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4 Clinical Physiology > L7 Renal > Flashcards

L7 Renal Flashcards

1
Q

Acute kidney injury

A

sudden, temporary, but sometimes fatal loss of kidney function

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2
Q

Chronic Kidney Disease

A

any condition that decreases kidney function over a period of time

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3
Q

End-stage renal disease

A

total and permanent kidney failure

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4
Q

Two common risk factors for Chronic Renal Failure

A

Diabetes
Hypertension

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5
Q

Drugs to avoid with kidney disease

A

antibiotics
antidepressants
antivirals
chinese herbal medicines
cholesterol lowering statins
diuretics
NSAID pain relievers
Stomach-acid reducers

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6
Q

Consequences of renal failure

A

HTN
Metabolic Acidosis
Muscle Weakness
Osteoporosis
Anemia
CNS/PNS?autonomic dysfunction

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7
Q

Renal Failure and Osteopororsis

A

excreting calcium more, retaining phosphate

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8
Q

Renal Failure and ANemia

A

kidneys produce erthryopoetin, decreases with failure

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9
Q

Renal Failure and CNS, PNS, Autonomic Dysfunction

A

buildup of urea, increased BUN. Toxic to nerves

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10
Q

Plasma K+ level

A

3.7 to 5.1 mEq/L

both hypo and hyper are dangerous, especially for cardiac function

you should always review electrolyte panel

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11
Q

BP Control

A

Lifestyle modifications
Anti-hypertensive medications

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12
Q

Lifestyle Modifications (BP control)

A

DASH diet
exercise
no smoking
limited alcohol

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13
Q

Anti-hypertensive medications (BP control

A

ACE inhibitors
BBs
CCBs
Diuretics
vasodilators

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14
Q

Management of renal disease

A

BP control
Anemia Control
Dialysis
Renal transplantation

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15
Q

Hemodialysis

A

Cleaning the blood, specifically from nitrogenous waste (urea and creatanine) products, metabolites from drugs

prescribed at less than 15% of function left

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16
Q

Arteriovenous fistula for hemodialysis

A

Surgically created connection between an artery and a vein that makes needle placements for dialysis easier

Takes 6 weeks to heal

Can be used for years, allows blood to flow out/in w/out damaging veins

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17
Q

Precautions for arm with AV fistula

A

No BP
Keep the port clean
No heavy lifting
Do not sleep with arm under head

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18
Q

Peritoneal Dialysis

A

allows individuals to do their own dialysis

blood is cleaned w/out removing it from the body

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19
Q

Can exercise training help patients with CKD?

A

Adults w/CKD have VO2max that are 1/3 to 1/2 that of age-matched sedentary adults w/out kidney disease

Exercise can: improve BP control, increase functional capacity, increase H/H levels, improves glucose metabolism

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20
Q

Functions of the kidneys

A
  1. Regulate ECF volume through urine formation
  2. Regulate blood volume and BP
  3. Regulate concentration of electrolytes
  4. Regulate concentration of waste products in blood
  5. Regulate pH
  6. Secrete erythropoietin, production of RBCs
  7. Excrete metabolites
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21
Q

Kidney Medulla

A

-renal pyramids separated by renal columns
-pyramid contain minor calyces, which become major calyces, and then renal pelvis

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22
Q

Nephron

A

urinary tubules and associated blood vessels

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23
Q

Filtration

A

Blood to tubules

water and solutes that pass from the plasma to inside of glomerular capsule and tubules

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24
Q

Secretion

A

Blood to Tubules (active)

active transport of substances from plasma into tubules

opposite of reabsorption

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25
Q

Reabsorption

A

Tubules to blood

return of filtered water and molecules from tubules into plasma

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26
Q

Excretion

A

Fluid and solutes leave body in urine

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27
Q

Proximal Convoluted Tubule (Reabsorb)

A

65% of H2O, NaCL, K+ Reabsorbed

100% of AA and glucose reabsorbed

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28
Q

Loop of henle makeup

A

Thin descending limb
Thin ascending limb
Thick ascending limb

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29
Q

Loop of henle (reabsorb)

