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Renal > Physiology > Flashcards

Physiology Flashcards

1
Q
  1. Define osmolarity
  2. What is it measured in?
  3. How is it calculated?
  4. What is the difference between osmolality and osmolarity?
A
  1. Concentration of osmotically active particles present in a solution
  2. mosmol/L (milliosmoles per litre)
  3. Number of osmotically active particles multiplied by the molar concentration
  4. Osmolarity= osmol/L Osmolality= osmol/kg
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2
Q
  1. Define tonicity

2. What is the difference between a Hypertonic/isotonic/hypotonic

A
  1. The effect that a solution has on cell volume

2. Hypertonic- volume decreases, isotonic stays the same, hypotonic- volume increases

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3
Q
  1. How does Total Body Water percentages differ between males and females?
  2. What is the ratio between ICF and ECF in humans?
  3. What does the ECF consist of?
  4. The concentration of Na+ and _____ is highest in the _______ whereas the concentration of K+ is highest in the _______.
A
  1. 60% mass males, 50% mass females
  2. 67% intracellular fluid 33% extracellular fluid
  3. 20% plasma, 80% interstitial fluid
  4. Cl-, ECF, ICF
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4
Q
  1. What are the three main determinants of plasma osmolarity?
  2. How might the plasma osmolarity be estimated?
A
  1. Na+, Cl-, HCO3-

