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Part 1 Physiology > Renal > Flashcards

Renal Flashcards

1
Q

ADH stimulation

A

Hypotension
Inc osmolality (sensed ant hypothalamus)
AT 2 around 3rd and 4th vents
Morphine
Barbiturates
Nicotine
Stress
Nausea and vomiting
Carbamazapine

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2
Q

ADH inhibition

A

Water
Alcohol
Cortisol
ANP
Lithium
Domeclocycline
Adr

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3
Q

ADH on kidney

A

Decreases blood flow to renal medulla
Vasoconstrictor at high concs
Increases inner medulla collecting dict permeability to aurea
Increases cd permeability to water

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4
Q

Maximum renal glucose resorbtion

A

300-375mg/m
Resorption via sodium glucose co transporter SGLT2 (secondary active)
Then GLUT2 on basolateral

Gluconeogenesis in renal cortex

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5
Q

Filtration fraction

A

GFR/RPF
0.2

Proportion if fluid reaching kidneys that passes into renal tubules

Increased by catecholamines
Decreased by diuretics

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6
Q

Angiotensin II effects

A

Arteriolar constriction
Aldosteron secretion
Mesengial cell constriction causing decreased GFR
Increased ADH
Increased ACTH
Decreased barreflex
Inc thirst
Norad release
less effective hypoNa and cirrhosis

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7
Q

Urea filtration kidney

A

Freely filtered
Half resorbed pct
Half secreted back into LOH
Half resorbed back CD

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8
Q

Mesangial cells

A

extraglomerular - part of JGA, lacis cells
Intraglomerular - structure, contract reduce GFR, phagocytic, secrete PGs and ECM

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9
Q

PCT

A

resorption 100% glucose SGLT2 cotransporter
65% NaCl +H20, K
60% calcium
80% bicarbonate
50% urea
H2 secreted (majority)
Ammonia produced and excreted
Small proteins and peptide hormones reabsorbed through endocytosis

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10
Q

Ascending LOH

A

25% sodium reabsorbed
20% potassium
chloride resorbed
calcium resorbed via PTH
50% urea secreted

Loop diuretic Na/K/2Cl

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11
Q

DCT

A

5% sodium resorbed
Thiazides inhibit Na Cl cotransporter
Potassium secreted

hypotonic

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12
Q

CDs

A

5% sodium resorbed - P cells regulated by aldosterone (ENaC)
Water reabsorbed (ADH)
Potassium secrete
50% urea resorbed (CD)

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13
Q

Renin inhibition

A

increased Na/Cl resorbtion macula densa
ADH
ATII
Beta blockers
ANP
Increased afferent arteriolar pressure
Baroreceptor firing

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14
Q

Measure renal blood flow

A

25%CO
Ficks principle used
PAH used
excreted not metabolised, does not affect flow
90% cleared from circulation

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15
Q

constriction afferent arteriole kidney

A

adenosine

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16
Q

Glomerular pressure

A

if MAP 100, glomerular cap 45
peritubular cap 8
renal vein 4

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17
Q

Regulation renal blood flow

A

ATII constricts afferent + efferent
Norad - afferent + interlobular
Adenosine - afferent
Dop and ACh - vasodilation
PGs - increased flow cortex, reduced medulla
Protein rich diet - increased renal blood flow, inc cap pressure

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18
Q

Symp action on kidneys

A

Beta 1 JGA -> renin release -> Na resorption
Norad afferent and interlobular vasoconstriction

High stimulus -> alpha vasoconstriction, reduced RBF and GFR(RBF>GFR)

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19
Q

Coretx vs medulla

A

cortex high blood flow low O2 demand
Medulla opposite, prone to ischemia

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20
Q

Contraction/ relaxation mesangial cells

A

contract - ATII
Relax - dopamine, cAMP, ANP, PGE2

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21
Q

Renal plasma flow

A

volume of blood plasma to kidneys/ unit time
600ml/m

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22
Q

Renal plasma clearance

A

Volume of plasma from which substance completely cleared / unit time

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23
Q

Tx kidneys

A

Amount of substance transferred into tubules in kidney
0 = GFR inulin
+ve exceeds GR e.g. PAH
-ve less than GFR e.g. glucose

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24
Q

Sodium transporters PCT

A

Co: SGLT2, phosphate, AA, lactate
Exchange: Na/H, Cl/base

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25
Q

Sodium transporters LOH asc

A

Co: Na/K/2Cl
Exchange; Na/H
Channel: K excretion

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26
Q

DCT and CD sodium

A

DCT NaCl cotransporter
CD ENaC

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27
Q

Aquaporins

A

1 - blm pct 70% resorption
desc lop 15%
2 - ADH on CD medulla, apical surface 15%

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28
Q

Counter-current mechanism

A

mechanism for kidney to conc urine
multiplier: Na pumped pumped out asc LOH, water absorbed from desc LOH
exchanger: vasa recta absorb water

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29
Q

Urea kidney

A

helps establish osmotic grad medulla
distal PCT Resorbed by facilitated diffusion UTa1-4 - up regulated by ADH
Resorbed PCT 50%
Secreted into LOH 50%
Resorbed CD 50%
40-50%% in urine

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30
Q

Regulation Na excretion

A

main determinant ECF volume
96-99% resorbed
Aldosterone up regs ENaC on principle cells - more resorbed
ANP down regulates ENaC
ATII causes Na and HCO3 resorb PCT

