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E-lfh FRCA Primary: Physiology - Renal > Primary FRCA Course Renal Physiology Exam Prep Questions > Flashcards

Primary FRCA Course Renal Physiology Exam Prep Questions Flashcards

1
Q

When measuring glomerular filtration rate:

The result matches the clearance of the marker if it behaves ideally

A

True. An ideal marker is cleared by glomerular filtration only, so its clearance equals GFR

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2
Q

When measuring glomerular filtration rate:

A single plasma creatinine concentration provides an accurate value

A

False. A single plasma creatinine value enables only an approximate GFR to be estimated

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3
Q

When measuring glomerular filtration rate:

Renal blood flow must be measured or calculated

A

False. Neither renal blood flow nor glomerular filtration fraction needs to be known to measure GFR

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4
Q

When measuring glomerular filtration rate:

Glomerular filtration fraction must be measured or calculated

A

False. Neither renal blood flow nor glomerular filtration fraction needs to be known to measure GFR

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5
Q

When measuring glomerular filtration rate:

Tubular reabsorption of the marker will lead to an erroneously low GFR

A

True. Tubular reabsorption means that not all of the filtered marker is found in the urine, thus underestimating GFR

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6
Q

Transport processes in the kidney include:

Tubular secretion of NH3

A

True. Ammonia secretion is a vital part of tubular buffering of excreted acid

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7
Q

Transport processes in the kidney include:

Reabsorption of 160 g glucose per day

A

True. A GFR of 180 L/day contains 900 mmol of glucose (Mol Wt 180) = approximately 160 g

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8
Q

Transport processes in the kidney include:

Excretion of bicarbonate ions buffered by phosphate

A

False. Bicarbonate is extensively reabsorbed, in the form of CO2. H+ ions are buffered by phosphate.

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9
Q

Transport processes in the kidney include:

Glomerular filtration of all molecules under 5 nm diameter

A

True. Virtually all molecules under 5 nm are filtered regardless of charge. Overlapping podocytes means that the cut off is around 8nm (~55-60,000 Da).

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10
Q

Transport processes in the kidney include:

Chloride reabsorption by co-transport with Na+ in the PCT

A

False. Chloride is reabsorbed in the PCT passively down its concentration gradient via the para-cellular route

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11
Q

The kidneys:

Have a large arteriovenous oxygen difference

A

False. The kidneys do use a lot of active processes and therefore oxygen, however their overall blood flow is so high that oxygen extraction ratio is only around 0.07.

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12
Q

The kidneys:

Produce around 180 L filtrate a day in a healthy adult

A

True. 120 mL/min equates to ~180 L/day

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13
Q

The kidneys:

Have no autonomic nervous innervation

A

False. Sympathetic innervation (B1 receptors) of the JGA contributes to renin release.

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14
Q

The kidneys:

Receive around 25% of the cardiac output

A

True. Renal blood flow is approximately 1.2 L/min

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15
Q

The kidneys:

Play an important role in vitamin D synthesis

A

True. The final hydroxylation of vitamin D occurs in the kidney

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16
Q

Antidiuretic hormone (ADH):

Decreases the volume of urine passed

A

True. By promoting water reabsorption from the CD, a fall in both urine volume and plasma osmolarity will result

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17
Q

Antidiuretic hormone (ADH):

Decreases the osmolarity of plasma

A

True. By promoting water reabsorption from the CD, a fall in both urine volume and plasma osmolarity will result.

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18
Q

Antidiuretic hormone (ADH):

Increases water reabsorption in the proximal convoluted tubule

A

False. ADH works solely in the CD in the kidney

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19
Q

Antidiuretic hormone (ADH):

Acts via DNA transcription

A

False. ADH is a peptide and acts on cell surface GPC receptors and leads to build up of cAMP.

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20
Q

Antidiuretic hormone (ADH):

Causes vasoconstriction

A

True. ADH, aka vasopressin, is a potent vasoconstrictor

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21
Q

Sodium reabsorption in the kidney:

Is the main objective of the countercurrent multiplier

A

False. The main objective of the countercurrent system is to generate a hyperosmolar environment in the renal medulla

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22
Q

Sodium reabsorption in the kidney:

Is the major energy consuming activity of the kidney

A

True. It is the main leader of reabsorption, requiring energy via the Na+/K+ pump

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23
Q

Sodium reabsorption in the kidney:

Occurs predominantly in the proximal convoluted tubule

A

True. Approximately 2/3 reabsorbed in the PCT

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24
Q

Sodium reabsorption in the kidney:

Is linked to H+ extrusion in the distal tubule

A

False. Na+ reabsorption/H+ extrusion occurs in the proximal tubule.

