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CPR Exam 2 > Renal Function - Pierce > Flashcards

Renal Function - Pierce Flashcards

1
Q

3 layers of the glomerular filtration barrier from capillary to bowmans capsule

A
  1. capillary endothelium (with glycocalyx -> sticks to - charge)
  2. Glomerular BM (3 layers to in, - charge proteoglycans)
  3. Podocyte epithelium (small pores up to 42Å)
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2
Q

layers of the Glomerular BM

A
  1. Lamina Rara Externa : proteoglycans - charge (NO PROTIEN)
  2. Lamina densa
  3. Lamina Rara Interna : proteoglycans - charge (NO PROTIEN)
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3
Q

what type of molecules get filtered though the glomerular barrier

A

HIGH : cations
medium or normal : neutral
LOW : Anions

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4
Q

Nephrotoxic Serum Nephritis

A

Disrupted Glycocalyx
= proteins can get through the barrier
= proteinuria

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5
Q

freely filtered molecules

A

water

small (glucose, aa, electrolytes)

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6
Q

what is not filtered

A

CELLS (RBC, WBC)

PROTIENS (large)

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7
Q

urinary excretion is what

A

Filtered + secreted - reabsorbed

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8
Q

what does Arterial input equal

A

Venous output + Urine output

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9
Q

Renal Clearance rate (Cx) is calculated how

A 
Cx = (Ux)(V) / (Px) * accounts for substance in plasma and the urine
V = urine flow rate
Ux = concentration in urine
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10
Q

Urine Excretion Rate is calculated how

A

(Ux)(V)
V = urine flow rate
Ux = concentration in urine

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11
Q

how much does the glomerulus usually filter (GFR) in %

A

20% of the RBF

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12
Q

what is the normal GFR amount in ml/min

A

125ml/min

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13
Q

average amount reabsorbed from the filtrate

A

99%

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14
Q

FF (filtration fraction is calculated how)

A

FF = GFR/RBF

normal RBF is 625ml/min

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15
Q

what increases FF and what is the consequence

A

BP

increases FF = more proteins left behind = more capillary oncotic P = more reabsoption

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16
Q

as GFR increases

A

capillary oncotic P increases and reabsorption increases

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17
Q

Filtered load is what and how is it calculated

A

amount of a substance is filtered as a rate (mg/min)

= GFR x Pna

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18
Q

Filtered fraction is what

A

a percent of filtrate based on the whole (RBF)

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19
Q

when does Cx = GFR

A

renal clearance = GFR when substance calculated for is freely filtered
no reabsorption, no secretion, to toxin, not broken down in kidney

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20
Q

2 substances that filter freely

A

INULIN

Cr

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21
Q

how to use creatine to get GFR

A

measure plasma Cr level for 24hrs (Px)
measure urine Cr level for 24hrs (Ux)
measure amount peed for that time (V)

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22
Q

sympathetic effect on kidneys

A

a1 : constriction on afferent arterioles (and a little but for efferent)
+ increase tubular reabsorption or H2O and Na (proximal tubule epithelial cells have NA-ATPase)
B1 : activates Renin release to increase H2O and Na reabsorption (JG cells)

23
Q

normal Bowman’s capsule oncotic P

A

0mmHg because there is no proteins in filtrate (piBC)

24
Q

what P is the higherst

A

Glomerular capillary Hydrostatic P (Pgc)

25
Q

what are 2 factors that change GFR

A
  1. permeability or leakiness of capillary (Lp)
  2. Total Hydrostatic P + Oncotic P in G capillary and BC (Puf)
  3. SA around glomerulus for filtration (Sf)
26
Q

what does Kf mean

A

ultrafiltration coefficient

Sf x Lf

27
Q

GFR calculation if you know Kf

A

GFR = Kf x Puf

28
Q

major factor changing Puf

A

Pgc (due to BP, or resistance in the efferent or afferent arteriole)

29
Q

what changes Kf

A

SA* for filtration is changes by Glomerular MESANGIAL cells that contract the endothelium

30
Q

biggest drop in Hydrostatic P in arterial flow

how is the P in Gc

A

in Afferent arteriole and Efferent arteriole

Glomerular capillary is stable and high Hydrostatic P for being a capillary

31
Q

2 things causing increased GFR

effect on RBF

A
  1. CONSTRICT Efferent (lower RBF)

2. DILATE Afferent (higher RBF)

32
Q

2 things causing decreased GFR

effect on RBF

A
  1. CONSTRICT Afferent (lower RBF)

2. DILATE Efferent (higher RBF)

33
Q

sympathetic stimulation causes what
(a1)
(B1)

A
  • during low BP**
    (a1) constriction of AFFERENT arteriole = lower GFR and lower RBF = bring GFR back down to normal
    (B1) release Renin = increase BP
34
Q

