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Physiology 208 > Renal > Flashcards

Renal Flashcards

1
Q

Renal History

A
  • urine characteristics have been used as an indicator of health
  • color, clarity, odor, taste
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2
Q

Honey-urine Disease

A
  • diabetes
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3
Q

Most Important Function of the Kidneys

A
  • homeostatic regulation of water and ion content of the blood
  • salt-water balance or fluid-electrolyte balance
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4
Q

Kidney Functions

A
  1. regulation of ECF volume and blood pressure
  2. regulation of osmolarity
  3. maintenance of ion balance
  4. homeostatic regulation of pH
  5. excretion of wastes
  6. production of hormones
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5
Q

Ions that Kidneys Balance

A
  • Na+, K+, Ca2+
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6
Q

Hormones Produced by Kidneys

A
  • erythropoeitin and renin
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7
Q

Excretion of Wastes

A
  • metabolic and xenobiotics
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8
Q

Reserve Capacity

A

1: 1000 born with one kidney

- can lose 3/4 kidney function before affecting homeostasis

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9
Q

CO received

A

20-25%

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10
Q

the kidney is divided into an _____ ______ and an _____ _______

A
  1. outer cortex

2. inner medulla

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11
Q

Urine leaving the _____ flows into the _____ ______ to passing through the ureter into the bladder

A
  1. nephron

2. renal pelvis

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12
Q

Nephrons

A
  • the functional unit of the kidneys
  • 80% cortical nephrons
  • 20% juxtamedullary nephrons
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13
Q

The cortex contains…

A
  • all Bowman’s capsules, proximal and distal tubules
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14
Q

The medulla contains…

A
  • loops of Henle and collecting ducts
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15
Q

Vascular Components in ORDER

A
  1. Renal artery
  2. Afferent arterioles
  3. Glomerulus (capillaries)
  4. Efferent Arterioles
  5. Peritubular Capillaries
  6. Renal Veins
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16
Q

One nephron has ___ arterioles and ____ sets of capillaries that form a _______

A
  1. two
  2. two
  3. portal system
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17
Q

Portal System

A
  • two capillary beds in a series
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18
Q

Tubular Components in ORDER

A
  1. Bowman’s Capsule
  2. Proximal Tubule
  3. Descending loop of Henle
  4. Ascending loop of Henle
  5. Distal tubule
  6. Collecting duct
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19
Q

capillaries at the glomerulus form a _____ mass

A

ball-like

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20
Q

4 Processes in the Kidney

A
  1. Filtration (glomerular)
  2. Reabsorption
  3. Secretion
  4. Excretion
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21
Q

Movement from blood to lumen is…?

A

filtration

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22
Q

Reabsorption

A

from lumen to blood

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23
Q

Secretion

A

from blood to lumen

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24
Q

Excretion

A

from lumen to outside the body

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25
Q

How much is filtered, reabsorbed, excreted per day

A
  • 180L filtered
  • > 99% is reabsorbed
  • ~1.5 L/day is excreted
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26
Q

~70% of reabsorption occurs where?

A

proximal tubule

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27
Q

Loop of Henle

A
  • responsible for creating dilute urine
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28
Q

Distal Tubule and Collecting Duct

A
  • regulate salt and water balance under control of hormones
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29
Q

T/F: the quantity and composition of substances being absorbed/secreted are equal in diff. segments of nephron

A

FALSE

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30
Q

amount excreted equation

A

amount filtered - amount reabsorbed + amount secreted

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31
Q

Filtration

A
  • filtration of plasma from glomerular into kidney tubule: first step in urine formation
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32
Q

What substances make up filtrate?

A
  • plasma and dissolved solutes
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33
Q

Where do RBC’s and plasma proteins go?

