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BMS2031 > RENAL > Flashcards

RENAL Flashcards

1
Q

What is the filtration unit of the nephron?

A
  • Renal Corpuscle
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2
Q

What does the renal corpuscle comprise of?

A
  • Glomerulus + Fluid filled bowmans capsule
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3
Q

What are the 3 processes involved in urine formation?

A
  1. Glomerular filtration
  2. Tubular reabsorption
  3. Tubular secretion
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4
Q

What is the renal blood vessel arrangement?

A
  • Arteriole–> Capillaries–> arterioles–> Venules
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5
Q

Do plasma proteins normally filter through the glomerulus?

A

NO! Too large

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6
Q

What is the difference between fluid in the plasma and bowman’s capsule?

A
  • Bowmans capsule is free of protein
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7
Q

In general, which of the 3 processes in urine formation would be active when glucose enters?

A
  • Filtration, COMPLETELY reabsorbed, NOT SECRETED
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8
Q

In general which of the 3 processes of urine formation would be active with many electrolytes (ions)?

A
  • FIltration, SOME absorption and NO SECRETION
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9
Q

Which force drives filtration?

A
  • Hydrostatic pressure and large finestrations (high permeability)
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10
Q

What are the 3 layers of the glomerular filtration barrier? (inside–> out)

A
  1. Single celled capillary endothelium (pores/finestrae)
  2. Non-cellular basement membrane
  3. Single celled epithelial lining of Bowmans capsule (podocytes and filtration slits)
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11
Q

What happens to the filtrations between endothelial cells in kidney failure?

A
  • Become clogged, so can’t filter well (also in diabetes)
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12
Q

Are waste products well absorbed?

A

-No!

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13
Q

Are ions well absorbed?

A
  • YES! Important to the body
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14
Q

How much filtrate is taken back into body?

A
  • 99%
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15
Q

What is the equation for excretion?

A
  • Excretion=Filtrate- (re absorption + Secretion)
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16
Q

Is glucose 100% reabsorbed normally?

A
  • YES!
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17
Q

Is sodium or water reabsorbed more in general? -

A
  • Sodium (99.5%) compared to H20 (99%)
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18
Q

What is GFR?

A
  • Glomerular filtration rate

- Volume of filtrate formed from kidney each minute (ml/min)

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19
Q

What is the normal GFR?

A
  • 125ml/min (180L/day)
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20
Q

What would happen without tubular reabsoprtion?

A
  • Whole plasma volume (3L) and essential solutes would be excreted within 30MINS
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21
Q

What would happen in the body if GF continued normally, but tubular reabsorption decreased to 50% of normal rate?

A

Excretion would increase

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22
Q

In tubular reabsoprtion, which two pathways can solutes take?

A
  • Transcellular (through cells)

- Paracellular (through tight junctions)

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23
Q

What is the transcellular pathway for tubular reabsorption?

A
  • Luminal membrane –> cytosol—> Basolateral membrane –> interstitial fluid–> Endothelial cells–> Plasma of peritubular capillareis
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24
Q

Is reabsorption of H20 secondary to Na+?

A

YES! Most of energy goes into reabsorbing sodium

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25
Q

Where is almost all water and sodium reabsorbed?

A
  • Proximal tubule
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26
Q

What happens if all the protein carriers are saturated with reabsoprtion?

A
  • There is more excretion of the substance (bc. they are saturated)-excess will be excreted
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27
Q

What is the transport maximum?

A
  • (Tm- mg/min)

- Maximum rate that solute can be transported to peritubular capillaries

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28
Q

What is the filtration rate of glucose proportional to?

A
  • Plasma concentration of glucose - until Tm is reached
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29
Q

What is glucosuria and what is it due to?

A
  • Presence of glucose in urine
  • Due to excess plasma glucose concentration– Tm reached so it is excreted in urine (diabetes)
  • 300mg/100ml
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30
Q

What is poyluria?

A
  • Excessive volume of urine
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31
Q

What is oliguria?

A
  • Small volume of urine
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32
Q

What does renal control of body water and Na+ determine?

A
  • Extracellular (plasma aswell) fluid volume and osmolarity
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33
Q

What does most renal energy go towards?

A
  • Na+ absorption
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34
Q

What would happen to our body (in general) if we only absorbed water (not Na+)?

