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BMS 538 > Renal > Flashcards

Renal Flashcards

1
Q

What are the three functions of the Renal System?

A
  1. Cleans the Blood2. Regulates many ECF Components3. Endocrine Tissue
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2
Q

How Does the kidney Clean the Blood?

A

It removes waste products through filtering and then reabsorbs what it wants. Undesirable components are expelled through the urine.

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3
Q

How does the renal system regulate ECF?

A

It receives 25% of cardiac output so it can regulate the levels of blood components especially ions (Na+, K+, and Ca2+) and acid base balance

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4
Q

How is the kidney an endocrine tissue?

A

It releases hormones important for regulating BP (renin) and rBC production (EPO and Erythropoietin)

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5
Q

How much cardiac out put does the kidney receive?

A

25%

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6
Q

where are the kidneys located?

A

Side of spinal column in the dorsal body cavity

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7
Q

In humans which kidney is more anterior?

A

Left Kidney/more cranial

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8
Q

What color and texture are the kidneys?

A

Red, Brown and smooth

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9
Q

How big are the kidneys in humans?

A

10-12 cm long

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10
Q

What supplies the kidney with blood?

A

Each kidney has a renal artery

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11
Q

What drains the kidney?

A

Each kidney has a renal vein

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12
Q

What does the ureter do?

A

Moves urine from each kidney by a peristalsic motion and gravity to bladder

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13
Q

Describe the bladder

A

Thin stretchy bag of muscle that stores urine

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14
Q

What does the urethra do?

A

Expels urine out of the body from the bladder.

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15
Q

What would we see in a sagittal section of the kidney?

A

Cortex(Dark), Medulla and Renal Pelvis(Pale)

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16
Q

Why is the cortex of the kidney darker?

A

More vasculature, different cell types

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17
Q

What explains the coloration difference between the cortex and medulla?

A

Different cells, more vasculature in the cortex

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18
Q

What color is the renal pelvis?

A

pale, creamy yellow

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19
Q

What is the renal pelvis?

A

An extension of the ureter that expands to fill out the hollow cavity of the kidney

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20
Q

What does the renal pelvis do?

A

collect urine that is formed and emerges from the innermost medulla

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21
Q

In what direction does the kidney work?

A

from the outside in

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22
Q

Where does blood enter the kidney?

A

blood enters cortex of the kidney from the renal artery

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23
Q

What happens to the blood in the cortex in general terms?

A

It gets filtered

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24
Q

What fluid emerges from the medulla?

A

Urine

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25
Q

What is the boundary called between the cortex and medulla?

A

Cortico-medullary boundary

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26
Q

What is the kidney composed of?

A

Hundreds of epithelial lined tube structures called nephrons

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27
Q

What is the functional unit of the kidney?

A

The nephron

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28
Q

Is there connective tissue in the kidney?

A

no

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29
Q

Where is the Macula Densa?

A

Cortex

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30
Q

What part of the kidney are distal tubules found?

A

Cortex

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31
Q

What part of the kidney do you find loop of Henle?

A

Medulla

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32
Q

Where do you find proximal tubule in the kidney?

A

Cortex

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33
Q

Where do you find collecting duct of the kidney?

A

Medulla and cortex

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34
Q

Where do you find bowmens capsule?

A

Cortex

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35
Q

Where do you find a connecting tubule?

A

Cortex

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36
Q

Where is the renal corpusle?

A

Cortex

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37
Q

What does the renal corpusule do?

A

filters the blood and generates filterate

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38
Q

What does the proximal tubule do?

A

Selective reabsorbtion

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39
Q

What does the proximal tubule reabsorb?

A

Na, K, glucose, amino acids , bicarbonate

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40
Q

Where does the epithelial type change?

A

at the loop of henle

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41
Q

What does the loop of henle do?

A

Reabsorb water and Sodium Chloride

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42
Q

What is another name for the thick ascending limb?

A

distal straight tubule

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43
Q

Where does the distal tubule run?

A

From the outer medulla to the cortex

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44
Q

What does the distal tubule do?

A

Selective reabsorption but not as powerful as the proximal tubule

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45
Q

What does the collecting duct do?

A

Fine tuning (secretion and reabsorption)

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46
Q

Which molecule reabsorbs Na+ at the luminal membrane of the early proximal tubule?

A

Na-glucose symporter

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47
Q

How is Na+ reabsorbed at the basolateral membrane of the early proximal tubule?

