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Physiology > IV- Renal Physiology > Flashcards

IV- Renal Physiology Flashcards

1
Q

Ultrafiltrate of blood

A

Urine

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2
Q

Waste product from proteins

A

urea

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3
Q

Waste product from purines

A

uric acid

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4
Q

Waste product from muscles

A

creatinine

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5
Q

Waste product from RBCs

A

bilirubin

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6
Q

Kidney: Location

A

T12-L3

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7
Q

Kidney: Weight

A

150g

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8
Q

Kidney: Lateral to Medial

A

capsule, cortex, medulla, renal papilla, renal calyces (minor/major), renal pelvis

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9
Q

Kidney: Circulation

A

renal a. → segmental a. → interlobar a. → arcuate a. → interlobular a. (cortical radiate/radial a.) → afferent arteriole → glomerular capillaries → efferent arteriole → peritubular capillaries/vasa recta → interlobular v. → arcuate v. → interlobar c. → segmental v. → renal v.

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10
Q

Glomerular capillaries are highly _____, are responsible for _____ and are the only capillaries that lead to _____.

A

fenestrated, GFR, arterioles

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11
Q

Capillaries that supplies oxygen and glucose to tubular cells

A

peritubular capillaries

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12
Q

Erythropoietin is produced in

A

interstitial cells

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13
Q

Hairpin loop-shaped peritubular capillaries of the juxtamedullary nephrons that participate in _____ exchange.

A

vasa recta, countercurrent exchange

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14
Q

Urinary Bladder: Capacity

A

600mL

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15
Q

Urinary Bladder: Urge to urinate at

A

150mL - 25%

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16
Q

Urinary Bladder: Reflex contraction at

A

300mL - 50%

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17
Q

Urinary Bladder: Main muscle

A

detrusor

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18
Q

Urinary Bladder: Involuntary sphincter

A

internal sphincter

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19
Q

Urinary Bladder: Voluntary sphincter

A

external sphincter

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20
Q

Functional and structural unit of the kidney

A

nephron

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21
Q

There are _____ nephrons per kidney.

A

750K - 1M nephrons per kidney

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22
Q

Nephrons _____ be regenerated.

A

cannot

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23
Q

Kidneys undergo _____ upon 75% damage to kidneys.

A

compensatory hypertrophy

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24
Q

Nephrons: 75%

A

cortical

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25
Q

Nephrons: Renal cortex

A

cortical

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26
Q

Nephrons: Short - only in the cortex

A

cortical

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27
Q

Nephrons: Suppled by peritubular capillaries

A

cortical

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28
Q

Nephrons: 25%

A

juxtamedullary

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29
Q

Nephrons: Cortico-medullary junction

A

juxtamedullary

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30
Q

Nephrons: Long - goes into pyramids

A

juxtamedullary

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31
Q

Nephrons: Suppled by vasa recta

A

juxtamedullary

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32
Q

Nephron: Initial filtrating segment

A

renal corpuscle

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33
Q

Nephrons: Mainly secretes and absorbs

A

renal tubular system

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34
Q

Renal Corpuscle: The capillary endothelium is highly _____ with pores _____ in diameter.

A

fenestrated, 8nm or 80 angstrom in diameter

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35
Q

Renal Corpuscle: The capillary endothelium is ___ more permeable than skeletal capillaries.

A

50x

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36
Q

Renal Corpuscle: The capillary endothelium secretes _____ and _____.

A

nitric oxide, endothelin-1

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37
Q

Renal Corpuscle: The basement membrane has _____ spaces, is made from type __ collagen and is highly _____.

A

large, type IV collagen, negatively charged

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38
Q

Renal Corpuscle: Cells of the capillary epithelium

A

podocytes (visceral epithelium)

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39
Q

Renal Corpuscle: Parietal epithelium

A

Bowman’s capsule

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40
Q

Renal Corpuscle: Podocytes have _____ and _____ responsible for filtration.

A

foot processes, filtration slits

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41
Q

Renal Corpuscle: 3 filtration and charge barriers (innermost to outermost)

A

capillary endothelium, basement membrane, podocytes

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42
Q

Albumin is ___ in diameter but is _____. In nephrotic syndrome, the _____ barriers are destroyed leading to proteinuria.

