Phys 25-32: Kidney make pee Flashcards by Albert Bouwer

Evaporation loss of water from skin/respiratory tract per day

700ml

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Intracellular fluid weight percent of body

Extracellular fluid weight percent of body

ICF 40%

ECF 20%

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Lymphedema parasite

Wucheria Bancrofti

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In advanced heart failure, increased secretion of _______ stimulates _______by the renal tubules, leading to _______

In advanced heart failure, increased secretion of ADH stimulates water reabsorption by the renal tubules, leading to hyponatremia and edema

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What substance is used to create spacing between renal tubule cells

Proteoglycan filaments

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Hypoxia stimulates kidney to secrete

Erythropoetin

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Calcitriol aka

1,25-dihydroxyvitamin D3

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Normal kidney blood flow per min

1100 ml

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Smooth muscle of bladder aka

Detrusor

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Max bladder pressure

40-60mmhg

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Bladder sympathetics

L2 hypogastric nerves

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Bladder parasympathetics

Sacral plexus S2/S3

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Micturition facilitation and inhibition centers where

Brainstem, mostsly pons

Some in cerebral cortex

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Cause of uninhibited neurogenic bladder

Damage to spinal cord means no brain inhibition of micturion reflex

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Charge effect on filterability of substance in nephron

Postive charge filters more readily

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Filtration coefficient equation

Kf = GFR/ filtration pressure

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Increased bowmans hydrostatic pressure does ____ to GFR

Decreases

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Increased glomerular colloid osmotic pressure does what to GFR

Decreases

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Increased glomerular hydrostatic pressure does what to GFR

Increases

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Renal blood flow equation

RBF = (Renal artery pressure - Renal vein pressure) / (renal vascular resistance)

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Angiotensin and GFR

Prevents it from coming down, doesnt change it significantly

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Sympathetic stim effect on GFR

Decreases

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Endothelial-Derived nitric oxide ______ Renal Vascular Resistance and ______ Glomerular Filtration Rate

Increases

Decreases

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NSAIDs and GFR

prostaglandins inhibitted, no efferent arteriole constriction

GFR down

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Juxtaglomerular cells where

Walls of efferent/afferent arterioles

Macula densa response to sodium changes (2)

When sodium is decreased, macula densa decreases glomerular pressure, increasing GFR. When sodium is decreased, macula densa signals juxtoglomerular cells to release renin

Protein ingestion and GFR

Increases GFR. Increased protein reabsorption = increased sodium reabsorption. This causes macula densa to increase GFR

GFR and age

Low at birth, reaches adult levels at 2yo. At 40 begins decreasing 5-10% per decade

Glucose reabsorption location and transporter

Early proximal tubule SGLT2

Protein reabsorption mechanism

Pinocytosis

% of sodium reabsorption in proximal tubule

65%

Site of secretion of organic acids and bases

Proximal tubule

Compound used to estimate renal plasma flow

PAH para-aminohippuric acid

thick ascending loop sodium transport by

NKCC2 co transporter.

Two types of cells in distal tubule

Principal cells Intercalated cells

Principal cells reabsorb _______ and secrete _____

Reabsorb water and sodium Secrete potassium

Intercalated cells reabsorb ___ and secrete _____

Potassium Hydrogen ion

how does type A principal cell secrete potassium

Na+/K+ ATPase in basolateral membrane creates gradient. K+ diffuses to lumen bc of gradient

Cell affected by potassium sparers

Principal cells (blocking sodium entry means no potassium efflux to lumen)

Type A vs B intercalated cells

Type A: Secretes hydrogen into lumen Type B: Secretes bicarb into lumen

Type B cells main transporter into lumen

**Pendrin** Cl-/HCO3- counter transporter

Urine is most dilute whre

Right at the end of the loop of henle

Permeability of collecting duct to water is controlled by

ADH

Substance used to calculate water reabsorption

Inulin (doesnt get reabsorbed)

Aldosteron acts on _____ (kidney)

Principal cells in collecting tube

aldosterone increases _____ reabsorption and ______ secretion is by stimulating _____ on the ______ side of the ______ membrane

aldosterone increases **sodium** reabsorption and **potassium** secretion is by stimulating the **Na+-K+ ATPase** pump on the **basolateral** side of the **cortical collecting tubule** membrane

Aldosterone defficiency lab values (serum)

Sodium goes down (lost in urine) Potassium goes up (can’t secrete)

