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Patho 2 > Renal - Exam 2 > Flashcards

Renal - Exam 2 Flashcards

1
Q

functions of kidney - 5

A
  1. excretion of wastes/foreign substances
  2. regulation of electrolyte balance
  3. regulation of acid-base balance
  4. regulation of fluid osmolality/volume
  5. production and secretion of hormones
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2
Q

3 hormones kidneys produce and secrete

A

Vit D3, erythropoetin, renin

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3
Q

nutcracker syndrome is where the..

A

LEFT renal vein becomes compressed between the SMA and AORTA

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4
Q

results of nutcracker syndrome - 3

A
  1. kidney enlargement
  2. venous HTN
  3. rupture of thin walled veins of collecting system (HEMATURIA)
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5
Q

urinary tract obstructions are caused by

A

many mechanisms

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6
Q

list 5 causes of urinary tract obstructions

A
  1. polycystic kidney
  2. kidney stones
  3. blood clot
  4. carcinoma
  5. endometriosis
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7
Q

___ is the outer portion of the kidney, houses the glomerulus (filtration) and is where the renal artery becomes the renal vein

A

cortex

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8
Q

____ is the pyramid shaped inner portion of the kidney which houses most of the nephron (maintenance of salt and water balance in blood)

A

medulla

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9
Q

____ is the functional filtering unit of the kidney

A

nephron

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10
Q

we have ___ million nephrons in each kidney, number naturally declines with age

A

1.2 million

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11
Q

each nephron filters…

A

a small amount of blood

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12
Q

5 parts of the nephron

A
  1. glomerulus (cortex - filtration)
  2. proximal tubule (cortex)
  3. loop of Henle (medulla - concentrates urine)
  4. distal tubule (cortex)
  5. collecting ducts (medulla)
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13
Q

the nephron works by:

  1. the glomerulus lets ____ and ____ pass but not ____ or ___
  2. filtered fluid passes through the tubule which sends minerals to blood and removes waste. the product is ____
A

the nephron works by:

  1. the glomerulus lets fluid and _waste pass but not cells or protein
  2. filtered fluid passes through the tubule which sends minerals to blood and removes waste. the product is urine
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14
Q

JGA is formed by ____ and ___

A

DCT and glomerular afferent arteriole

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15
Q

JGA regulates ___ and ____

A

BP and GFR

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16
Q

3 cell types in the JGA

A
  1. juxtaglomerular cells
  2. extraglomerular cells
  3. macula densa
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17
Q

juxtaglomerular cells are in the ___ and produce ____

A

afferent arteriole wall, produce renin

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18
Q

extraglomerular cells AKA

A

lacis cells

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19
Q

macula densa cells are in the ____

A

DCT

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20
Q

macula densa cells sense respond to ____ and…

A

INC NaCL, they vasodilate afferent arterioles and INC renal blood flow to maintain GFR

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21
Q

fx of glomerulus is

A

plasma filtration

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22
Q

____ brings blood into Bowmans capsule and goes out through the _____

A

AFFERENT brings blood in, EFFERENT out

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23
Q

the glomerulus contains a ____ ____

A

filtration barrier

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24
Q

___ and ____ cannot cross the barrier

A

cells and proteins

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25
Q

what 7 things are filtered in the glomerulus

A
  1. h20
  2. glucose
  3. electrolytes
  4. creatinine
  5. small peptides
  6. amino acids
  7. small chemicals
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26
Q

3 barriers to filtration in glomerulus

A
  1. endothelial cells
  2. GBM
  3. podocytes
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27
Q

endothelial cells have _____, small holes that allow plasma through but not protein/cells

A

fenestration

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28
Q

the GBM has a _____ that keeps ___ out

A

strong negative charge that keeps albumin out

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29
Q

the GBM is formed by

A

a matrix of proteins

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30
Q

___ is a disease that breaks down the GBM (loses neg charge and albumin is lost of urine, NOT normal)

A

DM

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31
Q

_____ like scleroderma causes changes in fenestration of endothelial cells

A

autoimmune diseases

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32
Q

podocytes are a cell unique to the

A

kidney

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33
Q

podocytes create a ____ formed by interdigitate interaction of adjacent podocytes

A

filtration slit

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34
Q

in minimal change disease ___ disappear

A

podocytes

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35
Q

mesangial cells are ____ in the filtration barrier of the glomerulus

A

support cells

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36
Q

net filtration pressure is ___ and favors…

A

12 mmHg and favors pushing plasma into filtration in bowman’s capsule

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37
Q

the ____ in the cortex is the major site of reabsorption

A

PCT

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38
Q

___ % Na, ___ % H2O, __ % bicarb, __ % of other electrolytes are reabsorbed in the PCT

A

60% Na, 70% H2O, 80% bicarb, 90% other electrolytes

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39
Q

type of cells in PCT

A

tubular epithelial cells

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40
Q

tubular epithelial cells have ___ and ___

A

brush border and mitochondria

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41
Q

the brush border

A

INC SA to touch as much filtrate as possible

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42
Q

the mitochonidria

A

provide energy for active transport of filtrate via transporter proteins

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43
Q

____ is death of the tubular epithelial cells which are susceptible to a lack of O2

A

ATN (acute tubular necrosis)

