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A/P lecture 1 > renal final > Flashcards

renal final Flashcards

1
Q

volume

A

L, mL, microliter, gallon

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2
Q

velocity

A

distance/time

meters/second
km/hr

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3
Q

pressure

A

force

mmHg
cmH20

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4
Q

area

A

size

cross sectional area
- internal diameter

surface area
-walls of cylinder

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5
Q

blood flow

A

volume/time
ml/min

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6
Q

vascular conductance

A

inverse of vascular resistance

the ease of blood flow through a vessel

high conductance= high flow

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7
Q

what 2 things affect conductance

A
  • viscosity
  • density
  • pipe length
  • pressure difference between both ends
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8
Q

3 main functions of circulatory system

A
  • transport nutrients to tissues
  • transport waste products away from tissues
  • transporting hormones
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9
Q

the greater the resistance…

A

the less flow

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10
Q

what does the brain use to drive brain blood flow

A

cerebral perfusion pressure

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11
Q

high conductance ->

A

high flow

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12
Q

what do the kidneys release to low MAP

A

renin released by juxtaglomerular cells

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13
Q

system in parallel ->

A

more pathways -> lower overall resistance

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14
Q

how does a larger cross sectional area affect blood flow in each individual tube?

A

lower velocity of blood flow

ex: capillaries (high cross sectional area) vs aorta

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15
Q

what are the 2 high resistance vessels

A

small arteries
*arterioles

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16
Q

what are the targets for pressers?

A

small arteries and *arterioles made of smooth muscle

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17
Q

why doesn’t BP decrease after the capillaries?

A

veins
-thin walls
- compliant
- decreased resistance

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18
Q

what is the BP from end of capillaries -> RA

A

10 mmHg

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19
Q

what does pressure drive?

A

blood flow

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20
Q

what does resistance drive?

A

Pressure

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21
Q

kidneys have how much blood flow and percentage of cardiac output

A

22% CO
1100 mL/min

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22
Q

why do the kidneys need extra blood flow?

A

filtration

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23
Q

large pressure difference in a vessel beginning to end ->

A

lots of flow

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24
Q

if you constrict vessel in half of its diameter ->

A

decrease flow by 16 fold

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25
Q

if you dilate the vessel twice its original size ->

A

increase flow by 16 fold

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26
Q

what vessel controls blood flow through capillaries

A

arterioles

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27
Q

describe small arteries and arteriole vessels and thickness

A

4 layers of smooth muscle
20 micrometers thick

UNITARY SMOOTH MUSCLE

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28
Q

how many capillaries in our body

A

10+ billion

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29
Q

capillary nutrient delivery includes (4)

A

glucose
fats
cholesterol
oxygen- exchange for CO2

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30
Q

describe capillary vessels and thickness

A

1 cell layer endothelial
1 micrometer thick
good for nutrient exchange

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31
Q

name 3 proteins of capillary oncotic pressure (in decreasing order)

A

albumin
globulins
fibrinogen

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32
Q

what is the other circulatory system in the body

A

lymphatics

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33
Q

what proteins make up the ISF colloid osmotic pressure

A

matrix proteins
- proteoglycan filaments
- hyaluronic acid
- collagen

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34
Q

how much can lymphatics increase activity in a health person

A

20-40x of fluid

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35
Q

what is the capillary filtration coefficient?

A

how permeable the capillaries are to FLUID

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36
Q

increased surface area in capillary means…

A

more permeation

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37
Q

what do lymphatics contain? like veins do

A

one way valves which rely on skeletal muscles to pump fluid back into circulation

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38
Q

where do lymphatics empty into?

A

lymphatic ducts into subclavian veins ontop of thorax

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39
Q

In systemic circulation, why is the overall capillary pressure 17.3 mmHg and not 20 mmHg

A

because capillary diameter gets larger on the venous end

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40
Q

Epithelial cells in a general capillary, the larger the ______ the LESS permeable the compound

A

molecular weight

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41
Q

what regulates GFR in the kidney

A

efferent arterioles

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42
Q

how much plasma is filtered in the kidney????

A

1/5th

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43
Q

whats the average GFR of ALL the glomerular capillaries combined?

A

125 mL/min

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44
Q

auto regulation controls what 2 things in the nephron?

A

blood flow
filtration

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45
Q

auto-regulation of renal blood flow is _____ as tight as it is in the brain

A

NOT

that’s why renal auto regulation is slanted

50-150 mmHg

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46
Q

what happens to proteins if they get in the tubule?

whats their pressure?

A

they get tethered to the cell membrane of tubule

no osmotic pressure associated with them

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47
Q

what vessel in kidney has the highest vascular resistance?

A

efferent arteriole

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48
Q

what percent of what gets filtered gets reabsorbed?

