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PGY 300 > Renal > Flashcards

Renal Flashcards

1
Q

internal sphincter

A

smooth muscle, autonomic control

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2
Q

external sphincter

A

skeletal muscle, voluntary control

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3
Q

renal function (kidney)

A

only connected to sympathetic neurons

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4
Q

where are most of the nephrons found?

A

80% in the cortex, 20% dip down into medulla (juxtamedullary nephrons)

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5
Q

effective circulating blood volume

A

determined by cardiac output, peripheral resistance, and actual blood volume (kidney function)

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6
Q

body % of water

A

55-60%

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7
Q

total body weight

A

ICF volume (2/3) + ECF volume (1/3)

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8
Q

intracellular fluid

A

2/3, water inside all cells of the body

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9
Q

extracellular fluid

A

1/3, subdivided into plasma (1/4) and interstitial (3/4)

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10
Q

sodium

A

low intracellular, high extracellular

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11
Q

potassium

A

high intracellular, low extracellular

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12
Q

blood flow in renal portal system

A

afferent arterioles -> glomerulus -> efferent arterioles > peritubular capillaries

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13
Q

vasa recta

A

in juxtamedullary nephrons, these are the long peritubular capillaries that dip into the medulla

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14
Q

parts of nephron (in order of movement)

A

Bowman’s capsule -> proximal tubule -> loop of henle (tDHL, tALH, TALH) -> distal tubule -> collecting duct

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15
Q

filtration

A

blood -> lumen of nephron

only occurs in renal corpuscle, Bowman’s capsule allows bulk flow

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16
Q

reabsorption

A

lumen -> blood
occurs primarily in proximal tubule
also occurs in loop of henle, distal tubule, and collecting duct

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17
Q

secretion

A

blood -> lumen of nephron

molecules in peritubular capillary blood enter lumen of nephron

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18
Q

excretion

A

lumen -> external environment

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19
Q

thick ascending limb

A

osmolality drops, “diluting segment” (salt removed)

impermeable to water

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20
Q

most common site of kidney failure

A

glomerular filtration

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21
Q

filtration fraction

A

20% of renal plasma flow (80% stays in circulation)
that is about 1/5 of cardiac output
FF = GFR/renal plasma flow

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22
Q

podocytes

A

cell type surrounding capillaries, “foot” cells
help maintain structural integrity
have high pressure

