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Exam 3 physio > Lecture 1 Renal > Flashcards

Lecture 1 Renal Flashcards

1
Q

what are the 2 keys to maintaining homeostasis within the kidney

A

excrete wastes/ drugs, balance intake and secretion

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2
Q

5 functions of kidneys

A 
eliminate waste like urea
regulate water and salts
removal foreign chemicals like drugs
gluconeogenesis
produce hormones
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3
Q

3 hormones produced by kidneys

A

renin
1,25 dihydroxyvitamin D
erythropotietin

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4
Q

what does renin do
INC in renin?
DEC in renin

A

renin regulates BP part of angiotensin -aldesterone cascade
INC renin INC BP
DEC renin DEC BP

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5
Q

what is Erythropoietin for

A

acts in bone marrow to stimulate production of RBCs

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6
Q

what is 1,25 Dihydroxyvitamin D for

A

regulation of Ca reabsorption

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7
Q

End State Renal disease can be acute or chronic which one needs dialysis

A

chronic ESRD requires dialysis

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8
Q

What does ESRD causes concerning kidney function

A

causes inability to excrete N wastes leading to excess ammonium

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9
Q

what does excess ammonium production by kidney lead to

A

INC blood pH- blood becomes alkalized which leads to INC pH in mouth!

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10
Q

ESRD oral health affects (4)

A

gingival enlargment (side effect of ESRD drugs)
xerostomia
tooth problems (premature loss, narrowing of pulp chambers, necrosis beneath restorations)
ammonium breath - from INC pH

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11
Q

what tooth problems from restricted blood flow arise from ESRD

A

premature tooth loss - which indicates stage of ESRD
narrowing of pulp chambers
necrosis beneath restorations

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12
Q

Contras for ESRD pts?

A

DO NOT use nephrotoxic drugs such as tetracycline, acyclovir, apsirin, NSAIDs

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13
Q

PTs with ESRD have a INC in what? what is this caused from

A

PTs with ESRD have INC in bleeding due to destruction of platelets

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14
Q

PTs with ESRD have INC bleeding so what drugs would you not want to prescribe to them?

A

aspirin and NSAIDs

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15
Q

position of kidney in abdominal cavity

A

retroperitoneal

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16
Q

Structure of kidney

A

outer cortex and inner medulla composed of many nephrons

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17
Q

functional until of kidney

A

nephron

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18
Q

what happens in renal cortex

A

blood is filtrated through glomeruli and filtrate passes thru tubule of nephron

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19
Q

what concentrates urine

A

LoH

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20
Q

in the medulla what do portions of the nephron do?

A

concentration and collection of urine

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21
Q

what do the tubules empty into? what does this empty in to?

A

tubules > renal pelvis > ureter

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22
Q

ureter empties in to what? this empties in to what?

A

ureter > urinary bladder > urethra

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23
Q

how many nephrons in each kidney

A

1.2 x 10^6

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24
Q

what is a nephron made of (x 5)

A 
renal corpuscle (glomerulus + capsule)
Prox tubule
loop of hence 
distal tubule
collecting duct (which is shared by several nephrons)
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25
Q

what is the renal corpuscle made of

A

glomerulus and renal capsule

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26
Q

two types of nephrons

A

superficial (cortical nephrons)

JA nephrons

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27
Q

describe the position and length of medullary tubules of the superficial (cortical) nephron and urine produced

A

the cortical nephron is mostly in the renal cortex and has short LoH which produces diluted urine

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28
Q

majority of nephrons are which type

A

superficial (cortical nephrons)

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29
Q

describe position and length of medullary tubules of the JA nephron, and urine produced

A

JA nephrons very close to medulla, have LONG LoH, and produced very concentrated urine

30
Q

what are the 3 renal processes of regulating blood composition

A

filtration
secretion
reabsorption

31
Q

what is filtration

A

solutes and water pass from blood into tubular fluid in renal capsule (bowmans space)

32
Q

where does filtration occur and how much plasma is filtered?

A

filtration occurs in glomerulus capillaries where 15-20% of plasma is filtered

33
Q

where does blood leaving the glomerulus capillaries go? 2 names for this are?

A

blood > glomerulus capillaries > peritubular capillaries (AKA vasa recta)

34
Q

what is secretion

A

secretion if the transport of substances from blood in vasa recta into tubular fluid

35
Q

what is reabsorption

A

reabsorption is substances transported from tubular fluid into the blood in the vasa recta (peritubular capillaries)

36
Q

does secretion and absorption occur throughout the length of the entire tubule?

A

YES

37
Q

what is the glomerulus

A

glomerulus is a dense capillary bed where filtration occurs surrounded by the bowmans capsule

38
Q

the renal capsule surrounds the glomerulus what is the renal capsules actions

A

the renal capsule collects filtrate from blood entering via AFFERENT ARTERIOLES

39
Q

what transports blood from the renal corpsucle into the peritubular capillaries

A

EFFERENT ARTERIOLES

40
Q

path of blood into renal corpuscle (glomerulus)

A

Afferent arterioles > renal corpuscle > Efferent arterioles

41
Q

how is blood flow regulated thru the glomerulus (x3)

A

smooth muscle contraction of afferent and efferent arterioles
JGA secretion of renin which regulates systemic BP

42
Q

where the the juxtaglomerular apparatus?