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31
Q

Na excretion up regulated by

A

PGE2
ANP (both cause inhib ENaC)
Stretch pulm veins - inhib symp to kidney
Inc GFR

32
Q

Water excretion

A

dink hypotonic fluid - excreted 15m post, max at 40
Hypoosmolality main determinant
Happens SIADH post surg

33
Q

K regulation kidney

A

65% resorbed PCT diffusion
20% resorbed DCT Na/K/2Cl symport
Secreted DCT + CD (aldosterone dependant in principle cells)

inc secretion in ADH + aldosterone, inc urine flow

dec in acidosis and decreased Na resorp

34
Q

Urge to urinate

A

First urge at 150ml, reflex contraction at 400ml

pons facilitates
midbrain + post hypothalamus inhib

35
Q

ADH receptors

A

V1 - inc Ca, vasoconstriction high doses
1a glycogenolysis
1b acth
V2 - inc cAMP - aquaporins

acts on area prostrema to dec CO
osmo receptors in ant hypthalamus when osm >285

T1/2 18m

36
Q

Diabetes insipidus

A

Central - ADH insufficiency
30% neoplastic, 30% post traumatic, 30% idiopathic
Nephrogenic - V2 or aquaporin gene mutation
Polyuria and polydypsia
Tx desmopressin

37
Q

Angiotensinogen

A

synth in liver
inc by glucocorticoids, thyroid hormones estrogen, cytokines, ATII

38
Q

Renin activation

A

PGs
sympathetic from renal nerves
Catecholamines on beta1 receptors JG cells, inc cAMP

39
Q

H+ excretion

A

predom PCT Na/H exchanger 2ry active
DCT + CD
- H+ ATPase
- H+ / K ATPase in I cells

limiting pH urine 4.5

40
Q

Urinary buffers

A
  1. Bicarb - pK6.1 PCT
  2. phosphate - pK6.8 DCT + CD
  3. Ammonia - pK9 PCT + DCT
41
Q

Factors affecting H+ secretion

A

inc with high CO2, aldosterone, ATII, decreased K intracellular
dec with carbonic anhydrase inhibitors

42
Q

H+ change with pH

A

drop 1 pH, H+ x 10

43
Q

Buffers by location

A

CSF + urine - phosphate and bicarbonate
Blood - bicarbonate, protein, Hb
Interstitial - bicarb
Intracellular - protein + phospate

In resp acid/ alk all buffering intracellular

44
Q

base excess

A

amout of acid needed to normalise 1L blood to pH7.4
+ve metabolic alkalosis
-ve metabolic acidosis

45
Q

3 hormones secreted by kidney

A

erythropoietin
vit D
Renin

46
Q

Omolality nephron

A

Isotonic PCT
hypertonic 1200 bottom LOH
Hypotonic DCT

47
Q

H2CO3:HCO3- at different pHs

A

PH 6 ratio 0.9
7.1 10
7.3 16
7.4 20

48
Q

Raised anion gap acidosis

A

G:glycols (ethylene glycol and propylene glycol)

O:oxoproline

L:L-lactate

D:D-lactate

M:methanol

A:aspirin

R:renal failure

K:ketoacidosis

49
Q

Definition anion gap acidosis

A

Gap between cations and anions not inc na, cl and hco3
Normal 12
Cations dec eg mg, k, ca
Organic ions eg lactate inc

50
Q

Renin released from

A

Granular juxtaglomerular ces

51
Q

Cause renin release

A

Decreased pressure afferent arteriole
Beta 1 activation
Macula densa decreased sodium chloride

52
Q

Drugs decreasing effect ADH

A

Domeclocycline
Lithium
Adrenaline

53
Q

ADH release inhibited by

A

Water
Alcohol
Cortisol
ANP

54
Q

Renal capillary hydrostatic pressure

A

55

55
Q

Renal autoregulation levels

A

90-220

56
Q

Constricts only afferent arteriole

A

Adenosine

57
Q

% potassium filtered that is excreted

A

10-15

58
Q

% potassium filtered that is excreted

A

10-15

59
Q

HDL function

A

Transports endogenous cholesterol from tissue to the liver

60
Q

Percent of nephrons with long loops

A

15

61
Q

Factors affecting permeability nephron

A

Size <4 free >8 not
Charge - positive freely through (membrane -ve)
Rbc too big
Hb and albumin -ve charge so can’t go through

62
Q

Intercalated cell cd

A

Hydrogen secretion into urine

63
Q

Main cause renal resorption na in pct

A

Na h exchanger

64
Q

Exchangers in pct

A

Na h
Cl base

65
Q

Where is na/h exchanger in nephron

A

Pct
Thick ascending LOH

66
Q

Where in nephron osmolality same in nephron and interstitium

A

Pct
Thin descending limb

67
Q

Parts of nephron impermeable to urea

A

Thick ascending
Dct
Cortical cd

68
Q

Maximum urea conc

A

600m osm/L

69
Q

Max water excretion/min

A

16ml

70
Q

Max water excretion/min

A

16ml

71
Q

Hydrogen secretion in urine

A

Na h exchanger in pct and thick loop
Proton pump in dct, inc by aldosterone
H k atpase in cd

72
Q

Titrateable acidity urine

A

Amount strong base needed to get urine back to pH 7.4

73
Q

Urine sodium conc

A

Less than plasma
90mmol

74
Q

Urine urea conc

A

900mg/dl

75
Q

Urine creatinine conc

A

150mg/dl

76
Q

Urine creatinine conc

A

150mg/dl

Part 1 Physiology (10 decks)

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