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RenalJaz > Physiology > Flashcards

Physiology Flashcards

1
Q

osmolarity =

A

concentration of osmotically active particles in a solution

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2
Q

units for osmolarity in body fluids

A

mosmol/l

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3
Q

osmolality =

for weak salt solutions like body fluids is interchangeable with __

A

osmol/kg water

osmolarity

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4
Q

tonicity is related to osmolarity but also considers

A

the ability of a solute to cross the cell membrane

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5
Q

total body water = __% of body wt in M + F

A

60% males

50% females - more adipose tissue

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6
Q

ICF = ___% of total body water

A

67

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7
Q

ECF = +++

A

plasma (20%)
interstitial fluid (80%)
lymph and transcellular fluid (negligible)

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8
Q

tracers to measure volume of fluid compartments
total body water =
ECF =
plasma =

A 
TBW = water
ECF = inulin
plasma = labelled albumin
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9
Q

equation for using a tracer to measure the volume of a fluid compartment

A 
initial dose of tracer  (mol) /
sample concn (mmol/l)
= volume (l)
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10
Q

insensible and sensible fluid losses

A 
insensible = skin and lungs
sensible = sweat, faeces, urine
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11
Q

in hot temperature and exercise lung loss of fluid __

A 
hot = decreases
exercise = increases
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12
Q

Na K Cl and HCO3 are higher or lower in ICF compared to ECF

A

in ICF - Na and Cl and HCO3 = lower

K = higher

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13
Q

main ions in ECF

A

Na Cl HCO3

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14
Q

main ions in ICF

A

K
Mg
-vely charged proteins

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15
Q

osmotic concns of ICF and ECF are __ at around __

A

equal

300mosmol/l

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16
Q

if gain NaCl ICF and ECF volumes __

A

ICF decreases

ECF increases

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17
Q

if gain isotonic fluid there is no __ change

ICF and ECF volumes __

A

osmolarity
ECF increase
ICF stays the same

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18
Q

> 90% of osmotic concn of ECF is from

A

Na salts = main determinant of ECF volume

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19
Q

> 95% of body __ is in ICF

so minor fluctuations in its __ concn => __+__

A

K+
plasma
paralysis + cardiac arrest

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20
Q

juxtaglomerular apparatus lies between __+__ in nephron

A

afferent and efferent arteriole

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21
Q

in cortical nephrons efferent arteriole > ___ > venules

A

peritubular capillaries

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22
Q

20% of nephrons =

80% =

A 
20% = juxtamedullary nephrons
80% = cortical
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23
Q

key differences of juxtamedullary nephrons compared to cortical nephrons

A

juxta = longer loop of Henle
make more concn urine
single vasa recta that follows loop of Henle (rather that peritubular capillaries)

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24
Q

equation for rate of filtration of a substance

A

concn of X in plasma x GFR

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25
Q

normal GFR=

A

120-125ml/min

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26
Q

rate of excretion of a substance equation =

A

concn of X in urine x rate of urine production

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27
Q

rate of reabsorption of a substance equation =

A

rate of filtration - rate of excretion

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28
Q

rate of secretion of a substance equation =

A

rate of excretion - rate of filtration

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29
Q

glomerular membrane = ++_

A

glomerular capillary endothelium
basal lamina
slit processes of podocytes - glomerular epithelium

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30
Q

the glomerular capillary endothelium in the glomerular membrane is a barrier to ___ filtration

A

RBC

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31
Q

the basal lamina in the glomerular membrane is a barrier to ___ filtration because it is __ due to +

A

-ve plasma proteins
-vely charged
collagen and glycoproteins

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32
Q

forces that favour filtration that make up part of net filtration P

A

glomerular capillary bp (BPgc = 55mmHg)

Bowman’s capsule oncotic P (COPbc = 0)

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33
Q

forces that are against filtration that make up part of net filtration P

A

Bowmans capsule hydrostatic P (HPbc = 15mmHg)

capillary oncotic P (COPgc =30)

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34
Q

net filtration P = __mmHg

A

10

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35
Q

Starling forces are the balance of +

A

hydrostatic and osmotic forces

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36
Q

GFR definition

A

rate at which protein free plasma is filtered from glomeruli into bowmans capsule per unit time

