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PSL301: Water 2 Flashcards

Glomerular function

1
Q
  • Old man
  • MI
  • low BP
  • Given ACE inhibitor
  • Serum creatinine increased 100 -> 200

Why?

A
  • GFR decreased by 50%
  • Low BP caused by MI
  • Low BP causes decreased afferent arteriole pressure
  • Normally would be okay because ANG II will decrease efferent arteriole pressure
  • ACE inhibitor stopped ANG II
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2
Q

Large volume of plasma is filtered through ___

A

glomerulus

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3
Q

Final urine =

A

amount filtered - amount reabsorbed + amount secreted

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4
Q

fluids & solutes enter the __ lumen

A

tubule

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5
Q

Function of tubules

A

reabsorb / secrete solute & water

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6
Q

Solutes & water is reabsorbed into…

A

peritubular capillaries

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7
Q

The kidney is divided into…

A

Cortex

Medulla

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8
Q

Most of the blood supply to the kidney goes to the…

A

cortex first

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9
Q

Number of nephrons in a kidney?

A

1 million

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10
Q

Where is the bowman’s space located?

A

Between glomerulus and Bowman’s capsule

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11
Q

What is shared between many nephrons?

A

The collecting duct

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12
Q

Passage of fluid in the nephron

A
  1. Glomerulus / Bowman’s capsule
  2. Proximal convoluted tubule
  3. Loop of Henle (descending & ascending limb)
  4. Distal convoluted tubule
  5. Collecting duct
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13
Q

___% of CO goes to the kidneys

A

20 - 25

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14
Q

The glomerulus is the only place that has…

A

efferent arteriole (instead of venule)

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15
Q

Purpose of the efferent arteriole

A

Control BP

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16
Q

The efferent arterioles flow into…

A

Peritubular capillaries

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17
Q

1 nephron has 2 ___ and 2 sets of ____

A

arterioles

capillaries

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18
Q

The 2 arterioles of the nephron

A
  1. afferent

2. efferent

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19
Q

The 2 sets of capillaries of the nephron

A
  1. Glomerulus

2. Peritubular

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20
Q

The capillary walls at the glomerulus has more ___ than normal

A

pores in the endothelium

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21
Q

What serves as a barrier to the Bowman’s capsule lumen?

A

Glomerular basement membrane / podocytes

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22
Q

The filtered material in the glomerulus goes…

A

into the Bowman’s Capsule lumen through filtration slits

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23
Q

Function of the glomerulus

A

Filter solutes, water into Bowman’s space & proximal tubule

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24
Q

> 90% of renal blood flow goes to ___ first through ___

A

Glomerulus

afferent tubules

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25
What do the peritubular capillaries drain into?
veins
26
Features of glomerular capillaries
- leaky to water - muscular arterioles put blood in and take blood out - contraction & dilation of afferent & efferent arterioles regulates GFR
27
The capillaries at the glomerulus is ___x more leaky
10^5
28
What regulates GFR?
contraction & dilation of afferent & efferent arterioles
29
Most important determinant of GFR
Renal blood flow
30
Renal blood flow is determined by...
- arterial BP (at heart) | - resistance (at the renal vessels)
31
Renal blood flow can be kept constant at what BP?
70 - 150 mmHg (systolic arterial pressure)
32
What is the main factor regulating renal blood flow?
myogenic reflex in the afferent arteriole
33
Myogenic reflex sensing decreased BP causes...
afferent arteriole to dilate
34
Myogenic reflex sensing increased BP causes...
afferent arteriole to constrict
35
What other factors are important at low blood pressure?
- ANG II | - Prostagladins
36
Effect of ANG II
Raise blood pressure | - efferent arteriole constrict
37
Effect of prostaglandins
Dilate afferent arteriole
38
What are the renal vasoconstricters?
- ANG II (efferent arteriole) | - Catecholamines (NE)
39
What are the renal vasodilators?
- prostaglandins - ANP - Pregnancy - high protein diet
40
What is one instance in which GFR changes? Why?
During pregnancy | - Both GFR and blood flow increases by 25%
41
What happens to blood pressure during pregnancy?
Goes down
42
Why might high protein diets cause renal arterioles to dilate?
???
43
Afferent arteriole constriction causes... (effect on GFR)
Reduces GFR
44
Decreased ____ = decreased GFR
capillary blood pressure
45
Efferent arteriole constriction causes... (effect on GFR)
Increased GFR (harder to leave capillaries)
46
Filtration fraction
GFR / RBF | Proportion of blood going into glomerulus that is filtered
47
Efferent arteriole constriction prevents...
drop in GFR when BP drops
48
ANG II increases ___
filtration fraction
49
Increased filtration fraction =
increased GFR
50
Role of ANG II in terms of GFR
Keeps it high at lower BP
51
Value: normal GFR
>90 mL/min | 125 L/day
52
What is affected during low blood pressure: BP, RBF, GFR, FF?
BP decreases RBF decreases GFR unchanged FF increases
53
Filtration of solutes is determined by...
1. convection (hydrostatic pressure & bulk flow of water) | 2. molecular weight
54
Cut offs for which molecular weight can be filtered and whatnot
< 15000 = freely filtered between plasma & Bowman's space 15000 - 60000 = only some are filtered > 60000 = albumin = not usually filtered
55
What does finding albumin in the urine tell us?
Problems with kidney wall permeability
56
Which solutes are freely filtered?
- Na - K - Cl - Glucose - Bicarb - Urea - Creatinine
57
Which solutes can't be filtered?
- Albumin | - Globulins (antibodies)
58
What is the best measure of kidney function?
GFR
59
Why is GFR such a good measure of kidney function?
- Correlates with clinical consequences of reduced kidney function - Most kidney diseases affect the glomerulus
60
Units for GFR
mL/min
61
Criteria for solute used to measure GFR
- freely filtered - not reabsorbed / secreted by tubules - amount filtered = amount excreted - GFR = amount found in urine every minute
62
Define: clearance
filtration rate
63
Why is glucose a bad measurement of GFR?
All glucose is reabsorbed
64
Why is urea a bad measurement of GFR?
50% of urea is reabsorbed
65
What is a good marker for GFR? Why?
Insulin (gold standard) - small - no reabsorption - filtration = excretion Creatinine
66
MW of insulin
5000
67
Problem with using insulin as a marker for GFR
Has to be given using intravenously
68
Formula: filtration
= GFR * [plasma x]
69
Formula: excretion
= urine flow rate * [urine x]
70
Formula: GFR
= urine flow rate * [urine x] / [plasma x]
71
What marker is usually used to measure GFR? How is it usually done?
Creatinine (24h urine sample)
72
Formula: GFR (using creatinine 24h urine sample)
= urine volume * [urine creatinine] / [plasma creatinine]
73
Creatinine is a good estimate for GFR only if...
- accurate urine collection - production of creatinine = secretion - serum creatinine is constant
74
If we want to be lazier than 24h urine sample, what can we do to measure GFR?
GFR = 1 / [plasma creatinine]
75
Plasma creatinine depends on...
- GFR | - muscle mass
76
Disadvantage of measuring GFR from plasma creatinine
Differs depending on age, weight, sex...
77
What must we know to calculate GFR from plasma creatinine?
Baseline: - creatinine - GFR (this gives us the constant value)
78
What drug is associated with causing acute kidney failure?
ACE inhibitors
79
GFR is usually autoregulated by...
afferent arteriolar tone
80
When BP is low, which hormones are important?
- prostaglandins | - ANG II

PSL301 (29 decks)

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