nephron tubule obstruction: increases Pt/decreases Kf, so decreases GFR. 3. Reduced plasma protein concentration: decreases πgc, so decreases GFR. 4. Small blood pressure increase: no effect due to myogenic autoregulation.
19
Q

Why is GFR clinically important? (x2)

A

• A drop in the rate is a cardinal feature of renal disease, and excretory proteins will build up in plasma: Most renal diseases result in destruction of nephrons, and GFR is equal to sum of functioning nephrons. • Useful in determining correct drug dosage as some drugs are excreted from the body primarily from glomerular filtration.

20
Q

Why is creatinine concentration in GF clinically important?

A

Raised or lowered plasma creatinine concentration is diagnostic of renal disease.

21
Q

What are the three pressures involved in glomerular filtration?

A

Hydrostatic pressure in glomerular capillaries, which is opposed by hydrostatic pressure of the tubule and osmotic pressure of the glomerular capillaries.

22
Q

What is the calculation for ultrafiltration PRESSURE?

A

Puf = Pgc – Pt – πgc.

23
Q

What is the normal value for ultrafiltration pressure?

A

Net pressure of 10-20mmHg.

24
Q

What does ureteral obstruction do to ultrafiltration pressure?

A

Will increase Pt, hence decreasing Puf and GFR.

25
Q

What is renal clearance?

A

It is the extent to which substances passing through the kidneys are removed from the blood and out of the body. The renal clearance of something is therefore equal to the volume of plasma which supplies that amount of the substance excreted by the kidneys per unit of time. An important point to remember is that clearance will always be expressed as a volume of plasma per unit of time. CALULATIONS ARE IN CLINICAL NEPHROLOGY.

26
Q

Where does creatinine originate?

A

Endogenous waste produce from creatinine in MUSCLE metabolism, and amount released relatively constant. If renal function stable, then amount in urine stable.

27
Q

How is creatinine handled in the kidneys?

A

Freely filtered, and not reabsorbed or metabolised in the kidneys. Some is secreted into the urine in the PCT.

28
Q

What proportion of the ultrafiltrate is reabsorbed back into the blood?

A

99%.

29
Q

Why is it important to maintain osmolarity?

A

If osmolarity fluctuates too much, cell volumes will also fluctuate because solute concentration and water potential are interdependent e.g. if osmolarity is high and there are too many solutes in a cell, water will move in to balance the osmolarity, and volume will increase.

30
Q

What is the proportion of water found across the body?

A

65% = intracellularly. 35% = extracellularly (mostly interstitial fluid, then plasma, lymph and transcellular (cerebrospinal, synovial…).

31
Q

What is the total volume of water in the body?

A

40L.

32
Q

What is the circulating volume of water in the blood?

A

~2.5 litres.

33
Q

What is the volume of blood?

A

5 litres.

34
Q

How does composition of body fluids vary intracellularly and extracellularly: Na+, Cl-, HCO3-, K+, HPO42-, Ca2+, Mg2+ and Protein?

A

Look at photo.

35
Q

How is fluid removed from the body? (x4)

A

Sweat, faeces, respiration (all uncontrollable); urine (controllable).

36
Q

What proportion of water is RETAINED in the tubules at each region of the nephron? Where can we control this retention?

A

Look at photo – most is removed in the PCT (~70%). THE GREEN REGION IS WHERE WE EXERT SOME CONTROL.

37
Q

How important is the loop of Henle in control of water between mammals?

A

The ratio of the volume of the medulla to the cortex determines how concentrated the urine can be made in the loop of Henle. For mammals that have the highest medulla:cortex volume, they can concentrate their urine further?

38
Q

If inulin concentration was 1 mmol/L, what would be the plasma inulin concentration in the efferent arteriole?

A

STILL 1 mmol/L because water and everything else has moved out too in the same proportions.

39
Q

If inulin concentration was 1 mmol/L, what would be the plasma inulin concentration in the renal vein?

A

> 99% water, glucose, amino acids move back into blood. We can assume this is 100%. And, since no inulin is reabsorbed, concentration falls to 0.8mmol.L in the renal vein because 20% was filtered.