Parathyroid hormone tubular absorption effect

Decreases PO4- reabsorption Increases Ca2+ reabsorption

ADH binds to ____, stimulating _______ movement to lumen

V2 AQP-2

Angiotensin II stimulates reabsorption of

Sodium, H20, H+

Atrial Natriuretic Peptide reabsorption effects

Decreases sodium and water

Sympathetic nervous system _____ sodium reabsorption

Increases Also renin release

ADH released by ____ in response to _____

Posterior pituitary increased osmolarity

Max daily urine excretion of water

20 liters

Tubular fluid in proximal tubules is ____osmotic

Isosmotic

Part of nephron where fluid is most concentrated

Bottom of loop of henle

Fluid leaving distal tubular segment is ___osmotic

Hyposmotic

Max urine concentration

1200-1400 mOsm/L

Maximum urine NaCl excretion

600 mOsm/L

Two requirements to make concentrated urine

1) High ADH level 2) High osmolarity renal medullary fluid

Osmolarity of medullary fluid

Increases progressively up to 1400 mOsm/L

Urea contributes to % of urine osmolarity

40-50%

Passice secretion of urea into thin loops off henle is facilitated by

Urea transporter *UT-A2*

Concentration of urea in tubular fluid in inner medullary collecting duct facilitated by

*UT-A1* and *UT-A3*

What prevents medullary hypersmolarity from being disapated

The Vasa recta

Increased medullary blood flow ____ urine concentration abilty

Decreases

Water diffusion across tubular epithelium is aidead by

Aquaporin 1

How to calculate osmolar clearance

(Urine Osmolarity x Volume) / (Plasma osmolarity)

How to calculate free water osmolarity

= (Urine volume) - (Urine volume)

Central diabetes insipiduse caused by

Failure to secrete ADH

Nephrogenic diabetes insipidus caused by

Kidneys fail to respond to ADH

Estimation of plasma osmolariy from plasma sodium formula

Plasma Osmolarity = 2.1 x Plasma sodium

ADH release steps

1) Increased plasma OSM causes osmoreceptor cells in anterior hypothalmus to shrink 2) Shrinkage of osmoreceptor cells causes them to fire 3) Action potentials are conducted to posterior pituitatry, which stimulates ADH release

Lesions in ___ brain region cause defecits of ADH secretion

AV3V region

Drugs that increase ADH release

Morphine Nicotine Cyclosphimide

Drugs that inhibit ADH release

Alcohol Clonidine Haldol

Nausea and ADH secretion

Nausea is a potent ADH release stimulus

Thirst mechanism activated at ___ (threshold)

Sodiun concentration 2mEq/l above normal

Angiotensin II and aldosterone effect on sodium concentration

Minimal

Cell potassium uptake after a meal is mediated by

Insulin

Alkalosis/Acidosis and potassium shift

Alkalosis pushes K+ into cells Acidosis pulls out K+ from cells

Potassium secretion occurs in _____ cells of _____

Principal cells of late distal and cortical collecting tubules

Secretion of potassium in principal cell steps

1) K+ passively diffuses from blood to renal interstitium 2) K+ actively transported into principal cells by Na/K ATPase 3) K+ passively diffuses into urine

Type A intercalated cell vs Type B intercalated cells (potassium)

Type A: Reabsorb potassium Type B: Secrete potassium

How does acidosis increase K+ extracellularly

Inhibits Na/K ATPase

PTH 3 main effects

1) Stimulates bone resoprtion 2) Stimulates Vitamin D activation 3)**increases renal tubular calcium reabsorption**

PTH acts at ______ to _____ calcium

Ascending loop of henle Reabsorb

Calcium reabsorption and acid/base

Acidosis: reabsorption increased Alkalosis: Reabsorption inhibited

Acidosis ______ potassium secretion by kidney

Decreases

Most important acid/base buffer in body (intracellular and extracellular

Intracelullar: Cell proteins Extra cellular: bicarb

Bicarb equation

Increased hydrogen Ion concentration in blood stimulates _____ (breathing)

Pulmonary ventilation

In late distal and collecting tubules, H+ is secreted via

Primary active tranport

Urinary ____ carries excessive H+ into urine and generates new _____

Phosphate Bicarb

Most important urinary buffer in chronic acidosis

Ammonia

Renal glutamine metabolism is stimulated by ____

Acidosis

How does glutamine metabolism help with acidosis

It is metabolized to NH4+ and HCO3-. NH4 is secreted, HCO3- is reabsorbed into blood

Net acid excretion rate calculation

Hydrogen secretion calculation

Renal tubular H+ secretion is stumulated by increases in:

Extracellular H+ Increased PCO2