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pharmacology > Renal > Flashcards

Renal Flashcards

1
Q

what do the kidneys play an important role in ?

A

regulating the h20 content and inorganic ion balance , this is ions like Na+ and K+ that we take in and then are excreted.

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2
Q

is water reabsorption passive or require energy and what does this control and change ?

A

it is passive and it controls and changes the blood pressure

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3
Q

3 roles of the kidneys ?

A
  • Filtration
  • Reabsorption
  • Excretion
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4
Q

what do the kidneys excrete ?

A

removal of metabolic waste products from the blood and foreign chemicals such as drugs and they are then excreted in urine.

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5
Q

gluconeogensis occurs at the kidneys , what is this ?

A

when there is a production of glucose from non carbohydrate substrates.

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6
Q

the endocrine functions include renin and erythropoietin , what are the roles of these ?

A

Erythropoietin is important in the production of RBC while renin controls the blood pressure.

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7
Q

where are the adrenal glands located and what hormone do they release ?

A

located on top of the kidneys , they release the hormone adrenaline which is not to be confused with the neurotransmitter noradrenaline!! The adrenal glands also release ‘stress hormones’ such as cortisol which helps regulate metabolism and helps your body respond to stress. Aldosterone is released as well which influences the kidneys and control the blood pressure.

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8
Q

what do the kidneys do to the plasma portion of the blood ?

A

removing substances from it and in a few cases add substances to it

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9
Q

do the kidneys work alone ?

A

no they work in an integrated manner along side the cardiovascular systems.

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10
Q

where is the renal cortex and function ?

A

located at the outside and this is where filtration occurs

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11
Q

renal medulla location and the function ?

A

inside , contains the collecting ducts and this is where re-absorption occurs.

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12
Q

renal pelvis ?

A

what leads to the ureter and the ureter is where excretion of urine occurs.

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13
Q

what is the functional unit of the kidney?

A

the nephron

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14
Q

what is the primary function of the kidney ?

A

filtration , this occurs at the nephron.

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15
Q

where is the glomerulus located and what is it’s function ?

A

inside the bowman’s capsule and this is where the filtration occurs. Glomerular filtrate drains into Bowman’s space, and then into proximal convoluted tubule.

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16
Q

afferent arteriole ?

A

blood flows in

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17
Q

efferent arteiole

A

blood flows out

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18
Q

the glomerulus contains pores , why ?

A

they are in the endothelium which allows small molecules such as water to flow

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19
Q

podocytes ?

A

these wrap around the capillaries of the glomerulus. The podocytes have negative charge. This and the basement membrane stops proteins getting through into tubular fluid.

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20
Q

Macula Densa ?

A

area that has closely packed specialised cells lining the distal tubule. It is sensitive to the Na levels in the filtrate. It can sense a change in the glomerular filtration rate ( GFR) , this is how well your kidneys filter each minute. It does so by the Na concentration.

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21
Q

juxtaglomerular cells ?

A

around the afferent arteriole and they are controlled by the sympathetic nervous system , they regulate the renal blood flow , GFR and also indirectly the Na balance as well as the blood pressure. It does so by releasing renin. If the blood pressure is low then the concentration of renin increases.

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22
Q

what 2 functional units do the nephrons contain and explain them ?

A
  • the tubular component (contains what will eventually become urine)
    – The vascular component (blood supply)
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23
Q

proximal convuluted tubule ?

A

The convolution of the tubule allows for more time for reabsorption of Na ions from the filtrate into the tubule. Therefore less Na in blood.

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24
Q

loop of Henle ?

A

This drives water reabsorption by creating a salt concentration gradient.

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25
Q

distal convulted tubule ?

A

this is where the filtrate flows into the collecting duct and it becomes officially urine.

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26
Q

what’s the 3 basic renal processes ?

A
  • Glomerular filtration
  • Tubular reabsorption
  • Tubular secretion
27
Q

what is normally the GFR for a day ?

A

very high around 180l/day

28
Q

is it the extracellular fluid being regulated or the urine ?

A

ECF

29
Q

why is it dangerous to keep supplying a patient with medicine if their GFR is low?

A

may need to be stopped as they will not be getting excreted and they will build up which is dangerous.

30
Q

how is the GFR regulated ?

A

diameters of the afferent and efferent arterioles

31
Q

what ANS affect these ?`

A

sympathetic vasoconstrictors

32
Q

what does ADH and RAAS affect ?

A

the GFR

33
Q

what prevents high pressure surges in the kidneys ?