A

Via Active Transport

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48
Q

What molecule reabsorbs Na+ at the luminal membrane of the early proximal tubule?

A

the Na-Glucose symporter

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49
Q

Where does the Na-Glucose symporter reabsorb Na+ in the early proximal tubule?

A

At the luminal membrane

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50
Q

What is the number one job of the kidney?

A

To clean the blood

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51
Q

What is the second most important function of the kidney?

A

regulate many components of the extracellular fluid

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52
Q

What are the two parts of the renal corpusle?

A
  1. A bundle of capillaries (glomerulus)2. Bowmans Capsule (surrounds glomerulus)
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53
Q

Where does the glomerulus receive blood from?

A

An Afferant Arteriole

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54
Q

Where does blood leave the glomerulus?

A

An Efferent Arteriole (E for Exit)

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55
Q

Where does the blood get filtered?

A

in the glomeruli

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56
Q

As the blood flows through the capillaries of the glomerulus is it under high or low pressure?

A

High because part of the fluid portion of the blood is squeezed through capillaries into bowmans capsule

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57
Q

How much of the fluid portion of the blood is squeezed into bowmens capsule during filtration?

A

20-25%

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58
Q

Where does the filterate go from bowmans capsule?

A

To the proximal tubule where selective reabsorbtion occurs

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59
Q

If a sodium ion wants to enter bowmans capsule from the glomerulus what does it have to do?

A

Cross the wall of the capillary and then the wall of bowmans capsule

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60
Q

What makes up the filteration barrier in the renal corpuscle?

A

Wall of the capillary in the glomerulus and the lining of bowmans capsule.

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61
Q

What can cross the filteration barrier of the renal corpuscle?

A

Anything super small : Ions (Na,K, Mg)Anything with a neutral charge or no net charge Example: glucose, Water, very small proteins

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62
Q

What cannot cross the filteration barrier of the renal corpuscle?

A

Cells (RBCs and WBCs)antibodies (large blood borne molecules)Most Protein

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63
Q

T/F The blood has lots of protein

A

TRUE

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64
Q

Describe the path of the proximal Tubule in the kidney.

A
  1. Begins in the cortex and winds around
  2. Dives into the medulla and turns into the loop of henle
  3. goes down the descending limb
  4. makes a hairpin loop in the deep medulla
  5. Comes back out in the ascending limb
  6. Turns into the distal straight tubule
  7. distal straight tubule goes back to glomerulus where it touches it at the vascular pole
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65
Q

Where is the vascular pole located in the renal corpuscle?

A

Where the afferent and efferent enter and exits

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66
Q

What is the distal tubule associated with?

A

The renal corpuscle

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67
Q

What are the specialized cells are the interface of the distal tubule and glomerulus called?

A

The macula densa

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68
Q

What are the cells of the macula densa important for?

A

regulation of control of filtration but not filtration itself

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69
Q

Why compels something to move out of the bloodstream to cross the glomerulus into bowmans capsule and then into the proximal tubule?

A

Starlings forces combined (net filtration pressure)

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70
Q

Are starlings forces unique to the glomerulus?

A

no, they function at any capillary bed

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71
Q

Define Hydrostatic Pressure

A

the pressure exerted by the fluid on the container that contains it. Fluid pushing out against cup

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72
Q

What are the two categories of starlings forces?

A

Hydrostatic and Oncotic Pressure

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73
Q

Define Oncotic Pressure

A

Osmosis generated by proteins in the blood

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74
Q

If there was a container with two fluids (one of water and one with sodium chloride) and a semipermeable membrane what way would the water move?

A

Toward the sodium chloride due to osmosis. (Sodium Chloride generates an osmotic pressure by pulling water across the membrane)

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75
Q

What can generate osmotic pressure?

A

Na+, Cl-, glucose, colloids, proteins

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76
Q

What is a colloid?

A

High molecular weight particle in the ECFUsually proteins

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77
Q

What are the two hydrostatic pressure?

A

Glomerular hydrostatic pressure and Bowmans space pressure

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78
Q

What is Glomelular (Capillary) Hydrostatic Pressure? (Pc)

A

As blood runs through the glomerulus it is under pressure and it exerts a pressure pushing out

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79
Q

What is bowmans hydrostatic pressure?

A

The pressure of the filterate in bowmans capsule pushing out. Opposes the glomerular hydrostatic pressure

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80
Q

What are the two oncotic pressures?

