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Physiology > Phys Exam 4 > Flashcards

Phys Exam 4 Flashcards

1
Q

what is the ultimate functions of the kidneys

A

homeostatic regulation of the water and ion/salt content of the blood

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2
Q

6 categories of renal function

A

regulation of extracellular fluid volume and blood pressure
regulation of osmolarity
homeostatic regulation of pH
waste/toxin management
production of hormones

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3
Q

how does the urethra differ b/w genders

A

shorter in F -> higher risk for UTI

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4
Q

what is the functional unit of kidneys

A

nephrons

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5
Q

what makes up the renal corpuscle

A

glomerulus + bowman’s capsule

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6
Q

where are 80% of nephrons

A

in the cortex

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7
Q

what is the peritoneum

A

serous membrane forming the lining of the abdominal cavity

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8
Q

what is each nephron composed of

A

initial filtering component (renal corpuscle) and a tubule specialized for reabsorption and secretion (renal tubule)

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9
Q

can we live without our kidneys

A

no!! blood would become toxic

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10
Q

does all blood get filtered in the glomerulus ?

A

NO!

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11
Q

what is the purpose of the renal portal system

A

allows for filtering of blood, cleaning, reabsorption and secretion

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12
Q

where are the 1st and 2nd capillary beds located from the renal portal system

A

1st: in renal cortex -> glomerulus
2nd: in renal cortex and medulla -> peritubular

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13
Q

where does the renal portal system empty into

A

the renal vein

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14
Q

route of the nephron tubule components

A

renal tubules begin at renal corpuscle -> PCT -> DL -> Loop of Henle -> AL -> DCT -> CD -> to bladder

collecting ducts typically receive drainage from ~8 nephrons

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15
Q

where does filtration occur in a nephron

A

ONLY in the renal corpusle. creates protein free plasma!!!

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16
Q

what 3 cellular layers facilitate filtration

A
  1. capillary endothelium -> fenestrated!!
  2. basal lamina
  3. podocytes (epi of bowmann’s)
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17
Q

where does reabsorption occur in nephrons

A

ALL areas EXCEPT renal corpuscle/Bowman’s capsule!!!

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18
Q

where does secretion occur in nephrons

A

PCT, DCT, CD

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19
Q

what does the urinary excretion of substances depend on

A

filtration, reabsorption, and secretion

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20
Q

what is glycosuria

A

glucose in urine. can be a sign of diabetes

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21
Q

what is the epi around glomerular capillaries modified into

A

podocytes

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22
Q

what are mesangial cells

A

provide structural support for the glomerular capillary loops

help regulate glomerular capillary flow and filtration

phagocytosis/endocytosis

secrete cytokines that interact with endothelial cells and podocytes

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23
Q

what are the processes that surround each capillary, leaving slits through which filtration takes place

A

podocytes

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24
Q

what are 3 filtration barriers

A
  1. glomerular capillary endothelium
  2. basal lamina
  3. capsule epi
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25
Q

3 primary influences on filtration

A
  1. capillary blood pressure
  2. osmotic pressure
  3. capsule fluid pressure
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26
Q

does 80% of blood go through the afferent or efferent arteriole in glomerular filtration

A

efferent!

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27
Q

less or greater than 99% of plasma entering kidney returns to systemic circulation

A

GREATER!

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28
Q

less or greater than 1% of volume is excreted to external environment

A

LESS

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29
Q

what are 3 things glomerular filtration is influenced by

A
  1. hydrostatic pressure - blood pressure
  2. colloid osmotic pressure
  3. fluid pressure created by fluid in Bowman’s capsule
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30
Q

is glomerular capillary pressure higher/lower than pressure in a typical capillary

A

HIGHER -> this favors the movement of capillary contents into Bowman’s capsule lumen (filtration)

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31
Q

inside glomerular capillaries, is the colloid osmotic pressure higher or lower

A

HIGHER inside -> favors movement of filtrate in Bowman’s capsule BACK INTO capillary via osmosis

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32
Q

filtration pressure in the renal corpuscle depends on _______________ and is opposed by ___________ and ____________________

A

hydrostatic pressure

colloid osmotic pressure AND capsule fluid pressure

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33
Q

what is GFR

A

the V of fluid that filters into Bowman’s capsule lumen per unit time

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34
Q

what is the most common and important measure of renal function

A

GFR

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35
Q

what are the 2 main mechs of autoregulations in glomerular filtration homeostasis

A
  1. myogenic responses
  2. tubuloglomerular feeback

autoreg maintains nearly a constant GFR!