A

99% of filtrate

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49
Q

what cells are in the tubule

A

endothelial

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50
Q

what 3 things get secreted?

A

larger waste compounds/toxins
K+

51
Q

what regulates renal blood flow in the kidney?

what regulates GFR?

A

afferent arteriole

efferent arteriole

52
Q

constriction of efferent or afferent arterioles will…

A

decrease renal blood flow

53
Q

3 conditions that make you unable to dilate your vessels

A

chronic HTN
sick (ICU)
DM

54
Q

MAP range of renal autoregulation

A

50-150 mmHg

*except for people unable to dilate thier vessels

55
Q

an example of something that’s filtered and PARTIALLY absorbed

A

Na+

56
Q

an example of something thats filtered and COMPLETE absorption

A

glucose in non-diabetic

57
Q

what is freely filtered and is FULLY secreted?

A

para aminohippuric acid

its actively secreted

diagnosis renal blood flow
* not present in renal vein means high renal blood flow

high clearance rate

58
Q

inner, middle, outter layers of the glomerular capillaries

A

endothelium
- more permeable due to fenestrations
- contain negative charges

basement membrane
- big connective tissue
- contain negative charges

epithelium
- podocytes, structural reinforcement

59
Q

where are podocytes located

A

epithelium
outer glom cap layer
provides structural reinforcement

60
Q

what type of solutes are more likely to be filtered?

A

small, positive or neutral charged

61
Q

what synthetic exogenous compound is used for finding GFR, more sensitive than creatinine

A

inulin
injected then check blood and urine levels

freely filtered NOT reabsorbed

62
Q

what structural component provides support in the brain capillary

A

astrocytes

63
Q

what are the “foot” processes of podocytes called which are littered with negative charges

A

slip pores

64
Q

how does kidney regulate pH

A

produces and reabsorbs bicarbonate

excretes excess protons

65
Q

where in the kidney regulates RBC hematocrit levels

what does kidney release

A

O2 sensors in deep medullary renal interstitium

releases erythropoietin

66
Q

what does erythropoietin do?

A

stimulates bone marrow to produce more RBC

67
Q

what vitamin is activated in the kidneys? why is this important?

A

vitamin D (calcitrol)

important for calcium absorption

68
Q

how do drugs gets cleared

A

drugs metabolized in liver (P450) to more water soluble form, then filtered/secreted by kidney

69
Q

what is a nitrogenous waste product of the kidney

A

urea

70
Q

increased osmolarity means what?

A

hypernatremic

71
Q

what in the brain cause ADH to be released

A

osmoreceptors

72
Q

what does the macula densa do?
where is it located?

A

autoregulation of GFR
- comes into contact with juxtaglomerular apparatus

thick ascending LOH

73
Q

at birth how many nephrons in EACH kidney

A

1 million

  • start loosing nephrons at age 40
74
Q

what makes up the nephron

A

afferent arteriole, efferent arteriole, peritubular capillaries, glomerular capillaries, tubules

75
Q

cortical nephrons

A

more superficial
- LOH and peritubular capillaries extend into the outer medulla

90-95% of total nephrons

76
Q

medullary nephrons

A

extend deep into the inner medulla… after the peritubular capillaries

  • depending vasa recta
  • ascending vasa recta (more)
77
Q

why is it important that the ascending vasa recta has more split points than the descending vasa recta?

A

to decrease flow -> maintain normal concentration of solutes in the deep medullary interstium

if flow too fast it washes out the interstitium

78
Q

what does angiotensin 2 constrict

another effect of angiotensin 2

A

efferent arteriole

increase Na reabsorption

79
Q

what supplies blood to the kidneys

A

mesenteric arteries

80
Q

what gland is onto of kidneys and what does it produce

A

adrenal glands
- glucocorticoids
- mineralocorticoids
- androgens

81
Q

what two things form the ureter

A

minor calyx and major calyx

82
Q

who was the chemist that took vitamin C (antioxidant) for prostate cancer

A

linus pauling

20,000 units vit C

83
Q

what nerve controls bladder and rectum

where is it located

A

pudendal nerve
comes off spinal nerves
* S2, S3, S4

external sphincter and bladder

84
Q

what is renal clearance

A

quantity of plasma that is cleared of a substance per measured time

ml/min

85
Q

rate of filtration
rate of reabsorption
urine output

A

125 ml/min
124 ml/min
1 ml/min

86
Q

if we reabsorb 100% of what was filtered (glucose) what is the clearance?

A

zero
(low clearance)

87
Q

dL to mL conversion

A

1 dL = 100 mL

88
Q

why is creatinine not as accurate for GFR?

A

its slightly secreted from the peritubular capillaries… therefore its a slight over estimate of GFR

89
Q

what is creatinine a by-product of?