A

< 8nm, negatively charged, charge barriers

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43
Q

Renal Corpuscle: Modified smooth muscle between capillaries

A

mesangial cells

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44
Q

Renal Corpuscle: Contractile, mediates filtration, take up immune complexes, involved in glomerular diseases

A

mesangial cells

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45
Q

Renal Corpuscle: Glomerular cells of the afferent arterioles, secrete renin

A

JG cells

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46
Q

Renal Corpuscle: Found in the walls of the DCT

A

macula densa

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47
Q

Renal Corpuscle: Monitor Na concentration in the DT (BP, GFR)

A

macula densa

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48
Q

Renal Tubular System: Workhorse

A

proximal convoluted tubule (PCT)

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49
Q

Renal Tubular System: Has Na-K-2Cl pumps

A

loop of Henle (LH)

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50
Q

Renal Tubular System: The macula densa can be found here

A

first part/early distal tubule (DT)

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51
Q

Renal Tubular System: Affected by aldosterone

A

second part/late distal tubule (DT)

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52
Q

Renal Tubular System: Affected by ADH

A

collecting ducts (CD)

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53
Q

Movement from glomerular capillaries to the Bowman’s space

A

Glomerular Filtration

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54
Q

Movement from tubules to interstitium to pertubular capillaries

A

Tubular Reabsorption

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55
Q

Movement from peritubular capillaries to interstitium to tubules

A

Tubular Secretion

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56
Q

Excretion =

A

(amount filtered) - (amount reabsorbed) + (amount secreted)

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57
Q

Glomerular Filtration: Substances that undergo filtration only, used to estimate GFR

A

inulin, creatinine

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58
Q

Glomerular Filtration: Substances that undergo filtration and partial reabsorption

A

electrolytes

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59
Q

Glomerular Filtration: Substances that undergo filtration and complete reabsorption, have a low clearance

A

glucose, amino acids

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60
Q

Glomerular Filtration: Substances that undergo filtration and secretion, have a high clearance

A

organic acids and bases, para-aminohippurate (PAH) - used to estimate renal blood/plasma flow

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61
Q

Amount filtered in the glomerular capillaries per unit time

A

GFR - 120mL/min or 180L/day

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62
Q

Fraction of renal plasma flow that is filtered

A

Filtration Fraction - 20%

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63
Q

Filtration Fraction =

A

GFR/RPF

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64
Q

Filterability of Solutes: Inversely proportional

A

size of solute - water, Na, glucose, inulin > myoglobin > albumin

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65
Q

Filterability of Solutes: ___ angstrom: filtered freely

A

< 20 angstrom

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66
Q

Filterability of Solutes: ___ angstrom: not filtered at all

A

> 42 angstrom

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67
Q

Filterability of Solutes: Charge

A

positive > neutral > negative

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68
Q

GFR =

A

Kf [ (Pgc-Pbs) - (Ogc-Obs) ]

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69
Q

Effect on GFR: Afferent Arteriole - dilate

A

increase

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70
Q

Effect on GFR: Afferent Arteriole - constrict

A

decrease

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71
Q

Effect on GFR: Efferent Arteriole - dilate

A

decrease

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72
Q

Effect on GFR: Efferent Arteriole - constrict moderately

A

increase

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73
Q

Effect on GFR: Efferent Arteriole - constrict severely

A

decrease

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74
Q

Effect on GFR: GC Hydrostatic Pressure - increased

A

increase

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75
Q

Effect on GFR: GC Oncotic Pressure - increased

A

decrease

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76
Q

Effect on GFR: BS Hydrostatic Pressure - increased

A

decrease

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77
Q

Effect on GFR: Kf - increased

A

increase

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78
Q

What causes decreased Kf in the glomerulus?

A

renal diseases, DM, HPN

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79
Q

What is the cause of increased BS Hydrostatic Pressure?

A

urinary tract obstruction

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80
Q

What are the causes of decreased GC Hydrostatic Pressure?

A

hypotension - decreased arterial P, ACE-I - efferent arteriole relaxation, sympathetic activity - afferent arteriole constriction

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81
Q

What hormones will increase GFR?

A

EDRF, PgE2, PgI2, bradykinin, glucocorticoids, ANP, BNP

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82
Q

Which hormone will preserve GFR?

