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CRAAB 6 > Katz: Renal Basics > Flashcards

Katz: Renal Basics Flashcards

1
Q

What is renal function good for?

A
  1. Homeostasis (keeping water and solutes balanced)
  2. Waste productds (Creatinine, NH4, Urea)
  3. Regulation of MAP
  4. H+ Acid Base Balance
  5. Endocrine Organ
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2
Q

What hormones is the kidney responsible for?

A
  1. EPO> RBC > hematocrit
  2. Active Vit D (hydroxylated in the kidney)
  3. Renin > ang I > ang II
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3
Q

What does the triple filtration barrier between the glomerular capillary lumen and bowman’s space consist of?

A
  1. Capillary endothelium (10% SA has fenestrations)
  2. GBM (sieve)
  3. Podocytes (filtration slits)
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4
Q

How does diabetic neuropathy lead to a loss of glomerular filtration?

A

DN causes glomerulosclerosis (collapse of the glomerular capillaries). About HALF of the dialysis pop has diabetes.

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5
Q

How does Good Pasture Syndrome affect the kidneys?

A

Autoantibodies target the GBM

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6
Q

What causes alport syndrome?

A

Mutations in the GBM

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7
Q

What is minimal change disease?

A

Podocyte foot processes are partially fused (diffuse retraction and effacement of the foot processes) >
loss of albumin in the urine

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8
Q

What is GFR?

A

The combined rate of fluid movement from glomerular capillary lumen to bowman’s space for all nephrons in both kidneys

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9
Q

What is the equation for GFR?

A

kf= openness of hte glumerular capillary pores

GFR= kf [( Pgc+ Obs) - (Pbs + Ogc)]

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10
Q

What is the relationship between the concentration of albumin and the plasma protein osmotic pressure Oc?

A

Only a tiny amt of albumin is filtered and 90% of the filtered albumin is reabsorbed back into the blood leading to the plasma protein osmotic pressure.

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11
Q

What is microalbuminuria?

A

AER (albumin excretion rate) > 30 mg/day

Can be indicative of glomerular disease

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12
Q

An AER >3000mg/day is indicatve of what?

A

Nephrotic syndrome–these people can have a LOW plasma albumin

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13
Q

Why is their enormous filtration across the glomerular capillaries?

A

B/c the kidneys receive about 1/5 of cardiac output

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14
Q

How much blood do the kidneys receive? How much plasma do they recieve?

A

Both kidneys receive about 1000 ml/min of blood.

If the hematocrit is 40%, then both kidneys combined receive 600 ml of plasma.

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15
Q

What generally is the RPF (renal plasma flow)?

A

600 mL/min

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16
Q

How much blood is filtered at the glomerular capillaries?

A

125 ml/min (GFR)

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17
Q

What happens to the remain 475 ml/min that doesn’t get filtered through the glomerular capillaries?

A

It leaves the kidney via the efferent arteriole

18
Q

What is the filtration fraction?

A

The fraction of the renal plasma flow that is filtered.

19
Q

What is the equation for filtration fraction?

A

GFR/RPF (125/600=.2)

Only about 20% of RPF gets filtered.

20
Q

What does NE do to the kidney?

A

Constricts the AFF and EFF arteriole

21
Q

What does Ang II do to the kidney?

A

only EFF constriction

22
Q

What does hte blood leaving the glomeruli through the efferent arteriole have a HIGH hematocrit and HIGH oncotic pressure?

A

There is a decreased concentration of water (b/c it has been filtered) resulting in increased water and increased albumin.

23
Q

How do the concentrations of Na differ in the aff and eff arterioles?

A

They are equal (both 140)

24
Q

What is the lumen of the proximal tubule lined with?

A

renal tubular epithelial cells

25
Q

What happens to GFR as you get older?

A

FALLS with increased age and weight

26
Q

What happens to Pgc, RPF and GFR when there is vasoconstriction of the aff arteriole?

A

All three are decreased

27
Q

What happens to Pgc, RPF and GFR when there is vasoconstriction of the eff arteriole (angio II)?

A

Pgc increases
RPF decreases
GFR increases or stays the same

28
Q

What’s more important in determining GFR, RPF or Pgc?

A

Pgc

29
Q

What happens when there is stimultaneous afferent/efferent arteriole vasoconstriction?

A

Pgc stays the same
RPF decreases
GFR stays the same or decreases

30
Q

Can the kidneys control Pgc and GFR somewhat independently of RPF?

A

Yes

31
Q

What is the filtered load of solute equal to?

A

GFR x (free plasma concentration of solute)

32
Q

What are the filtered loads of glucose and Na?

A

25,000 mM Na/day
900 mM glucose/day

Seemingly WAY to high

33
Q

What is the excretion rate of a solute?

A

Urine flow rate x (urinary concentration of a solute)

The excretion rate of water and solutes is just enough to stay in balance.

34
Q

What is one of the only solutes whose filtered load is equal to the excretion rate? What does this mean?

A

Creatinine

There is no resabsorption, secretion, production or destruction of these solutes by the nephron.

35
Q

What is the equation for GFR?

A

GFR= (UFR x [Cru] / [Cr}p

Excretion of special solutes (creatinine)/ special solute plasma concentration

36
Q

What happens to creatinine clearance as GFR falls?

A

creatinine clearance falls

37
Q

What is a good marker for GFR?

A

creatinine

38
Q

What happens to creatinine if GFR falls by 1/2?

A

Plasma creatinine will increase by a factor of 2

39
Q

What is the equation for creatinine production rate?

A

GFR x (creatinine in plasma)

40
Q

What is indicated by an increased BUN (plasma urea) in addition to a plasma creatinine?

A

GFR is almost certainly reduced

41
Q

What may be the best indication of reduced GFR?

A

Plasma cystatin C (endogenous protease inhibitor)

42
Q

What three products are affected by GFR?

A

Creatinine, cystatine C and BUN can only exit the body via GFR so if GFR falls their respective plasma concentrations increase

CRAAB 6 (9 decks)

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