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44
Q

with dec blood vol, there is dec circulation to kidneys this cell dies first so you have problems with reabsorption

A

tubular epithelial cells

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45
Q

ATP independent processes - 3

A

symporters, channels, exchangers (depend on conc. gradient)

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46
Q

ATP dependent processes need

A

transporter proteins

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47
Q

the capacity of transporter proteins can be ___ and the function can be ____

A

capacity can be saturated, fx regulated

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48
Q

____, ____, ____ are absorbed in the PCT by transporter proteins (ATP dependent)

A

ions, glucose, AA

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49
Q

H2O is absorbed by ____ and ____

A

tight junction and water channel (aquaporin)

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50
Q

bicarb cant enter as an ion, must be in the form of

A

CO2 gas

51
Q

bicarb is reabsorbed into the blood in the PCT by

A

sodium bicarb transporter, symporter

52
Q

peptides are absorbed via

A

receptor mediated endocytosis (megalin/cubilin complex)

53
Q

loop of henle aka

A

countercurrent multiplier

54
Q

loop of henle fx is to establish a _____ state in the

A

hyperosmotic state in the medullary interstitial fluid

55
Q

thin descending segment is

  1. H2O ____
  2. moderate permeability to ___ and ____
A

thin descending segment is

  1. H2O PERMEABLE
  2. moderate permeability to Na and urea
56
Q

thin ascending segment is

  1. H2O ____
  2. ONLY ____ reabsorbed
A

thin ascending segment is

  1. H2O IMPERMEABLE
  2. ONLY Na reabsorbed
57
Q

thick ascending segment is

  1. HIGHLY ____ permeable
  2. ___ and ____ IMPERMEABLE
A

thick ascending segment is

  1. HIGHLY Na, K, Cl permeable
  2. urea and H2O IMPERMEABLE
58
Q

filtrate entering the nephron is _____ to blood plasma and interstitial fluid

A

isosmotic

59
Q

water moves ____ the filtrate in the DESCENDING limb down its osmotic gradient which concentrates the fluid

A

OUT OF

60
Q

filtrate reaches its highest conc at the

A

bend of the bloop (WATER CANT GET OUT)

61
Q

Na and Cl are pumped out of the filtrate which ___ the interstitial osmolality

A

INC

62
Q

filtrate is MOST DILUTE as it

A

leaves the nephron loop (100 most it is hypo osmotic to the interstitial fluid)

63
Q

____ and ____ destroy the countercurrent multiplication system so that the kidney CANT reabsorb water

A

loop inhibitors and loop diuretics

64
Q

the two functions of the DCT

A

electrolyte homeostasis and hemodynamic regulation

65
Q

in the DCT, __ is reabsorbed (___ acts here)

A

Ca reabsorbed, PTH acts here

66
Q

cells responsible for hemodynamic regulation

A

macula densa

67
Q

macula densa release renin when

A

Na levels are low

68
Q

___ is the action site for hormones

A

collecting duct

69
Q

which hormones act in the collecting duct

A

aldosterone and ADH (vasopressin)

70
Q

two types of cells in the collecting duct

A

intercalated and principal

71
Q

intercalated cells have ____ reabsorption and ___ secretion

A

bicarb reabsorption and H secretion

72
Q

principal cells/aldosterone regulate ___ absorption and ___ secretion

A

NaCl absorption and K secretion

73
Q

the collecting duct leads to the

A

renal pelvis

74
Q

______ is a steroid hormone

A

aldosterone

75
Q

aldosterone is produced in the

A

adrenal gland

76
Q

antagonist to aldosterone

A

sprionolactone

77
Q

aldosterone acts on ____ to…

A

prinicpal cells to INC reabsorption of Na and secretion of K (leads to H2O retention and INC BP)

78
Q

____ disease is a lack of aldosterone, which INC K and DEC Na

A

addisons

79
Q

ADH/vasopression is made of

A

9 AA

80
Q

ADH is produced in the

A

hypothalamus (stored in the posterior pituitary)

81
Q

ADH is released in response to

A

INC plasma osmolality

82
Q

if you are dehydrated, ADH is released which acts on the..

