Renal 1 Flashcards
secretion vs. reabsorption
secretion: moving from system into glomiluar filtrate
reabsorption: from renal tubule into system
secretion vs. reabsorption
secretion: moving from system into glomiluar filtrate
reabsorption: from renal tubule into system
Renal activity major influencer of ____ and ____ fluid compartments
ECF and ICF
filtrate not urine until hits
ureter
Total boday water TBW broken into 2 categories
ECF 1/3
ICF 2/3
ECF broken into 3 categories
- interstitial fluid 3/4
- plasma 1/4
- transcellular fluid .5 liters
provides immediate environment around cell
ECF–responsible for health of individual cells
_____ plays major part in composition of ECF
kidneys
7 rolls of kidneys
- excretion of metabolic waste
- regulation of H2O/ electrolyte balance
- Regulate body fluid osmolarity
- Regulate arterial pressure
- Regulate acid/base balance–excretion of “fixed” acids
- Regulate erythrocyte production via erythropoietin- ^ HgB
- Influence Ca/ Phosphorus/ Vit D metabolic pathways
arterial pressure regulated by
- varying levels of Na+/H2O
2. direct and indirect effect of the Rennin-angiotensin-aldo system
Gen Kidney Functions 8
- osmotic press and volume
- ions
- Acid/Base
- BP
- waste removal
- Toxic compounds
- hormone production
- degrade hormones
Ca and Phosphorus move in ______ ________ in blood
opposite direction–seasaw
Functional unit of kidney
the nephron
____ kidney a little higher
left
outer layer of kidneys
cortex
______ and ______ calyx
major and minor
nephron composed of
- glomerulus–accompanying eff/aff arterial surrounded by Bowman’s capsule
- Renal tubules–
number of nephrons/ kidney
million
glomerulus produces
ultra filtrate of blood
renal tubules lined w/
epithelial cells function in reabsorption/ secration of:
water
electrolytes
and waste products
7 Areas of tubules
- proximal convoluted tubules
- proximal straight tubules
- thin descending limb of the loop of Henley
- thick ascending limp of LofH
- Early distal tubule and Macula densa
- distal convoluted tubule
- collection duct
second capillary network in the unusual arrangement of two capillary beds in series
peritubular capillary beds
kidneys engage in ________-allowing for consistant blood flow
autoregulation of blood flow–from roughly 60-180 torr–even for transplanted kidneys (not reliant on ANS)
**_______ ________ allows for autoregulation–watch video
jutaglomerular apparatus–macula densa cells at glomerular capillaries
_____% of blood presented to glomerulus is filtered
20%
filtrate is identical to serum plasma except missing
protein and other larger substances in serum plasma
GFR
glomerular filtration rate
ml/minute
renal pathophys
- DIABETES (main cause)
- HTN hypertension (^ African Americans–> kidney failure)
- glomerulunephritis
- UTI
if protein in urine
problem with glomerulus likely–podocytes damaged–> proteinuria
leakage of very large amounts of protein (albumin) from glomerulus resulting in massive proteinuria
nephrotic syndrome –> edema (lower oncotic pressure)
fenestrated filtering cells of glomerulus
podocytes
molecule used to test GFR
Inulin–Fick principle
small rises in serum creatinine may indicate
impairment or loss of function of majority of nephrons
constrict afferent blood flow
lower RBF
lower GFR
& visa versa for dilation
constrict efferent blood flow to glom
lower RBF
raise GFR
and visa versa for dilation
Renal activity major influencer of ____ and ____ fluid compartments
ECF and ICF
filtrate not urine until hits
ureter
Total boday water TBW broken into 2 categories
ECF 1/3
ICF 2/3
ECF broken into 3 categories
- interstitial fluid 3/4
- plasma 1/4
- transcellular fluid .5 liters
provides immediate environment around cell
ECF–responsible for health of individual cells
_____ plays major part in composition of ECF
kidneys
7 rolls of kidneys
- excretion of metabolic waste
- regulation of H2O/ electrolyte balance
- Regulate body fluid osmolarity
- Regulate arterial pressure
- Regulate acid/base balance–excretion of “fixed” acids
- Regulate erythrocyte production via erythropoietin- ^ HgB
- Influence Ca/ Phosphorus/ Vit D metabolic pathways
arterial pressure regulated by
- varying levels of Na+/H2O
2. direct and indirect effect of the Rennin-angiotensin-aldo system
Gen Kidney Functions 8
- osmotic press and volume
- ions
- Acid/Base
- BP
- waste removal
- Toxic compounds
- hormone production
- degrade hormones
