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Medicine > Kidney > Flashcards

Kidney Flashcards

1
Q

Which is true about post-glomerular capillaries?
a) Favour resorption
b) Favour filtration
c) High capillary hydrostatic pressure
d) Low cap hydrostatic pressure
e) Increases peritubular and vasa recta capillaries
f) Includes afferent and efferent arterioles

A

a, d, e

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2
Q

Choose highest to lowest BP
a) 1.) Peritubular Capillary 2.) Efferent Arteriole 3.) Glomerular Capillary 4.) Renal Artery 5.) Afferent Arteriole 6.) Intrarenal Vein 7.) Renal Vein

b) 1.) Afferent Arteriole 2.) Renal Artery 3.) Intrarenal Vein 4.) Efferent Arteriole 5.) Peritubular Capillary 6.) Renal Vein 7.) Glomerular Capillary

c) 1.) Renal Artery 2.) Afferent Arteriole 3.) Glomerular Capillary 4.) Efferent Arteriole 5.) Peritubular Capillary 6.) Intrarenal Vein 7.) Renal Vein

A

c

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3
Q

The sites of greatest vascular resistance and most significant drops in blood pressure occur in?

a) Afferent arteriole and Efferent Arteriole​

b) Renal Artery and Renal Vein​

c) Glomerular capillary and Peritubular Capillary​

d) Afferent arteriole and Renal Vein

A

A) Afferent and efferent arterioles

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4
Q

True or false: If a solute has a negative charge; it is more likely to pass through permeable membrane with ease.

A

FALSE

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5
Q

Which nerve innervates the detrusor and internal sphincter in the filling/storage phase

A

Hypogastric nerve (sympathetic)

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6
Q

Which nerve causes contraction of the detrusor in the voiding phase

A

Pelvic nerve (parasympathetic)

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7
Q

Which pathway is targeted in treatment for USMI

A

Alpha adrenergic

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8
Q

What electrolytes does the macula densa detect changes in to stimulate the RAAS

A

Sodium and chloride

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9
Q

What percentage of renal blow flow is delivered to the cortex and then directed to the medulla

A

100% and 10%

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10
Q

What is the equation for calculating GFR

A

GFR = Kfx(PGC - PBC - πGC)

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11
Q

Which molecule would pass freely through the glomerular filtration barrier?​

a) Negative charge, 65,000 Daltons​

b) Positive charge, 6500 Daltons​

c) Negative charge, 6500 Daltons​

d) Positive charge, 65,000 Daltons​

A

c)

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12
Q

An 8 year old female spayed dog shows 2+ glucosuria on wellness exam urinalysis. What are the possible causes for this finding?

a) Proximal Tubule Damage

b) Glucose solute load exceeds transmitter capacity

c) Both

A

c)

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13
Q

Choose all the reasons that are causes for glucosuria.

Select all that apply:

a) Distal tubule disease

b) Fanconi’s Syndrome

c) SLGT2 inhibitor medication

d) Disruption of the NA-K-ATPAse pump

e) Recent meal

f) Copper Storage Disease

A

b, c, f

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14
Q

A drug X secreted into the proximal tubule by a Tm-limited system. This implies that:

a) X cannot easily diffuse by the paracellular route

b) All the X that enters the renal vasculature will be secreted

c) X is not filtered at the glomerulus

d) The rate of X secretion is independent of the plasma concentration

A

a)

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15
Q

The descending loop of Henle reabsorbs ___ sodium and ___ Water.

a) No, 30

b) No, 20

c) No, 10

d) 20, none

A

c)

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16
Q

Reduction in what two hormones can reduce the medullary osmotic gradient

A

Aldosterone and ADH

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17
Q

What is the primary glucose transporter in the proximal tubule

A

SGLT2

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18
Q

Which solute is needed to power the active transport of glucose?

a) K+

b) Cl-

c) Na+

d) Ca+

A

d)

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19
Q

What is the rate limiting step in aldosterone secretion?

A

Renin activity

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20
Q

True or false: Vitamin D enhances the expression of apical calcium transport channelsand intracellular calcium binding proteins within the cells of the distal convoluted tubule and collecting duct.

A

TRUE

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21
Q

True or false: Vitamin D directly increases osteoclastic activity leading to increased reabsorption of Calcium and Phosphate?

A

FALSE

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22
Q

What does 1,25-hydroxyvitamin D3 cause?

A

Increased levels of 1,25-hydroxyvitamin D3 lead to increased intestinal absorption of Ca2+ and PO43−

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23
Q

Select all that are true about Vitamin D.

Select all that apply:

a) Vitamin D is a lipid soluble secosteroid molecule

b) Vitamin D is a vitamin that can be synthesized de novo

c) Vitamin D is a hormone that is secreted by an endocrine gland

d) Vitamin D is a hormone that is not secreted by an endocrine gland

A

a, b, d

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24
Q

Carnivores (usually) secrete ___ urine while herbivores secrete ___ urine?