A
  • stay in the blood
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34
Q

Filtration Fraction

A

only 20% of plasma that enters Bowman’s Capsule is filtered

- 80% continues to peritubular capillaries

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35
Q

Triple Filtration Barrier

A
  1. capillary endothelial cells (fenestrated)
  2. basal lamina (EC matrix)
  3. podocyte endfeet
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36
Q

Podocyte Foot

A
  • surround each capillary
  • leaves slits through which filtration takes place
  • can move to alter filtration
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37
Q

Mesangial Cells

A
  • between the capillaries
  • contract to alter blood flow
  • can alter filtration
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38
Q

3 Pressures that govern Filtration

A
  1. hydrostatic pressure
  2. colloid osmotic (oncotic) pressure
  3. Bowman’s capsule hydrostatic pressure
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39
Q

Hydrostatic Pressure

A
  • of blood in the glomerular capillaries
  • favours filtration
  • ~55 mmHg
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40
Q

Colloid Osmotic (Oncotic) Pressure

A
  • of the blood is the pressure gradient due to the presence of plasma proteins
  • opposes filtration
  • ~30 mmHg
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41
Q

Bowman’s Capsule Hydrostatic Pressure

A
  • fluid pressure
  • opposes filtration
  • ~15 mmHg
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42
Q

Net Filtration Pressure

A

Ph - pi - Pfluid

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43
Q

Glomerular Filtration Rate (GFR)

A
  • the volume of fluid that filters from the glomerular capillaries into the Bowman’s capsules/unit time
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44
Q

Normal GFR

A

~125 ml/min or 180L/day

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45
Q

How many times a day do the kidneys filter our entire plasma

A
  • 60 times a day

- plasma volume = 3 L

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46
Q

If plasma was not absorbed then…

A
  • run out of plasma in 24 min
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47
Q

2 Factors Influence GFR

A
  1. Net Filtration Pressure

2. Filtration Coefficient

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48
Q

Net Filtration Pressure

A
  • renal blood flow and blood pressure
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49
Q

Filtration Coefficient

A
  • the surface area of the glomerular capillaries available for filtration and permeability of interface between capillaries and Bowman’s capsule
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50
Q

T/F: GFR is relatively constant?

A

TRUE

- relatively constant over a wide range of blood pressures

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51
Q

How is GFR Regulated?

A
  • primarily by renal arterioles (afferent and efferent)
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52
Q

Renal Blood Flow (RBF)

A
  • dependent on overall resistance
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53
Q

Overall Resistance

A
  • determined by the resistance in both the afferent and efferent arterioles
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54
Q

What happens when afferent dilates and efferent stays the same?

A
  • RBF = increases
  • hydrostatic pressure = increases
  • GFR = increases
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55
Q

Regulation mainly occurs at the _____ arterioles

A

AFFERENT

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56
Q

T/F: RBF and GFR are always directly proportional

A

FALSE

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57
Q

What happens when afferent constricted and efferent stays the same?

A
  • RBF = decreases
  • hydrostatic pressure = decreases
  • GFR = decreases
58
Q

What happens when afferent stays the same and efferent dilates?

A
  • RBF = increases
  • hydrostatic pressure = decreases
  • GFR = decreases
59
Q

What happens when afferent stays the same and efferent constricts?

A
  • RBF = decreases
  • hydrostatic pressure = increases
  • GFR = increases
60
Q

GFR Autoregulation

A
  • protect the filtration barriers from high blood pressures that would cause damage
61
Q

2 Auto-Regulatory Mechanisms

A
  1. Myogenic response of the afferent arterioles

2. Tubuloglomerular Feedback

62
Q

Myogenic Autoregulation

A
  • contraction in response to stretch of the vascular smooth muscle
  • in afferent arteriole
63
Q

Myogenic Response of Afferent Arterioles Process

A
  1. increase intraluminal pressure
  2. increase vessel wall tension and VSMC stretch
  3. mechano-dependent event
  4. depolarization
  5. L-type Ca2+ channel activation and Ca2+ entry
  6. VSMC contraction
64
Q

Tubuloglomerular Feedback

A
  • local control pathway in which fluid flow through the tubule portion of the nephron influences GFR
65
Q

Macula Densa Cells

A
  • sense distal tubule flow and release paracrine that affect afferent arteriole diameter
  • become activated by increased NaCl
66
Q

Granular Cells

A
  • secrete renin
67
Q

Renin

A
  • enzyme involved in salt and water balance
68
Q

Tubuloglomerular Feedback Process

A
  1. GFR increases
  2. flow through tubule increases
  3. flow past macula dense increases
  4. paracrine from macula densa to afferent arteriole
  5. afferent arteriole constricts
  6. resistance in afferent arteriole increases
  7. Ph in glomerulus decreases
  8. GFR decreases
69
Q