2. By doubling the plasma sodium ion concentration

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5
Q
  1. Define fluid shift
  2. If NaCl concentration increases osmolarity Increases in the _______ and decreases in the _____ because Na+ is excluded from the _____.
A
  1. Movement of water between the ICF and ECF in response to an osmotic gradient
  2. ECF, ICF, ICF
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6
Q
  1. What is the primary function of the kidneys?
  2. What is the point where the afferent and efferent arterioles cross over the distal convoluted tubule called?
  3. Name the two types of nephrons
  4. How do they differ?
  5. Name the cells that produce and secrete renin
A
  1. Regulation of the volume, composition and osmolarity of body fluids
  2. Juxtaglomerular apparatus
  3. Juxtamedullary (20%) and Cortical (80%)
  4. Juxtamedullary much longer loop of Henle
  5. Granular cells
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7
Q
  1. What is the equation for the rate of filtration of a substance?
  2. What is the equation for rate of excretion?
  3. What is the equation for the rate of reabsorption?
  4. What about rate of secretion?
A
  1. Rate of filtration of X= [x]plasma x GFR
  2. Rate of excretion of X= [x]urine x Vu (urine flow rate)
  3. Rate of reabsorption= rate of filtration - rate of excretion
  4. Rate of secretion= rate of excretion - rate of reabsorption
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8
Q
  1. How much of the plasma that enters the glomerulus is filtered?
  2. What property of the basal lamina makes it an effective barrier to plasma proteins?
  3. Name the two pressure forces that oppose Glomerular Capillary Blood Pressure
A
  1. 20%
  2. Negatively charged
  3. Bowmans capsule hydrostatic blood pressure, Capillary oncotic pressure (due to plasma proteins)
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9
Q
  1. How is GFR calculated?
  2. On average how many times is our blood plasma filtered every day?
  3. What is the main variable that effects the GFR?
  4. What effect does vasoconstriction/vasodilatation of the afferent arteriole have on GFR?
A
  1. GFR= Net filtration rate x Filtration Coefficient (how permeable the membrane is)
  2. 65 times
  3. Glomerular capillary blood pressure
  4. Vasoconstriction- decreased GFR, Vasodilatation- increased GFR
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10
Q
  1. Name the two forms of autoregulation in the kidneys that result in the constriction of the afferent arterioles
  2. Explain each of these
  3. Name the tubular cells that detect NaCl levels in the tubular fluid
  4. Which starling forces increase due to a) Kidney stones and b) diarrhoea?
A
  1. Myogenic, Tubuloglomerular feedback
  2. Myogenic- when the afferent arteriole stretches the smooth muscle constricts to narrow the lumen.
    Tubuloglomerular feedback- when GFR becomes to high more NaCl flows through the tubule leading to afferent arteriole constriction
  3. Macula densa
  4. a) Bowmans capsule hydrostatic pressure
    b) Glomerular capillary oncotic pressure BOTH CAUSE DECREASE IN GFR
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11
Q
  1. Define plasma clearance
  2. How is clearance calculated?
  3. What is the unit for this?
  4. Name an exogenous substance which can be used to measure GFR that is not used clinically
  5. What substance is usually used clinically?
  6. What is the average GFR in a healthy individual?
A
  1. Volume of the plasma completely cleared of a substance per minute
  2. Clearance of substance x = Rate of excretion of X divided by plasma concentration of x
  3. ml/min
  4. Inulin with which GFR is equal to Rate of inulin excretion
  5. Creatinine
  6. 125ml/min
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12
Q
  1. What is PAH used to measure?
  2. What is the average renal plasma flow in a healthy individual?
  3. What is the filtration fraction?
  4. How is it calculated?
  5. How much of the cardiac output do the kidneys receive at rest?
A
  1. Renal Plasma Flow (RPF)
  2. 650ml/min
  3. The fraction of glomerular plasma that is filtered into the tubules
  4. Filtration fraction = GFR divided by Renal Plasma Flow
  5. 25%
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13
Q
  1. Which components of the glomerular filtrate are 100%, 99%, 50%, 0% reabsorbed?
  2. Approximately what volume of the glomerular filtrate is reabsorbed per minute in the proximal tubule?
  3. Identify some substances that are secreted by cells into the proximal tubule
  4. Name the capillaries into which the proximal tubule drains
  5. What is the difference between primary and secondary active transport?
A
  1. 100- Glucose and amino acids, 99- salt and fluid, 50- urea, 0- creatinine
  2. 80ml/min reabsorbed
  3. H+, toxins, drugs, Hippurates, neurotransmitters, Bile pigments, uric acid
  4. Peritubular capillaries
  5. Primary- uses energy from ATP
    secondary- molecule is transported coupled to the concentration gradient of an ion e.g. Na+
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14
Q
  1. In the proximal tubule Na+ ions are reabsorbed _______ which drives the __________ reabsorption of _____ ions. The net reabsorption of _____ leads to the passive paracellular reabsorption of _______
  2. How does glucose reach the capillary?
  3. What does Tm stand for?
  4. What is the renal threshold for plasma glucose levels above which glucose is excreted? Why is this clinically significant?
A
  1. Transcellularly, paracellular, Cl- ions, NaCl, water
  2. Secondary active transport into the tubule cells then facilitated diffusion into the basolateral interstitial fluid
  3. Transport maximum
  4. 12mmol/L explains glycosuria in diabetes
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15
Q
  1. What is the function of the loop of Henle?
  2. The descending limb reabsorbs ________ not ______. The ascending limb reabsorbs ________ not ________.
  3. How does NaCl gain entry to the cells of the ascending limb? How does Na+ enter the interstitial fluid?
  4. What drugs block the Triple co-transporters?
A
  1. Generates a cortico-medullary solute concentration gradient allowing the creation of hypertonic (concentrated) urine
  2. water, NaCl, NaCl, water
  3. Triple co-transporter, Na+/K+ ATPase
  4. Loop Diuretics
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16
Q
  1. What is the name of the mechanism of the loop of Henle?
  2. Name the two solutes that create the cortico-medullary concentration gradient.
  3. Where is urea reabsorbed?
  4. What happens to filtrate osmolality as it moves down the descending limb and up the ascending limb? 5. In what other vessel is this replicated in juxtamedullary nephrons?
A
  1. Countercurrent multiplier
  2. NaCl and urea
  3. Collecting duct
  4. down- osmolality increases because water lost and solute retained, up- osmolality decreases because solute lost and water retained
  5. Vasa recta
17
Q
  1. Name the hormone which acts to increase water reabsorption
  2. What is the effect of aldosterone
  3. What about Atrial Natriuretic hormone?
  4. Which part of the kidney is affected by these?
A
  1. ADH
  2. Na+ reabsorption and H+/K+ secretion
  3. Decreased Na+ reabsorption
  4. Collecting ducts
18
Q
  1. How does the early collecting duct differ from the late?
  2. Where is ADH created and stored?
  3. When is ADH released?
  4. The binding of ADH to the basolateral membrane leads to an increase in ____________ resulting in the opening of __________. High ADH causes the production of a _______ urine because there is increased water __________.
A
  1. Early- similar to distal tubule, Late- low ion permeability and ADH controlled permeability to Water and urea
  2. Created- hypothalamus, Stored- posterior pituitary
  3. In response to high plasma osmolality (dehydrated)
  4. Cyclic AMP, Aquaporins, hypertonic, permeability
19
Q
  1. Name the two types of diabetes insipidus
  2. What are the two main symptoms
  3. What is the main treatment for central diabetes insipidus?
A
  1. Central- problem in hypothalamus and nephrogenic- problem with responding to circulating ADH
  2. Constant thirst, Large volumes of dilute urine
  3. ADH replacement
20
Q
  1. When is aldosterone secreted?
  2. Where is it secreted from?
  3. What does it do?
  4. An increase in plasma _______ directly stimulates the adrenal cortex to secrete ________ thus stimulating the secretion of ________ in the kidneys. A decrease in plasma _________ causes an indirect secretion of ________ by means of the ______ _______ of the juxtaglomerular apparatus.
A
  1. In response to rising K+ and falling Na+ or following activation of the renin-angiotensin system.
  2. Adrenal cortex
  3. Na+ reabsorption and K+ secretion
  4. K+, aldosterone, K+, Na+, macula densa
21
Q
  1. Identify the four effects of Angiotensin II.