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25
Q

Sodium reabsorption in the kidney:

Is important for glucose reabsorption

A

True. The Na+/glucose symporter is the main method for glucose reabsorption.

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26
Q

In the proximal tubule of the nephron:

95% of filtered potassium is reabsorbed

A

False. Approximately 2/3 of the filtered K+ and water are reabsorbed in the PCT

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27
Q

In the proximal tubule of the nephron:

90% of filtered water is reabsorbed

A

False. Approximately 2/3 of the filtered K+ and water are reabsorbed in the PCT

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28
Q

In the proximal tubule of the nephron:

Sodium is actively reabsorbed

A

True. Na+ reabsorption is an active process

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29
Q

In the proximal tubule of the nephron:

Bicarbonate is secreted

A

False. Bicarbonate is extensively reabsorbed in the PCT

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30
Q

In the proximal tubule of the nephron:

50% of ammonia is reabsorbed

A

False. Ammonia is one of the important buffering systems in tubular fluid

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31
Q

Concerning water handling by the kidneys:

Water is actively transported out of the proximal tubule

A

False. Water reabsorption is passive, following Na+

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32
Q

Concerning water handling by the kidneys:

35% of the filtered water is reabsorbed in the proximal tubule

A

False. Approximately 2/3 of the filtered water is reabsorbed in the PCT

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33
Q

Concerning water handling by the kidneys:

Water reabsorption in the Loop of Henle is mainly in the ascending limb

A

False. The ascending limb of the LoH is impermeable to water

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34
Q

Concerning water handling by the kidneys:

Nearly 90% of filtered water is reabsorbed by the kidney

A

False. Over 99% of filtered water is reabsorbed in the nephron

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35
Q

Concerning water handling by the kidneys:

Antidiuretic hormone increases the permeability of the proximal tubule to water

A

False. ADH acts in the collecting duct not the PCT

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36
Q

Potassium:

Concentration in the plasma is a good reflection of total body potassium

A

False. The majority of the body’s K+ is intracellular

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37
Q

Potassium:

Concentration in the plasma rises in metabolic acidosis

A

True. In acidosis, H+ excretion is in exchange for K+ reabsorption

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38
Q

Potassium:

Excretion increases in hypovolaemia

A

True. In hypovolaemia, aldosterone increases Na+ reabsorption is in exchange for K+ excretion

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39
Q

Potassium:

Enters cells in the presence of insulin

A

True. Insulin promotes uptake of K+ into cells

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40
Q

Potassium:

Excretion is promoted by aldosterone

A

True. In hypovolaemia, aldosterone increases Na+ reabsorption is in exchange for K+ excretion

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41
Q

The ideal substance for determining glomerular filtration rate:

Is 100% bound to plasma proteins

A

False. Protein-bound substances will not be filtered.

The ideal substance for determining glomerular filtration rate has to be freely filtered (i.e. not protein-bound and has a low molecular weight), not reabsorbed or secreted by the tubules, non-toxic, and is not metabolised. Inulin, a polymer of fructose with a molecular weight of 5,200 meets these criteria.

42
Q

The ideal substance for determining glomerular filtration rate:

Is freely filtered from the plasma

A

True.

The ideal substance for determining glomerular filtration rate has to be freely filtered (i.e. not protein-bound and has a low molecular weight), not reabsorbed or secreted by the tubules, non-toxic, and is not metabolised. Inulin, a polymer of fructose with a molecular weight of 5,200 meets these criteria.

43
Q

The ideal substance for determining glomerular filtration rate:

Is entirely reabsorbed in the tubule

A

True.

The ideal substance for determining glomerular filtration rate has to be freely filtered (i.e. not protein-bound and has a low molecular weight), not reabsorbed or secreted by the tubules, non-toxic, and is not metabolised. Inulin, a polymer of fructose with a molecular weight of 5,200 meets these criteria.

44
Q

The ideal substance for determining glomerular filtration rate:

Is actively secreted by tubules

A

True.

The ideal substance for determining glomerular filtration rate has to be freely filtered (i.e. not protein-bound and has a low molecular weight), not reabsorbed or secreted by the tubules, non-toxic, and is not metabolised. Inulin, a polymer of fructose with a molecular weight of 5,200 meets these criteria.

45
Q

The ideal substance for determining glomerular filtration rate:

Has a molecular weight greater than 69,000

A

False.

The ideal substance for determining glomerular filtration rate has to be freely filtered (i.e. not protein-bound and has a low molecular weight), not reabsorbed or secreted by the tubules, non-toxic, and is not metabolised. Inulin, a polymer of fructose with a molecular weight of 5,200 meets these criteria.

