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Renal > Physiology > Flashcards

Physiology Flashcards

1
Q

What is creatinine?

A

A product of muscle metabolism.

Will be higher in those with high muscle mass.

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2
Q

How do creatinine levels change in those with a low GFR?

A

High creatinine

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3
Q

Which eGFR level is described as stage 5 CKD?

A

<15ml/min

Requires dialysis/renal transplant.

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4
Q

Which eGFR level is described as stage 4 CKD?

A

15-29ml/min

Requires treatment to preserve function.

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5
Q

Which eGFR level is described as stage 3 CKD?

A

30-59ml/min

Often seen in elderly patients - normal decline in renal function seen in age.

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6
Q

Which eGFR level is described as stage 2 CKD?

A

60-90ml/min

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7
Q

Which eGFR level is described as stage 1 CKD?

A

> 90ml/min

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8
Q

How much protein content is needed to be pathological in urine?

A

150mg/day

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9
Q

Which group of conditions cause gross oedema and significant proteinuria?

A

Nephrotic syndrome

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10
Q

How does protein loss lead to oedema?

A

Proteins should act to drag water out of the tissues and into the blood vessels.

When lost, results in leakage into tissues - producing oedema (nephrotic syndrome).

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11
Q

What may microalbuminuria indicate?

A

Diabetic neuropathy

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12
Q

What should be given to prevent worsening of diabetic nephropathy?

A

ACE inhibitor

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13
Q

Does high osmolarity mean high concentration?

A

Yes, high osmolarity means high ratio of solute compared to water molecules.

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14
Q

Should plasma osmolarity be higher than urine osmolarity?

A

No, urine osmolarity should be higher.

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15
Q

Which hormones are produced by the kidneys?

A

Renin (regulates BP)
Erythropoietin (encourages RBC production)

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16
Q

Which hormone controls the reabsorption Na+ in the distal convoluted tubule?

A

Aldosterone

Results in greater Na+, increasing blood volume (and therefore pressure).

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17
Q

What is the effect of a hypotonic solution?

A

Increases cell volume

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18
Q

What is the effect of a hypertonic solution?

A

Decreases cell volume

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19
Q

In which compartment is the majority of water found?

A

Intracellular - makes up 67%.

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20
Q

What 4 components make up the total extracellular fluid compartment?

A

Plasma
Interstitial fluid
Lymph
Transcellular fluid

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21
Q

Which ions are most concentrated within the ECF?

A

Sodium
Chloride
Bicarbonate

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22
Q

Which 2 ions are most concentrated with the ICF?

A

Potassium
Magnesium

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23
Q

What is responsible for the movement of fluid between the ICF and ECF?

A

An osmotic gradient

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24
Q

What is the typical kidney output of urine per day?

A

1.5L/day

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25
Q

How is bilirubin produced?

A

It is a by-product of haemoglobin metabolism.

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26
Q

How is uric acid produced?

A

A by-product of purine metabolism.

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27
Q

What is the role of erythropoietin?

A

To stimulate RBC production.

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28
Q

How does the kidneys process vitamin D?

A

Converts this to calcitriol (active form).

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29
Q

Can the bladder/ureters alter the composition of urine?

A

No, last alterations to this are at the kidneys.

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30
Q

Which 3 mechanisms take place at the nephrons to create urine?

A

Filtration
Reabsorption
Secretion

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31
Q

How does blood pass through the kidneys?

A

Renal artery > Afferent arteriole > Glomerulus > Efferent arteriole > Peritubular capillaries > Venules > Renal vein > IVC

32
Q

What is a normal GFR?

A

120ml/min

33
Q

What is the first step of urine production?

A

The passage of some plasma across the Bowman’s capsule, becoming the tubular fluid.

34
Q

What 3 barriers act to limit the glomerular function?

A

Glomerular capillary endothelium (blocks passage of RBCs)
Basement membrane (albeit has pores)
Slit processes of podocytes

35
Q

What is the purpose of podocytes?

A

To act as a molecular sieve - only small molecules can pass through.

36
Q

What is GFR?

A

The rate at which protein-free plasma is filtered from the glomeruli into the Bowman’s capsule, per unit of time.

37
Q

What is the purpose of the extrinsic regulation of the GFR?

A

When blood volume drops, afferent arterioles constrict, reducing urine production.

Ensures minimal fluid loss.

