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FERGU > PRIN Review > Flashcards

PRIN Review Flashcards

1
Q

Total body water percent in 70kg male

A

60% water by mass (50% in females due to higher body fat)

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2
Q

What two compartments make up total body water

A

Intracellular fluid (ICF) and extracellular fluid (ECF)

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3
Q

How much of total body water is ICF? ECF?

A

ICF=2/3 TBW ECF=1/3 TBW

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4
Q

How much of ECF is plasma? Interstitial fluid?

A

Plasma = 1/5 ECVF (5% TBW) Interstitial fluid = 4/5 ECFV (15% TBW)

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5
Q

How do you calculate plasma volume from blood volume?

A

plasma volume = blood volume X (1-hematocrit)

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6
Q

Main cation in ICF

A

K+

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7
Q

Main anion in ICF

A

proteins, organic phosphates, others

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8
Q

Main cation in plasma

A

Na+

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9
Q

Main anions in plasma

A

Cl-, HCO3- (more Cl-)

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10
Q

How much of plasma is water?

A

93%

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11
Q

Main cation in interstitial fluid

A

Na+

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12
Q

Main anion in interstitial fluid

A

Cl-, HCO3-

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13
Q

Why is there less protein found in interstitial fluid than plasma?

A

Because proteins are non penetrating so more likely to be in plasma

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14
Q

How do you calculate number of moles

A

mass/molecular weight=moles

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15
Q

What are osmolarity and osmolality measuring?

A

Number of osmotically active particles dissolved in water–independent of molecular size and valence

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16
Q

What is osmolarity

A

mosmol/L water

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17
Q

What is osmolality

A

mosmol/Kg water –like to use this because not affected by temperature like volume can be

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18
Q

How do the osmolalities of the major body fluid compartments compare normally

A

Osmolalities are all about equal–iso-osmotic

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19
Q

What is normal osmolality

A

280-300 mosmol/kg

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20
Q

What is the Gibbs-Donnan effect

A

proteins in plasma ( - charge) that can’t cross the membrane due to size result in increased cations in the plasma to compensate for the proteins’ negative charge—therefore ECF osmolality increases

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21
Q

Penetrating solutes

A

can move across membrane and thus achieve equal osmolality so do not cause net movement of water

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22
Q

Nonpenetrating solutes

A

CANT move across the membrane–“EFFECTIVE OSMOLES”–increased effective osmoles may cause net movement of water

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23
Q

What is an effective osmole in the ECF

A

Na+ –tends to stay in the ECF–increase or decrease in [Na+] in ECF will induce H20 to move in or out of ECF

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24
Q

What is an ineffective osmole example

A

Urea–CAN move across the membrane and thus doesnt change the osmotic gradient

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25
Q

What is tonicity

A

term used to describe effective osmolality of a solution ([effective osmoles])

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26
Q

Where does Na+ largely segregate

A

the ECF

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27
Q

How do you use Na+ to estimate Posm?

A

Posm = 2PNa+ (+10 to account for other solutes) (Plasma osmolarity= 2 salts and a sugar BUN//2Na+ glucose+urea)

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28
Q

What is osmotic pressure

A

the amount of pressure required to STOP the osmotic flow of water across a semi-permeable membrane

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29
Q

What is the osmotic pressure proportional to?

A

particles dissolved/unit volume (NOT related to solute size or valence) Osmotic pressure = nRTC(phi) (phi)=osmotic coefficient n=#dissolved particles R=0.082 Latm/mol T=temp in Kelcin C=concentration of total solute in OSMOLES

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30
Q

What are Starling’s Forces?