Select all that apply:

a) Acidic, basic

b) Basic, acidic

c) Neutral, neutral

d) Acidic, neutral

A

d

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25
Q

Bicarbonate secretion is stimulated by?

Select all that apply:

a) Alkalosis

b) Dietary restriction of NaCl

c) Aldosterone

d) None

A

a, b ,c

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26
Q

A protein-based diet leads to ____ while a carbohydrate-based diet leads to____ load.

a) Acid, base

b) Base, acid

c) Acid, none

A

c

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27
Q

Quite simply, acid or base loads are turned into an excess or deficit of_____?

A

HCO3-

28
Q

What is the significance of glutamate in acid-base balance?

a) Functions as a buffer

b) Acts as a base to alkalinize urine

c) Substrate for ammonia production

d) Accepts H+ in tubular lumen

A

c

29
Q

In what order do the lung, kidneys and chemical buffers react to changes in acid-base status?

A

Chemical buffers -> lungs -> kidneys

30
Q

Which of the following statements is false regarding Type A and Type B intercalated cells?

a) Type A cells reabsorb HCO3- and secrete H+

b) Type A cells are active during acidosis

c) Type A cells reabsorb H+ and secrete HCO3-

d) Type B cells are active during acidosis

A

d

31
Q

Which of the following are effects telmisartan, an angiotensin receptor blocker?

Select all that apply:

a) Systemic and renal vasoconstriction

b) Systemic and renal vasodilation

c) Increased renal sodium absorption

d) Decreased renal sodium absorption

e) Decreased aldosterone secretion

f) Increased aldosterone secretion

A

b, d, e

32
Q

The RAAS impacts which parts of the cardiac output equation?

A

Systemic vascular resistance and stroke volume

33
Q

Which of the following parts of RBC production are dependent on erythropoietin?

a) Pluripotent stem cells, colony forming unit erythroid cells

b) Colony forming unit erythroid cells, reticulocytes

c) Reticulocytes, pluripotent stem cells

d) Proerythroblasts, colony forming unit erythroid cells

A

d)

34
Q

What is the primary mechanism through which ACE inhibitors lead to a decrease in systemic blood pressure?

A

Decreased angiotensin II production

35
Q

Which of the following decreases aldosterone secretion?

a) Elevated potassium concentration

b) Increased angiotensin II levels

c) Decreased sodium concentration

d) Increased sodium concentration

A

c)

36
Q

Which of the following is an effect of both angiotensin II and aldosterone?

a) Increased sodium reabsorption

b) Vasoconstriction

c) Increased thirst drive

d) Increased potassium excretion

A

a)

37
Q

Which part of the adrenal gland produces aldosterone

A

zona glomerulosa

38
Q

What is glomerular filtration rate?

A

the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. It is an approximation of how efficiently the glomerulus is moving plasma volume and appropriate solutes into the tubular apparatus.

39
Q

What are the 7 main functions of the kidney?

A

1Regulation of water and electrolyte balance

2 Regulation of extracellular fluid volume and systemic blood pressure

3 Regulation of acid-base balance

4 Excretion of metabolic waste and foreign substances

5 Regulation of red blood cell production

6 Regulation of vitamin D production, and calcium and phosphate balance

7 Gluconeogenesis

40
Q

Which hormones cause vasoconstriction of the renal blood vessels, thus reducing GFR
a) adrenaline
b) noradrenaline
c) endothelin
d) angiotensin II
e) endothelial derived nitrous oxide
f) prostaglandins

A

a, b, c
- adrenaline and noradrenaline (sympathetic), constrict the afferent and efferent arterioles, reducing glomerular blood flow.
- endothelin released by damaged vascular endothelial cells, causes vasoconstriction.
- angiotensin II - neutral, vasoconstrictor of the EFFERENT arterioles, aims to prevent decr GFR by incr hydrostatic pressure.
- endothelial derived nitrous oxide causes vasodilation of the kidneys, incr GFR aiding excretion of sodium and water. - prostaglandins and bradykinin cause vasodilator and increase renal blood flow, therefore increase GFR

41
Q

What is the formula of filtration, resorption and secretion for renal excretion?

A

Filtration – reabsorption + secretion = Excretion

42
Q

What is the charge of the capillary membrane in the glomerulus?
a) Positive
b) Negative
c) Neutral

A

Negative

43
Q

What is the formula for filtration fraction?

A

GFR/ Renal Blood Flow

44
Q

What percentage of water and small molecules that enter the glomerulus are filtered into the Bowmans capsule and tubules?
a) 10-20%
b) 40-60%
c) 20-30%
d) 80-90%

A

c)

45
Q

Total body water is 20% ICF and 20% ECF. What percentage of the 20% ECF is interstitial and plasma?

