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5222: Advanced Physiology > Module 8 - Renal > Flashcards

Module 8 - Renal Flashcards

Exam 3

1
Q

What are the big 3 function of the renal system?

A

Filtration, reabsorption, and secretion

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2
Q

Where does filtration occur?

A

Renal Corpuscle - Glomerular capillaries / Bowman’s capsule

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3
Q

Where does reabsorption occur?

A

PCT, Loops of Henle, DCT, collecting ducts

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4
Q

Anything that moves from the filtrate in Bowman’s Capsule back to the peritubular capillaries is _____

A

Reabsorption

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5
Q

Anything that moves from the peritubular capillaries and into the filtrate is called _____

A

Secretion

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6
Q

The kidneys are located at which ribs?

A

11th and 12th

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7
Q

Purpose of ureters is ____

A

transport urine from the kidneys to the bladder

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8
Q

The purpose of the bladder is to ____

A

store urine until voided from the body

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9
Q

____ carries urine from the bladder to the outside of the body

A

Urethra

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10
Q

The tubular parts of the nephron include what 3 structures?

A

PCT, Loop of Henle, DCT (collecting ducts somewhat)

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11
Q

What are the two types of nephrons?

A

Juxtacortical and juxtamedullary

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12
Q

Which type of nephron is more prevalent?

A

Juxtacortical

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13
Q

Which nephron type has longer loops of Henle?

A

Juxtamedullary

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14
Q

How does blood enter the kidneys?

A

Through the renal artery

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15
Q

The renal artery attaches to what structure?

A

Afferent arteriole

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16
Q

Where is the key site of filtration?

A

Glomerular capillaries

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17
Q

What are the two layers of Bowman’s capsule?

A

Visceral (inner)
Parietal (outer)

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18
Q

Why is the glomerulus so good for filtration?

A

Highly porous, very fenestrated; high permeability makes it easy to filter things

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19
Q

What materials can pass through glomerular fenestrations?

A

(1) water
(2) glucose
(3) amino acids
(4) electrolytes
(5) proteins

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20
Q

What materials should NOT pass through the glomerulus (ideally)?

A

Proteins

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21
Q

What prevents proteins from passing through the fenestrations of the glomerulus?

A

The negative charge of the visceral layer of the Bowman’s Capsule - will repel the protein.

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22
Q

What makes up the juxtaglomerular apparatus?

A

Juxtaglomerular cells, Macula densa

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23
Q

What are juxtaglomerular cells?

A

Specialized cells of the afferent arteriole that produce renin

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24
Q

What are Macula densa?

A

Specialized chemoreceptors on the epithelial cells of the DCT

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25
Q

What is the function of the Juxtaglomerular apparatus?

A

Regulation of blood into the glomerulus for filtration

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26
Q

What are the factors / variables of glomerular filtration?

A

Permeability
Surface Area
Net filtration pressure (NFP)

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27
Q

Why is surface area typically high in the nephrons?

A

Because of the capillaries that are wound / bunched up

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28
Q

What does GFR indicate?

A

Flow rate of filtrate / the volume of fluid filtered from the glomerulus that enters into Bowman’s Space

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29
Q

We have a relatively stable GFR of ____

A

125 mL per minute

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30
Q

What happens when the GFR is too high?

A

Lots of fluid, but not able to reabsorb enough.

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31
Q

What happens when GFR is too low?

A

We are unable to filter out metabolic waste and electrolytes out of the blood.

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32
Q

T/F: We should not find protein or blood in our urine.

A

True.

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33
Q

If there is blood or protein in the urine, then there is a problem with _____

A

filtration membrane

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34
Q

What are the 3 Starling forces that determine NFP?

A

(1) Hydrostatic pressure of the glomerular capillaries (PGC)

(2) Osmotic force d/t protein in plasma (piGC)

(3) Fluid pressure in Bowman’s Space (PBS)

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35
Q

What factor in NFP favors filtration?

