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PHGY 210 > Renal > Flashcards

Renal Flashcards

1
Q

kidney function

A
  • water, inorganic ion and acid-base balance regulation
  • metabolic waste removal (accumulation may be toxic) via blood and urine
  • foreign chemical removal via urine
  • hormone and enzyme productions
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2
Q

hormones and enzymes produced in kidney

A
  • erythropoietin: controls erythrocyte (RBC) production
  • renin: controls angiotensin formation (influences blood pressure and sodium balance)
  • 1,25-dihydroxyvitamin D: influences calcium balance
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3
Q

renal cortex

A
  • exterior
  • darker color
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4
Q

renal medulla

A
  • interior
  • ligher color
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5
Q

urine production

A

renal cortex + renal medulla –> urine production in renal pelvis

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6
Q

ureter

A

transpsort urine from kidney to bladder

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7
Q

kidney vascular system

A
  • renal artery: direct branch of aorta
  • renal vein: into inferior vena cava
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8
Q

renal artery

A

renal artery –> inerlobar artery –> arcuate artery (parallel to kidney surface) –> interlobular artery (perpendicular to kidney surface) –> afferent arteriole

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9
Q

nephron

A
  • function unit of urine formation
  • stimulated by afferent arteriole
  • each kidney contains ~ 1 million nephrons
  • 2 components: renal corpuscle (glomerulus and Bowman’s space), tubule
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10
Q

renal tubule

A

proximal tubule –> loop of Henle –> distal (convoluted) tubule –> collecting duct system

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11
Q

proximal tubule

A
  • proximal convoluted tubule (PCT, cortex) –> proximal straight tubule (PST, medulla)
  • thinning at end of the proximal straight tubule
  • reabsorbs most of the filtered water and solutes
  • major site of solute secretions (except potassium ions)
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12
Q

loop of Henle

A
  • descending thin limb of Hele’s loop –> ascending thin limb of Henle’s loop –> thick ascending limb of Henle’s loop
  • end of loop of Henle at site of the renal capsule
  • reabsorbs relatively large quantities of major ions (less water)
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13
Q

distal (convoluted) tubule (DCT)

A
  • until merging with other distal convoluted tubules
  • volume of water and masses of solutes relatively small
  • determines the final amounts excreted
  • where most homeostatic controls occur
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14
Q

collecting duct system (CD)

A
  • cortical collecting duct (CCD) –> medullary collecting duct (MCD)
  • determines the final amounts excreted
  • where most homeostatic controls occur
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15
Q

Bowman’s space

A
  • space enclosed by a monolayer of epithelial cells
  • parietal layer: no contact with the glomerulus
  • visceral layer (podocytes): contact with the glomerulus
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16
Q

juxtaglomerular apparatus

A
  • juxtaglomerular cells
  • macula densa
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17
Q

juxtaglomerular cells

A
  • renin-secreting cell
  • surround afferent arteriole
  • contact with macula densa
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18
Q

mucula densa

A

ring of cells surrounding the beginning of the distal tubule

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19
Q

glomerular filtration barrier

A
  • podocytes
  • glomerular basement membrane
  • endothelial cells
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20
Q

peritubular capillaries

A

branched capillaries from the afferent arteriole to supply blood to the tubule

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21
Q

urine formation

A
  • glomerular filtration in the Bowman’s space
  • tubular secretion
  • tubular reabsorption
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22
Q

glomerular filatration

A

filtrate: cell-free, with excepts of small proteins, substances in plasma

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23
Q

tubular secretion

A
  • peritubular capillaries –> tubules
  • most important secretions: hydrogen and potassium ions
  • often couple to the reabsorption of sodium
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24
Q

tubular reabsorption

A
  • tubules –> peritubular capillaries
  • para-cellularly (via gap junction) or trans-cellularly (through tubular epithelial cells)
  • of waste products relatively incomplete
  • of useful plasma components relatively complete
  • some not regulated, some highly regulated
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25
Q

excretion

A
  • final elimination via urine
  • amount excreted=amount filtered+amount secreted-amount reabsorbed
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26
Q

para-amino-hippurate (PAH)

A

lots of secretion with no reabsorption –> all excreted

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27
Q

ions

A

no secretion with some reabsorption –> little excretion

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28
Q

glucose

A

no secretion with lots of reabsorption –> no excretion

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29
Q

net glomerular filtration pressure

A

glomerular capillary blood pressure (Pgc)-fluid pressure in Bowman’s space(Pbs)-osmotic pressure (pigc)

