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Renal > Physiology > Flashcards

Physiology Flashcards

1
Q

Define osmolarity

A
  • concentration of osmotically active particles present in a solution
  • mosmol/l
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2
Q

Calculate the osmolarity of 150mM of NaCl

A
  • molar conc = 150
  • 2 active particles
    2x150 = 300
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3
Q

What is the rough body fluid osmolarity?

A
  • 300mosmol/l
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4
Q

Unit for osmolality?

A
  • osmol/kg water
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5
Q

Unit of osmolarity?

A
  • mosmol/l
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6
Q

Define tonicity

A
  • the effect a solution has on a cell volume
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7
Q

Describe isotonic

A
  • no change in cell volume
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8
Q

Describe hypotonic

A
  • cells swell

- number of particles is less in the plasma

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9
Q

Describe hypertonic

A
  • cells shrink

- number of particles in plasma is more

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10
Q

Effect of RBC in urea solution?

A
  • urea moves into RBC due to receptors
  • water follows
  • cells swell
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11
Q

Effect of RBC in sucrose solution?

A
  • no affect - isotonic

- no direct receptors

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12
Q

What is the intracellular percentage of total body water?

A
  • 2/3rds
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13
Q

What is the extracellular percentage of total body water?

A
  • 1/3rd
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14
Q

What is extracellular compartment composed of?

A
  • plasma

- interstitial fluid

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15
Q

What tracer can be used for ECF?

A
  • inulin
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16
Q

What tracer can be used for plasma volume

A
  • labelled albumin
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17
Q

What ions are in higher concentration in the extracellular compartment?

A
  • Na
  • Cl
  • HCO3
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18
Q

What ions are in higher concentration in the intracellular compartment?

A
  • k+
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19
Q

What separates the intracellular and extracellular components?

A
  • plasma membrane

- cell membrane

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20
Q

What separates the plasma and interstitial fluid

A
  • capillary wall
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21
Q

How can plasma osmolarity be estimated?

A
  • doubling Na concentration
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22
Q

Increase in NaCl in ECF causes what to water concentrations in ECF and ICF

A
  • ECF = Increase water

- ICF = decrease water

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23
Q

General rule for Na and water

A
  • water follows sodium
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24
Q

Why is it important to regulate electrolytes?

A
  • directly affects water balance

- affects cell function

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25
Q

What are the most important electrolytes to balance?

A
  • Na

- K

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26
Q

Where is the majority of sodium found?

A
  • ECF
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27
Q

Where is the majority of K+ found

A
  • ICF
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28
Q

Loss of potassium balance can lead to?

A
  • muscle weakness

- cardiac irregularities

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29
Q

Name some functions of the kidneys?

A
  • water and salt balance
  • maintenance of plasma volume
  • acid base balance
  • endocrine gland
  • vitamin d activation
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30
Q

What is the functional unit of the kidney

A
  • the nephron
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31
Q

What are the 3 functional mechanisms of the nephron?

A
  • filtration
  • reabsorption
  • section
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32
Q

Explain the blood supply to cortical nephron

A
  • artery
  • afferent arteriole
  • glomerulus
  • efferent arterole
  • peritubular capillaries
  • vein
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33
Q

What is the blood supply to the juxtamedullary nephron?

A
  • vasa recta
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34
Q

Differences between juxtamedullary nephron and the cortical nephron?

A
  • Loop of henle much longer in juxtamedullary nephron
  • vasa recta
  • concentrated
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35
Q

What lines the inner aspect of Bowman’s capsule?

A
  • podocytes
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36
Q

Explain the juxtaglomerular apparatus

A
  • distal tubule passes between afferent and efferent arterioles
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37
Q

What cell releases renin

A
  • granular cells
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38
Q

What is responsible for sensing sodium concentrations

A
  • macula densa cells

- sense sodium and signal smooth muscle in afferent arteriole to control blood flow into glomerular capillaries

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39
Q

The __efferent/afferent___ arteriole goes into the glomerulus?