A

angiotensin II - preferentially constrict the efferent arteriole

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83
Q

Angiotensin II preferentially constricts the _____ arteriole.

A

efferent arteriole

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84
Q

Renal blood flow exhibits local autoregulation at a BP between

A

75-160mmHg

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85
Q

Blood flow in the renal cortex is _____ than in the renal medulla

A

cortex > medulla

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86
Q

RBF =

A

(renal artery P - renal vein P) / total renal vascular resistance

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87
Q

Massive sympathetic stimulation that results in massive vasoconstriction of the kidneys

A

CNS Ischemic Response

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88
Q

Tubuloglomerular Feedback

A

Macula Densa Feedback

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89
Q

Tubuloglomerular Feedback: Constant ___ load is delivered to the distal tubule

A

sodium (Na)

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90
Q

Tubuloglomerular Feedback: Afferent vasoconstrictor

A

adenosine - systemic vasodilator, renal vasoconstrictor

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91
Q

Tubuloglomerular Feedback: Afferent vasodilator

A

nitric oxide

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92
Q

Primary mechanism for autoregulation of GFR

A

Tubuloglomerular Feedback

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93
Q

Glomerotubular Balance: Percentage of _____ is held constant

A

solute reabsorbed

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94
Q

Buffers effects of drastic GFR changes on urine output

A

Glomerotubular Balance

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95
Q

Intrinsic ability of tubules to increase their reabsorption rate in response to increased tubular load

A

Glomerotubular Balance

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96
Q

Tubular Processing: Substances start to appear in the urine, some nephrons exhibit saturation

A

Renal Threshold

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97
Q

Tubular Processing: All excess substances appear in the urine, all nephrons exhibit saturation

A

Renal Transport Maximum

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98
Q

Normal Plasma Glucose

A

80-100 mg/dL

99
Q

Renal Threshold of Glucose

A

200 mg/dL

100
Q

Renal Transport Maximum of Glucose

A

375 mg/dL

101
Q

Does not have transport maximum and threshold, rate of transport is dependent upon electrochemical gradient, membrane permeability and time

A

Gradient-Time Transport

102
Q

Gradient-Time Transport: Exhibited by

A

all passively transported solutes (Cl, Urea), some actively transported solutes (Na in the PCT)

103
Q

Gradient-Time Transport: Increase in concentration

A

increase in rate of transport

104
Q

Gradient-Time Transport: Decrease in flow rate

A

increase in rate of transport

105
Q

Workhorse of the nephron, has low columnar cells with extensive brush border (microvilli) - unique among renal tubules

A

proximal convoluted tubules (PCT)

106
Q

Cells of the PCT are _____ columnar, _____ metabolic, have _____ mitochondria, have _____ brush border and channels.

A

low columnar, highly metabolic, many mitochondria, extensive brush border and channels

107
Q

PCT: Reabsorption

A

Isotonic Reabsorption, 100% - glucose, AAs, 66% - NaCl, H2O

108
Q

PCT: Secretion

A

H+, organic acids/bases, drugs - rapidly filtered and almost none reabsorbed

109
Q

Loop of Henle: Simple squamous with no brush border and few mitochondria, slow flow of fluid

A

thin segments of the loop of Henle

110
Q

Loop of Henle: Simple cuboidal

A

thick segments of the loop of Henle

111
Q

Loop of Henle: Reabsorption

A

20% - H2O, 25% - Na, K, Cl (Mg & Ca are also reabsorbed)

112
Q

Loop of Henle: Secretion

A

H+ via Na-H countertransport

113
Q

Loop of Henle: Impermeable to solutes, permeable to water

A

descending limb

114
Q

Loop of Henle: Impermeable to water, permeable to solutes

A

ascending limb

115
Q

Distal Tubule: Cells

A

simple cuboidal without brush border

116
Q

Distal Tubule: JuxtaGlomerular Apparatus, Macula Densa, JG Cells, Lacis Cells

A

first part

117
Q

Distal Tubule: Similar to the thick segment of LH, relatively impermeable to water