2. Which two sites on the cells of the distal tubule and collecting duct are effected by aldosterone?

A
  1. Increased Vasopressin, Increased Thirst, Increased arteriolar vasoconstriction, Aldosterone secretion from adrenal glands
  2. Apical Na+ pump and basolateral Na+/K+ ATPase
22
Q
  1. Where does ANP originate?

2. What effect does ANP have?

A
  1. Atrial muscle cells- secreted when they are stretched

2. Promotes excretion of Na+ ions and diuresis thus decreasing plasma volume

23
Q
  1. Name three effects of acidosis
  2. What is the equation for pH and pK
  3. Henderson-Hasselbalch equation?
  4. What is the most important buffer system in the body?
  5. How does the kidney contribute to this system? What is this driven by?
  6. Name the enzyme that is essential in this process
  7. When HCO3- levels are low what buffers are used?
  8. For every hydrogen ion secreted ______ HCO3- is reabsorbed. For every H2PO3- ion/NH4+ lost in the urine one _____ ____________ ion is transfered to the blood.
A
  1. Depression of the immune system, Influence K+ levels, Influence enzyme activity
  2. pH= -log[H+] pK= -log[K]
  3. pH = pK+ log [A-]/[HA]
  4. HCO3- PCO2 system
  5. Reabsorption of HCO3-, driven by H+ reabsorption
  6. Carbonic anhydrase
  7. Phosphate ions, ammonia- said to be ‘new’ HCO3- made
  8. one, new bicarbonate
24
Q
  1. What is the difference between compensation and correction?
  2. Define respiratory acidosis
  3. How does the kidney compensate for respiratory acidosis?
  4. Define respiratory alkalosis
  5. How do the kidneys compensate for respiratory alkalosis?
A
  1. Compensation is restoration of plasma pH to normal whereas correction is restoration of pH AND HCO3 and PCO2 back to normal
  2. Retention of CO2 in the body thereby increasing H+ and HCO3- (pH below 7.35 and pCO2 below 45mmHg
  3. The rise in pCO2 stimulates H+ ion secretion into the filtrate
  4. Excessive removal of CO2 from the body causing H= and HCO3- to fall
  5. The kidneys further decrease HCO3- to swing the concentration gradient around
25
Q
  1. What causes metabolic acidosis?
  2. How do the lungs and kidneys respond?
  3. Define metabolic alkalosis
  4. How do the lungs and kidneys compensate?
A
  1. Excess H+ from any source other than CO2 levels (low pH and low bicarbonate)
  2. Hyperventilation to decrease CO2 and generation of ‘new’ HCO3-
  3. Excessive loss of H+ from the body (High pH and High bicarbonate)
  4. Reduced breathing rate and increased HCO3- secretion

Renal (11 decks)

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