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BSI > Renal > Flashcards

Renal Flashcards

1
Q

What is the pathway of blood supply to the kidleys?

A

Renal Artery, Afferent Arterioles, Glomerular Capillaries, Efferent Arterioles, Peritubular Capillaries, Renal vein

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2
Q

What is the function of the Glomerulus?

A

Filtration membrane across capillaries: provides filtration of blood cells and most proteins

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3
Q

What are fenestrations?

A

large pores in endothelial cells

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4
Q

What are Mesangial cells?

A

Contractile cells located around glomerulus that help regulate how much surface area is available for glomerular filtration-when contracting the surface area for filtration decreases

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5
Q

What is the function of Juxtaglomerular apparatus?

A

helps regulate blood pressure

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6
Q

What are the functions of the kidney and urinary system?

A

excretion of metabolic waste products and foreign chemicals, regulate plasma volume, and blood pressure, regulate osmolarity and electrolytes, Vit. D synthesis, Erythropoietin synthesis, acid base balance, and gluconeogenesis

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7
Q

The efferent arteriole is ____ in diameter than the afferent arteriole in the kidney?

A

smaller

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8
Q

Resistance to blood outflow is high which _____ blood pressure within glomerulus?

A

increases

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9
Q

Capsular oncotic pressure is typically what?

A

zero, unless there is a pathological condition present

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10
Q

GFR=

A

Kf * net filtration pressure

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11
Q

what does Kf equal?

A

12.5

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12
Q

Constriction of afferent arteriole ____ blood flow into glomerulus

A

decreases

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13
Q

Constriction of afferent arteriole _____ blood hydrostatic pressure

A

decreases

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14
Q

Constriction of afferent arteriole ___ GFR

A

decreases

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15
Q

Constriction of efferent arteriole ___

A

outflow of blood from glomerulus

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16
Q

Constriction of efferent arteriole ___ blood hydrostatic pressure in glomerulus

A

increases

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17
Q

Constriction of efferent arteriole ____ GFR

A

increases

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18
Q

SNS causes ____ of afferent and efferent arterioles

A

vasoconstriction

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19
Q

What effect does ANGII have on the glomerulus?

A

vasoconstricts efferent arteriole

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20
Q

What effect does ANP have on the glomerulus?

A

dilates afferent arterioles

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21
Q

what effect does Norepi and Epi have on the glomerulus?

A

vasoconstricts afferent and efferent arterioles

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22
Q

what effect does Nitric oxide have on the glomerulus?

A

causes vasodilation of afferent arteriole

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23
Q

what effect do prostaglandins have on the glomerulus?

A

vasodilates afferent arteriole

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24
Q

what effect does endothelin have on the glomerulus?

A

vasoconstricts afferent arteriole

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25
Q

How would arteriosclerosis in the afferent arteriole decrease GFR?

A

decrease glomerular hydrostatic pressure

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26
Q

How would a kidney stone in a ureter decrease GFR?

A

increase capsular hydrostatic pressure

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27
Q

What effect does ANGII have on GFR?

A

Increase

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28
Q

What effect does ANP have on GFR?

A

Increase

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29
Q

What effect do prostaglandins have on GFR?

A

increase

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30
Q

what effect does strong SNS stimulation have on GFR?

A

Decrease

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31
Q

Secretion of H+ ions is essential for reabsorption of what?

A

HCO3-

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32
Q

What catalyzes H2CO3- into water and CO2?

A

carbonic anhydrase

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33
Q

What would happen to the HCO3- reabsorption in the PCT if the sodium/potassium ATPase in those cells was inhibited?

A

It would decrease because there will be a loss of the ion gradient to keep the H+ ions flowing with the sodium Hydrogen anti-porter

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34
Q

Where in the kidney pathway does urine become hypotonic?

A

ascending LOH and early DCT

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35
Q

How can inhibition of the Na/Cl/K symporter lead to hypomagnesemia?

A

This will block the K gradient building in the lumen which will lead to less positive pressure there to drive the Mg back into the blood.

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36
Q

If you increase sodium delivery you will increase potassium ____

A

secretion

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37
Q

A carbonic anhydrase inhibitor acting in the CD will cause alkalosis or acidosis?

A

Acidosis

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38
Q

Furosemide will have what effect on K+ secretion in the CD?

