RENAL FUNCTION Flashcards by Unknown Unknown

Paired, bean-shaped organs found retroperitoneally in
either side of the spinal column

Kidney

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kidney size About the size of a fist

10-12 cm)

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are important organs in the body because they
excrete the waste products of the body’s metabolism

Kidney

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at the back

retro

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abdomen

Peritoneal cavity

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kidney is in Between

T12 - L3

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○ Outside part of the kidney

renal cortex

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○ Heart-shaped
- contains 8-12 renal pyramids which contain of 1 million of nephrons

Renal medulla

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central region of the kidney
-located in the renal sinuses

The urine will go to the renal medulla and will
be collected in the renal pelvis and will go to the
ureters then bladder

renal pelvis

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are made up of nephrons

Kidneys

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kidneys Functional unit:

Nephrons

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Can’t be seen in the naked eye

nephrons

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filter the substances needed to be filtered)

Glomerulus

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Made up of tuft of capillaries and covered by
the Bowman’s capsule and the space inside it
is called __________

Bowman’s space

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Approaching the glomerulus

afferent

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Exiting the glomerulus

efferent

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2 types of nephrons in the body

cortical nephrons and juxtamedullary nephron

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known for short nephron loop
glomerulus further from the cortex medulla junction
efferent arterioles supplies peritubular capillaries

cortical nephrons

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known for long nephron loop
glomerulus closer from the cortex medulla junction
efferent arterioles supplies peritubular vasa recta

juxtamedullary nephrons

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U turn

loop of henle

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three loop of henle

○ Thin Descending LoH
○ Thin Ascending LoH
○ Thick Ascending LoH

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what percent made up of cortical nephrons?

85%

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what percent made up of juxtamedullary nephrons?

15%

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how many nephrons in a kidney?

1 million

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in glomerular filtrate there are ____ liters per a day filtrate and _______ of urine each day

180 liters an 1-2 litres of urine each day

is the movement of of substances outside of the tubules

reabsorption

Most important function ○ Filters unwanted substances in the body

● Urine formation

○ Kidneys secretes and reabsorbs water

● Fluid and electrolyte balance

Kidneys can also secrete acids (hydrogen) or base (bicarbonate)

● Regulation of acid-base balance

Reabsorbs rom the tubules to the capillaries back to the blood (back to the circulation)

● Tubular Absorption

Give me the renal basic process

Renal blood flow Glomerular filtration Tubular reabsorption Tubular secretion

What are the factors that make the glomerulus the best site for filtration?

High pressure in the glomerulus Semi-permeability of the glomerulus negatively charged basement membrane

what is the cut off value of the molecular size that is able to pass through glomerulus?

66,000 or 66kDA

the glomerular filtrate is around ___________

130-150 mL/min

volume of blood filtered per minute

Glomerular filtration rate

renal blood flow ml/L

1,200-1,500 ml/L

(6) can pass through glomerulus

water electrocytes glucose amino acid urea creatinine

(3) cannot pass through glomerulus

plasma proteins Cellular elements protein bound molecules

Happens when the substances from the tubular lumen are moved to the peritubular capillary plasma

tubular reabsorption

Tubular reabsorption Happens mostly at the _________

PROXIMAL CONVOLUTED TUBULE (90%)

in tubular reabsorption are 75% ________

75% of the sodium, chloride, water

TUBULAR REABSORPTION _______of the glucose

100%

TUBULAR REABSORPTION __________of uric acid is reabsorbed, only to be secreted at the DCT

98-100%

Variable amounts of urea, uric acid, ions (Ca, Mg, K, HCO3

TUBULAR REABSORPTION

mg/dl of renal threshold

160-180 mg/dl

uses energy, transport mechanisms, carriers, proteins to transport the substance from the tubules back to the capillaries

● Active transport

○ Freely flowing

● Passive transport

○ Excess of aldosterone ○ If there will be excess of aldosterone, sodium will be reabsorbed.

● Conn Syndrome?

Conn syndrome sodium in urine = _______ sodium in blood = _______

decreased increased

Deficiency of aldosterone ○ Sodium will not be reabsorbed

● Addison’s Disease?

● Addison’s Disease? sodium in urine = __________ sodium in blood = ________

increased decreased

Decrease in ADH ○ Water will be freely flowing and will not be reabsorbed ○ Water in the urine will increase ■ Urine will be more dilute ○ Water in blood will decrease

● Diabetes Insipidus?

Excess in ADH ○ Water will be reabsorbed from the tubule to the blood ○ Water in the urine will be decreased ○ Urine will be more concentrated ○ Water in the blood will increase

● Syndrome of Inappropriate ADH secretion (SIADH)?