A
  • Eventually, water would enter the cells and they would burst
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35
Q

Where is the majority of water reabsorbed?

A
  • In the proximal tubules (osmosis)-67% reabsorbed
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36
Q

What is a H2O diuresis?

A
  • the process of removing excess H2O to correct plasma hyposmolarity
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37
Q

In general, if you drank 1L of water, what effect would it have on various body fluids? (Total body H2O, ECF vol, ECF plasma osmolarity, ICF vol, ICF osmolarity, cells)?

A 
TOTAL BODY H2O: Increase
ECF FLUID VOLUME: Increase 
ECF PLASMA OSMOLARITY: Decrease 
ICF OSMOLARITY: Decrease 
CELLS SWOLLEN OR SHRUNK: Swollen
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38
Q

Which structure detects changes in plasma osmolarity?

A
  • Posterior pituitary secretes ADH
  • Paraventricular nucleus and supraoptic nucleus (contain osmoreceptors)
  • receptors change firing rate and so changes in ADH secretion
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39
Q

Is there ADH secretion with normal plasma osmolarity?

A

Small secretion

40
Q

What type of ADH secretion is occurring in a low plasma osmolarity ?

A
  • Swollen cell

- very little ADH secretion (neglibable )

41
Q

What type of ADH secretion is occurring for high plasma osmolarity?

A
  • HIGH adh secretion

- Cells will be shrunken so want to retain water (AP firing rate INCREASES—> ADH secretion increases)

42
Q

Which anatomical part is reabsorption (ADH secretion) focused on?

A
  • ONLY THE DISTAL TUBULES AND COLLECTING DUCTS

- 9% REMAINING that is filtered

43
Q

Is there a 24hr cycle of ADH secretion in body?

A
  • YES!

- Adults have increased secretion overnight

44
Q

What happens to the following body fluids in a state of dehydration?

  1. TOTAL body H20
  2. ECF volume
  3. ECF osmolarity
  4. ICF volume
  5. ICF osmolarity
  6. CELLS
A 
1. DECREASE 
2 DECREASE
3. INCREASE
4. DECREASE 
5. INCREASE
6. SHRUNKEN
45
Q

How does the body act to bring body levels back to normal following dehydration?

A
  • INCREASED OSMOLARITY (ECF)
  • Osmoreceptors SHRINK and firing rate DECREASES
  • Increased ADH secretion (from post pituitary nerve terminals)
  • Water reabsorption will INCREASE
  • Water excretion will DECREASE
  • So total body water and ECF osmolarity will go back to normal
46
Q

What is diabetes insipidus and what are the two forms of it?

A

Hypothalmic disorder

  • ADH/vasopressin defificiency (or can’t repsond to ADH)
  • No elevated plasma glucose (has nothing to do with it)
  • DILUTE URINE
    1. Central
    2. Nephrogenic
47
Q

What is central diabetes insipidus?

A
  • Failure of the posterior pituitary to secrete ADH (lack of the hormone)
48
Q

What is nephrogenic diabetes insipidus?

A
  • The kidney can’t respond to ADH due to pathology (like a tumor) –> ADH receptors on renal tubular cells not responding
49
Q

Do significant changes in blood cause a change in ADH secretion?

A
  • yes!
50
Q

How does blood volume affect MAP?

A
  • By affecting venous pressure (changes of volume of blood in veins)
51
Q

What is the general pathway for an increase in blood volume?

A
  • Firing rate of arterial and pulmonary stretch receptors + arterial baroreceptors INCREASES
  • INCREASE in neuronal impulses (cranial nerves) –> hypothalmic osmoreceptors
  • INHIBITION of hypothalmic synthesis and posteriour pituitary release of ADH
  • INCREASE in flow of dilute urine
52
Q

What is the rough pathway for a decrease in blood volume (MAP)?

A
  • Decrease in firing rate (atrial and pulmonary stretch recpetors and arterial cardiac and carotid) barareceptors
  • Decrease in neuronal impulses via cranal nerves –> hypothalmic osmoreceptors
  • Underestrained MASSIVE SYNTHESIS and posterior pit. release of ADH (acts on aquaporins and collectign ducts)
  • Water retention occurs and urinary `excretion lowers
53
Q

What two things is thirst triggered by?

