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Physiology > Lecture 14 and 15 Renal > Flashcards

Lecture 14 and 15 Renal Flashcards

1
Q

kidney function redundant meaning

A

only 1 fully functioning kidney is needed - this is why you can donate your kidney

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2
Q

structure of kidney

A
  • 1 renal artery and vein
  • isoosmotic renal cortex
  • hyperosmotic renal medulla made up of renal pyramids that are separated by renal columsn
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3
Q

arteries going through kidney

A

renal artery –> many small arterioles –> afferent arterioles –> glomerulus (ball of capillaries) –> efferent arterioles –> peritubular capillaries –> interlobular veins –> renal vein

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4
Q

nephron structure

A

PCT proximal convoluted tubule –> descending limb of loop of henle –> ascending limb of loop of Henle –> DCT distal convoluted tubule –> collecting duct

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5
Q

vasa recta

A
  • parts of peritubular capillaries that are parallel to the nephron
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6
Q

structures that drain filtrate

A

collecting duct –> minor and major calyces –> renal pelvis –> bladder

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7
Q

2 types of nephron - location and function

A
  • cortical, located mostly in cortex where it is isotonic to blood
  • juxtamedullarly, goes very deep into medulla where it is concentrated and is thus good and making concentrated urine
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8
Q

renal corpuscle - list 3 barriers and characteristics

A

1) fenestrae, holes between endothelial cells that prevent RBC, WBC, and platelets from pass through
2) basement membrane - negatively charged to repel negatively charged proteins
3) slit diaphragms created by large podocyte cells which have primary processes and pedicels, also negatively charged

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9
Q

glomerular filtration rate and pressure

A
  • about 120ml/min
  • 45 gallons = 180 liters a day
  • 10 mmHg net pressure
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10
Q

obligatory water loss and average urine production

A
  • obligatory = 400mL

- average = 1-2L

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11
Q

intrinsic regulation aka renal autoregulation - goal, name the 2 mechanisms

A
  • goal is to maintain 10mmHg filtration pressure regardless of blood volume adn pressure
  • myogenic and tubuloglomerular feedback by the JGA
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12
Q

myogenic regulation

A
  • hypertension –> smooth muscle contraction and afferent arteriole constriction so less blood flow
  • hypotension –> smooth muscle relaxation and more blood to afferent arteriole and more pressure
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13
Q

JGA and tubuloglomerular feedback - 2 important cell types and their function

A
  • macula densa: specialized cuboidal cells in DCT that sense sodium levels
  • sodium level = water and filtrate amount because water and sodium travel together
  • granular cells: between DCT and afferent arterioles, receive signals from macula densa and cause dilation/constriction of afferent arterioles
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14
Q

PCT - how are glucose, Na+, and proteins reabsorbed, what type of transport is. used

A
  • Na+/K+ ATP ase pumps Na+ out of cell and into blood
  • sodium glucose cotransporter and sodium amino acid cotransporter moves glucose and amino acid from filtrate and inito cell as Na+ follows down its concentration gradient - secondary active transport
  • glucose enters blood following its concentration gradient by facilitated diffusion
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15
Q

Cl- reabsorption in PCT

A
  • follows Na+ passively
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16
Q

electrolyte reabsorption

A
  • as water is removed from filtrate (as it follows Na+) filtrate gets more concentrated
  • this creates a concentration gradient which electrolytes can follow to go into blood
  • only as much electrolytes as needed are reabsorbed
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17
Q

water reabsorption - percentages in each portion of renal tubule

A
  • 65% in PCT 10% in descending henle, leftover 15% subjected to ADH and aldosterone in late DCT
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18
Q

ADH vs aldosterone effects

A
  • ADH: water reabsorption only

- aldosterone: water and Na+ reabsorption

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19
Q

what happens in descending Henle

A
  • aquaporins and concentration gradient causes what to be reabsorbed
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20
Q

what happens in ascending Henle - what important transporter

A
  • Na+ gets pumped out by NKCC
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21
Q

descending VR function

A
  • water released

- Na+ reabsorbed

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22
Q

ascending VR function

A
  • absorbs water from the descending Henle and brings it back to the body
  • Na+ also leaves to be recirculated
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23
Q

describe recirculation of salt

A
  • pushed out of filtrate by NKCC in ascending Henle
  • reabsorbed by descending Henle
  • pushed back into medulla by ascending henle
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24
Q

explain positive feedback / counter current multiplier system between descending and ascending henle

A
  • descending creates concentrated filtrate by water being reabsorbed through aquaporins
  • ascending releases Na+ in to medulla making it salty so that more water can go down concentration gradient and be reabsorbed in the descending limb
  • recall NKCC is driven by concentration gradient across filtrate and inside of the cell
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25
Q

NKCC - location, what is it driven by and what is transferred

A
  • located in thick ascending henle on the apical side (between filtrate and inside of the cell)
  • Na+/K+ ATPase moves Na+ into the medulla to decrease Na+ concentration in the cell
  • NKCC is a cotransporter, secondary active transport of 1 Na 1 K and 2 Cl
  • Na+ moves down concentration gradient and into cell
26
Q

urea - what is it and what is the flow of recirculation

A
  • waste product

- taken out of the colelcting duct –> into medulla –> brought back into filtrate by ascending and DCT

27
Q

ADH mechanisms - what else is needed to drive water reabsorption

A
  • ADH causes more aquaporins to be added to DCT by principal cells
  • concentration gradient is needed for water to be reabsorbed
  • hypertonicity created by NKCC
28
Q

aldosterone - what mechanism

A
  • lipophilic and genomic mechanism that causes Na+ and water that follows to be reabsorbed
29
Q

renal plasma clearance definition and formual

A
  • ability to remove substance from blood through urine
  • volume of plasma rom which a substance is entirely removed
  • RPC = (filtration + secretion) - reabsorption
30
Q