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36
Q

why is local homeostatic control of GFR important

A

if you dont have it –> damage to filtration membrane

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37
Q

what is myogenic responses in GFR

A

mechanical autoregulation of bloodflow –> vasoconstriction/dilation of arterioles via stretch of mechanoreceptors

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38
Q

what is tubuloglomerular feedback in GFR

A

chemical autoregulation –> vasoconstriction/dilation of arterioles

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39
Q

what is autonomic neurons and hormones in GFR

A

systemic response. can alter the filtration coefficient and can also change arteriole resistance

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40
Q

factors controlling filtration homeostasis (3)

A

myogenic response
tubuloglomerular feedback
autonomic neurons and hormones

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41
Q

INCREASED resistance in AFFERENT arterioles leads to _______ GFR (myogenic response #1)

A

DECREASED GFR

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42
Q

INCREASED resistance in EFFERENT arterioles leads to _______ GFR
(myogenic response #2)

A

INCREASED GFR

Due to low RBF into the afferent arterioles

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43
Q

what is one of the most common causes of renal failure

A

high BP

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44
Q

what is proteinuria

A

damage to the renal corpuscle filtration layers leads to increased protein in the filtrate, resulting in protein in the urine

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45
Q

clinically GFR is used to assess

A

renal function/extent of damage
kidney disease/loss of surface area available for filtration

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46
Q

what is the juxtaglomerular apparatus

A

area between afferent and efferent arterioles

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47
Q

what cells are found in the juxtaglomerular apparatus area

A
  1. macula densa
  2. juxtaglomerular cells
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48
Q

what are macula densa cells

A

found in the juxtaglomerular apparatus

chemoreceptors, monitor NaCl osmolarity and urine volume -> signal JG cells

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49
Q

what are juxtaglomerular cells

A

found in the juxtaglomerular apparatus

also known as granular cells. modified smooth muscle cells, secrete renin in response to low BP

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50
Q

what NS influences the renal system and what does it change

A

the SNS

resistance in arterioles

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51
Q

what are the most important hormones that influence the renal system (2)

A

angiotension II -> vasoconstrict

prostaglandins –> vasodilators

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52
Q

angiotension II do what to arterioles

A

vasoconstrict

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53
Q

PG do what to arterioles

A

vasodilator

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54
Q

where does excretion occur

A

once filtrate has exited CD -> now is urine

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55
Q

what are the benefits of filtering a TON of stuff but excreting only a SMALL amount

A

it simplifies homeostasis and enables rapid clearance

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56
Q

T/F reabsorption is only active

A

FALSE. Active AND passive

recovers important nutrients

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57
Q

filtration is _____ and ______

A

passive and indiscriminate -> enables rapid removal of foreign substances

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58
Q

diffusion of permeable solutes (K+ Ca2+ and urea) out of tubule, back into ECF may occur by

A

transepithelial/transcellular transport (membrane transport)

paracellular pathway

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59
Q

what is transepithelial/transcellular transport (membrane transport)

A

substances cross apical and basolateral membranes of the tubule epithelial cell (pass through cell)

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60
Q

what is paracellular pathway

A

pass between cells

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61
Q

difference b/w diffusion and osmosis

A

diffusion: doesnt need membrane

osmosis: membrane involved. only things that can pass through membrane

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62
Q

what is the primary driving force for most renal reabsorption

A

active reabsorption of sodium

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63
Q

what is sodium symport

A

another form of active transport. involves co-transportation of molecules in conjunction with Na+ reabsorption

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64
Q

T/F: urea is passive if a gradient is present

A

TRUE -> passive reabsorption occurs through tubule epi cell junctions if a gradient is present (paracellular pathway)

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65
Q

how do big proteins get reabsorbed

A

endocytosis.

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66
Q

4 main methods of reabsorption

A
  1. sodium transport starts the process (Na+/K+ pumps)
  2. Secondary active transport: symport of additional molecules with sodium
  3. passive reabsorption through paracellular pathway and passive transcellular (urea)
  4. receptor-mediated endocytosis (small plasma proteins)
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67
Q

T/F: mediated transport cannot become saturated

A

FALSE! they can!

at saturation, no more substrate can be reabsorbed, thus it is excreted in urine.

