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Pharm Final Exam > Renal Functions (Part 1) > Flashcards

Renal Functions (Part 1) Flashcards

1
Q

List 9 normal renal functions

A

1) Excretion of waste products & urine
2) Regulation of BP
3) RBC production → erythropoietin
4) Breakdown of drugs
5) Metabolism of hormones
6) Regulation of electrolytes & acid-base balance
7) Synthesis of vitamin D
8) Fluid balance
9) Balance pH of blood stream

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2
Q

What happens to vitamin D without proper kidney function?

A

Vitamin D becomes inactive; & plays a role with calcium absorption

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3
Q

How many lobes are there per kidney?

A

8-18 lobes

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4
Q

Where are the kidneys located?

A

Retroperitoneally on the posterior wall of the abdomen

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5
Q

What is each lobe of the kidney composed of?

A

Nephrons → functional units of the kidneys

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6
Q

What does the renal cortex contain? Hint: 3

A

Glomeruli, convoluted tubules, blood vessels

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7
Q

What does the inner medulla contain?

A

Renal pyramids

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8
Q

Which kidney is positioned slightly lower than the other?

A

The right → because of the liver

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9
Q

Why is it harder for kidneys to get injured?

A

They are semi protected by the ribs & other organs

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10
Q

What is considered the collection system of the urine?

A

Renal pelvis

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11
Q

How much of the body’s cardiac output do the kidneys take?

A

20-25%

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12
Q

Describe the renal artery Hint: 2

A

1) Divides into 5 segmental arteries that enter the hilus
2) Segmental artery inside kidney branches into lobular arteries, then interlobular arteries

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13
Q

Renal function begins with BF to the ____ ____

A

Renal vasculature

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14
Q

Kidneys filter ~ ___-___ mL of blood per minute

A

90-120 mL

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15
Q

What is the main functional unit of the kidney?

A

Nephron!!

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16
Q

Can the kidneys regenerate nephrons?

A

NO → therefore, there’s a generalized decrease in functioning nephrons w/ aging

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17
Q

Approx. what % of nephrons do adults lose for each decade? What age does this begin at?

A

~ 10% of nephrons for each decade; beginning at 40 yrs

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18
Q

Which capillary structure/ system of a nephron is responsible for filtration?

A

Glomerulus

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19
Q

Which capillary structure/ system of a nephron is responsible for reabsorption?

A

Peritubular capillaries

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20
Q

List 4 parts that make up the nephron?

A

1) Proximal convoluted tubule
2) Loop of Henle
3) Distal convoluted tubule
3) Collecting duct

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21
Q

List the 2 categories of nephrons

A

1) Cortical
2) Juxtamedullary nephrons

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22
Q

What category nephrons make up ~ 85% of the nephrons & where do they originate?

A

Cortical nephrons → Originate in the superficial part of the cortex

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23
Q

Describe cortical nephrons

A

They have short, thick loops of Henle that penetrate only a short distance into the medulla

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24
Q

Describe juxtamedullary nephrons

A

Originate deeper in the cortex & have longer, thinner loops of Henle that penetrate the entire length of the medulla