A

Autoregulation maintains the blood supply and as a result the GFR

34
Q

what is the high hydrostatic pressure at the glomerular capillaries due to ?

A

short, wide afferent arteriole (low R to flow) and the long, narrow efferent arteriole (high R).

35
Q

if there is a dilation in the afferent arterioles and a constriction in the efferent what does this result in the GFR ?

A

an increase in GFR

36
Q

why does dilation in the afferent occur ?

A

due to prostaglandins and kinins

37
Q

why does the constriction of the efferent occur ?

A

due to the Angiotensin II low doses

38
Q

if there is a constriction of the afferent and a dilation of the efferent what happens to the GFR ?

A

decrease in the GFR

39
Q

afferent constriction due to ?

A

angiotensin II high doses

40
Q

efferent dilation occur due to ?

A

angiotensin II blockade

41
Q

what are the 2 factors that determine blood pressure ?

A
  1. Cardiac output

2. Total peripheral resistance

42
Q

if there is an increase in the resistance , what happens to BP ?

A

increase also

43
Q

describe the short term control of the rise in BP ?

A

The baroreceptors are important for short term control. The mechanoreceptors located in the carotid sinus and in the aortic arch. Their function is to sense pressure changes by responding to change in the tension of the arterial wall. The SA node is slowed by the acetylcholine and heart rate slows to correct the increase in pressure. The ANS controls short term.

44
Q

describe what controls the BP long term ?

A

kidneys by controlling blood volume. The reduction in renal pressure is due to an intra-renal redistribution of pressure and increased absorption of salt and water.

45
Q

effects of Ang II

A

– Causes direct constriction of renal arterioles and increases BP
– Stimulation of aldosterone synthesis which causes sodium absorption and increase in intravascular blood volume.

46
Q

describe renin release and it’s effect ?

A

released from the juxtaglomerular cells that surround the afferent arteriole. It is released in response to a change in renal pressure and this is detected via the stretch receptors. Also, the juxtaglomerular cells are also stimulated to produce renin by the Macula Densa cells. The Renin then acts on the liver and causes angiotensin I to be produced and this enters the blood flow. The angiotensin I is picked up by the endothelium cells in the lungs and the ACE ( angiotensin converting enzyme) converts the AT I into AT II. The angiotensin II then causes vasoconstriction of the blood vessels and this increases blood pressure.

47
Q

Ang II and aldosterone ?

A

Angiotensin II causes the adrenal gland to produce aldosterone , this affects the collecting ducts in the renal medulla. This causes
• An increase in the Na reabsorption from the filtrate so there is an increase in the Na in the blood.
• Water to flow by osmosis which is passive , this is the secondary response to the hormone.

48
Q

when is the RAAS system activated ?

A

response to a reduced blood flow. A reno-vascular diseases can cause a decrease in the kidney blood flow ( GFR) and this could be due to an inappropriate activation of RAAS

49
Q

what is the principal factor controlling the Ang II level ?

A

release of renin

50
Q

what does the pharmacological control of BP follow ?

A

renal control that occurs

51
Q

what does Ang II cause the Macula densa ?

A

It becomes more sensitive and this leads to enchanced tuboglomerular feedback. It enhances Na-H exchanger and Na channel function to promote Na reabsorption. Renal hypertrophy. Also stimulates thirst and ADH release by acting upon hypothalamus.

52
Q

effects of aldosterone ?

A

stimulates Na+ reabsorption and K+ excretion by the renal tubule. Also exerts indirect negative feedback on RAAS by increasing ECV and by lowering plasma [K+].It is really important in conserving Na+ and water, but also really good at preventing massive swings in K+ levels.

53
Q

are AVP and ADH the same thing?

A

yes

54
Q

what is the effective circulating volume sensed by ?

A

carotis sinus , aortic arch , renal afferent arteriole and atria

55
Q

what is plasma osmolarity ?

A

is the Na and K in a solution

56
Q

what is this sensed by ?

A

hypothalamic osmoreceptors.

57
Q

efferent pathway ?

A

ADH and thirst

58
Q

ADH EFFECTOR ?

A

kidney

59
Q

effect ?

A

renal excretion

60
Q

thirst effector ?

A

brain

61
Q

effect ?

A

drinking behaviour and water intake

62
Q

for contraction , what are the agonists ?

A

noadrenaline and histamine

63
Q

effect ?

A

they block calcium channels and leads to depolarisation and contraction.

64
Q

relaxation ?

A

beta agonists and they are potassium channel activators

pharmacology (21 decks)

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