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J Renal > PHYSIOLOGY > Flashcards

PHYSIOLOGY Flashcards

1
Q

the kidney is an endocrine gland, what 2 hormones does it produce

A

renin for RAAS

erythropoietin (EPO) type of RBC

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2
Q

where is renin produced for RAAS

A

juxtamedullary cells in the afferent arteriole of the juxtaglomerular apparatus

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3
Q

what do the juxtamedullary cells in the afferent arteriole pick up on themselves thats causes renin release (for RAAS = Na reabsorption)

A

decreased pressure in afferent arteriole

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4
Q

increase in (parasympathetic/sympathetic?) activity results in renin release form juxtamedullary cells = RAAS activation = Na reabsorption = increase in BP

A

sympathetic

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5
Q

decrease in Na+ is picked up by … cells in the distal convoluted tubule

what does this cause the juxtamedullary cells in the afferent arteriole to do

A

macula densa

release renin = activation of RAAS = increased Na reabsorption = increase in BP

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6
Q

presence of ADH Causes the water channels in the collecting duct to ….

what does this cause

A

open

water reabsorption from tubule fluid to interstitial fluid

more concentrated low volume urine

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7
Q

in what physiological state is ADH present

A

dehydration

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8
Q

as a general rule, what follows the movement of salt

A

water

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9
Q

what is osmotic diuresis and water diuresis

A

osmotic diuresis - loss of salt and water

water diuresis - loss of water without salt

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10
Q

what is the body fluid osmolarity (same for ECF and ICF)

A

300 mosmol/l

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11
Q

what happens to the fluid in a cell when immersed in a hypotonic solution

A

enters cell = cell lysis

hypotonic solution = low conc of particles = high conc of water = water wants to move from high to low conc

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12
Q

which type of fluid (ECF or ICF) has more Na and Cl

A

extracellular

think bc we used to be sea creatures that the water outside our cells likes to be salty (Na)

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13
Q

apart from urine, what is the 2 biggest loses of water form the body

A 
skin diffusion (not sweat) 
lungs
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14
Q

% of plasma that enters the glomerulus that filters at bowmans capsule into tubules

A

20%

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15
Q

what is the glomerular filtration rate normally

A

125ml/min

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16
Q

what is tubular secretion

A

movement of things from peritubular artery/vasa recta into tubules

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17
Q

what is tubular reabsorption

A

movement of things from tubules into peritubular artery/vasa recta

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18
Q

tubular reabsorption>tubular secretion = net …

A

net reabsorption

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19
Q

tubular secretion>tubular reabsorption = net …

A

net secretion

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20
Q

what change in afferent arteriole size can increase GFR

A

vasodilation = increased blood flow

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21
Q

what change in afferent arteriole size can decrease GFR

A

vasoconstriction = decreased blood flow (hypoperfusion)

eg from haemorrhage

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22
Q

plasma clearance marker (2)

why

A

inulin IV or creatinine

bc their clearance is the same as GFR (they aren’t reabsorbed or secreted in the tubules)

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23
Q

why is creatinine used instead of inulin

why is inulin more accurate (2)

what is creatinine

A

inulin needs to be administered IV

slight tubular secretion of creatinine
initial creatinine levels (before filtration) vary dependant on age, gender, muscle size etc

creatinine is a marker of muscle breakdown

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24
Q

what do you use if you need an accurate GFR

A

51Cr-EDTA clearance

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25
Q

what is the normal clearance of glucose in urine

exception to normal, how does this present

A

0 - it is filtered at the glomerulus but is all completely reabsorbed in the tubules (by SGLT1 and 2)

hyperglycaemia >14mmol/l = glucose in urine

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26
Q

what is the clearance of urea (below or above GFR)

A
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27
Q

what is the value or normal renal plasma flow (RPF)

A

650ml/min

28
Q

what is the marker for renal plasma flow

what is the criteria for this

A

para-amine hippuric acid (PAH)

something that is filtered then completely secreted into tubules (none left in blood that leave kidneys)

29
Q

calculation for filtration fraction

explanation

normal value

A

GFR/RPF

how much filtration (out of the total plasma movement) of plasma happens at glomerulus compared to tubules

125/650 = 20%

30
Q

what are the 2 reasons proteins might get filtered at the glomerulus

A

high GFR from overflow (eg hypervolaemia, hypertension)

leaky glomerulus = no barrier to proteins

31
Q

what investigation do you want to do for proteinuria to figure out the cause (overflow or leaky glomerulus)

A

protein/creatinine ratio (PCR)

