Nphro - AdptKI Flashcards
This hypothesis states that reduction in the number of nephrons results in glomerular hypertension, hyperfiltration, and enlargement of glomeruli
Brenner Hyperfiltration Hypothesis
True about Brenner Hyperfiltration Hypothesis
a. reduction in nephrons results in glomerular hypotension, and enlargement of glomeruli
b. injury to glomeruli will give positive feedback resulting in hyperfiltration
c. both
d. neither
B
The following will experience Hyperfiltration except
a. low birth weight infants
b. CKD
c. CAKUT
d. Obese
e. AOTA
E
What is the most important prenatal environmental factor responsible for reduced nephron number in the fetus?
growth restriction within the uterus
Drugs that inhibit nephrogenesis (5)
DAANG Dexamethasone ACEi ARBs NSAIDs Gentamicin
part of kidney most susceptible to hypoxia
a. inner medulla
b. outer medulla
c. cortex
B
What is acute renal success according to Thurau
reduction in glomerular filtration as an adaptive response to hypoxia to reduce the “work” reqt for reabsorption of solutes by the tubule
True about adaptive response to kidney injury
a. in acute hypoxic kidney injury there is increase in sodium excretion
b. in chronic hypoxia of the kidneys, there is decreased sodium excretion
c. adaptive response to kidney injury is achieved via TGF
d. AOTA
C;
not increased natriuresis in acute hypoxia
increased natriuresis in chronic hypoxia
Gene activated by hypoxia that distal effectors of the pathway are involved in energy metabolism, angiogenesis and apoptosis
HIF alpha
hypoxia inducible factor alpha accumulates because of inhibition of HIF prolyl hydroxylase which normally promote degradation of HIF alpha.
HIF alpha dimerizes with HIG1 beta and the dimer moves to the nucleus where it upregulates the said effectors
Inhibitor of HIF alpha
HIF prolyl hydroxylase
Relationship between nephron number and hypertension in adults
inverse, lower nephron number, higher BP
this was defined by Hinman in 1923 as attempt on the part of the less injured or uninjured portion of the kidney to take over the work of the more injured portion
Renal counterbalance
2 types of renal reserve according to Hinman
Natural
Acquired
Growth compensation due to overstiumulation
Acquired renal reserve
if a kidney is injured by ischemia, and the other kidney is removed before the post ischemic kidney becomes severely atrophied, what would happen to the postischemic kidney?
hypertrophy
The following statements are true
a. nephrons of mammals regenerate and hypertrophy in response to acute injury
b. hyperfiltration of remaining kidney is related to increase in RBF in post nephrectomy of a donor.
c. increase in RBF is secondary to dilatation of efferent arteriole
d. arteriole dilate in response to NO.
B and D
a. do not regenerate, only hypertrophy
c. afferent arteriole
True of increased RBF and hyperfiltration
a. incrased wall tension and force is counteracted by contractile properties of endothelium and elastic properties of GBM
b. podocytes adapt by increasing cell adhesion
c. both
d. neither
C
With decrease in the number of functioning nephrons, each remaining nephron has to adapat to carry a larger burden of transport, synthetic function, and regulatory function. What hypothesis is this?
Intact nephron hypothesis
True of potassium balance in CKD EXCEPT
a. in CKD, patient has to be protected from lethal hyperkalemia
b. hyperkalemia could be adaptive
c. CKD patients can excrete potassium, but requires higher serum potassium to do so
d. effect of hyperkalemia on potassium excretion is influenced by aldosterone
D
True statement
a. in CKD, the excretion of dietary load of potassium occurs at the expense of an elevation in serum potassium concentrations
b. hyperkalemia upregulate aldosterone
c. aldosterone affect basolateral NaKAtpase of the collecting duct
d. aldosterone affect increase the number of apical Na channels of the collecting duct
e. AOTA
E
activation by the organism of intrinsic defense mechanisms to cope with pathologic conditions
preconditioning
what is ischemic preconditioning?
prior ischemic insult renders organ resistant to subsequent ischemic result
main difference in normal TGF vs. CKD TGF in terms of sodium balance with high sodium intake
in normal TGF, high sodium intake causes negative feedback. High sodium conc to distal delivery reduces GFR, however in CKD, this becomes positive feedback, therefore increasing GFR, in turn increases sodium filtration; triggered by adonesine-dominated vasoconstrictive feedback
Adpatation in terms of acid base homeostasis in the setting of reduced renal functional mass (3)
increased hydrogen secretion