A

first part

118
Q

Distal Tubule: Second Part

A

late distal tubule and cortical collecting tubule

119
Q

Distal Tubule: Principal Cells, Intercalated Cells

A

second part

120
Q

Distal Tubule: Responsive to aldosterone

A

second part - reabsorbs Na, secretes K & H

121
Q

Distal Tubule: Secrete K, absorb Na (using Enac channels) and H2O,

A

Principal Cells

122
Q

Distal Tubule: Secrete H (H-ATPase pump, Na-K countertransport, minimal absorption of K

A

Intercalated Cells

123
Q

Distal Tubule: Reabsorbs ___ H2O, impermeable to ___

A

5% H2O, urea

124
Q

Collecting Duct: Cells

A

cuboidal with well-defined boundaries between cells

125
Q

Site for regulation of final urine volume and concntration

A

collecting duct

126
Q

Collecting Duct: Responsive to _____, permeable to ___, secretes ___.

A

vasopressin, urea, H

127
Q

Peritubular Capillary Hydrostatic Pressure: Increased by

A

increased BP

128
Q

Peritubular Capillary Hydrostatic Pressure: Decreased by

A

afferent/efferent arteriole vasoconstriction

129
Q

Peritubular Capillary Oncotic Pressure: Increased by

A

plasma protein concentration, filtration fraction

130
Q

Effects of Increased Peritubular Capillary Hydrostatic Pressure

A

decreased reabsorption, increased secretion

131
Q

Effects of Increased Peritubular Capillary Oncotic Pressure

A

increased reabsorption, decreased secretion

132
Q

An increase in BP would _____ GFR and cause Pressure _____ and Pressure _____.

A

increase GFR, diuresis, natriuresis

133
Q

Aldosterone: Site of Action

A

DT, early CD

134
Q

Aldosterone: Effects

A

increase - Na & H2O reabsorption, K & H secretion

135
Q

Angiotensin II: Site of Action

A

PCT, TAL LH, DT

136
Q

Angiotensin II: Effects

A

increase - Na & H2O reabsorption

137
Q

Catecholamines: Site of Action

A

PCT, TAL LH, DT, CD

138
Q

Catecholamines: Effects

A

increase - Na & H2O reabsorption

139
Q

Vasopressin: Site of Action

A

DT, CD

140
Q

Vasopressin: Effects

A

increase - H2O permeability and reabsorption

141
Q

ANP (atrium), BNP (ventricle): Site of Action

A

DT, CD

142
Q

ANP (atrium), BNP (ventricle): Effects

A

decrease - Na reabsorption

143
Q

Uroguanylin, Guanylin: Site of Action

A

PCT, CD

144
Q

Uroguanylin, Guanylin: Effects

A

decrease - Na & H2O reabsorption

145
Q

Dopamine: Site of Action

A

PCT

146
Q

Dopamine: Effects

A

decrease - Na & H2O reabsorption

147
Q

PTH: Site of Action

A

PCT, TAL LH, DT

148
Q

PTH: Effects

A

decrease - phosphate reabsorption (PCT), increase - Ca reabsorption (DT), stimulates 1-alpha-hydroxylase

149
Q

What are the trigger for ADH secretion?

A

increased plasma osmolarity, decreased BP, decreased blood volume

150
Q

Effect of alcohol on ADH secretion

A

increased

151
Q

Which hormone secreted by the DT and CD act imilar to ANP?

A

Urodilatin

152
Q

Rate at which substances are removed from the blood in the kidneys

A

Renal Clearance

153
Q

Renal Clearance =

A

( [Ux] x V ) / [Px]

154
Q

If a substance has a high clearance it has

A

low blood level, high urine level

155
Q

If a substance has a low clearance it has

A

high blood level, low urine level

156
Q

Clearance Ranking of Substances

A

PAH > K > creatinine > inulin > urea > Na > glucose, AAs

157
Q

Renal Clearance: Substance with the highest clearance

A

PAH

158
Q

Renal Clearance: Substances with zero clearance

A

glucose, AAs

159
Q

Renal Clearance: Substances whose clearance estimate GFR

A

inulin, BUN, creatinine

160
Q

Renal Clearance: Substances whose clearance is used to estimate Renal Blood/Plasma Flow

A

PAH

161
Q

Substances that do not appear in the urine have a clearance of ___.

A

zero

162
Q

Substances filtered and partially reabsorbed have a clearance ___ than the GFR.