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37
Q

GFR = ___ x ___

A

Kf (filtration coefficient “holiness”)

net filtration P

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38
Q

main determinant of GFR

stays constant along length of glomerular capillary due to ___

A

glomerular capillary bp

change in capillary diameter

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39
Q

extrinsic control of GFR is due to __

where decreased blood volume causes increased ___ => vaso__ and decreased ____+__

A

baroreceptor reflex
sympathetic activity
constriction
glomerular capillary bp and GFR

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40
Q

autoregulation/intrinsic control of GFR = __+__

A

myogenic response

tubuloglomerular feedback

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41
Q

bowmans capsule hydrostatic P increases if ___

causes GFR to

A

there is an obstruction => fluid build up in kidneys

decreases

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42
Q

capillary oncotic pressure increases if ___

causes GFR to

A

dehydrated

decrease

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43
Q

bowmans capillary oncotic pressure decreases if ___

causes GFR to __

A

burned => decreased plasma proteins

increases

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44
Q

plasma clearance definition

A

volume of plasma completely cleared of a particular substance per min = ml/min

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45
Q

plasma clearance = (__x__)/___

A

[X] in urine x volume of urine

[X] in plasma

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46
Q

clearance of __ = GFR

A

inulin

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47
Q

why is inulin a good measurement of GFR?

A 
freely filtered at glomerulus
not absorbed or secreted in nephron
not metabolised by kidney
not toxic
easily measured in urine and blood
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48
Q

___ clearance is a close approximation of GFR
however some of it is ___
but it is ___ and so easier to measure than inulin

A

creatinine
secreted in nephron
endogenous

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49
Q

filtered, completely reabsorbed in prox tubule and not secreted

A

glucose

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50
Q

urea clearance is greater/less than GFR? because ?

A 
less
partly reabs (50%)
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51
Q

H+ clearance is greater/less than GFR?

because?

A

more

filtered, secreted from peritubular plasma + not reabsorbed

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52
Q

RPF (renal plasma flow) is calculated using __

A

PAH (para-amino hippuric acid)

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53
Q

exogenous organic anion used to measure RPF clinically =

A

PAH (para-amino hippuric acid)

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54
Q

PAH features that make it a good indicator of RPF

A

freely filtered at glomeruli
completely secreted into tubule
not reabsorbed
ie. completely cleared from plasma

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55
Q

filtration fraction = __/__ = __%

A

GFR/RPF

20% (125/650)

56
Q

RBF = __ x __/__

A

RPF

1/1-haematocrit

57
Q

RPF normally = ___ ml/min

A

650

58
Q

__% of fluid and slat is reabs in kidney

A

99%

59
Q

in proximal tubule ions and solutes are at ___ concn but there are no __/__

A

plasma

RBC/large proteins

60
Q

__ml/min is reabs in proximal tubule so __ml/min is goes on to enter loop of Henle

A

80

45

61
Q

in proximal tubule the reabsorbed fluid is ___ with the filtrate therefore there is no change in ___ as you go along the tubule

A

iso-osmotic

osmolarity

62
Q

5 things reabs in proximal tubule

A 
lactate
glucose
AAs
sulfate
phosphate
63
Q

6 things secreted in proximal tubule

A 
H+
toxins
drugs eg. morphine
uric acid
bile pigments
hippurates
64
Q

NaKATPase is found at the ___ membrane in proximal tubule and increases ___ levels of K+ and __ levels of Na+

A

basolateral
intracellular K+
interstitial Na+

65
Q

transporters at the luminal surface of proximal tubule for Na reabs

A

Na glucose
Na AA
Na H+ countertransporter

66
Q

Na+ reabs in proximal tubule sets up an ___ gradient for Cl- to enter interstitial fluid ___ => ___ pull

A

electrical
paracellularly
osmotic

67
Q

___ of peritubular plasma proteins causes H2O and Cl- reabs in proximal tubule

A

oncotic drag

68
Q

transporters involved in glucose reabs at proximal tubule

A

luminal Na glucose cotransporter

basolateral glucose facilitated diffusion

69
Q

__+___ systems in kidney are saturable and so once Tm is reached clearance is not __

A

reabsorption and secretory

constant

70
Q

Tm (transport maximum) of glucose =

renal threshold therefore for plasma glucose =

A

2mmol/min

10-12mmol/l

71
Q

__% of salt and water, __% of glucose and AAs are reabs in proximal tubule

A

67 salt and h2o

100 glucose and AA

72
Q

loop of henle generates a ___ concn gradient to allow for production of ____

A

cortico-medullary solute

hypertonic urine

73
Q

in loop of henle the medullary interstitial fluid is hypo/hypertonic

A

hypertonic

74
Q

descending limb of loop of henle is highly permeable to ___ but no ___ reabs

A

H2O

no salt

75
Q

in ascending limb of loop of Henle __+__ reabs
by __ in thick upper part and __ in thin lower part
is relatively impermeable to __