32
Q

2 routes of reabsorption in the proximal convoluted tubule

A

transcellular

paracellular (through tight junctions)

33
Q

where is most of the salt and water reabsorbed (from tubular fluid to blood stream)

A

proximal convoluted tubule

34
Q

by which route (transcellular or paracellular) does water get reabsorbed

does it need transporters

A

paracellular

no - bc it follows the Na osmotic gradient, doesnt need any fancy transporters to move it across just goes through the gap junctions

35
Q

by which route (transcellular or paracellular) does Na get reabsorbed

does it need transporters

A

transcellular

yes - Na+/K+ ATPase transporter at basolateral membrane

36
Q

what 3 things contribute to the osmolarity gradient in the renal medulla

A

loop of henle
vasa recta
urea

37
Q

what is the countercurrent multiplier

A

loop of henle

38
Q

which type of nephron create a larger osmotic gradient

A

juxtamedullary nephron (bc loop of henle is larger)

39
Q

which limb of the loop of henle (ascending or descending) reabsorbs water

A

descending

40
Q

which limb of the loop of henle (ascending or descending) reabsorbs salt

A

ascending

41
Q

in the ascending limb of the loop of henle what is the transporter that causes salt reabsorption

what blocks this cotransporter

A

Na+, K+. Cl- triple cotransporter

loop diuretics

42
Q

what is the difference in osmolarity of ascending loop of henle and the interstitial fluid

A

200 mosmol/l

43
Q

what happens to water and salt in the vasa recta as you go down the loop of henle

A

water is lost
salt is gained

to match the osmolarity of the interstitial fluid (osmolarity increases as you go down)

44
Q

what happens to water and salt in the vasa recta as you go back up the loop of henle

A

water is gained
salt is lost

to match the osmolarity of the interstitial fluid (osmolarity decreases as you go back up the loop of henle)

45
Q

overall what happens to the osmolarity of the vasa recta before and after it follows the loop of henle

A

nothing - it increases as you go down and decreases as you go up, but will be the same at the start and the end (300 mosmol/l)

46
Q

which part of the nephron does ADH work on

A

the collecting duct

47
Q

what does ADH do to aquqporin channels (water channels) in the collecting duct

what does this result in

A

increase their numbers

water reabsorption from tubular fluid to interstitial fluid (then blood)

48
Q

what physiological state is ADH high in

A

dehydration

49
Q

what physiological state is ADH low in

A

hydration

50
Q

where is ADH secreted from

A

posterior pituitary

51
Q

alternative name for ADH

A

vasopressin

52
Q

what type of urine (volume and conc) is produced in the presence of ADH

A

concentrated and low volume

ADH = increased aquaporins = water reabsorption = concentrated and low volume

53
Q

what type of urine (volume and conc) is produced in the absence of ADH

A

dilute and high volume

no ADH = decreased aquaporins = no water reabsorption = dilute and high volume urine

54
Q

in response to what 2 things is aldosterone produced

(and hence why

A

hyperkalaemia

hyponatraemia

55
Q

2 functions of aldosterone

A

increase K secretion

increase Na reabsorption

56
Q

function of aldosterone in RAAS

A

Na reabsorption = increase bp

57
Q

function of aldosterone in hyperkalaemia

A

increases K secretion into tubules = decreases serum K

58
Q

what hormone does the opposite to RAAS

A

ANH (atrial natriuretic hormone)

59
Q

where is ANH made

in response to what

hence what does it do

A

heart

hypertension (heart muscle stretched)

decreased Na reabsorption/increased Na secretion to lower bp

60
Q

when H+ is reabsorbed back into blood as HCO3, what enzyme is needed

A

carbonic anhydrase

61
Q

what 2 things are H+ secreted as, that cause HCO3 to be reabsorbed as a 1:1 excretion:reabsorption ratio

A

NH4 (ammonia) and H2PO4 (acid phosphate)

62
Q

normal fluid daily requirements

A

30ml/kg of fluid

63
Q

hyponatraemia and dry (not fluid overloaded) treatment

A

0.9% saline 500ml bolus and monitor

64
Q

hyponatraemia and fluid overloaded treatment

A

fix problem of fluid overload, dont give fluids bc the Na is actually fine, it is just ‘low’ bc of the high volume

65
Q

emergency hyponatraemia treatment

A

100ml 3% saline over 10-15mins

66
Q

complication of treated hyponatraemia

A

osmotic demyelination (irreversible brain damage, aka locked in syndrome)

J Renal (12 decks)

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