A

collecting duct to produce aquaporin receptors so water is reabsorbed, urine is low in volume and concentrated

83
Q

with DI (diabetes insidious) you lack

A

ADH

84
Q

with DI you have an abnormally large amount of

A

urine that is insidious (water not reabsorbing in collecting duct)

85
Q

with Central DI there is damage to the ____ which causes ____

A

damage to the hypothalamus/pituitary which causes disruption in the production, storage, and release of ADH

86
Q

nephrogenic DI is when the

A

kidneys DONT RESPOND normally to vasopressin

87
Q

3 types of regulation of RBF (renal blood flow)

A
  1. autoregulation
  2. neural regulation
  3. hormonal regulation
88
Q

autoregulation maintains a ____ RBF and GFR through a ___ mechanism

A

CONSTANT RBF and GFR through a myogenic mechanism (smooth muscle)

89
Q

if there is an increase in arteriole pressure the arterioles ___

A

relax

90
Q

neural regulation produces ___ and ___ GFR and RBF

A

vasoconstriction and DEC GFR/RBF

91
Q

the afferent and efferent arterioles are innervated by

A

sympathetic non-adrenergic nerve

92
Q

____ regulation of RBF takes place in an emergency volume depletion

A

neural

93
Q

the major hormonal regulation of RGF

A

RAAS

94
Q

the natural antagonizing agents of RAAS

A

natriuretic peptides

95
Q

RAAS is activate by __ BP and ___ in DCT, releases

A

DEC BP and NaCl in DCT, releases RENIN

96
Q

renin converts ___ to ____

A

angotensinogen to AT1

97
Q

____ turns AT1 to AT2

A

ACE

98
Q

___ is the active molecule which causes VASOCONSTRICTION and INC BP

A

AT2

99
Q

RAAS causes

A
  1. INC BP
  2. vasoconstriction
  3. INC NaCl
  4. water follows
  5. ALDOSTERONE secretion
  6. INC perfusion of JGA
100
Q

where are natriuretic peptides synthesized and secreted

A

heart cells

101
Q

natriuretic peptides INHIBIT ___ and ____ secretion

A

aldosterone, renin

102
Q

natriuretic peptides ____ afferent and efferent arterioles, dec blood vol, dec CO, dec BP

A

vasodilate

103
Q

_____ of the kidney are mutations in critical proteins that produce BRUSH border cells in PCT

A

hereditary disorders

104
Q

example of hereditary disorder of kidney

A

polycystic kindney disorder (mutation in proteins that form brush border cells)

105
Q

6 acquired diseases of the kidney

A
  1. inflammation (glomerulonephritis)
  2. diabetes (diabetic nephropathy)
  3. AKI (ischemic)
  4. chronic kidney disease (HTN)
  5. kidney stones
  6. drugs and toxins
106
Q

diabetic nephropathy is a chronic kidney disease characterized by these 4 things

A
  1. INC proteinuria
  2. DEC GFR
  3. HTN (activates RAAS - A2 constricts efferent arteriole, INC glomerular capillary pressure)
  4. INC risk/VC, morbidity/mortality
107
Q

normal BG

A

70-130

108
Q

diabetic BG

A

over 200

109
Q

early stage diabetic nephropathy

A

INC GFR, reversible albuminuria

110
Q

advanced diabetic nephropathy

A

GBM expansion, proliferation and hypertrophy

111
Q

with diabetic nephropathy there is a thickening of the GBM due to

A

elevated cell proliferation mediators (PDGF, TGF-B, VEGF)

112
Q

4 pathology signs of diabetic nephropathy

A
  1. expansion of mesangial matrix
  2. thickening of GBM
  3. arteriosclerosis
  4. tubulointerstitial fibrosis (proteins leaked into PCT initiate inflammatory response with leads to formation of fibroblasts)
113
Q

AKI is the sudden decline in kidney fx with a ___ GFR and ___ Cut and BUN

A

DEC GFR, INC Crt and BUN

114
Q

AKI is associated with oliguria (___) and anuria (____)

A

oliguria - less than 400 ml/day of urine

anuria - less that 50 ml/day of urine

115
Q

pre-renal AKI has

A

inadequate CO

116
Q

intrarenal has ___ and ____

A

ATN (most common cause of infrarenal AKI) and acute interstitial necrosis

117
Q

post renal is the

A

obstruction of urinary tract

118
Q

patho of ATN

A
  1. ischemia leads to cell injury
  2. loss of brush border in PCT cells
  3. loss of polarity and integrity of tight junctions
  4. relocation of Na/K/ATPase pumps and interns to the apical membrane
  5. cell death (apoptosis and necrosis)
  6. cast formation and obstruction of tubular lumen
119
Q

ATN is ____ if caught early

A

reversible (PCT cells are regenerative)

120
Q

causes of ATN

A

hypoperfusion, ischemia, nephrotoxic antiRX, xray media, cisplatin

121
Q

renal filtration regulation is composed of ___ and ___

A

GFR and RBF

122
Q

___ is constant even with BP change

A

RBF

123
Q

GFR = ___ per min and ___ per day

A

120 mL/min, 180 L/day

124
Q

RBF = ____ mL/blood/min and ____ mL/plasma/min

A

1000-1200 mL/blood/min, and 600-700 mL/plasma/min

Patho 2 (6 decks)

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