Paracrine Signals during Tubuloglomerular Feedback

A
  • possible ATP being converted to adenosine
70
Q

Integrating Centers Outside of Kidneys

A
  • capable of over riding the local control mechanisms by altering resistance or filtration coefficient
71
Q

Sympathetic Neurons

A
  • release norepinephrine
  • acts on a1 adrenergic receptors on both afferent and efferent arterioles
  • results in vasoconstriction
72
Q

Sympathetic Activation

A
  • only alters GFR under conditions of hemorrhage or severe dehydration when water needs to be conserved
73
Q

Hormones that Influence GFR

A
  • angiotensin II
  • prostaglandins
  • alter filtration coefficient by acting on podocytes and/or mesangial cells
74
Q

Angiotensin II

A
  • modulate arteriole resistance

- potent vasoconstrictor

75
Q

Prostaglandins

A
  • modulate arteriole resistance

- act as vasodilators

76
Q

Modulation of Podocytes

A
  • changes size of the filtration slits altering permeability for filtration
77
Q

Concentration of Mesangial Cells

A
  • alters capillary surface area available for filtration
78
Q

Less than ____ is actually excreted of 180 L/day

A

1% (1.5 L)

79
Q

Regulated Reabsorption

A
  • allows kidneys to selectively return ions and water to the plasma to maintain homeostasis
80
Q

Why filter 180L if only 1% is excreted?

A
  • many foreign substances are filtered into the tubules but not reabsorbed (rapid removal)
  • frequent filtration of ions and water into tubules simplifies regulation and allows it to occur rapidly
81
Q

T/F: Reabsorption may be passive or active

A

TRUE

82
Q

Filtrate in lumen and ECF initially have _____ solute []’s

A

similar

83
Q

Active Transport

A
  • used to generate electrochemical, osmotic and concentration gradients for reabsorption
84
Q

Most renal transport is…

A

TRANSCELLULAR

- uses membrane transporters

85
Q

Basolateral Na+ Transport

A
  • always active transport via Na-K-ATPase
  • Na+ enters cell, moving down electrochemical gradient
  • NA+ pumped out
86
Q

Secondary Active Transport

A
  • symport with Na+
  • sodium-linked reabsorption: indirect (secondary) active transport
  • a lot of substances depend on this active transport
87
Q

Passive Reabsorption

A

ex) urea
- nitrogenous waste product
- usually urea is equal but as fluid moves urea become diluted in ECF

88
Q

Endocytosis

A
  • very small plasma proteins or peptides
89
Q

Megalin

A
  • receptor mediated endocytosis receptor binding plasma proteins
  • once in the cell the proteins are digested by lysosomes
90
Q

Saturation

A
  • the maximum rate of transport that occurs when all available carriers are occupied
91
Q

the ____ of substances transported in the nephron use ______ _______

A
  • majority

- membrane proteins

92
Q

Amount of glucose filtered depends on…

A
  • the plasma [glucose]
93
Q

Transport Maximum

A
  • the transport rate at saturation
94
Q

Excess glucose filtered

A

= more glucose than transporters and some glucose is excreted (diabetes)

95
Q

Glucose

A
  • completely reabsorbed in the proximal
96
Q

Renal Threshold

A
  • the plasma concentration of a solute when it first begins to appear in the urine
97
Q

Glucosuria/Glycosuria

A
  • glucose appearing in your urine
  • occurs with elevated blood glucose
  • rare genetic disorder with reduced transporters
98
Q

Peritubular Capillary Pressures Favours…

A

reabsorption

99
Q

Reabsorption of water and solutes

A
  • water and solutes are reabsorbed from tubule lumen to interstitial space and must reenter circulation
100
Q

Hydrostatic Pressure in Glomerulus

A
  • 55mmHg
101
Q

Hydrostatic Pressure in Glomerulus After Fluid is Removed from Blood

A
  • drops to ~10 mmHg after exiting the glomerulus
102
Q

T/F: Plasma Proteins are filtered

A

FALSE

103
Q

Oncotic Pressure of Blood to Peritubular

A
  • remains at 30 mmHg as blood travels to peritubular
104
Q

Secretion

A
  • the transfer of molecules from the extracellular fluid into the lumen of the nephron
  • depends mainly on membrane transport proteins
105
Q

Secretion = Active Process

A
  • requires the movement of substances against their concentration gradients
106
Q

Secretion regulates what?