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68
Q

T/F: filtration does not saturate

A

TRUE

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69
Q

excretion =

A

filtration - reabsorption

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70
Q

how does the fluid reabsorbed from the tubule lumen into the interstitial space re-enter the peritubular capillary to increase blood volume

A

capillary hydrostatic pressure is lower than the pressure in the interstitial space -> favors reabsorption into capillary

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71
Q

what is secretion

A

transfer of molecules from ECF back into the lumen of the nephron

always an ACTIVE process

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72
Q

what is an example of a competitive process in terms of secretion

A

penicillin vs probenecid. once added probenecid, penicillin wouldnt get excreted ASAP anymore -> good!

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73
Q

what is excretion

A

filtration - reabsorption + secretion

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74
Q

what is clearance

A

non-invasive way to measure GFR and determine how the kidney is removing a substance like a drug

rate at which a solute disappears from the BLOOD by excretion

aka the V of plasma from which a substance is completely removed by the kidney in a given amt of time

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75
Q

is all of inulin filtered excreted?

A

YES! none metabolized and no reabsorption or secretion

76
Q

GFR value of what is normal

A

130-90

77
Q

GFR value of what is considered kidney damage

A

<90-15

78
Q

a substance that is 100% excreted, clearance will be _______ to GFR

A

EQUAL

79
Q

when is clearance equal to its GFR

A

for any substance that is freely filtered but not absorbed or secreted

80
Q

filtration is greater than excretion ->

A

molecule X is being reabsorbed

81
Q

excretion is greater than filtration

A

molecule X is being secreted

82
Q

filtration and excretion are the same

A

no net reabsorption or secretion of molecule X

83
Q

clearance of X is LESS than inulin clearance

A

reabsorption of X

84
Q

clearance is X is equal to inulin clearance

A

X is not reabsorbed or secreted

85
Q

clearance of X is greater than inulin clearance

A

X is secreted

86
Q

is glucose 100% reabsorbed from filtrate or secretion

A

filtrate -> NO excretion

**unless excessive amt in blood. glucose in urine

87
Q

50% urea is _________ and other 50% is __________

A

excreted and reabsorbed

88
Q

normal clearance values for
glucose
inulin
PAH

A

glucose: 0 (completed reabsorbed)
inulin: 125 (not reabsorbed or secreted = GFR)
PAH: 625 (completely secreted)

89
Q

does your renal system produce urine even when you are severly dehydrated

A

YES! still needs to get rid of toxins cells are producing

90
Q

are fluid and electrolyte levels constant?

A

NO! constantly fluctuating

91
Q

is edema/swelling ICF or ECF

A

ECF

92
Q

what conserves water but cannot replace it

A

kidneys. can only replace water by drinking it

93
Q

what is the most common cause of severe dehydration

A

severe diarrhea

94
Q

how do kidneys alter urine concentration

A

by varying the amounts of water and Na+ reabsorbed in the renal tubules (occurs in the loop of henle, distal tubule and collecting ducts)

95
Q

2 types of urine

A

dilute and concentrated

96
Q

osmolarity changes as

A

filtrate flows through the nephron

97
Q

what does the final concentration of urine depend on

A

the water permeability of the distal tubules and collecting ducts to water

98
Q

for water to flow out of the collecting duct via osmosis, the osmolarity of the surrounding interstitial space must be higher/lower than the osmolarity in the C-duct

A

HIGHER

99
Q

what is another name for vasopressin

A

ADH

100
Q

what makes ADH

A

posterior pituitary

101
Q

what influences ADH

A

BP, blood volume, blood plasma osmolarity/concentration

102
Q

if you have high blood plasma osmolarity, you are hydrated or dehydrated

A

dehydrated

103
Q

what will happen to ADH production if you have high blood plasma osmolarity

A

increase bc you are dehydrated

104
Q

what reabsorption is inhibited by

A

low ADH prodution

105
Q

ADH in simple terms

A

NOT removing H2O from body

106
Q

diuretic in simple terms

A

REMOVING H2O from body

107
Q

what does in mean in terms of urine if we have LOW ADH

A

urine is diluted

108
Q

water permeability is dependent on the amount of

A

ADH present

109
Q

how does ADH work

A

causes insertion of aquaporins into the apical membrane of the collecting duct cells by exocytosis of these pores

110
Q

when ADH is absent, what happens to the pores

A

withdrawn by endocytosis -> membrane recycling

111
Q

what happens to ADH production when you are dehydrated

A

increases production

112
Q

what is the most potent stimuli for ADH release

A

osmolarity –> direct connection to hypothalamus

113
Q

is more or less ADH secreted at night (circadian rhythm)

