Renal Flashcards
1
Q
Kidneys weigh ——-
- % of the body weight
A
they weigh 300g (0.4% of body weight)
2
Q
Kidney have a longitudinal slit called —- that leads to a shallow C shaped——
A
HILUS
renal sinus
3
Q
outer —— —- zone is —-
inner——- zone ——
A
.outer granular reddish zone cortex
.an inner paler striated zone medulla
4
Q
Junction between the 2 zones of the kidney is called the —-
A
Corticomedullary junction
5
Q
medulla’s striated look is due to——
A
medullary pyramids (straight ducts and cribiform plates)
6
Q
Cortex is made up of which parts of the nephron
A
Dct and pct
7
Q
each base of renal pyramid originates from the —-to the——
A
Corticomedularry junction
papilla
8
Q
Each kidney is made up of - nephrons
A
-1 to 1.4 million nephrons
9
Q
What seperates 2 pyramids
A
columns of bertini
10
Q
functional, structural unit of kidney is the ——
A
Nephron
11
Q
Types of nephrons ,their percentage in the kidney, and their structure
A
cortical nephron: from 2/3 of outer cortex and ends in outer medullary; more numerous (85%); secretes EPO
-juxta medullary nephron: 1/3 of cortex and ends in inner medullary or even papilla; longer loop of henry; 15% of total nephron; secretes renin and prostaglandin
12
Q
Which type of nephron has a longer loop of henle
A
-juxta medullary nephron
13
Q
Which type of nephron is used to produce conc urine
A
-juxta medullary nephron
14
Q
Number of nephrons started decreasing after what age
A
50
15
Q
malpigian / renal corpuscles = - + -
A
glomerulus + bowman’s capsule
16
Q
internally dilated part of a nephron is the -?
A
Bowman capsule
17
Q
-bowman capsule has a diameter of approximately—?
A
200um
18
Q
Which is bigger between the afferent and efferent arteriole
A
bigger afferent and smaller efferent arteriole
19
Q
How many layers does the glomerulus have
List them
A
3
Capillary endothelium
basal membrane/lamina
epithelium/pondocytes
20
Q
Function of the layers of the glomerulus
A
basal membrane/lamina to seperate the endothelium from epithelium
capillary endothelium with fenestra/holes for filtration
epithelium/pondocytes: numerous pedicles/pseudopodia that interdigitate to form slit pores
21
Q
Size of :
The holes in the capillary endothelium
The slot pores formed by podocytes
A
70-90nm
25nm
22
Q
in between the endothelium and basal laminar, are——- that aid in——
A
intraglomerular mesangial cells
contraction and regulate Glomerular filtration
23
Q
What type of cells make up the: Bowman capsule Pct Dct Thick descending Thin descending Thin ascending Thick ascending Collecting ducts
A
Flattened simple squamous Cuboidal cells with brush border Cuboidal cells without brush border cuboidal cells with brush border flattened epithelium) flattened epithelium) Cuboidal cells without brush border Cuboidal cells
24
Q
Type of mitochondria in the
Pct
Loop of henle
Dct
A
high density mitochondria
Few scattered mitochondria
few but more dense mitochondria
25
Absence. Of lateral spaces between bases of the cells of PCT
| T/F
F. bases of the cells have lateral spaces
26
What happens to the apical surface of the cells of the pct?
apical surface of cells bulge into tubular lumen;
27
Convoluted part of the the pct is called —-
pars convoluta
28
Straight part of the pct is called???
Pars recta/ thick descending limb
29
Length and diameter of pct
14mm length; 55um diameter
30
Who is longer
| Pct or dct
Pct
31
Which part of the loop of henle has numerous mitochondria
Thick ascending limb
32
How is macula densa formed
when the thick ascending limb passes between the afferent and efferent arteriole(closer to the afferent), it gets modified into macula densa
33
Macula densa secretes what?