A
  • afferent
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40
Q

What percentage of the plasma that goes through the kidneys is not filtered?

A
  • 80%
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41
Q

Define rate of filtration

A

= Xplasma conc x GFR

- Mass of X filtered into bowman’s capsule per unit time

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42
Q

Normal GFR for healthy adult

A

125ml/min

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43
Q

Rate of excretion calculation?

A

= X urine conc x urinary flow

- mass of x excreted per unit time

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44
Q

Rate of absorption calculation

A

= rate of filtration of X - rate of excretion of X

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45
Q

Which has a larger diameter the afferent or efferent arteriole?

A
  • the afferent arteriole has a larger diameter
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46
Q

What are the 3 barriers to filtration in the glomerulus?

A
  • glomerular capillary endothelium
  • basement membrane
  • slit processes of podocytes
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47
Q

What does the glomerular capillary endothelium barrier against?

A
  • RBC
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48
Q

What does the basement membrane and slit processes of podocytes barrier against?

A
  • plasma proteins
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49
Q

Glomerular filtration is a ___ process?

A
  • passive
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50
Q

What are the 4 glomerular pressures in glomerular filtration?

A
  • Glomerular capillary blood pressure
  • bowman’s capsule hydrostatic pressure
  • capillary oncotic pressure
  • bowman’s capsule oncotic pressure
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51
Q

What is the net filtration?

A

10 mmHg favouring filtration

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52
Q

Define the glomerular filtration rate

A
  • the rate at which protein free plasma is filtered from the glomeruli into the bowman’s capsule per unit time
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53
Q

Normal GFR

A

125

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54
Q

What is the major determinant of GFR?

A
  • Glomerular capillary fluid pressure
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55
Q

What are some extrinsic regulations of GFR?

A
  • Vasocontriction of afferent arterioles

- vasodilation of afferent arterioles

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56
Q

What are the 2 processes of autoregulation of GFR?

A
  • Myogenic

- Tubuloglomerular

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57
Q

Increase in BP causes and increase in ____

A
  • GFR
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58
Q

Describe myogenic autoregulation of GFR?

A
  • Smooth muscle of afferent arteriole
    • if vascular smooth muscle stretched
  • contracts to reduce flow
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59
Q

Explain tubuloglomerular feedback?

A
  • increase in GFR
  • more salt present
  • picked up by macula densa cells
  • constriction of afferent arterioles
  • reducing GFR
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60
Q

Where does tubuloglomerular feedback occur?

A
  • juxtaglomerular apparatus
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61
Q

Describe plasma clearance

A
  • measure of how effectively the kidneys can clean the blood of a substance
  • the volume of plasma cleared per minute
62
Q

What is the gold standard for GFR?

A
  • Inulin

- Inulin clearance = GFR

63
Q

What can be used as a close approximation of GFR?-

A
  • Creatinine clearance
64
Q

What is the usual glucose clearance?

A
  • 0ml/min
65
Q

Urea clearance is what compared to GFR?

A

Clearance < GFR

- Reabsorbed

66
Q

H+ clearance is what compared to GFR?

A
  • Clearance > GFR

- Secreted

67
Q

What can be used as a marker of renal plasma flow?

A
  • para-amino hippuric acid
68
Q

para-amino hippuric acid is __endogenous/exogenous__

A
  • exogenous
69
Q

Calculation of filtration fraction

A
  • the fraction of the plasma flowing through the glomeruli that is filtered into the tubule
70
Q

What percentage of plasma that enters the glomeruli is filtered?

A
  • 20%
71
Q

What is the equation for plasma clearance?

A

clearance of substance x = x conc in urine x urinary flow / x conc in plasma

72
Q

What is the normal renal plasma flow rate?

A

650ml/min

73
Q

If clearance > GFR that shows the substance was ___reabsorbed/secreted___

A
  • secreted
74
Q

How is filtration fraction calculated?

A

GFR/Renal plasma flow

75
Q

Describe glomerular filtrate compared to blood?