ACE inhibitor act where

A

EFFERNT ARTERIOLE —-I Angiotensin 2 = lowers GFR

35
Q

where does Angiotensin 2 act

A

EFFERENT ARTERIOLES to increase GFR
constricting it (bring it back to normal)
+
increase Na H2O reabsorption = increase BP

36
Q

where does sympathetic innervation act on most

A

AFFERENT ARTERIOLE to decrease GFR = less filtered = increase BP
+
releases some Renin = increase BP

37
Q

vasoconstrictors

A

Sympathetic (a)
ATP, adenosine
Angiotensin 2 (e)
endothelin

38
Q

vasodilators

A 
Prostaglandins
Bradykinin
NO
Dopamine
ANP
ACE-inhibitor (angiotensin 2)
39
Q

increase GFR does what to PCT

A

increase REABSORPTION at PCT beacuse:

  1. increased oncotic P in capillary
  2. increased stuff in the urine (diffusion)
  3. increases stretch and shear of apical microvilli = Na-ATPase is placed to reabsorb NA
40
Q

Autoregulation of BP 2 ways

A
  1. Local reflex

2. Physiological feedback ( Tubuloglomerular feedback)

41
Q

Local feedback

A 
*FAST REFLEX**** 1-2 sec
from myogenic cells feedback
during high BP : 
Dilate Efferent arteriole
Constrict Afferent Arteriole
42
Q

Tubuloglomerular Feedback

during high NA+

A

JG apparatus gets signal from

  1. Macula Densa (when Na is high in urine)
  2. JG cells cause NO Renin release
  3. lower reabsorption on NA into blood lower BP
  4. vasoconstrict AFFARENT arteriol
  5. lower GFR and RBF back to normal
43
Q

Tubuloglomerular Feedback

during low NA+

A
  1. macular densa senses low NA (from low BP)
  2. JG cells release renin = increase BP
  3. affarent arteriole vasodilation (increase GFR and RBF back to normal)
44
Q

Macula densa senses high NA

what are the biochemical steps to cause the results from this

A
  1. Macula densa cells reabsorb NA by (NKCC2 channel)
    *NKCC2 takes in Na, 2Cl, K to MD
  2. this causes MD to make ATP + adenosine
  3. MD releases this to basal side facing BVs SM (afferent)
  4. ATP –> P2X , Adenosine –> A1 on SM
  5. this causes CA release into the BV SM (afferent)
  6. VASOCONTRICTION of afferent arteriole
    = lower GFR lower RBF back to normal
45
Q

Macula densa senses low NA

what are the biochemical steps to cause the results from this

A
  1. Macula densa cells X NA by (NKCC2 channel)
    *NKCC2 takes in Na, 2Cl, K to MD
  2. this causes MD to X make ATP + adenosine
  3. MD releases X ATP or adenosine to BVs SM (afferent)
  4. X CA release into the BV SM (afferent)
  5. VASODILATION of afferent arteriole
    = higher GFR higher RBF back to normal
46
Q

2 things causing renin to be secreted

A
  1. low NAcl to MD

2. B1 to JG cells

47
Q

MC also activates JG cells and causes what

during low NA

A

vasoconstriction of EFFERENT arteriole

+ vasodilation of afferent on its own

48
Q

LOW BP causes what in SYMPA and MD direct and indirect **

A

SYMPA : directly by a1 = constrict AFFERENT (iBP)
MD DIRECT : no CA = dilate AFFERENT (iGFR)
MD INDIRECT : activate JG cells to release renin, angiotensin 2 = constrict EFFERENT (iGFR)

49
Q

reason angiotensin 2 causes vasoconstriction of the efferent arteriole during low BP

A

to increase GFR
to increase amount filtered
so that aldosterone can do its job and reabsorb a lot from the urine while also restoring low GFR

50
Q

ADH and ANP during low NA or low BP

A

increase PP stimulation to secrete ADH
inhibit Atrial myocytes from secreting ANP
= reabsorb NA = increase BP

51
Q

3 things that care about keeping GFR right

A

INTRINSIC

  1. autoregulation local reflex
  2. Tubuloglomerular feedback (MD)
  3. Angiotensin 2
52
Q

4 things that care about keeping BP right

A

EXTRINSIC

  1. Sympathetic
  2. Angiotensin 2
  3. Renin + ADH + other hormones
  4. Blood comosition
53
Q

FE

A 
Fractional Excretion 
1.0 : F GFR = E
0.9 : less excreted then filtered GFR
1.1 : more excreted then filtered GFR
FE= (Ux)(Pcr) / (Px)(Ucr)

CPR Exam 2 (22 decks)

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