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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
Q

where does osmolality of filtrate reach highest point

A

elbow of loop of henle

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26
Q

ascending limb of loop

A

impermeable to water

solutes are reabsorbed but water can’t follow therefore filtrate becomes more and more diluted

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27
Q

thick loop of henle

A

20-25% filtered Na, K, Cl are reabsorbed

development of transmembrane potential that favors passive reabsorption of Ca, Mg

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28
Q

distal convoluted tubule

A

only about 5% of Na, Cl left to be reabsorbed

Calcium ions are actively reabsorbed in

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29
Q

what drugs act on the distal convoluted tubule

A

thiazide diuretics

inhibit Na/Cl reabsorption

NOT as much reabsorption occurs here, so TZDs are weak drugs

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30
Q

late distal tubule

A

site where aldosterone exerts its action

major site of regulation of K excretion

31
Q

vasa recta

A

found in the medulla of the kidney

blood vessels that work to concentrate urine

32
Q

ADH

A

secreted by posterior pituitary

aquaporin channels to open renal tubule

free water to be reabsorbed from urine therefore increasing osmolality

33
Q

ADH and low ECV

A

kidney senses decreased CO and signals release

3rd spacing, HF, nephrotic disease

34
Q

renal blood flow

A

20-25% of cardiac output

needed to ensure sufficient GFR for removal of waste products

regulation to keep blood flow and GFR constant

35
Q

renal blood flow neuronal control

A

affarent and efferent arterioles innervated by sympathetic NS

sensitive to vasoactive hormones

36
Q

during period of strong sympathetic stimulation… (urine output)

A

urine output can fall

due to constriction of afferent arteriole (decrease in renal flow)

37
Q

vasoconstrictors that work on kidney flow

A

angiotensin II, ADH, endothelians

38
Q

endothelians

A

peptides released from damaged endothelial cells and may play role in decreasing blood flow following acute renal failure

39
Q

vasodilators

A

dopamine, nitric oxide, prostaglandins

40
Q

NO

A

produced by vascular endothelium

PREVENTS vasoconstriction of renal blood vessels to allowing normal excretion of sodium and water

41
Q

prostaglandins

A

mediators of cell function, local production and action

protect kidney against vasoconstriction effects of sympathetic stimulation and angiotensin II

42
Q

NSAIDs

A

inhibit prostaglandin synthesis

may cause a reduction of renal flow and GFR (therefore AKI)

43
Q

auto regulation of renal flow function

A

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
Q

autoregulator mechanisms

A
  1. direct effect on smooth muscle

2. juxtaglomerular complex

45
Q

direct effect on smooth muscle

A

causes blood vessels to relax when there is increased BP and constrict when w/ decreased systemic pressure

work opposite the systemic BP

46
Q

juxtaglomerular complex

A

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
Q

what happens if urine moves thru too quickly?

A

less time for sodium reabsorption and higher concentration delivered to distal tubule in urine

this is the result of macula densa cells

48
Q

effect of high protein and glucose levels on GFR

A

cause decreased sodium delivery to distal tubule

increase GFR by same mechanisms

49
Q

as renal function declines…

A

increase in serum levels of substances such as urea, Cr, PO4, K

this can be measured with blood tests

50
Q

renal clearance

A

volume of plasma that is completely cleared ea. minute of any substance that finds its way to urine

51
Q

renal clearance is determined by

A

ability of glomeruli to filter substance and capacity of renal tubules to reabsorb or secrete it

ea. substance has its own clearance rate

52
Q

aldosterone present and sodium

A

all sodium in distal tubular fluid is reabsorbed and urine is essentially sodium free

53
Q

aldosterone absent and sodium

A

no sodium is reabsorbed from distal tubule

54
Q

aldosterone and potassium

A

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
Q

ANP

A

hormone synthesized in atrial muscle cells in response to stretch

increases sodium and water excretion by kidney

56
Q

effects of ANP

A
  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
Q

kidney and pH

A

regulate body pH by conserving bicarbonate and eliminating H ions

only site for H ion removal

58
Q

buffers of urine

A
  1. bicarbonate
  2. HPo4
  3. ammonia
59
Q

bicarbonate

A

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
Q

bicarbonate reaction

A

CO 2 + H2O –> H2CO3 –> H + HCO3

61
Q

ammonia

A

formed by deamination of glutamine

can be accelerated and will increase if H+ concentrations have been elevated for 1-2 days

62
Q

how is uric acid produceD?

A

product of purine metabolism (A/G of DNA)

63
Q

hyperuricemia

A

elevations in levels of uric acid

causes gout, kidney stones

64
Q

uric acid elimination

A

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
Q

how much urea does an adult produce a day?

A

25-30 g.day

rises with high protein diet is consumed, excessive tissue breakdown, GI bleed

66
Q

GI bleed and uric acid

A

blood is broken down to form ammonia

ammonia is absorbed into portal circulation and converted by liver

67
Q

normal BUN

A

8-25mg/dL

68
Q

during dehydration, BUN levels

A

INCREASE

decreased blood volume and FGR

69
Q

drugs eliminated by kidney

A

only drugs NOT bound to plasma proteins are filtered and able to be eliminated

70
Q

endocrine functions of kidney

A
  1. control of BP via RAAS
  2. calcium metabolism/vitamin D
  3. erythropoietin and RBC
71
Q

erythropoietin

A

regulates RBC production in bone marrow

synthesis is stimulated by hypoxia

CKD pos are often anemic bc kidneys can’t produce this hormone

72
Q

vitamin D function

A

increases Ca absorption from GI

regulate calcium deposition into bone

stimulates renal calcium absorption

73
Q

activation of vitamin D

A

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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