A
  • modified version
  • contains ions and solutes at plasma concentrations
  • lacks RBCs and large plasma proteins
76
Q

Describe transcellular reabsorption

A
  • directly across the wall of the nephron
77
Q

Describe paracellular reabsorption

A
  • dependant on how leaky or tight the cell junctions are
78
Q

Describe primary active transport

A
  • energy dependant

- move substances against their concentration gradient

79
Q

Describe secondary active transport

A
  • carrier molecule transported coupled to an ion gradient

- e.g. Na+

80
Q

Describe facilitated diffusion

A
  • passive carrier mediated transport

- down concentration gradient

81
Q

Glucose crosses the nephron wall by what type of transport?

A
  • facilitated diffusion
82
Q

Where is the majority of sodium reabsorbed?

A
  • proximal convoluted tubule
83
Q

Where is sodium not reabsorbed?

A
  • in the descending limb of the loop of henle
84
Q

What are some examples of the apical membrane transporters for sodium

A
  • na+/glucose
  • na+/amino acid
  • na+/h+
85
Q

What is the net movement of sodium in the primary convoluted tubule?

A
  • from the filtrate into the interstitial fluid
86
Q

Sodium net movement creates an electrical chemical gradient for what substance?

A
  • chloride
87
Q

Sodium net movement creates an osmotic gradient for what substance?

A
  • water
88
Q

Where is the majority of glucose reabsorbed in the nephron?

A
  • proximal convoluted tubule
89
Q

What is the transporter for glucose from the filtrate into the cells of the nephron?

A
  • Na+/glucose transporter
90
Q

Describe the renal threshold for glucose?

A
  • saturation of glucose transporters
  • usually around 10-12mmol/l
  • excess glucose will be excreted
91
Q

What is the function of the loop of Henle?

A
  • creation of a portico-medullary solute concentration gradient
92
Q

What is the aim of the loop of henle?

A
  • to greater a hypertonic urine formation
93
Q

What is the name process that occurs to produce a hypertonic urine solution?

A
  • countercurrent multiplication
94
Q

The flow through the loop of henle is described as?

A
  • countercurrent flow
95
Q

The descending limb of the loop of henle is responsible for what?

A
  • water reabsorption
  • no NaCl- reabsorption
  • causes tubular fluid to become hyperosmotic
96
Q

The ascending limb of the loop of henle is responsible for what?

A
  • NaCl- reabsorption

- no water reabsorption

97
Q

The triple co transporter is found where and what is its function?

A
  • ascending limb of the loop of henle
  • Na+
  • K+
  • Cl-
98
Q

Loop diuretics block what process?

A
  • triple co transporter
99
Q

Function of the triple co transporter

A
  • to allow solute reabsorption in the ascending limb of the loop of henle
  • subsequent creation of a hyperosmotic interstitial fluid
  • passive movement of water in the descending limb
100
Q

What forms the countercurrent system?

A
  • loop of henle and the vasa recta
101
Q

What hormones are involved in water and solute balance in the renal system?

A
  • ADH
  • Aldosterone
  • atrial naturitic hormone
  • parathyroid hormone
102
Q

ADH aim?

A
  • increasing water reabsorption
  • concentrated urine
  • increase blood volume and pressure
103
Q

Where is ADH made and by what?

A
  • hypothalamus

- supraoptic and paraventricular nuclei

104
Q

Where is ADH stored and what releases it?

A
  • stored in posterior pituitary

- calcium dependant exocytosis

105
Q

What acts as a stimulus to release ADH?-

A
  • Dehydration

- increase osmolarity

106
Q

What detects an increase in plasma osmolarity?

A
  • hypothalamic osmoreceptors
107
Q

What is the effect of ADH?

A
  • Binds to vasopressin 2 receptor
  • increase in cAMP
  • Increase in aquaporins
  • water absorption
108
Q

Where does ADH target?

A
  • distal convoluted tubule

- collecting duct

109
Q

Low ADH creates a what urine?

A
  • hypotonic

- dilute

110
Q

High ADH creates a what urine?