A

PGC favors pressure to move everything OUT of the blood that needs to and INTO Bowman’s Capsule

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36
Q

What factors oppose filtration re: NFP?

A

PBS - repels the movement of fluid from the vascular space to Bowman’s space

piGC - more plasma proteins, means increase in osmotic pressure –> we will pull fluid back or repel the movement of fluid from the vascular space to Bowman’s Space

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37
Q

PGC means?

A

Hydrostatic pressure of glomerular capillaries

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38
Q

PBS means?

A

fluid pressure in Bowman’s Space

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39
Q

piGC means?

A

Osmotic force due to protein in plasma

40
Q

What is the most important factor in net filtration pressure?

A

The amount of blood that goes into the afferent arteriole and into the glomerulus on a minute-by-minute basis

41
Q

What is the equation for NFP?

A

NFP = PGC - PBS - piGC

42
Q

What’s the equation for GFR?

A

Flow = change in pressure / resistance

43
Q

What are the two ways we decrease GFR (arterioles)?

A

(1) Constrict afferent arteriole

(2) Dilate efferent arteriole

44
Q

What are the two ways we increase GFR (arterioles)?

A

(1) Dilate afferent arteriole

(2) Constrict efferent arteriole

45
Q

What is the key to resistance and GFR?

A

Radius of the arterioles

46
Q

what are two forms of autoregulation that can alter PGC?

A

(1) Myogenic
(2) Tubuloglomerular feedback

47
Q

What are two extrinsic ways to modify PGC?

A

(1) SNS
(2) Angiotensin II

48
Q

What is the stimulus for the myogenic response?

A

Increase in GFR d/t afferent arteriole being stretched.

49
Q

What is the stimulus for tubular glomerular feedback?

A

Increase in GFR through Macula Densa

50
Q

How does renal artery stenosis impact hydrostatic pressure of glomerular capillaries (PGC)?

A

Decreases PGC because less blood –> less water –> less pressure

51
Q

Where is angiotensinogen produced?

A

Liver

52
Q

Name the key functions of angiotensin II (4)

A

(1) preferentially bind to the efferent arteriole, causing vasoconstriction
(2) increase aldosterone production from the adrenal cortex
(3) increase ADH / vasopressin production from the posterior pituitary
(4) increase systemic vasoconstriction

53
Q

What is one consequence / downside of angiotensin II?

A

It can contribute to systemic hypertension

54
Q

Where does the majority of reabsorption occur in the body?

A

PCT

55
Q

Where does fine tuning of reabsorption occur?

A

DCT and collecting ducts

56
Q

Hormonal controls target which areas for reabsorption?

A

DCT and collecting ducts

57
Q

Name the general pathway of reabsorption through the PCT

A

Tubular lumen - tubular epithelial cells apical - tubular epithelial cells basolateral - interstitial fluid - peritubular capillaries

58
Q

Which two solutes are completely reabsorbed in the PCT?

A

Glucose and amino acids

59
Q

What does isosmotic reabsorption mean with regards to the PCT?

A

It means that there is no change in solute concentration at any point throughout the reabsorption process (starts and ends with 300 mOsm)

60
Q

What causes movement of materials from the interstitium to the peritubular capillaries?

A

Bulk Flow

61
Q

The descending loops of Henle are ____ to water and _____ to solute

A

permeable, impermeable

62
Q

The ascending loops of Henle are ____ to solute and _____ to water

A

permeable, impermeable

63
Q

The medullary interstitium is (1) hypotonic, (2) hypertonic, (3) isotonic?

A

hypertonic

64
Q

Why is reabsorption at the ascending loop of Henle important?

A

It helps to create an osmotic gradient for water reabsorption at the descending loop of Henle

65
Q

What is the role of the Na/K/2Cl Symporter?

A

Chemoreceptor and symport protein that moves solutes across the apical membrane and into ICF

66
Q

What is the driving force for water being reabsorbed through the Descending Loop of Henle?

A

Keeping the medullary interstitium hypertonic

67
Q

What is countercurrent exchange?