A
  1. Dehydration (Decrease in ECF volume + increase in plasma osmolarity)
  2. Blood plasma volume decreasing
54
Q

What roughly happens to trigger thirst through (1) dehydration?

A
  • osmoreceptors SHRINK–> signal to cerebral cortex–> sensation of thirst–> reflex (neuronal pathways) and drop in salivary secretion–> DRY MOUTH AND THROAT
    (SENSITIVE- DETECTS 1-2% CHANGES IN OSMOLARITY)
55
Q

What roughly happens to trigger thirst through blood plasma volume decreasing?

A
  • Stimulation of volume sretch sensitive receptors (baroreceptors/cardiopulmonary receptrs) –> stimulation of thirst centres in hypothalamus–> sensation of thirst
    (LESS SENSITIVE 10-15 % CHANGES)
56
Q

Which drugs alter ADH secretion?

A
  • CAFFINE AND ETHANOL(mild diuretcis–> inhibit ADH)
  • DIURETICS (water diuresis)–> e.g. shane warne to wash drugs out of system
  • ECSTACY –> stimulates ADH release –> dilutional hyponatremia
57
Q

What is the hormone Aldosterone involved in?

A
  • Regulating total Na+ levels
58
Q

When do we have the highest ADH levels?

A
  • Decreased blood volume associated with increased plasma osmolarity
59
Q

When ingesting NA+ tablets (chewing and swallowing), What happens to the ECF volume and osmolarity?

A
  • Volume stays the same

- ECF osmolarity INCREASES

60
Q

What happens if you have a net retention of NA+?

A
  • INcrease in ECF plasma volume (so increases CVS pressures) and MAP
61
Q

What are Na+ and H2O intake controlled by?

A
  • H20 intake and salt apeptite
62
Q

What are Na+ and H2O OUTPUTS controlled by?

A
  • Under influence of kidney (kidney regulating amount of Na+ and H2O in urine)
63
Q

Can the kideny corect for inadequate dietary Na+ and H20?

A
  • NO
64
Q

What does diuresis mean?

A
  • Excretion of h2O in urine (pure)
65
Q

What is naturesis?

A
  • Excretion of Na+ in urine
66
Q

Are there direct Na+ receptors to sense changes in the body?

A
  • NO!
67
Q

How does the body sense changes in Na+ levels (what detects the changes) ?

A
  • Indirectly senses changes in total body sodium via changes in PLASMA VOLUME
  • detected by CVS stretch sensitive and baroreceptros (atria, veins, arterioles)
    + Renal sensors (intrarenal baroreceptors, in the distal tubules -macula densa cells)
68
Q

How does the body adjust Na+ levels?

A
  • Adjusting the Na+ excreted (urine) by CHANGING GLOMERULAR FILTRATION RATE (GFR)
69
Q

What is the equation for Na+ excreted?

A
  • Na+ excreted= Na+ filtered - Na+ absorbed (GFR adjusted)
70
Q

Where is aldosterone secreted from?

A
  • Adrenal glands
71
Q

What type of hormenoe is alsosterone?

A
  • Steroid hormone (mineral corticoid)
72
Q

What is the most important controller for Na+ reabsoprton?

A
  • Aldosterone
73
Q

Where in the adrenal gland is aldosterone secreted?

A
  • Zona glomerular cells
74
Q

How can the amount of Na+ absorbed in the distal tubules of kidney be finetuned and regulated?

A
  • By varying the plasma aldosterone concentration
75
Q

With aldosterone entering cell and binding to mineral corticoid receptor to initiate protein synthesis, which proteins are involved?

A
  • P1: Na+ protein channel made
  • P2: ATPase Na+/K+ pump protein
    P3: ATP formation
    P4: K+ channel
76
Q

Roughly how many days does it take to get rid of sodium load in body?

A

-6-8 days

77
Q

What does binging on salty chips initially lead to?

A
  • Sodium retention initially (then water retention)–> ECF volume increase
  • Na+ channels & ATPase (etc.P1 P2 P3…) get retrieved from collecting ducts of late distal tubules
  • Become IMPERMEABLE to sodium
  • Decrease in reabsorption of collecting ducts and Na+
  • So INCREASE in excretion of Na+ in urine
78
Q

How long after ingesting water is the output the highest (to get rid of excess water)?