A
  • hypertonic

- concentrates

111
Q

Other than on aquaporin formation what does ADH also do?

A
  • arterial vasoconstriction
112
Q

Describe central diabetes insipidus?

A
  • failure to produce ADH
113
Q

Describe nephrogenic diabetes insipidus?

A
  • failure to respond to ADH
114
Q

Symptoms of diabetes insipidus?

A
  • large volume dilute urine

- thirst

115
Q

What are other factors that may cause ADH release?

A
  • high osmolarity of plasma
  • atrial stretch receptors
  • stretch receptors in GI tract
  • alcohol inhibits
  • nicotine stimulates
116
Q

Aldosterone is what type of hormone?

A
  • steroid
117
Q

Where is aldosterone secreted from?

A
  • adrenal cortex
118
Q

When is aldosterone secreted?

A
  • low Na+
  • low ECF volume
  • High k+
119
Q

Renin is released from what cells?

A
  • granular cells
120
Q

Aldosterone effect?

A
  • Na+ reabsorption
121
Q

3 factors that stimulate renin release?

A
  • reduced afferent arteriole pressure
  • Less NaCl in macula densa
  • increased sympathetic activity
122
Q

Treatment of an abnormal RAAS system?

A
  • ACEi

- Loop diuretic

123
Q

Where is ANP stored?

A
  • atrial muscle cells
124
Q

When is ANP released?

A
  • mechanical stretching of the atria
125
Q

ANP effect

A
  • excretion of Na+

- diuresis

126
Q

What are the 2 controls of bladder excretion?

A
  • micturition reflex (involuntary)

- voluntary

127
Q

Describe water diuresis?

A
  • increased urine flow but no increased solute excretion
128
Q

Describe osmotic diuresis?

A
  • increased urine flow because of a primary increase in salt excretion
129
Q

What is the pH of arterial blood

A
  • 7.45
130
Q

What is the pH of venous blood

A
  • 7.35
131
Q

Acidosis is described a pH of what?

A
  • less than 7.35
132
Q

Alkalosis is defined as a pH of what?

A
  • more than 7.45
133
Q

Define a strong acid

A
  • completely dissociates in solution
134
Q

Define a weak acid

A
  • partially dissociates in solution
135
Q

The dissociation constant is equal to what?

A
  • the pH at which equilibrium is achieved
136
Q

What catalyses H2CO3 –> HCO3- + H+

A
  • Carbonic anhydrase
137
Q

Role of the kidney in control of HCO3-

A
  • Variable reabsorption of filtered HCO3-
  • Kidneys can add new HCO3- to blood
  • dependant on H+ secretion
138
Q

Explain bicarbonate reabsorption in the kidney?

A
  • cannot be transported directly
  • combines with H+
  • Broken down to CO2 + H20
  • Transported into cell
  • reformed into HCO3-
139
Q

What are the 2 buffering systems important in H+ concentraion

A
  • phosphate

- ammonia

140
Q

If HCO3- is low in tubular fluid what does the H+ bind to?

A
  • ammonia
  • phosphate
  • for excretion
141
Q

Define compensation

A
  • restoration of pH

- irrespective of pCO2 and HCO3-

142
Q

Define correction

A
  • restoration of pH

- restoration of pCO2 and HCO3-

143
Q

What diagram shows the distribution of acid base balance

A
  • Davenport
144
Q

Causes of respiratory acidosis

A
  • retention of CO2
  • Chronic bronchitis
  • hypoventilation
145
Q

Compensatory affect of respiratory acidosis?

A
  • further increase in HCO3-
146
Q

Causes of respiratory alkalosis

A
  • hyperventerlation

- hypoxia

147
Q

Compensation affect of respiratory acidosis?

A
  • further lowering of HCO3-
148
Q

Causes of metabolic acidosis

A
  • ingestion of acids

- excessive loss of base e.g. diarrhoea

149
Q

Causes of metabolic acidosis

A
  • loss of HCl through vomit
150
Q

Compensation affect for metabolic alkalosis

A
  • further HCO3- increase

Renal (14 decks)

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