A

more -> dont get up in middle of night to pee

114
Q

which 4 electrolytes are essential for our bodies to function best

A

Na+
Ca2+
K+
Cl-

115
Q

filtrate and blood flow moves in the same or opposite directions

A

opposite -> countercurrent exchange

116
Q

what contributes to the high osmolarity in the renal medulla

A

urea

ADH influences the osmotic gradients of the renal medulla

117
Q

what is happening at descending limb

A

water reabsorption. H2O moves from filtration out to interstitial area of renal medulla by osmosis and into vasa recta

118
Q

where is filtrate at the highest concentration

A

loop turn

119
Q

what is happening at the ascending limb

A

ion reabsorption: ions moved out to interstitial area of renal medulla by active transport

120
Q

hyper/hypoosmotic interstitial fluid in the renal medulla

A

hyper

121
Q

hyper/hypoosmotic filtrate leaving the loop of henle

A

hypo

122
Q

what is necessary for the formation of concentrated urine as filtrate flows through the collecting tubules and ducts

A

high medullary osmolarity

urea is a key contributor to high osmolarity in the tissue surrounding the loop of henle in the renal medulla

123
Q

how does the countercurrent multiplier system work

A

reabsorption of ions (through active transport) in the thick ascending limb through the NKCC symporter creates a dilute filtrate in the lumen

124
Q

a drug that inhibits active transport of potassium out of the filtrate would promote what

A

urine production

125
Q

what happens to V when ingest salt

A

NO CHANGE

126
Q

what happens when you ingest salt

A

ADH secreted (via osmoreceptors) and thirst increased

127
Q

why is drinking seawater so bad

A

bc osmolarity jumps up SUPER high. renal system has to excrete a HUGE amount to balance it –> die

128
Q

what is aldosterone

A

hormone secreted by suprarenal glands regulates sodium reabsorption through channel expressions

primary site of action occurs in the last 1/3 of distal tubule

129
Q

increased aldosterone means what in terms of Na

A

increased reabsorption of Na+

130
Q

what is primary target of aldosterone

A

P cells (principle cells)

line the DCT, connecting tubule, and proximal collecting duct

131
Q

what stimulates release of aldosterone

A

decreased BP and increased K+ in the blood plasma and ANG II

132
Q

what does aldosterone promote

A

sodium reabsorption and potassium secretion

133
Q

P cells have

A

Na+/K+/ATPase pumps on the basolateral membrane and a variety of channels and transporters on the apical membranes

134
Q

stimulus for aldosterone release in blood

A

increased extracellular K+ concentration acts DIRECTLY on the adrenal cortex to increase aldosterone secretion

decreased BP (indirect)

135
Q

what is ANG II

A

potent vasoconstrictor

136
Q

ANG II stimulates

A

aldosterone secretion
ADH secretion
thirst sensation
vasoconstriction
activation of cardiovascular control center

137
Q

what do ACE inhibitors/renin do

A

blocks cascade -> lowers BP

138
Q

how does low BP stimulate renin production

A

decreases blood flow in afferent arteriole along with decrease in GFR stimulates renin release

139
Q

what is the most direct effect of sodium homeostasis

A

kidney

140
Q

what antagonizes ANG II

A

atrial natriuretic peptide (ANP)
brain natriuretic peptide (BNP)

increases BP
enhances Na+ and water excretion by increasing GFR

141
Q

where does most sodium in our bodies exist

A

intracellular

142
Q

hyperkalemia

A

high postassium levels

143
Q

K+ levels affect the resting membrane potential of

A

ALL cells

144
Q

hyperkalemia

A

high potassium levels

145
Q

hypokalemia

A

LOW potassium levels

146
Q

what are the 3 compartments total body Ca2+ is distributed among

A

extracellular fluid
intracellular fluid
extracellular matrix (bone)

147
Q

what 3 hormones control calcium balance

A
  1. parathyroid hormone
  2. Calcitriol
  3. Calcitonin
148
Q

what is PTH and what produces it

A

produced by parathyroid glands

increases Ca2+ in ECF/plasma
removes Ca2+ from bone
promotes renal resorption of Ca2+