Ca and Phosphorus move in ______ ________ in blood
opposite direction–seasaw
Functional unit of kidney
the nephron
____ kidney a little higher
left
outer layer of kidneys
cortex
______ and ______ calyx
major and minor
nephron composed of
- glomerulus–accompanying eff/aff arterial surrounded by Bowman’s capsule
- Renal tubules–
number of nephrons/ kidney
million
glomerulus produces
ultra filtrate of blood
renal tubules lined w/
epithelial cells function in reabsorption/ secration of:
water
electrolytes
and waste products
7 Areas of tubules
- proximal convoluted tubules
- proximal straight tubules
- thin descending limb of the loop of Henley
- thick ascending limp of LofH
- Early distal tubule and Macula densa
- distal convoluted tubule
- collection duct
second capillary network in the unusual arrangement of two capillary beds in series
peritubular capillary beds
kidneys engage in ________-allowing for consistant blood flow
autoregulation of blood flow–from roughly 60-180 torr–even for transplanted kidneys (not reliant on ANS)
**_______ ________ allows for autoregulation–watch video
jutaglomerular apparatus–macula densa cells at glomerular capillaries
_____% of blood presented to glomerulus is filtered
20%
filtrate is identical to serum plasma except missing
protein and other larger substances in serum plasma
GFR
glomerular filtration rate
ml/minute
renal pathophys
- DIABETES (main cause)
- HTN hypertension (^ African Americans–> kidney failure)
- glomerulunephritis
- UTI
if protein in urine
problem with glomerulus likely–podocytes damaged–> proteinuria
leakage of very large amounts of protein (albumin) from glomerulus resulting in massive proteinuria
nephrotic syndrome –> edema (lower oncotic pressure)
fenestrated filtering cells of glomerulus
podocytes
molecule used to test GFR
Inulin–Fick principle
small rises in serum creatinine may indicate
impairment or loss of function of majority of nephrons
constrict afferent blood flow
lower RBF
lower GFR
& visa versa for dilation
constrict efferent blood flow to glom
lower RBF
raise GFR
and visa versa for dilation
loop of Hennley dips into
medulla
inflammation of nephron
leads to scarring –> nonfunctioning
Highest portion of renal tubules for reabsorption of nutrients from glomerular filtrate
proximal convoluted tubules (90 L/day)
saturation kinetics
in relation to glucose reabsorption in proximal convoluted tubules–glucosuria when glucose transporters saturated
descending loop of Henley main function
highly permeable to water–>concentrates filtrate as is descends through pyramids–pumps –
proximal tubules less permeable to
waste products such as urea
inner renal medulla is very ________
hyperosmolar–sucks water from the tubules of osmosis –> ^ solute concentration in filtrate
THIN ascending loop of Henle ______ to H20
impermeable–permeable to NaCl–>medulla pulls salt out–CYCLE to keep gradiant high in medulla
THICK ascending loop of Henle _____ to H2O. Actively transports large amounts of ___ ___ and ____, making urine _____
impermeable-
Na, Cl, K-
HYPOtonic
test of GFR–minimally altered by glomerulus
creatinine clearance test– freely filtered–tests sum-total of creatine cleared–TESTS GFR
site of action of Loop Diuretics
Thick ascending loop of Henle–impair Na, Cl, K pumps
osmolarity
concentration of solutes in solution
juxtaglomerular complex located in
early portion of distal renal tubule–part of feedback control for GFR
Ascending loop of henle is the ________ portion
filtrate diluting
descending loop of henle is the _______ portion
filtrate concentrating
distal renal tubules are ______ to H2O. Avidly ____ ions
impermeable –
reabsorb
ADH (vasopresin) ______ pores
opens—in area btwn cortex and medulla
areas of final precessing of glomerular filtrate
late distal renal tubule and cortical collecting tubules
compound released by JG changes angiotensin I –> angiotensin II (jobs: vasoconstriction arterial, releases aldo from adrenal cortex, and ^ proximal renal tubule reabsorbtion of Na)
renin
permeability of late distal renal tubules and cortical collecting ducts controlled by
ADH–
hyperkalemia
^ potassium
in distal renal tubule and cortical collecting tubules, which cells absorb Na and H2O and secrete K
“Principle Cells”
Also increases Na absorption here–trades for K
area of final urine processing
medullary collecting ducts
Medullary collecting duct’s permeability to H2O controlled by? Secretes ___ against ______ gradient.
