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Kidney > Physiology > Flashcards

Physiology Flashcards

1
Q

What are the three roles of the kidneys

A

Maintain balance of salt, water and pH

Endocrine function - secreting hormones

Excrete products

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2
Q

What is the renal blood flow

Cardiac output
Renal blood flow
Urine flow

A

Cardiac output approx. 5 L/min

Renal blood flow approx. 1L/min

Urine flow approx. 1 mL/min

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3
Q

What is the order of renal blood supply

A

Renal artery
Interlobar artery
Arcuate artery
Interlobar artery
Afferent arteriole
(Nephron) - glomerular capillary then peritubular capillary

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4
Q

What are the two capillary beds in the nephron

A

Glomerular capillary
Peritubular capillary

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5
Q

What does the passage of fluid from the blood into Bowman’s space form

A

Filtrate

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6
Q

What is the approx surface area involved in glomerular filtration

A

1m2

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7
Q

What is the distal part of the nephron responsible for

A

Secretion and reabsorption

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8
Q

What are the five determinants which effecting the movement across the filtration barrier

A
  1. Pressure
  2. Size of the molecule
  3. Charge of the molecule
  4. Rate of blood flow
  5. Binding to plasma proteins e.g. calcium, hormones such as thyroxine
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9
Q

What can freely pass the filtration barrier

A

Small molecules and ions up to 10kDa

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10
Q

Name examples of ions which are up to 10kDa

A

Glucose
Uric acid
Potassium
Creatine

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11
Q

What is restricted crossing the filtration barrier

A

Larger molecules

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12
Q

What cannot cross the filtration barrier

A

Negatively charged anions

Due to the fixed negative charge in the glomerular basement membrane repels these

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13
Q

What are the key features of Albumin

A

66kDa - molecular weight

Negatively charged

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14
Q

What is the protein called in urine which is produced by tubule

A

Tamm Horsfall protein

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15
Q

What is filtered fluid free from

A

Proteins

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16
Q

What is the renal blood flow ml/min

A

1250

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17
Q

What is the renal plasma flow ml/min

A

700ml/min

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18
Q

What is the glomerular filtration rate ml/min

A

120ml/min

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19
Q

What is the urine flow rate ml/min

A

1ml/min

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20
Q

What is the bodies normal pH (hydrogen ion) range

A

7.35-7.45

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21
Q

What is the bodies normal pH (hydrogen ion) range

A

7.35-7.45

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22
Q

What is the minimum urine hydrogen ion concentration (pH)

A

4.5

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23
Q

Define Base

A

Accepts hydrogen ions

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24
Q

Define acid

A

Donates hydrogen ions

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25
Q

Carbohydrates + fats =

A

Carbonic acid

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26
Q

Number the buffers involved in dietary acid load

A

Plasma protein
Haemoglobin
Extracellular bicarbonate
Intracellular carbonate
Phosphate

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27
Q

What is the name of the protein which is present in urine produced by the tubule

A

Tamm Horsfall

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28
Q

What is the renal corpuscle made up of

A

Glomerulus (tuft capillaries) + Bowman’s capsule

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29
Q

What goes is the blood flowing into the glomerulus

A

Afferent arteriole

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30
Q

What is the blood flowing out of the glomerulus

A

Efferent arteriole

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31
Q

What does the glomerulus contain

A

Endothelial layer

Glomerular basement membrane

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32
Q

What does the endothelial layer contain

A

Fenestrated capillaries

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33
Q

What is the role of fenestrated capillaries

A

Cannot filter formed elements e.g. blood cells

Can filter elements less than 100nm in diameter

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34
Q

What are the layer of the glomerular basement membrane and its role

A

Lamina rara interna (heparin sulphate)

Lamina Densa (type 4 collagen with laminas)

Lamina rare externa (heparin sulphate)

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35
Q

What is the role of the glomerular basement membrane

A

Negatively charged on both sides

Cannot pass negative molecules e.g. plasma proteins

Easily pass positively charged molecules e.g. sodium

Can pass (but not as well as positively charged) negatively charged molecules e.g. chloride

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36
Q

What is the Bowman’s capsule made up of

A

Parietal layer

Visceral layer (podocytes)

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37
Q

What is the role of podocytes

A

Slit diaphragm in-between made of nephrin

Only allows less than 10nm through

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38
Q

What can pass through the renal corpusal

A

Charged ions less than 10nm

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39
Q

What can pass through the endothelial layer

A

Most substances

50-100nm

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40
Q

What cannot pass through the glomerular basement membrane

A

Negative molecules repelled

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41
Q

What can pass through the visceral layer of the renal corpuscle

A

Less than 10nm

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42
Q

What happens in the Renal corpuscle if a macromolecule e.g. plasma protein was to get stuck in the slit diaphragm