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23
Q

mesangial cell

A

can contract to change the surface area

may be involved in paracrine function

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24
Q

3 filtration barriers

A
  • glomerular capillary endothelium: fenestrated and allow most components of plasma in
  • basal lamina: basement membrane, negatively charged
  • epithelium of bowman’s capsule: podocytes and mesangial cells
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25
hydrostatic pressure
begins to drop due to resistance but then remains constant
26
oncotic pressure
slowly increases, does not hit equilibrium point inside glomerular capillary
27
net filtration
hydrostatic pressure > oncotic pressure | always in glomerular capillary
28
Kf (filtration coefficient)
the higher this value, the easier to be filtered | diabetics have a low Kf
29
GFR is influenced by?
net filtration pressure and Kf (SA and permeability)
30
vasoconstriction of afferent arteriole
decrease renal blood flow, decrease hydrostatic pressure, decreased GFR
31
vasoconstriction of efferent arteriole
decrease renal blood flow, increase hydrostatic pressure, increase GFR
32
GFR autoregulation
myogenic (bayless) | tubuloglomerular feedback
33
myogenic response
smooth muscle in afferent arterioles stretches due to increased pressure, ion channels open, cells depolarize, muscle contracts -vasoconstriction increases resistance to flow, thus filtration pressure decreases
34
tubuloglomerular feedback
macula densa: when senses increased NaCl going past, send paracrine message to afferent arterioles to constrict - these are at end of loop of henle and beginning of distal tubule - this increases resistance, and decreased GFR
35
transcellular transport
substances pass apical and basolateral membrances
36
paracellular transport
substances pass through cell junction
37
active transport of sodium
this is the driving force of most renal reabsorption - sodium enters the cell down the electrochemical gradient - sodium is pumped out of the cell by NaKATPase (primary active transport)
38
Na-Glucose transporter
secondary active transport | symport on apical membrane, brings in Na and glucose
39
glucose facilitated diffusion transporter
glucose passively leaves cells through basolateral membrane while the sodium is pumped is pumped out by the NaKATPase
40
mechanisms of sodium reabsorption in proximal tubule
- solute and water reabsorption - bicarbonate reabsorption - sodium-coupled solute reabsorption
41
bicarbonate reabsorption
- sodium-hydrogen coupling: sodium in, hydrogen out - protons pumped out bind with filtered bicarbonate and become CO2 which is lipid soluble and can reenter cell - the proton is not excreted, just recycled - the sodium that enters is pumped out by NaK pump - when CO2 reenters cell and combines with water will make bicarbonate and then be facilitated out of cell
42
Tm (transport maximum)
saturation occurs and we cannot transport anymore substrate
43
inulin
not reabsorbed or secreted, it is 100% excreted | inulin clearance is gold standard for measuring GFR
44
typical GFR
100-120 mL/min
45
para-amino hippurate (PAH)
used to measure renal plasma flow - not natural, must be infused - it is filtered and then secreted by proximal tubule - clearance of PAH will be greater than inulin, because inulin is only filtered
46
Cx > Cin
net secretion
47
Cx < Cin
net reabsorption
48
plasma solute that is only filtered
inulin
49
plasma solute that is filtered and reabsorbed
glucose
50
plasma solute that is filtered and secreted
penicillin and PAH
51
plasma solutes that are filtered, reabsorbed, and secreted
potassium and urea
52
hyperosmotic
has higher concentration of solute (less water)
53
hyposmotic
has lesser concentration of solute (more water)
54
hypertonic
cell will shrink
55
hypotonic
cell will swell
56
osmoreceptors
- respond to an increase is osmolarity - when receptors receive signal will send APs down axon to posterior pituitary - ADH (anti diuertic hormone) at these terminals - will also go to brain to stimulate thirst centers
57
ADH (vasopressin)
- decreases urine flow - targets late distal tubule and collecting duct - will bind to V2 receptor and increase cAMP in target cell - this stimulates insertion of water pores (AQP2) into apical membrane - increased water reabsorption to conserve water
58
baroreceptors
in aorta and carotid bodies, respond to drop in blood pressure
59
diuerisis
excreting water | -absence of vasopressin, collecting duct impermeable to water and urine is dilute
60
anti-diuresis
conserving water | -presence of vasopressin, water is being withdrawn into interstitial space
61
volume depletion hypovolemia
decrease amount of sodium, contracts the volume
62
volume expansion hypervolemia
increase amount of sodium, expand the volume
63
how do we measure volume in the body
volume sensors = baroreceptors low pressure: cardiac atria, pulmonary vasculature high pressure: carotid sinus, aortic arch, juxatglomerular appartus
64
sodium excretion is altered by what?
changes in GFR: if you don't filter it, don't have to reabsorb it changes in tubular reabsorption
65
RAAS (Renin-Angiotensin-Aldosterone System)
- liver constantly producing Angiotensin - drop in BP sensed by granular cells, renin is released - renin + angiotensin = angiotensin 1 - angiotensin 1 comes in contact with ACE enzyme which cleaves off AA and makes angiotensin 2 - as angiotensin 2 circulates it causes increase the BP
66
Angiotensin 2 circulation causes
OVERALL: increase BP -vasoconstriction of arterioles -directly tells medulla to increase CO -hypothalamus: release vasopressin and increase thirst signal -adrenal cortex: increase aldosterone, increase Na+ reabsorption this maintains osmolality and conserves ater
67
loop diuretics
very powerful, blocks the sodium 2 chloride potassium mechanism -without gradient, water cannot be reabsorbed
68
chlorothiazide
in distal tubule, blocks sodium chloride reuptake | -loss of sodium = loss of volume
69
amiloride
(gentlest) in the collecting duct, blocks the sodium channel found on the epithelium
70
atrial natriuretic peptide (ANP)
-produced in atria -when volume overloads, is activated -decrease tubular Na+ reabsorption -increase renin release -vasodilate afferent arterioles -decrease sympathetic nervous system OVERALL: increase sodium excretion
71
buffers
1st line of defense against acid input, act like sponges to resist sudden pH change ex) bicarbonate, protein, hemoglobin , phosphates, ammonia
72
net excretion of acid in two forms
1. ammonium (NH4+) | 2. titratable acid (mostly phosphoric acid)
73
volatile acids
excreted by respiratory system | -most important volatile acids come from carbohydrate metabolism
74
non-volatile acids
excreted by renal system (cannot be respired off)

PGY 300 (5 decks)

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