A
  • homeostatic regulation of K+ and H+ (distal)
  • regulates organic compounds (medications, food additives in proximal region)
  • very important
107
Q

Secretion and Excretion

A
  • secretion enhances the excretion of a substance
  • filtered and not reabsorbed
  • plus it’s secreted then excretion of substance will be very high
108
Q

Tertiary Action Transport

A
  • multi-step process

- secretion of organic solutes

109
Q

OAT Transporter

A
  • tertiary active transporter
  • uses energy from transporting dicarboxylates down its concentration gradient to move OA- against its concentration gradient
110
Q

aKG-

A

a-ketoglutarate

- by-product of the citric acid cycle

111
Q

Penicillin

A
  • isolated from bread mold
  • nearly all penicillin ingested would be excreted within 3-4 hours
  • given with probenecid
112
Q

Probenecid

A
  • competitor of penicillin

- preferentially secreted by the OAT transporter

113
Q

Fluid at the end of the Nephron

A
  • bears little resemblance to the filtrate
114
Q

Substances Reabsorbed

A
  • glucose, amino acids, useful metabolites
115
Q

Info from Excretion

A
  • tells us what body is eliminating

- can’t tell us details of renal function

116
Q

Excretion Equation

A

= filtration - reabsorption + secretion

117
Q

Renal Handling and GFR

A
  • GFR: indicator of overall kidney function

- renal handling/clearance info on new drugs is necessary

118
Q

Clearance is a _____ way to measure GFR

A
  • noninvasive
119
Q

Accurately Calculate GFR

A
  • look at clearance of a substance that is freely filtered and neither reabsorbed or secreted
120
Q

Inulin

A
  • polysaccharide found in a variety of plants
  • found in isolated nephrons
  • completely filtered and not reabsorbed
  • this is most accurate method, but impractical
121
Q

Filtered Load of X equation

A

= [X]plasma x GFR

122
Q

GFR Equation

A

= excretion rate of inulin ———————————– [inulin]plasma

123
Q

Clearance of X Equation

A

= excretion rate of X (mg/min) —————————————— [X]plasma (mg/mL plasma)

124
Q

Creatine Clearance

A
  • most commonly used to measure GFR
  • indicator of renal function
  • freely filtered by glomerulus, BUT secreted in very small amounts as well
  • slightly overestimated GFR
125
Q

Creatine

A
  • product of phosphocreatine breakdown

- produced and broken down at relatively stable levels in the body

126
Q

Net Renal Handling

A
  • determined by Clearance
  • once GFR is known, can look at how their kidneys handle any solute by measuring the solutes plasma concentration and excretion rate
127
Q

How to tell how the nephron handled a substance

A
  • comparing filtered load (filtered freely) with excretion rate
    OR
    -* compare GFR to calculated clearance
128
Q

Net Reabsorption

A
  • if less substance appears in the urine than was filtered

- excreted = filtered - reabsorbed

129
Q

Net Secretion

A
  • if more appears in urine than was filtered
130
Q

Net Handling of a Solute

A
  • comparison of clearance values
131
Q 
GFR = Clearance
Filtered = Excreted
A
  • filtered, not reabsorbed, not secreted

- ex) inulin

132
Q

GFR > Clearance

Filtered > Excreted

A
  • filtered and net reabsorption

- ex) glucose, urea

133
Q

GFR < Clearance

Filtered < Excreted

A
  • filtered and net secretion

- ex) penicillin

134
Q

Micturition Reflex

A
  • initiated by stretch receptors which are activated by the filling of the bladder
135
Q

Micturition Process

A
  1. stretch receptors fire
  2. parasympathetic neurons fire. motor neurons stop firing
  3. smooth muscle contracts. internal sphincter is passively pulled open. external sphincter relaxes
136
Q

Urge to urinate appears around _____ ml

A

200 ml

137
Q

when is the internal sphincter forced to open?

A
  • exceeding 500 ml

- reflexive opening of external sphincter and loss of voluntary opposition

138
Q

How much is left in the bladder after micturition?

A

~ 10 ml

139
Q

Incontinence

A
  • the inability to control urination voluntarily
140
Q

Incontinence in Infants

A
  • corticospinal connections necessary for voluntary control have yet to be established
141
Q

Incontinence Causes

A
  • infants
  • damage to internal or external sphincter
  • spinal cord damage
  • aging

Physiology 208 (11 decks)

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