RPC = 0 meaning and 2 ways

A
  • no filtration, like for proteins and RBC

- filtered but 100% reabsorbed like glucose

31
Q

RPC < GFR example

A
  • means some of it is reabsorbed

- urea because it recirculates in the medulla

32
Q

RPC = GFR example

A
  • creatinine and inulin

- no secretion and reabsorption

33
Q

RPC > GFR example

A
  • xenobiotics aka dugs

- more is secreted

34
Q

creatinine - origin, clinical usage

A
  • comes from creatine proteins in muscle that are broken down
  • high blood plasma creatinine levels = glomerular dysfunction
35
Q

inulin

A
  • similar to creatinine because RPC = GFR but inulin must be consumed orally
36
Q

organic anion transporters and organic cation transporters - where are they located and what do they transport

A
  • located in liver and kidney and secrete drugs into bile and urine
37
Q

renal blood flow meaning and amount

A
  • amount of blood flowing through the glomerulus
  • only 20% of it is actually filtered
  • 650 ml/min
38
Q

renal plasma threshold aka transport maximum meaning

A
  • maximum amount of a substance that can be reabsorbed by the transporters
  • glucose = 180-200mg/dL
39
Q

glomerular filtration rate meaning and amount

A
  • 120ml/min

- 45 gallons = 180L a day

40
Q

renal insufficiency vs renal failure glomerular filtration rate amount

A
  • renal insufficiency <60ml/min aka less than half of normal kidney function
  • 60ml/min is need for normal functioning
  • renal failure = <20% of normal function
  • main cause of renal failure and need for dialysis is diabetic neuropathy
41
Q

fasting blood glucose - normal, prediabetes, and diabetes

A
  • normal = 70-100
  • prediabetes >125
  • diabetes >145
42
Q

random glucose test range

A
  • always less than 200
43
Q

aldosterone - what is reabsorbed/secreted and hw much

A
  • 90% of Na+ and K+ are reabsorbed before DCT
  • without aldosterone 80% of remaining 10% of Na+ is reabsorbed along with water
  • with aldosterone 100% of remaining 10% is reabsorbed along with water that follows
44
Q

what stimulates aldosterone production and how

A
  • high K+ or low Na+
  • recall aldosterone causes Na+ reabsorption and K+ secretion
  • hyponatremia causes RAA system to be activated
  • hypokalemia stimulates zona glomerulosa directly
45
Q

K+ excretion (diagram)

A
  • 100% reasborbed in PCt

- some is secreted by aldosterone

46
Q

ANP - how produced, cause, mechanism of effect, and effect

A
  • atrial natriuretic peptide
  • stretch receptors in atrium sense high blood volume (opposite of dehydration)
  • more salt and water get excreted
  • mesengial cells between glomerular capillaries relax and increase blood flow and thus GFR
47
Q

summarize 3 effectors on GFR

A
  • autoregulation = no change in GFR
  • ANP = increased GFR
  • symapthetic = decreased GFR by constricting afferent arterioles
48
Q

relationship between Na+, K+, and H+ reabsorption

A
  • Na+ reabsorbed causing electrical gradient and K+ or H+ enters filtrate based on concentration
49
Q

diabetic acidosis - why does it cause hyperkalemia then hypokalemia

A
  • during acidosis H+ enters cells and K+ exits cells –> transient hyperkalemia causes body to excrete K+ through aldosterone –> hypokalemia
50
Q

what 2 organs/systems regulate blood pH

A
  • kidney and respiratory
51
Q

what does the kidney excrete to regulate blood pH

A
  • H+ and bicarbonate
52
Q

3 urine buffers and where are they created

A
  • ammonia made by cells lining the PCT which deamminate glutamic acid to produce ammonia
  • bicarbonate that is filtered from blood
  • phosphate ions
53
Q

Na+/H+ antiporters, where are they located, what are they driven by, what do they do

A
  • located on apical membrane of cells in the PCT

- move H+ into filtrate and Na+ into cell

54
Q

describe how bicarbonate is reabsorbed

A
  • converted by carbonic anhdyrase on cell surface to CO2 and H2O
  • bicarbonate cannot travel directly into cell
  • converted by CA in cell back into bicarbonate
  • bicarbonate goes down concentration gradient into blood where more buffer is needed due to acidosis
55
Q

diuretics - meaning and 2 main mechanisms

A
  • increase urine production
  • block Na+ reabsorption and water that follows
  • block water reabsorption directly
56
Q

carbonic anhydrase inhibitors - mechanism

A
  • mild diuretic
  • prevents CA from causing bicarbonate to be reabsorbed and as a result less water and CO2 are reabsorbed
  • used to treat alkalosis
57
Q

loop diuretics - mechanism and location

A
  • most powerful diuretic
  • blocks NKCC so that salt and water cannot be reabsorbed
  • also affects countercurrent multiplier system - medulla is less concentrated so less water is reabsorbed in descending henle by diffusion down gradient through aquaporins
58
Q

thiazide diuretics - mechanism and locaiton

A
  • prevetns reabsorption of last 10% of Na+ in DCT
59
Q

aldosterone antagonist - mechanism and location, why are they potassium sparing

A
  • recall aldosterone causes Na+ reabsorption and K+ secretion so aldosterone antagonists spare K+
  • DCT
60
Q

osmotic diuretics - mechanism, 1 example, relation to diabetes

A
  • increases osmotic activity of filtrate so that water is kept inside
  • mannitol = sugar alcohol orally consumed, not metabolized
  • mimics polyuria due to diabetes

Physiology (25 decks)

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