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FA17 Nephrology > Jill Renal Intro 1 > Flashcards

Jill Renal Intro 1 Flashcards

1
Q

urine formation involves which processes? (2)

A
  1. Filtration

2. reabsorption of electrolytes and nutrients

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2
Q

high pressure capillary filtration system located between 2 arterioles

A

glomerulus

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3
Q

high pressure in the glomerulus allows for…

A

face of fluid and solutes out of blood into glomerular space along bed’s entire length

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4
Q

bowman’s space

A

fluid filled space in bowman capsule

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5
Q

glomerular filtrate

A

portion of blood filtered into capsule space

large molecules don’t cross the glomerular wall (therefore no proteins)

similar composition to plasma

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6
Q

average daily GFR

A

125 mL of filtrate

regulated by afferent and efferent arterioles

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7
Q

effect of constriction of AFFERENT arteriole

pressure and GFR

A

not as much going in so…

DECREASED glomerular pressure and DECREASED GFR

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8
Q

effect of constriction of EFFERENT arteriole

pressure and GFR

A

can’t get out!

INCREASED glomerular pressure
INCREASED GFR

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9
Q

peritubular capillaries

A

originate from efferent arteriole and are low-pressure vessels

adapted for reabsorption

surround tubules and allow for reabsorption in the lumen

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10
Q

tubular transport can result in

A

reabsorption from fluid into capillaries OR secretion into tubular fluid from blood

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11
Q

Active reabsorption

A

Na, K, Cl, Ca, PO4

urate, glucose, amino acids

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12
Q

passive reabsorption

A

water and urea

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13
Q

secreted by kidneys

A

H+, K+, and urate ions

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14
Q

transport maximum

A

max amount of substance that can be reabsorbed per unit of time

depends upon the number of carrier proteins available for transport

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15
Q

renal threshold

A

palm level at which substance appears in urine

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16
Q

site of the most reabsorptive and secretory processes

A

proximal tubule

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17
Q

proximal tubule

complete reabsorption of

A

glucose, amino acids, lactate, water soluble vitamins

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18
Q

electrolytes partially reabsorbed in the proximal tubule

A

Na, K, Cl, bicarbonate

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19
Q

proximal tubule and water reabsorption

A

movement of sodium out of the tubular lumen

concentration gradient for water causes rapid movement out of the lumen

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20
Q

where are exogenous organic compounds excreted?

A

proximal tubule

i.e. penicillin, ASA, morphine

typically bound to plasma proteins and not filtered freely unless bound

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21
Q

loop of henle function

A

controlling concentration of urine

est. high concentration of osmotically active particles in renal parenchyma surrounding medullary collecting tubules where antidiuretic hormone exerts effects