A

Interstitial - 15%
Plasma - 5%

46
Q

What percentage of the fluid volume entering the tubular system is excreted as urine?

A

1%

47
Q

Which of these is a voluntary action?
a) Contraction of the internal urethral sphincter
b) Contraction of the detrusor
c) Contraction of the external urethral sphincter

A

c - via the pudendal nerve (somatic nervous system0

48
Q

What is the action of phenylpropanolamine?
a) alpha adrenergic antagonist
b) alpha adrenergic agonist
c) beta adrenergic agonist
d) beta adrenergic antagonist

A

b

49
Q

What percentage of resting cardiac output is directed to the kidneys?

a) 10%
b) 20%
c) 50%
d) 70%

A

b) 20% (only 10% of blood flow delivered to the cortex is then directed to the medulla)

50
Q

What is the renal blood flow equation?

A

Q = P(mean pressure in the vessel supplying the vascular bed - the pressure of the vessel draining it) / R (total vascular resistance in the vascular bed)

51
Q

What is Poiseuille’s law?

A

R = 8nl/πr^4

Resistance to blood flow = 8 x viscosity of blood x length of the vessel/ π x radius of vessel ^4

*can only have a 19% change in vessel radius to double or halve vessel resistance

Within the kidney, each interlobular artery branches into multiple afferent arterioles and glomeruli, which creates parallel connections. These parallel pathways result in a total low vascular resistance and high renal blood flow.

52
Q

Which of these statements if correct?

  1. High blood flow and the peritubular network in the cortex maintain the interstitial environment very close to that of blood plasma.
  2. Low blood flow and the peritubular network in the cortex maintain the interstitial environment very close to that of blood plasma.
  3. Lower blood flow and vascular bundling in the medulla allow the interstitial environment to differentiate from blood plasma, which is crucial in regulating water excretion and the formation of dilute and concentrated urine.
  4. Higher blood flow and vascular bundling in the medulla allow the interstitial environment to differentiate from blood plasma, which is crucial in regulating water excretion and the formation of dilute and concentrated urine.
A

1, 3

53
Q

What charge is the glycocalyx of the filtration barrier? What charged molecules do it allow to pass through?

A

Negative, positive and small anions (neg charge) pass through

54
Q

The glomerular filtrate composition is very similar to plasma with the exception of what?

A

Proteins

55
Q

What is the formula for filtration fraction?

A

GFR/ renal plasma flow (normal FF is 20-30%, remainder continues to the efferent arteriole)

56
Q

What is normal GFR in a cat and dog?

A

cat = 2ml/min/kg
dog = 2-5 ml/min/kg

57
Q

What is the filtration coefficient (Kf)

A

the product if the hydraulic permeability and the surface area (approx 12.5 ml/min/mmHG of filtration pressure)

58
Q

What is the filtration rate equation?

A

hydraulic pressure x surface area x net filtration pressure

59
Q

What is the NFP equation

A

= (Pgc - Pbs) - (πgc - πbc)

Hydrostatic - oncotic pressures

60
Q

What is net filtration pressure? (NFP)

A

Summation of all the forces favouring and opposing filtration

(higher in glomerulus cf capillary beds)

61
Q

How does Angiotensin cause increased GFR?
a) dilation of the afferent arteriole
b) constriction of the afferent arteriole
c) constriction of the efferent arteriole
d) dilation of the efferent arteriole

A

c)

*Decreases renal blood flow

62
Q

How does amlodipine cause increased GFR?
a) dilation of the afferent arteriole
b) constriction of the afferent arteriole
c) constriction of the efferent arteriole
d) dilation of the efferent arteriole

A

a)

  • increases renal blood flow
63
Q

How does the sympa NS cause decreased GFR?
a) dilation of the afferent arteriole
b) constriction of the afferent arteriole
c) constriction of the efferent arteriole
d) dilation of the efferent arteriole

A

b)

*Decreases renal blood flow

63
Q

How does AT II receptor blocker cause decreased GFR?
a) dilation of the afferent arteriole
b) constriction of the afferent arteriole
c) constriction of the efferent arteriole
d) dilation of the efferent arteriole

A

d)

*Increases renal blood flow

64
Q

What type of Urolith can be androgen dependent in dogs?
- ammonium urate
- calcium phosphate
- cystine
- calcium oxalate

A

Cystine - either SLC3A1 recessive (type 1), SLC3A1 and SLC7A9 dominant (type 2) or sex linked/ androgen responsive (type 3). Bulldogs, frenchies and mastiffs predisposed to type 3. Tx castration

65
Q

What is the link between hyperlipidaemia and proteinuria?

A

Proteinuria occurs with HTG in Miniature schnauzers and could be due to lipid-induced glomerular injury.

Medicine (10 decks)

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