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Renal Flashcards

1
Q

What is the order of the filtration membrane from inner to outer?

A

Fenestrated epithelium -> Basal Lamina -> Slit membrane

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2
Q

What does the fenestrated epithelium allow through?

A

Large, medium and small proteins

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3
Q

What does the basal lamina allow through?

A

Medium and small proteins

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4
Q

What does the slit membrane allow through?

A

Small proteins

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5
Q

What do none of the layers of the filtration membrane allow through?

A

Cells

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6
Q

What cells make up the visceral layer of the glomerular capsule?

A

Podocytes

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7
Q

After passing through the 3 layers of filtration, where is the filtrate?

A

Urinary/capsular space

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8
Q

How does blood enter the renal corpuscle?

A

Through the afferent arteriole

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9
Q

How does blood exit the renal corpuscle?

A

Through the efferent arteriole

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10
Q

What is the glomerulus?

A

Network of capillaries

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11
Q

What is the glomerular/bowmans capsule?

A

The pouch that covers the glomerulus

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12
Q

Describe the path of filtrate from the urinary space to the bladder

A

Proximal convoluted tubule -> thick descending LOH -> thin descending LOH -> thin ascending LOH -> thick ascending LOH -> distal convoluted tubule -> collecting duct -> papillary duct -> calyx -> renal pelvis -> ureter -> bladder

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13
Q

What are the 3 layers of protection around the kidney from outer to inner?

A

Renal fascia -> adipose capsule -> renal capsule

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14
Q

What separates lobules?

A

Interlobular arteties

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15
Q

What separates lobes?

A

Interlobar artieries

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16
Q

Describe the path of blood from the interlobular artery to the interlobular vein

A

Interlobular artery -> afferent arteriole -> glomerular capillaries -> peritubular capillaries of the cortex -> descending vasa recta -> peritubular capillaries of the medulla -> ascending vasa recta -> interlobular bein

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17
Q

Approx. how many nephrons are in each kidney?

A

~1 million

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17
Q

What controls the flow of blood into the glomerulus?

A

Afferent arterioles

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18
Q

How many lobes do human kidneys have?

A

8-12

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19
Q

How much does each kidney weigh?

A

150g

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20
Q

What are the protective layers of the kidneys made of?

A

Connective tissue

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21
Q

How is osmolarity calculated?

A

Molarity x dissociation factor

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22
Q

Does osmolarity measure solute or water?

A

Solute

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23
Q

What happens to a cell in a 150mM NaCl solution?

A

Nothing - it is isotonic

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24
Q

What is meant by hypotonic and what happens to a cell placed in a hypotonic solution?

A

A solution with a higher POsm than another - cell will shrink as water moves out

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25
Q

What happens to a cell in a 300mM urea solution?

A

Swells - cell is hypotonic to solution

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26
Q

What is meant by hypertonic and what happens to a cell placed in a hypertonic solution?

A

A solution with a lower POsm than another - cell will swell as water moves in

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27
Q

What is meant by isotonic and what happens to a cell placed in a isotonic solution?

A

2 solutions with the same POsm - no net water movement

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28
Q

What percent (and volume) of the body is fluid (70kg male)

A

60% - 42L

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29
Q

How much of the body’s fluid is intracellular (include approx. volume)?

A

2/3 - 28L (2/3 of 42)

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30
Q

How much of the body’s fluid is extracellular (include approx. volume)?

A

1/3 - 14L (1/3 of 42)

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31
Q

What makes up extracellular fluid, including approx percentages and volumes

A

20% plasma - 2.8L
80% interstitial - 11.2L

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32
Q

What are the 3 major sources of water intake?

A

Drinks, foods, metabolism

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33
Q

What are the 4 major sources of water output?

A

Urine, skin, lungs, feces

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34
Q

What ions have higher extracellular concentrations?

A

Na+ (142mM EC, 10mM IC), Cl- (103mM EC, 4mM IC), Ca2+

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35
Q

What ion has a higher intracellular concentration?

A

K+ (140mM IC, 4mM EC)

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36
Q

What percentage of body mass is the kidney?

A

0.5%

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37
Q

What percentage of cardiac output does the kidney receive at rest?

