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Su: Phys 2 > Renal > Flashcards

Renal Flashcards

1
Q

functional unit of kidney

A

nephron

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2
Q

nephron function

A

removes waste
mx ECF

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3
Q

when do you start trending toward kidney failure/uremia

A

loss of >50% nephrons

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4
Q

how many nephrons in kidney

A

1 million

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5
Q

how many nephrons are lost after age 40

A

10% per decade

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6
Q

how many nephrons do 80 year olds have

A

480-720k

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7
Q

if you have decr nephrons you have _____ GFR

A

decr GFR

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8
Q

CKD

A

acceleration of kidney ageing

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9
Q

early nephron

A

glomerulus
proximal tubule
descending loop of henle

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10
Q

proximal tubule function

A

reabsorb salts/H2O

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11
Q

descending loop of henle

A

permeable to H2O
–reabsorption of H2O via osmosis

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12
Q

as you move down the LoH, what happens to the [salt].

A

incr [salt] in ISF

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13
Q

mid nephron

A

ascending loop of henle
distal convoluted tubule
collecting duct

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14
Q

ascending LOH permeability

A

apearmeable to H2O

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15
Q

ascending LOH function

A

absorbs NaCl/K+
dilutes

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16
Q

counter current multiplier

A

ascending limb: pumps salt out
descending limb: incr H2O absorption

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17
Q

distal convoluted tubule function

A

adjusts salts
modulates pH
favors reabsorption

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18
Q

hyperkalemia reaction in distal convoluted tubule

A

DCT will secrete K+
– decr K+

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19
Q

collecting duct function

A

adjusts H2O

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20
Q

cortical collecting duct

A

upper 1/2

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21
Q

medullary collecting duct

A

lower 1/2

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22
Q

renal blood flow order

A

arcuate artery
interlobular artery
afferent arteriole
glomerulus
unfiltered
efferent arteriole
peritubular caps
vasa rector
interlobular vein
arcuate vein
renal vein

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23
Q

what contorls the level of vasoconstriction and vasodialtion

A

afferent arteriole

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24
Q

what surrounjds proximal and distal tubules

A

peritubular caps

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25
Q

function of peritubular caps

A

salt/H2O reabsorption

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26
Q

vasa rector includes

A

straight proximal tubule
ascending LoH
descending LoH

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27
Q

ascending LOH incr concentration of

A

salts (in ISF)

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28
Q

descending LOH incr concentration of

A

water

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29
Q

kidney size

A

0.5% of body mass

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30
Q

kidney blood flow

A

20% of CO
1L/min

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31
Q

why do kidneys need high blood flow

A

due to high filtration rate
high BF provides good control of ECF volume and osmolarity

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32
Q

what happens if BF is decr to kidneys

A

decr BF to paratubular caps
incr ischemia due to decr O2 supply with incr ATP demand

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33
Q

3 capillary beds

A

glomerulus
peritubular caps
vasa recta

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34
Q

glomerulus pressure

A

HIGH hydrostatic P
- promotes filtration
- incr peritubular oncotic P

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35
Q

peritubular caps pressure

A

HIGH oncotic P
- pulls salts/H2O INTO caps

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36
Q

vasa recta pressure

A

Low P
- osmotic gradient from counter current

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37
Q

urine producton steps

A

filtration
reabsorption by peritubular caps
secretion into tubular lumen
excretion

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38
Q

excretion equation

A

Exc = Fil - Reab + Sec

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39
Q

Filtered load equation

A

Fil = plasma [ ] x GFR

plasma [ ]:
Na+
Cl-
K+
H2O
Free Ca2+
Free Pi

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40
Q

fenestrated capillary endothelium

A

high permeability promotes filtration

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41
Q

basement membrane charge

A

(-) charge

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42
Q

basement membrane function

A

promotes filtration of small and (+) charged molecules

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43
Q

podocytes function

A

prevents filtration of large and (-) charged molecules

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44
Q

what glomular membrane changes incr filtration

A

sepsis
minimal change disease

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45
Q

what glomerular membrane changes decr filtration

A

endothelial cell swelling
basement remodeling

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46
Q

minimal change disease

A

decr podocytes
incr protein crossing

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47
Q

filtrate composition

A

low protein
no cells
no plts

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48
Q

plasma composition

A

high protein
cells
plts

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49
Q

sieving coefficient

A

[tubular fluid]/[plasma]

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50
Q

incr size _____ sieving coeff

A

decr sieving coeff

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51
Q

(+) charge _____ sieving coeff

A

incr sieving coeff

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52
Q

(-) charge ____ sieving coeff

A

decr sieving coeff

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53
Q

Pgc

A

glomerulus hydrostatic
== fluid OUT

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54
Q

Pi bs

A

bowman oncotic P
== Fluid OUT

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55
Q

Pi gc

A

glomerulus oncotic P
== fluid IN

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56
Q

P bs

A

bowman hydrostatic
== fluid IN

57
Q

normal P gc

A

50 mmHg

58
Q

normal Pi bs

A

0 mmHg

59
Q

normal Pi gc

A

25 mmHg

60
Q

normal P bs

A

10 mmHg

61
Q

primary driver of net filtration pressure and GFR

A

P gc

62
Q

NFP equation

A

NFP = (Pgc-Pbs) - (Pigc - Pibs)

