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Renal 2-Exam 1 (No Pathology) > Physiology-McCormick > Flashcards

Physiology-McCormick Flashcards

1
Q

Which cations and anions predominate IC?

A

K: IC=140, EC=4-4.2

Mg: IC=20

Phosphate: IC=11

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2
Q

Diarrhea/hemorrhage, water deprivation/dehydration, and diuretics/adrenal insufficiency have what effect on volume in a darrow-yanet?

A

Volume contraction

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3
Q

Infusion of isotonic NaCl, high NaCl intake, and SIADH have what effect on volume in a darrow yanet diagram?

A

Volume expansion

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4
Q

Distribution of fluid between the ECF and ICF is determined primarily by:

A 
Ion distribution (Na)
ATPase activity
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5
Q

Distribution of ECF between the plasma (vascular space) and interstitial (tissue) compartments is determined by:

A

Balance of hydrostatic vs oncotic pressures

Intravascular pressure in capillaries vs plasma protein and solute concentration

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6
Q

___ is swollen cells due to increased ICF volume..does NOT respond to diurectics

A

Non-pitting edema

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7
Q

___ is increased interstitial volume…nephrotic syndrome, CHF, pregnancy, cirrhosis

A

Pitting edema

Can respond to diuretics

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8
Q

These cells are within the afferent arteriole and cause renin secretion

A

Granular cells

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9
Q

___ are from the sacral micturition center S2-S4 (pelvic nerve) and stimulate detrusor muscle and inhibits contraction of internal urethral sphincter

A

Parasympathetic fibers (cholinergic-Ach)

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10
Q

___ inhibits detrusor constriction, constricts internal urethral sphincter

A

Sympathetic fibers (adrenergic-NE)

Hypogastric n.

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11
Q

__ are voluntary and constrict the external urethral sphincter

A

Somatic motor neurons

Pudendal n.

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12
Q

Which cations and anions predominate in the EC?

A

Na: plasma=142, interstitial=139, IC=14

Cl: Plasma and interstitial=108, IC=4

HCO3: plasma=24, interstitial=28.3, IC=10

Ca: EC=1.3, IC=0

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13
Q

What is the equation for GFR?

A

GFR=Kf x Puf

Kf-ultrafiltration coefficient

Puf-Capillary ultrafiltration pressure

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14
Q

How do you calculate the ultrafiltration pressure?

A

Puf=Pgc - (Pbc + piGC)

Pgc-glomerular capillary pressure

Pbc-bowmans capsule pressure

piGC-oncotic pressure in bowmans capsule

This is the net filtration pressure and bowmans capsule oncotic pressure is zero so not needed in calculation

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15
Q

Contraction of __ cells shortens capillary loops, lowers Kf, and, thus lowers GFR

A

Mesangial

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16
Q

Describe what happens to the following when you have afferent arteriole constriction:

  • Greater pressure ___ upstream of glomerular capillaries
  • Pgc will ___, which lowers GFR
  • Renal blood flow ___ due to increased resistance
A

Drop

Drop

Drop

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17
Q

Describe what happens to the following when you have efferent arteriole constriction:

  • Pooling of blood in the ___
  • ___ Pgc will increase GFR
  • Renal blood flow will ___
A

Glomerular capillaries

Increased

Decrease

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18
Q

Describe what happens to Pgc, RBF, and GFR when you have increased systemic arterial pressure:

A

They all increase

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19
Q

Describe what happens to Pgc, RBF, and GFR when you constrict the afferent arteriole

A

They all go down

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20
Q

Describe what happens to Pgc, RBF, and GFR when you have moderate efferent arteriolar constriction

A

Increased Pgc

Decreased RBF

Increased GFR

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21
Q

What is the equation for Clearance?

A

Cx= Ux x V / Px

Cx-Clearance of x

Ux-Concentration of x in urine

V-Urine volume

Px-Concentration of X in plasma

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22
Q

As creatinine goes up, what happens to GFR?

A

Goes down

Pcreatinine is inversely proportional to GFR–> useful for long-term monitoring of renal function

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23
Q

What is the equation for filtration fraction?

A

FF=GFR/RPF

Normally, approximately 20%

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24
Q

In renal artery stenosis, what happens to FF?

A

Increased–> decrease the denominator

FF=GFR/RPF

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25
Q

What is the equation for filtered load?

A

Filtered load of x=GFR x Px

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26
Q

If excretion is less than filtration, net __ occured

If excretion is greater than filtration, net __ occurred

A

Reabsorption

Secretion

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27
Q

The PCT reabsorbs most of filtered ___

Several organic anions and cations (drugs, drug metabolites, creatinine, urate) are secreted in the ___

A

Water, Na, K, Cl, bicard, Ca, P. Reabsorbs all of filtered glucose

PCT

28
Q

Proximal tubular __ reabsorption provides the driving force for reabsorption of water, other solutes.

A

Na

29
Q

Where is the Na/K ATPase?