A

20-25%

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38
Q

What is the blood flow through the kidney per minute (in a 70kg male)?

A

1100ml/min

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39
Q

How many litres of blood are filtered through the kidneys each day?

A

180L

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40
Q

How much urine is produced every day?

A

1.4L

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41
Q

What is the equation that represents urine production?

A

Excretion = filtration - reabsorption + secretion

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42
Q

What is not reabsorbed at all?

A

Creatinine

43
Q

What is the major driving force in the glomerular?

A

Glomerular capillary hydrostatic pressure

43
Q

What are the 4 pressures in the glomerular capillaries and their approximate values?

A

PGC - glomerular capillary hydrostatic pressure (55mmHg)

πBS - Bowman space oncotic pressure (

PBS - Bowman space hydrostatic pressure (15mmHg)

πGC - Glomerular capillary oncotic pressure (30mmHg)

44
Q

What 2 forces drive filtrate out of the glomerular capillaries?

A

PGC & πBS

45
Q

What 2 forces drive filtrate into the glomerular capillaries?

A

πGC & PBS

46
Q

What is the approx. value of net filtration pressure?

47
Q

What is the equation for net filtration pressure?

A

NFP = GBHP - CHP - BCOP

48
Q

What are the 2 autoregulation mechanisms of the kidneys?

A

Myogenic and tubuloglomerular feedback

49
Q

What effect does constriction of the afferent arteriole have on PGC/GBHP and GFR?

A

Decreased pressure and GFR

49
Q

What effect does constriction of the efferent arteriole have on PGC/GBHP and GFR?

A

Increased pressure and GFR

49
Q

What are the 3 ways in which glomerular filtration is regulated?

A

Autoregulation, neural, hormonal

50
Q

What are the 2 main things impacting GFR?

A

GBHP (PCG) and surface area

51
Q

What is the neural regulation of GFR?

A

Sympathetic nerve activity causing vasoconstriction of afferent arteriole(baroreflex)

52
Q

What is the overall effect of angiotensin 2 on GFR?

A

Maintained

53
Q

What are the 2 hormonal mechanism of GFR regulation?

A

Angiotensin 2 and ANP

54
Q

What does angiotensin do to the arterioles in the glomerular?

A

Constriction of both (however, tubuloglomerular feedback counteracts the constriction of afferent arteriole)

55
Q

What does ANP stand for?

A

Atrial Natriuretic Peptide

56
Q

What does ANP cause?

A

Relaxation of mesangial cells, leading to increased surface area for filtration -> more sodium release into the urine, leading to more water in the urine and an overall decrease in blood volume

57
Q

What causes ANP release?

A

Stretching of the atria

58
Q

What is the effect of SNS on GFR?

58
Q

What is the effect of ANP on GFR?

59
Q

What is urine output directly proportional to?

A

Renal pressure

60
Q

Describe tubuloglomerular feedback

A

Increased GFR -> increased Na+, Cl- and water content sensed by the macula densa cells in the distal tubule -> Juxtaglomerular cells in afferent arteriole sense macula densa cells -> decreased release of NO from juxtaglomerular cells -> afferent arteriole vasoconstriction -> decreased GBHP and GFR -> slower flow promotes more Na+ reabsorption

61
Q

What are corticol nephrons involved in the production of?

A

Dilute urine

62
Q

What are juxtamedullary nephrons involved in the production of?

A

Concentrated urine

63
Q

The cells of which part of the nephron have microvilli?

A

Proximal convoluted tubule

64
Q

Describe the cells in the loop of henle

65
Q

Where does the majority of reabsorption occur?

A

Proximal convoluted tubule

66
Q

What percentage of glomerular filtrate is reabsorbed in the proximal tubule?

67
Q

What percentage of NaCl & water is reabsorbed in the proximal tubule?

67
Q

What percentage of glucose is reabsorbed in the proximal tubule?

