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Pathology 2 > HOMEOSTASIS—RENAL STRUCTURE & FUNCTION > Flashcards

HOMEOSTASIS—RENAL STRUCTURE & FUNCTION Flashcards

1
Q

cortex

A

outer portion of the kidney and vascular
–>which contains an arterial network, all of the glomeruli, a dense peritubular capillary plexus, and a venous drainage system.

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2
Q

medulla

A

inner kidney which receives much less blood than the cortex and contains the collecting ducts.

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3
Q

pyramids

A

medulla
cone-shaped
where urine is formed

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4
Q

minor/major calyces

A

helps form ureter

act as collecting cups for the urine formed in the pyramids.

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5
Q

renal pelvis

A

funnel for urine

through the minor and major calyces –> pelvis–> ureter –> bladder –> urethra

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6
Q

renal interstitium

A

lies between tubules and blood vessels; <10% of renal volume; contains fluid and scattered interstitial cells (fibroblasts and others) that synthesize an extracellular matrix of collagen, proteoglycans, and glycoproteins

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7
Q

Is the loop of Henle located in the medulla or cortex?

A

Medulla

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8
Q

Afferent arteriole

A

Blood supply to kidneys. Takes blood into the glomerulus to be filtered

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9
Q

Efferent arteriole

A

Takes blood away from the kidneys

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10
Q

Bowman’s capsule

A

surrounds glomerulus

Contains a parietal and a visceral layer of stellate cells that are called podocytes

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11
Q

Glomerulus

A

A cluster of capillaries that brings blood into the kidney for filtration

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12
Q

What forms the Juxtaglomerular apparatus (JGA)?

A

distal convoluted tubule + the afferent arteriole= JGA

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13
Q

What is the function of the JGA?

A

Regulates blood pressure and the glomerulus filtration rate
distal convoluted tubule = epithelial Macula densa cells that detect sodium levels
afferent arteriole =specialized granular cells that secrete renin. Renin regulates blood pressure

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14
Q

What composes the convoluted tubule?

A

Proximal; Distal; thick and thin look of Henle

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15
Q

Where is most of the absorption occuring?

A

Proxmial convoluted tubule

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16
Q

What does the distal convoluted tubule mostly absorb?

A

Na

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17
Q

What is the Thick Ascending loop of Henle permable to?

A

Thick Ascending loop of Henle- Permeable to solute and not to water

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18
Q

What is the Thin Ascending loop of Henle permable to?

A

Thin descending loop of Henle- Permeable to water and not to solutes

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19
Q

Why is Thick Ascending loop of Henle signficant?

A

Critical role in creating an osmotic gradient and concentration of solute in urine

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20
Q

major excretory and non-excretory functions of the kidney

A

1) Regulation of Water and Electrolyte Balance
2) Excretion of Metabolic Waste
3) Excretion of Bioactive Substances That Affect Body Function
4) Regulation of Arterial Blood Pressure
5) Regulation of Red Blood Cell Production
6) Regulation of Vitamin D Production
7) Gluconeogenesis

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21
Q

What stimulates the bone marrow to increase its production of red blood cells ?

A

erythropoietin –> made in kidney

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22
Q

What types of molecules are easily filtered by the kidney? Difficult molecules to filter?

A

easy passage of small molecules

most proteins, large molecules and medium-large highly negatively charged particles more difficult.

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23
Q

Kidney Secretion

A

Molecules that do not filter through the glomerulus pass on into the efferent renal arteriole to the peritubular capillaries which surround the renal tubules. From there the molecule may be secreted into the tubular lumen where they are either excreted or reabsorbed.

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24
Q

Significance of the GFR equation

A

grading progression/improvement of chronic kidney disease and for dosing drugs which are primarily excreted via urine

low GFR= poor kidney function

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25
Q

Who has a higher TBW: males or females?

A

MALES: females typically have higher percentage of adipose tissue than males, they tend to have less body water
females= 55%
males 60% of body weight

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26
Q

How much of TBW is in ECF vs ICF?

A

1/3 TBW= ECF; 2/3 TBW=ICF

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27
Q

Intracellular fluid (ICF):

A

The water inside the cells in which all intracellular solutes are dissolved.

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28
Q

Extracellular fluid (ECF):

A

The water outside the cells.

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29
Q

Major cations in ICF =

A

Major cation in ECF = sodium (Na+)

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30
Q

Major anions in ECF =

A

Major anions in ECF = chloride (Cl-) and bicarbonate (HCO3-)

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31
Q

What is most abundant ion in ECF?

A

Na (Sodium)

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32
Q

ECF subcompartments are?