A

the JGA is at the intersection of the macula dense of the distal tubule with Afferent and Efferent arterioles

43
Q

actions of JGA? INC in Na causes what?

A

JGA secretes renin .

JGA senses INC in NA thus INC Renin thus INC BP

44
Q

stimulation of sympathetic NS does what

A

reduces blood flow through the glomerulus

45
Q

the Prox convoluted tubule drains the capsule what happens in the PCT

A

PCT reabsorbs 2/3 of filtered water and salts
reabsorbs all filtered GLUCOSE AND AAs
some diuretics act here

46
Q

after the PCT is the Loop of Henle what is this divided into? and describe the urine makeup bc of the LoH

A

LoH = thin descending limb, thin ascending limb and thick ascending lim
LoH DOES NOT CONCENTRATE URINE ITSELF! makes it possible for the urine to be concentrated later

47
Q

LoH produces what kind of urine

A

LoH produces a dilute filtrate, but is a site of countercurrent mechanisms needed to concentrate later

48
Q

the distal tubule drains the LoH what is the DCT actions

A

DCT = continued reabsorption of solutes, REGULATES Ca, site of action for diuretics

49
Q

What is the site of action for Ca regulation?

A

Distal Tubule!!

50
Q

Collecting duct collects fluid from multiple nephrons describe the collecting ducts site and action

A

Collecting duct extends from kidney context into the medullar
regulates Na, K, and H2O
diuretics act here

51
Q

what is renal clearance

A

Renal clearance is the rate of excretion of a solute through the kidney
represents the volume of plasma from which all of a substance is removed to urine
helps monitor renal function

52
Q

Renal clearance is used to monitor Glomerular Filtration rate (GFR) based on what 3 assumptions

A

substance is NOT secreted
substance is NOT reabsorbed
substance is freely filtered

53
Q

what is the normal GFR from all nephrons

A

125 ml/ min

180 L/ day

54
Q

what are 2 substances that can be used for assessing GFR

A

inulin and creatinine

55
Q

what is Inulin

A

Inulin is a small polysaccharide freely filtered and NOT secreted or absurd

56
Q

what is creatinine

A

creatinine is a product of muscle metabolism FREELY FILTERED, NOT reabsorbed and ALMOST NO secretion
Normal levels

57
Q

female GFR

A

125 ml/ min

58
Q

male GFR

A

90 -140 ml/ min

59
Q

Glomerular capillaries are fenestrated and podocytes around the capillaries have filtration slits describe the filtrate going thru

A

Filtrate will be ACELLULAR and protein free
Glucose, salts, AAs are freely filtered
42 A not filtered
Charge matters! (negative charged moderate sized particles limited bc BM is neg charged)

60
Q

where the route of filtrate

A

blood side > fenestrations in endothelium > Basement Membrane > filtration slits (bowman capsule) >

61
Q

what are Starling forces?

A

Starling forces is why filtration occurs due to the pressure differences between the blood in capillaries and the fluid in the capsule

62
Q

What is pressure due to fluid?

Higher in what?

A

Pressure due to fluid = hydrostatic pressure

P in capillaries > P in capsule fluid

63
Q

what is pressure due to solutes in fluid?

higher in what?

A

oncotic pressure is pressure due to solutes including those NOT dissolved
Oncotic pressure in capillaries > capsule fluid

64
Q

Net filtration pressure favors what

A

filtration from blood into capsule bc GFR = (Pgc - Pbs) - (Oncotic cap - Oncotic BS)

65
Q

Oncotic pressure in the bowman space is always what?

A

0!!

66
Q

what two intrinsic mechanisms auto regulate blood flow through the glomerulus

A

myogenic mechanism and tubuloglomerular feedback

67
Q

what is the myogenic mechanism

what happens during INC in sympathetic stimulation? DEC in Symp?

A

contraction and relaxation of smooth m affect BP thus affects RBF and GFR
Thus Inc Symp = contraction = INC Bp = DEC RBF = DEC GFR
DEC Symp = dilation = DEC BP = INC RBF = INC GFR

68
Q

describe the tubuloglomerular feedback

A

feedback from the JGA adjusts afferent arteriole diameter and thus GFR

69
Q

INC in GFR thus INC in NaCl in tubulular fluid > ? > ? finish path

A

INC GFR > INC NaCl tubular fluid > INC NaCl at macula densa > INC resistance in afferent arteriole > Dec GFR

70
Q

what extrinsic mechanisms can regulate RBF and GFR

A

diet, dehydration/ hemorrhage, Symp NS, angiotensin alderstone cascase and natriuretic peptides

71
Q

dehydration and hemorrhage leads to what of GFR

A

DEC GFR

72
Q

INC sympathetic does what to GFR

A

INC BP so dec GFR (Symp limits production of urine)

Exam 3 physio (4 decks)

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