63
Q

(+) NFP

A

filtering OUT

64
Q

(-) NFP

A

secreting IN

65
Q

GFR

A

rate of formation of filtrate by kidneys per min

66
Q

main difference between plasma and filtrate

A

protein higher in plasma than filtrate

67
Q

clearance

A

volume of plasma that solutes occupied

vol of plasma/time

68
Q

what % of plasma is delivered to kidney

A

20%

69
Q

clearance equation

A

C = urinary excretion ([U]x [UV]) / Plasma

70
Q

clearance units

A

mL/min

71
Q

U

A

[solute] in urine
mg/mL

72
Q

UV

A

vol urine
mL/min

73
Q

P

A

[solute] in plasma
mg/mL

74
Q

gold std marker of GFR

A

inulin

75
Q

inulin sieving coeff

A

1

76
Q

why is inulin great

A

does not alter GFR
it can only be filtered

77
Q

inulin pro

A

high accuracy
used in drug research

78
Q

inulin con

A

time intensive
expensive

79
Q

most common way to estimate GFR

A

creatinine

80
Q

creatinine is a metabolite of

A

creatinine phosphate

81
Q

what happens to creatinine if you have decr renal function

A

incr creatinine

82
Q

what is creatinine dependent on

A

muscle mass

83
Q

alternative options to measure creatining

A

cystatin C
inulin

84
Q

plasma Cr is _____ related to GFR

A

inversely releated

85
Q

normal GFR

A

125 mL/min

86
Q

Normal Cr

A

1 mg/dL

87
Q

normal GFR per day

A

180 L/day

88
Q

stage 1 CKD

A

> 90
damage
normal GFR

89
Q

Stage 2 CKD

A

60-89
damage
mild GFR

90
Q

Stage 3a CKD

A

45-59
mild to mod GFR

91
Q

Stage 3b CKD

A

30-45
mod GFR

92
Q

Stage 4 CKD

A

15-30
sev GFR

93
Q

Stage 5 CKD

A

<15 or dialysis
kidney failure

94
Q

what stage CKD do you see K+/P+/Ca2+ increase

A

stage 4

95
Q

blood flow to kidney

A

3.5 mL/min/gram of kidney

96
Q

filtration fraction (FF)

A

% plasma filtered into renal tubules

97
Q

FF equation

A

FF = GFR/renal plasma flow

98
Q

renal plasma flow equation

A

RPF = 20% CO / (1-hct)

99
Q

is O2 consumption critical for RBF regulation

A

No
high RBF is required for filtration, not metabolism

100
Q

constrict afferent arteriole

A

decr BF
decr Pgc
decr GFR

101
Q

dilate afferent arteriole

A

incr BF
incr Pgc
incr GFR

102
Q

constrict efferent arteriol

A

decr BF
incr Pgc
incr GFR

103
Q

how is GFR mx’d with low renal blood flow?

A

incr Pcg

104
Q

dilate efferent arteriole

A

incr BF
decr Pgc
dec GFR

105
Q

renal autoregulation

A

MAP 80-180 mmHg

106
Q

MAP > 180mmHg

A

incr GFR
incr urinary volume

107
Q

MAP < 80 mmHg

A

decr RBF
decr GFR
renal ischemia

108
Q

neuroendocrine reulators

A

vasoconstrictors
vasodialtors

109
Q

intrinsic renal autoregulation

A

myogenic mechanism
JGA (tuboglomerular feedback)

110
Q

without regulation if you incr BP 25%, what happens

A

incr GFR 25%
- lg filtration
- incr work to reabsorb salts
- incr urinary output

111
Q

constrictors _____ RBF

A

decr RBF

112
Q

afferent constrictors

A

NE/Epi
adenosine (ATP)

113
Q

NE/Epi released under:

A

pain
stress
exercise
hemorrhage

114
Q

adenosine (ATP) released by:

A

macula densa

115
Q

efferent constrictors

A

Ang2
ADH

116
Q

what counters Ang2/ADH efferent constriction

A

NO/PG released by afferent arteriole

117
Q

dilators ____ RBF

A

incr RBF

118
Q

afferent dilators

A

renal PGL
ANP

119
Q

both afferent and efferent dilators

A

NO
dopamine

120
Q

renal PGL

A

keeps GFR constant despite constrictions

decr renin
decr aldosterone

121
Q

ANP released

A

high atrial pressure

122
Q

NO released

A

shear stress

keeps GFR constant despire constrictions

123
Q

dopamine released

A

low doses preserve RBF during hemorrhage

124
Q

myogenic mechanim function

A

ensures beat to beat constant RBF and GFR

125
Q

incr arterial wall stretch causes

A

decr SBP

126
Q

vasoconstriciton causes

A

incr DBP

127
Q

high tubule flow

A

high NaCl in macula densa
= MD depolarization

128
Q

low tubule flow

A

low NaCl in macula densa
= no Depolarization

129
Q

AKI

A

kidney stops working abruptly

130
Q

AKI responses

A

decr GFR
decr urine output
incr BUN

131
Q

primary causes of AKI

A

pre-renal
intrinsic
post-renal

132
Q

most common cause of AKI

A

pre-renal

133
Q

prerenal AKI

A

hypovolemia
decr Q
decr ECFV
impaired autoreg

134
Q

prerenal AKI causes

A

cardiac sx
bypass

135
Q

intrinsic AKI

A

sepsis
necrosis/nephrotoxin

136
Q

postrenal AKI

A

obstruction of urinary collection system

137
Q

postrenal AKI causes

A

stones
tumors
ureter ligation
ureter compression

138
Q

anesthesia can cause AKI

A

compound A from sevo

139
Q

prevent AKI with sevo

A

FGF > 2L/min

Su: Phys 2 (12 decks)

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