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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
Sodium transporters LOH asc
Co: Na/K/2Cl Exchange; Na/H Channel: K excretion
26
DCT and CD sodium
DCT NaCl cotransporter CD ENaC
27
Aquaporins
1 - blm pct 70% resorption desc lop 15% 2 - ADH on CD medulla, apical surface 15%
28
Counter-current mechanism
mechanism for kidney to conc urine multiplier: Na pumped pumped out asc LOH, water absorbed from desc LOH exchanger: vasa recta absorb water
29
Urea kidney
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
30
Regulation Na excretion
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
31
Na excretion up regulated by
PGE2 ANP (both cause inhib ENaC) Stretch pulm veins - inhib symp to kidney Inc GFR
32
Water excretion
dink hypotonic fluid - excreted 15m post, max at 40 Hypoosmolality main determinant Happens SIADH post surg
33
K regulation kidney
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
Urge to urinate
First urge at 150ml, reflex contraction at 400ml pons facilitates midbrain + post hypothalamus inhib
35
ADH receptors
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
Diabetes insipidus
Central - ADH insufficiency 30% neoplastic, 30% post traumatic, 30% idiopathic Nephrogenic - V2 or aquaporin gene mutation Polyuria and polydypsia Tx desmopressin
37
Angiotensinogen
synth in liver inc by glucocorticoids, thyroid hormones estrogen, cytokines, ATII
38
Renin activation
PGs sympathetic from renal nerves Catecholamines on beta1 receptors JG cells, inc cAMP
39
H+ excretion
predom PCT Na/H exchanger 2ry active DCT + CD - H+ ATPase - H+ / K ATPase in I cells limiting pH urine 4.5
40
Urinary buffers
1. Bicarb - pK6.1 PCT 2. phosphate - pK6.8 DCT + CD 3. Ammonia - pK9 PCT + DCT
41
Factors affecting H+ secretion
inc with high CO2, aldosterone, ATII, decreased K intracellular dec with carbonic anhydrase inhibitors
42
H+ change with pH
drop 1 pH, H+ x 10
43
Buffers by location
CSF + urine - phosphate and bicarbonate Blood - bicarbonate, protein, Hb Interstitial - bicarb Intracellular - protein + phospate In resp acid/ alk all buffering intracellular
44
base excess
amout of acid needed to normalise 1L blood to pH7.4 +ve metabolic alkalosis -ve metabolic acidosis
45
3 hormones secreted by kidney
erythropoietin vit D Renin
46
Omolality nephron
Isotonic PCT hypertonic 1200 bottom LOH Hypotonic DCT
47
H2CO3:HCO3- at different pHs
PH 6 ratio 0.9 7.1 10 7.3 16 7.4 20
48
Raised anion gap acidosis
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
Definition anion gap acidosis
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
Renin released from
Granular juxtaglomerular ces
51
Cause renin release
Decreased pressure afferent arteriole Beta 1 activation Macula densa decreased sodium chloride
52
Drugs decreasing effect ADH
Domeclocycline Lithium Adrenaline
53
ADH release inhibited by
Water Alcohol Cortisol ANP
54
Renal capillary hydrostatic pressure
55
55
Renal autoregulation levels
90-220
56
Constricts only afferent arteriole
Adenosine
57
% potassium filtered that is excreted
10-15
58
% potassium filtered that is excreted
10-15
59
HDL function
Transports endogenous cholesterol from tissue to the liver
60
Percent of nephrons with long loops
15
61
Factors affecting permeability nephron
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
Intercalated cell cd
Hydrogen secretion into urine
63
Main cause renal resorption na in pct
Na h exchanger
64
Exchangers in pct
Na h Cl base
65
Where is na/h exchanger in nephron
Pct Thick ascending LOH
66
Where in nephron osmolality same in nephron and interstitium
Pct Thin descending limb
67
Parts of nephron impermeable to urea
Thick ascending Dct Cortical cd
68
Maximum urea conc
600m osm/L
69
Max water excretion/min
16ml
70
Max water excretion/min
16ml
71
Hydrogen secretion in urine
Na h exchanger in pct and thick loop Proton pump in dct, inc by aldosterone H k atpase in cd
72
Titrateable acidity urine
Amount strong base needed to get urine back to pH 7.4
73
Urine sodium conc
Less than plasma 90mmol
74
Urine urea conc
900mg/dl
75
Urine creatinine conc
150mg/dl
76
Urine creatinine conc
150mg/dl

Part 1 Physiology (10 decks)

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