A

20% H2O, NaCL reabsorbed

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30
Q

Macula Densa

A

sense the glomerular filtration rate (GFR)

cells are in the ascending loop

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31
Q

Juxtaglomerular apparatus

A

macula densa and afferent arterioles

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32
Q

Hormones of collecting ducts

A

aldosterone
ADH/vasopressin

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33
Q

Descending Limb

A

Passive H2O reabsorption

water goes into the vasa recta

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34
Q

Ascending Limb

A

NaCL active reabsorption, goes into the interstitum

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35
Q

Reabsorption of H2O and NaCL

A

85% of it is not under hormonal control

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36
Q

Pathway after a nephron

A

Collecting duct > minor calyx > major calyx > renal pelvis > ureter > bladder > urethra

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37
Q

Cortical nephrons

A

urine formed here is about the same concentration as plasma

short loops of henle

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38
Q

Juxtamedullary nephrons

A

Critical to produce concentrated urine

long loops of henle

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39
Q

Osmosis

A

passive diffusion of water from hypotonic to hypertonic solution

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40
Q

Renal blood vessels

A

Afferent arteriole
Glomerulus
Efferent arteriole
Vasa Recta

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41
Q

Afferent arteriole

A

delivers blood into glomeruli

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42
Q

Glomerulus

A

capillary network produces filtrate that enters urinary tubules at glomerular capsule

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43
Q

Efferent arteriole

A

delivers blood from glomeruli to peritubular capillaries

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44
Q

Vasa recta

A

-straight arterioles and venules that lie parallel to the loop of henle

-blood flows through the tight turn at very slow rate

-Proximity of vasa recta to loop of henle AND the slow flow rate are critical to maintain the concentration gradient in renal medulla

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45
Q

Bowman’s capsule

A

surrounds glomerulus

where GLOMERULAR FILTRATION occurs

46
Q

What does RBC in the urine indicate?

A

that there has been damage to the glomerular filtration membrane

47
Q

What makes up the glomerular filtration membrane?

A

(PLASMA) Capillary endothelium
Basement membrane
Foot processes of podocyte of glomerular capsule

48
Q

Endothelial cells of glomerular capillaries

A

have LARGE pores

permeable to plasma, H2O, solutes

pores do not allow formed elements of blood to pass through

49
Q

Basement Membrane

A

Filtrate must pass through basement membrane

thin glycoprotein layer that is negatively charged, does not allow plasma proteins to pass through

50
Q

Podocytes of visceral layer of Bowman’s capsule

A

spaces between foot pedicels from small filtration slits that allow filtered molecules to enter interior Bowmna’s capsule

51
Q

Ultrafiltrate

A

fluid that enters the glomerular capsule

formed under the hydrostatic pressure of blood

52
Q

Glomerular filtration rate

A

measures kidney function

volume of filtrate removed from the blood each minute

averages 180 L/day

decreases with age and w/kidney dysfunction and disease

53
Q

How to estimate GFR

A

can be closely estimated by blood, creatinine

one of the best tests to measure kidney function

used to determine stage of kidney disease

54
Q

Why does GFT need to be regulated?

A

needs to be high enough to eliminate wastes

shouldn’t be so high that it causes excessive BV loss

55
Q

How is GFR regulated?

A

vasoconstriction or vasodilation of afferent arterioles affects the rate of blood flow to the glomerulus

56
Q

Forces across glomerular capillaries

A
  1. Beginning net = +16 mmHg
  2. End net = 0 mmHg

Pressure going into bowman’s space stays the same, and the pressure going out from bowman’s space. But, the pressure of the glomerular capillary changes due to the amount of plasma proteins

57
Q

What systems regulate GFR?

A

sympathetic nervous system

autoregulation of intrinsic to the kidneys

renin-angiotensin system

58
Q

SNS activation of glomerulus

A

causes vasoconstriction of afferent arterioles

causes decreased glomerular capillary hydrostatic pressure AND decreased urine output

ultimately preserves blood volume to muscles and heart

59
Q

Renal autoregulation

A

ability of kidneys to maintain a relatively constant GFR under widely changing BPs

allows GFR to remain constant, even with changing BP

60
Q

How does autoregulation occur?

A

Different from SNS input

  1. Effects of locally produced chemicals on afferent arterioles
  2. Tubuloglomerular feedback from macula densa
61
Q

What is reabsorbed and filtered?

A

glucose and AA, water

62
Q

What is never filtered?

