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Physiology > Renal 3 > Flashcards

Renal 3 Flashcards

1
Q

Glomerular Filtration Rate (GFR)

Rate of production of

A

Glomerular Filtrate

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2
Q

Plasma volume filtered into nephrons/unit time

≈

A

125 ml/min = 180 liters/day

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3
Q

Entire plasma volume is filtered every

A

24 min (60x/day)

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4
Q

Glomerular Filtration Rate (GFR) occurs via

A

bulk flow

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5
Q

Glomerular Filtration Rate (GFR)

selectivity

A

Unselective (except for cells, proteins, Ca++, fatty acids and other protein-bound substances)

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6
Q

Glomerular Filtration Rate (GFR)

regulated by

A

multiple systems

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7
Q

Filtration Fraction = GFR/RPF

Averages

A

20% of renal plasma flow (RPF)

Can be altered

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8
Q

Function of Renal Corpuscle (3)

A
  1. Bowman’s Capsule (Parietal and Visceral layers)
  2. Glomerular Capillaries (Glomerulus/Glomeruli)
  3. Bowman’s Space
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9
Q

Protein Free fluid filtered out of glomerulus into

A

Bowman’s

Space

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10
Q

Filtrate flows

into

A

Proximal

Tubule

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11
Q

Blood in Glomerular Capillaries separated from

Bowman’s Space by a

A

Filtration Barrier

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12
Q

Composed of Three Layers (negatively charged)

A

1.Capillary endothelium (Fenestrated)
2.Basal Lamina (Basement Membrane)
3.Podocytes (Visceral Layer of Bowman’s
Capsule)

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13
Q

Foot processes that cover outside of —, creates

A

basal lamina

Filtration Slits

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14
Q

Mesangial Cells (4)

A
  • Modified smooth muscle cells
  • Surround Glomerular Capillary loops
  • Not part of filtration barrier
  • Modify size of filtration slits and alter rate of
    filtrate production
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15
Q

All substances small enough to fit through

filtration pores and slits will be

A

filtered

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16
Q

Little to no —

A

protein

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17
Q

Determinates of the Ability of a Solute to Penetrate

the Glomerular Membrane (2)

A

molecular size

ionic charge

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18
Q

Molecular size

A

( small molecules

filter better than large ones)

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19
Q

Ionic charge

A

(cations filter better

than anions)

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20
Q

Proteins are both (2), hence do not

filter well.

A

large and

negatively charged

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21
Q

Electrical properties of the

solutes:

A

more positive charge

 higher filterability

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22
Q

In minimal change nephropathy

A

– loss of negative charge on
GBM
-proteins filtered through GBM
-proteinuria

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23
Q

Capillary filtration coefficient

(Kf):

A

product of the
permeability and surface area
of the capillaries.

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24
Q

NFP:

A

Balance of hydrostatic
and colloid osmotic forces
acting across the capillary
membrane.

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25
Q

GFR is high because of

A

high
hydrostatic pressure and high
Kf .

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26
Q

NFP =

A

10 mmHg, 125 ml/min;

180 L/day

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27
Q

Kf =

A

hydraulic conductivity x surface area

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28
Q

Kf = hydraulic conductivity x surface area (3)

A

– 400x higher than any other capillary bed
– Normally not highly variable.
– Alterations in Kf not used to regulate GFR

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29
Q

Diseases can — Kf

A

lower

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30
Q

Diseases can lower Kf (2)

A

– Thickened basement membrane: hypertension,
diabetes mellitus
– Decreased capillary surface area: glomerulonephritis.

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31
Q

Hydrostatic Pressures (2)

A

Glomerular (PG)

Bowman’s Capsule (PB)

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32
Q

Primary control point for GFR.

A

Glomerular (PG)

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33
Q

Determinant of GFR most subject

to physiological control.

A

Glomerular (PG)

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34
Q

Factors that influence PG (3)

A
  • arterial pressure (effect is
    buffered by autoregulation)
  • afferent arteriolar resistance
  • efferent arteriolar resistance.
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35
Q

Bowman’s Capsule (PB)
 Not a — regulator
of GFR (normally changes as a
function of GFR).

