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princip, pharm, phys, regional > Phys: renal 1 > Flashcards

Phys: renal 1 Flashcards

1
Q

what is the maximum molecular weight that can be filtered by the kidneys

A

10,000 molecular weight

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1
Q

what are components of urine?

A

excess water, salt, vitamins, waste from foods, drugs, urea, and un-conjugated bilirubin (gives it its yellow color)

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2
Q

what is the unfinished product in the kidneys called before it is called urine (finished product)

A

filtrate

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3
Q

what are the sources and amounts of water intake for humans?

A
  1. oral intake (2-2.5 liters per day)
  2. metabolic water from electron transport chain (200 ml/day)or 1/10th (made by mitochondria-fatty acid is 12 carbons which is turned int 6 acetyl groups etc.).
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4
Q

what are methods of water loss

A

sensible and insensible

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5
Q

what are methods of insensible loss

A
  1. loss of vapor thru semi permeable stratified squamous epithelium of skin
  2. vapor loss in nose when warming and moisturizing inhaled air (via swelling bodies)
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6
Q

what are methods of sensible loss and the amounts
which method has the potential for most loss
which one is the most controlled

A
  1. sweat (100 to 2000 ml/day) -#1 potential for loss
  2. kidneys (500 to 1500 ml/day of urine)- #1 most controlled
  3. feces (100 ml/day)
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7
Q

what does the body do with ammonia?

A

ammonia goes to liver and is converted to urea. 50% of the urea is excreted and the other 50% is saved in the liver as an osmolyte

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8
Q
  1. what is the minimal amount of urine output in a day that would guarantee removal of harmful nitrogenous waste?
  2. how is this waste made?
A
  1. 500 ml (approximetey)-actual is .5 ml/kg/hr

2. amino acids are broken into sugar and an amine group (which becomes ammonia which we must excrete).

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9
Q
  1. how much of human body is water?
  2. how much of that is intracellular?
  3. how much is extracellular?
  4. how much is trans-cellular?
A
  1. 60% of human body is water
  2. 40% is intracellular (cytoplasm)
  3. 20% is extracellular (blood and interstitial fluid (between cells)
  4. the rest is (<1%) is transcellular
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10
Q

what is trans cellular fluid (where is it located)?

A

synovial, pericardial, pleural, CSF, peritoneal

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11
Q

which extracellular component has the most water-interstitial or blood?

A

Interstitial fluid has more water than blood

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12
Q

what is the fluid concentration formula? Explain it in solving for one of its factors.

A

volume A (inj)* concentration A (inj)= volume B * concentration B

to solve for volume B:
vol A * conc A
——————- = volume B
conc B

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13
Q

what would a lab do to test for intracellular volumes

A

inject scant amount of tridiated water H2(3)O (which is radioactive) into blood (tritium is taken into the cells-thus can test intracellular)

  1. wait 30 min, and draw lab
  2. apply formula with A being the volume and concentration of the injectate and B being the intracellular volume and concentration
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14
Q

how would a lab test for extracellular volume

2 methods

A

Method A
1. Inject radioactive sodium
2. wait 30 minutes
3. draw labs and apply formula(since there is 10x more sodium outside of cells than inside, you can check extracellular volumes
by how much residual sodium is retrieved).

method B:
give beet sugar called Inulin (which cannot enter cell)
draw labs, and calculate

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15
Q

how would a lab test for INTERSTITIAL (extracellular)volume?

2 methods

A

A. give radioactive iodine iv (it sticks to proteins), then draw labs to protein (gel) electrophoresis and see how much radioactive protein you have (which will tell you how much interstitial fluid you have).
(if patient cant tolerate radiation)
B. give Evans Blue dye (which doesnt enter cells)

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16
Q

how do you calculate total blood volume?

A

calculate what the plasma is, than divide that by 1-hematocrit

            plasma
          ------------
            1 - hct
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17
Q

What is the difference between anion and cation concentrations in intracellular and extracellular fluids

A

Intracellular: more K+, Mg++, SO4–, PO4–, Ca++

extracellular: more Na+, Cl-, HCO3-, some Ca++

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18
Q

what is the Donnan Effect?

A 
Extracellular protein (which is negatively charged) attracts some of the cations K+, Na+ and Ca++, leaving unpaired anions to draw more free cations to the extracellular space (extracellular actually draws 2% more cations than does intracellular)
The anions also cannot cross into the intracellular space because the intracellular anions repel them.
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19
Q

what happens to Cations during acidosis?

how is this like acid rain?

A

The H+ (hydrogen ions) displace the cations into the extracellular space, causing an increase in sodium, calcium (which increases the action potential threshold of neurons), and potassium.

