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Renal Physio > Intro to Renal Physio > Flashcards

Intro to Renal Physio Flashcards

1
Q

Kidney’s endocrine function

A

EPO (peritubular capillary cells), Vitamin D/Calcitriol (tubule cells, PTH and 1-alpha hydrogenase)

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2
Q

Kidney and CV systems are

A

interdependent

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3
Q

Functional unit of kidney

A

nephron

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4
Q

two parts of a nephron

A

Bowman’s capsule/gomerulus and tubule

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5
Q

Cortical nephron

A

glomeruli in cortex, Loop of Henle dips into outer medulla (electrolyte excretion)

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6
Q

Juxtamedullary nephron

A

glomeruli in cortex, Loop of Henle dips DEEP into inner medulla (urine concentration)

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7
Q

Path of blood from renal a to renal v

A

renal a -> afferent arteriole -> glomerular capillaries -> efferent arteriole -> pertitubular capillaries (cortical loops and medullary loops (vasa recta)) -> renal v

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8
Q

Bowman’s space

A

space between glomerular capillary and tubule, collects filtrate

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9
Q

JGA

A

thick ascending limb passes through angle of afferent and efferent arterioles

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10
Q

Macula Densa

A

specialized cells in the thick ascending limb

sense NaCl flow through tubule and send feedback to afferent arteriole’s juxtaglomerular cells

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11
Q

Tubuloglomerular Feedback

A

communication about NaCl flow from the macula densa to the glomerular arteriole

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12
Q

Renin producing cells are located _______

A

in the afferent arteriole adjacent to the macula densa

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13
Q

Extraglomerular mesangial cells

A

participate in transmitting infor from macula densa to afferent and efferent arterioles

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14
Q

What is the site of renin release

A

JGA

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15
Q

3 causes for renin release

A

renal SNS, decreased stretch or flow through afferent arteriole (renal baroreceptor), and stimulation from the macula densa ([NaCl])

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16
Q

Function of Renin

A

catalyzes Angiotensinogen –> Angiotensin I/II (ACE) which leads to the production of aldosterone by the adrenal cortex

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17
Q

Renin promotes the activation of what 2 hormones

A

Aldosterone (adrenal cortex) and ADH

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18
Q

Function of Aldosterone

A

(adrenal cortex) –> increases the activity of Na/K-ATPase -> increase Na+ followed by H2O reabsorption

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19
Q

Function of ADH

A

translocation of aquaporins to the surface of the collecting duct -> increase H2O reabsorption

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20
Q

SNS on renal function

A

Vasoconstriction of afferent and efferent arterioles

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21
Q

SNS impact on JGA

A

increases release of renin from afferent and efferent arteriole granular cells

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22
Q

SNS impact on tubules

A

reabsorption of Na

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23
Q

SNS’s NT and receptor

A

NE and alpha-adrenergic

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24
Q

Function of Mesangium

A

structural support of glomerular capillaries, secretion of prostaglandins (dilation of afferents), secretion of cytokines, and are phagocytic

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25
Q

What happens when immune complexes (infection or autoimmune) clog mesangium area?

A

Inflammatory response -> scarring -> loss of glomerular function -> renal failure

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26
Q

Proteinuria is a marker of

A

systemic endothelial cell dysfunction

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27
Q

Proteinuria may be a result of kidney damage but may also ___________

A

cause tubular and interstitial inflammation, ishemia, and fibrosis

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28
Q

Hypoalbuminemia via proteinuria

A

excessive loss of plasma protein, formation of peripheral edema, alters acid-base balance, and circulating hormones

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29
Q

4 types of proteinuria

A

Glomerular, tubular, exercise, and orthostatic

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30
Q

3 Layers to the glomerular filtration barrier

A

endothelium w/ fenestra, basement membrane, podocytes

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31
Q

Endothelium of the glomerular filtration barrier

A

large fenstra with negatively charged glycoproteins (not a size barrier - 70um)

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32
Q

Basement Membrane of the glomerular filtration barrier

A

composed of ECM, negatively charged

33
Q

Podocytes of the glomerular filtration barrier

A

Negatively-charged podocytes create filtration slits which is covered by a slit diaphragm

34
Q

Slit Diaphragm of the glomerular filtration barrier

A

thin, negatively-charged, selectively porous membrane

35
Q

What protein largely makes up the slit diaphragm and

A

nephrin

36
Q

What passes through the slit diaphragm?

A

H2O and electrolytes (unless damage has occurred)

37
Q

glomerular filtration barrier size barrier

A

20-42A; easily passes molecules 42A

38
Q

glomerular filtration barrier between the range of 20-42A

A

Dependent on charge and size, a cationic molecule will pass more easily

39
Q

Albumin does not pass the glomerular filtration barrier because

A

IT is highly NEGATIVELY-charged, size is irrelevant because it is 36A

40
Q

Size of albumin

A

36A

41
Q

Glomerular proteinuria may be due to

A

physiologic or pathological, transient or permanent, and can cause huge loss of protein

42
Q

Would it be more worrisome to have positive or negative proteins in the urine?

A

Negative; because the negatively charged glomerular filtration barrier should prevent the passage of negative molecules

43
Q

Loss of glomerular charge selectivity is > or < important than loss of size selectivity on Albuminuria

A

Charge is more important because size is already within range of 20-42A

44
Q

How would one detect the loss of glomerular size selectivity

A

you would see medium-sized proteins (like albumin) and larger proteins (like IgGs) in the urine

45
Q

What level of proteins are normally found in urine?