46
Q

Regarding tubular reabsorption of glucose:

The tubular transport maximum for glucose is around 2 mmol/minute

A

True. Tmax for glucose is between 1.5-2.0 mmol/minute

47
Q

Regarding tubular reabsorption of glucose:

An increase in GFR increases the risk of glycosuria

A

True. Glucose delivery to the PCT is determined by the concentration and the GFR. At a concentration of 8 mmol/L and a GFR of 125 mL/min, the delivery rate of glucose is 1 mmol/minute

48
Q

Regarding tubular reabsorption of glucose:

If the plasma concentration is <8 mmol/L, all will normally be reabsorbed

A

True. Glucose delivery to the PCT is determined by the concentration and the GFR. At a concentration of 8 mmol/L and a GFR of 125 mL/min, the delivery rate of glucose is 1 mmol/minute. This is easily reabsorbed by the PCT.

49
Q

Regarding tubular reabsorption of glucose:

Most reabsorption is via the para-cellular route in the PCT

A

False. Glucose is reabsorbed through the PCT cells via a symporter with sodium

50
Q

Regarding tubular reabsorption of glucose:

Reabsorption is by co-transport with sodium

A

True.

51
Q

The following have a higher intracellular than extracellular concentration:

Phosphate

A

True. Phosphate is the main intracellular anion

52
Q

The following have a higher intracellular than extracellular concentration:

Magnesium

A

True. Concentration inside cells is 2.5x that outside

53
Q

The following have a higher intracellular than extracellular concentration:

Potassium

A

True. Potassium is the main intracellular cation

54
Q

The following have a higher intracellular than extracellular concentration:

Calcium

A

False. The intracellular Ca2+ concentration is virtually zero

55
Q

The following have a higher intracellular than extracellular concentration:

Bicarbonate

A

False. The intracellular environment is slightly acidic compared to extracellular

56
Q

Anti-Diuretic Hormone:

Determines whether the majority of water is reabsorbed by the nephron or excreted

A

False. The majority of filtered water is reabsorbed in the PCT independently of ADH

57
Q

Anti-Diuretic Hormone:

Secretion is inhibited by alcohol

A

True. Alcohol leads to a diuresis because of this

58
Q

Anti-Diuretic Hormone:

Is a steroid

A

False. ADH is a peptide

59
Q

Anti-Diuretic Hormone:

Is synthesized in the posterior pituitary

A

False. ADH is synthesized in the hypothalamus and stored in the posterior pituitary

60
Q

Anti-Diuretic Hormone:

Increases arterial blood pressure

A

True. ADH (aka vasopressin) is a powerful vasoconstrictor

61
Q

Renal autoregulation:

Is effective up to a mean arterial pressure of 200 mmHg

A

False. It is effective up to around a MAP of 160 mmHg

62
Q

Renal autoregulation:

Has a contribution directly from the autonomic nervous system

A

False. The only contribution is via angiotensin II

63
Q

Renal autoregulation:

Involves simultaneous constriction of both afferent and efferent arterioles

A

False. Contributions come from afferent dilatation and efferent constriction

64
Q

Renal autoregulation:

Maintains a constant renal artery pressure despite changes in blood flow

A

False. It maintains a constant flow despite changes in pressure

65
Q

Renal autoregulation:

Increases glomerular filtration fraction in the presence of hypovolaemia

A

True. An increase in filtration fraction maintains GFR.

66
Q

Regarding sodium transport in the kidney:

The main active process occurs on the luminal side of tubular cells

A

False. The main active process is the Na+/K+ pump on the basal side of the cell

67
Q

Regarding sodium transport in the kidney:

Reabsorption in the Loop of Henle occurs with potassium and chloride

A

True. This occurs in the thick ascending limb via the NKCC

68
Q

Regarding sodium transport in the kidney:

The majority of reabsorption is regulated by aldosterone

A

False. Approximately 65% of reabsorption takes place in the PCT independent of aldosterone

69
Q

Regarding sodium transport in the kidney:

Approximately 1.5 kg of salt is reabsorbed by the kidney per day

A

True. A GFR of 180 L per day equates to 1.5 kg of salt - 99.5% is reabsorbed

70
Q

Regarding sodium transport in the kidney:

Final sodium excretion

A

True. The principal cell in the DCT is the site of action of aldosterone

71
Q

Regarding glomerular filtration:

Glomerular capillary hydrostatic pressure is lower than that of most capillary beds.

A

False. The hydrostatic pressure is far higher than ‘standard’, at 55 mmHg.