Thromboxane A2
34
Macula densa is majorly known as an
osmoregulator
35
Juxtaglomerula cells line the - arterioles up to - point
juxtaglumerulla granular cells line afferent arteriole densely before it enters the BC.
36
JG cells secrete—-
renin
37
extraglomerular messangial cells are found within the—— made by the —-
triangle
2 arterioles and macula densa
38
extraglomerular messangial cells are also called —-
Lacis cells or goomartogigh
39
Juxtaglomerula cells are granular or fine??
Granular cells
40
Lacis cells secretes ——?
prostaglandins and cytokinins
41
Abscence of microvilli on dct
| t/F
F. Just very little
42
Pct and dct have basal infoldings and a striated look
| T/F
T
43
Length and diameter of collecting duct
length of 20-22nm and diameter of 200um
44
Epithelium of collecting duct is made up of - and - cells
epithelium is made up of P cells and I cells
45
Function of :
I cells
P cells
And which one has fewer mitochondria
P cells: for osmoregulation; fewer mitochondria
| -I cells: for acid base regulation ; fewer than p
46
in the interstitium of the medulla are secretory cells called —-
type 1 medullary interstitial cells
47
Which is more Numerous in the dct
| I or P cells
P cells
48
RENAL ARTERY is from——
abdominal aorta around L2
49
The kidneys receive about —- % of the cardiac output
about 22-25% of cardiac output
50
Arrangement of structure in the hilus from front to back
Vein-artery-pelvis-artery
51
Renal artery to—- artery to—- to—- to—-, to—— to—- to——-
segmental
interlobar
arcuate
inter lobular
afferent arteriole
efferent arteriole
peritubular capillaries
52
URINE FORMATION involves how many steps
| List them
-3 basic renal actions
GLOMERULAR FILTRATION
REABSORPTION
Secretion
53
Describe the steps of urine formation
GF: filter the blood to form primitive urine
TR:absorp stuff from urine to blood
TS: secrete from blood to urine
54
List the pressure that affect GFR and describe their effect on GFR and by how much
glomerulus hydrostatic pressure which is approximately 60mmHg in the afferent arteriole supports filtration
- oncotic pressure: 25mmHg ; opposes filtration
- tissue resistance : 10mmHg; opposes filtration
55
The net filtration pressure of GFR is ——?
net filtration pressure is 25mmHg
56
substances with molecular weight of less than ——- get filtered
68000
57
GFR is formed at the rate of -/day and -/min
180L/day
| 125ml/min
58
whole plasma volume gets filtered ——-/day
65 times
59
Which formulae relates the GFR and net filtration pressure
filtration coefficient = GFR
—————
Net filtration pressure
60
Effect of the following on GFR:
Increased blood flow
Decreased plasma protein
Hemorrhage
```
Increase GFR
Increased gfr(causes edema)
Leads to decreased capillary bp=decreased GFR
```
61
List the Mechanisms of regulation of GFR
RENAL AUTOREGULATION
NEURAL REGULATION
HORMONAL REGULATION
62
Types of RENAL AUTOREGULATION and describe them
myogenic:
Blood flow: capillary pressure / flow resistance
-tubuloglomerular feedback : macula densa and renal tubule are used; macula sense the level of sodium chloride and adjusts the other guys accordingly
-AUTOREGULATION is possible within 80-180mmHg
63
Range at which AUTOREGULATION is possible
-AUTOREGULATION is possible within 80-180mmHg
64
Situations when neural regulation of GFR is major and important
hemorrhage or exercise
65
Compensatory mechanism of GFR during hemorrhage or exercise
vasoconstriction as a way to conserve blood volume during hemorrhage
-and greater blood flow during exercise
66
Effect of vasoconstrictors like angiotensin 2 on GFR
Reduces it
67
Effect of vasodilators on GFR
Increase it
68
Example of renal vasodilators
bradykinin, prostaglandins, and ANP
69
Renal blood flow is -L/min
1.25L/min
70
Luminal cell membranes face —-
| Basolateral cell membranes face —-
face the tubular lumen