A

skeletal muscle metabolism

bad measurement of GFR:
bed bound pt. has low skeletal mass -> low creatinine production -> not accurate GFR

90
Q

complications of chronic HTN on kidney

A
  • arteriolosclerosis of afferent arteriole due to constant constriction
  • glomerulus weakened podocytes, widened split pores/fenestrations, fibrosis

*glomerulus suffers most

91
Q

hypotension in the tubule effects on filtration and reabsorption

A

less filtration and more reabsorption b/c fluid in tubule longer

*reabsorption also less selective

92
Q

3 drugs that favor afferent arteriole

A

beta blockers
calcium channel blockers
pressors

93
Q

how do pressers work on the kidney

A

vasoconstrict both arterioles

*more afferent though

94
Q

where is the macula dense located

what does it monitor

A

thick ascending limb

monitors Na* and Cl TOAL NUMBERS not CONC.

monitors filtration rate

95
Q

where are juxtaglomerular cells located

A

afferent and efferent arterioles

release renin

96
Q

what do ACEi do?

A

prevent angiotensin 2 from being synthesized from angiotensin 1

97
Q

2 causes of increased Na reabsorption

A

hyperglycemia
elevated amino acids

both lead to decreased numbers of Na and Cl reaching the macula densa… and macula dense thinks GFR is low even though its not (bad)

98
Q

glucose threshold in the kidney

what does threshold mean

A

160 mg/dL

when glucose transporters begin to MISS glucose… glucose starts to be excreted in the urine

99
Q

glucose transport maximum glucose level

A

300 mg/dL

transport maximum:
all glucose is excreted into urine

transporters can’t change their confirmation change fast enough to transport the glucose

100
Q

secondary and tertiary effects from macula densa sensing low BP

A

nitric oxide mediated vasodilation of afferent arteriole

proximal tubule NaCl reabsorption via angiotensin 2

101
Q

laminar flow

A

normal, efficient, non-turbulent

middle of vessel blood is the fastest

102
Q

disorderly flow

A

turbulent flow

  • inefficient
  • can remodel vessels over time (calcifications , plaque build up)… calcium and cholesterol
  • often caused by plaque or clot to begin with -> chokepoint
  • initial velocity of flow through chokepoint is HIGH
  • occurs in lungs too
  • Reynold’s equation
103
Q

what vessels do we take blood pressure?

A

large arteries… proximal to the resistance

  • brachial artery, femoral artery
104
Q

Why the drop in BP that happens between large arteries and capillaries?

A

VASCULAR RESISTANCE

not* the fact that it has multiple pathways to take

105
Q

what is the total surface area of all capillaries combined

A

500-700 sq meters

106
Q

LANGE BOOK AUTHOR

A

mohrman

107
Q

where are endothelial cells located (4 places)

A

inner heart chambers
veins
arteries
capillaries

108
Q

delta P of capillary

A

30 mmHg arteriolar/arterial end

10 mmHg venous end

DELTA P= 20 mmHg

109
Q

why is the hydrostatic pressure in ISF negative

A

-3 mmHg

lymphatic system creating vaccum of negative pressure pulling ISF

110
Q

liver failure and hemorrhaging cause a ________ in plasma osmotic pressure

A

decrease

111
Q

if membrane becomes porous (sepsis) why does the plasma osmotic pressure decrease?

A

because the osmotic pressure is associated with a SEMIPERMEABLE MEMBRANE

*secondary problem is that the proteins can leak out

112
Q

what are the collection area for the lymphatics

A

lymph nodes

ex: inguinal nodes

113
Q

what is the average BP in a systemic capillary?

A

17.3 mmHg

114
Q

what are 2 examples of measuring how much excretion there is?

A

mLs (volume)

mol or mg (quantity)

115
Q

normal renal blood flow

A

1100 mL/min

116
Q

normal filtration fraction

A

20%

117
Q

bladder is controlled by ______ and ______ nervous systems

A

PNS and SNS

118
Q

kidney filters substance “X” and reabsorbs ONLY the fluid that substance “X” was dissolved in. This means clearance is _____

A

HIGH

119
Q

what is an exogenous compound that is freely filtered but NOT reabsorbed or excreted…. gold standard for measuring GFR

A

inulin

clearance rate = 124 mL/min

given IV, 2 measurements of urine and plasma at 2 different times

120
Q

2 things freely filtered but not reabsorbed at the PT

A

creatinine
urea

conc. increases throughout the tubule

121
Q

2 effects from angiotensin 2

A
  • increase GFR
  • Increase water retention via increased salt reabsorption
122
Q

glucose is ONLY reabsorbed at the ______

A

proximal tubule

123
Q

the filtered load of glucose is dependent on what 2 factors?

what does filtered load mean?

A

*plasma conc. of glucose
and GFR

filtered loads means quantity of glucose filtered

124
Q
A

A/P lecture 1 (9 decks)

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