A

Glomerular colloid oncotic pressure

Bowmans space oncotic pressure (should be very small)

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81
Q

In the renal corpuscle, where is the protein that exerts oncotic pressure?

A

It should be in the blood and not in bowmans space

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82
Q

What is capillary oncotic pressure? (symbol pi subscript c)

A

It is the pressure generated by protein in the blood pushing inward in the glomerulus

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83
Q

Why is the oncotic pressure small in bowmans space?

A

There is only a small amount of protein generating that pressure

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84
Q

What way does the oncotic pressure in bowmans space pull?

A

Out

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85
Q

What way does the hydrostatic pressure in bowmans space pull?

A

in

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86
Q

How do we calculate the net filteration pressure in the glomerulus?

A

Glomerular Hydrostatic Pressure - Bowmans capsule pressure (Hydrostatic) - Glomerular oncotic pressure

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87
Q

Given the following Starlings forces, what is the net pressure at the glomerulus? Bowmans space hydrostatic pressure = 24 mmHgCapillary Oncotic Pressure = 26 mmHgBowmans space oncotic pressure = 0 mmHgCapillary Hydrostatic pressure = 58 mmHg

A

58 mmHg - 24 mmHg - 26mmHg = 8mmHg

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88
Q

How does the kidney regulate the rate at which filtrate is generated? (Glomerular filtration rate)

A

The capillary hydrostatic pressure determines the glomerular filtration rate. If it increases so does the filtration rate.

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89
Q

How does the kidney increase or decrease the capillary hydrostatic pressure to change the glomerular filtration rate?

A

Constricting or dilating the arterioles controls how much blood can flow in and out of the glomerulus and then change the capillary hydrostatic pressure. (

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90
Q

Are arterioles a good conduit of blood alone?

A

No, they are small

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91
Q

What do the arterioles at the vascular pole of the renal corpuscle have that aid in changing the filtration rate?

A

Smooth muscle in their walls:If the smooth muscle tightens the arteriole constricts and less blood flows through (Pc decreases and filtration rate decreases)If the smooth muscle relaxes, the arteriole expands and more blood can go through.

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92
Q

What happens when the afferent arteriole constricts?

A

Pc decreases and GFR decreases

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93
Q

What are extra renal triggers?

A

They tell the kidney to adjust (constrict or dilate the afferent or efferent arterioles)

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94
Q

What is autoregulation?

A

When an organ detects a change and adjusts to correct it

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95
Q

How does the kidney autoregulate the GFR?

A

As systemic blood pressure increases more blood flows through the kidney and GFR increases but there is a range where the GFR and blood flowing in will not change even if the mean arteriole pressure increases or decreases

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96
Q

What is mean arterial pressure?

A

(x axis) systemic blood pressure

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97
Q

What is Renal Blood Flow?

A

(Y axis) How much blood is flowing through the kidneys

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98
Q

As Mean Arterial pressure increases blood flow ______ and GFR _________

A

As Mean Arterial pressure increases blood flow increases and GFR increases

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99
Q

As more blood flows into the glomerulus capillary hydrostatic pressure ______ and GFR_______.

A

increases, increases

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100
Q

What is the goal of renal autoregulation?

A

To keep blood flow and GFR steady even though systemic BP changes dramatically

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101
Q

Why does the kidney want to autoregulate?

A
  1. Prevents mechanical damage to glomeruli caused by spiking BP2. Prevents fluctuations in BP from changing delivery of filtrate to nephron (maintain constant GFR despite changes in BP)
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102
Q

What would happen if the nephron became overwhelmed with the amount of filtrate generated?

A

It could lose some important components in the urine rather than reabsorbing them

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103
Q

What happens to blood pressure and renal blood flow during anesthesia?

A

BP fluctuates while renal blood flow stays steady (autoregulation)

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104
Q

What are the two mechanisms that the kidney autoregulates?

A

Myogenic mechanism

Tubuloglomerular feedback

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105
Q

Describe the Myogenic mechanism

A

The afferant arteriole can sense if it should constrict or dialate based on if its smooth muscle is streched or relaxed and this adjusts the GFR

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106
Q

What happens when smooth muscle is stretched?

A

It contracts

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107
Q

T/F when smooth muscle is not stretched it is contracting

A

False, it is relaxed

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108
Q

If BP is high, the smooth muscle in the afferent arteriole will ________ , intracellular Ca+ will ______, vascular resistance will _________ and the arteriole will ______. Renal Blood flow will _____, _______GFR.