in contact with the lateral
intercellular spaces and peritubular
interstitium (“blood” side)
71
Describe transcellular and paracellular movement
The term transcellular refers to movement
of solutes and water through cells
• The term paracellular refers to movement
of solutes and water between cells
72
For most substances which is more important:
| ReAbsorption of secretion
ReAbsorption
73
For Which substances are secretion more important in:
K and H
74
How many percentage of the following are reabsorbed
```
Glucose
Amino acids
Bicarbonate
Calcium
Potassium
```
100
100
90
75
- % of sodium reabsorption occurs in the ——
90%
| In the pct
76
Permeability of water and salt through the following parts:
Descending thick limb
Ascending thin limb
Ascending thick limb
Impermeable to salt;permeable to water
Impermeable to water ; permeable to salt (passive reabsorption)
Impermeable to water ; permeable to salt (active reabsorptoin by Na-K-2Cl )
77
Glucose is reabsorbed in the —— portion of ——— from the lumen by ——— and then taken into the interstitium by ——-
Early portion of pct
SGLT2
GLUT2
78
Glucose reabsorption is by - type of transport
Secondary active co transport
79
when the Tm G is exceed, the amount of glucose in the urine ——
Rises
80
Transport maximum for glucose is —— in men and —— in women
375 mg/min in men and 300 mg/min in women.
81
Potassium level change from 4 to 5.5 mmoles/l =—-
hyperkalaemia
82
Potassium is not reabsorbed in the pct
| T/F
F
83
K + reabsorption along the proximal tubule is ——-and follows the ——- and fluid
But in collecting tubules, it may also rely on ——
largely passive
movement of Na +
active transport
84
K + secretion is by ——transport of K across ——- membrane and ———- across —- membrane into ——
active
basolateral
passive exit
apical
tubular fluid.
85
Mention the only 3 substances that are passively reabsorbed in the pct
Cl, H20, urea
86
How many % of the following age reabsorbed at pct
```
Potassium
Calcium
Magnesium
Sodium
Glucose
Amino acids
Bicarbonate
```
```
90%
65%
25%
90%
100%
100%
100%
```
87
Reabsorption of sodium at
First half of pct
Second half of pct
Is by which transporters and with who
SGLUT2: with glucose, amino acids etc
Na-H transporter: with chloride ions
88
Places with a Na-k-2cl transporter
Macula densa and thick ascending limb
89
Hydrogen secretion is through ———Transport.
Secondary active
90
90% of Hco3 is reabsorbed passively at pct while H is actively secreted
T/F
T
91
Ph of adult urine
Between ph 5-7
92
Adult urine is acidic
| T/F
F. It is slightly alkaline
93
Define the counter current system
A counter current system is a system in which the inflow runs parallel to, opposite to and in close proximity to for some distance.
94
counterthe outflow current mechanism is also called the———
Hair Pin countercurrent mechanism
95
Function of counter current mechanism
To form concentrated urine
96
The countercurrent mechanism depend on 3 things. List them
Loop of henle
Vasa recta
ADH
97
The superficial layer has an osmotic pressure of —- while in the deeper layers at the renal papillae, the osmotic pressure is——
~300 mosm
~1200 mosm
98
The counter current multiplier is the—-
| The counter current exchanger is the ———
Loop of henle
Vasa recta
99
What is the role of the vasa recta(counter current exchanger)
To take up the Na released from the nephron into the interstitium to make sure that the fluid reaching the dct is slightly hypotonic
100
Who preserves the pre-established osmotic gradient of the counter-current system
Vasa recta
101
Who prevent indefinite built up of salts inn the renal interstitial space?
Vasa recta
102
Define renal clearance
It is the vol. of plasma that is completely cleared of a sub. (x) per unit time.
103
Renal clearance is also called??
plasma clearance
104
Renal clearance is used for???