*(acid rain displaces cations out of the soil to get washed away)

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20
Q

what is the osmolarity of -180 g of glucose

                                   - 1 starch
                                   - 1 mol of CaCl2
A

a) glucose -1 osmo (because it does not dissociate)
b) starch- 1 osmo (because although it is thousands of glucose molecules, they are bound together and do not exert independent osmotic pull)
c) cacl2- 3 osmo because it breaks into calcium and 2 chlorides

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21
Q

what is normal osmolarity?

what is the difference between osmolarity and osmolality?

A
  1. osmolarity is 270-300g/L
  2. osmolaLITY (used in chemistry) is the measure of particles in 1 kg of solvent;
    osmolaRITY (used in medicine) is the measure of particles in 1 L of solution
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22
Q

if 1 mOsm=____mmHg_,
what approximately is the amount of pressure in the system from drinking a glass of water

what’s the math?

A

1 mOsm=19.3 mmHg
one glass of water generates almost 6000 mmHg of pressure (5,790 mmHg)
the math: water has 0 osmo, therefore 300 osm on the other side will rush thru at that pressure.

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23
Q

Is the pressure in the kidneys high?

what is the mOsm in the kidneys

A

yes!!!
average is 900mOsm (300-1200 mOsm)
900* 19.3=17,370

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24
Q
  1. what pressure must be exceeded in order for edema to take place?
  2. What is the normal tissue hydrostatic?
A
  1. must go from -3 to 14 mmHg (a 17 mmHg increase)

2. normal tissue hydrostatic (from lymphatics) is -3

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25
Q

(T.H.= tissue hydrostatic)

  1. what happens when T.H. increases from -3 to 0 mmhg
  2. what happens when T.H. increases from 0 to 7 mmhg
  3. what happens when T.H. increases from 7 to 14 mmhg
A
  1. (-3 to 0) elasticity with low compliance of matrix accommodates this change
  2. (0 to 7) high compliance; shearing of collagen leaves “rivulets” that water can flow down
  3. (7 to 14) tissue proteins are washed out into interstitium, this increases tissue oncotic pull furthering edema.
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26
Q

how many glucose molecules in 1 starch

A

1,000 glucose molecules

molecular weight=180,000

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27
Q

why are polymers osmotically benificial

A

because each separate glucose is osmotically active, so by polymerizing them, there is only one osmotically active structure, therefore instead of 1,000 molecules each drawing water, only 1 is drawing water (it saves on water draw-otherwise it would swell and burst the muscles and liver).

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28
Q
  1. what makes up the renal pyramids?

2. where do they empty

A
  1. nephrons

2. at the calyces

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29
Q

what is osmotic pressure

A

the force exerted on water to keep the volume constant.

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30
Q
  1. when the nephrons of the renal pyramids drain into the calyces, what ducts do they empty through?
  2. name the calyces in order through which filtrate empties:
A
  1. urine enters calyces thru Ducts of Bellini

2. filtrate drains into minor calyces, then into the major calyces

31
Q

blood comes from renal arteries to what (name the vessels in order)

A
  1. Renal arteries: enter renal pelvis and branch into…>
  2. inter-lobar arteries: branches that serve large lobes and form…>
  3. arcruate arteries (arc shaped): these branch into…>
  4. inter-lobular: go between renal pelvices and service the nephrons
32
Q

what arterioles branch off the interlobular arteries, with part of it becoming the glumerulous?

A

the afferent arterioles

33
Q

the glumerulous is a capillary bed that is emptied by what arterioles?

A

efferent arterioles

34
Q

efferent arterioles go to one of 2 capillary beds:

A
  1. Peritubular

2. Vasa Recta

35
Q

the arcurate artery divides the kidney into 2 distinct sections, name them:

A
  1. Cortex: the perimeter tissue (cortex=circumference)

2. Medulla: the tissue closer to the renal pelvis (medulla=middle)

36
Q

how does digestion affect your water supply

A

osmotically active food pulls water from the intestines, your large intestine pulls water back out (solidifying your stool), all is extracted back except for approx 100 ml.

37
Q

why is ammonia a neurotoxin?

what does it cause?

A

it is uncharged and therefore lipid soluble- so it can enter the nerves and it likes the fatty myelin etc. so it is a neuro toxin (causes tremors called “Liver Flap”).

38
Q

where is calcium stored in the intracellular fluid?

A

in the smooth ER

39
Q

what does the proximal convoluted tubule do?

A

it is the gross adjuster because it pulls everything out of the filtrate that your body could possibly need.
2. it is located distally from the bowman’s capsule

40
Q
  1. where is the bowman’s capsule located

2. and what does it do?