A

If BP is high, the smooth muscle in the afferent arteriole will stretch, intracellular Ca+ will increase, vascular resistance will increase and the arteriole will constrict. Therefore renal blood flow will decrease, decreasing GFR.

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109
Q

If BP is low, the afferent arteriole will ________ , intracellular Ca+ will ______, vascular resistance will _________ and the arteriole will ______. Renal Blood flow will _____, _______GFR.

A

If BP is low, the afferent arteriole will relax and dilate, intracellular Ca+ will decrease, vascular resistance will decrease . Renal Blood flow will increase, increasing GFR.

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110
Q

What is the response time of the myogenic mechanism?

A

1-2 seconds

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111
Q

What is the myogenic response to increased BP?

A

Afferant arteriole constricts

112
Q

What is the trigger for Tubuloglomerular Feedback?

A

changing distal tubule fluid compositon

113
Q

What is the response time for Tubuloglomerular Feedback to occur?

A

10-12 seconds (many more steps than the myogenic mechanism)

114
Q

How does the Tubuloglomerular mechanism work?

A

The macula densa senses changes in the distal tubule fluid caused by fluctuations in the GFR and responds by changing the resistance of arterioles to correct the GFR by regulate the amount of blood

115
Q

In the tubuloglomerular feedback mechanism of autoregulation what happens when the BP increases?

A

Normally a BP increase will increase Pc and GFR would then increase, due to the increase there is more filtrate. The macula densa senses the higher concentration of ions in the distal tubular fluid and transmit a signal to the wall of the afferent arteriole tell the smooth muscle to constrict and thus reduce the GFR

116
Q

What does it mean when we say the GFR is increased?

A

More filterate is being dumped into the system.

117
Q

In the tubuloglomerular feedback mechanism of autoregulation what happens when blood pressure is low?

A

GFR decreases normally due to lower capillary hydrostatic pressure. In the fluid at the distal tubule thereare less ions and the macula densa senses this. It then needs to increase GFR. The efferant arteriole constricts in the presence of angiotensin II released by renin and the afferent arteriole dilates when prostaglandin is sensed and GFR increases

118
Q

What is the tubuloglomerular response to lower than expected solute concentration in the distal tubule?

A

GFR will be increased

119
Q

What is reabsorption?

A

The movement of molecules in the tubular fluid accross the epithelial lining of the nephron back into the bloodstream via the peritubular capillary network

120
Q

After going through the peritubular capillary network in the kidney where does the blood go?

A

Dumps into the renal vein to exit the kidney

121
Q

What is the oppostite of reabsoption when talking about the kidney?

A

Secretion

122
Q

What is the opposite of reabsoption when talking about the kidney?

A

Secretion

123
Q

In the kidney, what is the luminal membrane>

A

Seperates tubular cell from tubular fluid

124
Q

In the kidney, what is the basolateral membrane?

A

The other side of the cell, seperates the cell from the peritubuler interstitium

125
Q

What is the goal of reabsorption?

A

To move stuff from the lumen of the tubular cells to the blood

126
Q

What part of the cell directly interacts with the filterate produced in the kidney?

A

The luminal membrane

127
Q

what are the pathways from the luminal membrane to the blood in kidney reabsorption?

A

Transcellular route and paracellular route

128
Q

Describe the transcellular route in reabsorption

A

Reabsorption through the cytoplasm of tubular cells (Through cells)

129
Q

Describe the paracellular route of reabsorption in the kidney

A

Reabsorption between tubular cells across tight junctions (Between Cells)

130
Q

What pathway is used for the majority of reabsorption in the kidneys?

A

Transcellular

131
Q

Define passive transport

A

NAME?

132
Q

What are the types of passive transport?

A

Diffusion and facilitated diffusion

133
Q

What types of things move using facilitated diffusion?

A

molecules that don’t easily cross biological membranes (Charge, polar (inbalance of charge) (Na, K, Mg, glucose)

134
Q

What does facilitated diffusion require?

A

a transporter

135
Q

What is a polar molecule?

A

A molecule with an uneven distribution of charge (Glucose)

136
Q

What is active transport?

A

energy is required

137
Q

What are the types of active transport?

A

Primary and Secondary

138
Q

What is all reabsorbtion linked in some way to?

A

NaK+ ATPase

139
Q

Where is Na K+ATPase located?

A

Basolateral membrane

140
Q

Where is NaK+ATPase not located in the basolateral membrane in the kidney?

