Renal 1 Flashcards
Blood flow runs in parallel, enters through ___, exit ___ > peri-tubular capillaries in the juxto-medullary nephron - we have the longer loops of henle the peri-tubular capillaries are known as the ___.
- afferent glomerulus
- efferent
- vasa recta
4 Major Terms:
1) This only occurs at the glomerulus?
2) This is going from tubule to blood?
3) This is going from blood to the tubule?
4) This is exiting passed the collecting duct?
1) Filtration
2) Reabsorption
3) Secretion
4) Excretion
Filtration is through the ___ into the ___.
Glomerulus
PCT
Intermediate structure (basically an epithelial cell) this is the working portion of any of those actions, excluding filtration. Reabsorption, secretion primarily focused on the tubule and what lines it are epithelial cells and then the capillaries via the endothelium. The interface btw the epithelial cell and the endothelial cell is where we get the actual movement. Where we can think of \_\_\_ and \_\_\_.
Secretion & reabsorption
Filtrate:
Concentration of these contents as we go through the nephron:
___ & ___ are important as these can be markers of kidney disease or injury. These increase as we exit towards the ___, thus we know its most likely not being reabsorbed back into the blood, stays in the tubule and will eventually become urine.
- Creatinine & urea
- collecting tubule
Filtrate:
Proteins by the time they reach the end of the ___ they are almost gone, we have reabsorbed them. Here is where we reabsorb the majority of ___ & ___ (by the time we leave the ___) - giving us an idea of how much work is being done here.
- PCT
- glucose & amino acids
- PCT
Filtrate:
___ line the proximal convoluted tubule - can reabsorb ___ & ___ a certain amount of times, if we increase the load we will put more work on them and they will die out/turn over faster. This gives us an idea of how diabetics/hyperglycemia can injure the kidney.
- Epithelial cells
- Glucose & amino acids
*The increased work causes increased epithelial cell turnover. Will reach a point where we can not make new cells at the same rate they are dying off, will have a hole or a non-functioning portion of the PCT. Why we need to manage/cut out glucose.
To estimate kidney function can give ___ (synthetic compound) it behaves like creatinine in that it is freely filtered. So that we know if these agents make their way to the ___ they will make their way to the ___. Freely filtered, not reabsorbed, not secreted.
- Inulin
- Glomerulus
- PCT
Majority of Bicarb - have a sharp drop in the ___. At this point is where we usually have to engage ___ & ___ to help buffer the urine and again when we use these to buffer the urine we lose bases, so by using these two we create a ___.
- PCT
- Phosphates & ammonia
- new Bicarb
? ? ? = sharp increase (especially with ?) as we get towards the latter end of the nephron there is fine tuning.
____ (in the beginning portion) we concentrate the urine in order to fine tune based on the bodies needs. Increase in these by the time we get to the ___ and ___. Try to drop these particular electrolytes and fine tune with the bodies needs.
- K, Cl, Na
- K
- Loop of Henle
- Distal tubule & collecting duct
Filtrate:
1) Thus __, __, __, __, __ all increase in the distal tubule and collecting duct in order to be peed out.
2) ___ & ___ (___) sharply decrease in the PCT because they are being reabsorbed.
3) ___ sharp drop in the PCT as well.
1) Creatinine, urea, Na, K, Cl
2) Amino acids & glucose (proteins)
3) Bicarb
Tubuloglomerular Feedback: thinking about the normal functions of the kidney so that when we injure/damage/cause inflammation will decrease these functions.
1) ___ deals with increase in load-this causes us to inhibit renin. Renin leads to aldosterone, aldosterone normally acts on the distal portion of the nephron (around the DCT) so by increasing the Na/K atpase pump we have increased sodium reabsorption. If we sense an increase in pressure > inhibit renin > inhibit aldosterone > inhibit increase in Na/K pump > inhibition of Na reabsorption.
2) ___ beta 1 adrenergics these will stimulate renin release, and there we want to conserve fluid volume. In a situation where we are fighting a bear, main focus is to increase blood flow to heart, lungs, muscles, not the best time to be creating wastes (kidneys/GI system).
3) ___ at the distal portion of the nephron we sense sodium chloride content, if there is high salt content it will give us an idea that we are overloaded. Therefore we inhibit renin > decrease aldosterone > decrease the action of the Na/K pump and therefore we decrease sodium reabsorption.
1) Baroreceptor mechanism
2) Sympathetic nerve mechanism
3) Macula densa mechanism
In the ___ is the ___, the sodium-glucose transporter. We can piggyback onto the concentration gradient of ___.
~Using this high sodium to low sodium inside the cell gradient, glucose can piggyback on top of that and make its way back into the blood.
On the vasolateral side - right next to the capillary or epithelial cells we have the ___ transporter - basically this follows the concentration gradient of ___.
~High glucose in the cell and low glucose in the blood > going from high to low and will follow that gradient.
*Reason why we have increased work on both sides, hyperglycemic patient you will overload both ends.
- PCT
- SGLT2
- sodium
- GLUT2
- glucose
Acid Base Regulation:
Bicarb is a primary/initial buffer, bicarb itself is freely filtered, so any bicarb that makes its way to the ___ will find its way to the ___.
- glomerulus
- PCT
Think of this epithelial cell as functioning in the distal tubule.
- If we run out of bicarb we then have to use any ___ that we have left over or that we created as well as any ___. This helps to buffer any acid in the urine so we do not burn our urinary tract.
- Remember that when we use ___ or ___ we create a new bicarb in that process.
- phosphates
- ammonia
- phosphates
- ammonia
Metabolic Acidosis: Someone drank battery acid > severely decrease your pH > increase acid filtration:
~Acute = respiratory
~Metabolic correction will take longer by increasing our acid filtration, getting rid of the acid that makes its way to the nephron. Use our ___ as well as ___ & ___ that help excrete the majority of urine as well as make or regenerate new bicarb all with the goal of returning us to a normal pH.
- bicarb
- phosphates
- ammonia
Hypochloremic Metabolic Alkalosis: Losing chloride or alkalosis. Start with vomiting > first losing hydrogen therefore we become basic > hypo-ventilate to increase CO2 levels and help to decrease the pH.
~Focusing on chloride and idea of electroneutrality. Chloride is -1 if we lose this -1 charge we try to increase our reabsorption of this -1 in the form of ___. But in doing so we are essentially exacerbating this alkalosis, making us more basic. Intervention is to give ___ & ___ to stop ___ reabsorption & hopefully correct for these losses.
- Bicarb
- NaCl
- K
- bicarb
Hypochloremic Metabolic Alkalosis:
NaCl & K focus would be the + charge on this potassium & with NaCl in dealing with electroneutrality issue. Remember this ___ ___ is a reaction to this -1 charge (from loss of chloride) so we need to try to stop this increased reabsorption which is exacerbating the alkalosis.
bicarb reabsorption