149
Q

what does calcitriol do

A

increases Ca2+ uptake in plasma/ECF
removes Ca2+ from bone
promotes renal resorption of Ca2+

made from vit D and also is known as 1,25 dihydroxycholecalciferol = vit D3

**production is regulated at the kidney by PTH

150
Q

what does calcitonin do and what produces it

A

opposite to PTH!
produced by thyroid gland

decreases Ca2+ in ECF/plasma
KEEPS Ca2+ in bone
promotes renal excretion of Ca2+

151
Q

what can phosphate influence

A

calcium

**P is second key ingredient in the hydroxyapatite of bone

152
Q

what is osteoporosis

A

bone loss

bone resorption exceeds bone deposition

153
Q

what is normal pH of blood plasma

A

7.35-7.45 pH

**slightly alkaline!

154
Q

what does acidosis do to neurons

A

neurons become less excitable and CNS depression occurs -> eventually coma

155
Q

what does alkalosis do to neurons

A

hyper-excitable neurons -> muscle twitches/spasms

156
Q

if ECF is acidosis, kidneys excrete and reabsorb what

A

excrete: H+
reabsorb: K+

157
Q

if ECF is alkalosis, kidneys excrete and reabsorb what

A

excrete: K+
reabsorb: H+

158
Q

where do we get our acid inputs

A

diet
metabolic intermediates –> cellular respiration

159
Q

where is our largest source of acid come from

A

cellular respiration - aerobic (CO2 production)

CO2 is known as a volatile acid bc it can combine reversibly with water to form carbonic acid –> H+ and HCO3-

160
Q

how is body fluid pH balanced maintained

A

if acid intake and production by the body = excretion

inputs are from external dit and internal metabolism
outputs are respiratory system mainly and some renal system

161
Q

how does the body manage constant variability in pH

A

buffers <- controls the most
ventilation
renal regulation

162
Q

what is the equation for carbonic acid

A

CO2 + H2O <-> H2CO3 <-> H+ + HCO3-
exhaled. acid buffer

163
Q

key info about buffers

A

buffers moderate acidity but DOES NOT prevent changes in pH

buffers combine or release H+ ions from a combination

buffers include cellular proteins, phosphate ions, and Hb exchanges

164
Q

HCO3- enters the plasma in exchange for

A

Cl- -> CHLORIDE SHIFT!!!

165
Q

hypoventilation results in an

A

internal acidotic state

166
Q

hyperventilation results in an

A

internal alkalosis state (to breathe off CO2 and increase H+)

167
Q

what manages 75% of pH distrubances

A

ventilation!! breathing

168
Q

what is the most direct approach of pH homeostasis management

A

renal regulation

but this also is the slowest mech!!

169
Q

how does renal regulation work for pH homeostasis management

A

direct compensation through excreting or reabsorbing H+

in-direct compensation by changing the rate at which the HCO3- buffer is reabsorbed or excreted

apical -> active transport
basolateral -> symport and antiporter

170
Q

renal collecting ducts intercalated cells type A do what

A

function in ACIDOSIS

bicarb reabsorption
hydrogen secretion into CD

171
Q

what are intercalated cells of the CD

A

help maintain pH homeostasis

have high concentration of carbonic anhydrase in cytoplasm

172
Q

how would excessive activity of type A intercalated cells affect K+ levels within the body

A

hyperkalemia -> create excessive amt K+ in plasma acidosis

173
Q

what do renal collecting duct intercalated cells type B do

A

function in ALKALOSIS

bicarb secretion into CD
hydrogen reabsorption

174
Q

disorders of CO2 are referred to as

A

respiratory disorders

175
Q

disorders of HCO3- of fixed acids are referred to as

A

metabolic disorders

176
Q

if pH shift is due to lung condition is is considered a

A

respiratory cause

177
Q

if PCO2 and pH are in the SAME direction, then

A

the problem is METAbolic related

**he said this backwards in lecture have to double check

178
Q

if PCO2 and pH are in REVERSE direction, then

A

problem is RESPIRATORY related

*****he said this backwards in lecture have to double check

179
Q

what can cause respiratory acidosis

A

COPD/emphysema

180
Q

what can cause metabolic acidosis

A

diabetes

181
Q

what type of breathing will a person with metabolic acidosis exhibit that also has diabetes

A

hyperventilation

182
Q

why do people with diabetes get metabolic acidosis

A

cant break down glucose bc not enough insulin so body starts breaking down fat for energy. bad!

183
Q

what can result in respiratory alkalosis

A

panic induced hyperventilation

184
Q

what can result in metabolic alkalosis

A

excessive puking

185
Q

You are taking excessive amounts of antacids for heartburn on a frequent basis: what is the most likely effect of this on your blood plasma

A

metabolic alkalosis –> it will slow down breathing = hypoventilation

186
Q

if you blood plasma is more alkaline what does this mean in terms of CO2

A

CO2 is LOW and a decrease in rate and depth of respiratory volume will occur as a compensation

187
Q

if your blood plasma is more acidic, what does this mean in terms of CO2

A

CO2 is HIGH and an increase in rate and depth of ventilations will occur as a compensation

Physiology (4 decks)

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