A

Loop of henle

141
Q

Is there a difference in concentration of molecules that are found in the filterate vs. the molecules in the interstiticial fluid?

A

No there is no gradient

142
Q

What makes the nephron tick?

A

The energy in NaKATPase

143
Q

How many sodium and potassium molecules does NaK+ATPase move?

A

3 Na+ ions out and 2 K+ ions in

144
Q

Does ATPase require energy?

A

Yes

145
Q

What is the Na K+ATPase mechanism in the basolateral membrane in the kidney?

A

To pump 3 Na+ out energy is required because it is moving against its electrochemical gradient

146
Q

What is the Na K+ATPase mechanism in the basolateral membrane in the kidney?

A

To pump 3 Na+ out energy is required because it is moving against its electrochemical gradient but since Na is going out an electrochemical gradient is generasted

147
Q

What is the function of NaKATPase in tubular reabsorption?

A

Maintains low intracellular Na+ to establish the electrochemical gradient up which all reabsorption depends

148
Q

Which of the following statements about Na+K+ATPase is correct?AIt transports Na+ and K+ at the luminal membrane of nephron epitheliaBIt moves 3 Na+ into the cells in exchange for 2 K+ out of the cellCNa+ movement is by facilitated diffusionCorrectDIt requires energy in the form of ATPEIt moves K+ paracellularly

A

D

149
Q

What does the proximal tubule reabsorb?

A

67% of filtered water ,Na, and Solutes
99% of filtered glucose and Amino Acids
90% bicarbonate

150
Q

What reabsorbs most water?

A

Proximal tubule

151
Q

What can get secreted from the proximal tubule?

A

Bases, protons, organic acids

152
Q

What special features do you find in the cells of the proximal tubule that tell you its function?

A

Brush Border-microvilli-increases surface area realitive to volume
Mitochondria-generates ATP

153
Q

What part of the membrane has the brush border in the proximal tubule?

A

Lumen

154
Q

What type of transport goes on in the proximal tubule?

A

Active-Mitochondria indicate that ATP is being made

155
Q

Where is the Na K ATPase located in the cells at the proximal tubule?

A

Basolateral membrane

156
Q

Describe the mechanism of action in the cells of the proximal tubule by where Na is reabsorbed

A
  1. NaKATPase pumps 3 Na ions out which creates a concentration gradient at the lumen membrane of the cell. 2. This allows Na to enter the cell via facilitated diffusion at the lumenal membrane3. Sodium goes in and then is pumped out by NaKATPase (reabsorbed)
157
Q

How does glucose enter the cell in the proximal tubule ?

A

NAME?

158
Q

Where do transporters move glucose and amino acids into the cell?

A

At the basolateral membrane

159
Q

How to amino acids enter the cell at the proximal tubule?

A

Secondary active transport

160
Q

What are Na proton exhangers?

A

a secondary transporter

161
Q

How does water enter the cell at the proximal tubule?

A

It is pulled with sodium by osmosis by NaKATPase

162
Q

In the first half of the proximal tubule, why does chloride concentration build up?

A

Water is leaving and chloride is staying in the tubular fluid

163
Q

What happens to chloride concentration in the second half of the proximal tubule?

A

Since it built up in the first half, there is now a concentration gradient for chloride and so chloride can move between cells by simple diffusion paracellularly into the blood. This only happens because Water was reabsorbed and water can move because of Na ion reabsorbtion

164
Q

What happens in the last part of the proximal tubule?

A

Cl- attracts Na+ paracellularly and more sodium is reabsorbed

165
Q

What does the loop of henly reabsorb?

A

25% of filtered NaCl and 15% of filtered water

166
Q

Where does water reabsorption occur in the loop of henle?

A

descending limb

167
Q

In the loop of henly is NaCl reabsorption passive or active?

A

passive

168
Q

Where is NacL reabsorped in the loop of henle?

A

ascending limb

169
Q

Where does the descending limb of the loop of henle go?

A

to the medulla

170
Q

Where does the ascending limb of the loop of henle go?

A

To the cortex

171
Q

What part of the loop of henle is permeable to water?

A

Descending Limb

172
Q

What part of the loop of henle is permeable to sodium and chloride?

A

Ascending

173
Q

What type of reabsorption occurs at the loop of henle?

A

passive

174
Q

What type of cells line the proximal tubule epithelium?

A

Low cuboidal

175
Q

What type if cells line the loop of henle epithelialum?