Movement of the substances from the peritubular capillary plasma to the tubular lumen ○ From the blood to the tubules ○ Baliktad ng tubular reabsorption ● Tubular cells secrete products of their own cellular metabolism to the filtrate in the tubular lumen ● The tubules are made up of cells and these cells have metabolic wastes ● Secrete waste products na hindi kaya ifliter ng glomerulus ● Can contribute to acid base balance, fluid balance, and electrolyte balance

tubular secretion

Some of the solute is filtered and most are secreted to the urine

● Substance A

○ Substance is filtered but reabsorbed

● Substance B

A lot of the substance is filtered in the glomerulus and all of the substance is reabsorbed

● Substance C

● Tests that determine of the kidneys are functioning well

RENAL FUNCTION TESTS

● These rely on the measurement of the waste products in the blood (usually urea and creatinine) which accumulate when the kidneys begin to fail

renal function tests

__________ are waste products of the blood

Urea and creatinine

increase in urea and creatinine in the bloof\d

kidney problems

There should be _________ of the nephrons still functioning (advanced renal failure) before concentration of these product begin to accumulate in the blood

20-30%

_______-of the nephrons ang masisira before these product accumulate ○ Not sensitive markers to test for renal failure, but if it is vast, it can accumulate in the blood and diagnosed as having kidney failure

70%-80%

Standard test used to measure the filtering capacity of the glomerul

Clearance Tests

Measures the rate at which the kidneys are able to remove a filterable substance from the blood

Clearance Tests

- measures the “concentration” of analytes in the urine

Osmolality and osmolarity

measures the amount of solute-free water excreted in the kidney

Free water clearance

- 24 hours fluid deprivation

Fishberg Test

Day vs Night concentration function

Mosenthal Test

To measure the exact amount of blood flowing through the kidney, it is necessary to use a substance that is:

Tubular Secretion and Renal Blood Flow Tests

How to measure the blood flowing to the kidney

Use a substance that is completely removed from the blood (peritubular capillaries) rather than being removed when the blood reaches the glomerulus

● NPN with the highest concentration in the blood ● Major excretory product of protein metabolism

Blood urea nitrogen

BUN →

Blood urea nitrogen

Has 2 amino groups and 1 carboxyl group

UREA

is formed in the liver from CO2 and ammonia (from the deamination of proteins)

Urea

The major waste product of protein metabolism

Urea

3 under azotemia

pre renal renal post renal

_______ are excreted in the GI tract and skin

<10%

_________ excretion and appears in the urine

○ 90%

azotemia + renal failure = ________

Uremia

■ Before the kidney

○ Prerenal

○ kidney

○ Renal

■ After kidney

post-renal

○ Elevation of urea with renal failure

uremia

elevation of urea in the blood

azotemia

● Concentration of urea in the blood is affected by

protein content of the diet rate of protein catabolism renal function and perfusion PRR

Formed from creatine and creatine phosphate in the muscle

Creatinine

_____________is synthesized in the liver from arginine, glycine, and methionine AGM

Creatine

3 muscle diseases in creatine

○ Muscular dystrophy ○ Poliomyelitis ○ Trauma

- increased in uric acid

Gout

Purine nucleic acid

guanine and adenosine

of filtered uric acid is reabsorbed in the PCT

98%-100%

excreted in the kidneys, others excreted in the GI tract

70%

Most uric acid in the plasma is in the form of

monosodium urate

At concentrations >6.8 mg/dL, the plasma is saturated forming __________

urate crystals

___________ (pH <5.75), uric acid predominates and is seen as uric acid crystals

acidic urine

Gout Found primarily in men (______ years old)

30-50 years old

https://www.youtube.com/watch?v=NaDVEY4_aE4

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Increased levels of urea because of protein metabolism from the muscles

○ Rate of protein metabolism

When there is a failure of renal function, the urea will not be excreted from the urine and will accumulate in the blood lading to increased levels

○ Renal function and perfusion

■ Product of protein metabolism/catabolism

○ Protein content of the diet

- elevation of urea in the blood

Azotemia

_____________ - afferent arteriole - tuft of capillaries - efferent of arteriole - bowman's capsule and space _________ __________ - thin descending -thin and thick ascending ___________ __________

Glomerulus proximal convoluted tubule loop of henle distal convoluted tubule collecting ducts

____________ in the glomerulus ____________ of the glomerulus __________ charged basement membrane Glomerular filtrate = ___________

high-pressure semi-permiability 130-150 ml/L

Remember: If a substance's concentration exceeds the renal threshold for tubular reabsorption, it will appear in the urine

Renal Threshold

The patient will just be sleeping, very confused, or in coma (in severe cases)

Hepatic Encephalopathy

X-linked genetic disorder caused by the complete deficiency of HGPRT (hypoxanthine guanine phosphoribsyl transferase)

● Lesch-Nyhan Syndrome

If bigger muscle mass = more creatine and creatine phosphate =

more creatinine

Protein-bound molecules can pass through the glomerulus because they are negatively charged. TRUE OR FALSE

FALSE

Creatinine is formed from phosphocreatine in the muscles.

TRUE

Creatine - water = __________

creatinine

Phosphocreatine - phosphoric acid =

creatinine