A
  1. the bowman’s capsule surrounds the glumerulous. It is located in the cortex
  2. this is where filtration takes place (it pulls fluids and such from the glumerulous).
41
Q
  1. where is the loop of Henle located?

2. what does it do?

A
  1. The loop of henle is located in the medulla as it dips down toward the pelvis
  2. creates a salt (hyper osmotic) gradient; making the medulla very salty (approx 1200 mOsm)
42
Q
  1. what does the Juxto-Glomerular aparatus do?

2. where is it located?

A
  1. the JGA is located distal to the loop of henle
  2. It samples the sodium levels in the filtrate after it passes thru the loop of henle, it tests it to see if you have too little or too much.
43
Q
  1. what does the distal convoluted tubule do?

2. how many sections does it have, name them

A
  1. the DCT is the “fine tuner”. If you dont need somthing, it gets rid of it (fine tunes salts and acids etc.)then empties into the collecting duct.
  2. has 2 parts (early and late)
44
Q
  1. what does the collecting duct do?

2. how do collecting ducts differ in the cortex and medulla?

A
  1. the collecting ducts collect filtrate
  2. the medulla and cortex collecting ducts differ in that:
    a) the collecting duct in the cortex works like the DCT
    b) the collecting duct in the medulla regulates water (creates a salt gradient so that wherever salt goes, water will follow).
45
Q
  1. what causes the DCT to regulate the sodium levels?

2. where does it come from?

A
  1. Hormones

2. released from the JGA (renin)

46
Q
  1. what controls the PCT removal of particles from the filtrate?
A
  1. Hormones (parathyroid)
47
Q

what controls the release of ADH which acts in the medullary collecting duct?

A

osmotic receptors in hypothalamus

48
Q

what are the 2 types of collecting ducts?

A

cortical and medullary collecting ducts

49
Q

name the 2 capillary beds of the kidney:

A

capillary bed #1= Gomerulus

capillary bed #2=Peritubular and Vasa Recta

50
Q
  1. What do the peritubular capillaries do?
  2. How much blood (C.O.)does the peritubular capillaries get
  3. how does that compare to the vasa recta
A
  1. peritubular capillaries secrete what we don’t need back into the filtrate and re-absorb what we do need (they are very busy).
  2. the peritubular caps get 99% of the kidneys C.O.
  3. the Vasa Recta only deals with the loop of henle (na+ & h2o)
51
Q

what types of nephrons do we have and at what percentages?

A

we have 2 types of nephrons:
75% are cortical nephrons (which have short tubules)
25% are juxta-medullary nephrons (which have long tubules

52
Q

what ways can filtration be altered based on the needs of the body?

A
  1. Increase filtration/ increase absorption rate (speed up “in” and speed up “taking”)
  2. increase filtration/ maintain absorption rate at normal
    (speed up “in”, keep taking at normal)
  3. decrease filtration/ increase absorption rate
    (decrease “in”, increase “taking”)
53
Q

what type of capillary bed is the glumerulus based on its shape?

A

capillary tuft

54
Q

the glumerulus joins with either the peritubular capillary or the vasa rects. this forms a dual capillary bed. what kind of system is this?

A

portal system=2 capillary beds joined together

55
Q
  1. what is the glumerulus lined with?
  2. why is it called this?
  3. what are the pores called that fluid moves thru?
  4. what is the diameter of these pores?
A
  1. the gluerulus is lined with fenestrated endotheilum (squamous)
  2. it is fenestrated because it has small pores in it
  3. these pores are called Fenestrae
  4. 8 nanometers
56
Q
  1. what type of junctions does the fenestrated endothelium have?
  2. why is it called this?
A
  1. tight-leaky junctions

2. because it has filtrate flowing thru it

57
Q

what is the charge of the basement membrane of the endothelium

A

it is negatively charged

58
Q
  1. the bowman’s capsule has special cells called?

2. how are they joined and what to they wrap around?

A
  1. podocytes (triangular foot processes)
  2. the podocytes interdigitate (like fingers) with each other and the thin protein membrane and wrap around the glumerulus (capillary tuft).
59
Q
  1. what is the molecular weight cutoff for materials to pass thru the podocytes, protein membrane and fenestrae
  2. could albumin get thru? why or why not.
  3. could a small but negatively charged peptide get thru? why or why not.
A
  1. 10,000 mw
  2. albumin is too big to get thru
  3. negatively charged peptides are repelled by the negatively charged protein basement layer
60
Q

is there a filtrate oncotic pressure?