Measure GFR
Measure RPF
Measure RBF
105
Formula for renal clearance?
Cx= Ux Vx
| Px
106
Meaning of the parameters for renal clearance formula
Cx=clearance of substance x Ux= conc. of x/ml of urine. V= vol. Of urine produced /min. Px = plasma conc. of subs .X/ml of plasma.
107
Preferred substance used for renal clearance
For research
For clinical use
Inulin
| Creatinine
108
Inulin clearance = GFR
| T/F
T. It’s 125ml/min
109
Inulin is gotten from —-
Plants…
110
If C < 125 ml/min, substance—-
If C = 0, substance ——
If C = 125 ml/min, ——-
If C > 125 ml/min, ——-
reabsorbed
completely reabsorbed, or not filtered
no net reabsorption or secretion
substance secreted (most drug metabolites)
111
What substance is used to measure renal blood flow
PAH ( Paraminohippurate ) is used.
112
Formulae for renal plasma flow
C C PAH PAH P = U PAH x V ml/mol PAH = RPF
113
What other substance can be used to measure RPF besides PAH
diodrast
114
Formula for ERBF
RPF x 100
——————-
100-HCT
115
Formula for TRBF
TRBF:RPF x 1
——
1-Hct
116
Values for
Urea clearance
PAH clearance
Inulin clearance
UREA CLEARANCE = 70ml/min
- PAH clearance = 660ml/min
- inulin clearance = 125ml/min
117
Ph range of arterial and venous blood
Arterial: 7.4 (+- 0.02)
Venous: 7.35(+-0.02)
118
Acids are proton —-
| Bases are proton ___
Donors
| Acceptors
119
Sources of hydrogen ion in the body
Phosphorus containing protein releases phosphoric acid
Anaerobic respiration of glucose produces lactic acid
Fat metabolism yields organic acids and ketone bodies
Transporting carbon dioxide as bicarbonate releases hydrogen ions
120
Vegetarian diet has an acidic effect
| T/F
F. They have alkalizing effect
121
What is a buffer
A buffer is a solution that accept little or no change in pH.
122
H+ is removed from the body by which mechanisms
Lungs and kidney
123
Examples of buffers
Bicarbonate buffer
Acetate buffer
Phosphorous buffer
124
First line of defense in case of H+ imbalance is —-
Second line—-
Third line is ——-
Chemical buffer systems-occurs in seconds
Lungs: works in minutes
Kidneys: takes hours
125
Blood buffers can remove H+ from the body
| T/F
F. They can only mop it up
126
Is the brain sensitive gon mood co2 and ph levels
Yes it is
127
Respiratory regulation of ph is by controlling ——
Co2 and H20
128
Which mechanism brings a permanent solution to the acid base imbalance
Renal mechanism
129
Hydrogen secretion occurs in type - cells and type - cells
I and A
130
principal function of Anti-Diuretic Hormone is —-
to cause
| retention of water by the kidney.
131
ADH regulates the body fluids by ——
increases the permeability to water of the distal tubules and the collecting ducts.
132
Deficiency of ADH leads to —-
diabetes insipidus
133
Describe diabetes insipidus
formation of hypotonic large volume of urine with net water loss from the bod
134
Renin- angiotensin system
- releases angiotensinogen
- converts angiotensinogen into x
- released by - converts x into y
Liver
Renin; angiotensin 1
ACE;lungs;angiotensin 2
135
Function of natriuretic hormone(ANP)
Its main function is to lower blood pressure and to control electrolyte homeostasis.