A

The difference in flow down through the descending limb and the upward flow back into the cortex via the ascending loop of Henle

68
Q

What type of hormone is aldosterone?

A

Steroid

69
Q

Where does aldosterone diffuse through?

A

Epithelial cells called Principle Cells

70
Q

What are Principle Cells?

A

Specialized epithelial cells of the DCT and collecting ducts

71
Q

Aldosterone affects _____ because it’s a steroid hormone

A

gene transcription

72
Q

What is one major stimulus for aldosterone release?

A

Elevated extracellular K+ levels

73
Q

Vasopressin / ADH stimulates the translocation of _____ on the ____ membrane of the ____ convoluted tubule and _____ ____.

A

AQP-2, apical, distal, collecting ducts

74
Q

T/F: Vasopressin / ADH translocates AQP-3 and AQP-4 on the basolateral membrane.

A

False. AQPs on the basolateral membrane of the DCT and collecting ducts are not under hormonal control

75
Q

Where does renal regulation of Calcium and Phosphate reabsorption occur?

A

DCT

76
Q

Renal regulation of Calcium and Phosphate reabsorption is controlled by what hormone?

A

parathyroid hormone

77
Q

How does PTH increase Ca reabsorption?

A

Through translocation of Ca channels on the apical membrane

78
Q

What does renal clearance (RC) mean?

A

The volume of plasma that is cleared of a substance in one minute (mL/min)

79
Q

What is the equation for renal clearance (RC)?

A

RC = UV/P
U - concentration of the substance in the urine (mg/mL)
V - flow rate of urine formation (mL/min)
P - concentration of the substance found in the plasma (mg/mL)

80
Q

If serum creatinine levels are increasing, what does this tell us?

A

There is some type of damage at the glomerulus (filtration process)

81
Q

As serum creatinine levels increase, what happens to eGFR?

A

eGFR will decrease

82
Q

Name three causes of a high serum creatinine level.

A

(1) reduced filtration capacity
(2) high protein diet
(3) high muscle mass

83
Q

Name three causes of low serum creatinine levels

A

(1) being elderly and having reduced muscle mass
(2) pregnancy, which can increase filtration
(3) pregnancy and hypovolemia

84
Q

If we find proteins in the urine, where does this indicate damage?

A

To the visceral layer of Bowman’s Capsule

85
Q

What does Blood Urea Nitrogen (BUN) indicate?

A

The amount of urea nitrogen found in the blood

86
Q

What does a high BUN indicate about filtration?

A

Inability to filter urea out of the blood and excrete in the urine

87
Q

What is the main function of a loop diuretic?

A

To block the Na/K/2Cl symporter

88
Q

Where is the Na/K/2Cl symporter found?

A

The macula densa of the thick ascending loop of Henle

89
Q

How do loop diuretics generally work?

A

They block the reabsorption of ions, which means you will also reabsorb less water because it does not have as many ions to follow / dilute.

90
Q

Which diuretic is considered the most potent?

A

Loop

91
Q

Why is the loop diuretic considered a more potent diuretic than others?

A

because it affects an area where you naturally see more reabsorption of NaCl

92
Q

Name a potential side effect of loop diuretics

A

Hypokalemia

93
Q

What is the function of thiazide diuretics?

A

Inhibit Na/Cl symporter

94
Q

How do thiazide diuretics generally work?

A

If you can’t reabsorb NaCl, you can’t reabsorb water at the distal part of the nephron –> result: pee out Na, Cl, and water

95
Q

What is the function of aldosterone blockers?

A

Block the effects of aldosterone on Principle Cells of the DCT

96
Q

What happens when you block the effects of aldosterone on principle cells?

A

Fewer Na/K leak channels on the apical membrane and fewer Na/K ATPase on the basolateral membrane –> less Na and water reabsorbed

97
Q

Aldosterone blockers are also called what?

A

Potassium-sparing diuretics

5222: Advanced Physiology (5 decks)

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