A

Simple squamous Epitheilium

176
Q

Is there mitochondria in the cells of the loop of henle?

A

not many as no energy is needed

177
Q

Is Cl- absorbed paracellularly or transcellularly in the proximal tubule?

A

both-paracellularly at the proximal tubule and transcellularly at the loop of henle

178
Q

How much water is reabsorbed at the distal tubule and collecting duct?

A

9-15%

179
Q

How much NaCl is reabsorbed at the distal tubule and collecting ducts?

A

7%

180
Q

What does water permeability depend on at the distal tubule and collecting duct?

A

ADH must be present

181
Q

What cell type is found in the distal tubule?

A

cuboidal

182
Q

What is the job of the nephron at the distal tubule and collecting duct?

A

Fine tuning

183
Q

What is reabsorbed at the distal tubule?

A

Na, K, Cl, ions

184
Q

What is secreted at the distal tubule?

A

protons

185
Q

In the distal tubule what are features of the cell?

A

Smaller brush border, some mitochondria

186
Q

What happens in the early part of the distal tubule (straight tubule)?

A

There is a very strong lumen postitve potential difference (fluid that runs is positively charged paracellularly) That repels other positively charged ions and they move paracellularly

187
Q

In the straight distal tubule (early) what is the transcellular method of reabsorbtion at the Lumenal membrane?

A

NaKATPase moves Na out but there is another molecule called NaKCC2 that can move 1 ion of Na, 1 ions K and 2 ions of chloride into the cell. This is based on the movement of Na.

188
Q

How is Cl- moved into the cell at the basolateral membrane?

A

Cl- channels

189
Q

What happens in the convoluted distal tubule(late)?

A

NaKATPase works at the basolateral membrane and a sodium chloride symporter works at the luminal membrane moving sodium and chloride in and chloride is then reabsorbed via chloride channels at the basolateral membrane

190
Q

What transports Na+ at the luminal membrane of the late distal tubule?

A

Na-Cl symporter

191
Q

What type of cells are found in the collecting duct in the cortex?

A

Principal cells and intercalcated cells

192
Q

What do principal cells absorb?

A

Na, K+ and some Cl-

193
Q

What is the function of intercalcted cells found in the collecting duct

A

Move protons and Bicarbonate (regulate pH)

194
Q

In the medullarly collecting duct what type of cells are found?

A

Only principal cells

195
Q

What do principal cells look like?

A

Lighter in color cuboidal

196
Q

Where do you find larger collecting ducts?

A

In the medulla

197
Q

What is the major mechanism for reabsorbtion in the collecting duct?

A

Ions moved basically via channels at the luminal membrane along with NaK ATPase at work in the basolateral membrane

198
Q

How is tubular reabsorption regulated?

A
  1. Glomerulotubular balance
  2. Starlings forces at the peritubular capillary bed
  3. Hormones
199
Q

How does Glomerulotubular balance work?

A

The more filterate dumped into proximal tubule, the more reabsorbed so as GFR increases, so does reabsorption

200
Q

How do starlings forces at the peritubular capillary bed regulate reabsoption?

A

Normally promote reabsorption in the proximal tubule Changes in the capilarry pressure and osmotic capillary pressure will change reabsorbtion

201
Q

How can hormones regulate reabsorption?

A
  1. Increase activity

2. Increase the number of transporter molecules

202
Q

Define Osmolarity

A

It is the concentration of osmotically active atoms per L of solvent.

203
Q

What way does water move in the presence of a high osmolarity substance such as NaCl?

A

Toward the higher osmolarity substance

204
Q

In the loop of henle where is it permeable to Na+ and impermeable to water?

A

ascending limb

205
Q

In terms of osmolarity, what is the fluid leaving the proximal tubule defined as?

A

isoosmotic (300 MOsm/kg)

206
Q

What creates an osmotic gradient in the distal straight tubule?

A

The active reabsorbtion of Na+. Water follows the Na+ as it is being reabsorbed leaving the descending limb passively (without the use of energy) of the loop of henle

207
Q

Where does osmolality increase in the loop of henle?

A

The Medullary interstitium-Na+ leaves the ascending limb contributing to osmolality. It leaves passively

208
Q

What happens in the hairpin loop in the loop of henle?

A

Water reabsorption has concentrated Na+ above interstitial concentration so now there is a Na+ gradient

209
Q

In terms of osmolarity, how do you describe the fluid going into the distal tubules at the end of the loop of henle?