A

HYDROSTATIC and ONCOTIC pressures in the capillary and interstitum —has to do with water and solute movement during filtration —Jv=Kf [(Pc-Pi) - (∏c-∏i)] —Pc = capillary hydrostatic pressure, Pi=interstitial hydrostatic pressure —Capillary oncotic pressure is mainly exerted by proteins (Interstitial oncotic pressure can be approximated to zero) +Jv value means that water is forces out of the capillaries into the interstitium

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31
Q

What is the composition of the ultrafiltrate in the glomerulus compared to plasma

A

same composition as plasma but without large macromolecules like proteins

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32
Q

What is GFR

A

volume of plasma being filtered per unit time–starlings forces put into practice

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33
Q

What determines GFR

A

afferent/efferent arteriole vasodilation/constriction, as well as hydrostatic and oncotic pressures in the glomerulus

34
Q

Clearance equation

A

Cx=(UxV)/Px where V = volume flow rate in mL/min

35
Q

What is the urinary excretion rate

A

UxV = urinary excretion rate of X in mg/min

36
Q

How is Creatinine used to estimate GFR? (equation)

A

Pcr X GFR = Ucr X V

37
Q

What does the Cockcroft-Gault formula get used for?

A

accounts for age and body mass when calculating GFR

38
Q

What is Puf?

A

Net filtration pressure (combination of Starlings forces–if get confused draw a capillary)

39
Q

GFR =

A

Kf X Puf

40
Q

How could you manipulate GFR?

A

change capillary permeability change capillary/diffusion/filter surface area change hydrostatic pressure gradient change oncotic pressure gradient

41
Q

What is autoregulation/myogenic control of GFR

A

refers to effect of vasoconstriction/dilation changes on GFR (compensatory responses) blood flow = change in pressure/change in resistance As BP rises, GFR rises and hydrostatic pressure in the glomerulus increases –> constrict afferent arteriole–> decreases GFR to keep it at stable level Can also vasodilate afferent arteriole to increase GFR Vasoconstrict efferent to increase GFR Vasodilate efferent to lower GFR

42
Q

What is tubuloglomerular feedback in the kidney?

A

point where thick ascending limb contacts its originating glomerulus to form the JUXTAGLOMERULAR APPARATUS (JGA)–> contains MACULA DENSA, granular cells, extraglomerular mesangial cells Feedback through RAAS

43
Q

How does the macula dense in the JGA participate in tubuloglomerular feedback in the kidney?

A

senses tubular flow rate and solute concentration when flow is high or solute concentration is high, macular dense sends signals that result in ATP and adenosine release which increases afferent arteriole CONSTRICTION/resistance when low flow rate or solute concentration is sensed–>signals release of NO and prostaglandin release which decreases afferent arteriole constriction

44
Q

Effect of angiotensin II on the filtration rate/GFR

A

will constrict both the efferent and afferent arterioles so the effect net will vary

45
Q

Describe the neurohormonal control of GFR

A

through RAAS and sympathetic system

46
Q

List 3 kidney functions

A
  1. regulatory–ion composition, pH balance, body fluid volume, long term regulation of BP 2. endocrine–production and secretion of ERYTHROPOIETIN, activation of vitamin P, production and release of vasoactive substances i.e in RAAS/kinins/prostaglandins 3. Excretion–formation of urine and elimination of waste (urea, uric acid, creatinine)
47
Q

Function of podocytes

A

attach capillary to Bowman’s capsule and create filtration units

48
Q

Path of filtrate in nephron

A

Proximal tubule –> loop of Henle–> distal tubule –> Collecting Duct system

49
Q

Where is the most important site for K+ balance in the nephron?

A

Distal nephron (the distal convoluted tubule and the collecting duct)

50
Q

How do you regulate ECFV

A

regulate it indirectly via regulation of Na+ balance–>where Na+ goes, volume will follow–>ECFV kept constant by matching sodium excretion to sodium ingestion nonrenal mechanisms are neurohormonal and involve changes in vascular resistance and cardiac output

51
Q

How do you regulate plasma osmolality

A

Na+ is regulated via water to keep Na+ homeostasis this is sacrificed to preserve ECFV only when severely volume depleted disturbances in Na+ lead to ADH secretion from posterior pituitary and activation of thirst mechanism–>ADK can be stimulation by volume depletion, nausea/vomiting, pain, exercise and some medications

52
Q

Where does ATII act in the nephron?