A

Phagocytosed by mesangial cells

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43
Q

What are the role of mesangial cells

A

Phagocytosis

Control the amount of blood flow

Gap junctions with juxtaglomerular cells

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44
Q

Define glomerular filtration rate

A

Filtration rate per unit of time (minutes)

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45
Q

What percentage of blood that passes into the renal corpuscle will be filtered

A

20%

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46
Q

What happens to hydrostatic pressure along the length of the capillary

A

Constant along the length

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47
Q

What happens to osmotic pressure along the length of the capillary

A

Rises along the length

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48
Q

What affects GFR

A

Net filtration rate

Surface area

Permeability of glomerulus

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49
Q

Define Osmolality

A

The concentration of a solution expressed as the total number of solute particles per kilogram

50
Q

What is the volume of urine

A

400ml-20L in 24 hours

51
Q

What is the pH of urine

52
Q

What is the concentration of sodium in urine

A

100-300 mmol/24 hours

53
Q

What is the concentration of potassium in urine

A

50-450 mmol/24 hours

54
Q

What is the concentration of glucose in urine

A

less than 1 mmol/24 hours

55
Q

What is the amount of amino acids in urine

A

Very little

56
Q

What is the concentration of HCO3 in urine

A

1 mmol/24 hours

57
Q

How much filtrate is there per day

58
Q

What is the main principle of the proximal convoluted tubule

A

Bulk absorption (leaky)

59
Q

What is the main principle of the distal convoluted tubule

A

Fine tubing (impermeable)

60
Q

What is the order of the nephron segments

A

Proximal convoluted tubule
Proximal straight tubule
Thin descending limb
Loop of Henle
Thin ascending limb
Thick ascending limb
Collecting tubule
Distal convoluted tubule
Collecting

61
Q

What parts of the nephron segments are in the cortex

A

Proximal convoluted tubule
Proximal straight tubule
Thick ascending limb
Collecting tubule
Distal convoluted tubule

62
Q

What parts of the nephron segments are in the medulla

A

Think ascending limb
Loop of Henle
Thin ascending limb
Collecting duct

63
Q

What is the functions of the proximal tubule

A

Bulk reabsorption of
- Na
- Cl
- Glucose
- Amino acids
- HCO3-

Secretion of organic ions

64
Q

What is the functions of the Loop of Henle

A

More Na reabsorption
Urinary dilution
Generation of medullary hypertonicity

65
Q

What is the function of the Distal convoluted tubule

A

Fine regulation of Na, K, CA, Pi
Separation of Na from H2O

66
Q

What is the function of the collecting duct

A

Similar to distal tubule

More acid secretion
Regulated H2O reabsorption concentrating urine

67
Q

What is bulk reabsorption in the proximal tubule driven by

A

Basolateral NaKATPase

68
Q

Where is the majority of bulk reabsorption achieved in the proximal tubule

A

Mostly achieved in the first half

69
Q

What permeability is the proximal convoluted tubule to H2O

70
Q

What is the basolateral layer

A

Between the cell and the capillary

71
Q

What is the apical layer

A

Between the cell and the lumen (of the proximal convoluted tubule)

72
Q

What is secondary active transport

A

A molecule which is going against its concentration uses a molecule is going with its concentration gradient to move across the cell

73
Q

What is the movement of potassium and sodium in ATPase

A

3 Na+ out
2 K+ IN

74
Q

Which molecules move across the apical membrane using secondary active transport (into the cell)

A

2Na+ and glucose

Na+ and phosphate

Na+ and amino acids

75
Q

What molecules in the proximal convoluted tubule make there way through the basal lateral membrane

A

Glucose
Amino acid
Lactate

76
Q

What percentage of glucose, amino acids and lactate are reabsorbed into the capillary

77
Q

What is the process of bicarbonate filtration in the proximal convoluted tubule

A

In lumen

Proton (H+) reacts with bicarbonate (HCO3-) to make carbonic acid

Carbonic anhydrase breaks this into CO2 and H2O

CO2 moves into the cell and reacts with water (using carbonic anhydrase) inside the cell to form carbonic acid

Carbonic acid is not stable

Dissociates into bicarbonate and proton

Bicarbonate used sodium to move into capillary

78
Q

Within the proximal convoluted tubule the reaction of bicarbonate from the lumen to capillary how many bicarbonate ions are secreted into the capillary

79
Q

Define glucose: Tubular maximum

A

As plasma glucose increases at a specific amount the amount of glucose reabsorbed will stay the same and the amount of glucose excreted will increase

80
Q

How does some potassium and chloride ions move across the cell in the proximal convoluted tubule

A

Using tight junctions between cells

81
Q

How are endogenous compounds (creatinine, urate and bile salts) and drugs transported in the proximal convoluted tubule