A

less

163
Q

Substances filtered and with net secretion have a clearance ___ than the GFR.

A

more

164
Q

Clearance of inulin is ___ the GFR.

A

equal to

165
Q

___ of fluid per day passes through the kidneys.

A

180L/day

166
Q

_____ plays a crucial role in water reabsorption and thus urine volume and concentration.

A

Vasopressin or ADH

167
Q

___% of all filtered water is absorbed.

A

87-98.7%

168
Q

Facilitates Glucose reabsorption

A

Na-Glucose cotransport in the proximal tubule

169
Q

Transports glucose from the lumen to the PCT

A

SGLT-2 (secondary active transport)

170
Q

Transports glucose from the PCT to the peritubular capillaries

A

GLUT-1 and GLUT-2 (facilitated diffusion)

171
Q

___ is always coupled with the movement of H+, phosphate, AAs and lactate.

A

Sodium (Na)

172
Q

Actively transported in all parts of the renal tubule EXCET the descending limb of the LH

A

Sodium (Na)

173
Q

Normal Plasma K

A

4.2 mEq/L

174
Q

___kalemia causes arrythmias while ___kalemia causes weakness.

A

HyperK - arrhythmia, HypoK - weakness

175
Q

K+ Shift: Insulin

A

into cells (Na-K-ATPase pump)

176
Q

K+ Shift: Aldosterone

A

into cells

177
Q

K+ Shift: Beta-Adrenergic Stimulation

A

into cells

178
Q

K+ Shift: Alkalosis

A

into cells

179
Q

K+ Shift: Insulin Deficiency

A

out of cells

180
Q

K+ Shift: Addison’s Disease

A

out of cells

181
Q

K+ Shift: Beta-Adrenergic Blockade

A

out of cells

182
Q

K+ Shift: Acidosis

A

out of cells (H-K exchange)

183
Q

K+ Shift: Cell Lysis

A

out of cells

184
Q

K+ Shift: Strenuous Exercise

A

out of cells

185
Q

K+ Shift: Increased ECF Osmolarity

A

out of cells

186
Q

Day-to-day regulation of K occurs in the _____ and the _____.

A

late DT, cortical CT

187
Q

Normal Plasma Ca

A

2.4 mEq/L

188
Q

___calcemia causes arrythmias while ___calcemia causes tetany.

A

HyperCa - arrhythmia, HypoCa - tetany

189
Q

In acidosis, ___ Ca is bound to plasma proteins leading to ___calcemia.

A

less bound Ca, hyperCa

190
Q

In alkalosis, ___ Ca is bound to plasma proteins leading to ___calcemia.

A

more bound Ca, hypoCa

191
Q

Phosphate Transport Maximum

A

0.1 mM/min - often exceeded in diets with milk and meat

192
Q

Renal phosphate reabsorption is inhibited by

A

PTH

193
Q

Unreabsorbed _____ serve as urinary buffer for H+.

A

phosphate

194
Q

Normal Plasma Mg

A

1.8 mEq/L

195
Q

__% Mg stored in bones

A

50%

196
Q

Only __% of plasma Mg is excreted daily because it is reabsorbed in the ___ and the ___.

A

10% excreted, PCT - 25% reabsorption, TAL LH - 65% reabsorption

197
Q

__% of water is reabsorbed before reaching the CT.

A

> 87%

198
Q

The _____ is where the final urine output and urine concentration isdetermined.

A

CD

199
Q

Effects of High ADH

A

water reabsorption - high (more aquaporins), urine volume - low (min: 500 mL/day), urine concentration - high (max: 1200 mOsm/L)

200
Q

Effects of Low ADH

A

water reabsorption - low (less aquaporins), urine volume - high (max: 20 L/day), urine concentration - low (min: 50 mOsm/L)

201
Q

ADH provides the opportunity for water reabsorption while _____ provides the stimulus.

A

Countercurrent Mechanism

202
Q

Creates the Corticopapillary Osmotic Gradient in the renal interstitium, loops of Henle

A

Countercurrent Multipliers

203
Q

Maintains the Corticopapillary Osmotic Gradient in the renal interstitium (prevents dissipation), vasa recta

A

Countercurrent Exchangers

204
Q

Why is the loop of Henle able to act as a countercurrent multiplier?