72
Q

Regarding glomerular filtration:

Colloid osmotic pressure in Bowman’s capule is almost zero

A

True. There should be almost no protein in the filtrate

73
Q

Regarding glomerular filtration:

Colloid osmotic pressure drops along the length of the glomerular capillary

A

False. Because water is lost and protein is not, the COP rises in the glomerular capillary

74
Q

Regarding glomerular filtration:

20% of renal plasma flow is filtered into Bowman’s capsule

A

True. Normal filtration fraction is 15-20%

75
Q

Regarding glomerular filtration:

Anions are more readily filtered than cations

A

False. The negative charge on the filtration channels favour passage of cations

76
Q

Primary active transport is used in the reabsorption of:

Sodium

A

True. The Na+/K+ pump on the basal side of the tubular cell is a primary active transport system that drives Na+ reabsorption by keeping the intracellular concentration low

77
Q

Primary active transport is used in the reabsorption of:

Chloride

A

False. Chloride is, for the most part, reabsorbed passively, down the concentration gradient established as water is removed from the tubular fluid; mostly this occurs by the para-cellular route. It is also re-absorbed as part of the NKCC co-transporter in the ascending limb of the loop of Henle, however this is secondary (not primary) active transport.

78
Q

Primary active transport is used in the reabsorption of:

Glucose

A

False. Glucose is reabsorbed by secondary active transport, via a symporter with Na+

79
Q

Primary active transport is used in the reabsorption of:

Bicarbonate

A

False. Bicarbonate is reabsorbed passively in the form of CO2

80
Q

Primary active transport is used in the reabsorption of:

Water

A

False. Water is reabsorbed passively driven by the osmotic pressure gradient generated

81
Q

Aldosterone

Acts primarily on the distal convoluted tubule

A

True. It acts on the principal cell in the DCT

82
Q

Aldosterone

Acts via tyrosine kinase linked receptors

A

False. It is a steroid and so works intracellularly

83
Q

Aldosterone

Decreases the osmolarity of urine

A

False. Urine osmolarity is determined by ADH

84
Q

Aldosterone

Increases potassium excretion

A

True. The Na+ reabsorption stimulated by aldosterone is linked to K+ excretion

85
Q

Aldosterone

Release is triggered by angiotensin II

A

True. Angiotensin II is the greatest stimulus for aldosterone release

86
Q

In the loop of Henle:

Fluid entering it is approximately isotonic with plasma

A

True. Fluid entering has an osmolarity of around 300 mOsmol/L

87
Q

In the loop of Henle:

The ascending limb is impermeable to water

A

True. This enables the tubular fluid delivered to the DCT to be hypo-osmolar

88
Q

In the loop of Henle:

The thin ascending limb is primarily responsible for the reabsorption of sodium

A

False. The thick ascending limb is where sodium reabsorption occurs

89
Q

In the loop of Henle:

Only 15% of the loops pass deeply into the medulla

A

True. Only around 15% of the loops are long in humans

90
Q

In the loop of Henle:

The osmolarity of tubular fluid increases to a maximum of 1200 mOsmol/L

A

True. In the tip of the LoH the osmolarity has increased approximately 4 fold

91
Q

Angiotensin II:

Decreases aldosterone release

A

False. It increases aldosterone release.

92
Q

Angiotensin II:

Decreases osmoreceptor firing

A

False. It does not influence osmolarity

93
Q

Angiotensin II:

Causes vasoconstriction

A

True. It is a powerful vasoconstrictor

94
Q

Angiotensin II:

Causes a decrease in renin secretion

A

True. It exerts negative feedback to inhibit further renin release

95
Q

Angiotensin II:

Has a half-life of a few seconds

A

False. Its half-life in the circulation is less than 30 seconds

96
Q

The following are involved in renal autoregulation:

Adenosine

A

True. Adenosine is an inhibitory influence in renal autoregulation, being produced when hydration/perfusion are good to limit renal blood flow/glomerular filtration

97
Q

The following are involved in renal autoregulation:

Aldosterone

A

False. Adenosine, prostaglandin E2 and angiotensin II are involved in autoregulation in the kidney.

98
Q

The following are involved in renal autoregulation:

Bradykinin

A

False. Adenosine, prostaglandin E2 and angiotensin II are involved in autoregulation in the kidney.

99
Q

The following are involved in renal autoregulation:

Prostaglandin E2

A

True. PEGE2 dilates the afferent arteriole to maintain renal blood flow when perfusion pressure falls.

100
Q

The following are involved in renal autoregulation:

Vasopressin

A

False. Adenosine, prostaglandin E2 and angiotensin II are involved in autoregulation in the kidney.

E-lfh FRCA Primary: Physiology - Renal (1 decks)

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