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Medical Physiology > Kidney Normal Stuff > Flashcards

Kidney Normal Stuff Flashcards

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USMLE® Step 1 flashcards
1
Q

Anatomy Review

Arcuate Artery is the boundary between?

Off arcuate artery is

KIdney has ___ artery that branches into__

Afferent wider diameter than

A

Anatomy Review

Arcuate artery is the boundary between cortex and medulla

interlobular artery which gives afferent arterioles

efferent artery, difference in diameter increases blood pressure to help force blood out through glomeruli

efferent, helps with above stuff

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2
Q

Pee path

A

Force fluid out capillariess into bowmans capsule

Urine filtrate to PCT (reabsorb/secretion), down into descening limb/ up ascending limb (modify conc of urine), DCT (back b/w afferent/efferent arterioles) at this point we have macula densa and JG apparatus (renin comes from here)

DCT join to collecting ducts, down to bladder

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3
Q

Descending limb of loop
Vs
Ascending Limb of loop
permeability

A

permeable to water, imp to salt

Ascending impermeable to water, active pump sodium out

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4
Q

DCT/colecting duct reabsorbtion/absortbtion is controlled by what biological mechanism?

A

HORMONAL

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5
Q

Absorbtion vs Reabsorbtion

A

Absorption
bring diff types of nutrients into blood stream.

Reabsorption
nutrients moving from urine filtrate back into blood stream

Both happen the same way
same processes drive both

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6
Q

Entire plasma volume is filtered but what percent is excreted as urine?

A

1%

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7
Q

3 steps of kidney

A

Golmerular filtration
force fluid/nutrients out of
blood into nephron

Reabsorb
everything good

Secretion
sub that dont get filtered
get forced into urine
filtrate

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8
Q

What is the cause/mechanism behind glomerular filtration?

A

Glomerular filtration is caused by the pressure difference between the afferent and efferent arterioles. The afferent arterioles have a larger diameter so the size difference increases blood pressure, forces liquid out into bowman capsule

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9
Q

When does tubular reabsorbtion/secretion

A

PCT

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10
Q

DCT/collecting ducts

A

changing concentration

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11
Q

GLOMERULAR FILTRATION:

Passive or active?
What powers it?

What is net filtration pressure (NFP)

Why glomeruli so good filter?

A

PASSIVE and NONSELECTIVE

Powered by hydrostatic pressure (NO ENERGY), forces fljuid and solutes through filtration membrane
no large protein
no large carbs
no blood !

High pressure that forces fluid out met with forces that drive fluid back into glomerulus

Fenestration capillaries, bp higher than other capillary beds (normally 18 mmhg, in here 55 mmhg) allows

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12
Q

GFR is defined as?

proportional to?

Normal GFR?

Governed by three factors

A

Volume of filtrate per minute by all glomeruli in kindey

GFR and NFP directly proportional

120-125 ml/min

  • total surface area for filtration
  • Filtration membrane permeability
  • NFP
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13
Q

what are 3 INTRINSIC controls of GFR

A

Renal autoregulation
myogenic mechanisms
tubuloglomerular mechanism

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14
Q

What is renal autoregulation

A

adjusting resistance of blood flow

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15
Q

Myogenic mechanism

A

stretch (when bp high) of smooth muscle (or lack of stretch) causes either vasoconstriction or vasodialation of afferent arteriole

happens with each heart beat, pump =constrction, relax = dialation

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16
Q

Tubuloglomerular mechanisms

A

macula densa cells of JGA

secrete VASOCONSTRICTOR in response to changes in osmolarity and filtrate flow in DCT

17
Q

What are the 2 EXTRINSIC controls of GFR

A

SNS controls

RAA system

18
Q

SNs controls of GFR

A

Extreme stress- override local renal control

Afferent arterioles constricted initally-blood goes to preferential organs

dec flow rate sensed by MACULA DENSA cells

Macula densa cells stimulage JG cells——SECRETE renin—-triggers RAA system

INCREASES BLOOD VOLUME AND BP

19
Q

RAA System

A

Renin-angiotensin—-angiotensin I

ACE changes angio I to angio II

angio II is a VASOCONSTRICTOR - incr bp througout body, efferent arteriole constrict more than afferent 
  causes release of 
   aldosterone--increased 
   sodium and water 
    absorption causes 
    increased in blood volume, 
     systemic bp and GFR 
     ADH--increased water absorbtion BY OPENING WATER CHANNELS also increases BV, BP, GFR
20
Q

When is renin is released by JG cells, it is caused by?

A

reduced stretch of JG cells

Stim of JG cells- MD, SNS, angiotensin II

21
Q

Tubular reabsorption

  • what is it?
  • Paracellular route?
  • Transcellular route?
A

Movement of molecules from filtrate to blood

Paracellular route- through
tight junct and into
preitubular capillaries
(h2o and ions)

Transcellular route 
    3 barriers
       luminal membrane of 
          tubule celll 
       basolateral membrane 
          of tubule cell 
       Peritubular capillary 
          wall 
    most substances reabsorbed this way
22
Q

What causes tubular reabsorption in PCT

How are sodium ions reabsorbed

How are glucose and other organics reabsorbed?

IONS, WATER, ORGANICS

A

sodium ion reabsorption creates gradients
drives reabsorbtion of
other substances in PCT

Luminal membrane-FACILITAED DIFFUSON COUPLED WITH COTRANSPORT

Basolateral membrane- active transport- na/k pump to release NA back into body

COTRANSPORT WITH NA ACROSS LUMINAL
FACILICATED DIFF ACROSS BASOLATERAL

PASSIVE DIFF

23
Q

Tubular Reabsorption
in Loop, DCT, collecting duct

What happens in Loop?

What happens in DCT and collecting ducts?

Hormones that control DCT/Collecting ducts

A

25% sodium, 35%Cl, 30% K, 10% water

DCT reabsorption all is hormonally controlled

Aldosterone: works on principle cells of dct.
sodium ion reabsorption/obligatory water reabsorption, less vol of urine

ADH- target principle cells
open or synth water channels-increase water reabsorb-conc urine (change osmolarity)

ANP- decreases sodium and water reabsorption. 
    inhibits secretion of 
     aldosterone. 
   sodium stays in urine, takes 
    water with it. bv/bp down
24
Q

What substances stay in urine?

A

urea, uric acid, creatine (excreted as creatinine

25
Q

what is T(m)

A

each substance EXCEPT sodium has a transport maximum
reflects number of carriers available to reabsorb into blood. if more substances there can be transported excreted. # of transporters = # of cashier. every cashier = Tm

26
Q

What is tubular secretion

A 
Movement of molecules from blood into filtrate 
    reabsoprtion in reverse 
    certain drugs 
     urea/uric acid 
     K+ (all get reabsrobed in PCT and loop, then secrete it buz of aldosterone in dct and cd 
      H+, HC30-keeps blood ph balance 
           too high-secrete HCO3 
            too low- secrete H+
27
Q

Hormone that controls 300 mOsm of body?

A

ADH - conreabsoprtion of H2O
present- reabsorb h2o
not- leave it alone

Medical Physiology (4 decks)

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