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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
Q

hydrostatic pressure

A

begins to drop due to resistance but then remains constant

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26
Q

oncotic pressure

A

slowly increases, does not hit equilibrium point inside glomerular capillary

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27
Q

net filtration

A

hydrostatic pressure > oncotic pressure

always in glomerular capillary

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28
Q

Kf (filtration coefficient)

A

the higher this value, the easier to be filtered

diabetics have a low Kf

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29
Q

GFR is influenced by?

A

net filtration pressure and Kf (SA and permeability)

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30
Q

vasoconstriction of afferent arteriole

A

decrease renal blood flow, decrease hydrostatic pressure, decreased GFR

31
Q

vasoconstriction of efferent arteriole

A

decrease renal blood flow, increase hydrostatic pressure, increase GFR

32
Q

GFR autoregulation

A

myogenic (bayless)

tubuloglomerular feedback

33
Q

myogenic response

A

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
Q

tubuloglomerular feedback

A

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
Q

transcellular transport

A

substances pass apical and basolateral membrances

36
Q

paracellular transport

A

substances pass through cell junction

37
Q

active transport of sodium

A

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
Q

Na-Glucose transporter

A

secondary active transport

symport on apical membrane, brings in Na and glucose

39
Q

glucose facilitated diffusion transporter

A

glucose passively leaves cells through basolateral membrane while the sodium is pumped is pumped out by the NaKATPase

40
Q

mechanisms of sodium reabsorption in proximal tubule

A
  • solute and water reabsorption
  • bicarbonate reabsorption
  • sodium-coupled solute reabsorption
41
Q

bicarbonate reabsorption

A
  • 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
Q

Tm (transport maximum)

A

saturation occurs and we cannot transport anymore substrate

43
Q

inulin

A

not reabsorbed or secreted, it is 100% excreted

inulin clearance is gold standard for measuring GFR

44
Q

typical GFR

A

100-120 mL/min

45
Q

para-amino hippurate (PAH)

A

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
Q

Cx > Cin

A

net secretion

47
Q

Cx < Cin

A

net reabsorption

48
Q

plasma solute that is only filtered

A

inulin

49
Q

plasma solute that is filtered and reabsorbed

A

glucose

50
Q

plasma solute that is filtered and secreted

A

penicillin and PAH

51
Q

plasma solutes that are filtered, reabsorbed, and secreted

A

potassium and urea

52
Q

hyperosmotic

A

has higher concentration of solute (less water)

53
Q

hyposmotic

A

has lesser concentration of solute (more water)

54
Q

hypertonic

A

cell will shrink

55
Q

hypotonic

A

cell will swell

56
Q

osmoreceptors

A
  • 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
Q

ADH (vasopressin)

A
  • 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
Q

baroreceptors

A

in aorta and carotid bodies, respond to drop in blood pressure

59
Q

diuerisis

A

excreting water

-absence of vasopressin, collecting duct impermeable to water and urine is dilute

60
Q

anti-diuresis

A

conserving water

-presence of vasopressin, water is being withdrawn into interstitial space

61
Q

volume depletion hypovolemia

A

decrease amount of sodium, contracts the volume

62
Q

volume expansion hypervolemia

A

increase amount of sodium, expand the volume

63
Q

how do we measure volume in the body

A

volume sensors = baroreceptors
low pressure: cardiac atria, pulmonary vasculature
high pressure: carotid sinus, aortic arch, juxatglomerular appartus

64
Q

sodium excretion is altered by what?

A

changes in GFR: if you don’t filter it, don’t have to reabsorb it
changes in tubular reabsorption

65
Q

RAAS (Renin-Angiotensin-Aldosterone System)

A
  • 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
Q

Angiotensin 2 circulation causes

A

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
Q

loop diuretics

A

very powerful, blocks the sodium 2 chloride potassium mechanism
-without gradient, water cannot be reabsorbed

68
Q

chlorothiazide

A

in distal tubule, blocks sodium chloride reuptake

-loss of sodium = loss of volume

69
Q

amiloride

A

(gentlest) in the collecting duct, blocks the sodium channel found on the epithelium

70
Q

atrial natriuretic peptide (ANP)

A

-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
Q

buffers

A

1st line of defense against acid input, act like sponges to resist sudden pH change
ex) bicarbonate, protein, hemoglobin , phosphates, ammonia

72
Q

net excretion of acid in two forms

A
  1. ammonium (NH4+)

2. titratable acid (mostly phosphoric acid)

73
Q

volatile acids

A

excreted by respiratory system

-most important volatile acids come from carbohydrate metabolism

74
Q

non-volatile acids

A

excreted by renal system (cannot be respired off)

PGY 300 (5 decks)

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