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Phys 2 > Renal 1 > Flashcards

Renal 1 Flashcards

1
Q

The nephron does the work of making urine to remove waste and reabsorbing electrolytes to maintain the what?

A

ECF

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2
Q

Loss of how many nephrons pushes you towards kidney failure/uremia?

A

> 50%

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3
Q

Age of 40 does what with nephrons?

A

Decrease about 10%/decade

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4
Q

Age of 80 does what with nephrons?

A

-40%; 480K-720K

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5
Q

What are the 3 early nephron units?

A

Glomerulus
Proximal tubule
Descending Loop of Henle

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6
Q

Net function of glomerulus?

A

Filters and hold capillary beds

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7
Q

Net function of proximal tubule?

A

Reabsorbs salts and drug secretion

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8
Q

New functions of descending LOH?

A

Reabsorbs water

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9
Q

What are the mid to late parts of the nephron?

A

Ascending loop of henle
Distal convoluted tubule
Collecting duct

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10
Q

Net functions of ascending LOH?

A

NaCl reabsorption

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11
Q

Net functions of distal convoluted tubule?

A

Adjusts salts

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12
Q

Net functions of collecting duct?

A

Adjusting water

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13
Q

What size of kidneys is only how much of the body mass?

A

.5%

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14
Q

Kidney gets how much of the cardiac output?

A

20%

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15
Q

Calculation of RBF:

A

5L/min x 20% = 1L/min

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16
Q

Name the 9 steps of blood flow through kidney:

A
  1. Arcuate artery
  2. Interlobular artery
  3. Afferent arteriole
  4. Glomerulus
  5. Efferent arteriole
  6. Peritubular capillaries
  7. Vasa recta
  8. Interlobular vein
  9. Arcuate vein
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17
Q

Why does such a small organ get such a large amount of blood flow?

A

For the process of filtration because ischemia causes problems in nephron

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18
Q

Where is there high pressure in the nephron and what is the function of that?

A

In the afferent arterial to the glomerulus

For filtration

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19
Q

What does the high pressure look like with hydrostatic and oncotic pressure?

A

Hydrostatic > oncotic

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20
Q

Where is there low pressure in the nephron and what is the function of that?

A

Efferent arterial and peritubular capillaries

Reabsorption of fluid

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21
Q

What does the low pressure look like with hydrostatic and oncotic pressure?

A

Oncotic > hydrostatic

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22
Q

What does the vasa recta provide pressure wise?

A

Low pressure osmotic counter current

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23
Q

Filtered load equation?

A

Plasma [x] x GFR

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24
Q

What does the filtered load equation tell you?

A

How much is actually filtered

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25
Q

What are the 3 layer barrier in the glomerulus that helps promote filtration and limit what is able to cross into the nephron?

A
  1. Fenestrated capillary endothelium
  2. Glomerular basement membrane
  3. Podocytes with filtration slits
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26
Q

What 3 things determine what crosses the membrane?

A
  1. Glomerular filtration membrane
  2. Size and charge of filtered molecules
  3. Net filtration pressure
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27
Q

What charge is the glomerular basement membrane?

A

Negative

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28
Q

When sizes are equal, what charge has a harder time being filtered?

A

Negative charged substances

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29
Q

When sizes are equal, which charge substances are easily filtered?

A

Positively charged substances

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30
Q

From easiest to hardest what is filterable: inulin, glucose, albumin, water, sodium, myoglobin, urea, hemoglobin

A

Urea, glucose, sodium, water, inulin
Myoglobin
Hemoglobin
Albumin

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31
Q

What is the major driving force of filtration?

A

High PGC (glomerular capillary hydrostatic pressure)

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32
Q

Net filtration pressure (NFP) equation?

A

(P GC-P BS)-(pie GC-pie BS)

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33
Q

Normal value for glomerular capillary hydrostatic pressure?

A

50

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34
Q

Normal value for Bowman’s space oncotic pressure?

A

0

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35
Q

Normal value for Bowman’s space hydrostatic pressure?

A

10

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36
Q

Normal value for glomerular capillary oncotic pressure?

A

25

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37
Q

Why is there no Bowman’s capsule colloid osmotic pressure?

A

Shouldn’t filter proteins because they don’t make it into the capsule

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38
Q

If you increase P GC then what happens to the filtration?

A

Increase

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39
Q

What 2 factors do GFR come down to?

A
  1. Permeability glomerular capillary

2. Net filtration pressure

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40
Q

Rate at which filtrate is formed by both kidneys per minute

A

Glomerular filtration rate (GFR)

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41
Q

What is the key measure of renal health?

A

GFR

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42
Q

GFR is passive process that is driven largely by what?

A

NFP (particularly high P GC)

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43
Q

What is the only thing that glomerular can not filtrate from plasma?

A

Proteins

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44
Q

Is it practical to measure GFR by Kf or NFP?

A

No

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45
Q

What represents how much of a substance can be removed from a certain amount of plasma volume in a given amount of time?

A

Clearance

46
Q

We can use clearance to estimate what?

A

GFR

47
Q

Clearance equation:

A

Urinary excretion ([U]x[UV])/plasma [P]

48
Q

What is the gold standard to find renal clearance?

A

Inulin

49
Q

What are the 4 reasons why inulin is ideal for renal clearance?

A
  1. Non-toxic and infusible
  2. Freely filterable by the kidney
  3. Not reabsorbs, secreted, metabolized, synthesized or stored in any way
  4. Unable to alter GFR
50
Q

Clearance of inulin is equal to what?

A

GFR

51
Q

What are the 4 steps to use inulin in renal clearance?