A

physiological

36
Q

Bowman’s Capsule (PB)

Diseases can affect GFR via PB (2)

A 
- Tubular Obstruction 
(kidney stones, tubular 
necrosis)
- Urinary tract obstruction 
(prostate 
hypertrophy/cancer)
37
Q

Glomerular Capillary Colloid Osmotic Pressure
(πG)
Increases along length
of

A

glomerular capillary:
– Affected by filtration
fraction.

38
Q

Glomerular Capillary Colloid Osmotic Pressure
(πG)
opposes

A

hydrostatic pressure

39
Q

Glomerular Capillary Colloid Osmotic Pressure
(πG)
GFR — along the length of capillary

A

decreases

factors that affect PiG

40
Q

Control of GFR by Changes in PG
Hydrostatic Pressure in Glomerular capillaries can be altered by
altering the — of the afferent and efferent arterioles.
Leads to changes in —

A

resistance

GFR

41
Q

— GFR due to increased
[plasma protein] caused
by — Filtration Fraction

A

decreased

increased

42
Q

physical determinants: ↓ Kf → ↓ GFR

physiologic/pathophysiologic causes: (3)

A

Renal disease, diabetes mellitus, hypertension

43
Q

physical determinants: ↑ PB → ↓ GFR

physiologic/pathophysiologic causes:

A

Urinary tract obstruction

44
Q

physical determinants: ↑ PiG → ↓ GFR

physiologic/pathophysiologic causes: (2)

A

Increased [proteins]plasma, Dehydration

45
Q

physical determinants: ↓ PG → ↓ GFR

physiologic/pathophysiologic causes:

A

?

46
Q

physical determinants: ↓ MAP → ↓ PG

physiologic/pathophysiologic causes:

A

↓ Arterial pressure (remember that normal MAP sits at

the low end of the myogenic autoregulatory range)

47
Q

physical determinants: ↓ RE → ↓ PG

physiologic/pathophysiologic causes:

A

↓ Angiotensin II (ACE inhibitors)

48
Q

physical determinants: increase RA → ↓ PG

physiologic/pathophysiologic causes: (2)

A

increase Sympathetic activity, vasoconstrictor hormones

49
Q

Renal Blood Flow ≈–% of total cardiac output

A

20

50
Q

RBF =

A

(Pa-Pv)/

Total Renal Vascular Resistance

51
Q

Kidneys tightly control RBF

-

A

– renal auto-regulation.

52
Q

Vascular resistance regulated by

factors acting on

A 
afferent and/or 
efferent arterioles (70% of total 
intrarenal resistance).
53
Q

Blood flow in medulla

A

<10% of total RBF

54
Q

Blood flow in medulla <10% of total

RBF

A
  • Very low flow in vasa recta contributes to
    generation of osmotic gradient for
    concentration/dilution
55
Q

O2 consumption reflects

A

ATP consumption.

56
Q

ATP consumption reflects

A

active transport.

57
Q

Primary Active Transporters (4)

A

 Na+-K+-ATPase
 H+-ATPase
 H+-K+-ATPase
 Ca++-ATPase

58
Q 
Control of RBF (and GFR)
1. Autoregulation  
A.Myogenic Autoregulation
Function: (1)
(2)
A

Keeps RBF and GFR relatively constant in spite of
changes in MAP
 Reflex vessel constriction in response to increase MAP
 Intrinsic to blood vessels

59
Q 
Control of RBF (and GFR)
1. Autoregulation
B. Tubuloglomerular Feedback (TGF)
Function: (1)
(2)
A

Helps ensure a nearly constant delivery of Na+ and Cl- to
the distal nephron
 Prevents spurious fluctuations in renal excretion
 Juxtaglomerular Apparatus

60
Q
  1. Autoregulation (Prevents
A

moment to moment changes in GFR)

61
Q

JGA Mediates the – Response

A

TGF

62
Q

JGA

Composed of: (2)