A

potassium
antibiotics
formed elements/plasma protein

63
Q

Reabsorption details

A

180 L of ultrafiltrate are produced/day

only 1-2 L urine is excreted

most filtered solutes and H2O from the ultrafiltrate are returned back into the peritubular capillaries

64
Q

Obligatory water loss

A

minimum of 400 ml/day urine is necessary to excrete metabolic wastes (urea and creatane)

this is what you need to survive

65
Q

Nephron makeup

A

urinary tubule and associated blood vessels

66
Q

Reabsorption in PCT

A
  1. 65% of salt and water that enter the glomerular capsule is reabsorbed across PCT and returned to the plasma
  2. Total solute concentration is same as plasma (isosmotic)
67
Q

How is that fluid in PCT is 1/3 of original volume but it is still isosmotic with plasma?

A

Active Na+ transport and osmosis

68
Q

What things are reabsorbed?

A

Na+
Cl-
H2O follows by osmosis
glucose
amino acids

65% of Na, Cl, H2O, and K+ is reabsorbed
100% of glucose and AA are reabsorbed

69
Q

Proximal convoluted tubule

A

single layer of cuboidal cells

Na/K ATP located in sides of cell membrane creates GRADIENT of Na, causes diffusion into cell

Cl follows electrical gradient

H2O follows by osmosis

70
Q

Glucose Reabsorption

A

100% occurs in PCT

filtered but not excreted (along with AAs)

Cotransporters help to reabsorb glucose and AA

71
Q

What occurs in cotransporter saturation?

A

amount of cotransporters are limited

Glycosuria = glucose in urine
happens when glucose is >180 mg’dl
sign of diabetes

72
Q

Osmolality and Tubules

A

the interstitial fluid surround teh tubules has to be hypertonic to pull water out of the tubules

73
Q

How is the concentration gradient maintained in the kidneys?

A

countercurrent multiplier system
vasa recta

74
Q

Countercurrent multiplier system

A

amount of salt determines how much H20 and Na leaves

refers to the interaction between the descending and ascending loop of henle

  1. More salt is added by PCT
  2. Higher osmolarity of ECF, the more water that leaves the descending limb
  3. The more water that leaves, the saltier the fluid in the tubule becomes (more urine is produced)
  4. The saltier the fluid in the ascending limb, the more salt the tubule pumps out

positive feedback loop

75
Q

Role of Vasa Recta

A

pulls the water leaving the tubules into the blood to prevent dilution of the interstitial fluid

also allows NA to remain in the intersitial fluid of the medulla

76
Q

Role of urea

A

nitrogenous waste product from protein

both ascending and terminal collecting duct are permeable to urea

recycyled through these two areas, contributing to the osmolality of the intersitial fluid in the inner medulla

77
Q

Order of the nephron

A

Bowman’s capsule
PCT
Loop of henle
Macula densa
DCT
Collecting Duct

78
Q

Order of chemical processes in nephron

A

Filtration
Reabsorption
Secretion
Excretion

79
Q

Collecting ducts anatomy

A

receive fluid from DCTs of nephrons
pass through renal pyramid into minor calyx

80
Q

Functions of collecting ducts

A
  1. Reabsorption–> h2o, influenced by ADH
  2. Secretion–> potassium, influenced by aldosterone
81
Q

Dehydration and ADH

A

Dehydration causes ADH to be released

  1. Increased salt/increased plasma osmolality
  2. Triggers osmoreceptors/thirst
  3. release of ADH from posterior pituitary
82
Q

Vasopression receptors

A

V1: vascular smooth muscle –> vasoconstriction
V2: cells of renal collecting duct –> water reabsorption

83
Q

Diabetes Insipidus

A

deficiency of ADH/vasopression

84
Q

Aldosterone

A

The final concentrations of Na and K are varied in DCT and collecting ducts because of aldosterone

Triggers: angiotensin 2, high plasma K, low plasma Na

increases blood pressure, reabsorbs Na and K secretion. results in water retention in exchange for loss of K

85
Q

How do the kidneys sense your BP?

A

juxtaglomerular apparatus
–> granular cells and macula densa

86
Q

H2O and Collecting Ducts

A

H2o is drawn out by osmosis
the rate is determined by the # of aquaporins

permeability to H2o depends on the presence of ADH

ADH helps to bind to CD cells, incorporating more aquaporins into cell membrane, allowing water reabsorption

87
Q

How does aldosterone reabsorb Na and secrete K?