A

Hypoosmotic

210
Q

Where are osmoreceptors located?

A

Hypothalamus

211
Q

What do osmoreceptors do?

A

Shrink and swell to detect changes in osmolality

212
Q

What do baroreceptors do?

A

Detect changes in plasma volume or pressure

213
Q

What happens when ADH is low?

A

A high volume of dilute urine is produced

214
Q

What happens when ADH is high?

A

Antidiuresis, where there is a low volume of concentrated urine produced

215
Q

What preserves medulla hypeosmolarity?

A

The vasa Recta

216
Q

What is an effective osmole?

A

It can generate osmotic pressure

217
Q

In the descending limb of the loop of henle what is the osmolarity in side the limb when compared to the intersticial fluid?

A

It is lower inside the limb so water moves out to the intersticial fluid

218
Q

What is countercurrent multiplication?

A

The thing in the loop of henle in the descending limb causes the opposite effect in the ascending limb

219
Q

Which statement about physiology at the loop of Henle is true?
Na+ is reabsorbed passively at the descending limb
B Water is reabsorbed down an osmolarity gradient (low to high osmolarity)
CI nterstitial osmolarity decreases as you move deeper into the medulla
D Distal tubule fluid is hypertonic to insterstitium

A

B Water is reabsorbed down an osmolarity gradient (low to high osmolarity)

220
Q

What are the triggers to produce ADH?

A

Low volume (Osmoreceptors detect shrinking) and Low pressure (Baroreceptors detect Pressure)

221
Q

what is the PRIMARY determinent of the release ADH?

A

Osmoreceptor response

222
Q

What is the response in the late distal tubule and collecting duct to ADH release?

A
  1. Increase expression of aquaporins in the luminal membrane of the late distal tubule and entire collecting duct so water can be reabsorbed.2. Increase number of urea transporters in the luminal membrane of the medullary collecting duct so urea it is permeable to urea
223
Q

What is the other word for ADH?

A

Vasopressin

224
Q

Does ADH affect filteration in the nephron?

A

no

225
Q

What happens when there is low ADH?

A

Diuresis and water is trapped in the distal tubule and collecting duct. A high volume of dilute urine is produced

226
Q

What happens when ADH is high?

A

Antidiuresis-Water is reabsorbed and urine is concentrated

227
Q

What is urea?

A

By product of protein metalbolism

228
Q

Is urea an effective osmole in the collecting duct?

A

no just in the loop of henle

229
Q

During diuresis, which of the following is true?AUrea reabsorption in medullary collecting duct is highBCollecting duct permeability to water is lowCWater reabsorption at loop is increasedDA small volume of urine is produced

A

BCollecting duct permeability to water is low

230
Q

What is the vasa recta?

A

A group of capillaries around the late distal tubule and collecting duct

231
Q

What is the function of the vasa recta?

A

To preserve medullary hyperosmolarity by keeping solutes

232
Q

What is the main ECF ion?

A

Na+

233
Q

What is changed by changing the amount of Na+?

A

ECF volume

234
Q

What is changed by changing the concentration of Na+?

A

ECF osmolarity

235
Q

What needs to be regulated to control the osmolarity and volume of the extracellular fluid?

A

ECF Na+

236
Q

Where is most of the Na+ located in the body?

A

Extracellular (ECF)

237
Q

Where does most of the K+ live in the body?

A

intracellularly

238
Q

What do you find in the cell

A

Mg++,K+ , PO4, protein

239
Q

Where do you find most Cl- in the body?

A

Extracellularly

240
Q

Where do you find most bicarbonate?

A

Extracellularly

241
Q

What is the derterminant of ECF osmolarity?

A

Na+ concentration

242
Q

High ECF Concentration is called

A

Hypernatremia

243
Q

What are the signs of hypernatremia?

A

Rupture of cerebral vesselsMuscle weaknessAtaxia,behavioral changeComa to death

244
Q

What is low Na+ ECF Concentration called?

A

Hyponatremia

245
Q

What are the signs of Hyponatremia?

A

Incoordination and seizures

246
Q

What is concentration?

A

The amount of a specified substance (Na+) in a unit amount of another substance (water)

247
Q

What detects change in ECF osmolarity

A

osmoreceptors in the pituitary gland

248
Q

When there is high ECF osmolarity what do the osmoreceptors do?