136
ANP causes an increase or decrease in GFR
Increase in GFR
137
ANP and aldosterone have the same or opposite effect
Opposite. ANP aids salt secretion
138
Function of erythropoietin
adjustment in erythropoiesis
139
What percentage of ERYTHROPOIETIN is produced in the liver and what percentage is produced in the kidney
●85% produced in the kidney and 15% in liver
140
Half life of EPO in circulation
5hrs
141
Major stimulus of EPO is—-
| Minor stimulus of EPO is —-
Hypoxia
Alkalosis at high altitude and hemorrhage
142
EPO is aided by which NTs and inhibited by what
Catecholamines, adenosine
Adenosine antagonists
143
Example of adenosine antagonists
Theophylline
144
Vitamin D3 is first converted to —- in the ——-
| Then it is finally converted to ——- in the ——- of the kidney by —- enzyme
25,hydroxycholecalciferol;liver
1,25 dihydroycholecalciferol in the pct of the kidney by 1 α-hydroylase.
145
Active vitamin D is stimulated by
Low. Ca level
146
Define micturition
It is the process by which the urinary bladder is emptied i.e. urination.
147
The 2 processes involved in micturition are???
the progressive filing of the bladder until the tension rises above the threshold level.
2.nervous reflex called micturition reflex.
148
The main bladder muscle is called
Detrusor muscle
149
What innervates the bladder
Sympa and parasympa nerves
150
Effect of sympathetic nerves and parasympathetic nerves on the bladder and the internal urethral sphincter
Sympathetic nerve inhibits the bladder and stimulate the internal sphincter.
• Parasympathetic nerve stimulate the bladder and inhibits the internal sphincter.
151
What innervates the external sphincter
Pudendal nerve
152
The parasympathetic nerves involved are—-?
| The sympathetic nerves involved are—-?
S2,3,4
| L1,2
153
First sensation of bladder filling is experienced at a volume of——
Then the 1st desire to void/urinate is when the bladder contains about———
A person becomes uncomfortably aware of a full bladder when the volume is——
The volume of urine that normally initiates a reflex contraction is about——-
An increase in volume to ——creates pain and loss of control!
100 – 150 ml in an adult.
150-250 ml of urine.
350-400 ml.
300-400 ml.
700ml
154
Cystometrogram is a plot of —-
intravesical pressure vs volume of fluid in the bladder
155
Cystometrogram has 3 segments. Describe them
Initial rise in pressure
Nearly flat segment
Sudden sharp rise in pressure
156
Define the law of Laplace
| And state the formulae
Pressure in a spherical viscus is equal to twice the wall tension divided by the radius
P=2T/r
157
In which segment of the Cystometrogram does the law of Laplace apply
Segment 2
158
In which segment of the Cystometrogram is the micturition reflex triggered
Third segment
159
Micturition reflex is self regenerative
| T/F
T
160
Micturition inhibitory areas of the brain and facilitatory areas are??
Pons and posterior hypothalamus
Cortex and midbrain
161
Micturition is purely —- in young kids and begins to come under —— control around 2-3 yes old
Reflex due to incomplete myelination of the nerve fibers
Cortical control
162
```
Causes of:
Atonic bladder
Automatic bladder
Uninhibited neurogenic bladder
Denervated/hyperactive bladder
```
Bbvc
163
Causes of atonic bladder
sensory nerve fibers (afferent) from bladder to spinal cord are damaged
Damage to the sacral region of the spinal cord
Tumors, tabes dorsalis
164
In atonic bladder, the efferent fiber are damaged
| T/F
F. They are intact
165
In atonic bladder, all reflex contraction is lost
| T/F
T
166
Atonic bladder leads to ——
Overflow incontinence
167
Cause of automatic bladder
spinal cord damage above sacral region
168
In which bladder issue is higher center voluntary control lost
Automatic bladder
169
Cause of Uninhibited Neurogenic Bladder
damage to brain/spinal cord that control inhibitory signals for micturition
170
Cause of Denervation/Hyperactive bladder
tumors of cauda equina / filum terminale
171
Effect of age on:
Frequency of involuntary bladder contraction
Total bladder capacity
incidence of nocturia
Bladder contractility
Increased
Reduced
Increased
Decreased
172
If the underlying problem is metabolic, - mechanism would help
Respiratory mechanism
173
Epithelial cells in the dct are - cells
I cells
174
Jg cells are most common in which tunicas
Tunica media and tunica adventitia
175
Ag1 is a —peptide
Ag2 is a —— peptide
Ag3 is a —peptide
Ag4 is a —-peptide
Deca
Octa
Hepta
Hexa
176
Angiotensin 2 has a short or long life span??