A

Basolateral membrane

30
Q

Where does Na cotransport with glucose, AA’s, phosphate, and Na countertransport with H+ occur?

A

PCT

31
Q

Where does Na/K/2Cl occur?

A

Thick ascending limb

32
Q

Where does Na/Cl cotransport occur?

A

Early DCT

33
Q

__ are a new class of oral antihyperglycemic agents which lower the Tmax for glucose excretion

A

SLGT-2

Side effects include UTIs and increase in the osmolarity in the tubule system due to excess glucose can lead to dehyrdration due to osmotic diuresis

34
Q

___ inhibits proximal tubular phosphate reabsorption

A

PTH

This effect of PTH increases the amount of P excreted at any given plasma P concentration

35
Q

Overdose of an organic acid (acetylsalicylate or aspirin) may be treated by ___ of urine through HCO3 administration which promotes urinary excretion by trapping the acid in tubular lumen

A

Alkalinization

36
Q

This portion is freely permeable to water and impermeable to Na and Cl

A

Desc limb of henle

37
Q

This portion is always impermeable to water

A

Asc limb of henle

38
Q

This portion of the ascending limb does NaCl reabsorption

A

Thin

39
Q

This part of the asc limb of henle has an active Na/K/2Cl cotransporter

A

Thick segment

40
Q

__ is the major site of physiological control of salt and water balance

A

Late DCT and CD

41
Q

__ stimulate Na reabsorption, K secretion, and H secretion in the late DCT and CD

A

Aldosterone

42
Q

Aldosterone acts primarily on these cells in CD

A

Principal cells

43
Q

What conditions can drive K out of the ICF and into ECF?

A

Hypokalemia and Acidemia

44
Q

What conditions can push K from the ECF into the ICF?

A

Hyperkalemia
B-adrenergic agonists (epi)
INSULIN

45
Q

__ is freely filtered into bowmans capsule, 67% reabsorbed in PCT, 20% reabsorbed in thick AL of henle, and physiological control is exerted in the CD

A

K

46
Q

__ cells either reabsorb or secrete K, depending on body’s K balance

A

Principal

47
Q

___ stimulates K secretion in CD to maintain electroneutrality when Na is reabsorbed

A

Aldosterone

48
Q

In a low-sodium diet, you get less __ delivery to the late distal tubule, the collecting duct will have less K secretion and excretion which can cause ___

A

Na

Hyperkalemia

HyperK can be treated by increasing downstream delivery of Na to distal tubules/CDs

49
Q

How does Mg paracelluarly diffuse in the thick AL?

A

K leak channels create a positive charge in the tubule which sets up a gradient to paracellularly transport

50
Q

___ increases water and urea permeability of late DCT and CD

A

ADH

51
Q

Describe water permeability of CD in a well-hydrated pt:

A

Water remains in tubular lumen; dilute urine is excreted

LOW ADH

52
Q

Describe water permeability in a dehydrated pt:

A

CD is highly water-permeable, water is reabsorbed, low volume of concentrated urine is excreted

HIGH ADH

53
Q

___ promotes urea reabsorption from inner medullary CD by increasing expression of urea transporters

A

ADH

54
Q

Describe the urine volume and concentration in dehydration and SIADH?

A

Low volume, highly concentrated

High ADH

55
Q

Describe the urine volume and concentration in diabetes insipidus and volume expansion

A

High volume of dilute urine is excreted

Low ADH

56
Q

__ increases Na and water excretion by increasing GFR, inhibiting Na reabsorption in medullary CD, suppressing renin secretion, suppressing aldosterone secretion, it is a systemic vasodilator, and suppresses AVP secretion

A

ANP

57
Q

How do you calculate Free Water clearance?

A

CH2O=V - Cosm

58
Q

If Uosm is less than Posm, CH2O is positive and pure water is ___

A

Cleared from the body

59
Q

If Uosm > Posm, CH2O is negative, pure water is ___

A

Retained

60
Q

How do you calculate Fractional Excretion of Na?

A

UNa x PCr / PNa x UCr

61
Q

What does a FENa below 1% suggest?

What does a FENa above 2% suggest?

A

Below 1%-prerenal and AGN-Na avidly reabsorbed

Greater than 2%-ATN, renal-Tubular damage disrupts normal Na reabsorption

62
Q

In acidemia, increased H has what effect on Ca?

A

Increased free plasma [Ca]

H displaces Ca from plasma proteins

Acidemic pts tend to have hyperkalemia

63
Q

Acidosis has what effect on EC potassium?

A

Hyperkalemia

64
Q

How do you calculate anion gap?

What is the normal range for anion gap?

A

Cations - anions

Na - (Cl + HCO3)

Normal range= 8-11 mEq/L

65
Q

What are causes of high anion gap acidosis?

A 
Methanol
Uremia
DKA
Propylene glycol
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

MUDPILES

Renal 2-Exam 1 (No Pathology) (3 decks)

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