A

Aldosterone inserts luminal Na channels, promotes synthesis of Na, K, ATPase in the principal cells of the CDs

88
Q

Role of aldosterone in K secretion

A

Final blood K is controlled by aldosterone
–> this only impacts FINAL, not the 90% that is reabsorbed early on in the nephrons

Aldosterone is the ONLY thing that controls K being excreted

89
Q

Hyperkalemia

A

could be caused by hypoaldosteronism, renal failure, diurectics, chronic acidosis

you would have low BP, severe cardaic arrthymias, renal failure

90
Q

Hypokalemia

A

could be caused by hyperaldosteronism, low potassium diet, diuretics, chronic allkalosis

also would experience hypertension, muscle spasms

91
Q

Acid-base regulation

A

Kidneys secrete H+ and reabsorb HCO3

H secretion occurs in proximal tubule in exchange for absorption of Na

Kidneys reabsorb almost all filtered HCO2 and excrete H, so urine is slightly acidic

H is excreted as HPO4 or as ammonia

92
Q

Relationship of Na, K, and H

A

Na is reabsorbed from CD, which creates an electrical K to be secreted (Na out, K in)

Plasma K levels indirectly affects plasma H

In severe acidosis, H is secreted at expense of K, which can cause hyperkalemia

93
Q

Diuretics

A

drugs that increase urine volume

increases frequency and volume

prescribed for HTN, heart failure, edema

inhibit the reabsorption of salt

classes of strong, weak, potassium sparing

94
Q

Strongest diuretics

A

loop and thiazide diuretics
inhibit salt and H2o reabsorption by as much as 25% (lasik)

95
Q

Potassium Sparing Diuretics

A

Prevent excessive K+ excretion that tends to occur with above diuretic classes
(spironolactone)

96
Q

Hypokalemia and Diuretics

A

–> these diuretics increase Na delivery to DCT, causing increased K loss. Na is reabsorbed, K and H are secreted

97
Q

If a substance is neither reabsorbed nor secreted…

A

the amount excreted = amount filtered

would be a perfect measure of GFR

no endogenous substance in the body perfectly fits this criterion

98
Q

GFR and inulin

A

inulin = fructose polymer that is neither reabsorbed or secreted

The GFR of inulin equals the clearnce of inulin

GFR = (inulin concentration x rate of urine formation)/plasma concentration

99
Q

Clearance

A

volume of plasma from which a substance is completely removed in 1 minute by excretion into urine

we can measure GFR by the clearance of a substance

100
Q

How can.GFR be measured?

A

Inulin levels (scientific)
Creatinine levels (clinical)

101
Q

Creatinine and GFR

A

filtered and secreted
excretion closely matches GFR, slightly overestimates it

if GFR decreases, plasma creatinine rises–> if kidneys are failing, then the creatinine levels rise

no normal value

102
Q

Blood urea nitrogen (BUn)

A

normal = 7-20

higher = kidney disease, heart failure, excessive protein levels
lower than normal = liver failure, low protein, malnutrition

103
Q

A low eGFR…

A

high creatinine
high BUN
high albumin in urine

104
Q

If substance is not filtered

A

the renal clearance rate = zero

proteins

105
Q

If substance is filtered, but not reabsorbed or secreted

A

renal clearance rate = GFR
inulin

106
Q

If substance is filtered and partially reabsorbed

A

renal clearnace rate is less than GFR

urea

107
Q

If substance is filtered and completely reabsorbed

A

the renal clearance rate is zero

glucose

108
Q

If substance is filtered and secreted

A

renal clearance rate is greater than GFR

109
Q

If substance is filtered, reabsorbed, and secreted

A

the renal clearance rate is variable

potassium

110
Q

GFR vs Renal Clearance Rate

A

GFR specifically focuses on the filtration of plasma through the glomeruli

renal clearance rate encompasses the complete removal of a substance from the blood, considering both filtration and any additional processes that occur in the renal tubules.

GFR is used as an indicator of overall kidney function

renal clearance rate can provide more detailed information about how efficiently the kidneys handle specific substances

4 Clinical Physiology (9 decks)

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