Short
177
ADH is secreted from ___
Hypothalamus
178
Kidneys have a portal circulation. List the 2 beds and state which is of higher pressure
Glomerulus -high (60)
Peritubular-low (10)
179
What is filtration fraction
fraction (portion) of the renal plasma, which becomes the filtrate.
FF= GFR/RPF x100
180
Define
High threshold substances
Low threshold substances
Non threshold substances
And give examples
Do not appear in urine under normal conditions. Glucose, amino acids,vitamins, etc
Appear in urine even under normal circumstances
Must appear in urine no matter the circumstances. Creatinine
181
Tubular epithelial cells are connected with their neighboring cells by——. And space between 2 cells are called—-?
tight junctions
| Lateral intercellular space
182
ADH binds with —- receptors that are —-tropic
Vasopressin
| Metabotropic
183
Which aquaporin does the kidney use
Aquaporin 2
184
Renal threshold for glucose is ?
180mg/dl
185
Location of specialization of the following H secreting mechanisms
```
Na-H pump
ATP pump
Bicarbonate
Phosphate
Ammonia
```
Dct
Dct;CD
Pct;loop;dct
Dct;CD
Pct
186
Which is easier to use, creatinine or inulin
Creatinine
187
Origin of pudendal nerve
S2,S3,S4
188
UNINHIBITED NEUROGENIC BLADDER is also called —-???
spastic neurogenic bladder or hyperactive neurogenic bladder.
189
ADH is produced by —- but secreted by —-
Hypothalamus
| Pituitary gland
190
```
In relation to plasma, what’s the osmolarity of the fluids in these regions.
Bowman’s capsule
Pct
Thick descending
Thin descending
Thin ascending
Thick ascending
Dct and CD
```
```
Isotonic
Isotonic
Slightly hypertonic
Very hypertonic
Slightly hypertonic
Hypotonic
Hypertonic
```
191
Which cells are responsible for the ADH induced water reabsorbtion
P cells
192
Pcells stands for —
| I cells stands for —-
Principal cells
| Intercalated cells
193
Define Osmotic diuresis
Diuresis is the excretion of large quantity of water through urine. Osmotic diuresis is the diuresis induced by the osmotic effects of solutes like glucose
194
Osmotic diuresis is common in what sickness
Diabetes mellitus
195
Define polyuria
Polyuria is the increased urinary output with frequent voiding.
196
Deficiency of ADH leads to—-
| Excess of ADH leads to —?
Diabetes insipidus
| Syndrome of inappropriate hyper secretion of ADH
197
Define Nephrogenic Diabetes Insipidus
ADH secretion is normal but the renal tubules just fail to respond to the ADH leading to polyuria
198
Define Barter Syndrome
Genetic defect in the thick ascending limb making the person not able to reabsorb enough NaCl and water leading to excretion of sodium and water in urine
199
Respiratory alkalosis can be fixed by ???
Metabolic mechanism
200
What is my name😤
thee stallion
201
Effect of spironolactone on potassium levels
Prefer hypokalemia
202
Beta blockers in hypertension treatment will contribute to hyperkalemia
T or F
T. Beta Adrenergic stimulation usually causes potassium to move into the cell
203
The most numerous intracrllular buffer is—-
Protein buffer
204
Normal bicarbonate levels :
| Normal co2 levels
Normal bicarbonate levels are: 23 to 30 mEq/L in adults.
the value of PCO2 ranges between 35 to 45 mmHg or 23 to 29 milliequivalents per liter (mEq/L)