68
Q

Describe the osmolarity of the fluid in the lumen of the proximal tubule at the start and end

A

Isosmotic (Na+ and water both reabsorbed together, ~290mOsmol/L)

69
Q

Describe the movement of ions and solutes in the proximal tubule

A

Na+ moved into cells along with glucose via symporter (both down conc. grad)

Na+ is pumped out of basement membrane by Na+/K+ ATPase (creating a concentration gradient for Na+ uptake)

Glucose diffuses through the transporter across the basement membrane

Water follows Na+ (osmosis)

70
Q

What is reabsorbed in the descending limb of Henle?

A

Only water

71
Q

Describe the filtrate at the bottom of the LOH

A

Very concentrated, 1200mOsmol/L

72
Q

What is reabsorbed in the thick ascending limb of Henle?

A

Only ions (NOT water)

73
Q

Describe the movement ions in the ascending LOH

A

Na+, Cl- and K+ all actively pumped into cell through symporter

Cl- diffuses out of cell across BM

Na+ pumped out of cell across BM

74
Q

Where is the interstitial fluid most concentrated?

A

Tip of the medulla

75
Q

What occurs in the distal convoluted tubule?

A

Additional reabsorption of NaCl & water (if ADH is present)

76
Q

What does the absence of ADH produce?

A

Dilute urine

77
Q

Where is glucose reabsorbed?

A

Proximal convoluted tubule

78
Q

What part of the nephron cannot reabsorb water?

A

Ascending LOH

79
Q

What releases renin?

A

Juxtaglomerular cells of afferent arteriole

80
Q

What hormone has the greatest influence on water retention?

81
Q

What part of the nephron does ADH act on?

A

Distal convoluted tubule and collecting duct

82
Q

What does ADH cause to happen in the apical membranes?

A

Insertion of aquaporin 2 channels via exocytosis

83
Q

What releases ANP?

A

Cardio myocytes

84
Q

What enzyme converts angiotensinogen to angiotensin 1?

85
Q

What is the effect of angiotensin 2 on the PCT?

A

Increased Na+ uptake via Na+/H+ antiporter

86
Q

What is the overall effect of ADH?

A

Increased water reabsorption through aquaporin 2 channels in the DCT and CD leading to increased water reabsorption, increased urine concentration and decreased urine production

87
Q

What is the overall effect of ANP?

A

Reduced renin, ADH and aldosterone

Increased GFR

Reduced Na+ and water reabsorption -> increased urination and decreased BV and BP

88
Q

What is the overall effect of Aldosterone?

A

Increased transcription of Na+/K+ ATPase in DCT and CD to increase Na+ and water reabsorption (and K+ secretion)

89
Q

What is the overall effect of Renin?

A

Maintenance of Na+ balance and blood pressure

90
Q

What is the overall effect of Angiotensin 2/ what does it do?

A

Vasoconstriction of blood vessels (predominantly efferent) to help maintain GFR

Increase Na+/H+ antiporters in PCT to increase Na+ and water reabsorption

Stimulates release of aldosterone from adrenal cortex -> increased Na+ reabsorption in DCT

Acts centrally to stimulate thirst and salt intake, release ADH and stimulate SNS

91
Q

What stimulates the release of ADH?

A

Increased Na+/Osmolarity - sensed by osmoreceptors in the hypothalamus

Decreased BP and BV (baroreceptors)

92
Q

What stimulates the release of Renin?

A

Decreased NaCl sensed by Macula Densa cells -> increased prostaglandin secretion

Decreased BP or BV. in afferent arteriole

Increased SNS stimulation

93
Q

How do osmoreceptors work?

A

Via stretch-activated ion channels, which are opened when ECF is hypertonic and cell shrinks, allowing Na+ ions to enter and an AP to be triggered

94
Q

What is the effect of an increase in plasma osmolality on ADH level?

A

Increased ADH release

95
Q

What is the effect of increased thirst on ADH?

A

Increased ADH release

96
Q

Name a common ACE inhibitor

A

Lisinopril

97
Q

What is the effect of increased salt intake on angiotensin 2?

98
Q

What is the effect of ANP on the arterioles?

A

Dilation of afferent, constriction of efferent

99
Q

What is the normal GBHP?

100
Q

What is the normal BCOP in the glomerulus?

101
Q

What is the normal CHP?

Medsci142 (15 decks)

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