ADH-
H+, gradient (IMP for acid/base regulation)
fixed acid
anything but CO2 for our purposes
system that controlles release of aldo
renin-angiotensin-aldosterone system
bicarbonate is ______ –generated by kidneys
basic
If osmolarity of body fluids is increased, the hypothalamus will stimulate pituitary to release ____.
ADH-increases reabsorption of H2O
hormone that inhibits reabsorption of Na+, H2O. (opposite of aldo)
atrial natriuretic peptide-
distention of atria (too much preload) ANP is released
hormone released by ____ ____ in response to low serum Ca?
parathyroid gland-
parathyroid hormone
parathyroid hormone increases _____ ___ _______, and decreases _____ _____ _______
renal Ca reabsorption-
renal phosphate reabsorption
kidney sends message with ______. Receives messages by way of _______, _____, _____,
Renin-
ADH, aldo, atrial natriuretic peptide
Kidney role in acid/base dynamic
- synth and reabsorb HCO3
2. excrete fixed acids i.e. NH4+
2 terms for buildup of nitrogen based waste products in body from inadequate renal function (renal failure)
- uremia
2. azotemia
RAPID decline in renal function
Acute renal failure–primarily result of decline in GFR
renal failure from lack of blood flow to kidneys
pre-renal failure
(acute) problem with kidney its self
intrinsic acute renal failure–i.e. toxin
(acute) obstruction in kidney output (bladder obsturction, prostatic hypertrophy, tumor, etc.)
post renal failure–backs urine up–no filtration
3 ACUTE liver failures–often reversible
pre-renal
intrinsic
and post-renal failure
non-reversible, decline in GFR over months-years–loss of nephron mass
chronic renal failure CRF
causes of chronic renal failure
HTN, Diabetes melitus, obstruction, infection
end stage chronic renal failure
anuria
Signs/ symptoms of chronic renal failure
- uremia
- hyperkalemia
- metabolic acidosis
- anemia
- osteoporosis
- volume overload-CHF
- pheripheral neuropathy
- anorexia
- endocrine disturbances
abnormal constituents of urine on urinalysis
- glucose
- proteinuria
- hematuria (RBCs or HgB)
- presence of WBCs
- ^ # of crystals (microscopically)
- Casts (“cast” of renal tubule–should never see i.e. blood)
- Bilirubin
measure of urine concentration by urinalysis
specific gravity–roughly 1035 (concentrated) - 1001 (dilute)
pH of urine
5-9, depending on diet
Renal function serum (blood) test (3)
- creatinine
- Blood urea nitrogen BUN
- creatinine clearance
prevent ARF and CRF
adequate treatment of streptococcal infections
specific gravity of ____ is apx isotonic with normal serum osmolarity
1010
afferent:
efferent:
in–larger
out–smaller
BUN vs. creatinine clearance
BUN not as useful–too much mod/reuptake of blood uria nitrate
one “unit” of blood
one pint = 450 mL
diarhea as from dissentery or cholera–water comes from
circulating blood volume–>no cardiac preload (pre-renal failure)–>heart collapse–>death
pancreas makes
- bicarb to neutralize stomach acid
- enzymes to break down foodstuffs
As it pertains to ADH action on:
V1 receptors:
V2 receptors:
V1 = vasoconstriction (hence the name “vasopressin”)
V2 receptors mediate water reabsorption
Angiotensin II ______ efferent vessels to greater degree than _______ vessels
constricts,
afferent
Prostaglandins cause __________ of afferent arterioles
vasodilation
SNS ______ afferent arterioles to greater degree than efferent
constricts
_______ and _____ ____ are completely reabsorbed
glucose and aa’s
loope of Henle responsible for _____ ______, hyperosmolar gradiant set by ascending pulls water from descending
countercurrent multiplication
________ ______ _______ secrete H+ against _____ _____
medullary collecting ducts,
large gradient
Aldosterone production directed by _____ ______, secretion directed by ____________________
pituitary gland,
renin-angiotensin-aldosterone system
renal hypoperfusion as from hypovolemia example of:
PRERENAL azotemia