30
Q

GFR regulation

A
  • net filtration
  • membrane permeability
  • surface area available for filtration (constriction of AA and dilation of EA –> decreased GFR; dilation of AA and construction of EA –> increased GFR)
30
Q

glomerular filtration rate (GFR)

A
  • volume of fluid filtered into Bowman’s space per unit time
  • normal GFR for 70kg person: 180L/day
31
Q

filtered load

A
  • total amount of any freely filtered substance per unit time
  • filtered load of a substance = GFR*plasma concentration of the substance
  • filtered load<amount excreted: net reabsorption
  • filtered load>amount secreted: net secretion
32
Q

tubular reabsorption mechanisms

A
  • diffusion
  • mediated transport
33
Q

diffusion

A

often para-cellularly

34
Q

mediated transport

A
  • trans-cellular epithelial transport
  • often coupled with sodium reabsorption
35
Q

transport maximum (Tm)

A

the limit at which the membrane transport proteins are saturated that the tubule can no longer reabsorb the substance any more

36
Q

tubular secretino mechanisms

A
  • diffusion
  • trans-cellular mediated transport
37
Q

clearance

A
  • volume of plasma from which that substance is completely removed by the kidney per unit time
  • clearance of S (Cs)=mass of S excreted per unit time/plasma concentration of S (Ps)=urine concentration of S (Us)*urine volume per unit time (V)/Ps
  • clearance>GFR: secreted at the tubule
  • clearance<GRF: reabsorbed at the tubule
38
Q

inulin clearance

A

no reabsorption, secretion or metabolism –> Cin = GFR

39
Q

creatinine clearance

A
  • waste product produced by muscles
  • no reabsorption, secretion (so little that can be neglected) or metabolism –> Ccr = GFR
40
Q

sodium balance

A
  • ~99% reabsorbed with no secretion
  • ~2/3 reabsorption occurs in the proximal tubule
  • major hormonal control at DCT and CD
  • active process in all tubular segments (except the descending thin limb of Henle’s loop)
  • influences water reabsorption via diffusion
  • basolateral membrane: active Na+/K+ ATPase
  • apical (luminal) membrane: proximal tubule –> Na+/H+ anti-porter or Na+/glucose co-porter; CCD –> diffusion via Na+ channel
41
Q

total body sodium and total body water

A
  • changes in total body sodium cause similar changes in ECF volume
  • plasma concentration of sodium is not a marker for total body sodium
42
Q

sodium excretion regulation

A
  • GFR (minor)
  • sodium reabsorption (major)
43
Q

GFR control of sodium excretion

A

increased Na+ and water loss –> decreased plasma volume –> decreased venous pressure –> afferent artery constriction –> decreased GFR –> decreased Na+ and water excretion

44
Q

reabsorption control of sodium excretion

A

hormonal control via aldosterone:
- no aldosterone: ~2% excretion, high aldosterone: ~0% excretion
- in DCT and CCT
- increases H+ secretion
- stimulate diffusion active transport
- decreased plasma volume –> increased renal sympathetic nerve activity, decreased arterial pressure, decreased GFR –> increased renal secretion –> increased plasma angiotensin II –> increased aldosterone secretion –> increased sodium reabsorption –> decreased sodium excretion
- also influenced by ANP (inhibits sodium reabsorption and increases GFR) and blood pressure (increased BP increases sodium secretion)

45
Q

aldosterone regulation

A

renin-angiotensin system:
- angiotensinogen (liver) + renin (kidney) –> angiotensin I + ACE –> angiotension II: stiulate aldosterone secretion (adrenal cortex)
- rate limiting step: renin secretion

46
Q

action of ANP

A

increased plasma volume –> cardia atria distension –> ANP secretion –> decreased plasma aldosterone –> decreased Na+ reabsorption and increased GRF –> increased sodium excretion

47
Q

osmolarity

A

total solute concentration of a solutionihy

48
Q

hypoosmotic

A

total solute concentration < 300 mOsm

49
Q

isoosmotic

A

total solute concentration = 300 mOsm

50
Q

hyperosmotic

A

total solute concentration > 300 mOsm

51
Q

water balance

A
  • ~99% reabsorbed
  • 2/3 reabsorptino occurs in the proximal tubule (same as sodium)
  • major hormonal control in CD (whereas also in DCT for sodium)
52
Q

water balance regulation

A
  • high osmolarity of the medullary interstitial
  • permeability of CD to water (regulated by vasopressin)
53
Q