A

no, because protein is too big and is repelled so never gets into the filtrate

61
Q
  1. what are the Starlings filtration forces in the kidneys and their pressures?
  2. what’s the math, and which pressure predominates?
A
  1. a)blood hydrostatic pressure (push out) 60 mmhg
    b) blood oncotic (pull in) 32 mmhg
    c) filtrate hydrostatic (push in) 18 mmhg
  2. 32+18=50; 60-50=+10 pushing …pushing predominates
62
Q
  1. what does high blood pressure do to the podocytes ?
  2. what does this cause in regards to protein?
  3. what will it cause as far as pressures?
A
  1. high blood pressure stretches the podocytes causing them to open up the tight junctions and
  2. this allows protein into the filtrate (pathologic/ BAD)
  3. this causes a filtration oncotic pulling pressure that pulls more fluid into the filtrate
63
Q
  1. how is filtration measured (2 ways)?

2. what is the formula

A
  1. filtration is measured either by GFR or renal blood flow
    2.the formula is:
    Urine Concentration x Urine Flow/ blood concentration
64
Q

how is GFR measured- what is done to test the formula (2 ways):

A

1.Inulin is injected (inulin is only filtered (not absorbed or secreted)
2. wait 1 hour and test
(inulin should stay in the blood stream unless GFR is off)
3. you can do a creatnine (with bun); creatnine helps recycle ATP and only 1% is secreted. If more is secreted, there is an issue.

65
Q

how is renal blood flow tested?

A

Para-aminohippuric acid (PAH) is a chemical that should be completely removed from the renal veins in one pass thru the kidneys.

66
Q

in the analogy of the bathtub;

  1. what is the bathtub?
  2. what is the fauced?
  3. what is the drain?
  4. how does this apply to the kidneys?
A
  1. The Bowman’s capsule is the tub (filtrate is the water)
  2. the Afferent arteriole is the faucet (going in)
  3. the efferent arteriole is the drain (taking away): efferent=efflux
  4. the fluid coming in, and the fluid going away control the amount of filtrate that is made.
67
Q

what is really happening?

  1. increasing the faucet causes increased filtrate-
  2. slowing the faucet decreases the filtrate-
  3. slowing the drain increases the filtrate
  4. increasing the drain decreases the filtrate
A

1.This is vasodilation of the Afferent, you increase filtration
(this would happen if the body needs to get rid of fluid)
2.vasoconstriction of the Afferent decreases filtration
(this would happen if the body is dry)
3. vasoconstriction of the Efferent increases the filtrate (keeps filtrate from leaving quickly)
4. vasodilation of the Efferent decreases the filtrate (takes filtrate away quicker)

68
Q

Fight or flight causes what response in the EA and AA? what receptors are affected? and what is the result?

A
  • NE and epi work on the B1 receptors (sympathetic/autonomic)
  • prolonged sympathetic stimulation (fight or flight) will cause vasoconstriction of AE and EE, decreasing filtrate.
69
Q

what vasoconstrictors come from the AA and EA themselves, and what causes these to be released?

A
  • Autocoids (self stimulating) from the AA & EA called Endothelin; which are vasoconstrictors that clamp down when there is hemorrhage in a non renal system (to preserve fluid)
  • also endothelin will be released if the renal flow is too much for the Proximal convoluted tubule to handle.
70
Q
  1. what does the renin-angiotensin system have to do with the EA
  2. where is the renin-angiotensin system located
A
  1. angiotensin II is a strong vasoconstrictor of the EA (preventing fluid from being taken away from the bowmans capsule) which increases filtration which causes the PCT to reabsorb more solute
  2. the renin-angiotensin system is located in the JGA
71
Q
  1. where is renin released from?
  2. what does renin do next?
  3. where is angiotensin I activated?
A
  1. renin is released by the JGA into the blood
  2. it then activates angiotensinogen- turning it into angiotensin I
  3. angiotensin I goes to the lungs and gets converted to angiotensin II which is a potent vasoconstrictor
72
Q

name the potent vasodilators and when/why they are activated

A
  • nitric oxide
  • prostaglandin E and I (prostaglandin F is a vasoconstrictor)
  • bradykinin- vasodilates the vessels near damaged tissue to bring blood and other mediators
73
Q

if you continue to vasoconstrict for too long, what happens?

A

you dont filter and you accumulate waste, you will push more fluid out of the glumerulus and you will lose all of your small particles except for protein molecules, but this will increase the blood oncotic pressure (pulling fluid back into the glumerulus, increasing pull in from 32 to (lets say 42), now your pushing out is still 60, but your pushing in is 18 and your pulling in is 42: 60=60, nothing will happen (except you will become very sick)

74
Q

if you speed up filtration, you must speed up reabsorption, what accomplishes this (to maintain equillibrium)?

A

autacoids

princip, pharm, phys, regional (18 decks)

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