A

Na and Cl
active transport in thick
passively in thin
H2O

76
Q

in thick ascending limb of loop of Henle there is the ___ cotransporter = blocked by ___

A 
TALH triple (Na K +2Cl)
loop diuretics
77
Q

in thick ascending limb of loop of henle interstitial fluids osmolarity ____ => __ cant enter descending limb and H2O leaves it by osmosis => fluid in descending limb is __ and so salt __ => cycle repeats (countercurrent multiplier)

A

increases
interstitial solutes
concentrated
leaves into interstitium

78
Q

___ fluid leaves loop of henle

A

hypoosmotic

79
Q

50% of cortico-medullary gradient is contributed to by ___

A

urea cycle

other 50% = salt

80
Q

urea cycle for loop of Henle:

urea ___ into loop > adds solute to ___ > distal tubule is not ___ to urea > collecting ducts ___ 50%(__ promotes this )

A 
diffuses passively
interstitium
permeable
reabs
ADH
81
Q

blood in vasa recta ___ with interstitial fluid across leaky endothelium

A

equilibriates

82
Q

3 features of vasa recta that mean salt and urea arent washed away from loop of Henle =

A

hairpin
freely permeable to NaCl and H2O
blood flow to it is low

83
Q

as vas recta goes down blood osmolarity __ and as it rises the osmolarity ___

A

increases

decreases

84
Q

4 hormones that control Na reabs in distal tubule/collecting duct =

A

aldosterone
ANP
ADH
PTH

85
Q

at resting state the distal tubule has low permeability to + and so ___ is concentrated in tubular fluid

A

urea and H2O

urea

86
Q

process that occurs in early distal tubule =

A

NaCl reabs by NaK2Cl cotransporter

87
Q

processes in late distal tubule and early collecting duct =

A

Ca2+ reabs
H+ secretion
Na + K reabs (in basal state)

88
Q

the late collecting duct has ___ ion permeability and + permeability are influenced by ADH

A

low

urea and H2O

89
Q

octrapeptide synthesised by supraoptic and paraventricular nuclei in hypothalamus =

A

ADH

90
Q

type 2 ADH receptors are on ____ and ATP>cAMP => more ___

A

basolateral membrane of tubular cells

aquaporins inserted on luminal membrane

91
Q

type 1 ADH receptors cause __

A

SM in arterioles to constrict

92
Q

high concn of ADH in collecting duct => ___ H2O perm and ___ urine as ___ equilibriates with ___

A

low
hypertonic, small vol
tubular fluid with interstitium

93
Q

most important stimulus of hypothalamus to release ADH =

A

hypothalamic osmoreceptors sense increased osmolarity

94
Q

__ sitmulates ADH release and __+__ inhibit it (toxic substances)

A

nicotine increases

alcohol and ecstasy

95
Q

aldosterone is secreted if __ increases/__ decreases in blood or __ is activated

A

K+ increases
Na decreases
RAAS

96
Q

increased K+ directly stimulates adrenal cortex to release ___ which causes __

A

aldosterone

K+ secretion

97
Q

decreased Na+ indirectly stimulates ___ release through __ causing RAAS activation

A

Aldosterone

juxtaglomerular apparatus

98
Q

renin release = ___ sense low __ in distal tubule => increased __ to ___ cells and released

A

macula densa
sodium
sympathetic activity
granular cells

99
Q

ATII effects =

A

aldosterone release
thirst
vasoconstriction of arterioles

100
Q

aldosterone acts on luminal ___ and basolateral __

A

Na+

NaKATPase

101
Q

__ is activated in HF due to low +
causes worsening of HF by __
Rx =

A 
RAAS
lbp and low CO
retention
low salt diet
ACEI 
loops
102
Q

ANP is produced by __ and stored in ___

A

heart

atrial muscle cells

103
Q

ANP is released when ___ due to increased ___

A

atrial muscle cells are stretched

plasma volume

104
Q

ANP => + increased, ___ decreased and afferent arteriolar vaso___ => increased GFR => + increased filtration and decreased ___ causing decreased CO and TPR