A

early proximal tubule–increases Na+ reabsorption and K+ excretion distal tubule–NaCl reabsorption

53
Q

Where does the majority of Na+ reabsorption happen in the nephron?

A

late proximal tubule–65% Na+ reabsorbed here–FIXED

54
Q

What percent of Na+ is not reabsorbed?

A

less than 1%

55
Q

What part of the nephron is impermeable to H20?

A

Ascending limb of loop of Henle–Na is reabsorbed here

56
Q

What part of the nephron is impermeable to Na+?

A

Descending limb of loop of Henle–H2O reabsorped here

57
Q

How much Na+ is reabsorbed in the ascending limb of the loop of Henle?

A

25%

58
Q

How much Na+ is reabsorbed in the distal tubule?

A

approx 5%–VARIABLE

59
Q

Where does aldosterone act in the nephron?

A

Thick ascending limb of loop of Henle and distal tubule (and collecting duct) (NaCl reabsorption increase)

60
Q

Which is usually preferentially maintained: volume or osmolality?

A

osmolality–exception is massive volume change if volume decreases by >15%, will preferentially preserve volume; otherwise preserves osmolality

61
Q

In a hypovolemic state, what is release? hypervolemic?

A

hypovolemic state–>release ADH to retain water hypervolemic state–>stop ADH to excrete water

62
Q

What receptors control water intake?

A

osmoreceptors in the anterior hypothalamus control water intake by altering thirst and renal water excretion by altering ADH release

63
Q

What magnitude change in Posm can be sensed by the osmoreceptors?

A

greater than or equal to 1% change

64
Q

Where is ADH released from?

A

the neurohypophysis in posterior pituitary

65
Q

How is a high volume state sensed?

A

arterial and carotid baroreceptors respond to vascular stretch also sensed in the JGA

66
Q

What magnitude change in vascular stretch can the baroreceptors sense?

A

8-10% change in volume increase in stretch signals SON and PVN and body adjusts

67
Q

In what situation is the RAAS system activated?

A

in cases of low BP or low perfusion at kidneys in order to increase BP

68
Q

What cells release renin

A

granular cells of the JGA

69
Q

ACtion of renin

A

promotes conversion of angiotensinogen (liver) to angiotensin I

70
Q

What does ACE do? Where is it released from?

A

released from lungs converts angiotensin I to angiotenin II

71
Q

What is the action of ATII?

A

increase Na+ reabsorption in proximal tubule induces thirst stimulates aldosterone production in adrenal cortex promotes ADH release

72
Q

What is the stimulus for the RAAS system?

A

decrease in circulating volume which increases renal sympathetic activity (B adrenergic receptors) which increase afferent arteriole constriction which reduces Na+ deliver to macular densa which causes renin release

73
Q

Action of ADH

A

acts in collecting duct to increase H2O reabsorption ADH acts on the V2 receptor (G protein coupled receptor with adenylyl cyclase)–> converts ATP to cAMP–>produces PKA–>PKA promotes migration of AQP2 to plasma membrane adjecent to lumen–>[most water flows through and with NaCl in proximal tubule//10% flows back in descending limb]–>ADH acts on COLLECTING DUCT to increase AQP2 expression on lumen membrane

74
Q

What would an ADH deficiency result in?

A

inability to concentrate urine (i.e in diabetes insipidus)

75
Q

Calculate filtered load

A

Px X GFR = “filtered load” where GFR = UxV/Px

76
Q

Calculate BP

A

BP=CO X SVR

77
Q

Fractional Excretion of water

A

FEwater = V/GFR

78
Q

Fractional Excretion of x

A

FEx = UxV/(GFR X Px)

79
Q

percent Fractional Excretion

A

%FE = FE X 100

80
Q

Describe renal anatomy

A

FERGU (9 decks)

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