A

Juxtaglomerular cells (JG)
Macula densa cells in the wall of
TAL

63
Q

Juxtaglomerular cells (JG) (2)

A
  • Primarily in walls of afferent
    arterioles
  • Secrete Renin
64
Q

Macula densa cells in the wall of

TAL (2)

A

In close contact with JG cells

Sense [Na+] and [Cl-] in filtrate

65
Q

Stimuli for Renin Release (3)

A

 decrease BP
 decreaseRBF
 decrease NaCl Delivery to Macula
Densa (TGF Response)

66
Q

Control of RBF (and GFR) (cont.)

Three levels

A

Autoregulation
Local Control
Systemic Control

67
Q

Autoregulation (2)

A

A.Myogenic Autoregulation

B.Tubuloglomerular Feedback

68
Q

Local Control (2)

A

 Paracrines and Autocrines

 Endothelin, Prostaglandins, NO, Bradykinin, Dopamine.

69
Q

Systemic Control (3)

A

 Sympathetic NS and Epinephrine
 Renin-angiotensin system
 Atrial natriuretic peptide

70
Q

SNS (and circulating epinephrine) has minor role in

A

regulating RBF in

“normal” state.

71
Q

Renal autoregulation smooths normal SNS-induced changes in (2)

A

arterial

pressure and cardiac output.

72
Q

SNS activation by — (blood loss, cardiac events, etc) can alter RBF.

A

stress

73
Q

SNS increases — of both afferent and efferent arterioles.

A

resistance

74
Q 
hormone or paracrine: NE/E (severe/acute 
disturbances)
mechanism:
effect on RBF:
effect on GFR:
A

↑RA and ↑RE
↓
↓

75
Q

hormone or paracrine: Endothelin
mechanism:
effect on RBF:
effect on GFR:

A

↑RA and ↑RE
↓
↓

76
Q

hormone or paracrine: Angiotensin II
mechanism:
effect on RBF:
effect on GFR:

A

mainly ↑ RE
↓
↑

77
Q

hormone or paracrine: PGE2, PGI2
mechanism:
effect on RBF:
effect on GFR:

A

↓RA
↑
↑

78
Q

hormone or paracrine: Bradykinin
mechanism:
effect on RBF:
effect on GFR:

A

↓RA
↑
↑

79
Q

hormone or paracrine: NO
mechanism:
effect on RBF:
effect on GFR:

A

↓RA and ↓RE
↑
↑

80
Q

Other Factors that increase GFR and RBF (2)

A
  1. High Protein Diet

2. High Blood Glucose levels

81
Q 
Other Factors that increase GFR and RBF
1. High Protein Diet
2. High Blood Glucose levels
 Both lead to pronounced 
increases in (2)
A

RBF and GFR

82
Q

Other Factors that increase GFR and RBF
1. High Protein Diet
2. High Blood Glucose levels
results in

A

reduced NaCl delivery to macula densa

83
Q

Other Factors that increase GFR and RBF
1. High Protein Diet
2. High Blood Glucose levels
TGF response functions to

A

keep NaCl delivery to macula densa constant

84
Q

Other Factors that increase GFR and RBF
1. High Protein Diet
2. High Blood Glucose levels
opposite effects seen if

A

PT reabsorption is reduced

85
Q

Calculating the Filtered Load (Fx) of a Substance (3)

A

 Rate at which substances enter the nephron
 Units = Amt/time
 Fx = (GFR) ([X]plasma)

86
Q

Calculating the Excretion rate (Ex) of a substance (3)

A

 Rate at which substances are excreted
 Units = Amt/time
 Ex = (Uv)([X]urine); where Uv =Urine Flow Rate

87
Q

Calculating the Clearance rate (Clx) of a substance (5)

A

 Determines the volume of blood cleared of a substance in a
given amount of time
 Units = Vol./time
 Clx = Ex/[X]plasma
 Clinulin and Clcreatinine used as index of GFR
 ClPAH used as index of RBF (Renal Blood Flow

Physiology (53 decks)

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