A 
Na excretion and diuresis increased
RAAS decreased
dilatation
Na and H2O filtration
decreased sympathetics
105
Q

blood pH 6.8 - &.35 =

A

acidotic

106
Q

blood pH 7.45 - 8 =

A

alkalosis

107
Q

3 ways in which H+ is constantly added to body fluids

A 
carbonic acid formation
inorganic acids (nutrient breakdown)
organic acids (metabolism)
108
Q

H2CO3 concn is dependent on ___ controlled by __
and HCO3- by __
therefore pH = __/___ function

A

PPCO2 - lungs
kidneys
kidneys/lungs

109
Q

kidney - variable reabs of HCO3- and addition of HCO3- to blood depends on ___

A

H+ secretion into tubule

110
Q

HCO3- reabs -
___ drives H+ secretion into tubule by ___ > + HCO3- > H2CO3 > + enter the cell > ____ > H2CO3 > H+ (secreted) + HCO3- -> ___ and enters interstitium

A 
CO2
Na/H exchanger
CO2 and H2O
carbonic anhydrase
basolateral Na/HCO3 cotransporter
111
Q

when HCO3 in tubular fluid is low H+ combines with __

as H+ is still secreted this causes a net gain of ___

A

phosphate

HCO3 from cleavage intracellularly from H2CO3

112
Q

titratable acid measures ___ largely as __ in urine

A

H+ excreted

H2PO4-

113
Q

titratable acid = the amount of __ added to circulation as a result of its formation

A

bicarbonate

114
Q

if severely acidotic tubular cells break down ___ from liver by ___ to form ___ which combines with H+ to form __ which is secreted in urine

A

glutamine
glutaminase
ammonia
ammonium

115
Q

amount of ammonium secreted in urine is the same as ___ added to the blood as a result

A

bicarbonate

116
Q

H+ excretion = + excretion = new __ generated

A

Titratable acid and ammonium

bicarbonate

117
Q

normal bicarb plasma concns

A

22-26

118
Q

normal PCO2 =

A

35-45mmHg

4.7-6kPa

119
Q

compensation of AB balance =

A

restoration of pH irrespective of bicarb and PCO2

120
Q

correction of AB balance =

A

restoration of pH and bicarb and PCO2

121
Q

pH is directly proportional to __/___

A

[HCO3] / [CO2]

122
Q

causes of resp acidosis =

A

COPD

airway restriction, opioids, chest trauma

123
Q

in resp acidosis:

increased CO2 causes increased __+__ (proportionally more __)

A

H+ and bicarb

more H+

124
Q

uncompensated resp acidosis pH and PCO2 =

A

pH <7.35

PCO2 > 45 mmHg

125
Q

compensation by kidneys in resp acidosis

A

PCO2 drives H+ secretion and HCO3- reabs and formation

H+ is excreted as titratable acid and ammonium

126
Q

causes of resp alkalosis =

A 
low PO2 at altitude
hyperventilation
fever
CNS damage
anxiety
127
Q

uncompensated resp alkalosis =

A

pH >7.45

PCO2 <35mmHg

128
Q

renal compensation of resp alkalosis =

A

decreased CO2 causes decreased H+ secretion => decreased HCO3- reabs and none new formed - so lose bicarc

129
Q

metabolic acidosis causes =

A

ingest acids
H+ production - lactic acid/ketones
diarrhoea

130
Q

uncompensated metabolic acidosis =

A

pH <7.35

[HCO3-]plasma <22

131
Q

compensation of metabolic acidosis by resp system

A

peripheral chemoreceptors stimulated by plasma pH

increase ventilation and decrease CO2

132
Q

renal correction of metabolic acidosis =

A

decreased CO2 causes HCO3- reabs and fromation with H+ secretion

133
Q

causes of metabolic alkalosis

A

vomit
ingest alkali
aldosterone hypersecretion

134
Q

uncompensated metabolic alkalosis

A

pH >7.45

HCO3- concn plasma >26

135
Q

compensation by resp system in metabolic alkalosis =

A

peripheral chemoreceptors see increased pH and decrease ventilation

136
Q

correction by kidneys in metabolic alkalosis

A

not all bicarb is reabs and so decreased H+ secretion

urine is alkaline

RenalJaz (10 decks)

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