A

Active transport

Uses organic cation/anion transporters

82
Q

Define glomerulotubular balance

A

More filtered load is matched by more proximal tubular reabsorption

83
Q

What does a greater filtration factor in the proximal convoluted tubule cause

A

Increases osmotic pressure in downstream peritubular capillaries

Sucks more back

84
Q

What does efferent arteriolar constriction in the proximal convoluted tubule cause

A

Reduces peritubular capillary hydrostatic pressure

85
Q

What are the two ways that glomerulotubular balance is achieved

A

Greater filtration factor

Efferent arteriolar constriction

86
Q

What is the osmolality in the glomerulus compared to when entering the proximal convoluted tubule

A

Same

Isotonic with the blood plasma

87
Q

What is the osmolality when entering the Loop of Henle

A

Same as the glomerulus

Isotonic with the blood plasma

Na+ and water are reabsorbed in the same amounts

88
Q

Where does solute reabsorption occur within the loop of Henle

A

Thick ascending limb

89
Q

What is the aim of countercurrent in the loop of Henle

A

Generate a hypertonic medullary interstitium so that H2O can be sucked out of the tubule in impermeable segments, thus concentrating the urine

90
Q

What is another word for high osmolality

A

Hypertonic

91
Q

What is another word for low osmolality

92
Q

How does counter current multiplier mechanism work

A
  1. Ascending limb lowers luminal osmolality and increases the medullary interstitial osmolality
  2. Increased interstitial osmolality draws H2O out of the descending limb, luminal osmolality increases
  3. Continuous flow of fluid pushes the hyperosmotic fluid from end of the thin limb to the ascending limb
93
Q

What does the counter current multiplier mechanism create

A

Medullary interstitial osmotic gradient

94
Q

What are the reasons why blood flow does not wash of the osmotic gradient achieved in the counter current multiplier mechanism

A

Vasa recta

Long capillaries extend into the medulla

Permeability to solute/water

95
Q

What allows water to move out of the descending limb in the counter current multiplier mechanism

A

Aquaporin type 1 channels

Passive

96
Q

Is the descending limb permeable to water

97
Q

Is the descending limb permeable to solute

98
Q

Is the ascending limb permeable to water

99
Q

Is the ascending limb permeable to solute

100
Q

How do solutes move out of the cell in the ascending limb

A

Na+/K+/2Cl- co-transporters

Move
Na+
K+
2Cl-
Out of the cell

101
Q

What also contributes to medulla hypertonicity (Loop of Henle)

A

Back leak of urea out of the medullary collecting duct

102
Q

What is the gradual medullary interstitial osmotic gradient

A

From

300
700
1000
1200

Moving down the lumen

103
Q

Osmolarity

A

The concentration of a solution expressed as the total number of solute particles per litre

104
Q

What is the role of the distal tubule

A

Continues the active dilution of urine by reabsorption of Na+ in water impermeable setting

105
Q

What are the two divisions of the distal convoluted tubule

A

Early
Late

106
Q

What is the late distal convoluted tubule responsive too

A

On hormones

107
Q

What happens in the early distal convoluted tubule

A

Parathyroid hormone - works out how much Ca2+ is in the blood

Parathyroid actives Ca2+ transporters to get into the cell

Pumps out Ca2+ into the bloodstream

108
Q

How does sodium get into the cell in the early distal convoluted tubule

A

Sodium chloride symporter (same direction)

Na+ and Cl-

109
Q

What happens in the late distal convoluted tubule

A

Aldosterone responding cells

Allows the pumping of Na+ out of the cell and K+ into the cell

110
Q

Is the collecting duct permeable to water

A

Impermeable

111
Q

What is the collecting duct surrounded by

A

Hypertonic medullary insterstitium

112
Q

What is collecting duct regulated by

A

Na reabsorption
K secretion
Acid secretion
Water reabsorption

113
Q

What are the two types of cells found in the collecting duct

A

Principal cell
Intercalated cell

114
Q

What is the mechanism of ADH on the collecting duct

A

ADH acts on receptor
Increases cAMP - kinases - vesicle shuttling
H2O enters the cell by the aquaporin 2 into the cell and leaves into the blood

115
Q

What is the action of aldosterone on the collecting duct

A

Increases transcription (steroid receptor) of ENaC (and NaKATPase)

Increases apical Na influx

Charge movement facilitates K efflux

116
Q

What does aldosterone drive in the collecting duct

A

Na reabsorption
K secretion

117
Q

What cell does ADH (vasopressin) act on

A

Principal cells

118
Q

What is the action of ADH in the collecting ducts

A

Adenylyl-cyclase coupled vasopressin receptor (V2R)

Kinase actions culminate in insertion of vesicles containing aquaporin 2 into the apical membrane

Increases water permeability

119
Q

Define osmolaRity

A

Number of particles per litre of fluid

NUMBER of particles

120
Q

Define osmolaLity

A

Total solute concentration within a specific volume of solute expressed in osmoles per litre (osm/L)

Kidney (7 decks)

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