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22
Q

taken as a whole, the loop of henle always reabsorbs

A

more sodium and chloride than water

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23
Q

drugs that work on thick ascending loop of Henle

A

site of action of loop diuretics

inhibit Na/K/Cl transporters

body is unable to reabsorb Na, so therefore unable to absorb water

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24
Q

thin descending limb of henle

A

highly permeable to water

moderately permeable to urea, Na, other ions

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25
where does osmolality of filtrate reach highest point
elbow of loop of henle
26
ascending limb of loop
impermeable to water solutes are reabsorbed but water can't follow therefore filtrate becomes more and more diluted
27
thick loop of henle
20-25% filtered Na, K, Cl are reabsorbed development of transmembrane potential that favors passive reabsorption of Ca, Mg
28
distal convoluted tubule
only about 5% of Na, Cl left to be reabsorbed Calcium ions are actively reabsorbed in
29
what drugs act on the distal convoluted tubule
thiazide diuretics inhibit Na/Cl reabsorption NOT as much reabsorption occurs here, so TZDs are weak drugs
30
late distal tubule
site where aldosterone exerts its action major site of regulation of K excretion
31
vasa recta
found in the medulla of the kidney blood vessels that work to concentrate urine
32
ADH
secreted by posterior pituitary aquaporin channels to open renal tubule free water to be reabsorbed from urine therefore increasing osmolality
33
ADH and low ECV
kidney senses decreased CO and signals release 3rd spacing, HF, nephrotic disease
34
renal blood flow
20-25% of cardiac output needed to ensure sufficient GFR for removal of waste products regulation to keep blood flow and GFR constant
35
renal blood flow neuronal control
affarent and efferent arterioles innervated by sympathetic NS sensitive to vasoactive hormones
36
during period of strong sympathetic stimulation... (urine output)
urine output can fall due to constriction of afferent arteriole (decrease in renal flow)
37
vasoconstrictors that work on kidney flow
angiotensin II, ADH, endothelians
38
endothelians
peptides released from damaged endothelial cells and may play role in decreasing blood flow following acute renal failure
39
vasodilators
dopamine, nitric oxide, prostaglandins
40
NO
produced by vascular endothelium PREVENTS vasoconstriction of renal blood vessels to allowing normal excretion of sodium and water
41
prostaglandins
mediators of cell function, local production and action protect kidney against vasoconstriction effects of sympathetic stimulation and angiotensin II
42
NSAIDs
inhibit prostaglandin synthesis may cause a reduction of renal flow and GFR (therefore AKI)
43
auto regulation of renal flow function
maintain renal flow consistent with needs of renal cells allow for precise regulation of solute and water excretion resistance to blood flow must be varied in proportion to arterial pressure
44
autoregulator mechanisms
1. direct effect on smooth muscle | 2. juxtaglomerular complex
45
direct effect on smooth muscle
causes blood vessels to relax when there is increased BP and constrict when w/ decreased systemic pressure work opposite the systemic BP
46
juxtaglomerular complex
found in distal tubule (macula densa cells w/renin) measures arterial and glomerular pressures and Na concentration and directly releases renin to raise stretch and increase GFR
47
what happens if urine moves thru too quickly?
less time for sodium reabsorption and higher concentration delivered to distal tubule in urine this is the result of macula densa cells
48
effect of high protein and glucose levels on GFR
cause decreased sodium delivery to distal tubule increase GFR by same mechanisms
49
as renal function declines...
increase in serum levels of substances such as urea, Cr, PO4, K this can be measured with blood tests
50
renal clearance
volume of plasma that is completely cleared ea. minute of any substance that finds its way to urine
51
renal clearance is determined by
ability of glomeruli to filter substance and capacity of renal tubules to reabsorb or secrete it ea. substance has its own clearance rate
52
aldosterone present and sodium
all sodium in distal tubular fluid is reabsorbed and urine is essentially sodium free
53
aldosterone absent and sodium
no sodium is reabsorbed from distal tubule
54
aldosterone and potassium
potassium is reabsorbed from and secreted into tubular fluid under influence of aldosterone only about 70 mEq sent to distal tubule, but more is consumed (excess K must be eliminated)
55
ANP
hormone synthesized in atrial muscle cells in response to stretch increases sodium and water excretion by kidney
56
effects of ANP
1. vasodilation of afferent and constriction of efferent arterioles = INCREASED GFR 2. inhibition of aldosterone = sodium reabsorption from collecting tubules 3. inhibition of ADH thereby increasing excretion of water by kidney
57
kidney and pH
regulate body pH by conserving bicarbonate and eliminating H ions only site for H ion removal
58
buffers of urine
1. bicarbonate 2. HPo4 3. ammonia
59
bicarbonate
combines with H+ to reform into water and CO2 CO2 is then reabsorbed by tubular cells and bicarb is regenerated the kidney tries to keep the CO2 low, so that the reaction favors hydrogen elimination
60
bicarbonate reaction
CO 2 + H2O --> H2CO3 --> H + HCO3
61
ammonia
formed by deamination of glutamine can be accelerated and will increase if H+ concentrations have been elevated for 1-2 days
62
how is uric acid produceD?
product of purine metabolism (A/G of DNA)
63
hyperuricemia
elevations in levels of uric acid causes gout, kidney stones
64
uric acid elimination
freely filtered and is reabsorbed and secreted into proximal tubules typically more is reabsorbed so that uric acid is eliminated from filtrate controlled to maintain a constant plasma level
65
how much urea does an adult produce a day?
25-30 g.day rises with high protein diet is consumed, excessive tissue breakdown, GI bleed
66
GI bleed and uric acid
blood is broken down to form ammonia ammonia is absorbed into portal circulation and converted by liver
67
normal BUN
8-25mg/dL
68
during dehydration, BUN levels
INCREASE decreased blood volume and FGR
69
drugs eliminated by kidney
only drugs NOT bound to plasma proteins are filtered and able to be eliminated
70
endocrine functions of kidney
1. control of BP via RAAS 2. calcium metabolism/vitamin D 3. erythropoietin and RBC
71
erythropoietin
regulates RBC production in bone marrow synthesis is stimulated by hypoxia CKD pos are often anemic bc kidneys can't produce this hormone
72
vitamin D function
increases Ca absorption from GI regulate calcium deposition into bone stimulates renal calcium absorption
73
activation of vitamin D
either cholecalciferol (skin) or synthetic (ergocalciferol) must have 2 hydroxylations to form 1-25 Dihydroxi.... if CKD, unable to transform vitamin D to active form

FA17 Nephrology (13 decks)

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