A

Increase; sodium reabsorption is inhibited in the LOH so there is more sodium in the filtrate and when it reaches the CD at that concentration a lot more sodium reabsorption occurs

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39
Q

Hyperaldosteronism can cause (hyper or hypokalemia) and (acidosis or alkalosis)

A

Hypokalemia and alkalosis

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40
Q

SNS stimulation and a drop in renal perfusion will ____ stimulation of renin

A

increase

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41
Q

Hyperkalemia can also _____ the aldosterone secretion

A

stimulate

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42
Q

What does ADH do to reabsorption?

A

increase reabsorption of water

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43
Q

What does ANGII do to reabsorption?

A

Increases Na and water reabsorption and secretion of H in PCT by stimulating Na/H anti-porters

44
Q

What does Aldosterone do to reabsorption?

A

stimulates release of aldosterone form adrenal gland. Increases Na reabsorption and secretion of K in principle cells. Stimulates H from intercalated cells.

45
Q

What does ANP do to reabsorption?

A

Released from atrial cells in response to stretching…directly inhibits Na reabsorption in the CD and suppresses secretion of renin

46
Q

what is the effect of PTH on reabsorption?

A

Released in response to hypocalcemia and increase Ca reabsorption in thick ascending LoH and early DCT…decreases HPO4 reabsorption in PCT

47
Q

In the PCT, the osmolarity of the filtrate (does/does not) change

A

does not; due to both water and solutes being reabsorbed

48
Q

In the descending LOH, filtrate becomes (more/less/same) concentration because…

A

more because only water is reabsorbed

49
Q

In the ascending LOH/early DCT, filtrate becomes (concentrated/dilute/remains neutral) since…

A

dilute since solutes are reabsorbed, but not water

50
Q

In the late DCT and CD, filtrate becomes (more/less) diluted because… (trick question…but why?)

A

more diluted in the absence of ADH…less with ADH

51
Q

What are the requirements for excreting concentrated urine?

A

ADH and hyperosmotic medullary interstitium

52
Q

Substances that slow renal reabsorption of water cause what?

A

cause diuresis and therefore decreases blood volume

53
Q

Caffeine does what to the kidneys?

A

inhibits Na reabsorption

54
Q

Alcohol does what to the kidneys?

A

inhibits ADH secretion

55
Q

pH= (classical formulation)

A

-log[H+]

56
Q

pH= (Henderson-Hasselbalch Equation)

A

6.1 + log (HCO3-/.03 * PCO2)

57
Q

Only multiply by .03 in the Henderson-Hasselbalch Equation if you (Did/Did Not) get the concentration of CO2?

A

Did Not

58
Q

H+ secreted by PCT is essential to reabsorb what?

A

HCO3-

59
Q

H+ secretion is driven by what?

A

Na reabsorption

60
Q

As PCO2 levels rise in the blood and filtrate, there will be (less/more) H+ secretion leading to (more/less) HCO3- reabsorption?

A

more, more

61
Q

What is the initial problem in Respiratory acidosis?

A

Increased PCO2 due to hypoventilation causes decreased pH

62
Q

What compensation occurs during Respiratory acidosis?

A

Increased renal secretion of H+ and reabsorption of HCO3-…pH still slightly low even with compensation

63
Q

what is the initial problem with Respiratory alkalosis?

A

Decreased PCO2 due to hyperventilation…increased pH

64
Q

What is the compensation that occurs during respiratory alkalosis?

A

Decreased reabsorption of HCO3- and secretion of H+… pH will be slightly over 7.4

65
Q

What is the initial problem during Metabolic alkalosis?

A

Increased free HCO3- (due to loss of acids or gain of HCO3-…increased pH

66
Q

What is the compensation that occurs with Metabolic alkalosis

A

Hypoventilation causes increase PCO2 and pH will be slightly high

67
Q

what is the initial problem with Metabolic acidosis?

A

Decreased pH, accompanied by decreased free HCO3- (due to gain of acids or loss of HCO3-

68
Q

what is the compensation that occurs with Metabolic acidosis?

A

Hyperventilation which decreases PCO2 and the pH will be slightly low

69
Q

What can the Anion gap tell you?