A

Shrink

249
Q

What are the effects of osmoreceptor shrinkage

A

ADH release and Thirst Body, ADH is released and aquaporins are made thus reabsorption of water takes place and ECF osmolarity decreases

250
Q

What occurs when there is more ECF in volume?

A

Hypervolemia (ascites and pulmonary edema)

251
Q

What happens when ECF volume is too low?

A

Hypovolemia-Hypovolemic shock, organ damage

252
Q

What can cause a volume change in ECF?

A

Na+, Blood loss, vomiting, liver failure

253
Q

What do kidneys do to when it detects a volume change of ECF.

A

Regardless of cause, they change the amount of ECF Na+ to correct the volume

254
Q

Does the kidney regulate protein?

A

no, the liver

255
Q

What will be the effect of increasing extracellular fluid sodium concentration?AECF volume will go downBECF volume will go upCECF osmolarity will go downDECF osmolarity will go up

A

DECF osmolarity will go up

256
Q

Where is the thirst center in the brain?

A

Hypothalamus

257
Q

Which statement about hyponatremia is most accurate?AA hyponatremic individual will have high ECF Na+ concentrationBThere will likely be translocation of fluid from ECF into ICFCOsmoreceptors in hypothalamus will shrinkDADH release will be increasedEThe individual will feel thirsty

A

BThere will likely be translocation of fluid from ECF into ICF

258
Q

What is more serious hypervolemia or hypovolemia?

A

Hypovolemia

259
Q

How does the kidney detect volume change in the ECF?

A
  1. Baroreceptors2. Juxtaglomerular Apparatus
260
Q

Where are baroreceptors located?

A

Heart (mostly right side), aorta, carotid sinus

261
Q

What do baroreceptors sense?

A

Stretch (increase in volume)

262
Q

When the baroreceptors stretch what is the response?

A

Sympathetic nervous system and natriuretic peptide release(decreases a high ECF volume)

263
Q

How does the juxtaglomerular Apparatus regulate ECF volume?

A

It has stretch receptors that stretch when ECF volume goes up.

264
Q

Where is the juxtoglomerular apparatus located?

A

By the afferant arterioles

265
Q

How does the juxtoglomerular apparatus increase a low ECF fluid?

A

The Renin-Angiotensin system

266
Q

How do we increase ECF volume?

A

When low ecf is detected the 1. sympathetic nervous system increases Na+ reabsorption ECF volume2. Increases GFR and Pic and Pc is reduced of the peritubular capillaries of the proximal tubule to increase rebsorbtion

267
Q

What does the sympathetic nervous system specifically do in when ecf volume is low?

A

norepinephrine constricts the efferant arteriole which builds capilary hydrostatic pressure within the glomerulus and the GFR increases promoting the movement of sodium back into the bloodstream

268
Q

What triggers the renin -angiotensin mechanism?

A

The afferant arteriole detects stretch and Low ECF volume triggers the release of renin from the juxtaglomerular cells

269
Q

What happens when renin is released?

A

Angiotensin II is increased and Na+ reabsorbtion is increased

270
Q

Describe the renin angiotensin mechanism

A
  1. Angiotensinogen is produced in the liver and enters the blood stream2. When it encounters renin, renin cleaves angiotensenogen to angiotensin I 3. Angiotensin I sits in the blood stream until it encounters Angiotensen converting enzyme4. This enzyme cleaves it to angiotensin II
271
Q

Where is angiotensin converting enzyme produced?

A

In the lungs

272
Q

What does angiotensin II do?

A
  1. Potent vasoconstrictor that changes starlings forces in peritubular capillaries2. Stimulate Aldosterone which increases Na+ reabsorbtion via NaK+Atpase
273
Q

Where is aldosterone found?

A

Adrenal gland

274
Q

How is ECF Volume decreased?

A

Natriuretic peptides inhibit the ways sodium can be reabsorbed and it promotes Na excretion through the urine

275
Q

What is the mechanism of natriuretic peptide release?

A

it inhibits renin-angiotensin II, aldosterone and Na+ channels in the collecting duct all decreasing renal Na+ reabsorption

276
Q

Which statement about hypovolemia is accurate?AIt is defined as high ECF volumeBIt is caused by low ECF Na+ concentrationCIn response, sympathetic flow to the kidneys is increasedDTo correct it, the Renin-Angiotensin system will be inhibitedSubmit

A

In response, sympathetic flow to the kidneys is increased

277
Q

Increased sodium_______ECF Volume

A

Increases

BMS 538 (8 decks)

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