A
  1. Infuse a substance into the pt
  2. Achieve steady plasma conc
  3. Collect urine and blood
  4. Calculate clearance
52
Q

What is the second best way to calculate renal clearance?

A

Creatinine

53
Q

What are the 5 reasons why creatinine is used for renal clearance?

A
  1. It’s a metabolite produced by creatinine phosphate metabolism (no infusion needed)
  2. In normal healthy person the rate of production is constant (rate of production=rate of excretion)
  3. Freely filterable by the kidney
  4. Not reabsorbed
  5. Small secretion into the nephron (~10%)
54
Q

What are the 3 steps to used creatinine for renal clearance?

A
  1. Collect blood
  2. Measure creatinine
  3. Use prediction equation
55
Q

How is plasma Cr related to GFR?

A

Inversely

56
Q

Doubling plasma Cr represent what with GFR?

A

Large reductions

57
Q

A 50% reduction in GFR from 125 to 62.5 induces what to plasma Cr?

A

100% increase from 1 to 2

58
Q

Does GFR decline naturally with aging?

A

Yes

59
Q

Stage 1 CKD; kidney damage with normal GFR

A

> 90 GFR

60
Q

Stage 2 CKD; kidney damage with mild GFR

A

89-60 GFR

61
Q

Stage 3A CKD; mild to moderate GFR

A

59-45 GFR

62
Q

Stage 3B CKD; moderate GFR

A

45-30 GFR

63
Q

Stage 4 CKD; severe GFR

A

30-15 GFR

64
Q

Stage 5 CKD; kidney failure

A

<15 or dialysis GFR

65
Q

What is the normal value of GFR?

A

125

66
Q

GFR of both kidney in ml/min and L/day?

A

125 ml/min

180 L/day

67
Q

What is the normal plasma volume (PV)

A

3L = filtered 60 x’s/day

68
Q

About how much of volume filtered (GFR) is reabsorbed?

A

~99%

69
Q

What is the calculation for RBF:

A

5-6L x 20% = 1000-1200ml/min

70
Q

How much RBF goes through the kidney when comparing body weight?

A

3.5 ml/min/g (

71
Q

What is the % plasma filtered into the renal tubules?

A

Filtration fraction (FF)

72
Q

What is the FF equation?

A

GFR/ renal plasma flow (RPF)

73
Q

What is the FF:

A

125/600 = 20%

74
Q

What is the normal renal plasma flow?

A

600 ml/min

75
Q

Is O2 a critical factor for regulating RBF?

A

Now

76
Q

Is high RBF for filtration or metabolism?

A

Filtration, not metabolism

77
Q

If we constrict only the AA what would happen to RBF, PGC, GFR?

A

Everything decreases

78
Q

If we constrict only EA, what would happened to RBF, PGC, and GFR?

A

Decrease RBF
Increase PGC
Maintain GFR

79
Q

What does the kidney use to protect RBF and GFR from changes in MAP?

A

Neuroendocrine regulation and intrinsic autoregulation

80
Q

What is the normal MAP for kidney?

A

80-180mmHg

81
Q

What is neuroendocrine regulation?

A

Vasoconstrictors vs dilators

Can be impaired during disease (HTN)

82
Q

Neuroendocrine influences what?

A

RBF

83
Q

NE/Epi primary effect and where?

A

Constrictor on AA

84
Q

What does NE/Epi do to the RBF?

A

Decrease

85
Q

Pain, stress, exercise, hemorrhage deals with what agent?

A

NE/Epi

86
Q

Primary affect of AngII and ADH/AVP and where?

A

Constrictor on EA

87
Q

What does AngII and ADH/AVP do to RBF?

A

Decrease

88
Q

Countered in AA via NO and PG is affected with what agent?

A

AngII and ADH/AVP

89
Q

Adenosine (ATP) has what primary effect and where?

A

Constrictor on AA

90
Q

What does adenosine (ATP) cause in RBF?

A

Decrease

91
Q

Released of macula densa during increase tubular flow deals with what agent?

A

Adenosine (ATP)

92
Q

NO primary effect and where?

A

Dilation on AA and EA

93
Q

What does NO do to RBF?

A

Increase

94
Q

Sheer stress; helps keep GFR constant despite constrictors deals with what agent?

A

NO

95
Q

Renal prostaglandins primary effect and where?

A

Dilation on AA

96
Q

What does renal prostaglandins do to RBF?

A

Increase

97
Q

Helps keep GFR constant depsite constrictors deals with what agent?

A

Renal prostaglandins

98
Q

ANP primary affect and where?

A

Dilation on AA

Constriction on EA

99
Q

High atrial pressure deals with what agent?

A

Dilation of ANP

100
Q

Dopamine primary effect and where?

A

Dilation on AA and EA

101
Q

Dopamine causes what with RBF?

A

Increase

102
Q

Stretching the vascular wall of blood vessel will have a reflexive contraction explains what?

A

Myotonic mechanism

103
Q

The reflexive contraction in myogenic mechanism is a what property?

A

Intrinsic property of smooth muscle

104
Q

Each nephrons distal tubules (downstream), can communicate with the arterials of the glomerulus (upstream) to alter GFR explains what?

A

Tubuloglomerular feedback (TGF)

105
Q

When Na in distal tubules is high, what happens with the GFR?

A

Lower

106
Q

When Na in distal tubules is low, what happens to GFR?

A

Rises

107
Q

Tubuloglomerular feedback helps keep what in nephron constant, which helps maintain ECFV?

A

GFR and Na

108
Q

Renal triad of AKI is:

A

Decrease in GFR
Decrease in urine output
Increase in BUN

109
Q

What is the first step of urine production?

A

Filtration

110
Q

Sevoflurance represents a theoretical risk for what?

A

AKI

Phys 2 (5 decks)

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