A

<20), plasma proteins, and renal tubule of urogenital tract proteins

46
Q

What is microalbunimuria?

A

excretion of 30-300mg of albumin/day; indicative of vascular dysfunction

47
Q

What is non-nephrotic proteinuria?

A

<3000mg/day excreted protein

48
Q

What is nephrotic range proteinuria?

A

> 3000mg/day excreted protein; may include excessive sloughed off tubular cells, RBCs, lipiduria, peripheral edema if hypoalbuminemia

49
Q

If protein is filtered where would it be reabsorbed? (<20A or plasma protein)

A

proximal tubule via endocytosis

50
Q

What protein can be measured to determine if the proximal tubule is functioning properly?

A

Beta-2 microglobulin; this protein is small and freely filtered but generally reabsorbed via endocytosis

51
Q

Proximal tubular damage may be caused by

A

ischemia, immunological damage, or heavy metal intoxication damage

52
Q

What will happen with albumin during proximal tubular damage?

A

albumin in urine will increase slightly bc it is still restricted by the glomerulus, but the small amount that enters the filtrate will not be reabsorbed

53
Q

Dip stick lab tests may identify which types of proteinuria

A

Glomerular proteinuria (large amounts of albumin) BUT NOT tubular proteinuria bc there is still a SMALL amount of albumin that is excreted

54
Q

What is overflow tubular proteinuria?

A

Small proteins that are filtered as filtrate normally are reabsorbed, but if they are filtered in excessive amounts the amount may exceed the body’s ability to reabsorb them (NOT due to tubular damage)

55
Q

2 types of non-pathological proteinuria

A

Exercise and orthostatic

56
Q

Exercise proteinuria

A

strenuous exercise leads to transient increase in protein excretion (albumin); can be tubular and glomerular proteinuria

57
Q

Orthostatic proteinuria

A

Upright position increases the excretion of protein (normal when lying down)

58
Q

Control of Micturition

A

internal and external urethral sphincter

59
Q

Internal urethral sphincter

A

involuntary, smooth muscle, tonic contractile tone (until pressure threshold of filling is reached)

60
Q

external urethral sphincter

A

skeletal muscle, voluntary, innervated by the pudendal n

61
Q

Pudendal n

A

innervates external urethral sphincter and carries sensory afferents from bladder and urethra

62
Q

Detrusor muscle

A

smooth muscle that surrounds the epithelial lining of the bladder

63
Q

Sacral n (pelvic n) carries

A

parasympathetic efferents to the detrusor muscle for voiding bladder (M3 receptor); sensory afferents (info to spine on fullness of bladder)

64
Q

Hypogastric n.

A

Sensory afferents (info to spine on fullness of bladder), efferents to bladder neck for contraction and storage of urine (alpha receptors) and some efferents to detrusor for relaxation (Beta-3 receptor)

65
Q

3 nerves that supply the bladder and their function

A 
Pudendal n (S2-S4): somatic innervation of external urethral sphincter
Hypogastric n (L1-L3): sympathetic innervation to the bladder neck for contraction and filling and to detrusor for relaxation; sensory afferents
Sacral (Pelvic) n (S2-S4): parasympathetic innervation to detrusor muscle for voiding; sensory afferents
66
Q

Micturition Reflex

A

spinal reflex that is modified by higher brain centers (pontine micturition center)

67
Q

What happens if the higher brain centers are separated from the spinal control of micturition?

A

Incontinence

68
Q

First step in micturition reflex

A

Bladder filling causes stretching of the detrusor muscle causing afferent sensory information to be sent to the spinal cord (150mL mild “fullness” signal and 400mL very strong signal)

69
Q

Second step in micturition reflex

A

parasympathetic efferent signal sent back to detrusor muscle causing contraction (may cause internal urethral sphincter to open)

70
Q

Once urine begins entering urethra and a second set of sensory afferents, ________

A

sympathetic signal is sent to the bladder neck and internal urethral sphincter that inhibits its tonic contraction

71
Q

The final step in micturition is

A

voluntary relaxation of the external urethral sphincter allows voiding

72
Q

Higher brain function can modify the afferent signals and micturition reflex

A

inhibit the parasympathetic contraction of the detrusor muscle, to avoid voiding. (decreased the sensitivity to the micturition reflex)

73
Q

What would happen to the micturition reflex if the spinal cord was transectioned?

A

Voluntary control is obliterated, and the micturition reflex will simultaneously contract the detrusor and EUS interfering with voiding

74
Q

What would happen to the micturition reflex if sympathetic nerves were blocked?

A

Nothing

75
Q

Urge Urinary Incontinence

A

involuntary leakage accompanied by the feeling of urgency; overactive parasympathetics to detrusor (treated by anti-cholinergic) or interstitial cystitis “painful bladder syndrome”

76
Q

Stress Urinary Incontinence

A

involuntary leakage accompanied by increased intra-abdominal pressure (coughing, sneezing); due to insufficient urethral sphincter

77
Q

Overflow Urinary Incontinence

A

Inability to completely empty bladder -> large bladder volume -> dribbling -> due to obstruction (BPH in men)or underactive parasympathetic innervation to the detrusor muscle

78
Q

Urinary Incontinence due to transient conditions

A

not associated with a lower UT dysfunction; bladder infection, increased urine production, mental status, medications

Renal Physio (8 decks)

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