A

1) Plasma (intravascular fluid) 2) Intersitital fluid

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33
Q

Plasma (intravascular fluid):

A

The fluid that circulates in the blood vessels. The aqueous component of blood. The fluid in which the blood cells are suspended

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34
Q

Interstitial fluid:

A

The fluid that actually bathes the cells. An ultrafiltrate of plasma, formed by filtration processes across the capillary wall; contains very little if any protein

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35
Q

How much of ECF is Intersitial fluid and plasma?

A

3/4 Intersitial fluid ; 1/4 Plasma (intravascular fluid)

36
Q

Water balance is regulated by

A

thirst and ADH (anti-diuretic hormone)

37
Q

Role of ADH

A

ADH released from the hypothalamus –>stimulates water conservation in the nephron be stimulating more water reabsorption in the collecting duct.

38
Q

What contributes most to water intake?

A

Water content in food

39
Q

Discuss “third-spacing”

A

the movement of body fluid to a non-functional space, i.e. outside of the extracellular (i.e. intravascular, interstitial) and intracellular spaces
–> not easily moved back into ECF or ICF

40
Q

Examples of third-spacing

A

Pleural Effusion; Ascites

41
Q

Ascites vs. interstitial edema

A

Ascites: fluid accumulation in the peritoneal cavity.

Interstitial edema: fluid accumulation in the tissues/spaces between cells

42
Q

Ascites is most commonly due to

A

portal hypertension

43
Q

Common causes for interstitial edema

A

1) decreased osmotic pressure (not enough albumin to keep water in)
2) Increased venous hydrostatic pressure: e.g. heart failure, sodium retention -> hypervolemia
3) Increased vascular permeability: e.g. inflammation
4) Blocked lymphatic drainage: e.g. parasitic infection (can you say filariasis?), cancer growing in lymphatics

44
Q

Osmosis

A

diffusion of water across a selectively permeable membrane –> water moves to the area of higher concentration

45
Q

Osmolarity (osmol/L) or Osmolaity (osmol/kg)

A

osmotic concentration –> higher osmolarity of a solution, the lower the water concentration

46
Q

Tonicity

A

Refers to the ability of a solute to cross a membrane and affects volumes of cells or a compartment

47
Q

Hypertonic

A

cell = SHRINK

48
Q

Hypotonic

A

cell = SWELL

49
Q

Isotonic

A

No net water movement

50
Q

Discuss sodium’s role in volume homeostasis

A

Hypervolemia reflects sodium retention Hypovolemia reflects sodium deficiency

REMEMBER: water follows sodium

51
Q

Na function

A

1) influences the degree of water retention in the body and participates in the control of acid-base balance.
2) Regulates ECF water balance, maintains blood volume, transmitting nerve impulses and contracting muscles (Muscle contractility).

52
Q

Na regulation

A

ALDOSTERONE!

1) glomerulo-tubular balance
2) Atrial natriuretic factor- induces Na+ excretion by decreasing Na+ reabsorption - get rid of Na+
3) Antidiurtic hormone (ADH) – Produced by the hypothalamus when there is an increase in plasma [Na+]. Promotes reabsorption of water in the kidney.

53
Q

K function

A

cell cycle regulation
muscle excitability
ICF water balance

54
Q

K regulation

A

plasma K
Aldosterone
nephron tubular rates

55
Q

HCO3- function

A

Acts as an extracellular buffer for acid-base balance; determinant of pH

56
Q

HCO3- regulation

A

primarily regulated by the kidneys and some at liver

57
Q

Ca2+ function

A 
stored in bone
membrane excitability
bone formation
coagulation
hormone actions
58
Q

CA2+ regulation

A

Alteration of intestinal absorption is the main way Ca++ is regulated. 1) Parathyroid hormone 2) Vitamin D 3) calcitonin 4)pH

59
Q

What is the most abdundant intracellular cation

A

K+

60
Q

How is K regulated by renal function and secretion?

A

Aldosterone –> ATPase pump –> K out/ Na in

Aldesterone increases membrane permeability to K+ –> stimulates the sodium-potassium ATPase pump –> facilitates passage of Na+ through channels= secretion of K+ into the renal tubular lumen for excretion. (Na in and K out)

61
Q

What are the effects of K on serum pH?

A

Serum pH – If pH decreases, plasma [K+] increases

62
Q

Insulin/Epinephrine both stimulate?

A

Both stimulate the entry of potassium (K+) into the cells.

63
Q

What is the Most abundant mineral in body?

A

Ca2+

64
Q

How does parathyroid regulate Ca2+?