A

if metabolic acidosis is due to loss of HCO3- from the body or an accumulation of acids

70
Q

Anion Gap=

A

Na- (Cl + HCO3-)

71
Q

Normal Anion Gap values range from

A

8-16 mEq/L

72
Q

If anion gap is normal, metabolic acidosis is due to what?

A

loss of HCO3- from the body

73
Q

What can happen with an accumulation of H+ released from acids in metabolic acidosis due to accumulation of acids?

A

binds to HCO3- which decreases free HCO3- which decreases and the anion gap increases

74
Q

Acidosis causes exchange of extracellular ___ for intracellular ____

A

H+ for K+

75
Q

Alkalosis causes exchange of intracellular ___ for extracellular ____

A

H+ for K+

76
Q

What is renal clearance?

A

volume of plasma from which a particular substance is completely removed per unit time (ml/min)

77
Q

A substance can be cleared from the blood by the kidneys via what?

A

filtration and/or secretion (not reabsorbance)

78
Q

To see if a substance has net reabsorption or secretion then compare it to what?

A

GFR of inulin/SCR and if it is higher then it is secreted

79
Q

what is the formula for GFR?

A

(Uinulin*V)/Pinulin

80
Q

What is the normal value of GFR?

A

125ml/min

81
Q

what is the normal range of CrCL?

A

90-140 ml/min

82
Q

which is more accurate and why (inulin vs. CrCl)

A

inulin…it is completely secreted from the body as the body has no physiologic need for/from it.

83
Q

What is the formula for reabsorption?

A

filtered load - excretion rate

84
Q

what is the formula for filtered load?

A

GFR*Ps

85
Q

What is the formula for excretion rate?

A

Us * V

86
Q

If a substance is bound to a protein such as albumin how will this affect its filtration?

A

decrease

87
Q

What is the formula for secretion rate?

A

excretion rate - filtered load

88
Q

What characterizes Acute renal failure?

A

A decrease in glomerular filtration rate

89
Q

What is oliguria?

A

diminished urine output

90
Q

What is anuria?

A

total cessation of urine output

91
Q

What are pre-renal causes of acute renal failure?

A

result in decreased glomerular hydrostatic pressure and therefore decreased GFR. Comes from a decrease in intravascular volume or loss of effective blood volume

92
Q

Renal failure due to kidney stones would be characterized as what?

A

Post-renal cause

93
Q

Post-renal causes of renal failure decrease GFR by what mechanism?

A

increasing capsular hydrostatic pressure

94
Q

Renal failure due to an ACE inhibitor would be characterized as what?

A

A pre-renal cause

95
Q

Pre-renal causes of renal failure decrease GFR by what mechanism?

A

Decreasing glomerular hydrostatic pressure

96
Q

What is the mechanism of an ACE inhibitor?

A

blocks vasoconstriction of efferent arteriole by ANGII which can lead to vasodilation and decreased GFR

97
Q

What is the mechanism of an NSAID upon the kidleys?

A

block synthesis of prostaglandins and interfere with afferent arteriolar vasodilation causing a decrease in GFR

98
Q

What is an Intrarenal cause of renal failure?

A

when direct damage occurs to the kidney rather than an obstruction or perfusion issue

99
Q

What is a post-renal cause to renal failure?

A

obstruction of urine flow

100
Q

Chronic renal failure will cause a ____ number of functioning nephrons and therefore a ____ GFR?

A

decreased, decreased

101
Q

What can cause proteinuria?

A

damage to the glomerulus

102
Q

What will prostaglandins do to the renal system?

A

mediated afferent arteriolar vasodilation in nephrons

103
Q

what will ANG II do to the kidneys?

A

mediated efferent arteriolar vasoconstriction in nephrons

104
Q

How can an ACE inhibitor delay the progression of chronic kidney failure?

A

by blocking ANGII which will cause vasodilation in efferent arterioles thus decrease glomerular hydrostatic pressure and preserves nephrons thru this mechanism.

105
Q

Can chronic kidney disease be present with a normal or near normal GFR?

A

yes, if other markers are present

106
Q

Serious symptoms usually do not occur in chronic renal failure until what?

A

loss of 70-75% of nephrons

107
Q

what is the most common cause of death from renal failure?

A

cardiac dysfunction

BSI (7 decks)

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