A

countercurrent flow (hairpin loop, difference in permeability to water and e- in the ascending and descending wall, Na-K-2Cl pump in the TAL LH, slow flow

205
Q

What is the end-result of the countercurrent mechanism?

A

Corticopapillary Osmotic Gradient: 300 mOsm (PCT), 1200 mOsm (tip of LH)

206
Q

Why do you need a countercurrent exchanger?

A

The gradient would dissipate quickly if Na and urea are removed quickly. Vasa recta preserve this gradient by moving around in circles.

207
Q

Vasa recta preserve this gradient by moving around in circles.

A

Corticopapillary Osmotic Gradient

208
Q

Urea contributes up to __% of renal medullary interstitial osmolarity resulting in hyperosmolarity of the renal medulla.

A

50%

209
Q

ADH stimulates these urea receptors

A

UT-1

210
Q

Effect of Urea to Urine Osmolarity

A

more urea reabsorbed → increase in renal interstitium concentration → more concentrated urine

211
Q

The thirst center is found in the

A

anteroventral wall of the 3rd ventricle, preoptic nuclei

212
Q

It takes ___ minutes for water to be absorbed and distributed in the body.

A

30-60 minutes

213
Q

The micturition center is found in the

A

pons

214
Q

Micturition is inhibited by the

A

cerebral cortex

215
Q

pH compatible with life

A

6.8-8

216
Q

Systems that regulate H concentrations

A

body fluid buffer systems (HCO3, phosphate, intracellular proteins), respiratory center (PCO2), kidneys (HCO3)

217
Q

50-75% effective in returning pH back to normal within 3-12 minutes.

A

Respiratory Regulation of Acid-Base Balance

218
Q

Respiratory Regulation of Acid-Base Balance: __% effective in returning pH back to normal within __ minutes.

A

50-75%, 3-12 minutes

219
Q

Renal Regulation of Acid-Base Balance

A

secretion of excess H, reabsorption of filtered HCO3, production of new HCO3, use of ammonia (NH3) and phosphate (NaHPO4) as buffers

220
Q

Due to conditions resulting in decreased ventilation

A

Respiratory Acidosis

221
Q

Due to conditions resulting in increased ventilation

A

Respiratory Alkalosis

222
Q

Due to conditions resulting in excess acid or loss of base

A

Metabolic Acidosis

223
Q

Gain of acids, increased organic anions to maintain electroneutrality

A

HAGMA

224
Q

Loss of bases, increased Cl to maintain electroneutrality, Hyperchloremic Metabolic Acidosis with Normal Anion Gap

A

NAGMA

225
Q

Due to conditions resulting in loss of acid or gain of base

A

Metabolic Alkalosis

226
Q

Metabolic Acidosis: Methanol

A

HAGMA

227
Q

Metabolic Acidosis: Uremia

A

HAGMA

228
Q

Metabolic Acidosis: DKA

A

HAGMA

229
Q

Metabolic Acidosis: Paraldehyde

A

HAGMA

230
Q

Metabolic Acidosis: Propylene Glycol

A

HAGMA

231
Q

Metabolic Acidosis: Iron

A

HAGMA

232
Q

Metabolic Acidosis: Isoniazid

A

HAGMA

233
Q

Metabolic Acidosis: Idiopathic Acidosis

A

HAGMA

234
Q

Metabolic Acidosis: Lactic Acid (sepsis, shock)

A

HAGMA

235
Q

Metabolic Acidosis: Ethylene Glycol

A

HAGMA

236
Q

Metabolic Acidosis: Ethanol

A

HAGMA

237
Q

Metabolic Acidosis: Salicylic Acid

A

HAGMA

238
Q

Metabolic Acidosis: Hyperalimentation

A

NAGMA

239
Q

Metabolic Acidosis: Acetazolamide

A

NAGMA

240
Q

Metabolic Acidosis: RTA

A

NAGMA

241
Q

Metabolic Acidosis: Diarrhea

A

NAGMA

242
Q

Metabolic Acidosis: Ureteroenteric Fistula

A

NAGMA

243
Q

Metabolic Acidosis: Pancreaticoduodenal Fistula

A

NAGMA

Physiology (8 decks)

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