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NPLEX I 2024 > Nephro Physiology > Flashcards

Nephro Physiology Flashcards

1
Q

anatomy of nephron in order

A

proximal tubule
loop of henle with capillary network (down thin descending, up thick ascending)
distal tubule
collecting duct

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2
Q

start of filtration of nephron

A

glomerulus surrounded by bowmans capsule

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3
Q

early/proximal convoluted tubule (PCT)

A
  • brush border that reabsorbs ALL glucose and AA (from urine > lumen > blood)
  • reabsorbs most bicarb, sodium, chloride, potassium, water, uric acid, and phosphorus

parathyroid hormone - inhibits sodium/phosphorus cotransport (reabsorption)

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4
Q

what enzyme is used in PCT resorption processes

A

carbonic anhydrase

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5
Q

thin descending loop of henle

A

-passive reabsorption of water
-impermeable to sodium
-makes urine hypertonic (concentrated)

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6
Q

functions of parts of the nephron

A
  • renal corpuscle: filtration
  • PCT: reabsorption, secretion (vital)
  • Loop of henle: solution concentration
  • DCT: reabsorption, secretion (optional)
  • collecting duct: (optional)
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7
Q

where is the only area of the nephron that cannot reabsorb sodium?

A

thin descending loop of henle

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8
Q

thick ascending loop of henle

A
  • reabsorbs smaller amounts of sodium, potassium, and chloride (requires ATP)
  • indirectly absorbs magnesium/calcium paracellularly (bw cells) via gradient generated by potassium backleak
  • impermeable to water
  • urine less concentrated
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9
Q

distal convoluted tubule

A

-reabsorbs even less sodium
-reabsorbs chloride
-impermeable to water
-makes urine fully dilute (hypotonic)

PTH inc ca reabsorption via ca/na exchange

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10
Q

collecting duct

A
  • reabsorbs small amounts of sodium in exchange for potassium/hydrogen (regulated by aldosterone)

ADH inserts more aquaporin water channels on apical side of membrane (urine side) and inc urea reabsorption

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11
Q

what section of the nephron is trying to absorb everything?

A

PCT

only gets rid of Hydrogen

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12
Q

concerning the RAA system, what do the kidneys produce vs the liver?

A

liver: angiotensinogen
kidneys: renin

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13
Q

what converts angiotensinogen to angiotensin I?

A

renin from the kidney

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14
Q

what converts angiotensin I to angiotensin II

A

ACE from the surface of the pulmonary and renal epithelium

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15
Q

what stimulates the kidneys to produce renin?

A

decrease in renal perfusion (JGA)

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16
Q

what are the effects of angiotensin II?

A

-inc symp activity
-stim tubular na/cl reabsorption, k excretion, h2o retention
-arteriolar vasoconstriction, inc BP
-stim ADH secretion via post pituitary
- stim h20 reabsorption in collecting duct
- inc aldosterone secretion via adrenal cortex (inc BV via inc na and h20)

overall water and salt retention, effective circulating volume inc. perfusion of JGA inc.

17
Q

RAA system regulation

A

neg feedback via JGA pressure measurements

18
Q

renin secretion and effects

A
  • secreted by JG cells
  • inc secretion due to dec renal perfusion pressure (low blood vol, detected by afferent arteriole)
  • inc renal sympathetic d/t (B1 effect)
  • dec NaCl delivery to macula densa cells (bc its reabsorbing it back into the blood)
19
Q

what things could be triggers for the RAA system?

A

dehydration
Na def
hemorrhage
high EC pot (affects at aldosterone stage, not full sys)

20
Q

ACE secretion and effects

A
  • catalyzes conversion of angiotensin I > II
  • located in multiple tissues
  • conversion occurs the most in the lung
  • provided by vascular endothelial cells in the lung
21
Q

angiotension II functions

A
  • maintains BP and volume
  • affects baroreceptors
  • limits reflex bradycardia (HR dropping with blood vol change)
22
Q

atrial/brain natriuretic peptide (ANP/BNP) secretion and functions

A
  • released from atria and ventricles
  • released due to inc volume to inhibit RAA system
  • relaxes vascular smooth muscle via cGMP > inc GFR, dec renin
  • dilates afferent arteriole
23
Q

ADH/vasopressin effect on nephro sys

A
  • regulates serum osmlolality
  • responds to low blood vol states
  • stim reabsorption of water in collecting ducts
  • stim reabsorption of urea in collecting ducts
24
Q

aldosterone effect on nephro

A
  • reg EC fluid vol and sodium content
  • inc release in hypovolemic states
  • inc potassim excretion in response to hyperkalemia (exchanging it for sodium)
25
Q

respiratory acidosis definition

A
  • arterial pH <7.35 (acidemia)
  • high carbon dioxide
26
Q
A
27
Q

respiratory acidosis causes

A

caused by hypoventilation,
- airway obstruction
- acute/chronic lung dz
- dec respiratory stimuli (anestheisa, opiods, sedatives)
- weakening of respiratory muscles

28
Q

respiratory acidosis sx

A

hypoventilation > hypoxia
- rapid, shallow respirations
- dec BP with vasodilation
- dyspnea
- headache
- hyperkalemia
- dysrhythmias (from inc K)
- drowsiness, weakness, disorientation
- muscle weakness, hyperreflexia

29
Q

metabolic acidosis

A

arterial pH < 7.35
low bicarb OR inc acids (INC anion gap)

30
Q

causes of metabolic acidosis with INC anion gap

A

INC anion gap (sodium-chloride+bicarb)

GOLDMARK
- glycols
- oxoproline (chronic acetominophen use)
- L lactate
- methanol
- aspirin
- renal failure (carbonic anhydrase inhibitor, RTA)
- ketones (DKA, starvation)

31
Q

causes of metabolic acidosis with NORMAL anion gap

A

HARDASS
- hyperchloremia
- addison dz (low cortisol)
- renal tubular acidosis
- diarrhea
- acetazolamide
- spironolactone
- saline infusion

32
Q

metabolic acidosis sx

A
  • headache
  • dec BP
  • hyperkalemia
  • muscle twitching
  • warm, flushed skin (vasodilation)
  • N/V
  • dec muscle tone and reflexes
  • kussmall respirations (compensatory hyperventilation)
33
Q

causes of metabolic acidosis

A

inc H production
- DKA, hypermetabolism

dec H elimination
- renal failure

dec HCO3 production
- dehydration, liver failure

inc HCO3 elimination
- diarrhea, fistulas

34
Q

respiratory alklaosis causes

A

pH > 7.35
low CO2; hyperventilation
- anxiety
- hypoxemia
- salicylates
- tumor
- PE
- pregnancy

35
Q

respiratory alkalosis sx

A
  • hyperventilation (inc rate + depth)
  • tachycardia
  • dec or normal BP
  • hypokalemia
  • numbness/tingling extremities
  • hyper reflexes, muscle cramping
  • seizures
  • inc anxiety, irritability
36
Q

metabolic alkalosis causes

A

pH > 7.35
high bicarb
check urine chloride

high chloride (saline resistant)
- hyperaldosteronism
- bartter syndrome
- gitelman syndrome

low chloride (saline responsive)
- vomiting
- recent loop/thiazide diuretics
- antacids

37
Q

metabolic alkalosis sx

A
  • restlessness > lethargy
  • dysrhytmias, tachycardia
  • compensatory hypoventilation
  • confusion (LOC, dizzy, irritable)
  • N/V, diarrhea
  • tremors, muscle cramps, tingling of fingers/toes
  • hypokalemia
38
Q
A

NPLEX I 2024 (23 decks)

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