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25
What category nephrons are the primary site of urine concentration?
Juxtamedullary nephrons
26
What is the glomerulus?
Capillaries enclosed in thin, double -- walled capsule (Bowman capsule)
27
Describe the flow of blood in a nephron
Afferent arteriole → glomerular capillaries → efferent arteriole → peritubular capillaries
28
List the 3 layers of glomerular capillary membrane
1) Capillary endothelial layer 2) Basement membrane 3) Single-celled capsular epithelial layer
29
Approx how many L of filtrates do we filter each day & what do they consist of?
~ 180 L per day → consists of water, electrolytes, creatinine, etc
30
What % of filtrates are reabsorbed into the bloodstream? What does this result in pertaining to urine?
90% of filtrates are reabsorbed → Results in ~ 1-2 L of urine per day
31
What does amount of urine output depend on?
The actual amount of fluid we drink **i.e. Drink 2 L = Urinate 2 L**
32
What happens to flow of blood & filtration if there are renal/ kidney stones?
Causes obstruction; & can lead to increased pressure & obstructed BF
33
What happens to flow of blood & filtration in someone with hypotension?
Slows things down!!
34
Average GFR for an adult
125 mL/ min or 180 L/day
35
What is filtration pressure & GFR regulate by?
1) Constriction/ relaxation of the afferent & efferent arterioles → Arterioles innervated by SNS → Arterioles sensitive vasoactive hormones
36
By age 70, what does renal function look like?
Renal function will be down by 30 mL/min so their avg GFR will be 95 mL/min
37
In healthy adults, decline in renal function has little impact until what age?
Age 90
38
Where does tubular reabsorption occur?
In the renal tubules (primarily proximal convoluted tubule)
39
The higher the # for GFR the...
Better it is!! → indicates better renal function
40
What will GFR look like in patients with ESRD?
GFR of 15 mL/min of less
41
ALL blood circulates through the ____
Kidneys
42
Why is it important that GFR is adequate?
In order to remove waste products
43
List 3 mechanisms for regulation of renal BF
1) Neural & humoral control mechanisms 2) Autoregulatory mechanisms 3) Effect of increased protein & glucose load
44
Neural & humoral control mechanisms: What does an ↑ in SNS activity lead to?
Leads to constriction of arterioles which leads to ↓ in renal BF
45
Neural & humoral control mechanisms: List the 3 humoral substances
1) Angiotensin II 2) Endothelin 3) Endothelial-derived nitric oxide
46
Neural & humoral control mechanisms: What does angiotensin II do?
Preferentially constricts efferent arterioles (we do NOT like)
47
Neural & humoral control mechanisms: What is endothelin?
Peptides released from damaged endothelial cells in the kidney & other tissues **Vasoconstrictor**
48
Neural & humoral control mechanisms: Endothelial-derived nitric oxide allows..
For normal excretion of sodium as well as water (We like it)
49
Neural & humoral control mechanisms: What kind of role do prostaglandins (PGE2 & PGI2) play?
Protective role against vasoconstricting effects of sympathetic stimulation & angiotensin II
50
Why do we like COX1?
It is an enzyme that plays a role in production of prostaglandins & helps protect the kidneys
51
What role do otc NSAIDs play in neural & humoral control mechanisms?
They inhibt prostaglandin synthesis; they ↓ renal BF & ↓ GFR
52
What types of patients should definitely avoid NSAIDs? Why?
Pts Dx with HTN → **double whammy** HTN already causes vasoconstriction & taking an NSAID on top of that will ↑ vasoconstriction & impair BF to kidneys
53
Autoregulatory mechanisms
**Exact mechanisms responsible for renal BF regulation are unclear** Proposed mechanisms: → Mechanism #1 → Mechanism #2
54
Autoregulatory mechanisms: Proposed mechanism #1: **Hint: 3**
1) Direct effect on vascular smooth muscle 2) ↑ in BP causes vessels to relax 3) ↓ in BP causes vessels to constrict
55
Autoregulatory mechanisms: Proposed mechanism #2:
**Juxtaglomerular complex** → Feedback control system that links RBF to GFR & composition of distal tubular fluid
56
List the 2 types of cells involved in the juxtaglomerular complex
1) Macula densa cells 2) Juxtaglomerular cells
57
What are the macula densa cells?
Specialized group of epithelial cells in distal tubule in close contact w/ afferent & efferent arterioles
58
List 2 things the macula densa cells monitor
1) BP by sensing the stretch of afferent arteriole (changes in volume delivery) 2) Sodium concentration in filtrate as it flows through
59
What do the juxtaglomerular cells contain?
Contains granules of inactive renin
60
How is renin release determined in the juxtaglomerular cells?
Information from macula densa is used to determine the renin release
61
What happens when there is decreased renal perfusion?
The RAAS will be triggered
62
Tubular reabsorption & secretion: ~ ____ % of reabsorption & secretory processes occur in proximal tubule Highly permeable to _____
~65% Permeable to water
63
List 7 things the proximal tubules reabsorb
1) Na+ 2) Cl- 3) HCO3- 4) K+ 5) H2O 6) Glucose 7) Amino acids
64
List 2 things proximal tubules secrete
1) H+ 2) Organic acids & bases
65
Tubular reabsorption & secretion: What happens at the descending loop of Henle (Loop elbow)?
Osmolality increases & is maximum here
66
List 1 thing the descending loop of Henle reabsorbs
1) H2O
67
Which loop of Henle is impermeable to water?
Ascending loop → as filtrate ascends it becomes more dilute
68
List 6 things the ascending loop of Henle reabsorbs
1) Na+ 2) Cl- 3) K+ 4) Ca++ 5) HCO3- 6) Mg++
69
List 1 thing the ascending loop of Henle secretes
1) H+
70
Tubular reabsorption & secretion: Distal convoluted tubule **Hint: 2**
1) Relatively impermeable to water 2) Thiazide diuretics work here by inhibiting NaCl reabsorption in this segment
71
List 4 things reabsorbed in the early distal tubule
1) Na+ 2) Cl- 3) Ca++ 4) Mg++
72
Tubular reabsorption & secretion: What type of diuretics work in the late distal tubule?
Potassium sparing diuretics
73
List 2 things the principle cells in the late distal tubule reabsorb
1) Na+ 2) Cl-
74
List 2 things the principle cells in the late distal tubule secrete
1) K+ 2) ADH-mediated H2O reabsorption
75
List 2 things the intercalated cells of the late distal tubule reabsorb
1) HCO3- 2) K+
76
List 1 thing the intercalated cells of the late distal tubule secrete
1) H+
77
List the 3 factors that determine how the kidneys concentrate urine
1) Osmolarity of interstitial fluids in the urine-concentrating part of the kidney 2) Antidiuretic hormone (ADH) 3) Action of ADH on the cells in the collecting tubules of the kidney
78
Elimination function of the kidney: Kidneys help remove what 4 things
1) Water 2) Waste products 3) Excess electrolytes 4) Unwanted substances
79
Diuretics & where they work in the kidneys: Osmotic diuretics
**Proximal tubule** → accounts for 65% of filtered Na+ reabsorption
80
Diuretics & where they work in the kidneys: Loop diuretics
**Thick ascending loop of Henle** → Accounts for 20% of filtered Na+ reabsorption
81
Diuretics & where they work in the kidneys: Thiazide diuretics
**Early distal tubule** → Accounts for 10% of filtered Na+ reabsorption
82
Diuretics & where they work in the kidneys: Potassium-sparing diuretics
**Late distal tubule** → Accounts for 2-5% of filtered Na+ reabsorption
83
List 4 endocrine functions of the kidneys
1) Assists w/ BP regulation through renin-angiotensin-aldosterone mechanism 2) Regulation of RBCs through synthesis of erythropoietin 3) Assists w Ca++ homeostasis by activating vit. D 4) Glucose homeostasis
84
List 4 things that decrease in the GU system as we age
1) BF to kidneys 2) # of functioning nephrons 3) GFR (most reliable indicator) 4) Tubular secretion
85
What do all the age related GU changes impact?
The elimination of medications!!
86
Why is GFR a better indicator of kidney function than BUN/Cr?
B/c it tells about kidney function & the kidneys ability to excrete wastes!!

Pharm Final Exam (26 decks)

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