A
  • After 60mins
  • pre formed aquaporins
  • ADH causes aquaporins to get inserted into luminal membrane (rapid)
79
Q

What happens with not enough aldosterone production?

A
  • Addinsons disease
  • BP decreases
  • Salt cravings and muscle weakness
80
Q

What is the proper name for salt cravings in a disease?

A

hyponatremia (low Na+ plasma concentration)

81
Q

What is the proper name for muscle weakness in disease with electrolyte imbalance?

A
  • Hyperkalemia (high plasma potassium concentration)
82
Q

What happens with TOO MUCH aldosterone in the body?

A
  • BP increases
  • Leads to hypernatremia (high plasma sodium conc.)
  • Leads to Hypokalemia (low plasma K+ conc
83
Q

What does the ACE enzyme do, and what does that allow for?

A

Converts inactive Angiotensin I –> active Angiotensin II

  • This then acts on adrenal cortex to secrete ALDOSTERONE
  • this increases tubular Na+ reabsorption
  • also acts on blood vessels (constricts vessels)
  • Acts on posterior pituitary to secrete ADH
  • Leads to INCREASED RETENTION OF WATER AND Na+
84
Q

When is the ACE enzyme recruited?

A
  • Decreased in perfusion of kidneys (BP lowers, decreased flow into kidneys
85
Q

What are ACE inhibitors used to treat?

A

Hypertension (HIGH BP)

86
Q

What is the rate limiting step in formation of Angiotensin II?

A
  • Level of Renin secreted (in plasma)
87
Q

What does the activation of the Renin-Angiotensin do?

A
  • INCREASED Na+ (tubular) reabsorption

- DECREASED Na+ (urinary) excretion

88
Q

What happens when body is lacking in Na+?

A
  • Increase renin conc. in plasma
  • Increase plasma angiotensin II
  • Increase aldosterone
89
Q

What causes renin to be secreted?

A
  • Stored, synthesised and released by gruanular cells in juxtaglomerular region (afferent renal arteriole–> although some are on efferent arteriole)
90
Q

What are 3 ways to increase secretion of renin?

A
  1. Decrease renal arterial pressure (intrarenal baroreceptors)
  2. Decrease luminal Na+ concentration passing macula densa
  3. Increase renal sympathetic nerve activity
91
Q

What does a decrease in plasma volume lead to for renal arterial pressure (increasing renin secretion)?

A
  • Decrease in renal arterial pressure
  • This DECREASES the stretch in the juxtaglomerular cells (decreased intracellular calcium)
  • So increased renin secretion (1)
92
Q

What does an increase in plasma volume cause for the renal arterial pressure (decreasing renin secretion)?

A
  • Increase in renal arterial pressure
  • Increase in stretch of juxtaglomerular cells (increase in Ca2+) intracellular concentration
  • Decrease in renin secretion
93
Q

For INCREASED luminal Na+ passing through the macula densa cells is there an increase or decrease in renin secretion?

A
  • Decrease in renin secretion
94
Q

For DECREASED luminal Na+ passing through macula densa cells is there an increase or decrease in renin secretion?

A
  • INCREASE in renin secretion (2)
95
Q

What happens to the renal sympathetic nerve activity for decreased body Na+?

A
  • Low plasma volume and low blood pressure (RSNA increases)
  • JUXTAGLOMERULAR Beta receptors are activated
  • Act to increase renin secretion (3)
96
Q

What is ANP?

A
  • Atrial Naturetic Peptide
  • With increased Na+ –> increased plas. vol.–> increased atrial filling (stretch) –> secretion of ANP hormone
  • ACTS TO INCREASE NATURESIS (URINARY EXCRETION OF Na+)
97
Q

What are 3 ways that ANP lowers BP?

A
  • (Increasing Na secretion-naturesis)
    1. Acts on collecting ducts by decreasing Na+ reabsorption
    2. Indirectly INHIBITS renin secretion (–> aldosterone secretion) and indriectly decreases this effect
    3. Dilation of afferent and constriction of efferent arteriole
  • Increases the GFR (and pressure) + filtered load of Na+–> leads to INCREASED EXCRETION of Na+

BMS2031 (7 decks)

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