A

raises blood [Ca++] by promoting intestinal absorption and increased renal tubular reabsorption=increasing plasma [Ca++].

65
Q

How does vitamin D regulate Ca2+?

A

increasing Ca++ uptake in the intestines and kidney

66
Q

How does calcitonin regulate Ca2+?

A

acts the opposite of parathyroid hormone and causes bone uptake of Ca++, reducing plasma [Ca++]

67
Q

How does pH regulate Ca2+?

A

Decreased pH decreases Ca++ binding to plasma proteins

68
Q

H+ function

A

pH determinant

69
Q

H+ regulation

A

1) diet
2) metabolic production of CO2
3) GI
4) Buffers

70
Q

Cl- function

A

maintains fluid and electrolyte balance and is and an important component of gastric juice

71
Q

Cl- regulation

A

high bicarbonate= low Cl-

72
Q

PO4-3 (Phosphate) function

A
  • Important in the structure of bones

- structure and functioning of all cells and DNA.

73
Q

PO4-3 (Phosphate) regulation

A

1) Vitamin D- increase phosphate with increase of Ca++ absorption
2) Parathyroid- inhibits renal reabsorption of phosphate at proximal tubule

74
Q

Most common extracelluar anion?

A

Cl-

75
Q

Clinical Feature, Lab Assessment and Tx: Hyponatremia

A

Clinical: low NA ion concentration ;
Lab Assessment: urine sodium, fena, osmolaity; Tx: if hypervolemic→diuretics & fluid restriction; if hypovolemic→saline; if euvolemic→ fluid restriction, perhaps saline plus loop diuretics.

76
Q

Clinical Feature, Lab Assessment and Tx: Hyperonatremia

A

Clinical: too much Na concentration;
Lab Assessment: Hx + PE, urine osm, serum osm, urine Na Tx: determine if chronic or acute; Calculate TBW deficit; can give oral water or IV.

77
Q

Clinical Feature, Lab Assessment and Tx: Hypokalemia

A

Clinical: Parasthesias, muscl cramps or weakness, ileus, cardiac arrhythmia, ECG: flat T waves, ST depression;
Lab Assessment: Hx + PE, FeK chemistries;
Tx: Potassium supplementation (oral or IV depending on severity).

78
Q

Clinical Feature, Lab Assessment and Tx: Hyperkalemia

A

Clincal: Parasthesias, muscle weakness, cardiac arrest. ECG: peaked T waves, PR prolongation, QRS widening;
Lab Assessment: Hx + PE, chemistries, urine potassium excretion.;
Tx: CaGluconate IV for cardiac stabilization; bicarbonate; beta agonist, insulin/ glucose. Potassium removal via urine or stool.

79
Q

Clinical Feature, Lab Assessment and Tx: Hypocalcemia

A

Clinical: Tetany, muscle spasm, cramps, seizures, arrhythmia, hypotension, and bradycardic.;
Lab Assessment: Mg, PTH, Vit D levels,
Phos level.; Tx: Depends on severity and acuity; IV or Hypo Ca.

80
Q

Clinical Feature, Lab Assessment and Tx: Hypercalcemia

A

Clinical: “stones, bones, groans, psychiatric overtones”; HTN, GI symptoms, MS changes, polyuria, kidney stones.;
Lab Assessment: PTH; Phos; Vit D level; Tx: increase urinary excretion of Ca (loop diuretic/ saline); if in renal failure consider dialysis

81
Q

Clinical Feature, Lab Assessment and Tx: Hypermagnesemia

A

Clinical: weakness, N/V, decreased respirations, HTN, arrhythmia & asystole, decreased or absent tendon reflexes, bradycardia;
Lab: Chemistries serum Mg levels;
Tx: IV CaGluconate, IV diuretics, dialysis

82
Q

Clinical Feature, Lab Assessment and Tx: Hypophosphatemia

A

Clinical: Decreased GI absorption (malnutrition, Vit D deficiency, malabsorption, binders); myalgia, weakness, rhabdomyolysis, MS changes
Lab: Chemistries;
Tx: Treat by repleating

83
Q

Clinical Feature, Lab Assessment and Tx: Hyperphosphatemia

A

Clinical: Decreased renal excretion; hypocalcemia, tetany, metastatic soft tissue calcification, secondary hyperPTH.;
Lab: chemistries;
Tx: cellular shifting and elimination

84
Q

Role of Erythropoietin

A

an essential hormone for red cell production

85
Q

osmoregulation is primarily regulated by?

A

ADH

86
Q

the concentration of what ion determines ECF volume?

A

Sodium

Pathology 2 (6 decks)

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