Regulated by sympathetic nervous system.

38
Q

What is meant by the term autoregulation?

A

The intrinsic regulation of kidney function by the kidney itself.

39
Q

Which cells produce constriction of the afferent arteriole in order to lower GFR?

A

Macula densa

40
Q

Clearance of which molecule is viewed as ‘gold-standard’ in determining GFR?

A

Inulin

41
Q

What is creatinine?

A

An endogenous substance produced during skeletal muscle metabolism.

Released at a constant rate.

42
Q

Initially, what differs between tubular fluid and plasma?

A

Not too much, only large plasma proteins are lost.

Exclusion due to the negative charge of the basal lamina.

43
Q

Which section of the nephron is reached by the interstitial fluid?

A

Proximal tubule

44
Q

What is the major site of reabsorption within the nephron?

A

Proximal tubule

45
Q

What is the only area of the nephron not involved in sodium reabsorption?

A

Descending limb of the loop of Henle

46
Q

Can water be reabsorbed in the ascending limb of the loop of Henle?

A

Minimally, primarily responsible for the reabsorption of sodium and chlorine ions.

47
Q

Which form of medication acts on the triple co-transporter of the ascending limb of the loop of Henle?

A

Loop diuretics

48
Q

How does the triple co-transporter impact the tubular fluid?

A

Removes solute from the ascending limb - leaving only water behind.

Results in dilute urine.

Blockage (with loop diuretics) produces concentrated urine.

49
Q

Which limb of the loop of Henle concentrates urine?

A

Descending

50
Q

Which limb of the loop of Henle dilutes urine?

A

Ascending

51
Q

What regulates the resorption of water?

A

ADH

52
Q

What is the action of aldosterone?

A

Promotes sodium resorption.

Allows K+ to be secreted.

53
Q

What is the action of PTH?

A

Increases calcium resorption
Decreases phosphate resorption

54
Q

Which part of the nephron is the ONLY area where hormones can influence the resorption of ions?

A

Collecting duct

55
Q

What is central diabetes insipidus?

A

An inability to produce ADH in the posterior pituitary.

56
Q

What is nephrogenic diabetes insipidus?

A

An inability of the kidneys to respond to ADH within the circulation.

57
Q

How is central DI treated?

A

ADH replacement

58
Q

How does alcohol impact ADH release?

A

Reduces it.

Explains why need to pee so much when drinking.

59
Q

When is aldosterone released?

A

Released from the adrenal cortex in response to:

High plasma K+
Low plasma Na+

60
Q

Why does aldosterone cause BP to rise?

A

As resorption of salt is promoted, which causes a rise in blood volume (as water dragged back in), thus increasing BP.

61
Q

How does hyponatraemia affect BP?

A

Lowers it.

62
Q

Where is renin produced?

A

Liver

63
Q

Where is ACE enzyme found?

A

Lungs

64
Q

What are the main functions of angiotensin II?

A

Promotes aldosterone release
Stimulates thirst
Promotes ADH release
Promotes vasoconstriction

65
Q

What 3 factors can trigger release of renin?

A

Reduced pressure in the afferent arterioles
Macula densa senses the amount of NaCl in the distal tubule
Increased sympathetic activity due to reduced BP

66
Q

Which extremes of pH signify a serious risk of death?

A

<6.8 and >8.0

67
Q

Which enzyme catalyses the creation of H+ and HCO3- ions from CO2 and H20?

A

Carbonic anhydrase

68
Q

Which organ controls HCO3- levels?

A

Kidneys

69
Q

Which organ controls PaCO2 levels?

A

Lungs

70
Q

Can the kidneys create HCO3 when this is low?

A

Yes, if low levels detected in the tubular fluid, H+ can be secreted into the nephron, binding with phosphate.

71
Q

What is respiratory acidosis?

A

Retention of CO2 within the body.

May be due to lung failure.

72
Q

What is the primary cause of respiratory alkalosis?

A

Hyperventilation

73
Q

Is metabolic acidosis due to CO2 retention?

A

No, problem not related to CO2.

74
Q

For respiratory disturbances of acid/base balance, where does compensation occur?

A

Kidneys

75
Q

For metabolic disturbances of acid/base balance, where does compensation occur?

A

Lungs

76
Q

Which metabolic acid/base disturbance is most commonly seen?

A

Metabolic acidosis

77
Q
A

Renal (14 decks)

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