countercurrent multiplier system

A
  • allow solute buildup in the medullary interstitium
  • occurs at Henle’s loop
  • step 1: active reabsorption of sodium and water impermeable in the ascending limb
  • step 2: sodium impermeable and water secretion in the descending limb
  • step 3: fluid movement (300(new) –> 400 –> 400 –> 200 –> 200(into DCT))
54
Q

vasa recta

A
  • blood vessels in the medulla
  • hairpin-loop structure to minimized excessive loss of solute
55
Q

vasopressin

A
  • determines water permeability
  • coupled with GPCR1 in smooth muscles and V2 in kidney
  • stimulate insertion of aquaporins in the luminal membrane –> increases permeability
  • malfunction of the vasopressin system –> diabetes insipidus
56
Q

vasopressin regulation

A
  • osmoreceptor (most important)
  • baroreceptor (less sensitive)
57
Q

osmoreceptor control of vasopressin secretion

A
  • sensitive to changes in osmolarity
  • excess water intake –> increased water osmolarity –> decreased firing by the hypothalamic osmoreceptors –> decreased vasopressin secretion –> decreased tubular water permeability –> decreased water reabsorption –> increased water excretion
58
Q

baroreceptor control of vasopressin secretion

A

decreased plasma volume –> decreased venous, atrial and arterial pressures –> increased vasopressin secretion –> increased tubular water permeanility –> increased water reabsorptin –> decreased water excretion

59
Q

thirst

A
  • triggered by decreased plasma volume, increased plasma osmolarity or dry mouth and throat
  • inhibited by metering of water intake by GIT
60
Q

sweats

A

severe sweating –> loss of hypoosmotic salt solution–> deceased plasma volume and increased plasma osmolarity –> decreased sodium and water secretion

61
Q

potassium balance

A
  • 98% in ICF
  • 2% in ECF
  • function: excite nerves and muscles
  • hyperkalemia ([K+] > 5 mEq/L) and hypokalemia ([K+] < 2.5 mEq/L) cause abnormal heart rhythms and skeletal muscle contractions
62
Q

potassium regulation

A
  • regulated by kidney: 90% –> urine; 10% feces/sweat
  • secreted at CCD (coupled with sodium reabsorption)
  • changes in excretion mainly due to changes in secretion in CCD (sometimes in the DCT)
  • secretion regulated by dietary intake and aldosterone
63
Q

potassium secretion regulation by dietary intake and aldosterone

A

increased potassium intake –> increased aldosterone (can be due to other causes) –> increased potassium secretion –> increased potassium excretion (as well as decreased sodium excretion)

64
Q

hyperaldosteronism

A
  • cause: adenoma of the adrenal gland causing autonomous aldosterone production
  • symptoms: increased fluid volume, hypertension hypokalemia, suppressed renin, metabolic alkalosis
65
Q

hydrogen ion balance

A
  • metabolic reactions highly sensitive to hydrogen ion concentration (pH) of the environment –> highly regulated
  • inversely impacted by bicarbonate concentration
66
Q

gain of hydrogen ions

A
  • from CO2
  • production of nonvolatile acids (e.g. phosphoric acid, sulfuric acid, lactic acid)
  • loss of bicarbonate in diarrhea or other nongastric GI fluid
  • loss of bicarbonate in urine
  • net average of 40-80 mmol of H+ produced per day
67
Q

loss of hydrogen ion

A
  • metabolism
  • vomitus
  • urine
  • hyperventilation (due to decreased [CO2])
68
Q

buffer

A
  • reversible bind hydrogen ions
  • extracellular: CO2/HCO3-
  • intracellular: phosphates and proteins
  • keep hydrogen ions “locked up”, not eliminated
68
Q

hydrogen ion regulation

A
  • respiration (by controlling [CO2])
  • kidney (by controlling [HCO3-])
69
Q

Henderson_Hasselbalch equation

A
  • calculates body pH in mammals
  • determined by HCO3- and Co2 ratio
  • pH=6.1+log10([HCO3-]/[CO2])=-logKa+log10([HCO3-]/(0.03*[CO2]))
  • Ka=dissociation constant for CO2/HCO3- system
  • 0.03=Co2 solubility at 37 degrees Celsius (normal mammalian body temperature)
70
Q

adding HCO3- to plasma

A
  • H+ secretion and excretion on non-bicarbonate buffers
  • glutamine metabolism with NH4+ excretion
  • only when all HCO2- has been reabsorbed and no longer available in the lumen
  • mostly in the proximal tubule

PHGY 210 (5 decks)

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